British journal of neurosurgery
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Despite the failure of the international extracranial-intracranial (EC-IC) bypass study in showing the benefit of bypass procedure for prevention of stroke recurrence, it has been regarded to be beneficial in a subgroup of well-selected patients with haemodynamic impairment. This report includes the EC-IC bypass experience of a single centre over a period of 14 years. All consecutive 72 patients with atherosclerotic occlusive cerebrovascular lesions associated with haemodynamic compromise treated by EC-IC bypass surgery were retrospectively reviewed. ⋯ Improved cerebral haemodynamics was documented in 81% of revascularised hemispheres. Patients with unchanged or worse haemodynamic parameters had significantly more post-operative TIAs or strokes when compared to those with improved perfusion reserves (30% vs.5% of patients, p<0.05). In conclusion, EC-IC bypass procedure in selected patients with occlusive cerebrovascular lesions associated with haemodynamic impairment has revealed to be effective for prevention of further cerebral ischemia, when compared with a stroke risk rate of 15% reported to date in patients only under antiplatelet agents or anticoagulant therapy.
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Case fatality rates after blunt head injury (HI) did not improve in England and Wales between 1994 and 2003. The United Kingdom National Institute of Clinical Excellence subsequently published HI management guidelines, including the recommendation that patients with severe head injuries (SHIs) should be treated in specialist neuroscience units (NSU). The aim of this study was to investigate trends in case fatality and location of care since the introduction of national HI clinical guidelines. ⋯ The reduction in odds of death following HI since 2003 is consistent with improved management following the introduction of national HI guidelines and increased treatment of SHI in NSUs.
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Case Reports
Sudden death following cranioplasty: a complication of decompressive craniectomy for head injury.
This report details three cases of massive post-operative cerebral swelling following autologous cranioplasty. All three patients had a bifrontal decompressive craniectomy for intractably raised intracranial pressure following severe neurotrauma, developed hydrocephalus necessitating shunt insertion and were making a poor neurological recovery.
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Cost effectiveness of a treatment is an important factor in decision making in the United Kingdom. Preceding most interventional health care treatments there is a waiting period between decision and procedure where health care costs may be lessened. Intrathecal drug delivery systems (IDDS) are a recognised pain management therapy for chronic non-malignant pain. ⋯ The cost per day changed significantly over the different periods (χ(2)(2) = 24.00, p < 0.05). The variability and significantly lower costs of the latent period may influence cost effectiveness evaluations and consequently decision making, if not considered. Further studies analysing the influence of a latent period on the cost effectiveness of other treatments are warranted.