Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2011
Delayed intracranial hemorrhage associated with antiplatelet therapy in stent-assisted coil embolized cerebral aneurysms.
Administration of oral clopidogrel plus aspirin is the most important regimen to reduce thromboembolic complications in stent-assisted coil embolization of cerebral aneurysm. However, such therapy may increase the risk of hemorrhage. The purpose of this study is to analyze the effect of two different antiplatelet regimens on hemorrhagic and thromboembolic complication rates around the stent-assisted coil embolization period. ⋯ The thromboembolic complication rates were not significantly different between the two groups. Oral administration of routine antiplatelet drugs for 3 days before stent-assisted coil embolization possibly increases the risk of delayed intracranial hemorrhage, compared to loading group. Symptomatic thromboembolic complications have no significant difference in the two different regimens.
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Acta Neurochir. Suppl. · Jan 2011
Clinical TrialRole of controlled lumbar CSF drainage for ICP control in aneurysmal SAH.
a prospective study of lumbar CSF drainage in the setting of raised intra-cranial pressure refractory to medical management and ventriculostomy placement is presented. There has been increasing data that this may be a effective and safe intervention for reduction of ICP. ⋯ we have shown that controlled lumbar drainage is a safe, efficacious and minimally invasive method for treatment of elevated ICP which refractory to medical management. Ventriculostomies are always placed before utilizing lumbar drains to minimize the risk of cerebral herniation. We would advocate making controlled lumbar drainage a standard part of ICP control protocols.
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Regardless of numerous efforts there is no prophylactic treatment proven to be effective in the prevention of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). As systemic administration of vasoactive drugs has been associated with significant side effects and insufficient efficacy, intrathecal administration of nicardipine prolonged-release implants (NPRI) has been developed. At the time of surgical clipping of the ruptured aneurysm, NPRIs are positioned next to the large cerebral arteries. ⋯ A separate patient series demonstrated the efficacy of fewer NPRIs in the perichiasmatic cistern. Further investigations were performed in comparison to coiled patients and with intraventricular implantation of NPRIs, which had a less pronounced effect. Overall, NPRIs are a most promising option for the prevention of cerebral vasospasm after SAH and large controlled trials are needed to further confirm these results.
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Acta Neurochir. Suppl. · Jan 2011
High-field iMRI in glioblastoma surgery: improvement of resection radicality and survival for the patient?
Since the first patients underwent intracranial tumor removal with the radicality control of intraoperative MRI (ioMRI) in September 2005 in our department, the majority of operations performed in the ioMRI room have been indicated for high grade gliomas. In order to elucidate the role of ioMRI scanning in patients harboring high-grade gliomas (HGG) on their survival, one hundred ninety three patients with gliomas WHO grades III and IV were operated either in a standard microsurgical neuronavigated fashion or using additionally ioMRI and were included in a follow-up study. The series started with surgeries from September 2005 until October 2007. ⋯ Patients were followed in regular intervals mostly until death. Statistical analysis showed a median survival time for patients in whom ioMRI had been used of 20, 37 months compared to 10, 3 months in the cohort who had undergone conventional microsurgical removal. Major influencing concomitants were WHO grades and age which were balanced in both groups.
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Acta Neurochir. Suppl. · Jan 2011
Comparative StudyComparison of nimodipine delivery routes in cerebral vasospasm after subarachnoid hemorrhage: an experimental study in rabbits.
nimodipine is the most widely preferred and administered calcium channel blocker in cerebral vasospasm prevention and treatment. There is no experimental or clinical study investigating the comparative effects of routine treatment modalities. ⋯ this is the first study to show the most effective drug delivery route in CVS after SAH. Nimodipine treatment in cerebral vasospasm is useful. This study showed that selective IA nimodipine treatment and IT nimodipine treatment must be preferred to IV and oral treatments of chronic vasospasm following SAH.