World Neurosurg
-
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.
-
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.
-
Thrombosed brain aneurysm is usually treated by cerebrovascular surgery rather than endovascular surgery. The basilar-superior cerebellar artery (BA-SCA) aneurysm can be accessed via the transsylvian, temporopolar, or anterior temporal approaches. However, a disadvantage of these approaches is that the surgical route is obstructed by the internal carotid artery (ICA). Therefore, we propose that after establishing a high-flow bypass, severing the ICA will enable safe clipping of a BA-SCA aneurysm. ⋯ Intentional severing of the ICA after establishing a high-flow bypass will not become the standard technique for treatment of upper basilar artery aneurysms. However, this technique can extend the operative field to allow clipping of an upper basilar artery aneurysm after several skull base techniques.
-
Intraoperative fluorescein detection has been used in the fields of vascular and oncologic neurosurgery since 1948. Modifications of the optics in order to enhance the fluorescence contrast under microscopic view have been developed by many authors. The industries, during the past 10 years, provided commercial high-cost optimized apparatuses. Reviewing the literature, we found that the prototypical techniques were definitely inexpensive but lacked reliability, reproducibility, and standard legal norms. ⋯ Our results show a good distinction of fluorescein-stained structures, with overall acceptable operating light conditions.
-
Controlled Clinical Trial
Pre-Treatment of Anxiety Prior to Cervical Spine Surgery Improves Clinical Outcomes: A prospective Single Institutional Experience.
Affective disorders such as depression and anxiety have been shown to contribute to inferior outcomes after spine surgery. A high baseline level of anxiety is associated with refractory postoperative pain and patient dissatisfaction with surgery. The aim of this prospective study is to assess whether the pretreatment of anxiety before spine surgery improves patient reported outcomes 1-year after an anterior cervical discectomy and fusion (ACDF) procedure. ⋯ Our study demonstrates that pretreatment of anxiety before cervical spine surgery results in a significant reduction in postoperative neck pain scores and may be a viable management strategy for patients with coexisting affective disorders and cervical spine pathology. Patients awaiting spine surgery should routinely be assessed for anxiety before surgery, and interventions to reduce and treat anxiety should be provided.