Journal of neurosurgery
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Journal of neurosurgery · Feb 2006
Prevention of painful neuromas by oblique transection of peripheral nerves.
Neuroma formation often occurs at the proximal stump of the transected nerve, complicating the healing process after gap injuries or nerve biopsies. Most such neuromas cause therapy-resistant neuropathic pain. The purpose of this study was to determine whether oblique transection of the proximal stump of the sciatic nerve can prevent neuroma formation. ⋯ The oblique transection of peripheral nerves, contrary to perpendicularly transected nerves, is rarely followed by classic neuroma development. Moreover, neuropathic pain is significantly reduced compared with that following the traditional method of nerve transection.
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Journal of neurosurgery · Jan 2006
Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis.
Routine microbiological and chemical analysis of cerebrospinal fluid (CSF) is often performed to diagnose external drainage-related bacterial meningitis (ED-BM) at an early stage. A cohort study was performed to investigate the value of several commonly used CSF parameters for the prediction and diagnosis of ED-BM. ⋯ Severe disturbances in the CSF of patients with external drains limit the value of routine CSF analysis for prediction or diagnosis of ED-BM. Routine Gram stain of CSF has also limited predictive or diagnostic value due to its low sensitivity in screening for ED-BM.
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Journal of neurosurgery · Jan 2006
Comparative StudyIdentification and management of intrathecal baclofen pump complications: a comparison of pediatric and adult patients.
Intrathecal baclofen therapy is an effective means of treating intractable spasticity and dystonia in the pediatric and adult population. The authors present a review of complications encountered in a series of 314 pump and catheter-related procedures. The identification and management of these complications will be reviewed. The authors will also identify populations that may be at increased risk for complications. ⋯ Intrathecal baclofen therapy is a highly effective treatment option for patients with medically refractory spasticity. The catheter, pump, and wound are subject to numerous complications both at the time of implantation and throughout the life of the implanted system. Careful technique, close observation, and aggressive evaluation and correction of problems can reduce the incidence and severity of the complications when they occur.
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Journal of neurosurgery · Jan 2006
Comparative Study Clinical TrialExperience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations.
Posterior fossa decompression with duraplasty is routinely used for the treatment of Chiari malformations. It has been traditionally believed that this procedure requires a watertight seal with primary closure of the dura with either pericranium or allograft. In this study, the authors evaluated two synthetic dural substitutes in this patient population for feasibility of use and identification of perioperative morbidity. ⋯ The synthetic dural substitutes DuraGen and AlloDerm provide a suitable alternative duraplasty with comparable complication rates. DuraGen requires a significantly shorter operative time than AlloDerm.
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Journal of neurosurgery · Jan 2006
Comparative Study Clinical TrialIntraoperative corticomuscular motor evoked potentials for evaluation of motor function: a comparison with corticospinal D and I waves.
The goal of this study was to compare motor evoked potentials recorded from muscles (muscle MEPs or corticomuscular MEPs) with corticospinal MEPs recorded from the cervical epidural space (spinal MEPs or corticospinal MEPs) to assess their efficacy in the intraoperative monitoring of motor function. ⋯ These results indicate that, during surgery, monitoring of corticomuscular MEPs (which are related to I waves) is a much more sensitive method for the detection of immediate motor cortical damage than monitoring of corticospinal MEPs (D wave).