Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Ventriculoperitoneal shunt placement is the standard of care for idiopathic normal pressure hydrocephalus (iNPH). Studies have reported shunt complication rates up to 38%, with subdural hemorrhage rates as high as 10%. Lumboperitoneal (LP) shunts with horizontal-vertical valves (HVV) are an alternative for cerebrospinal fluid (CSF) diversion that avoids direct cerebral injury and may reduce the risk of overdrainage. ⋯ There were no neurologic complications, including no hemorrhages. Thus, LP-HVV shunt placement is a safe and effective alternative to ventriculoperitoneal shunting for iNPH, resulting in significant symptomatic improvement with a low risk of overdrainage. It should be considered as an option for the treatment of patients with iNPH who demonstrate clinical improvement following lumbar drainage.
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A retrospective study was performed to compare the safety and efficacy in elderly patients of endovascular coiling, with clipping, for cerebral aneurysms. In total, 198 patients over 60 years of age with ruptured intracranial aneurysms were treated by microsurgical clipping (n=122) or endovascular coiling (n=76). Endovascular coiling achieved favorable outcome in 88.2% of patients, which was significantly higher than for the microsurgical clipping group. ⋯ Intraoperative time for microsurgical clipping was significantly longer than that for endovascular coiling. Length of hospitalization was shorter for the coiling group than for the clipping group. Our results suggest that endovascular coiling should be considered as the first-choice therapy in elderly patients with ruptured aneurysms, as it may reduce duration of both the operation and hospitalization.
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We investigated surgical outcomes of haematoma evacuation in patients with hypertensive putaminal haemorrhage, with emphasis on the development of postoperative refractory intracranial hypertension. Twenty-two consecutive patients with hypertensive putaminal haemorrhage underwent microsurgical clot removal without decompressive craniectomy. Medical histories, radiographic findings, and surgical notes were reviewed. ⋯ Five of these patients developed refractory intracranial hypertension (42%), and two of these patients died. Conversely, none of the 10 patients without preoperative transtentorial herniation experienced refractory intracranial hypertension, and they had a better outcome at discharge. The preoperative presence of clinical transtentorial herniation may predict the development of postoperative refractory intracranial hypertension, which may require decompressive craniectomy.
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Review Case Reports
Cerebral blood flow velocity changes and the value of the pulsatility index post decompressive craniectomy.
Decompressive craniectomy (DC) is used to relieve intractable intracranial hypertension and/or to prevent or reverse cerebral herniation. Significant controversy exists on selection of candidates, timing of the procedure and neurologic outcomes. Furthermore, the cerebral hemodynamic consequences post-DC have been researched only recently. ⋯ To our knowledge, this is the first report on FV/PI monitoring after SOC. TCD is a readily available, non-invasive test. The PI may provide useful information regarding timing and effectiveness of DC.
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Randomized Controlled Trial
A randomized, placebo-controlled pilot study of patients with spontaneous intraventricular haemorrhage treated with intraventricular thrombolysis.
Intraventricular hemorrhage (IVH) occurring after spontaneous intracerebral hemorrhage (ICH) is an independent risk factor for mortality. The use of intraventricular urokinase (Uk) to reduce intraventricular blood clot volume and improve outcome was investigated. Patients with IVH requiring external ventricular drainage were recruited and randomized into a double-blind placebo controlled study. ⋯ Our results showed an increase in both the drained CSF Hb concentration in patients treated with Uk compared to placebo and in the rate of resolution clot volume. No differences were found in the other outcome measures but there was a trend towards lowered mortality in the group treated with Uk. Therefore, intraventricular Uk resulted in faster resolution of IVH with no adverse events.