Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Jan 2021
Comparative StudyComparison of equiosmolar doses of 10% hypertonic saline and 20% mannitol for controlling intracranial hypertention in patients with large hemispheric infarction.
We conducted this prospective self-crossover controlled trial to compare the efficacy and safety of 10 % hypertonic saline (HS) and 20 % mannitol in doses of similar osmotic burden for the treatment of increased intracranial pressure (ICP) in patients with large hemispheric infarction (LHI). ⋯ Both the drugs can serve as first-line agents for treating intracranial hypertension caused by LHI and should be selected rationally according to the differences in efficacy and adverse effects.
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Clin Neurol Neurosurg · Jan 2021
Do safety-net hospitals provide equitable care after decompressive surgery for acute cauda equina syndrome?
Safety-net hospitals provide care to a substantial share of disadvantaged patient populations. Whether disparities exist between safety-net hospitals and their counterparts in performing emergent neurosurgical procedures has not yet been examined. ⋯ Emergent decompressive surgery for CES performed at SNHs is associated with greater inpatient costs, but not greater inpatient adverse events or LOS. Differences in workflows at SNHs may be the drivers of these disparities in cost and warrant further investigation.
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Clin Neurol Neurosurg · Jan 2021
Computed tomographic angiography to analyze dangerous vertebral artery anomalies at the craniovertebral junction in patients with basilar invagination.
Failure to detect dangerous anatomic vertebral artery anomalies (AVAAs) and dangerous functional vertebral artery anomalies (FVAAs) at the craniovertebral junction (CVJ) in patients with basilar invagination (BI) can result in major complications such as intraoperative vertebral artery injury, brain infarctions, and even death. Iatrogenic vertebral artery injury is a rare but severe complication of cervical spine surgery. We aimed to evaluate dangerous vertebral artery anomalies at the CVJ in patients with BI using computed tomographic angiography (CTA). ⋯ Dangerous vertebral artery anomalies at the CVJ have a high incidence in patients with BI. Preoperative CTA is highly recommended in such patients to identify anomalous vertebral arteries and reduce the risk of intraoperative injury.
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Clin Neurol Neurosurg · Dec 2020
Randomized Controlled TrialPercutaneous pulsed radiofrequency treatment of dorsal root ganglion for treatment of lumbar facet syndrome.
Percutaneous radiofrequency denervation of the medial dorsal branch is often used for treatment of chronic low back pain originating from intervertebral facets, which is sometimes associated with a low success rate and a higher incidence of recurrence of pain. We theorized that implementing pulsed radiofrequency treatment to dorsal root ganglion would increase the probability of successful pain relief. ⋯ In CLBP of facet origin, pulsed radiofrequency treatment of the dorsal root ganglia provides both a higher incidence as well as an extended period of pain relief compared to radiofrequency ablation of the medial dorsal branch of the facet joint.
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Clin Neurol Neurosurg · Dec 2020
Observational StudyGeneral surgery involvement with ventriculoperitoneal shunt insertions reduces revision rates.
Ventriculoperitoneal shunts (VPS) are placed for a variety of etiologies. It is common for general surgery to assist with insertion of the distal portion in the peritoneum. ⋯ The use of general surgeons in VPS insertion can be of benefit by decreasing operative time, length of stay, total revisions, and distal revision rates. Further prospective studies are warranted to determine true benefit.