Neurology India
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Randomized Controlled Trial Comparative Study
A comparative evaluation of nitrous oxide-isoflurane vs isoflurane anesthesia in patients undergoing craniotomy for supratentorial tumors: A preliminary study.
Neuroanesthesiologists are a highly biased group; so far the use of nitrous oxide in their patient population is concerned. We hypothesized that any adverse consequence with use of nitrous oxide should affect the patient so as to prolong his/her stay in the hospital. The primary aim of this preliminary trial was to evaluate if avoidance of nitrous oxide could decrease the duration of Intensive Care Unit (ICU) and hospital stay after elective surgery for supratentorial tumors. ⋯ From this preliminary study with a low statistical power, it appears that avoidance of nitrous oxide in one's practice may not affect the outcome in the neurosurgical patients. Further large systemic trials are needed to address this issue.
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We report our preliminary clinical experience with microscope-integrated intraoperative indocyanine green (ICG) videoangiography in the treatment of arteriovenous malformations (AVMs). Nine patients underwent surgical procedures for AVMs. All patients had preoperative and early postoperative digital subtraction angiography (DSA). ⋯ A total of 16 intraoperative ICG angiographies were performed. In all the patients the image quality was excellent, allowing intraoperative real-time evaluation of the completeness of the removal of the nidus. ICG videoangiography is easily performed during surgery for AVM and can confirm the completeness of the removal and may detect residual nidus, thus improving outcomes.
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Aneurysms of the posterior cerebral artery (PCA) are a distinct rarity and present with some peculiar morphologic features and specific clinical findings. These aneurysms can be managed endovascularly with good results. ⋯ PCA aneurysms have specific clinical characteristics compared with aneurysms located elsewhere. Endovascular technique can achieve good outcomes despite the aneurysmal site and size.