Neurosurgery
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Randomized Controlled Trial Multicenter Study Comparative Study
Comparison of infection rate with the use of antibiotic-impregnated vs standard extraventricular drainage devices: a prospective, randomized controlled trial.
External ventricular drainage (EVD) catheters provide reliable and accurate means of monitoring intracranial pressure and alleviating elevated pressures via drainage of cerebrospinal fluid (CSF). CSF infections occur in approximately 9% of patients. Antibiotic-impregnated (AI) EVD catheters were developed with the goal of reducing the occurrence of EVD catheter-related CSF infections and their associated complications. ⋯ AI-EVD catheters were associated with an extremely low rate of catheter-related infections. AI catheters were not associated with risk reduction in EVD infection compared to standard catheters. Use of AI-EVD catheters is a safe option for a wide variety of patients requiring CSF drainage and monitoring, but the efficacy of AI-EVD catheters was not supported in this trial.
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Randomized Controlled Trial
Ruptured status discrimination performance of aspect ratio, height/width, and bottleneck factor is highly dependent on aneurysm sizing methodology.
Numerous size and shape parameters have historically been used to describe cerebral aneurysms and to correlate rupture status. These parameters are often inconsistently defined. ⋯ Alternative aneurysm size definitions have a significant impact on prediction performance and optimal threshold values. Adoption of standard methodology and sizing nomenclature appears critical to ensure rupture detection performance and reproducibility across studies.
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Randomized Controlled Trial
Evaluation of epidural analgesic paste components in lumbar decompressive surgery: a randomized double-blind controlled trial.
Adjuncts for pain management in lumbar decompressive surgery are needed to reduce narcotic consumption and promote early mobility. ⋯ An analgesic paste containing methylprednisolone acetate is effective at reducing postoperative pain after lumbar decompressive surgery. Mixing effective doses of morphine sulfate in the paste abrogates the expected analgesic effects of epidural morphine.
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Randomized Controlled Trial Comparative Study
A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy.
Controversy exists as to the best posterior operative procedure to treat multilevel compressive cervical spondylotic myelopathy. ⋯ In many respects, ECL compares favorably to CLF. Although the patient numbers were small, there were significant improvements in pain measures in the ECL group while still maintaining range of motion. Restoration of spinal canal area was superior in the CLF group.
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Randomized Controlled Trial
Method of aneurysm treatment does not affect clot clearance after aneurysmal subarachnoid hemorrhage.
Patients undergoing neurosurgical clipping or endovascular coiling of a ruptured aneurysm may differ in their risk of vasospasm. ⋯ Aneurysm coiling and increased clot clearance were independently associated with decreased severity of angiographic vasospasm in multivariate analysis, although no differences in clot clearance were seen between coiled and clipped patients.