Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
-
Intraoperative rerupture (IOR) during clipping of cerebral aneurysms is a difficult complication of microneurosurgery. The aim of this study was to evaluate the incidence of IOR and analyze the strategies for controlling profound hemorrhage. A total of 165 patients with unruptured intracranial aneurysms and 46 patients with subarachnoid hemorrhage (SAH) treated surgically between April 2010 and March 2011, were reviewed. ⋯ One was major IOR, three were moderate and two were minor. Intraoperative rupture of an intracranial aneurysm can be potentially devastating in vascular neurosurgery. Aneurysm location, presence of SAH and surgical experience of the operating surgeon seem to be important factors affecting the incidence of IOR.
-
Pneumorrachis (PR) is characterized by the presence of air within the spinal canal. It can be classified descriptively into internal or intradural and external or epidural. The causes of PR can be divided as iatrogenic, nontraumatic and traumatic. ⋯ It is a marker of severe injury and the majority of such patients have a poor outcome. Although, PR is usually asymptomatic and reabsorbs spontaneously, prompt recognition and management of the underlying cause is essential. Therefore, clinicians should maintain a high level of suspicion for serious underlying injury in cases where initial radiological imaging reveals intraspinal air.
-
Review Meta Analysis
Outpatient anterior cervical discectomy and fusion: A meta-analysis.
Anterior cervical discectomy and fusion (ACDF) performed as an outpatient has become increasingly common for treating cervical spine pathology, largely due to its cost savings compared with inpatient ACDF. Nearly all outpatient ACDF patient reports have originated from single-center studies, with the procedure yet to be addressed via a meta-analysis of the peer-reviewed literature. The Entrez gateway of the PubMed database was used to conduct a comprehensive literature search for articles published in English up to 3/9/16. ⋯ Nearly two-thirds of outpatient ACDFs underwent single-level fusion, with virtually none undergoing 3+ level ACDF. Outpatient ACDF is safe, with a low readmission rate and complication rates comparable to those (2-5%) associated with inpatient ACDF. These findings support an argument for increasing ACDFs performed on an outpatient basis in appropriately selected patients.
-
The article describes the modified technique of measuring the diameters of the optic nerve sheath (ONSD) for assessment of the intracranial pressure (ICP) in patients with intracerebral or subarachnoid hemorrhage (SAH). The CT scans of 443 patients were analyzed retrospectively. The ONSDs were measured at 3mm behind the globe and at the point where the ophthalmic artery crosses the optic nerve. ⋯ There was an inverse correlation between ONSD/ETD ratio and Glasgow Outcome Score (r=-0.7) and direct correlation with invasive ICP readings. This study provides further evidence that in patients with intracranial hemorrhage and SAH, the presence of ONSD greater than a threshold of 5.5mm is significantly predictive of invasively measured elevated ICP. The prediction of raised ICP can be further refined by measuring ONSD at the point where the optic nerve and the ophthalmic artery cross, and by determining the ratio between the ONSD and ETD.
-
To elucidate the pituitary function of Japanese patients after aneurysmal subarachnoid hemorrhage (aSAH) and implicative factors related to growth hormone deficiency (GHD) after aSAH. We evaluated basal pituitary hormone levels among 59 consecutive aSAH patients with a modified Rankin Scale (mRS) ⩽4 at 3months after aSAH onset. Patients with low insulin-like growth factor 1 (IGF-1) SD score (SDS) or who seemed to develop pituitary dysfunction underwent provocative endocrine testing during a period of 3-36months after SAH onset. ⋯ The aneurysms in all GHD patients were located in internal carotid artery (ICA) or anterior cerebral artery (ACA). To the best of our knowledge, this is the first report describing the prevalence of GHD in Japanese patients after aSAH, and it was not as high as that of previous European studies. We recommend that screening pituitary dysfunction for aSAH survivors with their aneurysms located in ICA or ACA.