British journal of neurosurgery
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Tuberculum sellae meningiomas (TSMs) are usually removed through a transcranial approach. Recently, the sublabial transsphenoidal microscopic approach has been used to remove such tumours. More recently, endonasal extended transsphenoidal approach is getting popular for removal of tuberculum sellae meningioma. Here, we describe our initial experience of endonasal extended transsphenoidal approach for removal of suprasellar meningiomas in six consecutive cases. ⋯ The endoscopic endonasal extended transsphenoidal approach appears to be an effective minimally invasive method for removing relatively small to medium tuberculum sellae meningiomas. With more experience of the surgeon, larger tuberculum sellae meningioma may be removed by purely endoscopic techniques in near future.
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The authors investigated how effectively adults with severe traumatic brain injury (TBI) can be managed in a district general hospital intensive care unit offering intracranial pressure monitoring (ICPM) receiving advice from a neurosurgical unit. A single-centre case series with retrospective review of prospectively collected information was undertaken of 44 consecutive patients presenting over seven years from January 2003 to January 2010 with severe traumatic brain injury to a single district general hospital intensive care unit serving a population of 500,000 adults. A prospectively entered clinical database was used to obtain information including patient demographics, Glasgow Coma Score (GCS) on admission, ICPM insertion, ICPM-related complications, inpatient mortality and neurosurgical advice. ⋯ Carefully selected patients with severe TBI can be managed safely and effectively in a district general hospital offering ICPM insertion if transfer to a neurosurgical centre is not possible. Neurosurgical advice regarding patient selection and on-going management is fundamental to provide a good service. Protocol driven therapies provide a useful systematic approach to doctors who do not deal with severe TBI on a routine basis.
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Biography Historical Article
Biographical sketch: Nosrat Ollah Ameli, MB, ChB (Hons), ChM (Birm), FICS, FRCS (Eng).
Nosrat Ollah Ameli (1913-2010) was one of the pioneers in Iranian neurosurgery. After training in England in the 1950s, Ameli returned to his country to found the Darioush Kabir Hospital, where he started the first neurosurgical ward in collaboration with Prof. E. ⋯ He published extensively in international peer reviewed medical journals around the world and contributed to the foundation of Acta Medica Iranica journal, the first scientific medical journal in English published by Tehran University of Medical Sciences. His efforts to improve medical education in Iran continued even through his years of retirement. This article recounts Nosrat Ollah Ameli's many contributions to Iran's medical education as well as his achievements as a neurosurgeon.
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External ventricular drains (EVDs) are commonly placed freehand using targeting landmarks unchanged since the pre-CT era; it is known to be an inaccurate procedure. To our knowledge, this is the first study to assess the geometric reliability of specific trajectories in a three-dimensional model. ⋯ Despite its widespread use, the IMC trajectory performed poorly; PTS and CMC trajectories are more reliable ways of targeting the FILV when placing an EVD.
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Review Meta Analysis
A meta-analysis to determine the effect of anticoagulation on mortality in patients with blunt head trauma.
Patients on warfarin are increasingly common in an ageing population. Previously published case series and cohort studies have resulted in conflicting conclusions with regard to the risk of fatal intracranial haemorrhage. The aim of this study was to undertake a meta-analysis in order to compare the mortality rate of anticoagulated head injured patients against the mortality rate of head injured patients not on coumarin anticoagulation. ⋯ The results of this meta-analysis has shown that the cohort of patients who are anticoagulated and suffer blunt head trauma appear to have an increased risk of death compared to a similar cohort of head injured patients who are not anticoagulated.