World Neurosurg
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Randomized Controlled Trial
General anesthesia versus local anesthesia in stereotactic biopsies of brain lesions - a prospective randomized study.
Stereotactic biopsy of brain lesions with unknown entities is a common neurosurgical procedure to obtain tumor tissue. Pathologists can then provide an exact diagnosis on which further therapy, such as resection, radiotherapy, or chemotherapy, can be based. These procedures can be performed under local or general anesthesia. In this prospective study, we aim to show whether stress levels are higher for patients who undergo stereotactic biopsy under local or general anesthesia. ⋯ The willingness of patients to undergo randomization in this setting was low (13.3%). Within this highly selective group of patients, there was no significant difference for stress levels in patients who underwent stereotactic biopsy under local anesthesia versus general anesthesia. However, median values indicate a trend for higher stress-level values for patients undergoing local anesthesia.
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Pain relief comparable with radiofrequency thermocoagulation (RFT) alone and fewer side effects than RFT have been achieved by combination treatment with pulsed radiofrequency (PRF) and short-duration RFT in trigeminal neuralgia (TN). ⋯ The PRF treatment for recurrent TN after RFT in this study could be viewed as a combination of PRF and RFT treatments in succession. Therefore, PRF and RFT should be considered to be complementary rather than alternative in the management of TN.
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Jehovah's Witnesses (JW) are a Christian faith with >1 million members in the United States who do not accept autologous blood transfusions. The optimal management of these patients undergoing neurosurgical procedures is not well defined. Here, we examined the feasibility and safety of JW undergoing neurosurgery in a blood management program. ⋯ Neurosurgical procedures in Jehovah's Witnesses are feasible, safe, and have similar outcomes to patients willing to accept transfusion when managed within a multidisciplinary blood-management program.
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The scarcity of implants during the economic crisis partially has replaced decompression and instrumented fusion for the treatment of cervical spondylotic myelopathy with implant-less expansile cervical laminoplasty (ECL). The aim of the study was to compare the results obtained with instrumented anterior cervical corpectomy and fusion with implant-less ECL. ⋯ Our results created a nidus for further research of postdecompression spinal cord relaxation.
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Intracranial infectious aneurysms (IIAs) are a rare but unique subtype of potentially life-threatening vascular lesion. However, there is no widely accepted standard protocol for their management. We reviewed our treatment experiences of IIAs from 2001 to 2015 and proposed a treatment strategy for future use. ⋯ All patients with IIAs should undergo appropriate antibiotic therapy. In cases with unruptured IIA, patients can be managed using medical therapy with antibiotics alone for 4-6 weeks. However, neurosurgical treatment should be considered in cases of ruptured IIA or unruptured IIA that do not respond to antibiotic therapy.