Neurosurgery
-
Although spontaneous intracranial hypotension (SIH) is an increasingly recognized syndrome, the long-term outcomes have not been established. We conducted a long-term follow-up study to clarify the clinical features and long-term outcomes of patients with this disorder. ⋯ In this series, the outcome of SIH after conservative treatment was not as satisfactory as that reported in previous studies. We conclude that periodic follow-up examinations must be performed and a more effective treatment modality developed to achieve complete resolution of SIH.
-
Comparative Study
Survival of cardiac arrest after aneurysmal subarachnoid hemorrhage.
Survival of cardiac arrest (CA) after aneurysmal subarachnoid hemorrhage (SAH) is poorly characterized. We analyzed the clinical course and outcome of patients who survived resuscitation for CA after aneurysmal SAH. ⋯ Most cases of CA occur at the time of initial or recurrent SAH. Resuscitation for in-hospital CA is likely to be successful. Although CA after aneurysmal SAH is associated with significantly higher mortality, the outcome of survivors of CA is not worse than that for other patients after aneurysmal SAH.
-
Effect of the neurosurgeon's surgical experience on outcomes from intraoperative aneurysmal rupture.
The neurosurgeon's surgical experience is one of the most important and least studied factors affecting a patient's outcome after an intraoperative rupture of an aneurysm. Therefore, this analysis was undertaken to evaluate the effect of the neurosurgeon's experience on the management of this catastrophe in a consecutive series of patients treated microsurgically. ⋯ Intraoperative rupture is an unavoidable danger in aneurysm surgery that does not diminish with increasing surgical experience of the neurosurgeon performing the operation. However, experience did improve the neurosurgeon's response to aneurysm rupture and the patients' outcomes. Mental anticipation and technical repetition over time transform into efficiency, confidence, and insight in the management of this distressing intraoperative event.
-
Cervical arthroplasty is a relatively new method to maintain motion after cervical anterior discectomy. Two cases are presented in which bony fusion occurred around a cervical disc prosthesis. ⋯ This is the first report in the literature of bony fusion after cervical arthroplasty with the Bryan disc prosthesis.
-
The pterional approach represents the standard approach for most lesions of the anterior and middle cranial fossa. It requires some degree of frontal lobe retraction, which may result in temporary or permanent damage of olfaction because of nerve avulsion or mechanical compression. The purpose of this study, based on microanatomic dissection of human cadaveric specimens, was to review the microsurgical anatomic features of the nerve and suggest operative nuances that may contribute to reducing the rate of postoperative olfactory dysfunction. ⋯ The standard sylvian and basal cistern opening may be insufficient to guarantee preservation of olfactory function. Early identification and arachnoidal dissection of the nerve may reduce the rate of olfaction compromise. The opening of the subarachnoidal space should be performed in a proximal-to-distal manner to allow early visualization of the olfactory bulb and its dissection. The arachnoidal dissection should be performed with sharp instruments, avoiding any traction on the posterior portion of the olfactory tract. Any direct retractor compression should also be avoided to spare the microvasculature lying on the dorsal surface of the nerve.