Clinical neurology and neurosurgery
-
Clin Neurol Neurosurg · Oct 2020
Efficacy of scalp nerve blocks using ropivacaïne 0,75% associated with intravenous dexamethasone for postoperative pain relief in craniotomies.
Pain after supratentorial craniotomy is common, 55 % to 80 % of patients experience moderate to severe pain in the first 48 h(1-7). The importance of intravenous dexamethasone as an adjuvant to local anaesthetics is increasingly applied(1-7), however its role in scalp nerve blocks with ropivacaine 0.75 % remains unexplored in post-operative analgesia. We analyzed 134 supratentorial craniotomies under general anaesthesia, 46 of which had preoperatively bilateral scalp nerve blocks with ropivacaine 0.75 %. ⋯ Peroperatively the scalp nerve blocks group showed a decrease in opioid consumption and a better hemodynamic stability. No anesthetic or chirurgical complications related to the use of scalp blocks were observed. Scalp nerve blocks associated with intravenous dexamethasone are found to be a straightforward and efficient analgesic approach during supratentorial craniotomies.
-
Clin Neurol Neurosurg · Nov 2019
Comparative StudyConservative versus operative treatment in supratentorial intracerebral hemorrhage - A survey among neurosurgeons and neurologists in Germany.
Decision making for surgical therapy in patients with intracerebral hemorrhage is still controversial among neurologists and neurosurgeons. Whereas neurologists may favor conservative treatments, surgeons may opt for operations. This might lead to different therapy decisions. ⋯ Against common prejudices, the process of decision making for or against surgery in patients with spontaneous intracerebral hemorrhage is comparable among conservative physicians (neurologists) and neurosurgeons in Germany. This might be the result of joint efforts in spontaneous intracerebral hemorrhage (ICH) therapy, such as joint guidelines or a society of neurointensive care medicine.
-
Clin Neurol Neurosurg · Jul 2020
Relationshıp of spontaneous subarachnoid haemorrhage and cerebral aneurysm to serum Visfatin and Nesfatin-1 levels.
Visfatin and nesfatin are recently discovered peptides that play a role in various metabolic reactions exhibiting inflammatory and neuroprotective effects, and their levels are known to increase in cerebral ischaemia and haematomas. Inflammation plays a role in the development of aneurysm, and spontaneous subarachnoid haemorrhage (SAH) is typically caused by rupture of the aneurysmal sac because of the increased inflammation. In the present study, we investigated the relationship between serum visfatin and nesfatin levels and the clinical and radiological findings in patients with SAH. ⋯ In the present study, we demonstrated that the presence of aneurysm, size of aneurysm, number of aneurysms correlate with visfatin and nesfatin levels in patients with SAH, and visfatin and nesfatin may be biomarkers for predicting SAH and presence of aneurysm. Nonetheless, future studies can include patients with unruptured aneurysm and investigate their serum visfatin and nesfatin levels to prove whether visfatin and nesfatin can serve as biomarkers in the follow-up of these patients.
-
Clin Neurol Neurosurg · Aug 2020
Observational StudyAn 18-month single-center observational study of real-world use of andexanet alfa in patients with factor Xa inhibitor associated intracranial hemorrhage.
Intracranial hemorrhage is a life threatening complication of factor Xa inhibitors. Except for results of the open-label, single-arm ANNEXA-4 study, published real-world utilization of andexanet alfa is limited. We present our experience with andexanet alfa use in factor Xa inhibitor associated intracranial hemorrhage. The objective of this study was to assess the hemostatic efficacy and safety following early implementation of andexanet alfa use in factor Xa inhibitor associated intracranial hemorrhage. ⋯ In this cohort of a real-world utilization of andexanet alfa for reversal of factor Xa inhibitors in patients presenting with intracranial hemorrhage, we observed a high excellent/good hemostatic efficacy rate and lower than reported inpatient mortality and 30-day readmission due to thromboembolism consistent with the findings reported in ANNEXA-4 study. Despite the lack of comparative group, our outcomes, most noticeably hemostatic efficacy and inpatient mortality are consistent with those reported in the literature.
-
Clin Neurol Neurosurg · Oct 2020
Predict overall survival of spinal conventional chordoma: Development and assessment of a new predictive nomogram.
To predict the 5-year overall survival (OS) rate in patients with conventional chordoma of the spine PATIENTS AND METHODS: The Surveillance, Epidemiology, and End Results (SEER) Registry was used to identify patients with conventional chordoma of the spine from 1994 to 2013. The entire cohort(n = 294) was randomly divided into training (n = 147) and validation (n = 147) cohorts to construct a nomogram. We used the univariate Log-rank test and multivariate Cox model to examine the independent prognostic factors associated with OS. These prognostic factors were integrated to construct a nomogram through R studio. The predictive and validating capacity of the nomogram was calculated by Harrell's concordance index (C-index) and calibration curves. ⋯ The findings of this study provide population-based estimates of patients with conventional chordoma of the spine. Using this nomogram, surgeons can classify patients into different risk groups and achieve individualized treatment.