Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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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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Optimal airway management by the anaesthetist is particularly critical in neurosurgical patients. Standard intubation attempts may fail or have deleterious effects on cerebral dynamics so awake fibreoptic intubation is often the most suitable option for tracheal intubation. ⋯ Current practice and evidence for the use of the technique are reviewed and contraindications and complications discussed. A description of a typical awake fibreoptic intubation method is given with reference to the neurosurgical implications of local anaesthesia, sedation and the autonomic and neurophysiological responses that may occur.
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We prospectively investigated the complications associated with intraparenchymal intracranial pressure (ICP) monitoring using the Camino intracranial pressure device. A fiberoptic ICP monitoring transducer was implanted in 631 patients. About half of the patients (n=303) also received an external ventricular drainage set (EVDS). ⋯ The duration of monitoring had no effect on infection, whereas the use of an EVDS for more than 9 days increased infection risk by 5.11 times. Other complications included transducer disconnection (2.37%), epidural hematoma (0.47%), contusion (0.47%), defective probe (0.31%), broken transducer (0.31%), dislocation of the fixation screw (0.15%), and intraparenchymal hematoma (0.15%). In conclusion, intraparenchymal ICP monitoring systems can be safely used in patients who either have, or are at risk of developing, increased ICP.
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Clinical Trial
Impact of bilateral anterior cingulotomy on neurocognitive function in patients with intractable pain.
Although the cingulate cortices are important with regard to neurocognitive functions, outcome studies usually fail to identify evident cognitive dysfunction following anterior cingulotomy. The aim of this study was to document any impairment of neurocognitive functions following anterior cingulotomy. Between September 2002 and April 2004, 10 patients underwent stereotactic bilateral anterior cingulotomy for intractable cancer pain. ⋯ Most neurocognitive functions, including language, memory, motor, visual-constructional, and intellectual functions, remained unaffected. A decline in focused attention performance was identified at the early post-operative assessment. The results of this longitudinal evaluation will help to better define the risk-to-benefit profile of cingulotomy for intractable pain.
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Clinical Trial
Intraoperative electrophysiological monitoring in microvascular decompression for hemifacial spasm.
We aimed to determine the reliability of (i) intraoperative monitoring by stimulated electromyography (EMG) of the facial nerve to predict the completeness of microvascular decompression (MVD) for hemifacial spasm (HFS), and (ii) brainstem auditory-evoked potential (BAEP) to predict postoperative hearing disturbance. We conducted a prospective study of 36 patients who received MVD for HFS. We confirmed the disappearance of an abnormal muscle response in the facial nerve EMG to predict the completeness of MVD, and performed BAEP monitoring to predict postoperative hearing disturbance. ⋯ No false negative result was encountered for either EMG or BAEP monitoring. Facial nerve EMG correctly predicted whether MVD was successful in 35 out of 36 patients, and BAEP correctly predicted whether there was postoperative hearing disturbance in 34 out of 36 patients. Intraoperative facial nerve EMG provides a real-time indicator of successful MVD during an operation while BAEP monitoring may provide an early warning of hearing disturbance after MVD.