Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Jul 2019
Cefazolin versus vancomycin for neurosurgical operative prophylaxis - A single institution retrospective cohort study.
Cefazolin and vancomycin are common choices for neurosurgical antimicrobial prophylaxis. Cefazolin is typically first-line due to its lower toxicity profile and specificity for gram-positives such as skin commensals, while vancomycin is often reserved for patients with cephalosporin or penicillin allergies. However, one randomized clinical trial demonstrated superiority of vancomycin for cerebrospinal fluid (CSF) shunt insertions at a hospital with a high prevalence of methicillin-resistance Staphylococcus aureus (MRSA). We aimed to evaluate the association of prophylaxis choice and incidence of surgical site infection (SSI) at our own institution. ⋯ There was no significant difference in neurosurgical site infection incidence when vancomycin prophylaxis was substituted for cefazolin. S. aureus was isolated from patients who received cefazolin at a higher rate although this was not statistically significant. At our institution, S. aureus makes up 36% of isolated organisms from inpatient and intensive care units. Institutions should consider their own investigations into local antibiograms, SSI rates, and choice of prophylaxis.
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Clin Neurol Neurosurg · Jul 2019
The LACE+ index fails to predict 30-90 day readmission for supratentorial craniotomy patients: A retrospective series of 238 surgical procedures.
The LACE + index (Length of stay, Acuity of admission, Charlson Comorbidity Index (CCI) score, and Emergency department visits in the past 6 months) is a tool utilized to predict 30-90 day readmission and other secondary outcomes. We sought to examine the effectiveness of this predictive tool in patients undergoing brain tumor surgery. ⋯ The results of this study show that the LACE + index is ill-equipped to predict 30-90 day readmissions in the brain tumor population and further analysis of significant covariates or other prediction tools should be undertaken.
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Clin Neurol Neurosurg · Jul 2019
Transcalvarial brain herniation volume as a predictor of posttraumatic hydrocephalus after decompressive craniectomy.
In patients undergoing decompressive craniectomy for traumatic brain injury(TBI) there has been reported an incidence of hydrocephalus between 0-45%. There are several radiological and clinical features described in association with development of hydrocephalus. For study the influence of these factors we conducted a retrospective observational single-center cohort study in a tertiary care center with special attention to the transcalvarial herniation(TCH) volume after decompressive craniectomy. ⋯ There was a clear association between severity of TBI, TCH volume and subdural hygroma with the development of hydrocephalus. Clinicians should follow closely patients with those findings in order to avoid late deterioration.
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Clin Neurol Neurosurg · Jun 2019
Impact of sagittal imbalance correction on clinical outcomes in patients undergoing MIS-TLIF for LSS.
In the present study, we aimed to evaluate the effect of sagittal imbalance correction on clinical outcomes in patients undergoing single-segment minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar spinal stenosis (LSS). ⋯ A significant proportion of LSS patients with preoperative sagittal malalignment had a compensatory mechanism rather than a structural malalignment, while single-segment MIS-TLIF could effectively improve sagittal imbalance at 2-year follow-up. However, we found no correlation between the improvements of sagittal imbalance and 2- year clinical outcomes. Reconstruction of sagittal balance might not be the main goal of single-segment MIS-TLIF for LSS, and did not affect its clinical results at two-year follow-up.
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Clin Neurol Neurosurg · Jun 2019
Deterministic-tractography-based approach for diagnosis and disease monitoring of amyotrophic lateral sclerosis.
Upper and lower motor neuron signs are required for the diagnosis of amyotrophic lateral sclerosis. The detection of upper motor neuron signs is key for the diagnosis, as quite a few patients with amyotrophic lateral sclerosis lack upper motor neuron signs during the course of disease. This study sought to investigate whether deterministic tractography of the corticospinal tract, reflecting upper motor neuron signs, could be a surrogate biomarker for amyotrophic lateral sclerosis. ⋯ These findings suggest that the deterministic-tractography-based approach is a potential biomarker for the diagnosis and disease monitoring of amyotrophic lateral sclerosis.