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Neurosurgery Clinics of North America

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https://www.readbyqxmd.com/read/28325464/contemporary-management-of-subdural-hematomas
#1
EDITORIAL
E Sander Connolly, Guy M McKhann
No abstract text is available yet for this article.
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325463/perioperative-management-of-anticoagulation
#2
REVIEW
Daipayan Guha, R Loch Macdonald
Antiplatelet and anticoagulant drugs (antithrombotics) predispose to acute and chronic subdural hematomas. Patients on these drugs are at higher likelihood of presenting with larger hematomas and more severe neurologic deficits. Standard neurosurgical and neurocritical care of subdural hematomas involves reversal of antithrombosis preoperatively, whereas reversing antiplatelet drugs is less clear. This article highlights the spectrum of antithrombotic agents in common use, their mechanisms of action, and strategies for reversal...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325462/management-of-recurrent-subdural-hematomas
#3
REVIEW
Virendra R Desai, Robert A Scranton, Gavin W Britz
Subdural hematomas commonly recur after surgical evacuation, at a rate of 2% to 37%. Risk factors for recurrence can be patient related, radiologic, or surgical. Patient-related risk factors include alcoholism, seizure disorders, coagulopathy, and history of ventriculoperitoneal shunt. Radiologic factors include poor brain reexpansion postoperatively, significant subdural air, greater midline shift, heterogeneous hematomas (layered or multi-loculated), and higher-density hematomas. Surgical factors include lack of or poor postoperative drainage...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325461/neurocritical-care-of-acute-subdural-hemorrhage
#4
REVIEW
Fawaz Al-Mufti, Stephan A Mayer
Although urgent surgical hematoma evacuation is necessary for most patients with subdural hematoma (SDH), well-orchestrated, evidenced-based, multidisciplinary, postoperative critical care is essential to achieve the best possible outcome. Acute SDH complicates approximately 11% of mild to moderate traumatic brain injuries (TBIs) that require hospitalization, and approximately 20% of severe TBIs. Acute SDH usually is related to a clear traumatic event, but in some cases can occur spontaneously. Management of SDH in the setting of TBI typically conforms to the Advanced Trauma Life Support protocol with airway taking priority, and management breathing and circulation occurring in parallel rather than sequence...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325460/cranioplasty
#5
REVIEW
Matthew Piazza, M Sean Grady
Cranioplasty following craniectomy for trauma is a common, safe neurosurgical procedure that restores the natural cosmesis and protective barrier of the skull and may be instrumental in normalizing cerebrospinal fluid dynamics after decompressive surgery. Understanding the factors influencing patient selection and timing of cranioplasty, the available materials and methods of skull reconstruction, and the technical nuances is critical for a successful outcome. Neurosurgeons must be prepared to manage the complications specific to this operation...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325459/natural-history-of-acute-subdural-hematoma
#6
REVIEW
Rafael A Vega, Alex B Valadka
Because published guidelines for surgical decision-making in patients with acute subdural hematomas (ASDHs) are based largely on case series and other weak evidence, management often must be individualized. Nonoperative management is a viable option in many cases. The literature is divided about the effects of anticoagulant and antiplatelet medications on rapid growth of ASDHs and on their likelihood of progression to large chronic subdural hematomas. Close clinical and radiologic follow-up is needed, both acutely to detect rapid expansion of an ASDH, and subacutely to detect formation of a large subacute or chronic subdural hematoma...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325458/chronic-subdural-hematoma-icu-management
#7
REVIEW
Jeremy T Ragland, Kiwon Lee
Patients with cSDH presenting with new or worsening neurological deficits, especially if they are debilitating and adversely affecting quality of life require urgent medical and surgical attention. Neurological and neurosurgical critical care team need to stabilize the patient by reversing any underlying coagulopathy states in order to prevent further hematoma expansion.In the event of brain herniation and presumed ICP elevation and CPP compromise, step-wise ICP management should be instituted promptly.Seizure prophylaxis treatment is reasonable...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325457/craniotomy-for-treatment-of-chronic-subdural-hematoma
#8
REVIEW
Isaac Josh Abecassis, Louis J Kim
Chronic subdural hematomas are commonly encountered pathologies in neurologic surgery. Primary management for a symptomatic lesion usually entails surgical intervention. There is controversy regarding ideal modality selection among twist drill craniostomy, bur hole craniostomy, and craniotomy. Variations of the craniotomy include a minicraniotomy (usually defined as 30-40 mm diameter), minicraniectomy, and with or without either a partial or full membranectomy. In addition to medical complications, potential surgical complications include recurrence, seizures, intraparenchymal hemorrhage, and infection...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325456/minimally-invasive-surgical-approaches-for-chronic-subdural-hematomas
#9
REVIEW
Ian A Buchanan, William J Mack
Chronic subdural hematomas are one of the most common clinical entities encountered in today's neurosurgical practices owing to an aging population and continued increases in life expectancy. Although there is a role for conservative management, surgical drainage remains the mainstay of current therapy. Regardless of the technique used for hematoma drainage, there is level I evidence to suggest that use of closed-system drainage during the perioperative period significantly decreases the likelihood for hematoma recurrence, length of hospital stay, and mortality...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325455/chronic-subdural-medical-management
#10
REVIEW
David Roh, Michael Reznik, Jan Claassen
Chronic subdural hematomas (cSDHs) that are asymptomatic or have minimal symptoms have become more prevalent, with an increased rate of detection with neuroimaging in the setting of an aging population and increasing use of anticoagulants. These cSDHs have been known to spontaneously resolve, and subsequent efforts have been made to study the role of nonoperative initial medical management strategies in these patients. Current and potential strategies for the medical management of cSDH are discussed.
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325454/chronic-subdural-hematoma-epidemiology-and-natural-history
#11
REVIEW
Wuyang Yang, Judy Huang
This article discusses the epidemiology and natural history of chronic subdural hematoma (CSDH), a common disease prevalent in the elderly population. The incidence of CSDH ranges from 1.72 to 20.6 per 100,000 persons per year. Risk factors include advancing age, male gender, and antiplatelet or anticoagulant use. Clinical progression is separated into 3 distinct periods, including the initial traumatic event, the latency period, and the clinical presentation period. The recurrence of CSDH and nonsurgical predictive factors are described in detail to provide a comprehensive understanding of the outcome of this disease...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325453/imaging-of-subdural-hematomas
#12
REVIEW
Jason J Carroll, Sean D Lavine, Philip M Meyers
The imaging of subdural hematoma has evolved significantly. Computed tomography and MRI have supplanted other procedures and rendered most obsolete for the evaluation of intracranial pathology because of ease of use, tremendous soft tissue resolution, safety, and availability. Noncontrast computed tomography has become the accepted standard of care for the initial evaluation of patients with suspected subdural hematoma because of widespread availability, rapid acquisition time, and noninvasive nature. MRI offers important features in determining potential secondary causes of subdural hematoma, such as dural-based neoplasms...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/27886886/adult-and-pediatric-spine-trauma
#13
EDITORIAL
Douglas L Brockmeyer, Andrew T Dailey
No abstract text is available yet for this article.
January 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/27886885/classification-and-management-of-pediatric-subaxial-cervical-spine-injuries
#14
REVIEW
Casey J Madura, James M Johnston
Appropriate management of subaxial spine injury in children requires an appreciation for the differences in anatomy, biomechanics, injury patterns, and treatment options compared with adult patients. Increased flexibility, weak neck muscles, and cranial disproportion predispose younger children to upper cervical injuries and spinal cord injury without radiographic abnormality. A majority of subaxial cervical spine injuries can be treated nonoperatively. Surgical instrumentation options for children have significantly increased in recent years...
January 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/27886884/classification-and-management-of-pediatric-craniocervical-injuries
#15
REVIEW
Hannah E Goldstein, Richard C E Anderson
This article addresses the key features, clinical presentation, patterns of injury, indicated workup, and radiographic findings associated with craniocervical injuries in the pediatric population. It discusses nonsurgical and surgical management of pediatric cervical spine trauma, addressing when each is indicated, and the various techniques available to the pediatric neurosurgeon.
January 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/27886883/restorative-treatments-for-spinal-cord-injury
#16
REVIEW
Stephanie Chen, Allan D Levi
Spinal cord injury remains an incurable disease with an enormous impact functionally, financially, and emotionally on affected individuals and their families. Current treatment modalities are focused on minimizing secondary injury and maximizing residual function via rehabilitation. In this article, the authors discuss ambitious advancements under investigation aimed at restoring function. These promising experimental treatments focus on neuroprotection with hypothermia and pharmacologic therapies, regeneration via cell transplantation, and rewiring with electrical stimulation...
January 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/27886882/pharmacologic-management-of-acute-spinal-cord-injury
#17
REVIEW
Michael Karsy, Gregory Hawryluk
Spinal cord injury is a serious global public health problem that often leaves patients with devastating permanent disabilities. Although advances in supportive care have improved outcome in recent decades, there remains great need for a safe and efficacious medical treatment that improves neurologic outcome. This article reviews pharmacologic treatments evaluated or in the process of development in humans. Cellular transplantation strategies are briefly reviewed especially where they have been evaluated with pharmacologic treatments...
January 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/27886881/central-cord-syndrome
#18
REVIEW
Nathaniel P Brooks
Central cord syndrome is a common spinal cord injury. The purpose of this review article is to provide an overview of the anatomy, pathophysiology, prognosis, and management of this disorder.
January 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/27886880/timing-of-surgery-after-spinal-cord-injury
#19
REVIEW
Matthew Piazza, James Schuster
Although timing for surgical intervention after spinal cord injury remains controversial, there is accumulating evidence suggesting that early surgery may improve neurologic outcomes, particularly with incomplete spinal cord injury, and may reduce non-neurologic complications and health care resource utilization. Moreover, even in patients with complete spinal cord injury, minor improvement in neurologic function can lead to significant changes in quality of life. This article reviews the experimental and clinical data examining surgical timing after spinal cord injury...
January 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/27886879/thoracolumbar-trauma-classification
#20
REVIEW
Gregory D Schroeder, James S Harrop, Alexander R Vaccaro
Useful thoracolumbar injury classifications allow for meaningful and concise communication between surgeons, trainees, and researchers. Although many have been proposed, none have been able to obtain universal acceptance. Historically, classifications focused only on the osseous injuries; more recent classifications focused on the injury morphology and other critical determinants of treatment, including the posterior ligamentous complex integrity and the patient's neurologic status. This review details the important historic classifications and reviews more contemporary thoracolumbar injury classifications, such as the Thoracolumbar Injury Classification System and the AOSpine Thoracolumbar Injury Classification System...
January 2017: Neurosurgery Clinics of North America
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