British journal of neurosurgery
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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.
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Spontaneous supratentorial intracerebral haemorrhage (ICH) is a devastating condition with a high morbidity and mortality, and uncertainty remains regarding the role of surgery in many cases. The Surgical Trial in IntraCerebral Haemorrhage II (STICH II) was initiated to look at subjects with superficial lobar ICH, as the initial STICH trial showed the greatest benefit from early surgery in this subgroup. Our aim was to estimate how many patients with ICH referred to the Greater Manchester Neurosciences Centre (GMNC) met the inclusion and exclusion criteria of the STICH II trial. ⋯ The number of patients eligible for recruitment into STICH II is small, necessitating an aggressive recruitment approach. Recruitment should focus on neuroscience centres with neurosurgical units as opposed to stroke units.
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Two patients with Parkinson's disease (PD) treated successfully with subthalamic nucleus deep brain stimulation (STN-DBS) for 3-4 years are reported, who demonstrated a persistent improvement following removal of STN-DBS for late infection. Possible hypotheses are discussed--whether a microlesioning effect or a disease-modifying effect of STN-DBS, though neither adequately explain this phenomenon.
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Percutaneous glycerol rhizotomy (PGR) is an established technique to treat trigeminal neuralgia. Our aim was to establish how safe and efficacious repeat glycerol rhizotomies were on a study of 179 PGRs performed in our institution. There was an overall success rate of 92.1% in improvement of facial pain. ⋯ There was no evidence that the number of repeat glycerol rhizotomies affects the probability of them having a complication (p = 0.87). Glycerol rhizotomy for trigeminal neuralgia is a safe and efficacious method of pain relief, which is particularly useful in the elderly. It can be repeated many times with no increase in morbidity and most importantly, in our practice, no anaesthesia dolorosa.
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The luminousness of Ambroise Paré, the surgeon-statesman, has withstood the ravages of time as the mark of a man, a hero, a surgeon-par-excellence, and above all, a benevolent philosopher. A self-made individual, his tryst with the art of surgery emanated from the literally non-stop battlefields of 16th century feudal Europe. Although a maverick in the medical world of his times; he rose from the humblest origins to the highest echelons solely as a result of his own genius and diligence. Among his mammoth contributions to the renaissance of surgery, Paré did perform many procedures which we see as neurosurgical, especially in the realms of neurotrauma and paediatric neurosurgery; the present vignette is an attempt to elucidate the same.