Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Clinical Trial
Clinicopathological considerations in patients with lumbosacral extraforaminal stenosis.
Lumbosacral extraforaminal stenosis is not uncommon among patients being treated for radicular symptoms. Patients who had lumbosacral extraforaminal stenosis were reviewed, and cadaver dissection was used to determine the anatomy of extraforaminal lesions. A total of 167 patients with lumbosacral spinal stenosis who underwent surgery from March 2004 to February 2006 were reviewed retrospectively. ⋯ No major complications or recurrences were observed during follow-up. Therefore, lumbosacral extraforaminal stenosis should be included in the differential diagnosis of lumbar radicular pain. A precise diagnosis using MRI is important, and complete decompression with an understanding of the extraforaminal anatomy is required.
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There is an increasing amount of published literature supporting the use of decompressive craniectomy in the management of raised intracranial pressure and it appears that this procedure will become established as a method by which intracranial hypertension can be treated. While technically fairly straightforward, a decompressive craniectomy is not without complications. A further complication is presented here, which has not been previously reported. ⋯ He suffered further cerebral injury and subsequently died. Following a detailed review of the case a number of recommendations were made and a specific post-decompressive craniectomy operational policy for the assessment and management of these patients was implemented. While we accept that these particular guidelines are specific to a particular institution, this case highlights the need to view these patients as a particularly high risk and recommend that institutions review or establish a specific policy regarding their management.
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The neuroprotective effect of N-acetylcysteine (NAC), a sulfhydryl-containing antioxidant, on experimentally induced subarachnoid hemorrhage (SAH) in rats was assessed. NAC was administered to rats after the induction of SAH. Neurological deficits and brain edema were investigated. ⋯ We found that NAC markedly reversed the SAH-induced neurological deficit and brain edema. We further investigated the mechanism involved in the neuroprotective effects of NAC on rat brain tissue and found that NAC significantly increased CuZn-SOD and GSH-Px activity and decreased MDA content in the SAH brain. NAC has the potential to be a novel therapeutic strategy for the treatment of SAH, and its neuroprotective effect may be partly mediated via enhancing the activity of endogenous antioxidant enzymes and inhibiting free radical generation.
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Randomized Controlled Trial Comparative Study
Use of skin glue versus traditional wound closure methods in brain surgery: A prospective, randomized, controlled study.
Traditional skin sutures (TSS) and metal skin clips (SC) are the most common devices utilized for closure of surgical incisions. They are safe and effective, although they require instruments to apply them, are time consuming and, above all, create an extra staff and cost burden for removal of sutures/staples. The ideal incision closure should be simple, effective, safe, rapid, inexpensive, painless, cosmetic and bactericidal. ⋯ The mean application time of the tissue adhesive was significantly faster than that of the standard suture (115s vs. 300s; p<0.001); in the skin clips subgroup it was 105s. Our study suggests that the new NCA tissue adhesive is a safe, effective and reliable skin closure for neurosurgical procedures in the supratentorial region; it also achieves optimal cosmetic results, is less time consuming to use and has greater patient satisfaction. However, further studies with a larger number of patients are necessary to corroborate these results.
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We aimed to develop a double-injection model of intracerebral hemorrhage (ICH) in rabbits and to evaluate it as a tool for investigating post-ICH brain injury. Rabbits were injected with 300microL fresh autologous whole blood into the right basal ganglia. ⋯ At 1, 3 and 7 days after ICH, there were significant differences in the total neurological scores (p<0.01) and BWC (p<0.01) between a sham-operated group and the ICH group. These findings suggest that the model produces a persistent neurological deficit, hematoma volume and perihematomal edema and closely mimics human hypertensive basal ganglia ICH; it is a controllable and reproducible hematoma that lends itself to quantitative investigation.