British journal of neurosurgery
-
Balloon angioplasty and/or selective intra-arterial vasodilator therapies are treatment options in patients with vasospasm after subarachnoid hemorrhage (SAH). We analyzed the effect of balloon angioplasty and/or selective intra-arterial vasodilator therapy in our patients. ⋯ In SAH patients with vasospasm, a combination therapy of balloon angioplasty and intra-arterial nimodipine resulted in a more than doubled vasodilative effect in the central cerebral arteries compared to the sole infusion of nimodipine. Regarding the ICA and BA arteries, this beneficial effect was even more pronounced. Although there was a tendency of better effects of the BAP-N group, regarding the overall effect in all territories combined, this failed to reach statistical evidence. In cerebral peripheral arteries, no differences were observed, and there was no difference in clinical outcome, too.
-
In recent conflicts, many UK personnel sustained head injuries requiring damage-control surgery and aeromedical transfer to the UK. This study aims to examine indications, complications and outcomes of UK military casualties undergoing craniectomy and cranioplasty from conflicts in Afghanistan and Iraq. ⋯ Timely neurosurgical intervention is imperative for military personnel given high survival rates in those sustaining what are designated 'un-survivable' injuries. Early decompression facilitates safe aeromedical evacuation of casualties. Excellent outcomes validate the UK military trauma system and the stepwise performance gains throughout recent conflicts however trauma registers most evolving to have specific relevance to military casualties. In high-energy trauma with contamination and soft-tissue destruction, surgery should be conducted with regard for future soft tissue reconstruction. Bone flaps should be discarded and cranioplasty performed according to local preference. Facilities receiving military casualties should have specialist microbiological input mindful of the difficulties treating unusual microbes.
-
To report on the occurrence and management of subdural haematoma after shunt implantation for normal pressure hydrocephalus and to determine the risk of recurrence in the setting of antiplatelet medication. ⋯ Subdural haematoma in the setting of a ventriculoperitoneal implantation for normal pressure hydrocephalus and concomitant antiplatelet medication can be managed along usual lines. Antiplatelet medication can be recommenced in due course with a low risk of recurrence.
-
The introduction of antibiotic-impregnated catheters (AICs) has significantly reduced external ventricular drain (EVD) infection rates, inhibiting in particular Gram-positive microbial infection. There is a theoretical increased risk of selection of resistant and Gram-negative microorganisms. The aim of this study is to look at the impact of the introduction of AICs on microorganism susceptibility of infected EVDs and to determine whether the use of such devices results in shift from Gram-positive to Gram-negative microorganisms. A secondary aim is to determine if a change in routine empiric antimicrobial therapy is required because of a change in the microorganism(s) causing infection. ⋯ The study demonstrates that within a single neurosurgical centre there have been neither changes in susceptibility of microorganisms nor a change from predominately Gram-positive to Gram-negative microorganisms infecting EVDs following the switch to AIC. The infection rate has significantly reduced due to change in catheter type.
-
A new trauma care system with regional major trauma centres (MTC) was implemented on 1st April 2012 across England. We aimed to assess whether this has affected the referral pathways and mortality of patients undergoing emergency craniotomy for extradural haematoma (EDH), where clinical outcome is correlated with the time to intervention. ⋯ MTC implementation has not affected the time to operation or the mortality following EDH evacuation.