Monday, December 31, 2012

Best Neurosurgery Blog 2012

1)Advances and challenges in neurostimulation for headaches (Click here)

2) Idaho beauty queen Jamie Hilton survives horrific accident, then brain surgeries with skull buried in her stomach - NY Daily News (click here)

3) Lack of causal association between spontaneous intracranial hypotension and cranial cerebrospinal (click Here)

4)Factors influencing intracranial pressure monitoring guideline compliance and outcome after severe (Click here)

5) Skin closure in vascular neurosurgery: A prospective study on absorbable intradermal suture versus nonabsorbable suture - Surg Neurol Int (click here)

Friday, December 28, 2012

Benefits of early aneurysm surgery: Southern Iran experience

Abdolkarim Rahmanian, Mohammad Jamali, Ali Razmkon, Juri Kivelev, Rossana Romani, Ehsan-Ali Alibai, Juha Hernesniemi

Surgical Neurology International 2012 3(1):156-156

Background: Neurovascular surgery has been practiced in Shiraz, the main referral center of the Southern Iran, for over 30 years; however, the trend has accelerated tremendously in recent years following subspecialization of neurovascular surgery in Shiraz, Department of Neurosurgery. Over 100 patients are operated each year, and nearly all are addressed during the first 72 hours after presentation. Methods: In this paper, we focus on the description of techniques we apply for early clipping of ruptured intracranial aneurysms in the anterior circulation. Improvements in outcome, mortality, and rebleeding rates are also discussed. Results: Mortality and rebleeding rates have declined significantly since the institution of new techniques. Conclusion: The establishment of early surgery for ruptured anterior circulation aneurysms through the lateral supraorbital approach along with specific anesthetic protocol has resulted in significant improvement of morbidity, mortality, and rebleeding rates at our department.

http://www.surgicalneurologyint.com/article.asp?issn=2152-7806;year=2012;volume=3;issue=1;spage=156;epage=156;aulast=Rahmanian

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Júlio Leonardo B. Pereira

http://lattes.cnpq.br/7687651239699170

http://www.neurocirurgiabr.com

Thursday, December 27, 2012

Importance of recognizing sentinel headache Pereira JL, de Albuquerque LA, Dellaretti M, de Carvalho GT, Vieira G, Rocha MI, Loures LL, Christo PP, de Sousa AA - Surg Neurol Int

http://surgicalneurologyint.com/article.asp?issn=2152-7806;year=2012;volume=3;issue=1;spage=162;epage=162;aulast=Pereira

ORIGINAL ARTICLE

Surg Neurol Int 2012, 3:162

Importance of recognizing sentinel headache

Júlio Leonardo Barbosa Pereira¹, Lucas Alverne Freitas de Albuquerque¹, Marcos Dellaretti¹, Gervásio Teles Cardoso de Carvalho²,Gerival Vieira¹, Marcella Israel Rocha³, Laize Luzia Andrade Loures³, Paulo Pereira Christo⁴, Atos Alves de Sousa⁵

¹ Neurology and Neurosurgery Service, Santa Casa Hospital, Belo Horizonte, Minas Gerais, Brazil

² Neurology and Neurosurgery Service, Santa Casa Hospital, Belo Horizonte, Minas Gerais; Department of Neurosurgery, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil³ Medical Student, Universidade Federal de Minas Gerais, Minas Gerais, Brazil⁴ Neurology and Neurosurgery Service and Graduate and Research Program, Santa Casa Hospital, Belo Horizonte, Minas Gerais, Brazil⁵ Neurology and Neurosurgery Service and Graduate and Research Program, Santa Casa Hospital, Belo Horizonte, Minas Gerais; Department of Neurosurgery, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

Date of Submission	12-Aug-2012
Date of Acceptance	23-Oct-2012
Date of Web Publication	26-Dec-2012

Correspondence Address:
Gerival Vieira
Neurology and Neurosurgery Service, Santa Casa Hospital, Belo Horizonte, Minas Gerais
Brazil

© 2012 Pereira et al; This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.4103/2152-7806.105101

Abstract

Background: Sentinel headache (SH) is a kind of secondary headache and is characterized as sudden, intense, and persistent, preceding spontaneous subarachnoid hemorrhage (SAH) by days or weeks.
Methods: Eighty-nine consecutive patients with a diagnosis of spontaneous SAH were evaluated following admission to the Neurosurgical Service at Santa Casa Hospital, Belo Horizonte, between December 2009 and December 2010.
Results: Out of the 89 patients, 64 (71.9%) were women. Mean age was 48.9 years (SD ± 13.4, ranging from 18 to 85 years). Twenty-four patients (27.0%) presented SH, which occurred, in average, 10.6 days (SD ± 13.5) before a SAH. No statistically significant differences were observed between the presence of SH and gender, arterial hypertension and migraine ( P > 0.05), Glasgow Comma Scale (GCS) and World Federation of Neurological Surgeons (WFNS) scale at admission.
Conclusion: The prevalence of SH was 27% in this study but no related factors were identified. Therefore, further clarification of this important entity is required so as to facilitate its recognition in emergency services and improve the prognosis of patients with cerebral aneurysms.

Keywords: Intracranial aneurysm, sentinel headache, subarachnoid hemorrhage

How to cite this article:
Pereira JL, de Albuquerque LA, Dellaretti M, de Carvalho GT, Vieira G, Rocha MI, Loures LL, Christo PP, de Sousa AA. Importance of recognizing sentinel headache. Surg Neurol Int 2012;3:162

How to cite this URL:
Pereira JL, de Albuquerque LA, Dellaretti M, de Carvalho GT, Vieira G, Rocha MI, Loures LL, Christo PP, de Sousa AA. Importance of recognizing sentinel headache. Surg Neurol Int [serial online] 2012 [cited 2012 Dec 27];3:162. Available from: http://www.surgicalneurologyint.com/text.asp?2012/3/1/162/105101

Wednesday, December 26, 2012

Skin closure in vascular neurosurgery: A prospective study on absorbable intradermal suture versus nonabsorbable suture - Surg Neurol Int

http://www.surgicalneurologyint.com/article.asp?issn=2152-7806;year=2012;volume=3;issue=1;spage=94;epage=94;aulast=Pereira

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ORIGINAL ARTICLE

Surg Neurol Int 2012, 3:94

Skin closure in vascular neurosurgery: A prospective study on absorbable intradermal suture versus nonabsorbable suture

Julio Leonardo Barbosa Pereira¹, Gerival Vieira¹, Lucas Alverne Freitas de Albuquerque¹, George de Albuquerque Cavalcanti Mendes¹,Ludmila Rezende Salles², André Felipe Ferreira de Souza², Marcos Dellaretti¹, Atos Alves de Sousa³

¹ Department of Neurosurgery, Santa Casa Hospital of Belo Horizonte, MG, Brazil

² Facult of Medicine, Federal University of Minas Gerais (UFMG), MG, Brazil³ Department of Neurosurgery, Santa Casa Hospital of Belo Horizonte, MG; Lecturer at the Post-graduate and Research Program at Santa Casa Hospital of Belo Horizonte, MG, Brazil

Date of Submission	20-Jun-2012
Date of Acceptance	06-Jul-2012
Date of Web Publication	21-Aug-2012

Correspondence Address:
Gerival Vieira
Department of Neurosurgery, Santa Casa Hospital of Belo Horizonte, MG
Brazil

© 2012 Pereira et al; This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.4103/2152-7806.99941

Abstract

Background: The craniotomy performed with minimal hair removal and closure with intradermal suture alone is an option in neurosurgical procedures, which can help faster psychological recovery of the patient, as it allows a better cosmetic result. This study is aimed at evaluating if such method is safe and effective, compared with continuous skin sutures with 2-0 nylon.
Methods: We analyzed the sutures in 117 patients undergoing craniotomies for cerebral aneurysm clipping. In the case group (n = 49), closure of the scalp was performed only with intradermal absorbable sutures using wire Monocryl^; 2-0. In the control group (n = 68), closure was performed with continuous suture using 2-0 nylon.
Results: The case group was composed of 49 patients in whom just intradermal suture was performed. One (2.2%) patient developed wound infection and was given proper medical treatment. No cases of dehiscence or cerebrospinal fluid leaks were observed. The control group was composed of 68 patients in whom the skin was closed with 2-0 nylon continuous suture. Three (5.3%) patients developed wound infection and were given proper medical treatment. There were no cases of wound dehiscence. The overall infection rate in the control group was 4%. There was no statistically significant difference in the number of wound infections between the two groups (P = 0.73).
Conclusion: The closure with intradermal suture alone in craniotomies is as safe as the traditional skin closure with nylon sutures, besides eliminating the need for suture removal and providing a cosmetic advantage.

Keywords: Intracranial aneurysm, intradermal suture, skin closure

How to cite this article:
Pereira JL, Vieira G, Freitas de Albuquerque LA, Mendes GC, Salles LR, Ferreira de Souza AF, Dellaretti M, de Sousa AA. Skin closure in vascular neurosurgery: A prospective study on absorbable intradermal suture versus nonabsorbable suture. Surg Neurol Int 2012;3:94

How to cite this URL:
Pereira JL, Vieira G, Freitas de Albuquerque LA, Mendes GC, Salles LR, Ferreira de Souza AF, Dellaretti M, de Sousa AA. Skin closure in vascular neurosurgery: A prospective study on absorbable intradermal suture versus nonabsorbable suture. Surg Neurol Int [serial online] 2012 [cited 2012 Dec 26];3:94. Available from: http://www.surgicalneurologyint.com/text.asp?2012/3/1/94/99941

Decompressive hemicraniectomy after malignant middle cerebral artery infarction: rationale and contr

Neurosurgical FOCUS, Volume 30, Issue 6, Page E18, June 2011.

Omar M. Arnaout, M.D., Salah G. Aoun, M.D., H. Hunt Batjer, M.D., and Bernard R. Bendok, M.D. Malignant middle cerebral artery stroke carries a very poor prognosis. Significant retrospective data support the hypothesis that decompressive hemicraniectomy decreases mortality rates due to this disease entity. Recently, 3 randomized controlled studies have been published and shed light on these issues and enhance the quality of evidence revolving around this procedure. In this review, the rationale, risks, benefits, and unanswered questions related to hemicraniectomy for acute ischemic stroke are reviewed with an emphasis on how 3 randomized trials have influenced knowledge on this life-saving yet controversial procedure. Further randomized studies are needed to clarify lingering questions regarding age indications and impact on quality of life.

http://thejns.org/doi/abs/10.3171/2011.3.FOCUS1160?ai=rw&mi=3ba5z2&af=R

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Júlio Leonardo B. Pereira

http://lattes.cnpq.br/7687651239699170

http://www.neurocirurgiabr.com

Interobserver Variability of Grading Scales for Aneurysmal Subarachnoid Hemorrhage [Original Contrib

Background and Purpose—

Worldwide, different scales are used to assess the clinical condition on admission after aneurysmal subarachnoid hemorrhage. In addition to the prognostic value, the inter-rater variability should be taken into account when deciding which scale preferably should be used. We assessed the interobserver agreement of the commonly used World Federation of Neurological Surgeons, the Hunt and Hess, and the Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage scales.

Methods—

In a cohort of 50 subarachnoid hemorrhage patients, 103 paired assessments were performed on the 3 admission scales by 2 independent observers per assessment with a total of 57 different raters. Patients were assessed during the first week after the hemorrhage. The interobserver agreement was calculated using quadratic (weighted) kappa statistics.

Results—

The weighted kappa value of the Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage scale was 0.64 (95% CI, 0.49–0.79), of the World Federation of Neurological Surgeons scale was 0.60 (95% CI, 0.48–0.73), and of the Hunt and Hess scale was 0.48 (95% CI, 0.36–0.59).

Conclusions—

The Hunt and Hess scale showed the lowest interobserver agreement, whereas agreement of the World Federation of Neurological Surgeons and Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage scales was similar with overlapping CI.

http://stroke.ahajournals.org/cgi/content/short/42/6/1546?rss=1

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Júlio Leonardo B. Pereira

http://lattes.cnpq.br/7687651239699170

http://www.neurocirurgiabr.com

Meta-analysis of instrumented posterior interbody fusion versus instrumented posterolateral fusion i

Journal of Neurosurgery: Spine, Volume 15, Issue 3, Page 295-310, September 2011.
Object The authors compared the effectiveness of instrumented posterior lumbar interbody fusion (iPLIF) and instrumented posterolateral fusion (iPLF) for the treatment of low-back pain (LBP) due to degenerative lumbar disease. Methods Relevant randomized controlled trials (RCTs) and comparative observational studies through December 2009 were identified using a retrieval strategy of sensitive and specific searches. The study design, participant characteristics, interventions, follow-up rate and period, and outcomes were abstracted after the assessment of methodological quality of the trials. Analyses were performed following the method guidelines of the Cochrane Back Review Group. Results Nine studies were identified—3 RCTs and 6 comparative observational studies. No significant difference was found between the 2 fusion procedures in the global assessment of clinical outcome (OR 1.51, 95% CI 0.71–3.22, p = 0.29) and complication rate (OR 0.55, 95% CI 0.16–1.86, p = 0.34). Both techniques were effective in reducing pain and improving functional disability, as well as restoring intervertebral disc height. Instrumented PLIF was more effective in achieving solid fusion (OR 2.60, 95% CI 1.35–5.00, p = 0.004), a lower reoperation rate (OR 0.20, 95% CI 0.03–1.29, p = 0.09), and better restoration of segmental angle and lumbar lordotic angle than iPLF. There were no significant differences between the fusion methods regarding blood loss (weighted mean difference –179.63, 95% CI –516.42 to 157.15, p = 0.30), and operating time (weighted mean difference 8.03, 95% CI –45.46 to 61.53, p = 0.77). Conclusions The authors' analysis provided moderate-quality evidence that iPLIF has the advantages of higher fusion rate and better restoration of spinal alignment over iPLF. No significant differences were identified between iPLIF and iPLF concerning clinical outcome, complication rate, operating time, and blood loss.