Acta neurochirurgica
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Acta neurochirurgica · Feb 2012
Case ReportsSurgical treatment of spinal intradural carcinoma metastases.
Intradural metastases of nonneurogenic origin represent an extremely rare manifestation of systemic cancer. The respective literature is very scarce. ⋯ Intradural metastases are associated with limited survival time. Accordingly, the aim of surgery is strictly palliative. The majority of patients benefit with respect to neurological deficit/pain (67%) independent of the extent of resection. Thus, decompressive surgery is recommended to increase the quality of life.
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Acta neurochirurgica · Jan 2012
Comparative StudyIs the use of antibiotic-impregnated external ventricular drainage beneficial in the management of iatrogenic ventriculitis?
Profound evidence substantiates significantly reduced risk of catheter-related infections with prophylactic use of rifampin- and clindamycin-impregnated silicone catheters (Bactiseal(®), Codman Johnson & Johnson, Raynham, MA, USA) for external ventricular drainage (EVD). However, whether Bactiseal(®)-EVD (B-EVD) influences the treatment of EVD-related ventriculitis remains controversial. ⋯ This retrospective pilot study indicates that B-EVD might have no major advantage in the management of EVD or VP-shunt-related ventriculitis. Based on published reports and the results of this study, data support only the prophylactic use of B-EVD for prevention of EVD-related infections. Prospective randomized clinical trials are warranted to further evaluate the role of B-EVD in the treatment of ventriculitis.
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Acta neurochirurgica · Jan 2012
The usefulness of S100B, NSE, GFAP, NF-H, secretagogin and Hsp70 as a predictive biomarker of outcome in children with traumatic brain injury.
Predicting the long-term outcome after traumatic brain injury (TBI) is an important component of treatment strategy. Despite dramatically improved emergency management of TBI and apparent clinical recovery, most patients with TBI still may have long-term central nervous system (CNS) impairment. ⋯ Although further prospective study is warranted, these findings suggest that levels of biomarkers correlate with mortality and may be useful as predictors of outcome in children with TBI.
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Acta neurochirurgica · Jan 2012
Ventral compression in adult patients with Chiari 1 malformation sans basilar invagination: cause and management.
A small subset of patients with adult Chiari I malformation without basilar invagination (BI) and instability show ventral cervicomedullary distortion/compression and have symptoms pertaining to that. The cause of this ventral compression remains speculative. Additionally, it is unclear if these patients would require ventral decompression with posterior fusion or only posterior decompression would suffice. ⋯ VCMC in adult patients with Chiari I malformation in the absence of BI and/or AAD is due to periodontoid tissue (crown) or retroverted dens. Though a long-term study is required, it appears that all patients with Chiari I malformation, irrespective of the VCMC, can be given a chance with posterior decompression alone. Transoral decompression with posterior fusion may be required in a small subset of patients who fail to improve or worsen following posterior decompression only.