Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Ventriculoperitoneal (VP) shunt insertion is a common neurosurgical procedure, essentially unchanged in recent years, with high revision rates. We aimed to identify potentially modifiable associations with shunt failure. One hundred and forty patients who underwent insertion of a VP shunt from 2005-2009 were followed for 5-9years. ⋯ In conclusion, poor catheter placement (revision rate 77%) was found to be the strongest predictor of shunt failure, with no difference in revisions between excellent (43%) and moderate (43%) catheter placement. Avoiding poor placement in those with mild or moderate ventriculomegaly may best reduce VP shunt failures. There may also be an influence of valve choice on VP shunt survival.
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It has been suggested that inflammatory damage may be involved in the pathogenesis of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH). High-mobility group box-1 protein (HMGB1) has been identified as a potent proinflammatory mediator, and may trigger increases in other inflammatory cytokines. However, little is known about the role of HMGB1 in SAH-induced cerebrovascular inflammation. ⋯ Elevated expression of HMGB1 was detected after SAH and was highest on day 3 and 5. HMGB1 is increasingly expressed in parallel to the development of CVS in this rat experimental model of SAH. These results suggest that HMGB1 may be related to the CVS observed after SAH and HMGB1 may play a key role in the inflammatory response in CVS after SAH.
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Intraventricular hemorrhages (IVH) can occur as a consequence of spontaneous intracerebral hemorrhage, aneurysm rupture, arteriovenous malformation hemorrhage, trauma, or coagulopathy. IVH is a known risk factor for poor clinical outcome with up to 80% mortality. The current standard treatment strategy for IVH consists of the placement of an external ventricular drain. ⋯ Most of the IVH reduction occurred in the frontal horn and atrium of the lateral ventricle, as well the third ventricle. One (1/8) procedure-related complication occurred consisted of a tract hemorrhage. The Apollo system can be used for minimally invasive IVH evacuation to achieve significant blood clot volume reduction with minimal procedure-related complication.
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Clivus chordomas present a great challenge for neurosurgeons, and the prognosis is poor. To investigate bone invasiveness characteristics in regard to the prognosis of clivus chordomas, a retrospective study of 19 patients with primary clivus chordoma was performed. ⋯ There were 12 patients in the endophytic group and seven in the exophytic group, and the exophytic group exhibited a higher recurrence rate than the endophytic group (p=0.006). Chordomas with an exophytic growth pattern were more likely to recur than those with an endophytic growth pattern, and the surgical approach can be tailored according to each growth pattern.