British journal of neurosurgery
-
Review Meta Analysis
A narrative review of the clinical application of pressure reactiviy indices in the neurocritical care unit.
Pressure reactivity indices are used in clinical research as a surrogate marker of the ability of the cerebrovasculature to maintain cerebral autoregulation. The use of pressure reactivity indices in patients with neurological injury represents a potential to move away from population-based physiological targets used in guidelines to individualized physiological targets. The aim of this review is to describe the underlying principles and development of pressure reactivity indices, alongside a critique of how they have been used in clinical research, including their limitations. ⋯ There is an association between pressure reactivity indices and neurological outcomes, however the use of pressure reactivity indices as a prognostication tool is to be challenged. Average values of cerebral perfusion pressure that are not close to averaged values of optimal cerebral perfusion pressure are also associated with poor outcome. Further research is required to ascertain whether targeting an optimal cerebral perfusion pressure may alter outcome.
-
For cases of cervical disc herniation, highly migrated cervical disc (HMCD) is clinically rare and usually treated with anterior cervical corpectomy and fusion (ACCF). This study aims to analyze the feasibility of anterior cervical discectomy and fusion (ACDF) for the patients with HMCD. ⋯ ACDF is feasible for patients with HMCD except for cases of epidural disc prolapse adhesion or huge disc prolapse which migrates over the axial length of the vertebral body. Clinical symptoms can be significantly improved with few serious complications in those patients including ones underwent alternative ACCF due to a failed ACDF.
-
The Neurology and Neurosurgery Interest Group (NANSIG), the student arm of the Society of British Neurological Surgeons (SBNS), organised a neurosurgical skills workshop in January 2017 following evidence of high demand among medical students and foundation trainees. The workshop involved ten delegates and five neurosurgical trainees with one senior consultant. Modules covering head positioning, burr holes, ventricular access, and flaps were included. This 'Introduction to Neurosurgery' skills workshop demonstrated significantly improved knowledge and confidence of delegates with attending and assisting in theatre in the future.