Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Oct 2015
Impact of percutaneous dilatational tracheostomy in brain injured patients.
Tracheostomy is an established method in the airway management of critically ill patients with traumatic and non-traumatic brain injuries. High priority in the treatment of those patients is to protect vulnerable brain tissue. While bedside percutaneously dilatative tracheostomy (PDT) technique is increasingly used, there is disagreement about the harms of this intervention for the damaged brain. Therefore, discussions about the safety of tracheostomy in those patients must consider direct and indirect cerebral parameters. ⋯ PDT is a safe procedure for the most common neurosurgical diseases, even for patients with respiratory insufficiency. Shortening surgical time seems to be the most important factor to avoid ICP increase.
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Clin Neurol Neurosurg · Oct 2015
Treatment of selected syringomyelias with syringo-pleural shunt: the experience with a consecutive 26 cases.
It is well established that syringomyelia can cause neurological symptoms and deficit by accumulation of fluid within syrinx cavities that lead to internal compression within the spinal cord. When other intervention treating the underlying etiology failed to yield any improvement, the next option would be a procedure to divert the fluid from the syrinx cavity, such as syringo-subarachnoid, syringo-peritoneal or syringo-pleural shunting. The indications and long term efficacy of these direct shunting procedures are still questionable and controversial. ⋯ Collapse or remarkable shrinkage of the syrinx by SPS could ameliorate or at least stabilize the symptoms for the patient. We recommend small laminectomy and a less than 3mm myelotomy either at PML or DREZ. The SPS procedure can be an effective and relatively long-lived treatment for the idiopathic syringomyelia and those that failed other options.
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Clin Neurol Neurosurg · Sep 2015
ReviewEarly cranioplasty vs. late cranioplasty for the treatment of cranial defect: A systematic review.
Cranioplasty is considered as a routine procedure in everyday neurosurgical practice for the patient with cranial defect, however, there is no established consensus on optimal surgical timing. ⋯ Early CP can only reduce the duration of operation, but cannot reduce the complications of patients and even increase the risk of hydrocephalus. More evidence from advanced multi-center studies is needed to provide illumination for the timing selection of CP surgery.
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Clin Neurol Neurosurg · Sep 2015
Impact of elective versus emergent admission on perioperative complications and resource utilization in lumbar fusion.
The notion of higher complication rate and mortality in emergency surgeries is well established. There is a paucity of literature demonstrating the impact of emergent versus elective admissions for spinal surgery on the perioperative outcomes. We aim to evaluate the influence of the type of admission (elective or emergent) and day of surgery (same day versus other days within the emergent group) on the incidence, pattern of perioperative complications and hospital charges in the patients undergoing lumbar fusion for degenerative spine disease. ⋯ 'Emergent admission' and surgery performed on the 'other days' in lumbar fusion are independent risk factors for the higher incidence of perioperative complications. Complicated hospital course and longer stay of the patients in the emergent admission and 'other days' group seems to be associated with higher total hospital charges.
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Clin Neurol Neurosurg · Sep 2015
Risk factors for predicting complications associated with growing rod surgery for early-onset scoliosis.
To identify risk factors for postoperative complications associated with growing rod surgery for early-onset scoliosis (EOS). ⋯ The occurrence of postoperative complications in growing rod surgery for EOS is most likely multifactorial and is related to curve magnitude in last follow-up and duration between growing-rod lengthening procedures.