Neurosurgery clinics of North America
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The safe performance of complex spine surgery requires the close collaboration of the anesthesiology and surgical teams. The avoidance of medical and anesthetic complications depends on the appropriate preoperative medical evaluation, patient positioning, selection and administration of anesthetic agents, management of intraoperative fluid status, emergence from anesthesia, and administration of postoperative analgesia.
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In adults, symptomatic scoliosis is usually a de novo primary degenerative deformity that develops in the fifth or sixth decade or an unrecognized or untreated idiopathic deformity with superimposed degeneration. The evaluation and treatment of adult scoliosis must focus on addressing patient symptoms while limiting the consequences of the treatment. The presence of neurological deficits, the flexibility of the deformity, the coronal and sagittal balance, and status of spinal segments outside of the main deformity are all important considerations when planning surgery. The complication rate of deformity surgery in adults is potentially high; but excellent functional outcome and patient satisfaction can occur with thorough preoperative patient education and meticulous surgical technique.
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Neurosurg. Clin. N. Am. · Jul 2006
ReviewBlood loss minimization and blood salvage techniques for complex spinal surgery.
Several techniques to limit blood loss and salvage lost blood are available to surgeons, physicians, and personnel who treat complex spinal disorders. These techniques include red blood cell augmentation, intraoperative antifibrinolytic administration, use of topical hemostatic agents, and intraoperative blood salvage and postoperative blood salvage. A substantial amount of research has been directed toward reducing perioperative blood loss in spinal surgery. More efforts need to be directed toward effective perioperative blood management in complex spinal surgery.
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Neurosurg. Clin. N. Am. · Jul 2005
ReviewIntensive care unit management of interventional neuroradiology patients.
The management of interventional neurologic patients in the intensive care unit is based on their underlying disease for the most part. Patients with ischemic stroke are largely managed like patients with ischemic stroke who have not undergone interventional procedures, and the same is true for those with an aneurysmal subarachnoid hemorrhage or intracerebral hemorrhage secondary to an arteriovenous malformation, for example. Having said this, there are some special considerations that require special mention when it comes to managing patients after catheter-based procedures.
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Neurosurg. Clin. N. Am. · Jul 2005
ReviewEndovascular treatment of cerebral vasospasm: transluminal balloon angioplasty, intra-arterial papaverine, and intra-arterial nicardipine.
Cerebral vasospasm is still one of the leading causes of morbidity and mortality from subarachnoid hemorrhage. Vasospasm refractory to medical management can be treated with endovascular therapies, such as transluminal balloon angioplasty or infusion of intra-arterial vasodilating agents. ⋯ Intra-arterial nicardipine therapy produced clinical improvement in 42% of patients, significantly improved mean TCD velocities (P <.001) for 4 days, and was associated with no complications in our small series. We have adopted a treatment protocol at our institution of transluminal balloon angioplasty and intra-arterial nicardipine therapy as the endovascular treatments for medically refractory cerebral vasospasm.