Pub Date : 2021-09-15DOI: 10.33962/roneuro-2021-062
Ivan David Lozada Marintez, O. J. Díaz-Castillo, M. G. Ortega-Sierra, Jhon Jairo González-Monterroza, Teddy Javier Padilla-Durán, H. S. Castillo-Pastuzan, J. Robledo-Arias, M. Bolaño-Romero, A. Pacheco-Hernandez, L. Moscote-Salazar
The extent and progression of neurological impairment in traumatic brain injury depend significantly on the area of perilesional gloom, where neuronal apoptosis occurs. Inhibition of apoptosis becomes a therapeutic strategy to preserve brain tissue and promote functional recovery. Hyperbaric oxygen therapy is a treatment by which 100% oxygen is administered, with the aim of achieving a higher pressure than atmospheric pressure at sea level, to decrease ischemia and intensity of inflammatory processes triggered, compromising the viability of the tissues. For mild traumatic brain injury, studies indicate that hyperbaric oxygen therapy is no better than sham treatment. For acute treatment of moderate to severe traumatic brain injury, although the methodology is questionable in certain studies due to the complexity of the brain injury, hyperbaric oxygen therapy has been shown to be beneficial as a relatively safe adjunctive therapy. The objective of this review is to discuss aspects related to the pathophysiology of traumatic brain injury, the mechanism of action of hyperbaric oxygen therapy, and correlate these results with the use of this therapy in the prevention of neuronal injury, supported by original studies reported in the scientific literature
{"title":"Hyperbaric oxygen therapy","authors":"Ivan David Lozada Marintez, O. J. Díaz-Castillo, M. G. Ortega-Sierra, Jhon Jairo González-Monterroza, Teddy Javier Padilla-Durán, H. S. Castillo-Pastuzan, J. Robledo-Arias, M. Bolaño-Romero, A. Pacheco-Hernandez, L. Moscote-Salazar","doi":"10.33962/roneuro-2021-062","DOIUrl":"https://doi.org/10.33962/roneuro-2021-062","url":null,"abstract":"The extent and progression of neurological impairment in traumatic brain injury depend significantly on the area of perilesional gloom, where neuronal apoptosis occurs. Inhibition of apoptosis becomes a therapeutic strategy to preserve brain tissue and promote functional recovery. Hyperbaric oxygen therapy is a treatment by which 100% oxygen is administered, with the aim of achieving a higher pressure than atmospheric pressure at sea level, to decrease ischemia and intensity of inflammatory processes triggered, compromising the viability of the tissues. For mild traumatic brain injury, studies indicate that hyperbaric oxygen therapy is no better than sham treatment. For acute treatment of moderate to severe traumatic brain injury, although the methodology is questionable in certain studies due to the complexity of the brain injury, hyperbaric oxygen therapy has been shown to be beneficial as a relatively safe adjunctive therapy. The objective of this review is to discuss aspects related to the pathophysiology of traumatic brain injury, the mechanism of action of hyperbaric oxygen therapy, and correlate these results with the use of this therapy in the prevention of neuronal injury, supported by original studies reported in the scientific literature","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47672355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.33962/roneuro-2021-049
Ulaş Yüksel, Mustafa Ogden, M. Karagedik, T. Kultur, B. Bakar
Background: Although age, comorbidity, duration and severity of symptoms, slippage degree, and flexion-extension slipping stability during X-ray imaging are effective in making a surgical decision in patients with spondylolisthesis, these factors are rarely based on definitive evidence. The aim of this study was to determine the efficacy of clinical, radiological and biochemical findings in surgical decision making in these patients. Materials and Methods: Patients’ data including age, gender, degree and type (i.e. degenerative or isthmic) of the spondylolisthesis, urinary incontinence, neurogenic claudication were recorded. Radiological imaging studies (lumbar dynamic X-ray, computed tomography, magnetic resonance imaging), serum glucose, C-reactive protein and erythrocyte sedimentation rate values of the patients obtained during hospital admissions were evaluated. Results: Forty patients were followed conservatively and 12 patients were treated surgically. Degenerative spondylolisthesis was seen in 22 patients. Nine patients had neurogenic urinary incontinence and 19 patients had neurogenic claudication. When the patients were divided into two groups with and without surgical treatment, the presence of the pars defect, slipping distance in a neutral position and slipping distance in flexion position was significantly different between groups. A positive correlation was found between pars defect and surgical treatment. Likelihood ratio test results revealed that the presence of pars defect, neurogenic claudication and neurogenic urinary incontinence could be the best parameters in decision making the surgical treatment. Conclusion: The presence of pars defect, neurogenic claudication and urinary incontinence could be the best parameters that may help the surgeon to make the surgical treatment decision.
{"title":"Possible predictive markers in surgical decision making in patients with degenerative or isthmic lumbar spondylolisthesis","authors":"Ulaş Yüksel, Mustafa Ogden, M. Karagedik, T. Kultur, B. Bakar","doi":"10.33962/roneuro-2021-049","DOIUrl":"https://doi.org/10.33962/roneuro-2021-049","url":null,"abstract":"Background: Although age, comorbidity, duration and severity of symptoms, slippage degree, and flexion-extension slipping stability during X-ray imaging are effective in making a surgical decision in patients with spondylolisthesis, these factors are rarely based on definitive evidence. The aim of this study was to determine the efficacy of clinical, radiological and biochemical findings in surgical decision making in these patients.\u0000Materials and Methods: Patients’ data including age, gender, degree and type (i.e. degenerative or isthmic) of the spondylolisthesis, urinary incontinence, neurogenic claudication were recorded. Radiological imaging studies (lumbar dynamic X-ray, computed tomography, magnetic resonance imaging), serum glucose, C-reactive protein and erythrocyte sedimentation rate values of the patients obtained during hospital admissions were evaluated.\u0000Results: Forty patients were followed conservatively and 12 patients were treated surgically. Degenerative spondylolisthesis was seen in 22 patients. Nine patients had neurogenic urinary incontinence and 19 patients had neurogenic claudication. When the patients were divided into two groups with and without surgical treatment, the presence of the pars defect, slipping distance in a neutral position and slipping distance in flexion position was significantly different between groups. A positive correlation was found between pars defect and surgical treatment. Likelihood ratio test results revealed that the presence of pars defect, neurogenic claudication and neurogenic urinary incontinence could be the best parameters in decision making the surgical treatment.\u0000Conclusion: The presence of pars defect, neurogenic claudication and urinary incontinence could be the best parameters that may help the surgeon to make the surgical treatment decision.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41604650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.33962/roneuro-2021-054
Abhishek Katyal, Daljit Singh
Background: Fibrous dysplasia is a fibro-osseous lesion of unclear aetiology wherein normal bone is replaced by abnormal fibrous tissue and immature bone. Fibrous dysplasia is associated with a defect in osteoblastic differentiation and maturation that originates in the mesenchymal precursor of the bone & is well documented to affect craniofacial structures. Case description: A case of the lesser sphenoid wing fibrous dysplasia is described which presented with symptoms of pressure effects on the optic nerve, managed subsequently with microsurgical decompression of the nerve. Conclusion: Craniofacial fibrous dysplasia is an uncommon entity which can present with loss of vision, wherein the visual prognosis depends upon timed & adequate surgical intervention.
{"title":"Fibrous dysplasia of sphenoid bone presenting as a case of loss of vision","authors":"Abhishek Katyal, Daljit Singh","doi":"10.33962/roneuro-2021-054","DOIUrl":"https://doi.org/10.33962/roneuro-2021-054","url":null,"abstract":"Background: Fibrous dysplasia is a fibro-osseous lesion of unclear aetiology wherein normal bone is replaced by abnormal fibrous tissue and immature bone. Fibrous dysplasia is associated with a defect in osteoblastic differentiation and maturation that originates in the mesenchymal precursor of the bone & is well documented to affect craniofacial structures.\u0000Case description: A case of the lesser sphenoid wing fibrous dysplasia is described which presented with symptoms of pressure effects on the optic nerve, managed subsequently with microsurgical decompression of the nerve.\u0000Conclusion: Craniofacial fibrous dysplasia is an uncommon entity which can present with loss of vision, wherein the visual prognosis depends upon timed & adequate surgical intervention.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42164434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.33962/roneuro-2021-059
L. Tyngkan, A. Singh, A. Bhat
The risk of hydrocephalus in posterior fossa tumour is quite high (71- 90%), cerebrospinal fluid (CSF) diversion procedures like ventriculoperitoneal (VP) shunt, Endoscopic third ventriculostomy (ETV) and external ventricular drainage (EVD) are emergency procedures and may improve symptoms like headache and vomiting. However, post-operative deterioration after CSF diversion should alert the clinician to the possibility of RBH which is rare (3%) and has a high mortality. We report a case of a 12-year female child with a left cerebellar lesion with hydrocephalus. VP shunt was done and her pupils revert back to normal size, two hours post-surgery her pupils become dilated and not reacting to light, an urgent CT was done which showed reverse brain herniation. Reverse brain herniation is a very rare complication after the CSF diversion procedure with a poor prognosis.
{"title":"A reverse brain herniation (RBH) after ventriculoperitoneal shunt (VP) in posterior fossa tumour with obstructive hydrocephalus","authors":"L. Tyngkan, A. Singh, A. Bhat","doi":"10.33962/roneuro-2021-059","DOIUrl":"https://doi.org/10.33962/roneuro-2021-059","url":null,"abstract":"The risk of hydrocephalus in posterior fossa tumour is quite high (71- 90%), cerebrospinal fluid (CSF) diversion procedures like ventriculoperitoneal (VP) shunt, Endoscopic third ventriculostomy (ETV) and external ventricular drainage (EVD) are emergency procedures and may improve symptoms like headache and vomiting. However, post-operative deterioration after CSF diversion should alert the clinician to the possibility of RBH which is rare (3%) and has a high mortality. We report a case of a 12-year female child with a left cerebellar lesion with hydrocephalus. VP shunt was done and her pupils revert back to normal size, two hours post-surgery her pupils become dilated and not reacting to light, an urgent CT was done which showed reverse brain herniation. Reverse brain herniation is a very rare complication after the CSF diversion procedure with a poor prognosis.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46519666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.33962/roneuro-2021-055
Ashutosh Roy, Somil Jaiswal, B. Ojha, C. Srivastava
Objective: Covid19 pandemic challenged the global healthcare system and both developed and developing countries responded with their might to fight this global pandemic. Road traffic accidents are a major cause of morbidity and mortality in India and we studied the impact of lockdown on neurosurgery trauma patients in a tertiary care centre in India. Methods: Indian government announced complete lockdown on 25th march 2020 and India remained in complete lockdown till 31st May 2020. We included the patients admitted from 1st January 2020 to 24th March 2020 in pre lockdown period and25th march to In this cross-sectional study we divided the patients into two groups of pre lockdown and lockdown period and incidence of neurosurgery trauma patients was assessed for Road Traffic Accident, assault, hit by animal and fall from height. Result: In our study 491 patients were admitted in pre lockdown and 369 patients were admitted in lockdown period. Road traffic accident patients were more in pre lockdown 39.5% (n=194) as compared to lockdown period 31.2% (n=115). However, cases of assaults were more in the lockdown period (14.6%, n=54) as compared to pre lockdown (3.9%, n=19). The death rate in neurosurgery trauma patients reduced significantly in lockdown (7.3%, n=27) as compared to pre lockdown (21.8%, n=107). Conclusion: The COVID19 pandemic induced lockdown resulted in a decrease in motor vehicle movements which further decreased the incidence of RTA and related trauma however incidence of assault-related trauma and cases increased significantly in this period. The overall outcome of such patients improved probably due to better utilization of available health care facilities.
{"title":"The impact of lockdown on incidence of neurosurgery trauma patients in India","authors":"Ashutosh Roy, Somil Jaiswal, B. Ojha, C. Srivastava","doi":"10.33962/roneuro-2021-055","DOIUrl":"https://doi.org/10.33962/roneuro-2021-055","url":null,"abstract":"Objective: Covid19 pandemic challenged the global healthcare system and both developed and developing countries responded with their might to fight this global pandemic. Road traffic accidents are a major cause of morbidity and mortality in India and we studied the impact of lockdown on neurosurgery trauma patients in a tertiary care centre in India.\u0000Methods: Indian government announced complete lockdown on 25th march 2020 and India remained in complete lockdown till 31st May 2020. We included the patients admitted from 1st January 2020 to 24th March 2020 in pre lockdown period and25th march to In this cross-sectional study we divided the patients into two groups of pre lockdown and lockdown period and incidence of neurosurgery trauma patients was assessed for Road Traffic Accident, assault, hit by animal and fall from height.\u0000Result: In our study 491 patients were admitted in pre lockdown and 369 patients were admitted in lockdown period. Road traffic accident patients were more in pre lockdown 39.5% (n=194) as compared to lockdown period 31.2% (n=115). However, cases of assaults were more in the lockdown period (14.6%, n=54) as compared to pre lockdown (3.9%, n=19). The death rate in neurosurgery trauma patients reduced significantly in lockdown (7.3%, n=27) as compared to pre lockdown (21.8%, n=107).\u0000Conclusion: The COVID19 pandemic induced lockdown resulted in a decrease in motor vehicle movements which further decreased the incidence of RTA and related trauma however incidence of assault-related trauma and cases increased significantly in this period. The overall outcome of such patients improved probably due to better utilization of available health care facilities.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47289911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.33962/roneuro-2021-048
Surendra Gupta, D. Singh, A. Chhabra, M. Kaif, Kuldeep Yadav, R. Singh
Introduction: Functional improvement in lumbar PIVD patients can be assessed either objectively like improvement in SLRT, relief in pain, etc or subjectively using different types of scales. In our study, we have used Revised Oswestry Disability Index (RODI) score, Ronald–Morris disability questionnaire (RDQ), The Back Bournemouth Questionnaire (BQ) to analyse functional outcome in single and double level lumbar PIVD patients pre-operatively and post-operatively. Method: It is a prospective study including 80 patients of lumbar PIVD who failed to respond to conservative treatment. Patients were clinically evaluated and disability scales viz- RODI, RDQ & BQ were recorded. After lumber discectomy, patients were again assessed and scored as per disability scales at 1 month, 6 months and 1 year postoperatively. Result: RODI, RDQ and BQ scores were calculated at pre-operatively and post-operatively 1, 6 and 12 months and statistically analysed. The mean RODI scores at pre-operative and postoperative 1, 6, and 12 months were 72, 18, 10, and 6 respectively. The mean RDQ scores at pre-operative and postoperative 1, 6, and 12 months were 15, 5, 3, and 2 respectively. Similarly, the mean BQ scores at pre-operative and postoperative 1, 6, and 12 months were 51, 12, 8, and 4 respectively. Statistically, significant improvement was seen in mean scores of all 3 functional scales and maximum changes were observed after 1 month. Statistically, significant improvements were observed in 54 out of 62 patients (87%). Three questions of BQ related to the patient social and family activities, anxiety and depression were separately compared pre and post-operatively and they showed a statistically significant improvement. Conclusion: Overall 87% of patients had a significant improvement in functional assessment using RODI, RDQ and BQ scales. On comparing single and double level discectomy patients, the functional improvement was similar in follow up of one year. Social and family activities (SFA), depression and anxiety of the patients improved significantly over 1 year.
{"title":"Analysis of functional outcome of single and double level lumbar discectomy","authors":"Surendra Gupta, D. Singh, A. Chhabra, M. Kaif, Kuldeep Yadav, R. Singh","doi":"10.33962/roneuro-2021-048","DOIUrl":"https://doi.org/10.33962/roneuro-2021-048","url":null,"abstract":"Introduction: Functional improvement in lumbar PIVD patients can be assessed either objectively like improvement in SLRT, relief in pain, etc or subjectively using different types of scales. In our study, we have used Revised Oswestry Disability Index (RODI) score, Ronald–Morris disability questionnaire (RDQ), The Back Bournemouth Questionnaire (BQ) to analyse functional outcome in single and double level lumbar PIVD patients pre-operatively and post-operatively.\u0000Method: It is a prospective study including 80 patients of lumbar PIVD who failed to respond to conservative treatment. Patients were clinically evaluated and disability scales viz- RODI, RDQ & BQ were recorded. After lumber discectomy, patients were again assessed and scored as per disability scales at 1 month, 6 months and 1 year postoperatively.\u0000Result: RODI, RDQ and BQ scores were calculated at pre-operatively and post-operatively 1, 6 and 12 months and statistically analysed. The mean RODI scores at pre-operative and postoperative 1, 6, and 12 months were 72, 18, 10, and 6 respectively. The mean RDQ scores at pre-operative and postoperative 1, 6, and 12 months were 15, 5, 3, and 2 respectively. Similarly, the mean BQ scores at pre-operative and postoperative 1, 6, and 12 months were 51, 12, 8, and 4 respectively. Statistically, significant improvement was seen in mean scores of all 3 functional scales and maximum changes were observed after 1 month. Statistically, significant improvements were observed in 54 out of 62 patients (87%). Three questions of BQ related to the patient social and family activities, anxiety and depression were separately compared pre and post-operatively and they showed a statistically significant improvement.\u0000Conclusion: Overall 87% of patients had a significant improvement in functional assessment using RODI, RDQ and BQ scales. On comparing single and double level discectomy patients, the functional improvement was similar in follow up of one year. Social and family activities (SFA), depression and anxiety of the patients improved significantly over 1 year.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43781539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.33962/roneuro-2021-064
D. Chouksey, N. Goyal, Rishu Garg, A. Sodani
Gliomas are malignant, and intrinsic cerebral tumours may cause tumour-infiltrative oedema. Meningiomas are mostly benign, extrinsic cerebral tumours that do not infiltrate the surrounding parenchyma. Meningiomas may give rise to vasogenic oedema in the peritumoral tissue.[1] The radiological diagnosis of cerebral tumours may be non-conclusive on conventional MRI in few cases, and diagnosis must rely on histopathological analysis. [2] We report a case that has an atypical clinical presentation with nonconclusive MRI brain, and finally, histopathology confirmed the diagnosis.
{"title":"Letter to the editor. Face-off between glioma and meningioma","authors":"D. Chouksey, N. Goyal, Rishu Garg, A. Sodani","doi":"10.33962/roneuro-2021-064","DOIUrl":"https://doi.org/10.33962/roneuro-2021-064","url":null,"abstract":"Gliomas are malignant, and intrinsic cerebral tumours may cause tumour-infiltrative oedema. Meningiomas are mostly benign, extrinsic cerebral tumours that do not infiltrate the surrounding parenchyma. Meningiomas may give rise to vasogenic oedema in the peritumoral tissue.[1] The radiological diagnosis of cerebral tumours may be non-conclusive on conventional MRI in few cases, and diagnosis must rely on histopathological analysis. [2] We report a case that has an atypical clinical presentation with nonconclusive MRI brain, and finally, histopathology confirmed the diagnosis.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44338039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.33962/roneuro-2021-045
S. Mass-Ramirez, Carmen Sierra-Ochoa, Ivan David Lozada Marintez, B. Aristizábal-Carmona, Juan Esteban Suárez-Muñoz, Lina Marcela Ortiz-Roncallo, José David Rubiano-Buitrago, Bryan Hernández-Nieto, S. A. Barahona-Botache, Julián Eduardo Cárdenas-Mayorga, L. Moscote-Salazar
Nimodipine is a drug belonging to the group of calcium channel blockers, very well tolerated, widely recognized for its central action as a vasodilator preventing vasospasm secondary to aneurysmal subarachnoid haemorrhage. It is currently approved as a drug used in the treatment of this type of haemorrhage, mainly because it is effective in reducing neurological deficits due to delayed cerebral ischemia. In addition, due to its relaxing action on the cerebral vascular musculature and its facility to cross the blood-brain barrier, it has multiple functions in other types of cerebral vascular lesions such as ischemic stroke and other neurological conditions involving stress or cell death. Its role as a prophylactic agent in the treatment of migraine and its effect as a neuroprotective agent have also been evaluated.
{"title":"Essentials of nimodipine in neurocritical care patients","authors":"S. Mass-Ramirez, Carmen Sierra-Ochoa, Ivan David Lozada Marintez, B. Aristizábal-Carmona, Juan Esteban Suárez-Muñoz, Lina Marcela Ortiz-Roncallo, José David Rubiano-Buitrago, Bryan Hernández-Nieto, S. A. Barahona-Botache, Julián Eduardo Cárdenas-Mayorga, L. Moscote-Salazar","doi":"10.33962/roneuro-2021-045","DOIUrl":"https://doi.org/10.33962/roneuro-2021-045","url":null,"abstract":"Nimodipine is a drug belonging to the group of calcium channel blockers, very well tolerated, widely recognized for its central action as a vasodilator preventing vasospasm secondary to aneurysmal subarachnoid haemorrhage. It is currently approved as a drug used in the treatment of this type of haemorrhage, mainly because it is effective in reducing neurological deficits due to delayed cerebral ischemia. In addition, due to its relaxing action on the cerebral vascular musculature and its facility to cross the blood-brain barrier, it has multiple functions in other types of cerebral vascular lesions such as ischemic stroke and other neurological conditions involving stress or cell death. Its role as a prophylactic agent in the treatment of migraine and its effect as a neuroprotective agent have also been evaluated.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43663150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.33962/roneuro-2021-051
J. Bajaj, Sharad Sharma, G. Maravi, A. Iqbal, Y. Yadav, A. Shrivastava, Ketan Hedaoo, Ambuj Kumar, Mallika Sinha, Shailendra Ratre, V. Parihar, Narayan M. Swamy
Aim: Awake craniotomy has been proven to be safe and effective. It has generally been used for non-edematous conditions. If done in edematous states, large craniotomies are advised. Here, we report the combined use of techniques of awake anaesthesia and focussed craniotomy for dealing with large/edematous brain lesions. Materials and Methods: This was a prospective single-centre study from May to October 2019. Included were adult cooperative patients presenting with edematous brain lesions. A completely awake cycle was used using ring scalp block, Dexmedetomidine loading, and maintenance infusion, and use of Midazolam and Fentanyl. The dural flap was lifted limited to the lesion, and sometimes in stages to tackle the bulging brain. Data was collected for resection volume, pain scores using visual analogue scale (VAS) during the surgery, seizures, complications, new deficits, blood loss, duration of surgery, ICU, and postoperative hospital stay. Results: Fifteen patients underwent the procedure. Pathologies were high-grade gliomas (7), low-grade gliomas (3), tuberculoma (2), metastasis (1), ependymoma (1), and meningioma (1). Fourteen patients underwent total, and one underwent subtotal excision. Brain bulge could be handled with the staged opening of the dura and intratumoral decompression. No patient required postoperative ventilatory support. Intraoperative pain scores ranged from 2-3. The duration of surgery ranged from 60-280min. Blood loss ranged from 75-300ml. Postoperative stay varied from 3-20 days. There were two intraoperative seizures (managed), two CSF leaks, and two infections. Two patients developed transitory motor deficits. Conclusion: Awake focussed craniotomy was found safe and effective for large/edematous brain lesions in appropriately selected patients.
{"title":"Awake focussed craniotomy for oedematous/large brain lesions","authors":"J. Bajaj, Sharad Sharma, G. Maravi, A. Iqbal, Y. Yadav, A. Shrivastava, Ketan Hedaoo, Ambuj Kumar, Mallika Sinha, Shailendra Ratre, V. Parihar, Narayan M. Swamy","doi":"10.33962/roneuro-2021-051","DOIUrl":"https://doi.org/10.33962/roneuro-2021-051","url":null,"abstract":"Aim: Awake craniotomy has been proven to be safe and effective. It has generally been used for non-edematous conditions. If done in edematous states, large craniotomies are advised. Here, we report the combined use of techniques of awake anaesthesia and focussed craniotomy for dealing with large/edematous brain lesions.\u0000Materials and Methods: This was a prospective single-centre study from May to October 2019. Included were adult cooperative patients presenting with edematous brain lesions. A completely awake cycle was used using ring scalp block, Dexmedetomidine loading, and maintenance infusion, and use of Midazolam and Fentanyl. The dural flap was lifted limited to the lesion, and sometimes in stages to tackle the bulging brain. Data was collected for resection volume, pain scores using visual analogue scale (VAS) during the surgery, seizures, complications, new deficits, blood loss, duration of surgery, ICU, and postoperative hospital stay.\u0000Results: Fifteen patients underwent the procedure. Pathologies were high-grade gliomas (7), low-grade gliomas (3), tuberculoma (2), metastasis (1), ependymoma (1), and meningioma (1). Fourteen patients underwent total, and one underwent subtotal excision. Brain bulge could be handled with the staged opening of the dura and intratumoral decompression. No patient required postoperative ventilatory support. Intraoperative pain scores ranged from 2-3. The duration of surgery ranged from 60-280min. Blood loss ranged from 75-300ml. Postoperative stay varied from 3-20 days. There were two intraoperative seizures (managed), two CSF leaks, and two infections. Two patients developed transitory motor deficits.\u0000Conclusion: Awake focussed craniotomy was found safe and effective for large/edematous brain lesions in appropriately selected patients.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47168310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-15DOI: 10.33962/roneuro-2021-050
A. Bocco, Liévin Panu, A. Chellaoui, A. Lakhdar, A. Naja
Background: Surgical site infections in neurosurgery are serious due to their proximity to the central nervous system and their management is a challenge. The aim of our work is to report surgical site infections (SSI) in patients who underwent brain or spinal surgery and to describe their characteristics. Materials and method: We conducted a retrospective study involving patients who underwent surgery in our facility's neurosurgical emergency department over 5 years from January 2015 to December 2019. The data were collected from medical hospital and follow-up records. Results: Fifty-eight cases of SSI were identified out of 2889 operations in total, for a frequency of 2%. The series consisted of 36 men (62.07%) and 22 women (37.93%). The average age was 43.9 years (19-72 years). 46 patients (79.31%) had undergone urgent surgery and 12 patients (20.69%) for delayed surgery. 40 patients (68.97%) had undergone cranial intervention and 18 patients (31.03%) underwent spinal surgery. The identified germ was Staphylococcus aureus in 13 cases (76.48%). Mortality was 13.8% (8 out of 58 cases). Conclusion: The majority of microorganisms that cause the infections contaminate the surgical site intraoperatively. Preventive measures can reduce the rate of surgical site infections.
{"title":"Surgical site infections in neurosurgery","authors":"A. Bocco, Liévin Panu, A. Chellaoui, A. Lakhdar, A. Naja","doi":"10.33962/roneuro-2021-050","DOIUrl":"https://doi.org/10.33962/roneuro-2021-050","url":null,"abstract":"Background: Surgical site infections in neurosurgery are serious due to their proximity to the central nervous system and their management is a challenge. The aim of our work is to report surgical site infections (SSI) in patients who underwent brain or spinal surgery and to describe their characteristics.\u0000Materials and method: We conducted a retrospective study involving patients who underwent surgery in our facility's neurosurgical emergency department over 5 years from January 2015 to December 2019. The data were collected from medical hospital and follow-up records.\u0000Results: Fifty-eight cases of SSI were identified out of 2889 operations in total, for a frequency of 2%. The series consisted of 36 men (62.07%) and 22 women (37.93%). The average age was 43.9 years (19-72 years). 46 patients (79.31%) had undergone urgent surgery and 12 patients (20.69%) for delayed surgery. 40 patients (68.97%) had undergone cranial intervention and 18 patients (31.03%) underwent spinal surgery. The identified germ was Staphylococcus aureus in 13 cases (76.48%). Mortality was 13.8% (8 out of 58 cases).\u0000Conclusion: The majority of microorganisms that cause the infections contaminate the surgical site intraoperatively. Preventive measures can reduce the rate of surgical site infections.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46008013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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