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neurosurgical management

Ramesh Kumar, Frederic W B Deleyiannis, Corbett Wilkinson, Brent R O'Neill
OBJECTIVE The authors' goals in this study were to describe a series of dog attacks on children that required neurosurgical consultation and to better understand the pattern of injuries inflicted, the circumstances that place children at risk for attack, and the dog breeds involved. In addition, the authors review the surgical and medical management of these patients. METHODS The authors performed a retrospective review of all children requiring neurosurgical consultation for dog bite at a regional Level 1 pediatric trauma center over a 15-year period...
October 21, 2016: Journal of Neurosurgery. Pediatrics
Nicola Benedetto, Carlo Gambacciani, Nicola Montemurro, Riccardo Morganti, Paolo Perrini
OBJECTIVE: To evaluate the clinical outcome of patients over 70 years old who have received surgical treatment for traumatic acute subdural haematoma (aSDH) in our Neurosurgical Department. We also disclose related surgical and medical costs. METHODS: A retrospective analysis was performed by analyzing the medical records of patients older than 70 who had undergone surgery for evacuation of traumatic aSDH between June 2011 and December 2014. Through univariate and multivariate analyses, we correlated clinical and radiological pre-operatory features with outcome at one and six months after surgery...
October 19, 2016: British Journal of Neurosurgery
Paul Klimo, Patrick Ryan Lingo, Lissa C Baird, David F Bauer, Alexandra Beier, Susan Durham, Alexander Y Lin, Catherine McClung-Smith, Laura Mitchell, Dimitrios Nikas, Mandeep S Tamber, Rachana Tyagi, Catherine Mazzola, Ann Marie Flannery
BACKGROUND: Plagiocephaly, involving positional deformity of the calvarium in infants, is one of the most common reasons for pediatric neurosurgical consultation. OBJECTIVE: To answer the question: "what is the evidence for the effectiveness of repositioning for positional plagiocephaly?" Treatment recommendations are provided based on the available evidence. METHODS: The National Library of Medicine MEDLINE database and the Cochrane Library were queried using MeSH headings and key words relevant to repositioning as a means to treat plagiocephaly and brachycephaly...
November 2016: Neurosurgery
David Graham, Kristian Aquilina, Stephanie Cawker, Simon Paget, Neil Wimalasundera
The management of cerebral palsy (CP) is complex and requires a multidisciplinary approach. Selective dorsal rhizotomy (SDR) is a neurosurgical technique that aims to reduce spasticity in the lower limbs. A minimally invasive approach to SDR involves a single level laminectomy at the conus and utilises intraoperative electromyography (EMG). When combined with physiotherapy, SDR is effective in selected children and has minimal complications. This review discusses the epidemiology of CP and the management using SDR within an integrated multidisciplinary centre...
September 2016: J Spine Surg
Merritt D Kinon, Rani Nasser, Jonathan Nakhla, Rupen Desai, Jessica R Moreno, Reza Yassari, Carlos A Bagley
Pediatric emergency physicians must have a high clinical suspicion for atlantoaxial rotatory subluxation (AARS), particularly when a child presents with neck pain and an abnormal head posture without the ability to return to a neutral position. As shown in the neurosurgical literature, timely diagnosis and swift initiation of treatment have a greater chance of treatment success for the patient. However, timely treatment is complicated because torticollis can result from a variety of maladies, including: congenital abnormalities involving the C1-C2 joint or the surrounding supporting muscles and ligaments, central nervous system abnormalities, obstetric palsies from brachial plexus injuries, clavicle fractures, head and neck surgery, and infection...
October 2016: Pediatric Emergency Care
Michael A Bohl, James Forseth, Peter Nakaji
BACKGROUND: Arginine vasopressin (AVP) is a common second-line or third-line vasopressor used in critically ill neurosurgical patients. Neurosurgical indications include hyperdynamic therapy for vasospasm, maintenance of cerebral perfusion pressure in patients with intracranial hypertension, and prevention of hypotension in patients with sepsis. CASE DESCRIPTION: A series of six neurosurgical patients receiving AVP infusions developed severe but transient diabetes insipidus (tDI) after cessation of AVP...
October 11, 2016: World Neurosurgery
Wonhyoung Park, Jae Sung Ahn, Jung Cheol Park, Byung Duk Kwun, Deok Hee Lee
OBJECTIVE: Intracranial infectious aneurysms (IIAs) are a very rare but unique subtype of potentially life-threatening vascular lesion. However, there is no widely accepted standard protocol for their management. We reviewed our treatment experiences of IIAs from 2001 to 2015 and proposed a treatment strategy for future use. METHODS: We retrospectively reviewed 25 patients with 33 IIAs. All patients had predisposing infectious disease for which the causative organism had been identified...
October 11, 2016: World Neurosurgery
Menekse Oksar
Although anesthetic requirements for minimally invasive neurosurgical techniques have been described in detail and applied successfully since the early 2000s, most of the literature on this subject has dealt with cranial cases that were operated on in the supine or sitting positions. However, spinal surgery has also used minimally invasive techniques that were performed in prone position for more than 30 years to date. Although procedures in both these neurosurgical techniques require the patient to be awake for a certain period of time, the main surgical difference with minimally invasive spinal surgery is that the patients are in the prone position, which may result in increased requirement of airway management because of deep sedation...
2016: TheScientificWorldJournal
Preeda Sumritpradit, Thitipong Setthalikhit, Sorayouth Chumnanvej
Background and Objective. To determine the value of repeated brain CT in TBI cases for risk-stratified care management (RSCM) and to identify predicting factors which will change the neurosurgical management after repeated brain CTs. Methods. A 5-year retrospective study from January 2009 to August 2013 was conducted. The primary outcome was the value of repeated brain CT in TBI cases. The secondary outcome is to identify predicting factors which will change the neurosurgical management after repeated brain CTs...
2016: Neurology Research International
David O Udoh, Emmanuel Ibadin, Mojisola O Udoh
BACKGROUND: Intracranial abscess collections, though uncommon, are dreaded complications of head trauma, neurosurgical operations, meningitis, and otogenic, mastoid, and paranasal air sinus infections. Combining surgical evacuation with the appropriate antibiotic therapy is the effective treatment for intracranial abscesses. However, literature on surgical treatment is replete with several procedures which, on their own, may not. OBJECTIVES: To determine the epidemiology and outcomes (of various treatment modalities) of intracranial abscesses in our institution, a major referral center for neurosurgical conditions in the midwestern region of Nigeria...
October 2016: Asian Journal of Neurosurgery
Yad R Yadav, Vijay Parihar, Hemant Namdev, Jitin Bajaj
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. There is lack of uniformity in the treatment of CSDH amongst surgeons in terms of various treatment strategies. Clinical presentation may vary from no symptoms to unconsciousness. CSDH is usually diagnosed by contrast-enhanced computed tomography scan. Magnetic resonance imaging (MRI) scan is more sensitive in the diagnosis of bilateral isodense CSDH, multiple loculations, intrahematoma membranes, fresh bleeding, hemolysis, and the size of capsule...
October 2016: Asian Journal of Neurosurgery
Taopheeq Bamidele Rabiu, Edward Oluwole Komolafe
BACKGROUND: Africa has very few neurosurgeons. These are almost exclusively in urban centers. Consequently, people in rural areas, most of the African population, have poor or no access to neurosurgical care. We have recently pioneered rural neurosurgery in Nigeria. OBJECTIVES: This report details our initial experiences and the profile of neurosurgical admissions in our center. METHODS: A prospective observational study of all neurosurgical patients managed at a rural tertiary health institution in Nigeria from December 2010 to May 2012 was done...
October 2016: Journal of Neurosciences in Rural Practice
Sindhura Pisipati, Kyle A Smith, Kushal Shah, Koji Ebersole, Roukoz B Chamoun, Paul J Camarata
OBJECTIVE Laser interstitial thermal therapy (LITT) is used in numerous neurosurgical applications including lesions that are difficult to resect. Its rising popularity can be attributed to its minimally invasive approach, improved accuracy with real-time MRI guidance and thermography, and enhanced control of the laser. One of its drawbacks is the possible development of significant edema, which contributes to extended hospital stays and often necessitates hyperosmolar or steroid therapy. Here, the authors discuss the use of minimally invasive craniotomy to resect tissue ablated with LITT in attempt to minimize cerebral edema...
October 2016: Neurosurgical Focus
Lukas Andereggen, Janine Frey, Robert H Andres, Marwan El-Koussy, Jürgen Beck, Rolf W Seiler, Emanuel Christ
While dopamine-agonists are the first-line approach in treating prolactinomas, surgery can be considered in selected cases besides non-responders or patients with dopamine-agonist intolerance. The aim of the present study was to compare the long-term outcome in women with prolactinomas treated primarily either surgically or medically who had not had prior dopamine-agonist treatment. Retrospective case-note study of all consecutive women with prolactinomas primarily managed with medical therapy or surgery in a tertiary referral centre...
September 29, 2016: Endocrine
Lakshmi N Kurnutala, Gurneet Sandhu, Sergio D Bergese
A 62-year-old man with a left temporal lobe tumor was scheduled for a semiurgent craniotomy for tumor excision. Previously, the patient had a laryngeal carcinoma that was resected and treated with chemotherapy and radiotherapy and a history of laryngeal biopsy with awake fiberoptic intubation. Because a difficult airway was anticipated, awake fiberoptic nasopharyngoscopy of the airway was performed under topical anesthesia in the operating room. This revealed a narrow glottic opening with no supraglottic pathology or friable tissue...
November 2016: Journal of Clinical Anesthesia
Ataru Nishimura, Kunihiro Nishimura, Akiko Kada, Koji Iihara
The management, analysis, and integration of Big Data have received increasing attention in healthcare research as well as in medical bioinformatics. The J-ASPECT study is the first nationwide survey in Japan on the real-world setting of stroke care using data obtained from the diagnosis procedure combination-based payment system. The J-ASPECT study demonstrated a significant association between comprehensive stroke care (CSC) capacity and the hospital volume of stroke interventions in Japan; further, it showed that CSC capabilities were associated with reduced in-hospital mortality rates...
September 27, 2016: Neurologia Medico-chirurgica
Anne-Lyse Jaquot, Emmanuel Vega, Xavier Molders, Walter Daveluy, François Kopciuch, Anne Benoit, Etienne Allart
OBJECTIVE: Management of tracheotomy is a key point of the coma arousal phase. Tracheal lesions can interfere with the decannulation of the patient. The objectives of our study were to determine the incidence of post-tracheotomy tracheal lesions in patients with brain injury, identify their associated factors and to specify their impact on rehabilitation. MATERIAL/PATIENTS AND METHODS: We retrospectively included brain-injured patients hospitalized in the neurosurgical intensive care unit then in the coma arousal unit of the Lille university hospital between January 2012 and December 2014...
September 2016: Annals of Physical and Rehabilitation Medicine
Bradley A Gross, Karam Moon, Andrew F Ducruet, Felipe C Albuquerque
BACKGROUND/OBJECTIVE: The rarity of petrous internal carotid artery (ICA) aneurysms has largely precluded analyses of their presentation and management in case series format. METHODS: We performed a retrospective analysis of our endovascular database of patients treated from January 2001 to May 2016 to identify patients with petrous ICA aneurysms. We evaluated the treatment approach and results for patients managed in the era of dedicated intracranial stents and flow diverters, noting clinical and angiographic results...
September 26, 2016: Journal of Neurointerventional Surgery
Mario Giordano, Cinta Arraez, Amir Samii, Madjid Samii, Concezio Di Rocco
INTRODUCTION: The treatment of low-grade gliomas (LGGs) in pediatric age is still controversial. However, most authors report longer life expectancy in case of completely removed cerebral gliomas. Intraoperative magnetic resonance imaging (iMRI) is increasingly utilized in the surgical management of intra-axial tumor in adults following the demonstration of its effectiveness. In this article, we analyze the management of LGG using iMRI focusing on its impact on resection rate and its limits in the pediatric population...
October 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Sean C Martin, Bassam O Dabbous, Elliott E Ridgeon, Shailendra A Magdum, Thomas A D Cadoux-Hudson, Erlick A C Pereira
OBJECTIVES: Anterior cervical discectomy and fusion (ACDF) is a common operative treatment of compressive pathology of the cervical spinal cord, when caused by one or more degenerated intervertebral discs or related osteophytes. In addition to intra-operative radiographs to confirm spinal level before discectomy and implant position after insertion, traditional practice is to obtain post-operative antero-posterior and lateral plain radiographs (XR) before hospital discharge, despite a paucity of evidence supporting their benefit to patient care...
September 22, 2016: British Journal of Neurosurgery
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