Surg Neurol
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Fractionated stereotactic radiotherapy (FSRT) combines the precision of stereotactic positioning with the radiobiologic advantage of dose fractionation. ⋯ Fractionated stereotactic radiotherapy is a high-precision technique. It is safe and feasible in the primary and adjuvant treatment of cavernous sinus meningiomas. Fractionated stereotactic radiotherapy allowed local control in more than 90% of patients.
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The present study was undertaken to evaluate 10% hydroxyethyl starch (HES 200/0.5) with regard to its clinical outcome and safety in the treatment of severe head injury. ⋯ The 10% HES (200/0.5) can be used in the treatment protocol of severe head injury. There is no definite bleeding complications documented by current dosage of HES. Besides, balanced fluid management can be achieved without causing serious pulmonary complications. However, a further randomized, prospective study is needed to define the actual benefit of HES in fluid management and clinical outcome.
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Controlled Clinical Trial
Magnesium sulfate: role as possible attenuating factor in vasospasm morbidity.
Among the many complications of SAH, one of the most important is vasospasm. Several treatment alternatives have been proposed for this condition, with far-from-ideal results being obtained. Magnesium sulfate recently returned to the scene (with still unproven benefit) as an adjuvant in the treatment of vasospasm. ⋯ Magnesium did not seem to interfere in vasospasm frequency but apparently acted favorably in decreasing morbidity and length of hospital stay.
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Head injury is the leading cause of death and disability for patients who experienced a major accident. It has been suggested that a well-planned neurointensive care management can effectively reduce the secondary brain insults. The BTF and the AANS proposed the Guidelines for the Management of Severe Head Injury in 1995. The purpose of this study was to obtain a consensus on whether the guidelines are suitable for treating patients with severe head injury in Taiwan. ⋯ The most beneficial feature of the guidelines was the close control of ICP with an ICP monitor. Patients who received prophylactic sedatives had a favorable outcome (odds ratio, 2.8; CI, 1.0-7.5). There were no significant statistical differences between patients with and those without application of hyperventilation for maintenance of CPP.
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Case Reports
Acute combination fracture of atlas and axis: "triple" anterior screw fixation in a 92-year-old man: technical note.
The combination of odontoid and bilateral transarticular C1-C2 anterior screw fixation is a recent addition in treating C1-type II odontoid fractures. When feasible, it ensures early maximal stability, even if it slightly reduces the mobility of C1-C2 complex. We report a case of combination atlas-type II odontoid fracture that occurred in a 92-year-old man. The instability was treated with odontoid screw fixation and anterior bilateral C1-C2 transarticular screw fixation in a single stage. The aim of the article is to describe the feasibility of "triple" anterior screw fixation in the presence of C1-type II odontoid fracture. ⋯ The authors suggest that in presence of C1-type II odontoid fracture, the triple anterior screw fixation has to be taken into account as salvage procedure, especially if other methods of stabilization failed or cannot be safely performed. This technique seems to be safety feasible also in old patients, as our report and the experience of others confirm.