British journal of neurosurgery
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Successful surgical treatment of cerebral aneurysms requires complete occlusion of the aneurysm lumen while maintaining patency of the adjacent branching and perforating arteries. Intraoperative flow assessment allows aneurysm clip repositioning in the event these requirements are not met, avoiding the risk of postoperative rehemorrhage or infarction. A number of modalities have been proposed for primarily intraoperative qualitative blood flow assessment, including microdoppler ultrasonography, intraoperative digital subtraction angiography (DSA), and more recently noninvasive fluorescent angiography including indocyanine green (ICG) fluorescent imaging. ⋯ A high-risk situation for such a false-negative study is an atherosclerotic middle cerebral artery (MCA) aneurysm in which vessel wall plaque interferes with the ICG signal. Furthermore, a decreased flow within the aneurysm may not allow enough emission light for detection under the current technology. In this report, we describe our experience with cases of MCA aneurysms with false-negative ICG-VA studies requiring clip adjustment for optimal surgical treatment and discuss two illustrative cases of MCA aneurysms with intraoperative fluorescence studies that were falsely negative, requiring puncture of the aneurysm to correctly identify incomplete aneurysm occlusion.
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Review Meta Analysis
The effectiveness of specialist neuroscience care in severe traumatic brain injury: a systematic review.
UK trauma services are currently undergoing reconfiguration, but the optimum management pathway for head-injured patients is uncertain. We therefore performed a systematic review to assess the effects of routine inter-hospital transfer and specialist neuroscience care on mortality and disability in patients with non-surgical severe traumatic brain injury injured nearest to a non-specialist acute hospital. ⋯ There is limited evidence supporting a strategy of secondary transfer of severe non-surgical traumatic brain injury patients to specialist neuroscience centres. Randomised controlled trials powered to detect clinically plausible treatment effects should be considered to definitively investigate effectiveness.
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Randomized Controlled Trial
Microsurgical treatment assisted by intraoperative ultrasound localization: a controlled trial in patients with hypertensive basal ganglia hemorrhage.
This study investigated the clinical value of performing microsurgical treatment on hypertensive basal ganglia hemorrhage assisted by intraoperative ultrasound localization (IUL). A total of 107 patients with hypertensive basal ganglia hemorrhage were randomly separated into two groups for this controlled clinical trial. In the IUL group, 51 patients with hypertensive basal ganglia hemorrhage were operated on with the support of ultrasonic imaging; 56 patients underwent conventional microsurgery to evacuate the hemorrhage. ⋯ A significant difference in the ADL score was recorded between the two groups, with ADL scores of the IUL group exceeding 60 (indicating good recovery) at 6 months after the operative procedure (P < 0.05). In conclusion, the microsurgical treatment of hypertensive basal ganglia hemorrhage assisted by IUL improved the precision of the operation. This procedure removed the hemorrhage and reduced the changes of re-occurrence, as well as elevated the quality of life of patients after the operation.
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Recent studies suggest more favourable recovery of oculomotor nerve palsy (ONP) caused by posterior communicating artery (PComA) aneurysms with microsurgical clipping compared to endovascular coiling. We describe a consecutive series of patients with ONP from PComA aneurysms treated by microsurgical clipping or endovascular coiling. ⋯ We found no significant difference between clipping and coiling in the recovery of ONP due to PComA aneurysms. Patient who present with incomplete ONP are more likely to have a full recovery of ONP following either treatment modality than those who present with complete ONP.