Asian journal of neurosurgery
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The objective is to evaluate the efficacy of early decompressive craniectomy (DC) versus standard medical management ± late DC in improving clinical outcome in patients with traumatic brain injury (TBI). Electronic databases and gray literature (unpublished articles) were searched under different MeSH terms from 1990 to present. Randomized control trials, case-control studies, and prospective cohort studies on DC in moderate and severe TBI. ⋯ However, good clinical outcome is the same. Early DC saves lives in patients with TBI. However, further clinical trials are required to prove if early DC improve clinical outcome and to define the best early time frame in performing early DC in TBI population.
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Conventionally, intradural spinal tumor excision requires longer skin incision, bilateral subperiosteal muscle stripping, and total laminectomy, thereby decreasing the stability of the spine and increasing the morbidity. Minimally invasive surgery (MIS) for intradural spinal tumor excision preserves the posterior supporting structures of the spine in the midline and on the contralateral side and decreases morbidity and achieves the resection of the tumor. ⋯ Anteriorly or laterally placed intradural spinal tumors confined to the spinal canal can be excised safely and effectively using tubular retractor system, with adding the advantages of the MIS surgery. When in doubt, always convert the MIS to open surgery to avoid injury to vital structures.
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The motor evoked potential (MEP) monitoring is routinely used as an adjunct in the microsurgical clipping of anterior circulation. We describe a case of unruptured basilar tip aneurysm treated with microsurgical clipping developed loss in MEP recording of the left abductor pollicis brevis (APB) following clipping of basilar tip aneurysm. A 58-year-old man was referred to the Fujita Health University Banbuntane-Hotokukai Hospital, Nagoya, Aichi, Japan, with incidental finding of unruptured 6.5 mm basilar tip saccular aneurysm. ⋯ This is the first reported ICA occlusion due to its mobilization in microsurgical clipping of basilar tip aneurysm. The use of neuromonitoring especially MEP is essential even in the posterior circulation aneurysm surgery especially when excessive manipulation of the ICA is unavoidable. When performing intraoperative angiography for aneurysm surgery, it is prudent to detect any filling defect within the surrounding vessels.
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Glioblastoma (GBM) is a leading cause of brain cancer-related death. The blood-brain barrier (BBB) prevents the transport of most systemic delivered molecules to the brain. This constitutes a major problem in the therapy of brain tumors. ⋯ Furthermore, only one study was a clinical study. The research field is focused on preclinical drug development trials and less emphasis is placed on the CED technique itself. However, it is important that future studies focus on establishing optimal protocols for the use of CED in rodents as well as for big brain models to be able to use the CED method in patients with GBM.
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Long Term Outcome in Survivors of Decompressive Craniectomy following Severe Traumatic Brain Injury.
Decompressive craniectomy (DC) is done for the management of intracranial hypertension due to severe traumatic brain injury (sTBI). Despite DC, a number of patients die and others suffer from severe neurological disability. We conducted this observational study to assess functional outcome as measured by Glasgow outcome scale-extended (GOSE) in survivors of DC. The correlation between various factors at admission and hospital with functional outcome was also obtained. ⋯ Significant disability is seen among the survivors of DC. Tracheostomy and MAP at admission were found to be independently associated with the patient outcome.