World Neurosurg
-
Case Reports Comparative Study
New target specific oral anticoagulants and intracranial bleedings management and outcome in a single-center case series.
New target-specific anticoagulants such as the direct thrombin inhibitor dabigatran and the factor Xa inhibitor rivaroxaban are used in an increasing number of patients. Several studies comparing these new oral anticoagulants with vitamin K antagonists revealed a lower risk of severe bleeding complications and reduced thromboembolic events. However, the lack of antidotes is a challenging issue in the treatment of traumatic or spontaneous intracranial hemorrhage. ⋯ Only a few case reports have analyzed the clinical course and the outcome after intracranial bleeding under new target-specific oral anticoagulants. Here, one of the first larger series is presented. Because of the lack of reversibility of the anticoagulative effects and the overall risks with geriatric patients, surgical treatment should be delayed as long as possible and comorbidities have to be considered.
-
Comparative Study
Relationship between clinical features and T2-weighted magnetic resonance images in symptomatic Rathke's cleft cysts.
It is not known when surgery is appropriate for the treatment for incidental Rathke cleft cysts because knowledge of their natural history is lacking. In this study, we sought to determine whether symptomatic Rathke cleft cysts could be distinguished by their signal intensities in magnetic resonance (MR) images. We analyzed the relationship between these signal intensities and clinical manifestations of the cysts and their patterns of expansion. ⋯ We conclude that Rathke cleft cysts that show an MR signal intensity similar to that of cerebrospinal fluid grow slowly and are frequently diagnosed as cysts associated with visual disturbance when they become large. It may be possible to predict the clinical progression of Rathke cleft cysts by assessing MR signal intensities.
-
Secondary complications (SC) after intracerebral hemorrhage (ICH) can worsen outcome and are associated with early death. The purpose of the present study was to determine in-hospital mortality rates and SC after spontaneous ICH during acute care stay in a population-based cohort in central Europe. ⋯ Surgical treatment of hematomas is associated with an increased rate of SC, but not with higher mortality rates compared with conservatively treated patients. The prevention of an accumulation of SC could lead to a decrease of in-hospital mortality after spontaneous ICH.
-
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.
-
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.