World Neurosurg
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Different surgical options are available to treat radicular pain syndromes of the cervical spine. Use of the posterior approach for foraminotomy and sequestrectomy (Frykholm) fusion can be avoided, but neck pain affects the postoperative course. This retrospective study compares the classical Frykholm approach and the transtubular microsurgical approach for foraminotomy. ⋯ The transtubular microsurgical approach shows advantages regarding postoperative neck pain, surgery time, and hospital stay with a trend towards an earlier return to work.
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Multicenter Study
Steroid Use For Acute Spinal Cord Injury in Latin America: A Potentially Dangerous Practice Guided by Fear of Lawsuit.
Current international guidelines do not recommend the routine administration of methylprednisolone (MP) in patients with acute spinal cord injury (SCI). Its use is known to be associated with complications and death. ⋯ Despite increasing evidence against the routine administration of MP in patients with SCI and international guidelines that do not recommend its use, this potentially dangerous practice remains common on this continent. The Latin American medical associations need to produce guidelines to standardize practices with acute SCI. Moreover, educational campaigns might reduce practices guided mainly by misperception of legal issues instead of clinical benefit.
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Observational Study
Surgery for acute subdural haematoma: replace or remove the bone flap?
In surgery for acute subdural hematoma (ASDH), the bone flap can be fixed onto the skull, left riding to provide partial skull decompression, or removed. This study assessed whether removing the bone flap improved outcome. ⋯ Our study concluded that removing the bone flap after ASDH evacuation was not associated with a better outcome. We recommend replacing the bone flap if brain conditions allow. Further research is required to evaluate the role of skull decompression in surgery for ASDH.
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Controlled Clinical Trial
Is there an influence of routine daily transcranial doppler examination on clinical outcome in patients after aneurysmal subarachnoid hemorrhage?
Transcranial Doppler (TCD) is widely used as a daily routine method to detect vasospasm in patients after aneurysmal subarachnoid hemorrhage (aSAH); however, there are only limited data about the real benefit of this examination. Therefore, the clinical outcome of 2 cohorts with and without daily TCD after aSAH was assessed. ⋯ With the limitation of an explorative cohort study, the results indicate that routine TCD studies do not improve the overall outcome of patients after aSAH.
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Comparative Study Controlled Clinical Trial
Comparison of Conventional and Kilohertz Frequency Epidural Stimulation in Patients Undergoing Trialing for Spinal Cord Stimulation: Clinical Considerations.
Compare therapeutic response of patients to conventional versus high-frequency spinal cord stimulation (SCS). ⋯ HFS significantly altered the feeling of paresthesias in the majority of patients (ten of 12), was preferred to LFS in five of 12 patients, and non-inferior to LFS in eight of 12 patients. Both 4 kHz and 10 kHz stimulation allowed patients to benefit from HFS. HFS allowed maximum voltage stimulation without discomfort.