British journal of neurosurgery
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In the context of traumatic brain injury (TBI), decompressive craniectomy (DC) is used as part of tiered therapeutic protocols for patients with intracranial hypertension (secondary or protocol-driven DC). In addition, the bone flap can be left out when evacuating a mass lesion, usually an acute subdural haematoma (ASDH), in the acute phase (primary DC). ⋯ An update on the RESCUEicp study, a randomised trial of DC versus advanced medical management (including barbiturates) for severe and refractory post-traumatic intracranial hypertension is provided. In addition, the rationale for the RESCUE-ASDH study, the first randomised trial of primary DC versus craniotomy for adult head-injured patients with an ASDH, is presented.
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Student-selected components (SSCs) are protected periods of time in the undergraduate medical curriculum which allow students to explore an area of medicine they are interested in. They are particularly valuable in exposing students to smaller specialties like neurosurgery, which are often sparsely covered in the rest of the undergraduate curriculum. Moreover, they provide opportunities for students interested in pursuing a career in neurosurgery to increase their likelihood of being successful in specialty training applications. ⋯ Furthermore, we have set out to establish a series of achievable objectives over the course of a typical SSC in neurosurgery. This includes the possibility of participation in research and audit, which, if well planned, can be rewarding for both the student and the host unit. SSCs are an effective means of exposing medical students to neurosurgery and provide a multitude of opportunities for enhancing clinical competencies and career development.
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Observational Study
Cranioplasty outcomes and associated complications: A single-centre observational study.
The resurgence of decompressive craniectomy has led to recent published reviews of the safety of cranioplasties. To date there is a wide range of reported mortality and morbidity. This observational study reports the outcomes of the cranioplasty operations from a single centre and evaluates the factors involved in their management. ⋯ Some potentially preventable complications have been addressed with a resulting rate of complications lower than other published reports. We use two standard adjuncts: the presence of a senior surgeon and strict antimicrobial regimens. We believe that our results could be transferrable to other units by following similar guidelines.
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External ventriculostomy-related infection (VRI) of cerebrospinal fluid (CSF) is a source of significant morbidity and mortality. In previous trials, antibiotic-impregnated ventricular catheters have been associated with lower incidence of CSF infections. We undertook this retrospective observational study to evaluate whether the introduction of antibiotic-impregnated external ventricular drains (EVDs) in 2004 has decreased VRI in our neurosurgical unit. ⋯ Our study demonstrates that there was no statistically significant difference in the infection rates for the Standard and antibiotic-impregnated external ventriculostomy catheters. The duration of catheterization was significantly higher for the Antibiotic-impregnated catheter group. The antibiotic-impregnated catheter infections tended to occur later as compared with the Standard catheter group.
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The aim of this study was to evaluate the safety and outcomes of decompressive craniectomy (DC) after intravenous tissue plasminogen activator (IV tPA) administration for malignant cerebral infarction. ⋯ Although the main limitation is that the number of patients in our serie was small, which reduced the statistical power, our study suggest that DC after failure of IV tPA administration for malignant cerebral infarction is safe and did not cause an excess of complications arising from the use of fibrinolytic.