Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Dec 2014
Risk factors for failed transverse sinus stenting in pseudotumor cerebri patients.
Idiopathic intracranial hypertension (IIH) when no underlying etiology is found, is a clinical syndrome characterized by elevated intracranial pressure (ICP) (>25 cm H2O), which may lead to headaches and visual symptoms. In patients with IIH who are found to have transverse sinus stenosis, placement of a venous stent across the stenosis has been shown to lower ICP and to resolve the symptoms in several case series, with generally favorable results. In this study, we examine common risk factors associated with failure of transvenous stenting for IIH. If venous sinus stenting fails, CSF diversion should be considered as the next line of treatment. ⋯ In patients with IIH and documented evidence of venous sinus stenosis with a pressure gradient, venous sinus stenting should be the primary treatment of choice; however, some patients may be refractory to stenting and still require permanent CSF diversion, which can be complicated in these chronically anticoagulated patients. Patients with persistent papilledema post-stenting and highly elevated opening pressure pre-stenting should be followed closely as they are at greatest risk of requiring a shunt and failing stenting.
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Clin Neurol Neurosurg · Dec 2014
Peripheral field stimulation for thoracic post herpetic neuropathic pain.
Post herpetic neuralgia is a chronic, debilitating pain with very few management options and is often refractory to treatment. We present our experience with a series of 4 patients who underwent subcutaneous peripheral field stimulation for treatment of thoracic post herpetic neuropathic pain. ⋯ Peripheral field stimulation for the treatment of post herpetic neuropathic pain is a safe and effective method for pain relief for an extremely complex problem with very few solutions. Patient selection and proper lead placement is most important for the success of treatment.
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Clin Neurol Neurosurg · Dec 2014
Impact of body mass index in spinal surgery for degenerative lumbar spine disease.
Obesity is a factor for degenerative lumbar spine disease (DLSD), with increasing prevalence worldwide. Consequently, patients who are overweight or obese have benefited from surgical treatment for DLSD, despite their anatomical and clinical differences. ⋯ BMI is not a complicating factor for the outcome of patients undergoing surgery for DLSD in terms of SSI, surgical complications, and re-operation rates. Furthermore, the extent of surgery was associated with increased postoperative SSI and the need for a second surgery due to the failure of the first procedure.
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Clin Neurol Neurosurg · Nov 2014
Review Case ReportsCavernous malformations isolated from cranial nerves: Unexpected diagnosis?
Cranial nerves (CN) cavernous malformations (CMs) are lesions that are isolated from the CNs. The authors present three cases of CN CMs, for which MR was demonstrated to be critical for management, and surgical resection produced good outcomes for the patients. Surgical removal is the recommended course of action to restore or preserve neurological function and to eliminate the risk of future haemorrhage. However, the anatomical location and the complexity of nearby neural structures can make these lesions difficult to access and remove. In this study, the authors review the literature of reported cases of CN CMs to analyse the clinical and radiographic presentations, surgical approaches and neurological outcomes. ⋯ CN CMs present with specific symptoms and require complex surgical techniques for resection. These lesions are frequently symptomatic, because of the complexity of the origin tissue. Symptomatic CN CMs should be resected microsurgically and completely when possible to prevent further losses of nerve function, improve function, avoid recurrence, and to eliminate the risk of future haemorrhages. The authors discuss the therapeutic options and the radiological features of these infrequent localisation of CMs. Specifically, the authors focus on the role of magnetic resonance imaging in the identification of these rare lesions.
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Clin Neurol Neurosurg · Nov 2014
ReviewTherapeutic hypothermia does not diminish the vital and necessary role of SSEP in predicting unfavorable outcome in anoxic-ischemic coma.
Rational medical management of patients who remain comatose following cardio-pulmonary resuscitation (CPR) due to anoxic-ischemic encephalopathy depends upon the early identification of those with a hopeless prognosis - regardless of how aggressively they are managed. Conversely, it is mandatory that we recognize those patients with the potential to recover in order to institute aggressive therapeutic measures. The bilateral absence of the N20 Cortical Somatosensory Evoked Potential has been identified as the most reliable predictor of an unfavorable prognosis in normothermic patients. ⋯ Eight studies targeting patients who were comatose following CPR, treated with TH, and using SSEP as an outcome predictor are reviewed. There is only one patient treated with TH who appears to have fully recovered following cardiac arrest who was initially found to have bilateral absent cortical potentials. This opinion paper will address whether the criteria that placed reliance upon SSEP to predict unfavorable outcome in post cardio-pulmonary arrest patients after receiving TH, still apply.