Neurosurgery
-
Meta Analysis
Does intracisternal thrombolysis prevent vasospasm after aneurysmal subarachnoid hemorrhage? A meta-analysis.
Despite existing strategies for the treatment of vasospasm after aneurysmal subarachnoid hemorrhage, vasospasm remains a persistent contributor to death and disability. The intracisternal application of thrombolytic agents to dissolve subarachnoid clot has been advocated. The goal of this analysis was to assess the currently available evidence regarding the effectiveness of this treatment. ⋯ The meta-analysis suggests a clinically relevant and statistically significant beneficial effect of intracisternal thrombolysis. However, the results of the analysis are limited by the predominance of nonrandomized studies. Further randomized, blinded, placebo-controlled trials of high-risk patients would be justified.
-
Hypertrophic neuropathy of the cauda equina (HNCE) is a rare form of peripheral neuropathy. The diagnosis is complicated by an insidious clinical presentation and complex radiographic images. We present a case of HNCE caused by chronic inflammatory demyelinating polyneuropathy with symptomatic improvement after decompressive lumbar laminectomy and dural expansion. ⋯ HNCE is a rare disorder that can cause radicular pain and lower-extremity weakness, sensory loss, and hyporeflexia. One possible cause is demyelinating polyneuropathy. Although medical management is typically effective in the treatment of demyelinating polyneuropathy, it has little effect on compressive symptoms caused by intradural nerve root enlargement. As this case demonstrates, surgical management of symptomatic radiculopathy by lumbar laminectomy is a reasonable and effective approach to the treatment of HNCE.
-
The advantage of anterior column support and fusion in addition to pedicle fixation in patients with degenerative spinal disorders has become increasingly clear. With the increase in popularity of this treatment, a variety of techniques have been used to achieve the goal of anterior column support, fusion, and segmental instrumentation. Posterior lumbar interbody fusion has been used since the late 1940s in the treatment of degenerative lumbar spine. We evaluated a modification to posterior lumbar interbody fusion called transforaminal lumbar interbody fusion (TLIF). ⋯ TLIF is a reliable and safe technique for interbody support that can be performed with excellent clinical outcome. In the authors' experience, TLIF offers excellent exposure with minimal risk. This applies particularly in cases of repeat spine surgery, in which the presence of scar tissue makes traditional posterior lumbar interbody fusion techniques difficult or impossible. In addition, TLIF seems to be a viable alternative to anteroposterior circumferential fusion and/or anterior lumbar interbody fusion.
-
The William H. Welch Medical Library was founded in 1929 with the merger of three libraries, namely, the library of the School of Medicine, the library of the School of Hygiene and Public Health, and the library of the Johns Hopkins Hospital. Engendered by the dreams of Johns Hopkins University bibliophiles, such as founding Hopkins physicians William Osler, William Stewart Halsted, Howard Kelly, and William Henry Welch, the library flourished and expanded. ⋯ Welch as its first director. Innovative leadership led to many exciting projects, such as the Welch Indexing Project, which was a prototype for the National Library of Medicine's medical subject headings, and the establishment of a laboratory for research into the application of information technologies to knowledge management. The Welch Library enters the 21st century as a dynamic library committed to the continuing delivery of information services, as well as ongoing research into the development of library services for the coming 100 years.
-
Eptifibatide, a competitive platelet glycoprotein IIb-IIIa receptor inhibitor with high selectivity for platelet glycoprotein IIb-IIIa receptors and a short half-life, has been shown to reduce the risk of ischemic events associated with coronary interventions, particularly when used in high doses. However, its role in conjunction with neurointerventional procedures needs to be determined. We report the results of an open-label prospective registry to evaluate the safety (in terms of avoiding hemorrhagic complications) and effectiveness (in terms of preventing ischemic complications such as stroke) of administering high-dose eptifibatide during internal carotid artery angioplasty and stent placement (CAS) for extracranial carotid artery stenosis. ⋯ High-dose eptifibatide administered as an adjunct to CAS seems to be safe. Further studies are required to analyze its effectiveness and role in neurointerventional procedures.