Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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In view of the early results and halt of recruitment from both the Carotid Occlusion Surgery Study (COSS) and Stenting and the Aggressive Medical Therapy for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study we should seize this opportunity to reflect on future directions, rather than abandoning these procedures, during this period of disillusionment. We here suggest the reasons for the failure of these two clinical trials and review future directions for researche in cerebral revascularization.
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Comparative Study
Development and validation of the Asian Migraine Criteria (AMC).
Physicians often do not use the International Classification of Headache Disorders (ICHD-II) for diagnosis of migraine in their routine clinical practice. The diagnosis of headache subtypes in 453 patients was made by headache experts according to the ICHD-II and the likelihood ratios (LR) of clinical characteristics of migraine were calculated in Part I of the study. Asian headache specialists designed the Asian Migraine Criteria (AMC) based on these LR and their experience. ⋯ The AMC had a sensitivity 93.5%, specificity 46.8%, PPV 69.9%, NPV 86.6% and a validity of 73.4% for detection of childhood migraine against the ICHD-II. The AMC was shown to be a highly valid and reliable tool for screening of adult migraine by non-neurologists. AMC was shown to be moderately valid for detection of pediatric migraine.
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Comparative Study
Integration of diffusion tensor-based arcuate fasciculus fibre navigation and intraoperative MRI into glioma surgery.
This study was designed to evaluate the feasibility and efficacy of diffusion tensor-based arcuate fasciculus (AF) fibre navigation in combination with 1.5-Tesla (1.5-T) intraoperative MRI (iMRI) for the resection of gliomas involving eloquent language fibre tracts (AF tracts). Twenty patients with AF tract-involved gliomas in the dominant hemisphere were prospectively enrolled. The patients were divided into two groups. ⋯ At a 3-month to 6-month follow-up, only two patients from the normal group suffered exacerbated language deficits due to tumour recurrence. Meanwhile, language function in all patients in the aphasia group had improved. Therefore, AF neuronavigation, combined with 1.5 T iMRI, is a feasible method of maximising resection and minimising language deficits when removing gliomas that involve the AF.
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Comparative Study
Resolution of extra-axial collections after decompressive craniectomy for ischemic stroke.
Extra-axial fluid collections are known consequences of decompressive hemicraniectomy. Studies have examined these collections and their management. We retrospectively reviewed 12 consecutive patients who underwent decompressive hemicraniectomy for the treatment of malignant cerebral edema after infarction and evaluated the evolution, resolution and treatment of post-operative extra-axial fluid collections. ⋯ In the final analysis, 18% of patients developed extra-axial collections and all resolved spontaneously. The incidence of extra-axial collections after decompressive hemicraniectomy following ischemic stroke was lower in our retrospective series than has been reported by others. The collections resolved spontaneously, suggesting that early anticipatory, corrective treatment with cerebrospinal fluid diversion or cranioplasty may not be warranted.
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Despite benefit in acute ischaemic stroke, less than 3% of patients receive tissue plasminogen activator (tPA) in Australia. The FASTER (Face, Arm, Speech, Time, Emergency Response) protocol was constructed to reduce pre-hospital and Emergency Department (ED) delays and improve access to thrombolysis. This study aimed to determine if introduction of the FASTER protocol increases use of tPA using a prospective pre- and post-intervention cohort design in a metropolitan hospital. ⋯ Only two referrals (<5%) were stroke mimics. Introduction of the FASTER pathway also significantly reduced time to thrombolysis and time to admission to the stroke unit. Therefore, fast-track referral of potential tPA patients involving the ambulance services and streamlined hospital assessment is effective and efficient in improving patient access to thrombolysis.