Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Review Case Reports
Dural-based Rosai-Dorfman disease: differential diagnostic considerations.
Extranodal sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) is a non-neoplastic condition that has rarely been reported to involve the central nervous system. This report documents a 28-year-old man with Rosai-Dorfman disease who presented with a seizure and a dural-based mass that was thought to represent a meningioma. ⋯ Emperipolesis with intracytoplasmic lymphocytes and plasma cells was present. Differential diagnostic considerations will be discussed.
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Meta Analysis
Dexmedetomidine as an anesthetic adjuvant for intracranial procedures: meta-analysis of randomized controlled trials.
This meta-analysis aimed to systematically collect the current evidence regarding the efficacy and safety of dexmedetomidine (DEX) as an anesthetic adjuvant for patients undergoing intracranial surgery. A systematic literature search of randomized controlled trials (RCT) was conducted to compare DEX with placebo or opioids in patients undergoing intracranial procedures. Hemodynamic data, opioid consumption, and recovery parameters were pooled. ⋯ Patients also had lower mean arterial pressure and heart rate when extubated (mean difference [MD]=-9.74 mm Hg, 95% CI -12.35 to -7.12, p<0.00001; and MD=-16.35 beats/minute, 95% CI -20.00 to -12.70, p<0.00001, respectively), a lower intraoperative additional fentanyl consumption (MD=-0.78 μg/kg, 95% CI -1.51 to -0.05, p=0.04), and lower postoperative antiemetic requests (RR=0.51, 95% CI 0.33-0.80, p=0.003). DEX may not increase extubation time, postoperative PaCO2, or the risk of perioperative bradycardia. Only a small number of RCT are available, but meta-analysis shows evidence that DEX as an anesthetic adjuvant during intracranial procedures leads to better perioperative hemodynamic control, less intraoperative opioid consumption, and fewer postoperative antiemetic requests.
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Clinical Trial
Microdiscectomy with and without insertion of interspinous device for herniated disc at the L5-S1 level.
The role of interspinous devices (ISD) after lumbar herniated disc surgery for the prevention of postoperative back pain is controversial. The aim of this comparative prospective study was to determine outcomes in a selective cohort with L5-S1 disc herniation and degenerative disc changes after microdiscectomy with or without insertion of an ISD. One hundred and two consecutive patients underwent an L5-S1 microdiscectomy with or without implantation of an ISD. ⋯ Forty four percent of Group 1 patients and 80% of Group 2 patients showed improvement using the modified MacNab criteria. Patients in both groups reported significant improvement in sciatic pain and disability after microdiscectomy with or without an ISD implant. Patients with mild degenerative disc changes were more likely to achieve improvement of their low-back pain when treated with both microdiscectomy and ISD insertion.
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Comparative Study
Outcomes of single-level cervical disc arthroplasty versus anterior cervical discectomy and fusion.
Several studies have established the short-term safety and efficacy of cervical disc arthroplasty (CDA) as compared to anterior cervical discectomy and fusion (ACDF). However, few single-center comparative trials have been performed, and current studies do not contain large numbers of patients. We retrospectively reviewed all patients from a single military tertiary medical center between August 2008 to August 2012 who underwent single-level CDA or single-level ACDF and compared their clinical outcomes and complications. ⋯ Reoperation rates were higher in the ACDF group (5.7% versus 3.5%). To our knowledge, this review is the largest, non-funded, comparison study between single-level CDA and single-level ACDF. This study demonstrates that CDA is a safe and reliable alternative to ACDF in the treatment of cervical radiculopathy and myelopathy resulting from spondylosis and acute disc herniation.
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Cervical disc arthroplasty has emerged as a viable technique for the treatment of cervical radiculopathy and myelopathy, with the proposed benefit of maintenance of segmental range of motion. There are relatively few, non-industry sponsored studies examining the outcomes and complications of cervical disc arthroplasty. Therefore, we set out to perform a single center evaluation of the outcomes and complications of cervical disc arthroplasty. ⋯ Symptomatic cervical radiculopathy is a common problem in both the civilian and active duty military populations and can cause significant disability leading to loss of work and decreased operational readiness. There exist several surgical treatment options for appropriately indicated patients. Based on our findings, cervical disc arthroplasty is a safe and effective treatment for symptomatic cervical radiculopathy and myelopathy, with a low incidence of complications and high rate of symptom relief.