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Neurosurgery Clinics of North America

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https://www.readbyqxmd.com/read/28600018/current-controversies-in-spinal-and-cranial-surgery
#1
EDITORIAL
Russell R Lonser, Daniel K Resnick
No abstract text is available yet for this article.
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600017/comparison-of-prenatal-and-postnatal-management-of-patients-with-myelomeningocele
#2
REVIEW
Sergio Cavalheiro, Marcos Devanir Silva da Costa, Antonio Fernandes Moron, Jeffrey Leonard
Myelomeningocele (MMC) is a costly lifetime disease with many comorbidities, including sensory and motor lower limb disability, bladder/bowel dysfunction, scoliosis, club foot, and hydrocephalus. MMC treatment options have changed over time because routine use of fetal ultrasonography and MRI has provided prenatal diagnosis and the potential for fetal surgery. There is still no consensus on how to treat the MMC diagnoses prenatally, mainly related to the infrastructure required to operate on pregnant patients...
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600016/surgical-treatment-of-trigeminal-neuralgia
#3
REVIEW
Sarah K B Bick, Emad N Eskandar
Trigeminal neuralgia is characterized by severe, episodic pain in the trigeminal nerve distribution. Medical therapy is the first line treatment. For patients with refractory pain, a variety of procedures including microvascular decompression, percutaneous radiofrequency rhizotomy, percutaneous glycerol rhizotomy, percutaneous balloon compression, and stereotactic radiosurgery are available. We review the literature and suggest that microvascular decompression remains the gold standard operative therapy. For patients with recurrent pain or who are poor operative candidates, percutaneous radiofrequency rhizotomy offers the best pain response rates and has the advantage of being able to selectively target affected trigeminal divisions...
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600015/reoperation-for-recurrent-glioblastoma-multiforme
#4
REVIEW
Adam M Robin, Ian Lee, Steven N Kalkanis
The role of reoperation for glioblastoma multiforme (GBM) recurrence is currently unknown. However, multiple studies have indicated that survival and quality of life are improved with a repeat operation at the time of disease recurrence. Prognosis is likely interdependent on several factors, including age, functional status, initial resection status, disease location, and surgical efficacy. However, there are significant data indicating no survival benefit for reoperation. This comprehensive literature review considering the controversial question of whether to operate for progressive or recurrent GBM seeks to evaluate the current available evidence and report on its conclusions...
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600014/surgical-management-of-incidental-gliomas
#5
REVIEW
Imran Noorani, Nader Sanai
Detailed brain imaging studies discover gliomas incidentally before clinical symptoms or signs show. These tumors represent an early stage in the natural history of gliomas. Left untreated, they are likely to progress to a symptomatic stage and transform to malignant gliomas. A greater extent of resection delays the onset of malignant transformation and prolongs patient survival. Because incidental gliomas are typically smaller and less likely to be in eloquent brain locations, there is a strong case for early surgical intervention to maximize resection and improve outcomes...
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600013/management-of-small-incidental-intracranial-aneurysms
#6
REVIEW
Jan-Karl Burkhardt, Arnau Benet, Michael T Lawton
Advances in neuroimaging and its widespread use for screening have increased the diagnosis of unruptured intracranial aneurysms (UIAs), including small-sized UIAs. The clinical management of these small-sized UIAs requires a patient-specific judgment of the risk of aneurysm rupture, if not treated, versus the risk of complications from surgical or endovascular treatment. Experienced cerebrovascular teams recommend treating small UIAs in young patients or in patients with more than one aneurysm rupture risk factor who also have a reasonable life expectancy...
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600012/flow-diversion-after-aneurysmal-subarachnoid-hemorrhage
#7
REVIEW
Sabareesh K Natarajan, Hussain Shallwani, Vernard S Fennell, Jeffrey S Beecher, Hakeem J Shakir, Jason M Davies, Kenneth V Snyder, Adnan H Siddiqui, Elad I Levy
Flow diversion after aneurysmal subarachnoid hemorrhage (SAH) is the last treatment option for aneurysm occlusion when other methods of aneurysm treatment cannot be used because of the need for dual antiplatelet therapy. The authors' general protocol for treatment selection after aneurysmal SAH is provided to share with readers our approach to securing the aneurysm before embarking flow diversion for primary treatment or delayed adjunctive treatment to primary coiling. The authors' experience with flow diversion after aneurysmal SAH, review of pertinent literature, and the future of flow diversion after aneurysmal SAH are discussed...
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600011/direct-versus-indirect-bypass-for-moyamoya-disease
#8
REVIEW
Jonathan J Liu, Gary K Steinberg
Moyamoya disease is a progressive occlusive vasculopathy that involves the supraclinoid internal carotid arteries and Circle of Willis, and results in the formation of collateral vessels at the skull base. The progressive nature of this disease leads to cerebral ischemia and sometimes intracerebral hemorrhage. The treatment of moyamoya disease is mainly surgical revascularization, using revascularization techniques that include direct, indirect, and combined strategies. Here we discuss the available options for revascularization as well as our opinions regarding the surgical management of patients with moyamoya disease...
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600010/hemicraniectomy-for-ischemic-and-hemorrhagic-stroke-facts-and-controversies
#9
REVIEW
Aman Gupta, Mithun G Sattur, Rami James N Aoun, Chandan Krishna, Patrick B Bolton, Brian W Chong, Bart M Demaerschalk, Mark K Lyons, Jamal McClendon, Naresh Patel, Ayan Sen, Kristin Swanson, Richard S Zimmerman, Bernard R Bendok
Malignant large artery stroke is associated with high mortality of 70% to 80% with best medical management. Decompressive craniectomy (DC) is a highly effective tool in reducing mortality. Convincing evidence has accumulated from several randomized trials, in addition to multiple retrospective studies, that demonstrate not only survival benefit but also improved functional outcome with DC in appropriately selected patients. This article explores in detail the evidence for DC, nuances regarding patient selection, and applicability of DC for supratentorial intracerebral hemorrhage and posterior fossa ischemic and hemorrhagic stroke...
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600009/the-case-for-deformity-correction-in-the-management-of-radiculopathy-with-concurrent-spinal-deformity
#10
REVIEW
Sigurd Berven, Anthony DiGiorgio
The management of adult deformity varies significantly. Options range from nonoperative care to limited decompression to decompression with limited or extensive fusion. The appropriate surgical management is the approach that optimizes the likelihood of improvement in health-related quality of life, while limiting risks of complications and costs. Decompression alone is unreliable in the setting of significant deformity contributing to radiculopathy. Decompression with limited fusion is most appropriate for patients with age-appropriate global alignment of the spine, and decompression with more extensive fusion is most appropriate for patients with progressive deformity or with global sagittal or coronal malalignment...
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600008/lumbar-radiculopathy-in-the-setting-of-degenerative-scoliosis-mis-decompression-and-limited-correction-are-better-options
#11
REVIEW
Ricardo B Fontes, Richard G Fessler
Surgery for adult spinal deformity (ASD) has emerged as an efficient treatment alternative, but it is fraught with potential perioperative morbidity, incompletely mitigated by emerging minimally invasive surgical techniques. In mild-to-moderate ASD balanced in the sagittal plane, there are situations in which the counterintuitive simple decompression through a foraminotomy or laminectomy, or even a short-segment fusion may be an attractive treatment. This article presents a case example and the authors' treatment rationale and reviews the limited available literature supporting it...
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600007/bone-morphogenic-protein-use-in-spinal-surgery
#12
REVIEW
John F Burke, Sanjay S Dhall
Bone morphogenic protein (BMP) provides excellent enhancement of fusion in many spinal surgeries. BMP should be a cautionary tale about the use of industry-sponsored research, perceived conflicts of interest, and holding the field of spinal surgery to the highest academic scrutiny and ethical standards. In the case of BMP, not having a transparent base of literature as it was approved led to delays in allowing this superior technology to help patients.
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600006/is-there-still-a-role-for-interspinous-spacers-in-the-management-of-neurogenic-claudication
#13
REVIEW
Vijay M Ravindra, Zoher Ghogawala
Lumbar spinal stenosis with neurogenic claudication is prevalent in the elderly population. Decompression for this condition is the operation most commonly used to treat older patients. Because of the risks associated with open decompression procedures, particularly in older patients with comorbidities, minimally invasive procedures with implantation of interspinous process devices have been developed. This article reviews the current role of interspinous spacers in the treatment of lumbar spinal stenosis with neurogenic claudication and discusses the body of literature surrounding this treatment alternative...
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600005/sacroiliac-fusion-another-magic-bullet-destined-for-disrepute
#14
REVIEW
Robert W Bina, R John Hurlbert
Pain related to joint dysfunction can be treated with joint fusion; this is a long-standing principle of musculoskeletal surgery. However, pain arising from the sacroiliac (SI) joint is difficult to diagnose. Several implant devices are available that promote fusion by simply crossing the joint space. Evidence establishing outcomes is misleading because of vague diagnostic criteria, flawed methodology, bias, and limited follow-up. Because of nonstandardized indications and historically inferior reconstruction techniques, SI joint fusion should be considered unproven...
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28600004/the-sacroiliac-joint
#15
REVIEW
David W Polly
The sacroiliac joint moves 2.5°. It is innervated with nociceptive fibers. It is a common cause of low back pain (15%-30%). Degenerative changes occur, especially after lumbosacral fusion. When performed in series, physical examination maneuvers are diagnostic. Confirmatory image-guided injections can aid the diagnosis. In randomized clinical trials, surgical treatment in appropriately selected patients has been demonstrated to be statistically and clinically superior to nonsurgical management.
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325464/contemporary-management-of-subdural-hematomas
#16
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
#17
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
#18
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
#19
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
#20
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
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