Acta neurochirurgica. Supplement
-
Acta Neurochir. Suppl. · Jan 2011
O-arm guided balloon kyphoplasty: preliminary experience of 16 consecutive patients.
Balloon kyphoplasty is now widely used for the treatment of vertebral compression fractures. Excellent pain relief is achieved with cement injection, but the safety of the procedure relays on excellent radiological exposure. The balloon kyphoplasty technique is usually performed using one or two C-Arm devices to allow correct antero-posterior (AP) and lateral view throughout the surgical procedure. ⋯ We prospectively evaluate on 16 consecutive patients, the feasibility of the O-Arm guided kyphoplasty procedure with the original, usual tools, and we measured the fluoroscopy time and the X-ray exposure. We didn't experience any device related problem and demonstrated a significant reduction of X-ray exposure and time of fluoroscopy. We believe that using this new intraoperative system, the overall time of surgery and fluoroscopy could still be reduced in a near future.
-
Acta Neurochir. Suppl. · Jan 2011
The prediction of 30-day mortality and functional outcome in spontaneous intracerebral hemorrhage with secondary ventricular hemorrhage: a score comparison.
The original ICH (oICH) score was tested in different populations and showed good accuracy in the prediction of outcome and 30-day mortality after spontaneous ICH. The oICH was developed to stratify patients with all types of spontaneous intracerebral hemorrhage (SICH). Several modifications of the oICH score exist in the literature. ⋯ The best AUC for functional outcome was observed for the mICH-B score (0.823). For the mICH-A and the IVH score, an AUC of 0.811 was calculated. The scores that include the quantification of IVH or the grading of hydrocephalus show good accuracy in the prediction of 30-day mortality and functional outcome at 6 months in SICH with secondary IVH.
-
Acta Neurochir. Suppl. · Jan 2011
Neuromonitoring in intensive care: a new brain tissue probe for combined monitoring of intracranial pressure (ICP) cerebral blood flow (CBF) and oxygenation.
the benefits of monitoring cerebral blood flow (CBF) in stroke patients are apparent. New techniques combining near infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution to estimate cerebral hemodynamics are available. However, with transcutaneous NIRS and optodes applied over the skin, the signal is contaminated by extracerebral tissues. The objective is to develop a new brain tissue probe for combined monitoring of intracranial pressure (ICP), CBF and cerebral blood volume (CBV). ⋯ NIR spectroscopy allows the synchronous determination of multiple parameters with one single device. By measurements in parallel with the NeMo Probe and NIRS optodes placed over the skin, new algorithms can be developed to subtract the extracerebral contamination from the NIRS signal.
-
Acta Neurochir. Suppl. · Jan 2011
Improving patient safety in the intra-operative MRI suite using an on-duty safety nurse, safety manual and checklist.
This paper describes the use of an on-duty safety nurse, a surgical safety manual and a checklist as an essential precursor to evaluating how these approaches affect surgical quality, communication in surgery crews and contribute to the safety of surgical care in the intra-operative magnetic resonance imaging (MRI) suite.
-
Acta Neurochir. Suppl. · Jan 2011
Randomized Controlled Trial Multicenter StudyClazosentan: prevention of cerebral vasospasm and the potential to overcome infarction.
Cerebral vasospasm is a common complication occurring after aneurysmal subarachnoid hemorrhage (SAH). It is recognized as a leading preventable cause of morbidity and mortality in this patient group, but its management is challenging, and new treatments are needed. Clazosentan is an endothelin receptor antagonist designed to prevent endothelin-mediated cerebral vasospasm. ⋯ Clazosentan reduced angiographic vasospasm dose-dependently relative to placebo with a maximum risk reduction of 65% with the highest dose. Despite this, there was no benefit of clazosentan on the secondary protocol-defined morbidity/mortality endpoint; however, additional post-hoc and modified endpoint analyses provided some evidence for a potential clinical benefit. Two additional large-scale studies (CONSCIOUS-2 and CONSCIOUS-3) are now underway to further investigate the potential of clazosentan to improve long-term clinical outcome.