Clinical neurology and neurosurgery
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Deep brain stimulation is nowadays a frequently performed surgery in patients with movement disorders, intractable epilepsy, and severe psychiatric disorders. The most feared complication of this surgery is an intracerebral hemorrhage due to the electrode placement, either for intraoperative electrophysiology (microelectrode recording) and/or implantation of the final electrode (macroelectrode). Here, we have investigated the risk of developing an intracerebral hemorrhage in our cohort of deep brain stimulation patients over a period of 15 years. ⋯ We have found that the risk of developing an intracerebral hemorrhage due to deep brain stimulation surgery is low. The clinical course of the patients with an intracerebral hemorrhage was generally favorable.
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Clin Neurol Neurosurg · Dec 2015
A minimally invasive approach to defects of the pars interarticularis: Restoring function in competitive athletes.
To understand that young athletes have a higher incidence of pars interarticularis defects than the general population. This may be due to an immature spine put under higher stress loads at an early age. Traditionally, surgery was reserved for those who failed conservative therapy, and consisted of open exposure, bone grafting and placement of pedicle screws. This leads to a long recovery period and limited ability to return to competitive sport. ⋯ MIS advantages include less muscle tissue disruption and restoration of the natural anatomy. This leads to a more rapid recovery, decreased perioperative pain, minimal blood loss, earlier mobilization and decreased hospital length of stay. Overall this allows the athlete to start therapy earlier and return to competition sooner and at his/her pre-operative competitive level. The described MIS repair technique outcomes are similar to those that have been reported in the literature and have allowed a high rate of return to athletics in high performing patients; critical to their quality of life.
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Clin Neurol Neurosurg · Dec 2015
ReviewIatrogenic neurologic deficit after lumbar spine surgery: A review.
Iatrogenic neurologic deficits after lumbar spine surgery are rare complications, but important to recognize and manage. Complications such as radiculopathy, spinal cord compression, motor deficits (i.e. foot drop with L5 radiculopathy), and new onset radiculitis, while uncommon do occur. Attempts at mitigating these complications with the use of neuromonitoring have been successful. ⋯ Despite the introduction of neuromonitoring, these complications still occur. Interpretation of neurologic injury rates for lumbar surgery is limited by the few prospective and cohort-matched controlled studies. Likewise, most injuries were associated with the placement of instrumentation despite the type of approach.
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Clin Neurol Neurosurg · Dec 2015
Status epilepticus severity score (STESS): A useful tool to predict outcome of status epilepticus.
The treatment protocols for status epilepticus (SE) range from small doses of intravenous benzodiazepines to induction of coma. The pros and cons of more aggressive treatment regimen remain debatable. The importance of an index need not be overemphasized which can predict outcome of SE and guide the intensity of treatment. We tried to evaluate utility of one such index Status epilepticus severity score (STESS). ⋯ STESS can reliably predict the outcome of status epilepticus. Further studies on STESS based treatment approach may help in designing better therapeutic regimens for SE.
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Clin Neurol Neurosurg · Dec 2015
Supracerebellar infratentorial approach with paramedian expansion for posterior third ventricular and pineal region lesions.
Surgical treatment for lesions in the posterior third ventricle is technically challenging. Surgical approaches to this area carries a risk of both venous and neural injury, with subsequent morbidity. Several approaches are used to reach the pineal region. The supracerebellar infratentorial approach is the commonly approach used for such lesions. ⋯ The paramedian expansion offers a better lateral and inferior tumor resection and a better view of the contralateral extension within the posterior third ventricle. Collicular lesions are better controlled using this approach by gentle inferior and lateral retraction of the cerebellum. The expanded supracerebellar infratentorial approach allows for working on the lateral tumor extension without jeopardizing the deep venous system.