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Neurosurgery Clinics of North America

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https://www.readbyqxmd.com/read/30223974/coagulation-and-hematology-in-neurologic-surgery
#1
EDITORIAL
Shahid M Nimjee, Russell R Lonser
No abstract text is available yet for this article.
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223973/management-of-intracranial-hemorrhage-in-the-anticoagulated-patient
#2
REVIEW
Robert Loch Macdonald
Antiplatelet and anticoagulant drugs (antithrombotic drugs) can cause or be associated with intracranial hemorrhage. Patients who take antithrombotic drugs are at higher risk for intracranial hemorrhage after trauma and are neurologically worse acutely compared with patients not on antithrombotic drugs. Treatment of patients on antithrombotic drugs who have intracranial hemorrhage includes reversal of anticoagulant drugs in almost all cases. This article is a synopsis of the data pertaining to intracranial hemorrhage and antithrombotic drugs and methods to diagnose the pharmacologic effects and to reverse the effects of these drugs in patients with traumatic or spontaneous intracranial hemorrhage...
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223972/management-of-acute-ischemic-thrombosis
#3
REVIEW
Kunal Vakharia, Gursant S Atwal, Elad I Levy
Acute ischemic thrombosis in patients who have undergone neurosurgical procedures is a leading cause of mortality and long-term disability. Endovascular therapy has become an important treatment modality for acute ischemic thrombosis in these patients. Noninvasive imaging has dramatically changed the understanding of cerebral blood flow and the concepts of cerebrovascular reserve and salvageable penumbra. Increasingly, reliance on perfusion imaging to discern tissue viability and potential outcomes has become standard of care...
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223971/management-of-venous-sinus-thrombosis
#4
REVIEW
Nicholas Sader, Madeleine de Lotbinière-Bassett, Michael K Tso, Mark Hamilton
Cerebral venous sinus thrombosis (CVST) is a rare subtype of cerebrovascular disease representing 0.5% of strokes. The signs and symptoms of CVST are often nonspecific, and variable in duration, with the common results being delayed diagnosis and treatment. Increased awareness in the medical community and advancements in imaging modalities have produced faster diagnosis with improved patient outcomes. The preferred initial treatment is with a low molecular weight heparin. After the acute stage of CVST, treatment with a vitamin K antagonist (oral anticoagulant therapy) is recommended...
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223970/postoperative-anticoagulation-after-neurologic-surgery
#5
REVIEW
Joel Z Passer, Christopher M Loftus
Management of anticoagulation and antiplatelet medications after neurosurgery can be complex, especially given that these patients have multiple medical comorbidities. In turn, neurosurgical patients are at high risk for the development of venous thromboembolism after surgery, so neurosurgeons must consider the use of pharmacologic prophylaxis. Developments in endovascular neurosurgery have produced therapies that require close management of antiplatelet medications to prevent postoperative complications. Any of these patient populations may need intrathecal access...
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223969/deep-vein-thrombosis-prophylaxis-in-the-neurosurgical-patient
#6
REVIEW
Ammar Shaikhouni, Justin Baum, Russell R Lonser
The optimal approach for deep vein thrombosis (DVT) prophylaxis in the neurosurgery patient is a challenge of balancing the reduction in incidence of DVT and pulmonary embolus (PE) without risking an increase in catastrophic hemorrhages. In this article, the authors review the current literature on DVT/PE prophylaxis in neurosurgery. Mechanical and pharmacologic DVT prophylaxis strategies are discussed in terms of their efficacy in reducing DVT/PE rates as well as safety in terms of catastrophic hemorrhages...
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223968/management-of-intraoperative-coagulopathy
#7
REVIEW
Michal Bar-Natan, Kenneth B Hymes
Intraoperative bleeding can be minimized with optimal preoperative preparation but cannot be completely prevented. There are circumstances when patients need emergent operative intervention, and thorough hemostatic evaluation and preparation is not possible. In this review, the authors summarize the recommendations for rapid reversal of vitamin K antagonists and direct oral anticoagulants before procedures. The authors review the potential causes for intraoperative bleeding and the methods for rapid and accurate diagnosis...
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223967/intraoperative-blood-and-coagulation-factor-replacement-during-neurosurgery
#8
REVIEW
James J Zhou, Tsinsue Chen, Peter Nakaji
Intraoperative blood and coagulation factor transfusion is of particular importance to neurosurgeons. Maintaining the hematologic and coagulation parameters of the patient within normal limits during surgery is critical to facilitate normal hemostasis, reduce transfusion requirements, and prevent complications associated with excessive blood loss. In this article, the authors review topics relevant to intraoperative transfusion during neurosurgery, including laboratory studies and other diagnostic modalities available to help with decision making, blood components and coagulation factors currently available for transfusion, and indications for intraoperative transfusion during cranial and spinal neurosurgical procedures...
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223966/reversal-of-systemic-anticoagulants-and-antiplatelet-therapeutics
#9
REVIEW
David Dornbos, Shahid M Nimjee
Although antiplatelet medications and anticoagulants are necessary for numerous cardiac comorbidities, prevention of stroke, and treatment and prevention of venous thromboembolic events, they pose a significant treatment dilemma in neurosurgical patients, particularly in the setting of intracranial hemorrhage or prior to emergent neurosurgical procedures. For the majority of current anticoagulation and antiplatelet therapies, no direct reversal agents exist; however, there are numerous strategies that can be used to reverse or mitigate their antithrombotic properties...
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223965/common-conditions-requiring-long-term-anticoagulation-in-neurosurgical-patients
#10
REVIEW
Augustus J Perez, Gerald A Grant
Long-term anticoagulant therapy prevents thrombosis. Management of neurosurgical patients with conditions such as atrial fibrillation, mechanical heart valves, and other prothrombotic states necessitates application of a strategy to mitigate hemorrhagic complications of anticoagulation. Development of direct oral anticoagulants, which include the direct thrombin and factor X inhibitors, yields new considerations to be had, in particular, the introduction of reversal agents. This article reviews the more common chronic clinical entities that require the use of prolonged anticoagulant therapy with special consideration for neurosurgical patients...
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223964/use-of-antiplatelet-agents-in-the-neurosurgical-patient
#11
REVIEW
Amanda S Zakeri, Shahid M Nimjee
Antiplatelet agents used to treat neurovascular disease include aspirin; P2Y12 receptor antagonists clopidogrel, prasugrel, and ticagrelor; ADP antagonist ticlopidine; phosphodiesterase inhibitor dipyridamole; and glycoprotein IIb/IIIa inhibitors abciximab, eptifibatide, and tirofiban. Numerous studies have been performed evaluating their efficacy in stroke, extracranial carotid artery disease and dissection, intracranial atherosclerotic disease, and moyamoya disease. The rapid technological advancements in endovascular neurosurgical devices have also made antiplatelet therapy a necessary part of treating intracranial aneurysms...
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223963/anticoagulants-pharmacokinetics-mechanisms-of-action-and-indications
#12
REVIEW
Tracy A DeWald, Jeffrey B Washam, Richard C Becker
Anticoagulant medications are used widely for a variety of medical and surgical diseases, disorders, and conditions associated with thrombosis and thromboembolism. This review highlights labeled indications, mechanisms of action, potential drug interactions, and specific pharmacokinetic characteristics of available anticoagulants as an essential foundation for guiding selection and management of therapies for patients undergoing neurosurgical procedures.
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223962/genetics-of-hypercoagulable-and-hypocoagulable-states
#13
REVIEW
Daulath Singh, Arjun Natarajan, Sucha Nand, Hanh P Mai
Hemostasis is the normal process of blood coagulation in vivo to stop pathologic bleeding. Virchow triad includes venous stasis, hypercoagulability, and vascular injury. Natural anticoagulants include protein C, protein S, and antithrombin. Factor V Leiden is the most common inherited thrombophilia, followed by prothrombin gene mutation. All inherited thrombophilias are passed down in an autosomal dominant fashion. Patients harboring the antiphospholipid antibodies have an increased risk for thrombosis. von Willebrand disease is the most common inherited bleeding disorder; the pattern of inheritance is autosomal...
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223961/evaluation-of-coagulation-in-the-neurosurgery-patient
#14
REVIEW
George M Rodgers
Normal hemostasis provides for balanced interactions between the blood vessel wall, coagulation proteins, and platelets. After vascular injury, primary hemostasis and secondary hemostasis function in a coordinated fashion to stop bleeding. Standard coagulation tests have been shown in multiple studies to predict bleeding and mortality in neurosurgical patients. Emerging coagulation tests are useful point-of-care assays that guide transfusion therapy and diagnose patients with hyperfibrinolysis. This article provides an overview of hemostasis, a summary of standard coagulation testing and point-of-care tests, and a brief review of coagulation test usefulness in neurosurgery, focusing on studies in patients with traumatic brain injury...
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/30223960/biology-of-coagulation-and-coagulopathy-in-neurologic-surgery
#15
REVIEW
Ammon M Fager, Maureane Hoffman
Hemostasis is a cell-based process that is regulated in a tissue-specific manner by the differential expression of procoagulant and anticoagulant factors on endothelial cells from different sites throughout the vasculature. The central nervous system, in particular, exhibits unique mechanisms of hemostatic regulation that favor increased activity of the tissue factor pathway. This results in an unusually high degree of protection against hemorrhage, at the potential expense of increased thrombotic risk. Unfortunately, standard laboratory assays, including the PT and aPTT, do not accurately reflect the complexity of hemostasis in vivo; therefore, they cannot predict the risk of bleeding or thrombosis...
October 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/29933815/degenerative-spinal-deformity-creating-lordosis-in-the-lumbar-spine
#16
EDITORIAL
Sigurd Berven, Praveen V Mummaneni
No abstract text is available yet for this article.
July 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/29933814/the-challenge-of-the-lumbosacral-fractional-curve-in-the-setting-of-adult-degenerative-scoliosis
#17
REVIEW
Peter G Campbell, Pierce D Nunley
Adult degenerative scoliosis treatment is complicated by its predilection for an elderly patient population that often exhibits multiple unrelated medical comorbidities. As spine surgeons attempt to treat this disease process with less invasive solutions, the fractional curve at L4, L5, and S1 is often overlooked or undertreated secondary to required increased perioperative morbidity associated with its treatment. A treatment strategy to identify, address, and treat the fractional curve with either open or minimally invasive techniques can lead to improved patient outcomes and decreased revision rates in this complicated pathologic process...
July 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/29933813/minimally-invasive-pedicle-subtraction-osteotomy
#18
REVIEW
Andrew A Fanous, Jason I Liounakos, Michael Y Wang
For patients with significant spinal deformity, the pedicle subtraction osteotomy provides a powerful means for correction, albeit with high morbidity. With the trend toward minimally invasive spine surgery, multiple less invasive techniques have been devised; however, there seems to be an upper limit to the degree of correction possible. The mini-open pedicle subtraction osteotomy addresses these limitations by minimizing the extent of soft tissue destruction needed to perform the osteotomy and by using the rod-cantilever technique to achieve maximum lordosis...
July 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/29933812/can-minimally-invasive-transforaminal-lumbar-interbody-fusion-create-lordosis-from-a-posterior-approach
#19
REVIEW
Neel Anand, Christopher Kong
The transforaminal lumbar interbody fusion (TLIF) is a well-established 3-column fusion technique that can be used to manage lumbar stenosis, instability, and deformity. Having been in use for more than 20 years, it has evolved into many different renditions. This includes protocols using minimally invasive surgery (MIS) approaches. To avoid the development of flatback syndrome, it is important that a TLIF procedural technique is capable of reproducibly restoring lordosis. This article describes one of many MIS TLIF protocols and presents some of its previously published outcomes...
July 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/29933811/navigation-assisted-minimally-invasive-surgery-deformity-correction
#20
REVIEW
Taemin Oh, Paul Park, Catherine A Miller, Andrew K Chan, Praveen V Mummaneni
Surgical correction of deformity is a complex endeavor. Although more traditional, open techniques remain important, minimally invasive surgery (MIS) techniques have been increasingly studied as an alternative approach. In particular, the circumferential MIS approach, which may incorporate a lateral/anterior as well as a subsequent posterior approach, has been investigated as a promising algorithm/protocol. Utilization of navigation guidance during MIS deformity correction is an important intraoperative tool for the surgeon...
July 2018: Neurosurgery Clinics of North America
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