Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Apr 2014
Use of thrombin-based hemostatic matrix during meningioma resection: a potential risk factor for perioperative thromboembolic events.
Hemostatic agents are widely used in patients undergoing intracranial tumor resection to facilitate local hemostasis. We hypothesized that systemic activation of the clotting cascade after local application of hemostatic agents may result in unintended thromboembolic events, including deep venous thrombosis (DVT) and pulmonary embolism (PE). We performed a retrospective analysis to identify potential associations between hemostatic agent use and DVT/PE. ⋯ Hemostatic agents are valuable tools in modern neurosurgery, however their use may be associated with an increased risk of DVT/PE in patients undergoing meningioma resection. This finding provides the impetus for more definitive clinical and laboratory studies to characterize the biology of this association and helps identify patients at increased risk for thromboembolism. This study also affirms the association between high BMI and the risk of thromboembolism. Interestingly the use of prophylactic anticoagulation after surgery did not decrease the incidence of DVT/PE.
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Clin Neurol Neurosurg · Apr 2014
Long-term follow-up of bilateral anterior capsulotomy in patients with refractory obsessive-compulsive disorder.
Obsessive-compulsive disease (OCD) is a severe psychiatric disorder suffers tens of millions of people around the world. There are many treatment options available, however, still nearly 40% of OCD patients do not respond very well to the therapeutic methods. For treatment-refractory OCD patients, bilateral anterior capsulotomy is a potential therapy. ⋯ Our study indicates that bilateral capsulotomy is a precise and relatively safe therapy for refractory OCD, which can improve patients' quality of life and restores their social function. There must be strict inclusion criteria for patients considering of the complications and the irreversibility of this procedure.
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Clin Neurol Neurosurg · Apr 2014
Review Comparative StudyRegional anesthesia versus general anesthesia for surgery on the lumbar spine: a review of the modern literature.
Lumbar spine surgery can be performed using different anesthetic techniques such as general endotracheal anesthesia (GA) or spinal-based regional anesthesia (RA). Several studies have been performed comparing these two anesthetic techniques and have revealed disparate results. As such, we set out to review the relevant literature. ⋯ Of these, 4 were randomized control trials, 3 were case control trials, 2 were prospective cohorts, and 2 retrospective analyses. Seven-out-of-seven studies reported reduced HRs and MAPs in the RA compared to GA group, and 7/9 studies reported a lower incidence of post-operative analgesic requirement and/or decreased pain scores for the RA group. Our review of the literature suggests that both RA and GA are safe and effective techniques for lumbar spine surgery and that RA may prove a better alternative than GA for healthy patients undergoing simple lumbar decompression procedures or for patients who are at high risk for general anesthetic complications.
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Clin Neurol Neurosurg · Apr 2014
Clinical REM sleep behavior disorder and motor subtypes in Parkinson's disease: a questionnaire-based study.
Studies documenting the association between rapid eye movement sleep behavior disorder (RBD) and motor subtypes in Parkinson's disease (PD) are rare. Our hypothesis is that RBD may be more severe in non-tremor dominant (NTD) patients with RBD than those tremor dominant (TD) with RBD. In this study, we investigated the association between motor subtypes and clinical RBD in PD. ⋯ In our study, frequency of clinical RBD was unrelated to motor subtypes of PD. However, in the present study, we found a weak correlation between clinical severity (UPDRS and the Hoehn-Yahr) of PD and severity of clinical RBD in the NTD subtype but not in the TD subtype.
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Clin Neurol Neurosurg · Apr 2014
Seizure outcome after surgical resection of supratentorial cavernous malformations plus hemosiderin rim in patients with short duration of epilepsy.
The objective of this study was to retrospectively review the postoperative seizure outcome in patients with short duration of epilepsy associated with cavernous malformations and analyze the effect of surgical methods on seizure outcome in such population. ⋯ The analysis of the seizure outcome demonstrate patients with short duration of epilepsy associated with cavernous malformations could benefit greatly from complete resection of hemosiderin rim and cavernous malformations.