Journal of neurosurgery
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Journal of neurosurgery · Aug 2017
Meta AnalysisEffect of statin treatment on vasospasm-related morbidity and functional outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.
OBJECTIVE The efficacy of statin therapy in treating aneurysmal subarachnoid hemorrhage (SAH) remains controversial. In this meta-analysis, the authors investigated whether statin treatment significantly reduced the incidence of cerebral vasospasm and delayed neurological deficits, promoting a better outcome after aneurysmal SAH. METHODS A literature search of the PubMed, Ovid, and Cochrane Library databases was performed for randomized controlled trials (RCTs) and prospective cohort studies investigating the effect of statin treatment. ⋯ CONCLUSIONS Treatment with statins significantly decreased the occurrence of vasospasm after aneurysmal SAH. The incidence of DIND, delayed cerebral infarction, and mortality were not affected by statin treatment. Future research should focus on DIND and how statins influence DIND.
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Journal of neurosurgery · Aug 2017
Meta AnalysisPrevalence and characteristics of brain arteriovenous malformations in hereditary hemorrhagic telangiectasia: a systematic review and meta-analysis.
OBJECTIVE Patients with hereditary hemorrhagic telangiectasia (HHT) are known to suffer from high rates of cerebral arteriovenous malformations (AVMs). The authors performed a systematic review and meta-analysis of the literature examining prevalence rates, characteristics, and clinical presentation of cerebral AVMs in the HHT population. METHODS To identify studies on AVM prevalence and characteristics in the HHT population, 4 databases (MEDLINE, EMBASE, Scopus and Web of Science) were searched by a reference librarian with over 30 years experience in systematic reviews and meta-analysis. ⋯ HHT1 patients are significantly more likely to have brain AVMs than HHT2 patients. Most AVMs in the HHT population are symptomatic. The Spetzler-Martin grade for these lesions is 2 or less in nearly 90% of patients.
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Journal of neurosurgery · Aug 2017
Case ReportsVentriculo-ureteral shunt insertion using percutaneous nephrostomy: a novel minimally invasive option in a patient with chronic hydrocephalus complicated by multiple distal ventriculoperitoneal shunt failures.
The management of ventriculoperitoneal (VP) shunt failure is a common problem in neurosurgical practice. On occasion, extraperitoneal sites for CSF diversion are required when shunting to the peritoneal cavity has failed after multiple attempts. The authors report a novel minimally invasive procedure allowing cannulation of the ureter for the purpose of ventriculo-ureteral (VU) shunting. ⋯ Following successful placement of the VU shunt, the patient's hydrocephalus stabilized and she returned to her regular functional status. The only long-term complication noted within 36 months of follow-up was a transient episode of electrolyte disturbance and dehydration associated with a diarrheal illness that responded to adequate hydration and salt supplementation. By its minimally invasive nature, this approach offers a reasonable extraperitoneal alternative after multiple distal shunt catheter failures have occurred.
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Journal of neurosurgery · Aug 2017
A systematic review of 30-day readmission after cranial neurosurgery.
OBJECTIVE The 30-day readmission rate has emerged as an important marker of the quality of in-hospital care in several fields of medicine. This review aims to summarize available research reporting readmission rates after cranial procedures and to establish an association with demographic, clinical, and system-related factors and clinical outcomes. METHODS The authors conducted a systematic review of several databases; a manual search of the Journal of Neurosurgery, Neurosurgery, Acta Neurochirurgica, Canadian Journal of Neurological Sciences; and the cited references of the selected articles. ⋯ Complications arising during or after neurosurgical procedures were a prime reason for readmission. Race, comorbidities, and longer hospital stay put patients at risk for readmission. CONCLUSIONS Although readmission may be an important indicator for good care for the subset of acutely declining patients, neurosurgery should aim to reduce 30-day readmission rates with improved quality of care through systemic changes in the care of neurosurgical patients that promote preventive measures.
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Journal of neurosurgery · Aug 2017
Comparative StudyAre Hispanic patients with subarachnoid hemorrhage treated differently in border states than in nonborder states?
OBJECTIVE Recent studies have found an underutilization of in-hospital procedures in treatments of Hispanic patients admitted with coronary artery disease in states along the US-Mexico border ("border states"). The purpose of this study was to determine any treatment disparities between patients treated for subarachnoid hemorrhage (SAH) in border and nonborder states and whether this disparity was associated with differential hospital charges. METHODS Using the National (Nationwide) Inpatient Sample, the authors retrieved data of Hispanic and non-Hispanic patients who were admitted in 2011 for SAH in a border state (California, Arizona, New Mexico, and Texas) or nonborder state (the remaining 46 US states). ⋯ In the nonborder states, the rates of surgical treatment were similar for Hispanic and non-Hispanic patients (14.0% vs 15.6%, p = 0.6). Hispanic patients with SAH were billed significantly higher in-hospital charges in border states than in nonborder states ($219,260 and $192,418 [US dollars], respectively, p < 0.001). CONCLUSIONS Use of surgical treatments for Hispanic patients with SAH residing in border states has a unique pattern, which significantly increases in-hospital charges in this patient population.