Neurosurgery
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Randomized Controlled Trial Multicenter Study Comparative Study
The comparative impact of video consultation on emergency neurosurgical referrals.
Neurosurgical resources are concentrated in tertiary referral centers, whereas emergencies identified from district general hospitals are traditionally referred by telephone consultation (TC). Recent advances in communication technology offer the alternative options of teleradiology (TR) and video consultation (VC). This study aimed to determine the differences among these three consultation methods on the basis of their process-of-care indicators, clinical outcomes, and cost-effectiveness. ⋯ Emergency neurosurgical consultation assisted by TR and VC achieved a higher diagnostic accuracy in comparison with conventional TC. Although VC did not show an advantage over TR in process-of-care indicators, clinical outcome, and cost, it has been proven to be a safe mode of consultation in emergency neurosurgery.
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Comparative Study
Preoperative prediction of long-term outcome in poor-grade aneurysmal subarachnoid hemorrhage.
To evaluate which presentation indices, demographics, and clinical information predict 12-month outcome in poor-grade aneurysmal subarachnoid hemorrhage (SAH), and to provide a preoperative index of prognosis. ⋯ Outcome in poor-grade aneurysmal SAH is strongly predicted by patient age, worst preoperative Hunt and Hess clinical grade, and aneurysm size. Hyperglycemia on admission after poor-grade aneurysmal SAH increases the likelihood of poor outcome, and is a potentially modifiable risk factor. The Prognosis Score is a useful tool for preoperatively assessing the likelihood of a favorable outcome for poor-grade aneurysmal SAH patients.
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Comparative Study
Cervical catheter tip placement for intrathecal baclofen administration.
Intrathecal baclofen can reduce congenital and posttraumatic spasticity. Traditionally, the catheter tip for baclofen delivery is placed in a low thoracic position, which can result in a lumbar-to-cisternal cerebrospinal fluid baclofen concentration gradient. We investigated whether more rostral catheter placement was technically feasible, safe, and able to control upper extremity spasticity. ⋯ In this series, placement of intrathecal baclofen catheters in the cervical region resulted in equal control of spasticity in the upper and lower extremities and did not increase complications related to the catheter position.
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Case Reports
Internal jugular venous thrombosis as a complication after an elective anterior cervical discectomy: case report.
Anterior cervical discectomy is one of the most common spine procedures in neurosurgery. Various complications, including hoarseness, hematoma, and dysphagia, have been reported in the literature. We report the first case of internal jugular venous thrombosis after an elective anterior cervical discectomy. ⋯ This is the first report of internal jugular venous thrombosis after an elective anterior cervical discectomy. Internal jugular venous thrombosis should be considered in the differential diagnosis of a patient presenting with cervical swelling after an anterior cervical discectomy.
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To correlate high-resolution magnetic resonance imaging (MRI) with immunohistopathology in the injured human spinal cord. ⋯ MRI, the only imaging technique that currently provides useful information on the spinal cord parenchyma after trauma, is rapidly evolving. High-field scanners of up to 9.4 T are being clinically tested. The present postmortem investigation of an isolated spinal cord specimen demonstrates the precise correlation that can be achieved between imaging and pathology. In future investigations, this type of technique can lead to a more precise description of spinal cord injuries and their consequences in remote tissue. Translation into the clinical setting will improve diagnosis and follow-up of spinal cord injured patients.