World Neurosurg
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Despite 50 years of research, prognostication post cardiac arrest traditionally occurs at 72 hours. We tested the accuracy of a novel bedside score within 24 hours of hospital admission, in predicting neurologically intact survival. ⋯ This study demonstrates that a score based on clinical and easily accessible variables within 24 hours can predict neurologically intact survival following cardiac arrest.
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Ischemic stroke has been associated with stunned myocardium and neurogenic pulmonary edema (NPE). We studied a population of patients with large vessel brainstem ischemic stroke to see if there was an increased risk of pulmonary edema associated with strokes in this region independent of myocardial stunning. ⋯ In a retrospective case control study, large vessel brainstem stroke was associated with the development of pulmonary edema independent of cardiac abnormalities associated with myocardial stunning, suggesting a separate brainstem pathophysiologic mechanism which directly affects the lungs but not the heart.
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Knowledge of tool-tissue interaction is mostly taught and learned in a qualitative manner because a means to quantify the technical aspects of neurosurgery is currently lacking. Neurosurgeons typically require years of hands-on experience, together with multiple initial trial and error, to master the optimal force needed during the performance of neurosurgical tasks. The aim of this pilot study was to develop a novel force-sensing bipolar forceps for neurosurgery and obtain preliminary data on specific tasks performed on cadaveric brains. ⋯ The force-sensing bipolar forceps were able to successfully measure and record real-time tool-tissue interaction throughout the 3 experiments. This pilot study serves as a first step toward quantification of tool-tissue interaction forces in neurosurgery for training and improvement of instrument handling skills.
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A steady trend in medicine has been discharging patients earlier after surgical procedures, a trend that has been resisted by many in the field of intracranial tumor surgery. Here we demonstrate the feasibility of discharge on postoperative days 1 or 2 for patients undergoing elective intracranial surgery. ⋯ Our data suggest that the most serious complications occur within hours of the procedure, not days. The complications requiring readmission that we observed would not have been avoided with longer inpatient courses. Thus, consideration should be given to sending well-looking patients home to recover on postoperative days 1 or 2.
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The use of blood products after subarachnoid hemorrhage (SAH) is common, but not without controversy. The optimal hemoglobin level in patients with SAH is unknown, and data on perioperative need for red blood cell (RBC), fresh frozen plasma (FFP), or platelet transfusions are limited. We studied perioperative administration of RBCs, FFP, and platelets and the impact of red blood cell transfusions (RBCTs) on outcome in patients undergoing surgery for ruptured a cerebral arterial aneurysm. ⋯ Transfusion frequencies of RBCs, FFP, and platelets were relatively low. Intraoperative RBCT was strongly related to intraoperative rupture of the aneurysm in patients with poor-grade SAH. The observed association between poor outcome and RBCT in patients with SAH warrants further study.