Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Complications of subthalamic nucleus stimulation in Parkinson's disease.
Subthalamic nucleus deep brain stimulation (STN-DBS) is effective for medically refractory Parkinson's disease. We retrospectively analyzed complications in 180 consecutive patients who underwent bilateral STN-DBS. Surgery-related complications were symptomatic intracerebral hemorrhage in 2, chronic subdural hematoma in 1, and transient deterioration of medication-induced psychosis in 2 patients. ⋯ In conclusion, STN-DBS seems to be a relatively safe procedure. Although serious complications with permanent sequelae are rare, significant incidences of adverse effects occur. Physicians engaged in this treatment should have a comprehensive understanding of the probable complications and how to avoid them.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsTraumatic longitudinal clival fracture in a child--case report.
A 7-year-old boy presented with a longitudinal clival fracture following a traffic accident. The boy presented only with temporary unconsciousness despite suffering a fracture of the clivus. Fractures of the clivus are often caused by severe head trauma, and the mortality rate is high due to coexisting injury of the adjacent vessels, brain stem, and lower cranial nerves. Review of the radiological and clinical findings of longitudinal clival fractures found that all reported pediatric patients with longitudinal clival fracture, including the present case, suffered an occipital impact, whereas the majority of longitudinal clival fractures in adults occur following frontal or axial impact.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Comparative StudyTreatment selection for ruptured aneurysm and outcomes: clipping or coil embolization.
The International Subarachnoid Aneurysm Trial has shown that coil embolization achieves a better outcome for aneurysms treatable by either clipping or coil embolization. However, many ruptured aneurysms are hardly treatable by either clipping or coil embolization. Selection of either clipping or coil embolization will affect the treatment outcome for ruptured aneurysms. ⋯ Low invasiveness coil embolization is better than clipping to obtain good neurological outcome for patients with perforators difficult to dissect, aneurysms difficult to dissect due to previous open surgery, and aneurysms requiring bilateral open surgery, despite the slightly higher rebleeding rate in coil embolization. Overall outcomes were modified Rankin Scale (mRS) 0-2 in 82 of 113 patients (73%) and mRS 3-6 in 31 (27%). Appropriate selection of clipping or coil embolization can achieve acceptable treatment outcomes for ruptured aneurysm.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Comparative StudyEvaluation of combined use of transcranial and direct cortical motor evoked potential monitoring during unruptured aneurysm surgery.
The feasibility and reliability of combined use of transcranial and direct cortical motor evoked potential (MEP) monitoring during unruptured aneurysm surgery were evaluated. Forty-eight patients with unruptured cerebral aneurysms underwent craniotomy and neck clipping accompanied by muscle MEP monitoring. MEPs were elicited successfully by transcranial electrical stimulation in all patients. ⋯ Direct MEP was sensitive in detecting ischemic stress to descending motor pathways during aneurysm surgery. Transcranial MEPs could be elicited in patients in whom direct MEPs could not be obtained, and during periods such as craniotomy or after dural closure, in which direct MEPs could not be recorded. These findings suggest that combined transcranial and direct cortical MEP recording may improve the feasibility and reliability of MEP monitoring during unruptured aneurysm surgery.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Clinical outcomes and adverse events following transforaminal interbody fusion for lumbar degenerative spondylolisthesis in elderly patients.
Transforaminal lumbar interbody fusion (TLIF) procedure is widely used, but the surgical indications for TLIF in elderly patients remain controversial because of potential risks such as inferior bone quality and higher rate of postoperative complications. Clinical efficacy and operative risk of TLIF in elderly patients are unclear. This study investigated the clinical effect and safety of TLIF for lumbar degenerative spondylolisthesis with radiculopathy or neurogenic claudication in patients aged 70 years or older. ⋯ Postoperative complications not related to the surgical procedure were factors affecting poor results. TLIF is acceptable for achieving clinical recovery and lumbar fusion with high radiographic fusion success even in elderly patients, although clinical benefits were limited compared with those of younger patients. Postoperative morbidity was mainly related to general or non-operative site complications.