Neurosurgery
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Randomized Controlled Trial Multicenter Study
Perioperative fever and outcome in surgical patients with aneurysmal subarachnoid hemorrhage.
We examined the incidence of perioperative fever and its relationship to outcome among patients enrolled in the Intraoperative Hypothermia for Aneurysm Surgery Trial. ⋯ These findings suggest that fever is associated with worsened outcome in surgical subarachnoid hemorrhage patients, although, because the association between fever and the primary outcome measure for the trial is dependent on the covariates used in the analysis (particularly operative events and delayed ischemic neurological deficits), we cannot rule out the possibility that fever is a marker for other events. Only a formal trial of fever treatment or prevention can address this issue.
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Multicenter Study Clinical Trial
Plate fixation of odontoid fractures without C1-C2 arthrodesis: practice of a novel surgical technique for stabilization of odontoid fractures, including the opportunity to extend the fixation to C3.
Surgical treatment of odontoid fractures that do not allow interfragmentary fracture compression involves either posterior atlantoaxial arthrodesis or additional anterior stabilization using a plate construct. The purpose of this study was to determine the clinical and radiographic outcome after anterior plate fixation of odontoid fractures that were not suitable for anterior screw fixation. ⋯ We had promising results using anterior plate fixation for surgical treatment of odontoid fractures that did not allow interfragmentary fracture compression. Because this method avoids the rigid fixation of the atlantoaxial joint in contrast to techniques of posterior cervical arthrodesis, it seems to be a practical option for the management of fracture types that require additional stabilization of the odontoid.
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Multicenter Study
Patients with moderate head injury: a prospective multicenter study of 315 patients.
To analyze the risk factors of worst outcome associated with moderate head injury. ⋯ There is a high percentage of surgery and worsening on computed tomographic scans in patients with moderate head injury. Neuroworsening, seizures, and medical complications as outcome predictors were more strongly associated with a GCS score of 11 to 13, whereas a low motor GCS score was more outcome-related in patients with GCS scores of 9 and 10.
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Multicenter Study
Assessment of zero drift in the Codman intracranial pressure monitor: a study from 2 neurointensive care units.
Intraparenchymal monitoring devices play an important role in the daily management of head injury and other critically ill neurosurgical patients. Although zero drift data exist for the Camino system (Camino Laboratories, San Diego, CA), only in vitro data exist for the Codman system (Codman and Shurtleff, Inc., Raynham, MA). The aim of this study was to assess the extent of zero drift for the Codman intracranial pressure (ICP) monitor in patients being monitored in 2 neurointensive care units. ⋯ These data demonstrate that a small amount of zero drift exists in ICP monitors and that this drift increases with time. The wide range in the data demonstrates that some drift readings are quite excessive. This reinforces the school of thought that, although ICP readings contribute significantly to the management of neurosurgical patients, they should be interpreted carefully and in conjunction with clinical and radiological assessment of patients.
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Multicenter Study
Endovascular treatment of intracranial aneurysms using Matrix coils: short- and mid-term results in ruptured and unruptured aneurysms.
A prospective multicenter registry was conducted in France to evaluate the safety and efficacy of Matrix coils (Boston Scientific Neurovascular, Fremont, CA). The short- and mid-term results are presented. ⋯ In-hospital and 1-year morbidity and mortality rates in patients harboring ruptured or unruptured aneurysms treated with Matrix coils were similar to those previously reported with the use of bare coils. The efficacy of Matrix coils to prevent aneurysm recanalization was not demonstrated, despite a high percentage of progressive thrombosis that suggests biological activity resulting from Matrix coils.