Neurosurgery
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Cerebral hyperperfusion after carotid endarterectomy (CEA) occurs in patients with preoperative impairments in cerebral hemodynamics. Signal intensity of the middle cerebral artery (MCA) on single-slab 3-dimensional time-of-flight magnetic resonance angiography (MRA) can assess hemodynamic impairment in the cerebral hemisphere. The purpose of the present study was to determine whether the signal intensity of the MCA on preoperative MRA could identify patients at risk for cerebral hyperperfusion after CEA. ⋯ Signal intensity of the MCA, as assessed by this simple MRA method, may identify patients at risk for post-CEA cerebral hyperperfusion.
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Clinical Trial
Chronic subdural hematomas treated by burr hole trepanation and a subperiostal drainage system.
Most symptomatic chronic subdural hematomas are treated by subdural drainage. However, a subperiostal (i.e., extracranial) passive closed-drainage system in combination with double burr hole trepanation is used at our institution. Therefore, we wanted to analyze our results and compare them with the alternate treatment strategies reported in the current literature. ⋯ Double burr hole trepanation combined with a subperiostal passive closed-drainage system is a technically easy, highly effective, safe, and cost-efficient treatment strategy for symptomatic chronic subdural hematomas. The absence of a drain in direct contact with the hematoma capsule may moderate the risk of postoperative seizure and limit the secondary spread of infection to intracranial compartments.
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Although the use of prophylactic antibiotics has been shown to significantly decrease the incidence of meningitis after neurosurgery, its effect on extra-neurosurgical-site infections has not been documented. The authors explore the effect of risk-stratified, protocol-based perioperative antibiotic prophylaxis on nosocomial infections in an audit of 31 927 consecutive routine and emergency neurosurgical procedures. ⋯ A risk-stratified protocol of perioperative antibiotic prophylaxis may help to significantly decrease not only neurosurgical, but also extra-neurosurgical-site body fluid bacteriological culture positivity.
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At present, there is no consensus on the optimal monitoring method for cerebral blood flow (CBF) in neurointensive care patients. The aim of the present study was to investigate whether continuous transcranial Doppler (TCD) monitoring with modulation of partial pressure of CO2 reflects CBF changes. This hypothesis was tested in 2 pathological settings in which cerebral ischemia can be imminent: after an episode of cerebral ischemia and during vasospasm after subarachnoid hemorrhage. ⋯ The present study provides experimental support that, in clearly defined conditions, continuous TCD monitoring combined with chemoregulation testing may provide an estimate of CBF in the early postischemic period.
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High rates of restenosis after stenting to treat vertebral artery (VA) origin disease have revitalized interest in microsurgical revascularization for this condition. This study analyzes the outcomes of microsurgical revascularization used to treat proximal VA occlusive disease. ⋯ Microsurgical revascularization is a good alternative treatment for proximal VA occlusive disease. Randomized studies are needed to compare the efficacy of surgical revascularization and stenting, especially drug-eluting stents, for this indication.