British journal of neurosurgery
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The aim of this study was to evaluate the safety and outcomes of decompressive craniectomy (DC) after intravenous tissue plasminogen activator (IV tPA) administration for malignant cerebral infarction. ⋯ Although the main limitation is that the number of patients in our serie was small, which reduced the statistical power, our study suggest that DC after failure of IV tPA administration for malignant cerebral infarction is safe and did not cause an excess of complications arising from the use of fibrinolytic.
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No published guidelines exist for how receiving unit doctors should manage referrals. Feedback regarding the quality of neurosurgical referral handling in our hospital has, in the past, been poor. We designed a novel means to appraise specialist referral handling, such that service delivery could be improved. We also aimed to identify differences, if any, between doctor perceptions versus actual satisfaction with the on-call neurosurgery service in our centre. ⋯ We describe a novel method for receiving units to appraise their referral services and demonstrate its usefulness in our tertiary neurosurgical unit. We also demonstrate that most referring doctors are satisfied with the handling of their neurosurgical referrals, despite perceptions to the contrary.
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Observational Study
Cranioplasty outcomes and associated complications: A single-centre observational study.
The resurgence of decompressive craniectomy has led to recent published reviews of the safety of cranioplasties. To date there is a wide range of reported mortality and morbidity. This observational study reports the outcomes of the cranioplasty operations from a single centre and evaluates the factors involved in their management. ⋯ Some potentially preventable complications have been addressed with a resulting rate of complications lower than other published reports. We use two standard adjuncts: the presence of a senior surgeon and strict antimicrobial regimens. We believe that our results could be transferrable to other units by following similar guidelines.
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External ventriculostomy-related infection (VRI) of cerebrospinal fluid (CSF) is a source of significant morbidity and mortality. In previous trials, antibiotic-impregnated ventricular catheters have been associated with lower incidence of CSF infections. We undertook this retrospective observational study to evaluate whether the introduction of antibiotic-impregnated external ventricular drains (EVDs) in 2004 has decreased VRI in our neurosurgical unit. ⋯ Our study demonstrates that there was no statistically significant difference in the infection rates for the Standard and antibiotic-impregnated external ventriculostomy catheters. The duration of catheterization was significantly higher for the Antibiotic-impregnated catheter group. The antibiotic-impregnated catheter infections tended to occur later as compared with the Standard catheter group.
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Observational Study
Predicting outcomes of decompressive craniectomy: use of Rotterdam Computed Tomography Classification and Marshall Classification.
Data on the evaluation of the Rotterdam Computed Tomography Classification (RCTS) as a predictor of outcomes in patients undergoing decompressive craniectomy (DC) for trauma is limited and lacks clarity. ⋯ RCTS is an independent predictor of unfavourable outcomes and mortality among patients undergoing emergency DC.