Clinical neurology and neurosurgery
-
Clin Neurol Neurosurg · Aug 2013
Microsurgical clipping of previously coiled intracranial aneurysms.
Endovascular coiling techniques for the treatment of intracranial aneurysms have rapidly developed as an alternative option to surgical clipping. A distinct problem after endovascular coiling is the management of a residual aneurysm neck due to incomplete filling, compaction of coils or regrowth of the aneurysm. Treatment options in this situation include surgical clipping, re-coiling, stent implantation or observation. ⋯ Coiled aneuryms with incomplete occlusion, coil compaction or regrowth of the aneurysmal neck can be successfully treated with microsurgical clipping. Coil extrusion was more often observed intraoperatively than expected. Complete occlusion of the aneurysm can be performed safely, even if loops of coils protrude into the aneurysmal neck. In these cases intraoperative removal of the coils enables secure closure of the aneurysm with a surgical clip.
-
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.
-
Clin Neurol Neurosurg · Jan 2021
Neutrophil to lymphocyte ratio - A novel prognostic marker following spontaneous intracerebral haemorrhage.
Inflammation plays a role in secondary brain injury after intracerebral haemorrhage (ICH). Peripheral biomarkers of inflammation especially the neutrophil-to-lymphocyte ratio (NLR) have been shown to influence outcome following ischemic stroke and traumatic brain injury. Role of NLR in outcome prognostication following haemorrhagic stroke has not yet been conclusively established. This study analyses the prognostic significance of admission neutrophil to lymphocyte ratio on mortality and 90-day outcome in patients admitted with acute SICH. ⋯ Elevated levels of admission NLR were independently related to poor mortality and 90-day outcome after ICH. NLR is a novel, easily available and cost effective prognostic biomarker following ICH.
-
Clin Neurol Neurosurg · Apr 2017
A prospective study of diffusion weighted magnetic resonance imaging abnormalities in patients with cluster of seizures and status epilepticus.
To study the frequency, imaging characteristics, and clinical predictors for development of periictal diffusion weighted MRI abnormalities. ⋯ Diffusion abnormalities on MRI are common in patients with cluster of seizures and status epilepticus and were highly concordant with clinical semiology and EEG activity. Patients with longer duration of seizures/status were more likely to have PMA.
-
Clin Neurol Neurosurg · Dec 2019
Pros and cons of a minimally invasive percutaneous subdural drainage system for evacuation of chronic subdural hematoma under local anesthesia.
Chronic subdural hematoma (CSH) is a common neurosurgical disease among elderly population with concomitant degenerative neurological disorders. This is a retrospective series-control analysis of prospectively collected data, aiming to show advantages and indications of a minimally invasive, percutaneous drainage system for CSH. ⋯ Pre-operative evaluation of radiological features of CSDHs is crucial in determining the right indication for a minimally invasive drainage. Minimally invasive treatments of CSH may reduce the use of anaesthetic drugs and worsening of pre-existing neurodegenerative disorders.