Can J Neurol Sci
-
The growing science and technology of various neurosurgical areas fosters subspecialization. The transmission of this expanding knowledge base to the neurosurgical resident becomes an increasing challenge. A survey of neurosurgical residency program directors was undertaken to evaluate their response to the budding subspecialization of spine surgery within general neurosurgery. ⋯ The current practice of the overwhelming majority of Canadian academic neurosurgical centers is to have neurosurgical spinal subspecialists working under the umbrella of the general neurosurgical division. A large percentage of neurosurgical program directors in Canada believe that the management of spinal disease, including both intradural procedures and instrumentation, is and should remain an integral part of general neurosurgical training. A consensus statement regarding the requirements of neurosurgical training in spinal disorders is the expressed desire of almost all program directors. A proposed direction and resolution is discussed.
-
Comparative Study
Jugular bulb oximetry for prediction of vasospasm following subarachnoid hemorrhage.
Cerebral vasospasm adversely impacts the outcome of those suffering aneurysmal subarachnoid hemorrhage (SAH). Prediction of vasospasm could improve outcomes. We hypothesized that preclinical vasospasm would be heralded by an increase in cerebral oxygen extractions (AVDO2) which could be detected by jugular bulb oximetry. A pilot study was conducted to address this hypothesis. ⋯ Jugular bulb oximetry is simple and cost effective. Increases in AVDO2 using this technique were predictive of clinically evident vasospasm in the subsequent hours to days. This investigation supports a larger study to assess the utility of jugular bulb oximetry in predicting vasospasm in aneurysmal SAH.
-
Review
Progress in clinical neurosciences: therapeutic hypothermia in severe traumatic brain injury.
Severe traumatic brain injury (sTBI) is a relatively common problem with few therapies proven effective. Despite its use for over 50 years, therapeutic hypothermia has not gained widespread acceptance in the treatment of sTBI due to conflicting results from clinical trials. ⋯ In addition, issues of rewarming and optimal temperature will be discussed. Finally, the future of hypothermia in sTBI will be addressed.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Dexamethasone for morbidity after subdural electrode insertion--a randomized controlled trial.
Invasive monitoring with subdural electrodes (SDE) for investigation of medically intractable epilepsy may be associated with undesirable immediate postoperative morbidity such as headache, nausea, vomiting, fever, and meningism. We undertook to evaluate the potential beneficial role of perioperative dexamethasone in reducing these symptoms. ⋯ Dexamethasone appears to have a role in reducing immediate morbidity following SDE insertion but its effect is not uniform in the postoperative period; it appears to be delayed in onset, and of limited duration. Further study is necessary to determine the ideal dosing schedule.
-
Multicenter Study
The Consortium to Investigate Vascular Impairment of Cognition: methods and first findings.
The Consortium to Investigate Vascular Impairment of Cognition (CIVIC) is a Canadian, multi-centre, clinic-based prospective cohort study of patients with Vascular Cognitive Impairment (VCI). We report its organization and the impact of diagnostic criteria on the study of VCI. ⋯ Consensus-based criteria for VaD omit patients who do not meet dementia criteria that are modeled on Alzheimer's disease. Even for patients who do, the proportion identified with VaD varies widely. Criteria based on empirical analyses need to be developed and validated.