World Neurosurg
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Randomized Controlled Trial Multicenter Study Comparative Study
A Comparative Study of Bolus Dose of Hypertonic Saline, Mannitol, and Mannitol Plus Glycerol Combination in Patients with Severe Traumatic Brain Injury.
This prospective randomized controlled study compared the efficacy of an equiosmolar and isovolumetric dose of 3% hypertonic saline, 20% mannitol, and 10% mannitol plus 10% glycerol combination in reducing the raised intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI). ⋯ All 3 osmotic compounds exhibit comparable effectiveness in reducing ICP when a similar osmotic load is administrated, but 3% hypertonic saline appeared to be more effective followed by 10% mannitol plus 10% glycerol combination and 20% mannitol. A dose of 1.4 mL/kg can be recommended as an initial bolus dose for 3% hypertonic saline. Hypertonic saline can be recommended to treat patients with pretreatment hypovolemia, hyponatremia, or renal failure. There is no clear benefit compared with 20% mannitol in regard to neurologic outcome, even though there is a minor positive trend for 3% hypertonic saline and 10% mannitol plus 10% glycerol combination.
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Randomized Controlled Trial Multicenter Study
Recovery trajectories and long-term outcomes in traumatic brain injury: A secondary analysis of the phase 3 COBRIT clinical trial.
Prospects for recovery after traumatic brain injury (TBI) are often underestimated, potentially leading to withdrawal of care in the comatose TBI patient who may ultimately have a favorable outcome with aggressive care. Outcomes and trajectories of recovery in a large series of patients with TBI were evaluated at 30, 90, and 180 days postinjury. ⋯ In this secondary analysis of the COBRIT trial, most patients had favorable outcomes by the GOS-E at 6 months postinjury in all complicated mild and moderate TBI groups, with over half of patients with severe TBI achieving a favorable outcome as well. Of subjects in a vegetative state (GOS-E score 2) at 1 month postinjury, 18% improved to a favorable outcome by 6 months postinjury. There was substantial improvement in all groups from 1 to 6 months, and this improvement may continue beyond 6 months. Clinical trials in TBI should consider recovery curves with repeated measures to assess outcomes because arbitrary single-moment outcome determination likely underestimates treatment effect in TBI care.
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Review Comparative Study
Mechanical Thrombectomy with Intraoperative Local Thrombolysis Versus Mechanical Thrombectomy with Continuous Thrombolysis for Treatment of Cerebral Venous Sinus Thrombosis: A Systematic Review of 82 Cases.
The first-line treatment of cerebral venous sinus thrombosis (CVST) is systemic anticoagulation. However, patients with severe or a clinically worsening condition might benefit from mechanical thrombectomy (MT) combined with intraoperative thrombolysis (IOT) or MT with continuous thrombolytic infusion (CTI). The present study compared the efficacy and safety of these 2 endovascular therapeutic methods by performing a systematic review of the literature. ⋯ The results from our review suggest that MT with local thrombolysis is relatively safe, with no significant differences in efficacy and safety between MT+IOT alone and MT+CTI/MT+IOT+CTI. However, randomized controlled studies are required to provide a definitive answer on its use for CVST.
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Review Case Reports
Treatment and survival outcomes of primary intracranial squamous cell carcinoma.
Primary intracranial squamous cell carcinoma (SCC) is a rare neoplasm associated with malignant transformation of benign epidermoid or dermoid cysts. The optimal treatment and prognosis of this rare disease are unclear. ⋯ Primary intracranial SCC shows poor prognosis, with controversial management. The results of this study indicate that complete resection of tumor when possible, followed by radiotherapy, is the optimal treatment for improving patient outcome.
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Review Case Reports
Neurenteric cyst of the ventral craniocervical junction: Case report and a literature review.
Neurenteric cysts (NCs) are rare, non-neoplastic lesions arising from a failure of dissolution of the transient neurenteric canal between the foregut and the notochord. They are most frequently seen in the intradural extramedullary space in the lower cervical and upper thoracic spine. The authors describe a rare case of NC arising from the ventral cervicomedullary junction that was totally resected via a posterior approach. ⋯ NC is a rare lesion of the craniospinal junction and should be considered among differential diagnoses. Complete excision is the treatment of choice. In most instances a dorsal surgical approach will be satisfactory.