Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Meta Analysis Comparative Study
A meta-analysis of cervical arthroplasty compared to anterior cervical discectomy and fusion for single-level cervical disc disease.
There is no consensus on whether anterior cervical arthroplasty or anterior cervical discectomy and fusion (ACDF) is the optimal treatment for single-level cervical radiculopathy or myelopathy. We conducted a meta-analysis of randomized controlled trials to compare the safety and efficacy of anterior cervical arthroplasty with ACDF. ⋯ However, there were no significant differences in the neck disability index (NDI) scores (MD=-3.81, 95% CI=-8.12 to 0.51), number of adverse events (RR=0.77, 95% CI=0.48 to 1.23), or radiological success rate (OR=0.87, 95% CI=0.36 to 2.09). Based on this meta-analysis, cervical arthroplasty is a safe and effective surgical procedure for treating single-level cervical radiculopathy or myelopathy.
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Intracranial dural arteriovenous fistulas (DAVFs) of the transverse and sigmoid sinuses (TSS) are rare in Asian populations. This study sought to evaluate the treatment outcomes of intracranial TSS DAVFs at a single Asian institute. Between 1989 and 2007, 122 patients presented to the Seoul National University Hospital with intracranial DAVFs; we performed a retrospective analysis of the 38 patients (31.1%) with TSS DAVFs. ⋯ Five patients (13.2%) exhibited clinical or angiographic signs of recurrence, and five patients had permanent complications. TSS DAVFs were less common than cavernous sinus DAVFs, unlike in Western countries, but the angiographic and clinical characteristics of TSS DAVFs were similar to those in Western countries. TSS DAVFs were successfully managed with different modalities, but both surgery and TVE were superior to conservative management or TAE.
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Case Reports
Non-Hodgkin's B-cell lymphoma of a lumbar nerve root: a rare cause of lumbar radiculopathy.
Non-Hodgkin's lymphoma involving the spinal nerve roots is rare. The presentation of nerve root lymphoma mimics other forms of radiculopathy. In vivo, nerve root lymphomas are difficult to differentiate from nerve sheath tumors by imaging studies. ⋯ Surgical removal of nerve root lymphomas commonly produces trauma to the nerve roots. Hence, we prefer to use surgical decompression of nerve roots rather than tumor enucleation. Here, we present a patient with a lumbar nerve root lymphoma to remind clinicians of the possibility of non-Hodgkin's lymphoma in instances of lumbar radiculopathy.
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Based on the Corticosteroid Randomisation after Significant Head Injury (CRASH) trial database, a prognosis calculator has been developed for the prediction of outcome in an individual patient with a head injury. In 47 patients with severe traumatic brain injury (sTBI) prospectively treated using an intracranial pressure (ICP) targeted therapy, the individual prognosis for mortality at 14 days and unfavourable outcome at 6 months was calculated and compared with the actual outcome. An overestimation of the risk of mortality and unfavourable outcome was found. ⋯ The CRASH prognosis calculator overestimates the risk of mortality and unfavourable outcome in patients with sTBI treated with an ICP-targeted therapy based on the Lund concept. We do not advocate the use of the calculator for treatment decisions in individual patients. We further conclude that patients with blunt sTBI admitted within 8 hours of trauma should be treated regardless of their clinical status as long as the initial cerebral perfusion pressure is >10 mmHg.