Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Nov 2019
Embolization of the Middle meningeal artery in chronic subdural hematoma - A systematic review.
Chronic subdural hematomas (cSDH) are one of the most frequent reasons for consultation in neurosurgery. Multiple authors have proposed middle meningeal artery embolization (MMAE) as an option in cSDH patients to manage recurrence or avoid surgery altogether. Although many articles have been published on the matter, the current body of evidence still has to be evaluated before MMAE is integrated into clinical practice. ⋯ Although the definition of resolution varied among authors, cSDH resolution was reported in 96.8% of cases. MMAE is a feasible technique for cSDH, but the current body of evidence does not yet support its use as a standard treatment. Further studies with a higher level of evidence are necessary before MMAE can be formally recommended.
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Clin Neurol Neurosurg · Oct 2019
ReviewBrain death: Radiologic signs of a non-radiologic diagnosis.
Brain death is a clinical diagnosis characterized by the irreversible loss of neurologic function caused by global injury to the brain, including the brain stem. This is often caused by trauma and subarachnoid hemorrhage amongst other etiologies. This injury results in extensive cerebral edema, a rise in intracranial pressure, and eventual cessation of cerebral blood flow. ⋯ Cerebral angiography, transcranial Doppler, and cerebral scintigraphy are the only imaging studies to have been validated by the American Academy of Neurology for diagnosis of brain death. However, characteristic findings on computed tomography, computed tomography perfusion, computed tomography angiography, magnetic resonance imaging, and magnetic resonance angiography may suggest the diagnosis. In this article, the clinical criteria, pathophysiology, pathology, and variations in current practice of brain death diagnosis are discussed, and the imaging findings of brain death are reviewed.
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Clin Neurol Neurosurg · Jul 2019
Meta AnalysisComparative safety and efficacy of percutaneous approaches for the treatment of trigeminal neuralgia: A systematic review and meta-analysis.
Percutaneous treatments for trigeminal neuralgia (TN) include glycerol rhizotomy (GR), radiofrequency thermocoagulation (RF), and balloon compression (BC), which aim to provide pain relief by targeted injury to the trigeminal nerve pain fibers. All three techniques are well established and can provide immediate pain relief; however each of them can be associated with a range of complications. Our objective was to compare the safety and efficacy of GR, RF and BC in patients with TN. ⋯ The comparisons of BC vs RF comprised 3,183 patients and did not show significant differences between the two groups. RF is associated with statistically significant higher odds for immediate pain relief and anesthesia and lower risk for post-operative herpes eruption as compared to GR. Patients in the BC group had a statistically significant higher risk to develop post-operative mastication weakness and diplopia when compared to GR.
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Clin Neurol Neurosurg · May 2019
Meta AnalysisMeta-analysis of recent literature on utility of follow-up imaging in isolated perimesencephalic hemorrhage.
Isolated perimesencephalic subarachnoid hemorrhage is an uncommon, distinct subtype of subarachnoid hemorrhage with a more benign prognosis. A negative computed tomographic angiogram has been shown to be reliable in excluding aneurysmal rupture as the underlying etiology. However, some studies continue advocating for more imaging to determine a vascular cause in perimesencephalic subarachnoid hemorrhage. The objective of this study is to evaluate the evidence for use and utility of repeat angiographic imaging after a negative computed tomographic angiogram in patients with perimesencephalic subarachnoid hemorrhage. ⋯ Use of repeat angiographic imaging after a negative computed tomographic angiogram for perimesencephalic subarachnoid hemorrhage patients remains not uncommon, despite previous meta-analysis. Review of the more recent literature is consistent with previously published meta-analysis and shows limited benefits despite frequent use. In patients with a strictly defined perimesencephalic subarachnoid hemorrhage pattern and clinical picture consistent with perimesencephalic subarachnoid hemorrhage, an initial negative computed tomographic angiogram should be adequate and repeated follow-up studies can be avoided.
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Clin Neurol Neurosurg · Dec 2018
Anticoagulant prophylaxis against venous thromboembolism following severe traumatic brain injury: A prospective observational study and systematic review of the literature.
Venous thromboembolism (VTE) is a serious complication following severe traumatic brain injury (TBI), however, anticoagulant prophylaxis remains controversial due to concerns of intracranial hemorrhage (ICH) progression. We examined anticoagulant prophylaxis practice patterns at a major trauma centre and determined risk estimates for VTE and ICH progression classified by timing of anticoagulant initiation. ⋯ VTE is a common complication after severe TBI. Anticoagulant prophylaxis is often started late (≥3d) post-injury. Randomized trials are justifiable and necessary to provide practice guidance with regards to optimal timing of anticoagulant prophylaxis.