Neurosurgery clinics of North America
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For over 50 years, clinicians have used hypothermia to manage traumatic brain injury (TBI). In the last two decades numerous trials have assessed whether hypothermia is of benefit in patients. ⋯ Randomized control trials for short-term hypothermia indicate no benefit in outcome after severe TBI, whereas longer-term hypothermia could be of benefit by reducing ICP. This article summarises current evidence and gives recommendations based upon the conclusions.
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Neurosurg. Clin. N. Am. · Jul 2016
ReviewPercutaneous Procedures for the Treatment of Trigeminal Neuralgia.
Three major percutaneous procedures are currently used to treat trigeminal neuralgia (TN). Percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation interrupt afferent pain fibers by injury to the trigeminal nerve root or ganglion. Each is capable of offering immediate and durable pain relief. ⋯ Patient heterogeneity, technical variation, and nonstandard outcomes plague the existing outcomes literature and limit comparisons of treatments. Rendering treatment selection a function of individual physician preference and practice patterns. Randomized, prospective trials are needed; in the meantime, percutaneous rhizotomy remains an excellent treatment for selected patients.
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Neurosurg. Clin. N. Am. · Apr 2016
ReviewEndoscopic Endonasal and Keyhole Surgery for the Management of Skull Base Meningiomas.
The resection of anterior skull base meningiomas has traditionally been performed via pterional or unilateral/bilateral subfrontal craniotomies. The supraorbital keyhole approach and the endoscopic endonasal approach, techniques in which the endoscope is used to aid visualization, were developed to provide alternative, less-invasive approaches to aid the resection of these tumors. ⋯ In this article, the advantages and disadvantages of each approach are discussed, along with complications specific to each technique. Furthermore, a detailed procedural description of each surgical approach is described.
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Neurosurg. Clin. N. Am. · Jan 2016
ReviewThe Role of Stereotactic Laser Amygdalohippocampotomy in Mesial Temporal Lobe Epilepsy.
Stereotactic laser amygdalohippocampotomy (SLAH) uses laser interstitial thermal therapy guided by magnetic resonance thermography. This novel intervention can achieve seizure freedom while minimizing collateral damage compared to traditional open surgery, in patients with mesial temporal lobe epilepsy. An algorithm is presented to guide treatment decisions for initial and repeat procedures in patients with and without mesial temporal sclerosis. SLAH may improve access by medication-refractory patients to effective surgical treatments and thereby decrease medical complications, increase productivity, and minimize socioeconomic consequences in patients with chronic epilepsy.
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Chiari malformation type 1 (CM-I) is a common and often debilitating neurologic disease. Reliable evaluation of treatments has been hampered by inconsistent use of clinical outcome measures. A variety of outcome measurement tools are available, although few have been validated in CM-I. The recent development of the Chicago Chiari Outcome Scale and the Chiari Symptom Profile provides CM-I-specific instruments to measure outcomes in adults and children, although validation and refinement may be necessary.