Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2010
Randomized Controlled TrialEffects of magnesium sulfate infusion on cerebral perfusion in patients after aneurysmal SAH.
A meta-analysis of current data suggests that magnesium sulfate infusion improves the outcome after aneurysmal subarachnoid hemorrhage through a reduction in delayed ischemic neurological deficit. Two multi-center randomized controlled trials are currently underway to investigate this hypothesis. The possible pharmacological basis of this hypothesis includes neuroprotection and vasodilatation. We aim to investigate the cerebral hemodynamic effects of magnesium sulfate infusion in aneurysmal subarachnoid hemorrhage patients. ⋯ Magnesium sulfate infusion, in the dosage of current clinical trials, did not increase cerebral blood volume and cerebral blood flow, as postulated by dilation of small vessels and/or collateral pathways.
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Acta Neurochir. Suppl. · Jan 2010
Randomized Controlled Trial Multicenter StudyIs it possible to minimize overdrainage complications with gravitational units in patients with idiopathic normal pressure hydrocephalus? Protocol of the randomized controlled SVASONA Trial (ISRCTN51046698).
Overdrainage is a common complication observed after shunting patients with idiopathic normal-pressure hydrocephalus (iNPH), with an estimated incidence up to 25%. Gravitational units that counterbalance intracranial pressure changes were developed to overcome this problem. We will set out to investigate whether the combination of a programmable valve and a gravitational unit (proGAV, Aesculap/Miethke, Germany) is capable of reducing the incidence of overdrainage and improving patient-centered outcomes compared to a conventional programmable valve (Medos-Codman, Johnson & Johnson, Germany). ⋯ One planned interim analysis for safety and efficacy will be performed halfway through the study. To detect the hypothesized difference in the incidence of overdrainage with a type I error of 5% and a type II error of 20%, correcting for multiple testing and an anticipated dropout rate of 10%, 200 patients will be enrolled. The presented trial is currently recruiting patients, with the first results predicted to be available in late 2008.
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Acta Neurochir. Suppl. · Jan 2008
Randomized Controlled Trial Clinical TrialPreliminary findings of the minimally-invasive surgery plus rtPA for intracerebral hemorrhage evacuation (MISTIE) clinical trial.
Compared to ischemic stroke, intracerebral hemorrhage (ICH) is easily and rapidly identified, occurs in younger patients, and produces relatively small initial injury to cerebral tissues--all factors suggesting that interventional amelioration is possible. Investigations from the last decade established that extent of ICH-mediated brain injury relates directly to blood clot volume and duration of blood exposure to brain tissue. Using minimally-invasive surgery plus recombinant tissue plasminogen activator (rtPA), MISTIE investigators explored aggressive avenues to treat ICH. ⋯ There is tentative indication that minimally-invasive surgery plus rtPA shows greater clot resolution than traditional medical management.
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Acta Neurochir. Suppl. · Jan 2007
Randomized Controlled Trial Clinical TrialImplantation of surgical electrodes for spinal cord stimulation: classical midline laminotomy technique versus minimal invasive unilateral technique combined with spinal anaesthesia.
The implantation of surgical electrodes is still considered painful and invasive. Is there a possibility to diminish these disadvantages by applying a less invasive implantation procedure at the thoracic level and eventually combine this approach with a less stressful paresthesia coverage testing in the intraoperatively awake patient? In this paper, the postoperative outcome of two surgical techniques to insert surgical plate electrodes at the thoracic level is compared. In a prospective single blind study. the Classical Midline Laminotomy technique (CML) is opposed to a Minimal Invasive unilateral Technique (MIT). ⋯ In all comparisons, the MIT group scored significantly better. It can be concluded that a minimal invasive unilateral technique has some advantages over midline laminotomy. Refinements of the implantation procedure are discussed, i.e minimal invasive unilateral technique in combination with spinal (intrathecal) anaesthesia, surgical hints and the technique's use in revision surgery for migrated electrodes.
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Acta Neurochir. Suppl. · Jan 2006
Randomized Controlled Trial Multicenter StudyDecompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUEicp study (www.RESCUEicp.com).
The RESCUEicp (Randomized Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of intracranial pressure) study has been established to determine whether decompressive craniectomy has a role in the management of patients with traumatic brain injury and raised intracranial pressure that does not respond to initial treatment measures. We describe the concept of decompressive craniectomy in traumatic brain injury and the rationale and protocol of the RESCUEicp study.