Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Aug 2013
Microsurgical clipping of previously coiled intracranial aneurysms.
Endovascular coiling techniques for the treatment of intracranial aneurysms have rapidly developed as an alternative option to surgical clipping. A distinct problem after endovascular coiling is the management of a residual aneurysm neck due to incomplete filling, compaction of coils or regrowth of the aneurysm. Treatment options in this situation include surgical clipping, re-coiling, stent implantation or observation. ⋯ Coiled aneuryms with incomplete occlusion, coil compaction or regrowth of the aneurysmal neck can be successfully treated with microsurgical clipping. Coil extrusion was more often observed intraoperatively than expected. Complete occlusion of the aneurysm can be performed safely, even if loops of coils protrude into the aneurysmal neck. In these cases intraoperative removal of the coils enables secure closure of the aneurysm with a surgical clip.
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Clin Neurol Neurosurg · Aug 2013
Multicenter StudyProtecting facet joints post-lumbar discectomy: Barricaid annular closure device reduces risk of facet degeneration.
Lumbar discectomy is an effective treatment for lumbar disc herniation (LDH). Although the majority of patients experience successful outcomes, a significant fraction will experience a recurrence of their back pain due to facet joint degeneration. Facet joint degeneration after discectomy may be the result of excessive nuclear removal, disc space narrowing, and annular injury. ⋯ CT interpretations were collected preoperatively and 12 months post-discectomy. Patients implanted with Barricaid had significantly reduced rates and grades of facet degeneration than patients without Barricaid. Reinforcing the annulus fibrosus with Barricaid during lumbar discectomy may slow the progression of facet joint degeneration.
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Clin Neurol Neurosurg · Aug 2013
Observational StudyA population based study of outcomes after evacuation of primary supratentorial intracerebral hemorrhage.
The role of surgery after primary intracerebral hemorrhage (ICH) is controversial. To explore whether hematoma evacuation after ICH had improved short-term survival or functional outcome we conducted a retrospective observational population-based study. ⋯ Improved 3-month survival was observed in patients who had undergone hematoma evacuation relative to patients not undergoing evacuation particularly in the subgroup of patients aged≤70 years with ≥30 ml supratentorial hematomas. Surgery might improve outcome if cases could be selected more precisely and if performed before deterioration.
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Clin Neurol Neurosurg · Aug 2013
Angiogram negative subarachnoid haemorrhage: outcomes and the role of repeat angiography.
Angiogram negative sub-arachnoid haemorrhage (SAH) is generally considered to have a more benign course than SAH of known cause. There is also variability from centre to centre as to what proportion of angiogram negative SAH patients undergo repeat Digital Subtraction Angiography (DSA). We performed a retrospective study looking at the last four years' of SAH patients at our institution in order to ascertain the clinical course, the nature and results of repeat imaging. ⋯ While generally more benign, angiogram negative subarachnoid haemorrhage can have a complicated clinical course. In our experience repeat DSA should be reserved for cases in which there is significant suspicion of occult vascular lesion. However, evidence-based guidelines are needed to aid the development of management protocols for angiogram-negative SAH and ensuring optimal patient outcomes.
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Clin Neurol Neurosurg · Aug 2013
Posterior reduction and instrumentation with rod-screw construct for atlanto-axial dislocation: a single institutional study with 21 consecutive cases.
Atlanto-axial dislocation is one of the leading causes for occipito-cervical instability. This study aimed for investigating the clinical outcome of rod-screw construct rather than traditional posterior wiring for atlanto-axial dislocation. ⋯ This surgical procedure provided satisfactory reduction of the atlanto-axial joint with significant neurological improvement. Moreover, we successfully avoided complications of posterior wiring.