Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Intraoperative imaging during skull base surgery allows the surgeon to evaluate surgical results and direct further bone resection prior to closure, avoiding the potential morbidity of inadequate surgical therapy or reoperation. Intraoperative CT (iCT) scanning has become widely available in recent years, but its neurosurgical applications have been limited mostly to spinal and functional operations. ⋯ Postoperatively, the patient experienced resolution of her proptosis, and her vision remains clinically normal. The O-arm(®) can be easily incorporated into standard operating rooms and is useful in tailoring bony skull base resections.
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The development of shunt-dependent hydrocephalus is a well-recognised complication after aneurysmal subarachnoid haemorrhage, and negatively impacts on outcomes among survivors. This study aimed to identify early predictors of shunt dependency in a large administrative dataset of aneurysmal subarachnoid haemorrhage patients. We reviewed the National Hospital Morbidity Database in Australia for the years 1998 to 2008 and investigated the incidence of ventricular shunt placement following aneurysmal subarachnoid haemorrhage admissions. ⋯ Among them, 701 (6.5%) required a permanent cerebrospinal fluid diversion procedure during the same admission as the aneurysmal subarachnoid haemorrhage. On multivariate analysis, poor admission neurological grade, acute hydrocephalus, the presence of intraventricular haemorrhage, ruptured vertebral artery aneurysm, surgical clipping, endovascular coiling, meningitis, and a prolonged period of external ventricular drainage were significant predictors of shunt dependency. A patient with a ruptured middle cerebral artery aneurysm was unlikely to develop shunt dependency (odds ratio 0.58; 95% confidence interval 0.46-0.73; p < 0.001).