Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Apr 2018
Optic nerve sheath diameter based on preoperative brain computed tomography and intracranial pressure are positively correlated in adults with hydrocephalus.
The usefulness of optic nerve sheath diameter (ONSD) in predicting increased intracranial pressure (ICP) is not well established in adults with hydrocephalus. In this retrospective study, we evaluated the correlation between ONSD measured on brain computed tomography (CT) and ICP in adults with hydrocephalus. ⋯ ONSD measured on preoperative brain CT was linearly correlated with ICP in adult patients with communicating and non-communicating hydrocephalus, and it was a predictor of increased ICP with good discrimination and high inter-observer reliability. These results suggest that preoperative ONSD measurement on brain CT can be helpful to safely manage such patients by providing information about ICP.
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Clin Neurol Neurosurg · Apr 2018
The surgical management of dysphagia secondary to diffuse idiopathic skeletal hyperostosis.
This study reviews the management pathway and surgical outcomes of patients referred to and operated on at a tertiary neurosurgical centre, for dysphagia associated with anterolateral cervical hyperostosis (ACH) in diffuse idiopathic skeletal hyperostosis (DISH). ⋯ All our patients experienced significant and sustained clinical improvement. Anterior cervical osteophytectomy consistently leads to improvement in symptomatic ACH patients without recurrence. Early referral to a neurosurgical multi-disciplinary team (MDT) is indicated in ACH related dysphagia, once conservative management has failed.
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Clin Neurol Neurosurg · Apr 2018
Significance of novel subcortical low intensity score on transient neurological events after revascularization surgery for moyamoya disease.
Transient neurological events (TNEs) are frequently observed after revascularization surgery for moyamoya disease (MMD). Recently, two signs on fluid-attenuated inversion recovery magnetic resonance images, a cortical hyperintensity belt (CHB) sign possibly reflecting vasogenic edema and a transient subcortical low intensity (SCLI) sign possibly reflecting cytotoxic edema, were reported associated with TNEs. The purpose of this study was to create a SCLI score and to investigate the significance of the score in TNEs. ⋯ The novel SCLI score may be useful for diagnosing TNEs after revascularization surgery for MMD, although both vasogenic and cytotoxic edema may be involved in postoperative TNEs.
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Clin Neurol Neurosurg · Apr 2018
Clinically aggressive phenotype: A clinicopathological case series of atypical pituitary adenomas.
Atypical pituitary adenomas were relatively more malignant lesions defined by WHO criteria. However, not all of them show clinically aggressive behavior. Thus, the current WHO criteria of atypical adenoma didn't seem to be enough to distinguish clinically aggressive adenoma. Therefore, we would like to identify other clinical factors in a cohort of atypical pituitary adenomas to a better identification of clinical aggressiveness. ⋯ Gender, functional status, tumor size and Ki-67 index ≥4.45% were associated with clinical aggressiveness. A clinicopathological classification of pituitary adenomas may be useful to determine who should be under closer radiological follow-up or followed multimodal treatment strategy.
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Clin Neurol Neurosurg · Apr 2018
Results of interdisciplinary management of 693 patients with aneurysmal subarachnoid hemorrhage: Clinical outcome and relevant prognostic factors.
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high rates of morbidities and fatalities. The continuous evolution of neurosurgical, endovascular and neuro-intensive cares has improved the overall mortality. In this study we sought to evaluate the clinical outcome after aSAH from a single tertiary center. ⋯ The management of aSAH remains challenging but good clinical outcome can be achieved in a substantial subset of patients. Age, initial clinical condition, early aneurysm re-rupture, PH and MCA-aneurysm are important prognostic factors. Early detection and appropriate treatment of CVS are crucial for successful management.