Journal of neurosurgery
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Journal of neurosurgery · May 2011
Portable head CT scan and its effect on intracranial pressure, cerebral perfusion pressure, and brain oxygen.
Follow-up head CT scans are important in neurocritical care but involve intrahospital transport that may be associated with potential hazards including a deleterious effect on brain tissue oxygen pressure (PbtO(2)). Portable head CT (pHCT) scans offer an alternative imaging technique without a need for patient transport. In this study, the investigators examined the effects of pHCT scans on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and PbtO(2) in patients with severe brain injury. ⋯ These data suggest that pHCT scans do not have a detectable effect on a critically ill patient's ICP, CPP, or PbtO(2).
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Journal of neurosurgery · May 2011
Petroclival meningiomas: study on outcomes, complications and recurrence rates.
Petroclival meningiomas are notoriously difficult lesions to manage surgically, given the critical neurovascular structures that are intimately associated with the tumors. In this paper, the authors' aim was to review their series of patients with petroclival meningiomas who underwent surgical treatment; emphasis was placed on evaluating modes of presentation, postoperative neurological outcome, complications, and recurrence rates. ⋯ Petroclival meningiomas still pose a formidable challenge to neurosurgeons. In their series, the authors used multiple skull base approaches and careful microneurosurgical technique to achieve a good functional outcome (Glasgow Outcome Scale Score 4 or 5) in 92% of patients, although the extent of gross-total resection was only 28%. The authors' primary surgical goal was to achieve maximal tumor resection while maintaining or improving neurological function. The authors favor the treatment of residual tumor or recurrent tumor with stereotactic radiosurgery.
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Journal of neurosurgery · May 2011
Comparative StudyResponse to intracranial hypertension treatment as a predictor of death in patients with severe traumatic brain injury.
The normalization of increased intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI) is assumed to limit secondary brain injury and improve outcome. Despite evidence-based recommendations for monitoring and treatment of elevated ICP, there are few studies that show an association between response to ICP-directed therapeutic regimens and adjusted mortality rate. This study utilizes a large prospective database to examine the effect of response to ICP-lowering therapy on risk of death within the first 2 weeks of injury in patients who sustained TBI and are older than 16 years. ⋯ Patients who responded to ICP-lowering treatment had a 64% lower risk of death at 2 weeks than those who did not respond after adjusting for factors that independently predict risk of death.
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Journal of neurosurgery · May 2011
Biography Historical ArticleReflections on the contributions of Harvey Cushing to the surgery of peripheral nerves.
By the time Harvey Cushing entered medical school, nerve reconstruction techniques had been developed, but peripheral nerve surgery was still in its infancy. As an assistant surgical resident influenced by Dr. William Halsted, Cushing wrote a series of reports on the use of cocaine for nerve blocks. ⋯ Additionally, Cushing's experience with facial nerve neurotization is reviewed. The history, physical examination, and operative notes shed light on Cushing's diagnosis, strategy, technique, and hence, his surgery on peripheral nerve injury. These contributions complement others he made to surgery of the peripheral nervous system dealing with nerve pain, entrapment, and tumor.
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Journal of neurosurgery · May 2011
Case Reports Comparative StudyRecurrence rates after neuroendoscopic fenestration and Gamma Knife surgery in comparison with subtotal resection and Gamma Knife surgery for the treatment of cystic craniopharyngiomas.
The object of this study was to compare the recurrence rates of cystic craniopharyngiomas after neuroendoscopic cyst fenestration combined with Gamma Knife surgery (GKS) and after subtotal resection (STR) combined with GKS. ⋯ This investigation confirms that STR followed by GKS results in a lower recurrence rate than neuroendoscopy and GKS. Neuroendoscopy and GKS, however, results in a better preservation of endocrine function. These results suggest that a generalized multimodal approach including endoscopic fenestration in addition to GKS is hindered by higher recurrence rates.