Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Decompressive craniectomy has been considered the most attractive option for surgical treatment of malignant middle cerebral artery (MCA) infarction. We retrospectively reviewed the clinical and radiological records of 78 patients with malignant MCA infarction who underwent decompressive craniectomy with dura augmentation over a 6-year period. Twenty-six patients had undergone additional anterior temporal resection during decompressive craniectomy. ⋯ Although no patient with an infarction on the dominant side recovered effective verbal ability during the 6 months of follow-up, there was no significant difference between the two groups in clinical outcome at 6 months after surgery. The 30-day survival rate in the 26 patients who underwent additional anterior temporal lobectomy was significantly higher (84.6%) than that in patients who underwent decompressive craniectomy and duroplasty only (69.2%) (p<0.05). However, in patients who survived, this additional procedure does not appear to improve the functional outcome.
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For the past decade, a screw-rod construct has been used commonly to stabilize the atlantoaxial joint, but the insertion of the screw through the C1 lateral mass (LM) can cause several complications. We evaluated whether using a higher screw entry point for C1 lateral mass (LM) fixation than in the standard procedure could prevent screw-induced occipital neuralgia. We enrolled 12 consecutive patients who underwent bilateral C1 LM fixation, with the modified screw insertion point at the junction of the C1 posterior arch and the midpoint of the posterior inferior portion of the C1 LM. ⋯ Twenty screws were positioned correctly through the intended entry points, but three screws were placed inferiorly (that is, below the arch), and one screw was inserted too medially. When performing C1-C2 fixation using the standard (Harms) construct, surgeons should be aware of the possible development of occipital neuralgia. A higher entry point may prevent this complication; therefore, we recommend that the screw should be inserted into the arch of C1 if it can be accommodated.
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Comparative studies evaluating efficacy and safety of minimally invasive spinal fusion between patients with significant obesity (body mass index [BMI]≥35 kg/m(2)) and those of normal weight are scarce. We examined complication rates and outcomes for minimally invasive transforaminal lumbar interbody fusion (MITLIF) in patients with significant obesity and those of normal weight undergoing treatment for symptomatic spondylolisthesis. Patients with a BMI≥35 kg/m(2) or <25 kg/m(2) undergoing elective MITLIF for symptomatic spondylolisthesis for the period 2006-09 were identified. ⋯ There were no statistically significant differences between normal weight and obese groups in postoperative VAS (p=0.728) and ODI (p=0.886) scores. Patients with significant obesity experienced clinical improvement similar to that of patients with normal weight, suggesting that obesity does not impact MITLIF outcomes. In addition, both groups experienced similar complication rates, operative times, EBL, and length of hospital stay.
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Historical Article
History of the Asian Australasian Society of Neurological Surgeons from 1964 to 2012: a personal account.
A steering committee of the Asian Australasian Society of Neurological Surgeons (AASNS) first met on 17 October, 1961, and between 29 and 31 October 1964, the First Congress was held in Canberra, Australia. A Constitution was accepted and Sir Ian (Douglas) Miller was elected as the first President. The Society was established "to facilitate personal association of neurosurgeons in the region" and to develop training programs and neurosurgical services. ⋯ Two special milestones have included the establishment of the Journal of Clinical Neuroscience in 1993 and the launching of the Asian Australasian Travelling Fellowship in 1987. The current President of the AASNS is Professor Andrew H. Kaye from Melbourne, Australia, and the President-elect of the WFNS is Professor Yong-Kwang Tu from Taipei, Taiwan.
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Acute subdural hematoma (ASDH) results in neuronal death due to mitochondrial dysfunction and a subsequent cascade of apoptotic and necrotic events. We previously demonstrated that mitochondrial ATP-dependent potassium (mitoK(ATP)) channels have a major role in cerebral ischemic preconditioning in vivo and in vitro. However, the role of the mitoK(ATP) channel has not been investigated in the context of ASDH. ⋯ Pretreatment with diazoxide significantly reduced infarct volume and brain edema formation after ASDH. However, the effects of diazoxide were abolished by co-treatment with 5-HD. 5-HD alone increased infarct volume. These data suggest that the mitoK(ATP) channel is an important mediator of the neuroprotective effects of cerebral preconditioning in a rat model of ASDH.