Neurosurgery
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Few recommendations have been outlined in the neurosurgical literature regarding when it is safe to initiate postoperative or posthemorrhage anticoagulation (AC), or for what duration it is safe to discontinue AC therapy in patients with clear indications for AC therapy. Our objective was to formulate guidelines for managing AC in neurosurgical patients, based on patients' needs for AC and the risk of complications. ⋯ Adequate preoperative correction of coagulation abnormalities and strict regulation of coagulation to avoid supratherapeutic AC is essential. Reintroduction of AC after an intracranial hemorrhage treated without surgery, or after a neurosurgical procedure, particularly an intracranial procedure, can be guided by determining whether the patient is at high, moderate, or low risk for thromboembolic complications. On the basis of experimental studies, the patient's thromboembolic risk, and the experience of other surgeons, we propose therapeutic options for use of AC in neurosurgical patients undergoing intracranial procedures.
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Review Comparative Study
Dural closure with nonpenetrating clips prevents meningoneural adhesions: an experimental study in dogs.
Meningospinal and cranial dural adhesions were compared in a canine model, after duraplasty using nonpenetrating clips or penetrating needles and sutures. ⋯ This report is the first long-term experimental study comparing two fundamentally different methods for dural repair in a relevant animal model.
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Case Reports
Vascular compression of the medulla oblongata by the vertebral artery: report of two cases.
Compression of the medulla oblongata by a tortuous vertebral artery is rare. We report two patients with this lesion who were treated with vascular decompression of the vertebral artery. ⋯ Although compression of the medulla oblongata by a tortuous vertebral artery is rare, it can cause brainstem dysfunction. Magnetic resonance imaging clearly revealed the vascular compression in these patients. Surgical treatment was effective. The symptoms related to a tortuous vertebral artery and some techniques for surgical treatment are discussed. Awareness of this rare lesion is necessary to ensure appropriate treatment.
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In an effort to increase the effect of intrathecal baclofen on upper-extremity spasticity, the tip of the intrathecal catheter was placed at the T6-T7 level rather than at the traditional T11-T12 level in children with spastic quadriparesis. ⋯ Compared with published results, placement of the tip of the intrathecal catheter at the T6-T7 level was associated with greater relief of upper-extremity spasticity without loss of effect on the lower extremities. The mean dosages of baclofen in our study group were lower compared with mean dosages administered at the T11-T12 level. There was no morbidity related to the more rostral location of the catheter.
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The University of Lausanne was founded in 1537. The faculty of medicine was created in 1890, and the service of surgery was directed by César Roux. Roux, a well-known surgeon, was visited by Harvey Cushing during 1900-1901. ⋯ Eric Zander created the division of neurosurgery in 1959; it became an independent service in 1967. Nicolas de Tribolet served as chairman from 1984 until 1994, when he was asked to take charge of the merger of the university services of Geneva and Lausanne. In October 1997, Jean-Guy Villemure joined him in the newly merged department, becoming chairman in Lausanne, while de Tribolet is chairman in Geneva and head of the department comprising both services.