Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Dec 2016
The incidence of and risk factors for ischemic complications after microsurgical clipping of unruptured middle cerebral artery aneurysms and the efficacy of intraoperative monitoring of somatosensory evoked potentials: A retrospective study.
Ischemic complications (ICs) account for 6.7% after microsurgical clipping of unruptured intracranial aneurysms. This study aimed to evaluate the efficacy of somatosensory evoked potential (SSEP) monitoring during microsurgical clipping of unruptured middle cerebral artery (MCA) aneurysms and evaluate the incidence of and risk factors for ischemic complications after clipping of unruptured MCA aneurysms. ⋯ Clinicians should consider the possibility of IC during microsurgical clipping of unruptured MCA aneurysms in patient≥62.5years and/or a history of stroke. Intraoperative SSEP monitoring is an effective and feasible tool for preventing IC.
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Clin Neurol Neurosurg · Nov 2016
ReviewIntervention for A randomized trial of unruptured brain arteriovenous malformations (ARUBA) - Eligible patients: An evidence-based review.
While intervention for ruptured arteriovenous malformations (AVMs) of the brain is typically warranted, the management of unruptured AVMs remains controversial. Despite numerous retrospective studies, only one randomized controlled trial has been conducted, comparing the role of medical management alone to medical management plus surgical and/or radiosurgical intervention in patients with unruptured AVMs: A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA). To great controversy, ARUBA concluded that medical management alone was superior to intervention for unruptured AVMs, which was subsequently challenged by various single-institution and multi-center studies analyzing outcomes of ARUBA-eligible patients. ⋯ The rates of the primary endpoint of symptomatic stroke or death were low among the analyzed studies (0-12.2%, mean 8.0%) and similar to the medically managed arm of ARUBA (10.1%). Likewise, the percentage of patients with impaired functional outcomes (modified Rankin score ≥2) in the reviewed studies was low (5.9%-13.1%; mean: 9.9%) and comparable to the 14.0% observed in the medically management arm of ARUBA. The key findings of ARUBA and subsequent work in its aftermath are overviewed and analyzed for the role of surgery and/or radiosurgery in patients with unruptured AVMs.
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Clin Neurol Neurosurg · Nov 2016
Comparative StudyTransforaminal lumbar interbody fusion versus instrumented posterolateral fusion In degenerative spondylolisthesis: An attempt to evaluate the superiority of one method over the other.
Various surgical procedures have been recommended for the treatment of degenerative spondylolisthesis,but Controversy still exists regarding the optimal surgical technique . In this study,we compared the clinical and radiologic outcome of the Transforaminal lumbar interbody fusion(TLIF) method with the Instrumented Posterolateral fusion(PLF) in these patients. ⋯ Our study showed that TLIF is superior to PLF with respect to functional outcome and fusion rate.
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Clin Neurol Neurosurg · Nov 2016
Randomized Controlled TrialPercutaneous radiofrequency facet capsule denervation as an alternative target in lumbar facet syndrome.
Percutaneous radiofrequency denervation of the medial dorsal branch is often used in chronic low back pain of intervertebral facet etiology, which is sometimes difficult to perform and recurrence of pain often ensues. We theorized that shifting the target of RF coagulation to the facet joint capsule would provide an easier target and a longer-lived pain relieving response. ⋯ In CLBP of facet origin, shifting the target of percutaneous radiofrequency to the facet joint capsule provides an easier technique with an extended period of pain relief compared to the medial dorsal branch of the facet joint.