Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Deliberate mild hypothermia was first used in 1955 as an intraoperative technique to ameliorate new neurological deficits following cerebral aneursym clipping, and subsequently was also used following neonatal asphyxia, head trauma and cardiac arrest. The Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST II) randomized control trial was designed to determine the effectiveness of mild hypothermia to decrease neurological deficits following aneurysm surgery. No overall benefit was demonstrated in the hypothermic group versus normothermic group (67% versus 63% good outcome; p=0.32), with a higher rate of bacteraemia in the hypothermic group (5% versus 3%; p=0.05). We undertook a survey of Australasian and Asian neuroanaesthetists to determine whether their thermal management of patients undergoing cerebral aneursym clipping had changed in response to the IHAST II trial results.
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Certifying the competence of neurosurgeons is a process of critical importance to the people of Australia and New Zealand. This process of certification occurs largely through the summative assessment of trainees involved in higher neurosurgical training. Assessment methods in higher training in neurosurgery vary widely between nations. However, there are no data about the 'utility' (validity, reliability, educational impact) of any national (or bi-national) neurosurgical training system. The utility of this process in Australia and New Zealand is difficult to study directly because of the small number of trainees and examiners involved in the certifying assessments. This study is aimed at providing indirect evidence of utility by studying a greater number of trainees and examiners during a formative assessment conducted at a training seminar in Neurosurgery in April 2005. ⋯ This analysis is not directly applicable to the Fellowship examination itself. However, this study does suggest that the effect of assessment instruments upon neurosurgical trainees' learning strategies should be carefully considered.
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Case Reports
Vasospasm followed by diastolic flow reversal in the intracranial arteries after subarachnoid haemorrhage.
Vasospasm and raised intracranial pressure (ICP) are common complications in subarachnoid haemorrhage (SAH) due to ruptured intracranial aneurysm. Vasospasm can be reliably monitored by repeated transcranial Doppler (TCD) examinations. The changes in flow velocities due to vasospasm are useful for early diagnosis, monitoring effectiveness of treatment and determining prognosis. ⋯ These temporal changes observed during serial TCD examinations were well correlated with the ICP. Transcranial Doppler is a reliable, beat-to-beat, non-invasive and reproducible bedside test that can be used to monitor vasospasm and ICP in SAH. The use of TCD can be extended to other intracranial diseases that can potentially lead to an abnormally high ICP.
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Brain involvement with hydatid disease occurs in 1-2% of all Echinococcus granulosus infections. Cerebral hydatid cysts are usually supratentorial, whereas infratentorial lesions are quite rare. Here we report a 19-year-old man with hydatid cysts in the right cerebellopontine cistern with the involvement of internal acoustic canal and jugular foramen. ⋯ Surgery was performed in the semi-sitting position using a lateral suboccipital approach for a right-sided craniotomy. Magnetic resonance imaging clearly demonstrated cisternal, neural and vascular relationships which aided in intact surgical removal of the lesion using microsurgical techniques. Total removal without rupture should be the surgical goal in all hydatid cysts.
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Clinical Trial
Outcome of and prognostic factors for decompressive hemicraniectomy in malignant middle cerebral artery infarction.
Decompressive hemicraniectomy as an appropriate treatment for malignant middle cerebral artery (MCA) infarction is still a controversial issue. This study aimed to determine the survival rate and functional outcome, and factors associated with these, in patients with malignant MCA infarction. From January 2000 to December 2003, 60 patients with malignant MCA infarction were treated in our hospital. ⋯ The factors associated with favourable outcome were age<60 years and treatment within 24 hours of ictus, before clinical signs of herniation were noted. Decompressive hemicraniectomy should be performed in patients younger than 60 years within 24 hours of ictus before clinical signs of herniation develop. Age, timing of surgery and clinical signs of herniation are prognostic factors for mortality and functional outcome.