World Neurosurg
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Cerebral blood volume (CBV) acquired with the use of flat-detector computed tomography with contrast media (CM) injected at the ascending aorta provides real-time brain functional information with minimized CM usage; however, unexpected asymmetric perfusion is observed for certain patients without cerebral circulatory disorders. This work tested the feasibility of left ventricle (LV) CM injection to achieve symmetric perfusion. ⋯ CBV maps acquisition with LV injection offered an approach to acquire immediate brain functional information for patients who are limited by asymmetric perfusion using ascending aorta injection and are sensitive to CM dose.
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Adhesions and scarring of the subcutaneous tissue to the dura mater or dural substitute often complicate cranioplasty. We present our experience with epidural bovine pericardium as a barrier membrane to minimize adhesions and facilitate separation of tissue layers. ⋯ Epidural bovine pericardium at the time of decompressive craniectomy facilitates dissection at the time of cranioplasty and is not associated with any additional risks.
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New therapeutic option for drop foot with the ActiGait peroneal nerve stimulator - A technical note.
A drop foot occurs in up to 20% of stroke patients and leads to an increased risk of falls. Until recently, only a foot orthosis or surface stimulation was able to improve the gait of these patients. ⋯ The application of this therapeutic option is restricted to patients with a drop foot attributable to a lesion of the first motor neuron caused by stroke, multiple sclerosis, or tumors. In this paper, we present the first technical note with possible pitfalls of the surgical procedure and the perioperative care after implantation of ActiGait drop foot stimulators in 50 patients.
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Case Reports
A Novel Use of Direct Platelet Application During Surgery for Clopidogrel-Associated Intracerebral Hemorrhage.
Dual antiplatelet therapy is associated with increased rates of intracerebral hemorrhage, especially in the context of subarachnoid hemorrhage. We present a case of a spontaneous hemorrhage in a patient treated with a Pipeline stent for a ruptured dissecting vertebrobasilar aneurysm and the novel use of direct application of platelets during surgery to control bleeding. ⋯ This is the first reported description of direct application of platelets to achieve intraoperative hemostasis. Platelets are activated by thrombin and collagen and the use of Floseal (a bovine-derived, gelatin matrix and human-derived thrombin) further potentiated the effectiveness of this strategy. With the increased incidence of intracerebral hemorrhage associated with dual antiplatelet therapy, this technique may provide a useful tool in the neurosurgical armamentarium.
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Postoperative central nervous system infections (PCNSIs) are rare but serious complications after neurosurgery. The purpose of this study was to examine the prevalence and causative pathogens of PCNSIs at a modernized, resource-limited neurosurgical center in South Asia. ⋯ This study summarizes the prevalence, causative organism of PCNSI, and antibiotic usage for all of the neurosurgical cases over a 13-month period in a modernized yet resource-limited neurosurgical center located in South Asia. The results from this study highlight the PCNSI landscape in an area of the world that is often underreported in the neurosurgical literature because of the paucity of clinical neurosurgical research undertaken there. This study shows an increasing prevalence of gram-negative organisms in CSF cultures from PCNSIs, which supports a trend in the recent literature of increasing gram-negative bacillary meningitis.