2301
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Elgueta MF, Vega P, Lema G, Clede L. Should we monitor with bispectral index in all patients at high risk for seizures in the operating room? Rev Esp Anestesiol Reanim 2013; 60:469-471. [PMID: 22947193 DOI: 10.1016/j.redar.2012.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 06/27/2012] [Indexed: 06/01/2023]
Abstract
We report the case of a patient with a cerebral aneurysm, located in the left middle cerebral artery. During the clipping of this aneurysm, the bispectral index (BIS) increased for no apparent reason. This was then interpreted as intraoperative non-convulsive status epilepticus. This clinical condition may have negative impact in the prognosis of the patient, so it is very important to be able to detect this conditions as early as possible. Measuring the BIS while the patient is anaesthetised could be useful in this situation, considering that an increase in values greater than 60, associated with acidosis and without any other peri-anaesthetic explanation, may provide evidence of a convulsive equivalent state, allowing appropriate action to be taken.
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Affiliation(s)
- M F Elgueta
- Division of Anaesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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2302
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Affiliation(s)
- N Tanaka
- Laboratory of Comprehensive Veterinary Clinical Studies, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa 252-0880, Japan
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2303
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Choi SH, Choi SH. Predictive performance of serum procalcitonin for the diagnosis of bacterial meningitis after neurosurgery. Infect Chemother 2013; 45:308-14. [PMID: 24396632 PMCID: PMC3848519 DOI: 10.3947/ic.2013.45.3.308] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/30/2013] [Accepted: 05/30/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Postoperative bacterial meningitis (PBM) is a serious potential complication after neurosurgery. Early diagnosis and introduction of antimicrobial therapy are necessary to reduce the rate of fatal outcomes from PBM. However, PBM is not easily differentiated from postoperative aseptic meningitis (PAM), which usually has favorable clinical outcomes. Serum procalcitonin (S-PCT) has been found to be a useful marker for distinguishing community-acquired bacterial from viral meningitis. We investigated the predictive performance of S-PCT for PBM in patients who underwent neurosurgery. MATERIALS AND METHODS Between September 2009 and August 2010, we prospectively collected data from patients who underwent neurosurgery and had cerebrospinal fluid (CSF) pleocytosis within 14 days of surgery. Based on the CSF culture results, patients were categorized as either PBM or PAM cases. We compared the laboratory test results including S-PCT levels between PBM and PAM cases, and investigated the predictive performance of S-PCT for PBM. RESULTS During the study period, PBM and PAM occurred in 14 and 64 patients, respectively. There was no significant difference in CSF profiles between PBM and PAM cases. S-PCT level ≥ 0.15 ng/mL (50.0% vs. 20.0%, P = 0.07) and C-reactive protein (CRP) level ≥ 2.5 mg/dL (75.0% vs. 46.5%, P = 0.16) tended to be more frequent in PBM than in PAM cases. A blood white blood cell (B-WBC) count ≥ 9,500/mm(3) was more frequently found in PBM cases (85.7% vs. 50.8%, P = 0.02) than in PAM cases. For the diagnosis of PBM, an S-PCT level ≥ 0.15 ng/mL had a specificity of 80.0%. The combined criteria of a CRP level ≥ 2.5 mg/dL, B-WBC count ≥ 9,500/mm(3), and an S-PCT level ≥ 0.15 ng/mL had the highest specificity (92.6%) of all the criteria. An S-PCT level ≥0.15 ng/mL had low sensitivity (50.0%), and the combined criteria of CRP level ≥ 2.5 mg/dL, B-WBC count ≥ 9,500/mm(3), and S-PCT level ≥ 0.15 ng/mL had an improved sensitivity of 85.7%. However, the sensitivity did not significantly differ from that of a B-WBC count ≥ 9,500/mm(3) (85.7%). CONCLUSIONS S-PCT showed limited performance for the diagnosis of postoperative meningitis. However, it could be a useful adjunct for the improvement of diagnostic sensitivity when used in combination with other inflammatory markers.
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Affiliation(s)
- Seong-Ho Choi
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang-Ho Choi
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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2304
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Gasco J, Patel A, Luciano C, Holbrook T, Ortega-Barnett J, Kuo YF, Rizzi S, Kania P, Banerjee P, Roitberg BZ. A novel virtual reality simulation for hemostasis in a brain surgical cavity: perceived utility for visuomotor skills in current and aspiring neurosurgery residents. World Neurosurg 2013; 80:732-7. [PMID: 24076054 DOI: 10.1016/j.wneu.2013.09.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 07/24/2013] [Accepted: 09/19/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To understand the perceived utility of a novel simulator to improve operative skill, eye-hand coordination, and depth perception. METHODS We used the ImmersiveTouch simulation platform (ImmersiveTouch, Inc., Chicago, Illinois, USA) in two U.S. Accreditation Council for Graduate Medical Education-accredited neurosurgical training programs: the University of Chicago and the University of Texas Medical Branch. A total of 54 trainees participated in the study, which consisted of 14 residents (group A), 20 senior medical students who were neurosurgery candidates (group B), and 20 junior medical students (group C). The participants performed a simulation task that established bipolar hemostasis in a virtual brain cavity and provided qualitative feedback regarding perceived benefits in eye-hand coordination, depth perception, and potential to assist in improving operating skills. RESULTS The perceived ability of the simulator to positively influence skills judged by the three groups: group A, residents; group B, senior medical students; and group C, junior medical students was, respectively, 86%, 100%, and 100% for eye-hand coordination; 86%, 100%, and 95% for depth perception; and 79%, 100%, and 100% for surgical skills in the operating room. From all groups, 96.2% found the simulation somewhat or very useful to improve eye-hand coordination, and 94% considered it beneficial to improve depth perception and operating room skills. CONCLUSION This simulation module may be suitable for resident training, as well as for the development of career interest and skill acquisition; however, validation for this type of simulation needs to be further developed.
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Affiliation(s)
- Jaime Gasco
- Division of Neurological Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA.
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2305
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Roux FE, Reddy M. Neurosurgical work during the Napoleonic wars: Baron Larrey's experience. Clin Neurol Neurosurg 2013; 115:2438-44. [PMID: 24120506 DOI: 10.1016/j.clineuro.2013.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 09/05/2013] [Accepted: 09/08/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Considered as the most famous French military surgeon, Dominique-Jean Larrey (1766-1842), who joined all the campaigns of Napoleon, wrote his memoirs and several medical articles. This paper discusses how in the Napoleonic times, Larrey dealt with neurosurgical diseases or injuries. PATIENTS AND METHODS We reviewed four main publications of Larrey published between 1812 and 1838 and analyzed the type of neurosurgical cases presented and their treatment. RESULTS These works include his practice of what we call now "neurosurgery" since most injuries described concern the skull or spine. He seemed to treat patients with humanity, integrity and perseverance. Larrey dealt with many aspects of neurosurgery, such as cranial or spinal trauma surgery, and also infectious diseases. He saw many head injuries inflicted not only by muskets or artillery, but also with spears and sabers. Unlike some others, Larrey advocated the use of trepanation in many situations as practiced, for instance, in the treatment of depressed fractures or in presence of subdural collections. On the other hand, this surgeon who saw thousands of amputees during his career did not mention the phantom limb phenomenon in his memoirs. Similarly, the issue of cerebral localizations is only mentioned in his last work, published in 1838. CONCLUSIONS In his work, Larrey (and all his contemporaries) dealt essentially with "cranial" surgery, as in skull fractures where the brain could potentially have been injured by bone fragments. The time for brain surgery had not come yet.
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Affiliation(s)
- Franck-Emmanuel Roux
- UMR Unité 825, Université Paul Sabatier, IFR 96 and Pôle Neurosciences, Centres Hospitalo-Universitaires, F-31059 Toulouse, France.
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2306
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Croft LJ, Rankin PM, Liégeois F, Banks T, Cross JH, Vargha-Khadem F, Baldeweg T. To speak, or not to speak? The feasibility of imaging overt speech in children with epilepsy. Epilepsy Res 2013; 107:195-9. [PMID: 24054425 DOI: 10.1016/j.eplepsyres.2013.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/19/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
We systematically compared fMRI results for covert (silent) and overt (spoken) versions of a language task in a representative sample of children with lesional focal epilepsy being considered for neurosurgical treatment (N=38, aged 6-17 years). The overt task was advantageous for presurgical fMRI assessments of language; it produced higher quality scans, was more sensitive for identifying activation in core language regions on an individual basis, and provided an online measure of performance crucial for improving the yield of presurgical fMRI.
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Affiliation(s)
- L J Croft
- Developmental Cognitive Neurosciences Unit, Institute of Child Health, University College London, 30 Guilford Street, London WC1 N 1EH, United Kingdom; Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1 N 3JH, United Kingdom.
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2307
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2308
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van Aalst J, Jeukens CRLPN, Vles JSH, van Maren EA, Kessels AGH, Soudant DLHM, Weber JW, Postma AA, Cornips EMJ. Diagnostic radiation exposure in children with spinal dysraphism: an estimation of the cumulative effective dose in a cohort of 135 children from The Netherlands. Arch Dis Child 2013; 98:680-5. [PMID: 23838129 DOI: 10.1136/archdischild-2012-303621] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Based on the assumption that children with spinal dysraphism are exposed to a large amount of ionising radiation for diagnostic purposes, our objective was to estimate this exposure, expressed in cumulative effective dose. DESIGN Retrospective cohort study. SETTINGS The Netherlands. PATIENTS 135 patients with spinal dysraphism and under 18 years of age treated at our institution between 1991 and 2010. RESULTS A total of 5874 radiological procedures were assessed of which 2916 (49.6%) involved ionising radiation. Mean cumulative effective dose of a child with spinal dysraphism during childhood was 23 mSv, while the individual cumulative effective dose ranged from 0.1 to 103 mSv. Although direct radiography accounted for 81.7% of examinations, the largest contributors to the cumulative effective dose were fluoroscopic examinations (40.4% of total cumulative effective dose). CONCLUSIONS Exposure to ionising radiation and associated cancer risk were lower than expected. Nevertheless, the use of ionising radiation should always be justified and the medical benefits should outweigh the risk of health detriment, especially in children.
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Affiliation(s)
- Jasper van Aalst
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
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2309
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Kshettry VR, Chotai S, Hou J, Lamki T, Ammirati M. Successful resection of anterior and anterolateral lesions at the craniovertebral junction using a simple posterolateral approach. J Clin Neurosci 2014; 21:616-22. [PMID: 24210804 DOI: 10.1016/j.jocn.2013.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/10/2013] [Indexed: 11/23/2022]
Abstract
Tumors at the craniovertebral junction (CVJ) often present a challenge due to proximity to vital neurovascular structures. In the last few decades, many authors have proposed complex surgical approaches to access pathologies located anterior or anterolateral to the CVJ with the hopes of reducing morbidity. We propose that the simple posterolateral approach in a semi-sitting position can be used to resect most anterior and anterolateral CVJ tumors safely and effectively. We retrospectively reviewed the clinical series of 10 patients treated by the senior author using the posterolateral suboccipital approach to treat anterior or anterolateral CVJ pathologies. We describe our surgical techniques, outcomes, and present illustrative patients. Gross total resection was achieved in eight patients (80%). Good functional outcome (Glasgow Outcome Scale 4-5) was obtained in all patients. Preoperative symptoms and deficits were improved (78%) or stable (22%) in all patients. There was one (10%) surgical complication that was cerebrospinal fluid leak requiring reoperation. There was no permanent morbidity or mortality in this series. There were two (20%) medical complications including deep vein thrombosis and pulmonary embolus. There were three (30%) transient neurologic complications, dysphagia in two and dysarthria in one, all of which resolved completely in early follow-up. The majority of anterior or anterolateral CVJ lesions can be successfully removed using the simple posterolateral approach.
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2310
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Fargen KM, Dow J, Tomei KL, Friedman WA. Follow-up on a national survey: american neurosurgery resident opinions on the 2011 accreditation council for graduate medical education-implemented duty hours. World Neurosurg 2013; 81:15-21. [PMID: 23954736 DOI: 10.1016/j.wneu.2013.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 08/13/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We previously performed a nationwide survey of American neurosurgical residents before the initiation of the 2011 Accreditation Council for Graduate Medical Education regulations, in which more than 70% indicated the proposed changes would negatively impact residency training. We sought to resurvey the resident population as to the actual changes that occurred to their programs after the 2011 standards went into effect. METHODS Surveys were mailed to every neurosurgery training program in the United States and Puerto Rico. Program directors and coordinators were asked to distribute surveys to their residents. RESULTS A total of 253 neurosurgery residents responded. Reported duty-hour violations were largely unchanged after the 2011 duty-hour changes. Sixty-percent of residents reported that they had underreported duty hours, with nearly 25% of respondents doing so on a weekly or daily basis. Most reported that the 2011 changes had not affected operative caseload, academic productivity, quality of life, or resident fatigue. The majority of residents disagreed or strongly disagreed that the PGY-1 16-hour limitation had a positive impact on first-year resident training (69%) or had improved patient safety (62%). Overall, the majority of respondents reported that the 2011 changes had a negative (35%) or negligible (33%) effect on residency training at their institution. CONCLUSION Respondents indicated that the 2011 Accreditation Council for Graduate Medical Education regulations have had a smaller perceived effect on neurosurgical training programs than previously predicted. However, the majority of residents admitted to underreporting duty hours, with a quarter doing so on a regular basis. The 16-hour rule for interns remains unpopular.
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Affiliation(s)
- Kyle M Fargen
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
| | - Jamie Dow
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Krystal L Tomei
- Department of Neurosurgery, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - William A Friedman
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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2311
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Walcott BP, Boehm KM, Stapleton CJ, Mehta BP, Nahed BV, Ogilvy CS. Retrievable stent thrombectomy in the treatment of acute ischemic stroke: analysis of a revolutionizing treatment technique. J Clin Neurosci 2013; 20:1346-9. [PMID: 23938012 DOI: 10.1016/j.jocn.2013.03.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/26/2013] [Accepted: 03/30/2013] [Indexed: 11/26/2022]
Abstract
Acute ischemic stroke resulting from intracranial vessel occlusion is associated with high morbidity and mortality. The mainstays of therapy are fibrinolytics and mechanical thrombectomy in properly selected patients. A new Food and Drug Administration-approved technology to perform thrombectomy, retrievable stenting, may provide superior revascularization rates and improved patient outcomes. We analyzed the cumulative human experience reported for the Trevo Pro Retrieval System (Stryker, Kalamazoo, MI, USA) and the Solitaire FR Revascularization Device (ev3, Irvine, CA, USA) as the definitive treatment for acute ischemic stroke. A literature search was undertaken to identify studies using the retrievable stents published up to September 2012. Nineteen studies identified a total of 576 patients treated with either the Trevo (n=221) or Solitaire (n=355) devices. Pooled data analysis identified median baseline National Institutes of Health Stroke Scale scores of 18.5 ± 0.289 (standard error of the mean) and 17.9 ± 0.610, and time to recanalization of 53.9 ± 23.6 minutes and 59.0 ± 8.0 minutes for the Trevo and Solitaire groups, respectively. Recanalization was variably defined by individual studies, most commonly achieving at least a thrombolysis in cerebral infarction score of 2a-3 or a thrombolysis in myocardial infarction score of 2-3. Revascularization (83%, 82%), mortality (31%, 14%), hemorrhage (8%, 6%), device complications (5%, 6%), and good patient outcomes (51%, 47%) were found with the Trevo and Solitaire devices, respectively. Preliminary analysis reveals excellent clinical outcomes for retrievable stent technology. This may be attributable to both high rates of revascularization with a relatively short time to perfusion restoration.
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Affiliation(s)
- Brian P Walcott
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA.
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2312
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Abstract
Endoscopic transsphenoidal pituitary surgery has become increasingly more popular for the removal of pituitary adenomas. It is also widely recognised that transsphenoidal microscopic removal of pituitary adenomas is a well-established procedure with good outcomes. Our objective was to meta-analyse the short-term results of endoscopic and microscopic pituitary adenoma surgery. We undertook a systematic review of the English literature on results of transsphenoidal surgery, both microscopic and endoscopic from 1990 to 2011. Series with less than 10 patients were excluded. Pooled data were analysed using meta-analysis techniques to obtain estimate of death, complication rates and extent of tumour removal. Complications evaluated included cerebrospinal fluid leak, meningitis, vascular complications, visual complications, diabetes insipidus, hypopituitarism and cranial nerve injury. Data were also analysed for tumour size and sex. 38 studies met the inclusion criteria yielding 24 endoscopic and 22 microscopic datasets (eight studies included both endoscopic and microscopic series). Meta-analysis of the available literature showed that the endoscopic transsphenoidal technique was associated with a higher incidence of vascular complications (p<0.0001). No difference was found between the two techniques in all other variables examined. Meta-analysis of the available literature reveals that endoscopic removal of pituitary adenoma, in the short term, does not seem to confer any advantages over the microscopic technique and the incidence of reported vascular complications was higher with endoscopic than with microscopic removal of pituitary adenomas. While we recognise the limitations of meta-analysis, our study suggests that a multicentre, randomised, comparative effectiveness study of the microscopic and endoscopic transsphenoidal techniques may be a reasonable approach towards establishing a true valuation of these techniques.
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Affiliation(s)
- Mario Ammirati
- Department of Neurosurgery, Ohio State University, 410 West 10th Avenue, N1025 Doan Hall, Columbus, OH 43210, USA.
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2313
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Lemcke J, Meier U, Müller C, Fritsch MJ, Kehler U, Langer N, Kiefer M, Eymann R, Schuhmann MU, Speil A, Weber F, Remenez V, Rohde V, Ludwig HC, Stengel D. Safety and efficacy of gravitational shunt valves in patients with idiopathic normal pressure hydrocephalus: a pragmatic, randomised, open label, multicentre trial (SVASONA). J Neurol Neurosurg Psychiatry 2013; 84:850-7. [PMID: 23457222 PMCID: PMC3717598 DOI: 10.1136/jnnp-2012-303936] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate whether gravitational valves reduce the risk of overdrainage complications compared with programmable valves in ventriculoperitoneal (VP) shunt surgery for idiopathic normal pressure hydrocephalus (iNPH). BACKGROUND Patients with iNPH may benefit from VP shunting but are prone to overdrainage complications during posture changes. Gravitational valves with tantalum balls are considered to reduce the risk of overdrainage but their clinical effectiveness is unclear. METHODS We conducted a pragmatic, randomised, multicentre trial comparing gravitational with non-gravitational programmable valves in patients with iNPH eligible for VP shunting. The primary endpoint was any clinical or radiological sign (headache, nausea, vomiting, subdural effusion or slit ventricle) of overdrainage 6 months after randomisation. We also assessed disease specific instruments (Black and Kiefer Scale) and Physical and Mental Component Scores of the Short Form 12 (SF-12) generic health questionnaire. RESULTS We enrolled 145 patients (mean (SD) age 71.9 (6.9) years), 137 of whom were available for endpoint analysis. After 6 months, 29 patients in the standard and five patients in the gravitational shunt group developed overdrainage (risk difference -36%, 95% CI -49% to -23%; p<0.001). This difference exceeded predetermined stopping rules and resulted in premature discontinuation of patient recruitment. Disease specific outcome scales did not differ between the groups although there was a significant advantage of the gravitational device in the SF-12 Mental Component Scores at the 6 and 12 month visits. CONCLUSIONS Implanting a gravitational rather than another type of valve will avoid one additional overdrainage complication in about every third patient undergoing VP shunting for iNPH.
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Affiliation(s)
- Johannes Lemcke
- Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Str 7, Berlin 12683, Germany.
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2314
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Sood S, Vaid VK, Bhartiya H. Meningitis due to Stenotrophomonas maltophilia after a Neurosurgical Procedure. J Clin Diagn Res 2013; 7:1696-7. [PMID: 24086879 DOI: 10.7860/jcdr/2013/5614.3248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 06/03/2013] [Indexed: 12/25/2022]
Abstract
Stenotrophomonas maltophilia is an aerobic, glucose non- fermentative, gram negative bacillus, which is being increasingly recognized as a cause of serious infections such as bacteraemia, urinary tract infections, respiratory tract infections, skin and soft tissue infections, endocarditis, meningitis and ocular infections in hospitalized patients. The treatment of invasive S. maltophilia infections is difficult, as this pathogen shows high levels of intrinsic or acquired resistance to different antibiotics, thus reducing the options which are available for treatment. Meningitiscaused by S. maltophilia is rarely encountered and so its experience is also limited. We are describing here a case of a six months old, male child who developed meningitis caused by Stenotrophomonas maltophilia, after he underwent a neurosurgical procedure.
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Affiliation(s)
- Smita Sood
- Microbiologist, Department of Laboratory Medicine, (SRL Ltd.), Fortis Escorts Hospital , Jaipur, India
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2315
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McLaughlin N, Winograd D, Chung HR, Van de Wiele B, Martin NA. Impact of the time-out process on safety attitude in a tertiary neurosurgical department. World Neurosurg 2013; 82:567-74. [PMID: 23891814 DOI: 10.1016/j.wneu.2013.07.074] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/31/2013] [Accepted: 07/19/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In July 2011, the UCLA Health System released its current time-out process protocol used across the Health System. Numerous interventions were performed to improve checklist completion and time-out process observance. This study assessed the impact of the current protocol for the time-out on healthcare providers' safety attitude and operating room safety climate. METHODS All members involved in neurosurgical procedures in the main operating room of the Ronald Reagan UCLA Medical Center were asked to anonymously complete an online survey on their overall perception of the time-out process. RESULTS The survey was completed by 93 of 128 members of the surgical team. Overall, 98.9% felt that performing a pre-incision time-out improves patient safety. The majority of respondents (97.8%) felt that the team member introductions helped to promote a team spirit during the case. In addition, 93.5% felt that performing a time-out helped to ensure all team members were comfortable to voice safety concerns throughout the case. All respondents felt that the attending surgeon should be present during the time-out and 76.3% felt that he/she should lead the time-out. Unanimously, it was felt that the review of anticipated critical elements by the attending surgeon was helpful to respondents' role during the case. Responses revealed that although the time-out brings the team together physically, it does not necessarily reinforce teamwork. CONCLUSION The time-out process favorably impacted team members' safety attitudes and perception as well as overall safety climate in neurosurgical ORs. Survey responses identified leadership training and teamwork training as two avenues for future improvement.
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Affiliation(s)
- Nancy McLaughlin
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Deborah Winograd
- Department of Quality Management, Ronald Reagan UCLA Medical Center and Santa Monica UCLA Medical Center & Orthopedic Hospital, University of California, Los Angeles, California, USA
| | - Hallie R Chung
- Department of Quality Management, Ronald Reagan UCLA Medical Center and Santa Monica UCLA Medical Center & Orthopedic Hospital, University of California, Los Angeles, California, USA
| | - Barbara Van de Wiele
- Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Neil A Martin
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
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2316
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Howe KL, Zhou G, July J, Totimeh T, Dakurah T, Malomo AO, Mahmud MR, Ismail NJ, Bernstein MA. Teaching and sustainably implementing awake craniotomy in resource-poor settings. World Neurosurg 2013; 80:e171-4. [PMID: 23871816 DOI: 10.1016/j.wneu.2013.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 07/10/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Awake craniotomy for brain tumor resection has the benefit of avoiding a general anesthetic and decreasing associated costs (e.g., intensive care unit beds and intravenous line insertion). In low- and middle-income countries, significant resource limitations for the system and individual make awake craniotomy an ideal tool, yet it is infrequently used. We sought to determine if awake craniotomy could be effectively taught and implemented safely and sustainably in low- and middle-income countries. METHODS A neurosurgeon experienced in the procedure taught awake craniotomy to colleagues in China, Indonesia, Ghana, and Nigeria during the period 2007-2012. Patients were selected on the basis of suspected intraaxial tumor, absence of major dysphasia or confusion, and ability to tolerate the positioning. Data were recorded by the local surgeons and included preoperative imaging, length of hospital admission, final pathology, postoperative morbidity, and mortality. RESULTS Awake craniotomy was performed for 38 cases of suspected brain tumor; most procedures were completed independently. All patients underwent preoperative computed tomography or magnetic resonance imaging. In 64% of cases, patients remained in the hospital <10 days. The most common pathology was high-grade glioma, followed by meningioma, low-grade glioma, and metastasis. No deaths occurred, and no case required urgent intubation. The most common perioperative and postoperative issue was seizure, with 1 case of permanent postoperative deficit. CONCLUSIONS Awake craniotomy was successfully taught and implemented in 6 neurosurgical centers in China, Indonesia, Ghana, and Nigeria. Awake craniotomy is safe, resource-sparing, and sustainable. The data suggest awake craniotomy has the potential to significantly improve access to neurosurgical care in resource-challenged settings.
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Affiliation(s)
- Kathryn L Howe
- Global Health Education Institute, University of Toronto, Toronto, Ontario, Canada.
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2317
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Tian LJ, Zhuang HQ, Yuan ZY. A comparison between cyberknife and neurosurgery in solitary brain metastases from non-small cell lung cancer. Clin Neurol Neurosurg 2013; 115:2009-14. [PMID: 23850045 DOI: 10.1016/j.clineuro.2013.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/04/2013] [Accepted: 06/10/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the efficacy of cyberknife (CK) and neurosurgery (NS) in patients newly diagnosed as solitary brain metastasis (SBM) from non-small cell lung cancer (NSCLC). METHODS AND MATERIALS We retrospectively analyzed 76 patients between 1990 and 2012 from our institution, including 38 patients performing CK and the other half performing NS. The observation end point was overall survival time (OS), local control of treated metastasis (LC) and intracranial control (IC). Kaplan-Meier OS curves were compared with the log-rank test. Cox regression analysis was used to determine prognosticators for OS, LC and IC. RESULTS The baseline characteristic between the two groups was not significantly different. The 1-year OS rates were 53.5% and 30.5% in the CK group and NS group, respectively, (p=0.121). The 1-year LC rates were 50.8% and 31.3%, respectively, (p=0.078). The 1-year IC rates were 50.8% and 27.7%, respectively, (p=0.066). In multivariate analysis, improved OS was significantly associated with younger age (p=0.016), better ECOG performance status (p=0.000) and graded prognostic assessment (GPA, 3.5-4.0, p=0.006). The LC was also associated with better ECOG performance status (p=0.000). The IC was associated with both better ECOG performance status (p=0.000) and GPA (3.5-4.0, p=0.005). CONCLUSIONS There was no statistical difference between CK and NS for SBM from NSCLC in OS, LC and IC. However, CK is less invasive and may be more acceptable for patients. The result needs randomized trials to confirm and further study.
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2318
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Dinca EB, Banu M, Ciurea AV. Constantin N. Arseni (1912-1994) centenary: the birth of modern neurosurgery in Romania. World Neurosurg 2013; 82:e371-3. [PMID: 23816709 DOI: 10.1016/j.wneu.2013.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
Prof. Dr. Constantin N. Arseni and his mentor, Prof. Dr. D. Bagdasar, are revered by later generations of doctors as the forefathers of Romanian neurosurgery. In 2012, we have celebrated 100 years since Prof. Arseni's birth in a small village within a deprived area of the country. Through his talents and perseveration, he rose to be a neurosurgical school creator and one of the most prominent figures in 20th-century Eastern European neurosurgery. This historical vignette is a modest tribute to his legacy and tells the story of his titanic endeavor.
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Affiliation(s)
- Eduard B Dinca
- Leeds and York Partnership NHS Foundation Trust, York, United Kingdom.
| | - Matei Banu
- Brain Tumor and Stem Cell Laboratory, Department of Neurological Surgery, Cornell University, New York, New York, USA
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2319
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Delwel EJ, de Jong DA, Dammers R, Kurt E, van den Brink W, Dirven CMF. A randomised trial of high and low pressure level settings on an adjustable ventriculoperitoneal shunt valve for idiopathic normal pressure hydrocephalus: results of the Dutch evaluation programme Strata shunt (DEPSS) trial. J Neurol Neurosurg Psychiatry 2013; 84:813-7. [PMID: 23408069 DOI: 10.1136/jnnp-2012-302935] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In treating idiopathic normal pressure hydrocephalus (INPH) with a shunt there is always a risk of underdrainage or overdrainage. The hypothesis is tested whether patients treated using an adjustable valve preset at the highest opening pressure leads to comparable good clinical results with less subdural effusions than in a control group with an opening pressure preset at a low pressure level. METHODS A multicentre prospective randomised trial was performed on a total of 58 patients suspected of INPH. Thirty patients were assigned to (control) group 1 and received a Strata shunt (Medtronic, Goleta, USA) with the valve preset at a performance level (PL) of 1.0, while 28 patients were assigned to group 2 and received a Strata shunt with the valve preset at PL 2.5. In this group the PL was allowed to be lowered until improvement or radiological signs of overdrainage were met. RESULTS Significantly more subdural effusions were observed in the improved patients of group 1. There was no statistically significant difference in improvement between both groups overall. CONCLUSIONS On the basis of this multicentre prospective randomised trial it is to be recommended to treat patients with INPH with a shunt with an adjustable valve, preset at the highest opening pressure and lowered until clinical improvement or radiological signs of overdrainage occur although slower improvement and more shunt adjustments might be the consequence.
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Affiliation(s)
- Ernst J Delwel
- Department of Neurosurgery, Erasmus University Medical Centre, 's Gravendijkwal 230, Rotterdam 3000 CA, The Netherlands.
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2320
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Qvarlander S, Lundkvist B, Koskinen LOD, Malm J, Eklund A. Pulsatility in CSF dynamics: pathophysiology of idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 2013; 84:735-41. [PMID: 23408066 DOI: 10.1136/jnnp-2012-302924] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND It is suggested that disturbed CSF dynamics are involved in the pathophysiology of idiopathic normal pressure hydrocephalus (INPH). The pulsatility curve describes the relationship between intracranial pressure (ICP) and the amplitude of cardiac related ICP pulsations. The position of baseline ICP on the curve provides information about the physiological state of the CSF dynamic system. The objective of the study was to investigate if shunt surgery modifies the pulsatility curve and the baseline position on the curve, and how this relates to gait improvement in INPH. METHODS 51 INPH patients were investigated with lumbar CSF dynamic investigations preoperatively and 5 months after shunt surgery. During the investigation, ICP was measured at baseline, and then a CSF sample was removed, resulting in pressure reduction. After this, ICP was regulated with an automated infusion protocol, with a maximum increase of 24 mm Hg above baseline. The pulsatility curve was thus determined in a wide range of ICP values. Gait improvement was defined as a gait speed increase ≥0.1 m/s. RESULTS The pulsatility curve was unaltered by shunting. Baseline ICP and amplitude were reduced (-3.0±2.9 mm Hg; -1.1±1.5 mm Hg; p<0.05, n=51). Amplitude reduction was larger for gait improvers (-1.2±1.6 mm Hg, n=42) than non-improvers (-0.2±0.5 mm Hg, n=9) (p<0.05) although mean ICP reduction did not differ. CONCLUSIONS The pulsatility curve was not modified by shunt surgery, while the baseline position was shifted along the curve. Observed differences between gait improvers and non-improvers support cardiac related ICP pulsations as a component of INPH pathophysiology.
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Affiliation(s)
- Sara Qvarlander
- Department of Radiation Sciences-Biomedical Engineering, Umeå University, Umeå 901 85, Sweden.
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2321
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Agarwal N, Chaudhari A, Hansberry DR, Tomei KL, Prestigiacomo CJ. A comparative analysis of neurosurgical online education materials to assess patient comprehension. J Clin Neurosci 2013; 20:1357-61. [PMID: 23809099 DOI: 10.1016/j.jocn.2012.10.047] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 10/28/2012] [Indexed: 10/26/2022]
Abstract
Americans have increasingly utilized the internet as a first-line resource for a variety of information, including healthcare-oriented materials. Therefore, these online resources should be written at a level the average American can understand. Patient education resources specifically written for and available to the public were downloaded from the American Association of Neurological Surgeons website and assessed for their level of readability using the Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook Grading, Coleman-Liau Index, and Gunning-Fog Index. A total of 71 subsections from different neurosurgical specialties were reviewed, including Cerebrovascular, Spine and Peripheral Nerves, Neurotrauma and Critical Care, Pain, Pediatric, Stereotactic and Functional, and Tumor material. All neurosurgical subspecialty education material provided on the American Association of Neurological Surgeons website was uniformly written at a level that was too high, as assessed by all modalities. In order to reach a larger patient population, patient education materials on the American Association of Neurological Surgeons website should be revised with the goal of simplifying readability.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, 90 Bergen Street, Suite 8100, Newark, NJ 07101-1709, USA
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2322
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Kim SH, Lee SG, Kim SH, Kim DS, Kim HD. Relapsed herpes simplex virus encephalitis after epilepsy surgery. J Epilepsy Res 2013; 3:28-31. [PMID: 24649468 PMCID: PMC3957312 DOI: 10.14581/jer.13005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/03/2013] [Indexed: 11/04/2022] Open
Abstract
Relapsed herpes simplex virus (HSV) encephalitis after neurosurgery is a very rare condition. An 11-year-old boy suffered from relapsed HSV encephalitis five days after neurosurgery to remove the epileptogenic focus six years after prior HSV encephalitis. He was diagnosed with HSV encephalitis reactivation after positive HSV polymerase chain reaction results following a lumbar puncture, and this diagnosis was supported by consistent radiologic and histopathologic findings. Moreover, focal cortical dysplasia coexisted with inflammatory changes resulting from a viral infection based upon the removed brain tissue. This case may support the hypothesis that neurosurgery may be a triggering factor of HSV reactivation.
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Affiliation(s)
- Shin Hye Kim
- Department of Pediatrics, Myongji Hospital, Kwandong University College of Medicine, Goyang
| | - Seung Goo Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Department of Pathology, Severance Hospital,Yonsei University College of Medicine, Seoul, Korea
| | - Dong Seok Kim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Pediatric Epilepsy Clinics, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Korea
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2323
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Maskin LP, Capparelli F, Mora A, Hlavnicka A, Orellana N, Díaz MF, Wainsztein N, Del Castillo M. Cerebrospinal fluid lactate in post-neurosurgical bacterial meningitis diagnosis. Clin Neurol Neurosurg 2013; 115:1820-5. [PMID: 23810183 DOI: 10.1016/j.clineuro.2013.05.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 05/05/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Differential diagnosis between post-neurosurgical bacterial meningitis (PNBM) and aseptic meningitis is difficult. Inflammatory and biochemical cerebrospinal fluid (CSF) changes mimic those classically observed after CNS surgery. CSF lactate assay has therefore been proposed as a useful PNBM marker. OBJECTIVE To evaluate the diagnostic accuracy of CSF lactate as a PNBM marker in patients hospitalized after a neurosurgical procedure. METHODS Between July 2005 and June 2009, a prospective clinical study, in which all patients with clinical suspicion of PNBM were enrolled, was conducted at our neurosurgical Intensive Care Unit. PNBM diagnosis was categorized as proven, probable or negative before the analysis. RESULTS Seventy-nine patients, 51 males with a mean age of 50 years (range 32-68 years) were included. Surgery was elective in 76% patients, mostly for brain tumors (57%); thirty PNBM episodes were identified. CSF parameters were significantly different in glucose concentration (27 mg% vs. 73 mg%, p<0.001), lactate (8 mmol/L vs. 2.8 mmol/L, p<0.001), CSF neutrophil pleocytosis (850 mm(-3) vs. 10mm(-3), p<0.001), and protein levels (449 mg% vs. 98 mg%) between the PNBM and non-PNBM groups. The ROC curve that best fits PNBM diagnosis is lactate. CONCLUSION Increased CSF lactate is a useful PNBM marker, with better predictive value than CSF hypoglycorrhachia or pleocytosis. Lactate levels ≥ 4 mmol/L showed 97% sensitivity and 78% specificity, with a 97% negative predictive value.
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Affiliation(s)
- Luis Patricio Maskin
- Intensive Care Unit, Raúl Carrea Neurological Research Institute, FLENI, Buenos Aires, Argentina.
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2324
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Dworkin RH, O'Connor AB, Kent J, Mackey SC, Raja SN, Stacey BR, Levy RM, Backonja M, Baron R, Harke H, Loeser JD, Treede RD, Turk DC, Wells CD. Interventional management of neuropathic pain: NeuPSIG recommendations. Pain 2013; 154:2249-2261. [PMID: 23748119 DOI: 10.1016/j.pain.2013.06.004] [Citation(s) in RCA: 281] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 05/24/2013] [Accepted: 06/03/2013] [Indexed: 11/30/2022]
Abstract
Neuropathic pain (NP) is often refractory to pharmacologic and noninterventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group, the authors evaluated systematic reviews, clinical trials, and existing guidelines for the interventional management of NP. Evidence is summarized and presented for neural blockade, spinal cord stimulation (SCS), intrathecal medication, and neurosurgical interventions in patients with the following peripheral and central NP conditions: herpes zoster and postherpetic neuralgia (PHN); painful diabetic and other peripheral neuropathies; spinal cord injury NP; central poststroke pain; radiculopathy and failed back surgery syndrome (FBSS); complex regional pain syndrome (CRPS); and trigeminal neuralgia and neuropathy. Due to the paucity of high-quality clinical trials, no strong recommendations can be made. Four weak recommendations based on the amount and consistency of evidence, including degree of efficacy and safety, are: 1) epidural injections for herpes zoster; 2) steroid injections for radiculopathy; 3) SCS for FBSS; and 4) SCS for CRPS type 1. Based on the available data, we recommend not to use sympathetic blocks for PHN nor radiofrequency lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available data. Whenever possible, these interventions should either be part of randomized clinical trials or documented in pain registries. Priorities for future research include randomized clinical trials, long-term studies, and head-to-head comparisons among different interventional and noninterventional treatments.
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Affiliation(s)
- Robert H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA Department of Neurology, Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA University of Rochester, Rochester, NY, USA Stanford University, Palo Alto, CA, USA Johns Hopkins University, Baltimore, MD, USA Oregon Health and Science University, Portland, OR, USA Northwestern University, Chicago, IL, USA University of Wisconsin, Madison, WI, USA University of Kiel, Kiel, Germany Schmerzfachpraxis, Krefeld, Germany University of Washington, Seattle, WA, USA Universität Heidelberg, Mannheim, Germany Pain Matters, Liverpool, UK
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2325
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Wagner K, Uherek M, Horstmann S, Kadish NE, Wisniewski I, Mayer H, Buschmann F, Metternich B, Zentner J, Schulze-Bonhage A. Memory outcome after hippocampus sparing resections in the temporal lobe. J Neurol Neurosurg Psychiatry 2013; 84:630-6. [PMID: 23345282 DOI: 10.1136/jnnp-2012-304052] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE Epilepsy surgery within the temporal lobe of the language dominant hemisphere bears the risk of postoperative verbal memory decline. As surgical procedures have become more tailored, the question has arisen, which type of resection within the temporal lobe is more favourable for memory outcome. Since the hippocampus (HC) is known to play an essential role for long-term memory, we examined whether HC sparing resections help to preserve verbal memory functions. METHODS We retrospectively analysed neuropsychological data (prior to and 1 year after surgery) of patients undergoing either HC sparing resections (HC-S, N=65) or resections including the hippocampus (HC-R, N=62). RESULTS Prior to surgery, the HC-R group showed worse memory performance as compared to HC-S patients. Both patient groups revealed further deterioration over time, but in verbal learning HC-R patients demonstrated a stronger decline. Predictors for verbal learning decline were left-sided surgery, better preoperative performance, higher age at surgery, hippocampus resection, and lower preoperative IQ. In patients with spared HC, resection of the left-sided parahippocampal gyrus was rather accompanied by a decline in verbal learning performance. For visual memory, better preoperative performance best predicted deterioration after surgery. Seizure outcome was comparable between the two groups (HC-S: 66%, HC-R: 65% Engel 1a). CONCLUSIONS Temporal lobe resections within the language dominant hemisphere can be accompanied by a decline in verbal memory performance, even if the HC is spared. Yet, HC sparing surgery is associated with a benefit in verbal learning performance. These results can help when counselling patients prior to epilepsy surgery.
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Affiliation(s)
- Kathrin Wagner
- Epilepsy Centre, University Hospital Freiburg, Breisacher Str. 64, Freiburg 79106, Germany.
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2326
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Lequin MB, Verbaan D, Jacobs WCH, Brand R, Bouma GJ, Vandertop WP, Peul WC. Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial. BMJ Open 2013; 3:bmjopen-2012-002534. [PMID: 23793663 PMCID: PMC3657649 DOI: 10.1136/bmjopen-2012-002534] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study describes the 5 years' results of the Sciatica trial focused on pain, disability, (un)satisfactory recovery and predictors for unsatisfactory recovery. DESIGN A randomised controlled trial. SETTING Nine Dutch hospitals. PARTICIPANTS Five years' follow-up data from 231 of 283 patients (82%) were collected. INTERVENTION Early surgery or an intended 6 months of conservative treatment. MAIN OUTCOME MEASURES Scores from Roland disability questionnaire, visual analogue scale (VAS) for leg and back pain and a Likert self-rating scale of global perceived recovery were analysed. RESULTS There were no significant differences between groups on the 5 years' primary outcome scores. Despite at least 6 months of conservative treatment 46% of the conservatively allocated patients were treated surgically because of severe leg pain and disability. Forty-nine (21%) patients had an unsatisfactory recovery at 5 years and the recovery pattern showed that there was a variable group of 66 patients (31%) with at least one unsatisfactory outcome at 1, 2 or 5 years of follow-up. Multivariate logistic regression showed that age (>40; OR 2.42 (95% CI 1.16 to 5.02)), severity of leg pain (VAS >70; OR 3.32 (95% CI 1.69 to 6.54)) and the Mc Gill affective score (score >3; OR 6.23 (95% CI 2.23 to 17.38)) were the only significant predictors for an unsatisfactory outcome at 5 years. CONCLUSIONS In the long term, 8% of the patients with sciatica never showed any recovery and in at least 23%, sciatica appears to result in ongoing complaints, which fluctuate over time, irrespective of treatment. Prolonged conservative care might give patients a fair chance for pain and disability to resolve without surgery, but with the risk to receive delayed surgery after prolonged suffering of sciatica. Age above 40 years, severe leg pain at baseline and a higher affective Mc Gill pain score were predictors for unsatisfactory recovery. Trial Registry ISRCT No 26872154.
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Affiliation(s)
- Michiel B Lequin
- Department of Neurosurgery, Academic Medical Center, Neurosurgical Center Amsterdam, Amsterdam, The Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Academic Medical Center, Neurosurgical Center Amsterdam, Amsterdam, The Netherlands
| | - Wilco C H Jacobs
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ronald Brand
- Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerrit J Bouma
- Department of Neurosurgery, Academic Medical Center, Neurosurgical Center Amsterdam, Amsterdam, The Netherlands
| | - William P Vandertop
- Department of Neurosurgery, Academic Medical Center, Neurosurgical Center Amsterdam, Amsterdam, The Netherlands
| | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
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2327
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Affiliation(s)
- M Ross Bullock
- Department of Neurosurgery, University of Miami, Miami, Florida, USA.
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2328
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Affiliation(s)
- F-X Liebel
- Davies veterinary specialists, Higham Gobion, UK.
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2329
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Affiliation(s)
- Giovanni Broggi
- Department of Neurosurgery, Istituto Neurologico Carlo Besta of Milano, Milan and Department of Neurosurgery, Istituto O.Galeazzi, Milan, Italy.
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2330
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Affiliation(s)
- Robert M Starke
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA; Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aaron S Dumont
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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2331
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Affiliation(s)
- Kevin Mohee
- School of Medicine, University of Leeds, School of Medicine, Leeds, UK.
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2332
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Abstract
Traumatic brain injury (TBI) remains a major public health problem. This review aims to present the principles upon which modern TBI management should be based. The early management phase aims to achieve haemodynamic stability, limit secondary insults (eg hypotension, hypoxia), obtain accurate neurological assessment and appropriately select patients for further investigation. Since 2003, the mainstay of risk stratification in the UK emergency departments has been a system of triage based on clinical assessment, which then dictates the need for a CT scan of the head. For patients with acute subdural or extradural haematomas, time from clinical deterioration to operation should be kept to a minimum, as it can affect their outcome. In addition, it is increasingly recognised that patients with severe and moderate TBI should be managed in neuroscience centres, regardless of the need for neurosurgical intervention. The monitoring and treatment of raised intracranial pressure is paramount for maintaining cerebral blood supply and oxygen delivery in patients with severe TBI. Decompressive craniectomy and therapeutic hypothermia are the subject of ongoing international multi-centre randomised trials. TBI is associated with a number of complications, some of which require specialist referral. Patients with post-concussion syndrome can be helped by supportive management in the context of a multi-disciplinary neurotrauma clinic and by patient support groups. Specialist neurorehabilitation after TBI is important for improving outcome.
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Affiliation(s)
- Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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2333
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Goodrich JT. Models of functional cerebral localization at the dawning of modern neurosurgery--a perspective on these remarkable events. World Neurosurg 2013; 81:300-1. [PMID: 23416780 DOI: 10.1016/j.wneu.2013.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 02/08/2013] [Indexed: 11/25/2022]
Affiliation(s)
- James Tait Goodrich
- Division of Pediatric Neurosurgery, Leo Davidoff Department of Neurological Surgery, Children's Hospital at Montefiore, Montefiore; and Clinical Neurosurgery, Pediatrics, Plastic and Reconstructive Surgery, Albert Einstein College of Medicine, Bronx, New York, USA.
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2334
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Zhang ZY, Yao Y, Zhou LF. To err is human--medicolegal issues and safe care in neurosurgery. World Neurosurg 2014; 81:244-6. [PMID: 23403343 DOI: 10.1016/j.wneu.2013.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 02/02/2013] [Indexed: 11/21/2022]
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2335
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Thongrong C, Kong N, Govindarajan B, Allen D, Mendel E, Bergese SD. Current purpose and practice of hypertonic saline in neurosurgery: a review of the literature. World Neurosurg 2014; 82:1307-18. [PMID: 23402866 DOI: 10.1016/j.wneu.2013.02.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 02/05/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To review and summarize controversies and current concepts regarding the use of hypertonic saline during the perioperative period in neurosurgery. METHODS Relevant literature was searched on PubMed and Scopus electronic databases to identify all studies that have investigated the use of hypertonic saline in neurosurgery. RESULTS Fluid management during the course of neurosurgical practice has been debated at length, especially strategies to control intracranial pressure and small volume resuscitation. The goal of fluid therapy includes minimizing cerebral edema, preserving intravascular volume, and maintaining cerebral perfusion pressure. Mannitol is widely recognized as the gold standard for treating intracranial hypertension but can result in systemic hypotension. Thus, hypertonic saline provides volume expansion and may improve cerebral and systemic hemodynamics. Recently published prospective data, however, regarding the use of osmotic agents fails to establish clear guidelines in neurosurgical patients. CONCLUSIONS We suggest that hypertonic saline will emerge as an alternative to mannitol, especially for a long-term use or multiple doses are needed and lead to a great opportunity for collaborative research.
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2336
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Bean JR. The search for sanctuary. World Neurosurg 2013; 81:242-3. [PMID: 23376391 DOI: 10.1016/j.wneu.2013.01.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Affiliation(s)
- James Richard Bean
- Neurosurgical Associates, Central Baptist Hospital, Lexington, Kentucky, USA.
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2337
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Quintana LM. Let's focus on preventive strategies: about medical-legal aspects in neurosurgery. World Neurosurg 2014; 81:240-1. [PMID: 23376393 DOI: 10.1016/j.wneu.2013.01.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
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2338
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Nakamura M, Montibeller GR, Götz F, Krauss JK. Microsurgical clipping of previously coiled intracranial aneurysms. Clin Neurol Neurosurg 2013; 115:1343-9. [PMID: 23352715 DOI: 10.1016/j.clineuro.2012.12.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/09/2012] [Accepted: 12/23/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Endovascular coiling techniques for the treatment of intracranial aneurysms have rapidly developed as an alternative option to surgical clipping. A distinct problem after endovascular coiling is the management of a residual aneurysm neck due to incomplete filling, compaction of coils or regrowth of the aneurysm. Treatment options in this situation include surgical clipping, re-coiling, stent implantation or observation. METHODS From June 2006 to August 2011, 15 patients underwent surgical clipping of residual or recurrent aneurysms after previous endovascular treatment. The mean age of the patients was 50.6 years (range, 27-85 years). The mean interval between coiling and clipping was 76.5 weeks (range, 0-288 weeks). RESULTS Thirteen patients revealed a regrowth of coiled aneurysms, and in 5 patients compaction of coils was present. Coil extrusion was observed in 9 patients intraoperatively. In case of coil obstruction at the aneurysmal neck during surgery, coils were partially or completely removed. In all cases complete occlusion of the aneurysms was surgically achieved. CONCLUSION Coiled aneuryms with incomplete occlusion, coil compaction or regrowth of the aneurysmal neck can be successfully treated with microsurgical clipping. Coil extrusion was more often observed intraoperatively than expected. Complete occlusion of the aneurysm can be performed safely, even if loops of coils protrude into the aneurysmal neck. In these cases intraoperative removal of the coils enables secure closure of the aneurysm with a surgical clip.
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Affiliation(s)
- Makoto Nakamura
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
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2339
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Affiliation(s)
- Daniel L Barrow
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
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2340
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de Almeida AN, Alho EJ, Teixeira MJ. Models of functional cerebral localization at the dawning of modern neurosurgery. World Neurosurg 2013; 81:436-40. [PMID: 23314029 DOI: 10.1016/j.wneu.2013.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 08/25/2012] [Accepted: 01/08/2013] [Indexed: 11/17/2022]
Abstract
The concept of a functional cerebral localization gave the needed support for the development of neurosurgery as a specialty. It should be noted though that the presence of functions on discrete areas of the cortex was a very controversial topic at that time. The objective of this paper is to review models of cortical organization at the end of the 19th century, highlighting beliefs, theories, and controversies behind them. A better understanding of this historical moment is essential to appreciate the debate between holists and localizers that stirred neuroscientists worldwide in the first half of the 20th century.
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Affiliation(s)
| | - Eduardo Joaquim Alho
- Laboratory for Morphological Brain Research, Department of Psychiatry, University of Würzburg, Würzburg, Germany
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2341
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Emery E, Balossier A, Mertens P. Is the medicolegal issue avoidable in neurosurgery? A retrospective survey of a series of 115 medicolegal cases from public hospitals. World Neurosurg 2013; 81:218-22. [PMID: 23314027 DOI: 10.1016/j.wneu.2013.01.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 09/02/2012] [Accepted: 01/07/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Since the mid-1950s, neurosurgery has benefited from the remarkable progress due to tremendous advances in neuroimaging techniques, neuroanesthesia, neurostimulation, and brain-computer interfaces, as well as breakthroughs in operating microscopes and surgical instruments. Yet, this specialty has to do with delicate human structures and is hence considered as highly risky by insurance companies. In France, although neurosurgery's casualty rate (6%) is lower than in other specialties, the number of legal prosecutions has increased since 2002 because of easier access to medicolegal procedures. In order to avoid patients' resorting to the law courts, it becomes necessary to clearly identify the risk factors. METHODS From the data bank of the insurer Société Hospitalière d'Assurances Mutuelles (SHAM, main insurance company for public hospitals in France), we retrospectively analyzed 115 files (34 cranial and 81 spinal surgeries) covering the period 1997-2007 for the reasons for complaints against French neurosurgeons working in public hospitals. RESULTS Five main causes were identified: surgical site infection (37%), technical error (22%), lack of information (14%), delayed diagnosis (11%), and lack of supervision (9%). CONCLUSION Some causes are definitely avoidable at no cost to the hospital. Besides basic preventive safety procedures, we reiterate the mandatory steps for a good defense when being prosecuted. The evolution of patients' attitudes toward medical institutions observed in most countries has forced surgeons to adapt their practice. In this context, a common action certified by learned societies on sustainable health care quality, patient safety, and respect of good practices appears as the golden path to maintain a favorable legal, insurance, and financial environment.
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Affiliation(s)
- Evelyne Emery
- CHU de Caen, Service de Neurochirurgie, Caen, France; Université de Caen Basse-Normandie, UFR de Médecine, Caen, France
| | | | - Patrick Mertens
- Service de Neurochirurgie, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, Faculté de Médecine, Université Lyon 1, Lyon, France
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2342
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Shokouhi G, Ghojazadeh M, Sattarnezhad N. Organizing Evidence Based Medicine (EBM) Journal Clubs in Department of Neurosurgery, Tabriz University of Medical Sciences. Int J Health Sci (Qassim) 2012; 6:59-62. [PMID: 23267304 DOI: 10.12816/0005973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION A journal club is a group of individuals who meet regularly to evaluate critically the clinical application of latest medical literature. Evidence-based medicine (EBM) is 'the use of current best evidence, in making decisions about the care of individual patients'. For this purpose, we organized journal clubs using standard EBM method, to substitute for traditional ones, evaluating efficacy of evidence based meetings in improvement of medical education in department of Neurosurgery. METHODS AND MATERIALS After six traditional journal clubs two validated questionnaires (evaluating organizing method and degree of satisfaction), were filled out by the residents. After an instructing workshop and six evidence based journal sessions, the same questionnaires were completed by the attendees. The collected data were analyzed using SPSS 17. RESULTS The mean score of the first questionnaires (Evaluating the method of organizing sessions) 16.72±7.86 (median=14) for traditional journal clubs and 40.18±6.38 (median=40) for evidence based forms (P=0.003).The mean grade of the second questionnaires (degree of satisfaction) was 13.18±4.6 (median=14) and 21.90±4.27 (median=22), for traditional and evidence based ones, respectively. (P=0.006). CONCLUSION The aim of evidence based journal club is to help individuals to evaluate the current literature critically. The best way to decide if any adjustments are necessary is to ask the participants whether they are satisfied with the conference. As improvement of critical judgment is the goal of the journal clubs, the response of the resident according to the knowledge of methodology and biostatistics, is a principle. In present study, significant improvement in critical appraisal skills was seen after holding evidence based journal clubs.
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Affiliation(s)
- Ghaffar Shokouhi
- Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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2343
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Herreras Gutiérrez JL, Gilsanz Rodríguez F. [Pneumocephalus as a cause of a decrease in the bispectral index]. ACTA ACUST UNITED AC 2012; 61:43-6. [PMID: 23261226 DOI: 10.1016/j.redar.2012.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 10/15/2012] [Accepted: 10/22/2012] [Indexed: 11/16/2022]
Abstract
A sharp decrease in the values of the bispectral index (BIS), along with an increase in suppression rate, was observed in a patient after the removal of an epidermoid tumor in the cerebellopontine angle by right retrosigmoid access under general anesthesia. This was probably related to a frontal pneumocephalus. No accompanying neurological signs were observed. The patient was extubated in the Recovery Room with no further incidents, as the BIS increased again. The neurosurgeons chose conservative treatment, relying on the reabsorption and redistribution of the air.
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Affiliation(s)
| | - F Gilsanz Rodríguez
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
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2344
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Subramanian A, Sagar S, Kumar S, Agrawal D, Albert V, Misra MC. Maximum surgical blood ordering schedule in a tertiary trauma center in northern India: A proposal. J Emerg Trauma Shock 2012; 5:321-7. [PMID: 23248501 PMCID: PMC3519045 DOI: 10.4103/0974-2700.102391] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 05/23/2011] [Indexed: 11/30/2022] Open
Abstract
Context: Over ordering of blood is a common practice in elective surgical practice. Considerable time and effort is spent on cross-matching for each patient undergoing a surgical procedure. Aims: The aim of this study was to compile and review the blood utilization for two key departments (Neurosurgery and Surgery) in a level 1 trauma center. A secondary objective was to formulate a rational blood ordering practice for elective procedures for these departments. Materials and Methods: Analysis of prospectively compiled blood bank records of the patients undergoing elective surgical, neurosurgical procedures was carried out between April 2007 and March 2009. Indices such as the cross-matched/transfused ratio (C/T ratio), transfusion index and transfusion probability were calculated. The number of red cell units required for each procedure was calculated using the equation proposed by Nuttall et al, using preoperative hemoglobin and postoperative hemoglobin for each elective surgical procedure. Results: There were 252 surgery patients (age range: 2-80 years) in the study. One thousand and eighty-eight units of blood were cross-matched, 432 were transfused (CT ratio 2.5). 44.0% patients did not require transfusion during entire hospital stay. Three (50%) elective procedures had CT ratio >2.5and 4 (66.6%) elective procedures had TI <0.5. There were 200 neurosurgery patients (age range: 2-62 years) in the study. Total 717 units of blood were cross-matched and 161 transfused (CT ratio 4.5). Nine elective procedures had CT ratio >2.5, with five of them exceeding 4. In procedures like spinal instrumentation the CT ratio was <2.5 and 10 (90.9%) of elective procedures had TI <0.5. Conclusions: In this study 40% and 22% of cross-matched blood was being utilized for elective general surgery and neurosurgical procedures, respectively. The calculated required blood units for all elective Trauma surgery procedures were more than 2 units. The calculated required blood units were less than 0.5 units in four of the 11 neurosurgical procedures, and hence only one unit should be arranged for them. It is crucial for every institutional blood bank to formulate a blood ordering schedule. Regular auditing and periodic feedbacks are also vital to improve the blood utilization practices.
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Affiliation(s)
- Arulselvi Subramanian
- Blood Bank and Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
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2345
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Kim J, Kim CH, Kang HS, Park CK, Chung CK. Cognitive Function of Korean Neurosurgical Patients: Cross-sectional Study Using the Korean Version of the Mini-mental Status Examination. J Cerebrovasc Endovasc Neurosurg 2012; 14:11-21. [PMID: 23210025 PMCID: PMC3471253 DOI: 10.7461/jcen.2012.14.1.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 01/04/2012] [Accepted: 02/01/2012] [Indexed: 11/26/2022] Open
Abstract
Objective As interest in life quality and expectancy increases, cognitive dysfunction is becoming an important topic. Although there are many foreign articles on this topic, they require cultural interpretation to be applicable to Koreans. The purpose of this study was to assess cognitive function in Korean neurosurgical patients. Methods We recruited 214 adult Korean patients with various cerebral pathologies and treatments from an outpatient clinic. The male-to-female ratio was 88:126, and their ages ranged from 28 to 81 years (mean: 57.9 years). The Korean version of the mini-mental status examination (K-MMSE) was adopted as an instrument for measuring cognitive function, and a score ≤23 was defined as cognitive dysfunction. K-MMSE scores were analyzed considering the patients' gender, age, time elapsed since treatments, pathology and treatment modality. A serial analysis was performed for 59 patients who completed the K-MMSE more than once. Results The mean K-MMSE score of 214 patients was 22.3, and 133 patients (62.1%) had a score ≤23. Cognitive dysfunction was common regardless of age, gender, pathology or treatment modality. Serial analysis revealed K-MMSE score improvement in 45 of 59 patients (76.3%). The mean time interval between two tests was 11.9 months, and the mean K-MMSE score improvement was 2.7, which was statistically significant (P = 0.000). However, many still had cognitive impairment. Conclusion Most Korean neurosurgical patients showed cognitive dysfunction despite improvement after several months. Patients with trauma or ischemic disease were more vulnerable. More attention should be paid to neuropsychological complications such as cognitive dysfunction.
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Affiliation(s)
- Jiha Kim
- Department of Neurosurgery, Kangwon National University Hospital, Seoul, Korea
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2346
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Dhaliwal P, Benzel EC. Refocusing continuing medical education in neurosurgery. World Neurosurg 2013; 80:e103-4. [PMID: 23165174 DOI: 10.1016/j.wneu.2012.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/09/2012] [Indexed: 11/23/2022]
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2347
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Affiliation(s)
- Dattatraya Muzumdar
- Department of Neurosurgery, Seth G.S.Medical College and King Edward VII Memorial hospital, Parel, Mumbai, India
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2348
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Rezaei S, Asgari K, Yousefzadeh S, Moosavi HA, Kazemnejad E. Effects of neurosurgical treatment and severity of head injury on cognitive functioning, general health and incidence of mental disorders in patients with traumatic brain injury. Arch Trauma Res 2012; 1:93-100. [PMID: 24396755 PMCID: PMC3876538 DOI: 10.5812/atr.6546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 08/14/2012] [Accepted: 09/05/2012] [Indexed: 11/16/2022]
Abstract
Background Neurosurgical treatment and the severity of head injury (HI) can have remarkable effect on patients’ neuropsychiatric outcomes. Objectives This research aimed to study the effect of these factors on cognitive functioning, general health and incidence of mental disorders in patients with a traumatic brain injury (TBI). Patients and Methods In this descriptive, longitudinal study, 206 TBI patients entered the study by consecutive sampling; they were then compared according to neurosurgery status and severity of their HI. Both groups underwent neurosurgical and psychological examinations. The mini mental state examination (MMSE) and general health questionnaire–28 items (GHQ-28) were administered to the study participants. At follow-up, four months later, the groups underwent a structured clinical interview by a psychiatrist based on the diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) diagnostic criteria regarding the presence of mental disorders. Results Analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA) were performed and adjusted for the effect of confounding variables (age, gender, Glasgow outcome scale (GOS) , and level of education). The severity of HI had the most significant effect for the following variables; cognitive functioning and physical symptoms (P < 0.05). The effect of the neurosurgical treatment factor was not significant; however, the interaction effect of the two variables on social dysfunction, and total score of the GHQ-28 questionnaire appeared to be significant (P < 0.05). Fisher's exact test indicated that after a four month follow-up period, no significant differences were seen between the two groups (with or without neurosurgery) in the incidence of mental disorders, while χ2 Test showed that having a more severe HI is significantly correlated with the incidence of mental disorders (P < 0.01). Conclusions The implications of this study should be discussed with an emphasis on negative, effective factors on the cognitive – behavioral and neuropsychiatric outcomes of a TBI.
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Affiliation(s)
- Sajjad Rezaei
- Guilan Road Trauma Research Center, Department of Psychology, University of Isfahan, Isfahan, IR Iran
- Corresponding author: Sajjad Rezaei, Guilan Road Trauma Research Center and Department of Psychology, University of Isfahan, Isfahan, IR Iran. Tel.: +98-9113390785, Fax: +98-1313238373, E-mail:
| | - Karim Asgari
- Department of Psychology, University of Isfahan, Isfahan, IR Iran
| | - Shahrokh Yousefzadeh
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran
| | | | - Ehsan Kazemnejad
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran
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2349
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Do WS, Kim TK, Kim HK, Kim CH. The EC(50) of remifentanil to minimize the cardiovascular changes during head holder pinning in neurosurgery. Korean J Anesthesiol 2012; 63:327-33. [PMID: 23115685 PMCID: PMC3483491 DOI: 10.4097/kjae.2012.63.4.327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/05/2012] [Accepted: 05/09/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During neuroanesthesia, head holder pinning commonly results in sympathetic stimulation manifested by hemodynamic changes, such as increased heart rate and arterial blood pressure. Remifentanil has been used successfully to control acute autonomic responses during neurosurgical procedures. The objective of this study was to determine effect-site concentration of remifentanil for suppressing the hemodynamic response to head holder pinning with the probability of 50% (EC(50)). METHODS Forty-one ASA physical status I or II patients, between the ages of 20-70, who were scheduled for neurosurgery were recruited into this study. After arrival in the operating room, standard monitoring was applied throughout the study, which included a bispectral index monitor. Both propofol and remifentanil were administered by Target-control infusion device. The Dixon "up-and-down" sequential allocation method was used to determine the EC(50) of remifentanil. RESULTS The EC(50) of remifentanil was 2.19 ± 0.76 ng/ml by the turning point estimate (TPE). In probit analysis, EC(50) was 2.42 ng/ml (95% CI : -0.62-4.66) and EC(95) was 5.70 ng/ml (95% CI : 4.02-67.53). The EC(50) estimator comes from isotonic regression is 2.90 ng/ml (95% CI : 1.78-3.65). The EC(95) estimator comes from isotonic regression is 4.28 ng/ml (95% CI : 3.85-4.41). CONCLUSIONS This study showed that EC(50) of remifentanil was 2.19 ± 0.76 ng/ml by TPE. EC(50) was 2.42 ng/ml (95% CI -0.62-4.66) in probit analysis, as back up analysis. The EC(50) estimator comes from isotonic regression is 2.90 ng/ml (95% CI : 1.78-3.65).
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Affiliation(s)
- Wang Seok Do
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
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2350
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Coburger J, Leng LZ, Rubin DG, Mayaya G, Medel R, Ngayomela I, Ellegala D, Durieux ME, Nicholas J, Härtl R. Multi-institutional neurosurgical training initiative at a tertiary referral center in Mwanza, Tanzania: where we are after 2 years. World Neurosurg 2014; 82:e1-8. [PMID: 23023049 DOI: 10.1016/j.wneu.2012.09.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/18/2012] [Accepted: 09/24/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND The paucity of neurosurgical care in East Africa remains largely unaddressed. A sustained investment in local health infrastructures and staff training is needed to create an independent surgical capacity. The Madaktari organization has addressed this issue by starting initiatives to train local general surgeons and assistant medical officers in basic neurosurgical procedures. We report illustrative cases since beginning of the program in Mwanza in 2009 and focus on the most recent training period. METHODS A multi-institutional neurosurgical training program and a surgical database was created at a tertiary referral center in Mwanza, Tanzania. We collected clinical data on consecutive patients who underwent a neurosurgical procedure between September 9th and December 1st, 2011. All procedures were performed by a local surgeon under the supervision of a visiting neurosurgeon. Since the inception of the training initiative, comprehensive multidisciplinary training courses in Tanzania and an annual visiting fellowship for East African surgeons to travel to a major U.S. medical center have been established. RESULTS At initial visits infrastructure and feasibility of complex case scenarios was assessed. Surgeries for brain tumors and complex spinal cases were performed. During the 3-month training period, 62 patients underwent surgery. Pediatric hydrocephalus comprised 52% of patients, 11% suffered from meningomyelocelia, and 6% presented with an encephalocele. A total of 24% of patients were treated for trauma-related conditions, representing 75% of the adult patients. A total of 10% of patients had surgery because of traumatic spine injury, and 15% of operations were on patients with severe head injury. A total of 6% of patients presented with degenerative spine disease. One patient sustained a fatal perioperative complication. At the end of the training period, the local general surgeon was able to perform all basic neurosurgical cases independently. CONCLUSIONS Neurosurgical care in Tanzania needs to address a diverse, unique disease burden. We found that local surgeons could be enabled to safely perform basic cranial and spinal neurosurgical procedures through immersive, 1-on-1 on-site collaborations, multidisciplinary courses, and educational visiting fellowships.
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