British journal of neurosurgery
-
Intraoperative motor evoked potential (MEP) monitoring in patients with spinal and cranial lesions is thought to be a valuable tool for prevention of postoperative motor deficits. Aim of this study was to investigate its diagnostic value in a spinal and a cranial patient group. Ninety-six patients, 31 with spinal and 65 with intracranial lesions, were studied. ⋯ Transcranial electrical monitoring of MEP is a practicable and safe method. However, there are many events, which can cause amplitude changes of MEP independent from surgical manipulations. Although sensitivity is high for both groups, this results in a moderate specificity for the cranial group and a low positive predictive value for both groups.
-
Editorial Historical Article
Neuroradiology influences on neurosurgery; past, present and future.
-
The neuropsychological outcome and Health Related Quality of Life (HRQOL) after SAH have been largely believed to be unrelated to the location of the ruptured aneurysm. This notion needs verification due to the contemporary availability of more sensitive neuropsychological test batteries and more recent clinical observations of deviant behaviour after SAH. To this end, we compared patients with ruptured aneurysms on respectively the anterior communicating artery (ACoA) (n = 24) or middle cerebral artery (MCA) (n = 22). ⋯ None of the patient groups scored for apathy and depression. Some measures of HRQOL were equally reduced as compared to the population norm in both groups. ACoA patients remained longer on sick-leave compared to MCA patients.
-
Patients undergoing craniotomy may experience moderate to severe pain postoperatively. An audit of analgesia of post-craniotomy patients at King's College Hospital demonstrated variable analgesic prescribing practices and suboptimal analgesia in some patients. Prior to introducing a formal post-operative analgesic regime, a survey of the adult neurosurgical units within the United Kingdom was undertaken to ascertain whether there was a general consensus regarding post-craniotomy pain management. ⋯ Cyclizine was the first-line anti-emetic in 45% of the units, ondansetron in 29% and metoclopramide in 16%. There is currently no consensus on pain management after craniotomy in neurosurgical centres in the UK. Until there are sufficiently powered randomized controlled studies to address the main safety and efficacy issues progress in this area will remain slow.
-
Lobectomy for intractable complex partial epilepsy (iCPE) continues to be underutilized despite numerous reports showing low mortality and complications. Our objective was to evaluate patient demographics and in-hospital complications of intracranial electrode (IE) implantation and lobectomy for evaluation and treatment of iCPE in a nationwide cohort in recent years. We queried the Nationwide Inpatient Sample for patients admitted with iCPE in the years 2000-2005. ⋯ Procedure utilization insignificantly increased over the 6 years studied (p = 0.06). Invasive monitoring is associated with increased risks of ICH and SE. Although the risks of invasive monitoring and lobectomy are low, epilepsy surgery continues to be underutilized in iCPE.