British journal of neurosurgery
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Comparative Study
The safety and efficacy of vertebroplasty using Cortoss cement in a newly established vertebroplasty service.
Vertebroplasty provides an effective means of treating painful vertebral lesions although the majority of the literature relates to vertebroplasty using PMMA cement. The purpose of this study is to assess the safety and efficacy of vertebroplasty using Cortoss, a recently developed bis-GMA resin. Our newly established vertebroplasty service exclusively uses Cortoss cement and has a patient database which is updated on a regular basis using the medical records. ⋯ In 38% there was an asymptomatic leakage of Cortoss. Four patients (11.8%) experienced significant complications: one asymptomatic PE, one episode of transient radicular leg pain, one generalized rash and one patient suffered retropulsion of the Cortoss due to further vertebral malignancy. Cortoss vertebroplasty provides comparable efficacy and safety to the published literature for PMMA.
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Chronic subdural haematoma (cSDH) is one of the most frequent neurosurgical entities. Current treatment options include burr hole craniostomy, twist drill craniostomy or craniotomy. While burr hole craniostomy is the most often used technique, there are no studies analysing the use of one vs. two burr holes in respect to recurrence rates and complications. ⋯ Patients with one burr hole had a statistically significant (p < 0.05) higher recurrence rate (29 vs. 5%), longer average hospitalization length (11 vs. 9 days) and higher wound infection rate (9% vs. 0%). A multivariate regression analysis identified the number of holes as single predictor for postoperative recurrence rate (r(2) = 0.12; p < 0.001). In this study, the treatment of cSDH with one burr hole only is associated with a significantly higher postoperative recurrence rate, longer hospitalization length and higher wound infection rate.
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The primary aim of this study was to assess whether there exists a relationship between lumbar cerebrospinal fluid (CSF) pressure and intracranial blood flow velocities as measured by transcranial Doppler sonography (TCD) in children with scaphocephaly. Another aim was to compare pre- and postoperative TCD. Using a transducer, lumbar CSF pressure (LP) was assessed in 21 children with scaphocephaly. ⋯ There was no association between LP and PI and RI indices. In children with scaphocephaly a higher LP can be expected with age. Moreover, TCD is not a reliable tool in predicting abnormal LP values.
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A simple way of evaluating surgical outcomes is to compare mortality and morbidity. Such comparisons may be misleading without a proper case mix. The POSSUM scoring system was developed to overcome this problem. ⋯ The difference between observed and predicted deaths at different risk levels was not significant with P-POSSUM (p = 0.424) and was significantly different with POSSUM score (p < 0.001). P-POSSUM scoring system was highly accurate in predicting the overall mortality in neurosurgical patients. In contrast, POSSUM score was not useful for prediction of mortality.