Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Jan 2018
ReviewPre-optimization of spinal surgery patients: Development of a neurosurgical enhanced recovery after surgery (ERAS) protocol.
Despite surgical, technological, medical, and anesthetic improvements, patient outcomes following elective neurosurgical procedures can be associated with high morbidity. Enhanced recovery after surgery (ERAS) protocols are multimodal care pathways designed to optimize patient outcomes by addressing pre-, peri-, and post-operative factors. Despite significant data suggesting improved patient outcomes with the adoption of these pathways, development and implementation has been limited in the neurosurgical population. ⋯ of this study will guide further efforts to limit post-operative morbidity in patients undergoing elective spinal surgery and to highlight the impact of ERAS care pathways in improving patient reported outcomes and satisfaction.
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Clin Neurol Neurosurg · Apr 2017
ReviewBlood transfusion indications in neurosurgical patients: A systematic review.
Neurosurgical procedures can be complicated by significant blood losses that have the potential to decrease tissue perfusion to critical brain tissue. Red blood cell transfusion is used in a variety of capacities both inside, and outside, of the operating room to prevent untoward neurologic damage. ⋯ Recently, a paradigm shift has occurred in neurocritical intensive care units, whereby restrictive transfusion is increasingly favored over liberal transfusion but the ideal strategy remains in clinical equipoise. The authors of this study perform a systematic review of the literature with the objective of capturing the changing landscape of blood transfusion indications in neurosurgical patients.
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Clin Neurol Neurosurg · Apr 2017
ReviewBlood transfusion indications in neurosurgical patients: A systematic review.
Neurosurgical procedures can be complicated by significant blood losses that have the potential to decrease tissue perfusion to critical brain tissue. Red blood cell transfusion is used in a variety of capacities both inside, and outside, of the operating room to prevent untoward neurologic damage. ⋯ Recently, a paradigm shift has occurred in neurocritical intensive care units, whereby restrictive transfusion is increasingly favored over liberal transfusion but the ideal strategy remains in clinical equipoise. The authors of this study perform a systematic review of the literature with the objective of capturing the changing landscape of blood transfusion indications in neurosurgical patients.
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Clin Neurol Neurosurg · Mar 2017
Review Meta AnalysisCalcitonin gene-related peptide monoclonal antibody for preventive treatment of episodic migraine: A meta analysis.
Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) have shown promise in the preventive treatment of migraine. Therefore, we performed a meta-analysis to evaluate the efficacy and safety of CGRP mAbs for preventive treatment of migraine. Database including Ovid-SP, Cochrane Library, Pubmed and Web of Science (ISI) were systematically searched up to April 2, 2016 for randomized controlled trials(RCTs) which were dealing with the efficacy and safety of CGRP mAbs for preventive treatment of episodic migraine. ⋯ And CGRP mAbs improved the decrease of monthly migraine days from baseline to week 9-12, no matter in single dose subgroup (WMD=1.83, 95%CI=[0.06,3.60], I2=69%,P=0.04) or in multiple doses subgroup (WMD=1.77, 95%CI=[0.40,3.14], I2=61%,P=0.01). And there were no difference in incidence of adverse events between CGRP mAb group and placebo group. In conclusion, CGRP mAbs was a safety and effective preventive treatment for episodic migraine.
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Clin Neurol Neurosurg · Feb 2017
Review Meta Analysis Comparative StudyIs clipping better than coiling in the treatment of patients with oculomotor nerve palsies induced by posterior communicating artery aneurysms? A systematic review and meta-analysis.
Posterior communicating artery aneurysms (PcomAAs) are the second most common aneurysm, accounting for 25% of all aneurysms and 50% of internal carotid artery aneurysms. It has been estimated that oculomotor nerve palsy (ONP) occurs in up to one-third of patients with posterior communicating artery (PcomA) aneurysms. Recent research showed a better outcome of ONP in patients with PcomAA after surgical clipping when compared to endovascular coiling. We compared the effect of clipping and coiling on recovery of ONP in the management of patients with PcomAAs. ⋯ A superiority of clipping over coiling for the complete recovery of oculomotor nerve palsy in patients that had suffered an SAH from a ruptured aneurysm of the posterior communicating artery was found in the present meta-analysis. Limited by the relatively small sample sizes included, there were no significant differences observed in the clinical outcome between coiling and clipping in the treatment of unruptured PcomAA causing ONP. More evidence from advanced multi-center studies of large scale is needed to provide insight into the optimal treatment for outcome of ONP caused by PcomAAs.