Clinical neurology and neurosurgery
-
Clin Neurol Neurosurg · Oct 2013
Patients benefit from low-pressure settings enabled by gravitational valves in normal pressure hydrocephalus.
The ability of siphon regulatory devices to improve overdrainage control despite low-pressure settings of the valve for the horizontal body position has been described previously. We aim to provide a systematic investigation on the ability of gravitational units as siphon regulatory devices to improve clinical outcome in shunt therapy. ⋯ Adjustable and gravity-assisted valves like the proGAV® improve overdrainage control and enable thus low-pressure settings for the horizontal body position. We observed an improved and more sustainable functional outcome for iNPH patients with an adjustable and gravity-assisted valve compared to iNPH patients without an integrated siphon regulatory device.
-
Clin Neurol Neurosurg · Oct 2013
Characteristics of neurological manifestations of Behçet's disease: a retrospective monocentric study in Tunisia.
The aim of the present study was to analyze demographic, clinical and genetic features of Behçet's disease patients with neurological involvement through a monocentric study of a homogenous group of hospitalized patients observed in the same department and to compare them with those of other ethnic and geographic groups. ⋯ Clinical and epidemiological features of NBD are various. In our Tunisian cohort of NBD patients the main characteristic features were male predominance, a relatively high prevalence of CVT, a low prevalence of intra-cranial hypertension and a significant lower frequency of HLA-B51 haplotype.
-
Clin Neurol Neurosurg · Oct 2013
Gamma Knife radiosurgery in the management of brainstem metastases.
Metastases to the brainstem portend a poor prognosis and present a challenge in clinical management. Surgical resection is rarely a viable option. ⋯ Stereotactic radiosurgery is an effective treatment for brainstem metastases and should be considered especially for patients with good performance status.
-
Clin Neurol Neurosurg · Oct 2013
Intraoperative neurophysiologic monitoring and neurologic outcomes in patients with epidural spine tumors.
Multimodal intraoperative neurophysiologic monitoring (IOM) provides assessment of spinal cord pathways during neurosurgery. Despite widespread use, few data exist regarding sensitivity and specificity of IOM in predicting neurologic outcome during decompression and instrumentation for epidural spine tumors. ⋯ These cases are often long with significant blood loss, and stability of multiple IOM modalities provides reassurance that spinal cord function remains intact. Signal changes should result in scrutiny of blood pressure, surgical technique and anesthesia. Preserved IOM signals are suggestive of preserved neurologic outcome.
-
Clin Neurol Neurosurg · Oct 2013
Clinical success of transforaminal endoscopic discectomy with foraminotomy: a retrospective evaluation.
Transforaminal endoscopic surgery has evolved from an intradiscal procedure to a true foraminal epidural procedure where both a targeted discectomy and foraminal decompression can be performed. The success of transforaminal decompression for radiculopathy using preoperative selective nerve root block as part of a treatment algorithm for single level and multilevel lumbar disc herniations is described here. ⋯ Patients with single level lumbar herniations receiving one endoscopic discectomy have excellent outcomes, but with a good response to a selective nerve root block as a preoperative adjunct, patients with multilevel disc herniations also have significant benefit from single level endoscopic discectomy.