Surg Neurol
-
Randomized Controlled Trial
Magnesium sulfate in the management of patients with aneurysmal subarachnoid hemorrhage: a randomized, placebo-controlled, dose-adapted trial.
Recent studies suggest that high-dose MgSO4 therapy is safe and reduces the incidence of DIND and subsequent poor outcome after SAH. We intended to assess the safety and efficacy of high-dose MgSO4 therapy after SAH as means to prevent DIND and to evaluate the impact on clinical outcome. ⋯ High-dose MgSO4 therapy might be efficient as a prophylactic adjacent therapy after SAH to reduce the risk for poor outcome. Nevertheless, because of the high frequency of the side effects, patients should be observed in an intensive or intermediate care setting.
-
Randomized Controlled Trial Comparative Study
Endoscopic surgery for spontaneous basal ganglia hemorrhage: comparing endoscopic surgery, stereotactic aspiration, and craniotomy in noncomatose patients.
This prospective study aimed to evaluate the safety, neurological outcomes, and cost-effectiveness of 3 surgical procedures for spontaneous basal ganglia hemorrhage. ⋯ Both endoscopic surgery and stereotactic aspiration are minimally invasive and are effective procedures with low complication and mortality rates; however, the waiting timing of stereotactic aspiration is usually longer. Endoscopic surgery may be an appropriate substitute for stereotactic aspiration. It produces good neurological outcomes and aids in rapid hematoma evacuation. Craniotomy may be used for emergency decompression of enlarged hematoma if endoscopic surgery or stereotactic aspiration is not available.
-
Randomized Controlled Trial Clinical Trial
Ventriculoperitoneal shunt of continuous flow vs valvular shunt for treatment of hydrocephalus in adults.
Shunting for hydrocephalus is the neurosurgical procedure most frequently associated with long-term complications. We developed an alternative to valvular shunts based on a simple shunt procedure whose functioning depends on a peritoneal catheter with a highly precise cross-sectional internal diameter of 0.51 mm. Preliminary studies have shown that the shunt of continuous flow (SCF) is superior to valvular shunts for the treatment of hydrocephalus in adults. Here, we show the long-term performance of the SCF in adult patients with hydrocephalus secondary to a comprehensive variety of neurological disorders. ⋯ The design of the SCF was calculated according to the mean rates of cerebrospinal fluid production; it takes simultaneous advantage of the intraventricular pressure and the siphon effect and complies with the principle of uninterrupted flow, maintaining a fair equilibrium that prevents under- and overdrainage. The SCF is a simple, inexpensive, and effective treatment for hydrocephalus in adults.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Superficial vs combined cervical plexus block for carotid endarterectomy: a prospective, randomized study.
The present study compares combined and superficial cervical plexus block in patients submitted to carotid endarterectomy (CEA) in terms of anesthetic efficacy, satisfaction of the patient and surgeon, complications resulting from the type of anesthesia, and final outcome. ⋯ Superficial cervical anesthetic block shows the same efficacy as combined block, with the surgical conditions being closely similar. The incidence of complications related to the anesthetic technique is higher for combined block. The type of block does not influence the final outcome of the patients.
-
Randomized Controlled Trial Clinical Trial
Randomized, pilot study of intermittent pneumatic compression devices plus dalteparin versus intermittent pneumatic compression devices plus heparin for prevention of venous thromboembolism in patients undergoing craniotomy.
Unfractionated heparin and the low molecular weight heparin, dalteparin, are used for prophylaxis against venous thromboembolism in patients undergoing craniotomy. These drugs were compared in a randomized, prospective pilot study comparing intermittent pneumatic compression devices plus dalteparin to intermittent pneumatic compression devices plus heparin. ⋯ There was no significant difference in postoperative hemorrhage, venous thromboembolism or thrombocytopenia between heparin and dalteparin. The results suggest that, given the small sample size of this trial, both drugs appear to be safe and the incidence of venous thromboembolism by postoperative screening duplex ultrasound appears to be low when these agents are used in combination with intermittent pneumatic compression devices.