Surg Neurol
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The initial decrease in the level of consciousness after subarachnoid hemorrhage (SAH) is commonly considered secondary to cerebral hypoperfusion and metabolic depression. Age, intracranial pressure, and the amount of cisternal blood are closely related to the clinical grade on admission after SAH. Transcranial Doppler (TCD) may partially and indirectly estimate cerebral blood flow through analysis of flow velocity in the middle cerebral artery (MCA). Besides, pulsatility index (PI) can also be considered an indirect estimator of cerebrovascular resistance. The objective of this study was to determine the TCD parameters in the early stage after SAH and to analyze their correlation with the main clinical and radiological variables on admission. ⋯ A global decrease in blood velocity in the MCA along with a rise in PI is present in the first 24 hours after SAH. These changes correlate with the clinical deterioration and partially with the amount of blood in the initial CT scan. These findings support the hypothesis that low cerebral perfusion caused by high intracranial pressure leads to diffuse ischemic changes in the early phase of SAH.
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Pitfalls in a parieto-occipital interhemispheric precuneus approach for the ventricular trigonal region of a dominant hemisphere have been rarely reported. We described a case with memory disturbance after surgery using this approach. ⋯ An interhemispheric precuneus approach is a useful alternative to trigonal tumors with few surgical complications, but postoperative memory disturbance can be one pitfall of this procedure.
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Clinical Trial
Nonsuture dural repair using polyglycolic acid mesh and fibrin glue: clinical application to spinal surgery.
In spinal surgery, repair of the dura is difficult when it is torn or fragile or is ossified as in cases with ossification of posterior longitudinal ligament. We report our experience with a nonsuture dural repair technique in patients undergoing spinal surgery; it uses a dura substitute composed of polyglycolic acid (PGA) mesh and fibrin glue. Here, we report the efficacy and safety of nonsuture duroplasty using PGA mesh and fibrin glue (PGA-fibrin sheet). ⋯ In combination with CSF diversion, the PGA-fibrin sheet is a viable alternative method for dural repair in spinal surgery.
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Comparative Study Controlled Clinical Trial
Bedside twist drill craniostomy for chronic subdural hematoma: a comparative study.
Although the bedside twist drill craniostomy is used to treat chronic subdural hematomas, the efficacy of this technique has not been compared with that of standard treatments (operative bur hole or craniotomy). ⋯ Twist drill craniostomy performed at the bedside is just as effective in treating chronic subdural hematomas as bur holes or craniotomy in the operating room. This procedure can most often be the first line of treatment in patients with symptomatic chronic subdural hematomas.
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An alternative approach for the treatment of the degenerative or unstable lumbar spine using retroperitoneal lateral LIF with anterolateral screw-plate or screw-rod fixation is introduced. Special attention is given to application of this procedure in patients who have undergone prior lumbar surgery. ⋯ Retroperitoneal lateral LIF with anterolateral instrumentation is an attractive alternative for the treatment of the degenerative or unstable lumbar spine in the absence of significant spinal stenosis. This approach is particularly useful for treating spondylolisthesis or degenerative foraminal stenosis in the postoperative lumbar spine.