Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2014
Review Case ReportsPneumocephalus and pneumorrhachis after spinal surgery: case report and review of the literature.
Trauma is a common cause of pneumocephalus, or air in the cranial cavity, and of pneumorrhachis, or the presence of intraspinal air. After spinal surgery, occurrence of pneumocephalus, especially with pneumorrhachis, is extremely rare. We report the case of a patient who developed pneumocephalus and pneumorrhachis after lumbar disc surgery and pedicle screw fixation. ⋯ On postoperative day 1, the patient complained of headache, nausea, and dizziness. Brain and lumbar computed tomography scans revealed pneumocephalus and pneumorrhachis. With conservative treatment, the patient's complaints resolved within 10 days.
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Neurol. Med. Chir. (Tokyo) · Jan 2014
Recent advances and future directions of hypothermia therapy for traumatic brain injury.
For severe traumatic brain injury (TBI) patients, no effective treatment method replacing hypothermia therapy has emerged, and hypothermia therapy still plays the major role. To increase its efficacy, first, early introduction is important. Since there are diverse pathologies of severe TBI, it is necessary to appropriately control the temperature in the hypothermia maintenance and rewarming phases by monitoring relative to the pathology. ⋯ Brain temperature management was performed mainly in young patients, and the outcome on discharge was favorable in patients who received brain temperature management. Particularly, patients who need craniotomy for removal of hematoma were a good indication of therapeutic hypothermia. Improvement of therapeutic outcomes with widespread temperature management in TBI patients is expected.
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Neurol. Med. Chir. (Tokyo) · Jan 2014
Comparative StudyTransoral vs. endoscopic endonasal approach for clival/upper cervical chordoma.
The surgical results of 18 cases of clival/upper cervical chordoma treated in the last decade via the endoscopic endonasal approach (EEA, 9 cases) and the transoral-transpalatal approach (TO-TPA, 9 cases) were compared. Each group showed the same incidence of subdural invasion, with 5 cases each. The superior (frontal base) and lateral surgical fields were wider by EEA, but the inferior view lower than the cranio-vertebral junction (CVJ) was wider by TO-TPA. ⋯ The surgical results were more radical and less invasive in the EEA group than the TO-TPA group. However in tumors extending below the CVJ, the surgical field in EEA was limited, indicating the need to use the transoral route or a combination of routes. A higher complication rate following subdural management was a negative factor that requires improvement in the EEA group and two-staged EEA followed by a transcranial approach may be considered for the cases with subdural invasion.
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Neurol. Med. Chir. (Tokyo) · Jan 2014
Comparative StudyHemorrhage rates associated with two methods of ventriculostomy: external ventricular drainage vs. ventriculoperitoneal shunt procedure.
Cerebrospinal fluid (CSF) diversion is an essential component of neurosurgical care, but the rates and significance of hemorrhage associated with external ventricular drainage (EVD) and ventriculoperitoneal (VP) shunt procedures have not been well quantified. In this retrospective study, the authors examined the frequencies of hemorrhagic complications associated with EVD and VP shunt procedures, and attempted to identify associated risk factors. The treatment records of 370 EVDs in 276 patients and 102 VP shunts in 96 patients performed between 2008 and 2010 were retrospectively reviewed. ⋯ Ventriculostomy-related hemorrhagic complications were more common than anticipated, especially for the VP shunt procedure. However, such hemorrhages are rarely large, rarely the cause of neurological deterioration, and rarely require surgical removal. Preoperative anti-platelet medication appears to affect EVD-related hemorrhage development.
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Neurol. Med. Chir. (Tokyo) · Jan 2014
A simple, 10-minute procedure for transforaminal injection under ultrasonic guidance to effect cervical selective nerve root block.
The aim is to provide a detailed procedure of a simple and 10-minute cervical nerve root block (CNRB) under ultrasonic guidance, and to report the clinical outcomes, disorders, and complications. Records of patients who had undergone CNRB, were reviewed under ultrasonic guidance at the hospital from 2010 through 2012. The procedure is described in detail. ⋯ At the final follow-up periods, 17.2 (10-24 months), the median VAS score of the patients, 23 (0 to 71 mm), was significantly improvement (P = 0.001) in comparison to before injection 88 (range; 56-100). No complications occurred. The cervical nerve root block under ultrasonic guidance simply, safely, and efficaciously decreased radicular pain for 17.2 months in 62% patients with intolerable radicular pain.