RESUMEN
Motorcycles represent less than 2% of the licensed vehicles but motorcyclists account for 12% of road deaths in Ireland. The British Road Safety Authority has introduced the Sharp programme, which hopes to save 50 lives in the U.K. each year alone by helping riders to choose the best-fitting and safest helmets. We evaluated the pattern of head injuries sustained by motorcyclists referred to the two neurosurgical centres Beaumont Hospital and Cork University Hospital in Ireland and ascertained if the new SHARP guidelines could be of benefit in reducing the burden of motorcycle related neurotrauma and disability in Ireland. Despite Ireland having mandatory helmet laws almost a quarter of our motorcyclists with traumatic brain injury were unhelmeted. A significant reduction in mortality and morbidity is predicted if all motorcyclists in Ireland were to wear helmets that satisfied the SHARP criteria.
Asunto(s)
Accidentes de Tránsito , Traumatismos Craneocerebrales/prevención & control , Dispositivos de Protección de la Cabeza , Motocicletas , Accidentes de Tránsito/mortalidad , Adolescente , Adulto , Niño , Traumatismos Craneocerebrales/economía , Traumatismos Craneocerebrales/mortalidad , Femenino , Humanos , Irlanda/epidemiología , Masculino , Persona de Mediana Edad , Motocicletas/legislación & jurisprudencia , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Adulto JovenRESUMEN
The purpose of this paper was to report our experience with lateral mass screw fixation when used in a variety of complex cervical pathologies. A prospective observational study was undertaken of all patients who underwent lateral mass screw fixation for complex spinal pathology. There were 59 patients. Pathology included cervical spondylosis with deformity 58%, rheumatoid arthritis 19%, tumours 15%, multiple level trauma 8%. The median follow-up time was 23 months. The patient's myelopathy scores improved in 64% of patients. 79% reported an improvement in their neck disability scores. 73% had improvement in their visual analogue pain score. Sixty-one per cent had preoperative high signal change on T2WI MRI. Sixty per cent had loss of normal cervical lordosis on presentation or were kyphotic. Sixty-four per cent of patients had grade 3 compression on MRI (Singh). Postoperative alignment was maintained in all cases. No late kyphotic deformity occurred. Lateral mass screw fixation can be used effectively and safely for different cervical spine pathologies with good functional and radiological outcome.
Asunto(s)
Artritis Reumatoide/cirugía , Tornillos Óseos , Vértebras Cervicales/cirugía , Fijadores Internos , Lordosis/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
We performed a left nephroureterectomy for a gentleman with transitional cell carcinoma of the upper ureter. Histological analysis revealed it to be a T1 lesion, but to be highly mitotically active. The gentleman defaulted on adjuvant therapy and defaulted on follow-up. He represented with symptoms of acute spinal cord compression and magnetic resonance imaging demonstrated a lesion at T6/7. Neurosurgical resection of the lesion showed it to be a metastatic deposit from the ureteric primary. Despite surgical debulking and subsequent radiotherapy to the lesion, the patient died secondary to metastatic complications. This case report is of interest to the surgeon as it demonstrates both the high metastatic potential of upper tract carcinomas and educates the surgeon on the presentation of acute spinal cord compression.
Asunto(s)
Carcinoma de Células Transicionales/secundario , Compresión de la Médula Espinal/etiología , Neoplasias de la Columna Vertebral/secundario , Neoplasias Ureterales/patología , Carcinoma de Células Transicionales/complicaciones , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Columna Vertebral/complicacionesRESUMEN
With the increased use of MRI, tonsillar ectopia, the hallmark of the adult Chiari malformation (ACM) is being more frequently recognized. However, in some cases, the patient's symptoms do not fit with the classical presentation for ACM, but are similar to intracranial hypertension (IH). The latter may be difficult to diagnose in absence of ventricular enlargement. We report a case of ACM and IHWV due to carcinomatous meningitis.
Asunto(s)
Malformación de Arnold-Chiari/complicaciones , Neoplasias de la Mama/diagnóstico , Hipertensión Intracraneal/complicaciones , Neoplasias Meníngeas/complicaciones , Adulto , Malformación de Arnold-Chiari/diagnóstico , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/secundario , Femenino , Humanos , Hipertensión Intracraneal/diagnóstico , Neoplasias Meníngeas/secundario , Resultado del TratamientoRESUMEN
Despite a body of evidence showing that various neurotrophic factors support the survival of nerve cells and stimulate axonal outgrowth, doubt remains about their optimal site of application as well as the more compelling question of what clinical benefit, if any, they would confer. Ciliary neurotrophic factor (CNTF) supports the survival of motorneurons in vitro and in vivo. Direct delivery of CNTF to the cell bodies may help reduce the side effects and overcome the problem of rapid systemic clearance. The aim of this study was to establish whether nerve regeneration may be improved upon by the controlled addition of a specific humoral neurotrophic substance (CNTF) at the level of the cell body. Three groups of five adult sheep were used. The first group acted as normal controls. In the second and third groups, the median nerve was divided and repaired using an epineurial suture technique. In the second group, CNTF was supplied into the CSF at the level of C6 by an implanted osmotic pump. In the third group physiological saline was placed in the osmotic pump. The animals underwent comprehensive electrophysiological and isometric tension experiments at six months. All of the animals had reduced electrophysiological, morphometric and isometric tension indices after surgery compared to normal. The CNTF group had better results than the saline group in the following; (1) area and amplitude of the muscle action potential (2) the percentage of tetanus and muscle mass preserved after repair. These differences were only statistically significant for amplitude of the muscle action potential. No statistical difference was found in the morphological indices (fibre diameter, axon diameter, myelin thickness and internodal length) between the CNTF and saline groups. CNTF does not confer a functional benefit when applied at the level of the cell body.
Asunto(s)
Factor Neurotrófico Ciliar/administración & dosificación , Nervio Mediano/lesiones , Nervio Mediano/fisiopatología , Regeneración Nerviosa/efectos de los fármacos , Animales , Líquido Cefalorraquídeo , Vértebras Cervicales , Bombas de Infusión Implantables , Infusiones Intralesiones , Nervio Mediano/efectos de los fármacos , Conducción Nerviosa/fisiología , OvinosRESUMEN
BACKGROUND: The aim of this paper was to outline the use of frameless stereotaxy for the safe insertion of C1/C2 transarticular screws in the clinical setting of patients with atlanto-axial instability. METHODS: A retrospective review was conducted of cases involving the use of image guidance for the accurate placement of transarticular C1/C2 screws. The outcome measures considered were neural injury, vascular injury, death, and screw placement on postoperative imaging. RESULTS: We evaluated 60 patients for image-guided C1/2 transarticular screw fixation. There was a total of 109 screws inserted. There were no intraoperative complications. CONCLUSIONS: Frameless stereotaxy can be applied safely in a clinical setting for transarticular screw fixation. Image guidance can facilitate preoperative planning and help determine an optimal trajectory that avoids the vertebral artery.
Asunto(s)
Articulación Atlantoaxoidea/cirugía , Tornillos Óseos , Inestabilidad de la Articulación/cirugía , Neuronavegación/instrumentación , Implantación de Prótesis/instrumentación , Robótica/instrumentación , Fusión Vertebral/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Vértebras Cervicales/cirugía , Diseño de Equipo , Análisis de Falla de Equipo , Femenino , Humanos , Fijadores Internos , Masculino , Persona de Mediana Edad , Neuronavegación/efectos adversos , Neuronavegación/métodos , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/métodos , Estudios Retrospectivos , Robótica/métodos , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Resultado del TratamientoRESUMEN
Certain aneurysms of the anterior circulation continue to offer a technical challenge for safe exposure and clipping. The purpose of this paper was to describe the cranio-orbital approach for surgical clipping of complex aneurysms and to evaluate prospectively the associated complications of this approach. Prospective audit of all patients undergoing cranio-orbital approach for aneurysm surgery from 1997 to 2004 by the senior author. Twenty-five patients, eight male and 17 female, median age of 52 years, range 28-73. All patients had a standard pterional approach supplemented by an orbital osteotomy. In the 7-year period 367 patients underwent treatment for their aneurysms (169 clipped and 198 coiled). Of the 169 patients who were operated on, 29 had a skull base approach, of which 25 were cranio-orbital. The aneurysm location was as follows: 16 middle cerebral artery (MCA), three carotid bifurcation, four anterior communicating artery (ACOMM), one ophthalmic and one basilar. There were no approach-related complications. The cranio-orbital craniotomy can be a useful adjunct in the surgical treatment of giant or complex aneurysms. It offers the following advantages over a standard pterional approach: reduces operative distance; allows easy splitting of the sylvian fissure; and provides a wide arc of exposure with multiple working corridors.
Asunto(s)
Aneurisma Intracraneal/cirugía , Adulto , Anciano , Femenino , Humanos , Aneurisma Intracraneal/patología , Masculino , Auditoría Médica , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Órbita/cirugía , Osteotomía/métodos , Estudios Prospectivos , Base del Cráneo/cirugíaRESUMEN
Giant serpentine aneurysms (GSAs) form a specific subgroup of giant cerebral aneurysms that have pathognomonic angiographic features. We report the angiographic findings of a GSA demonstrating a striking convoluted dynamic flow pattern, which we have called the 'pretzel sign'. The aneurysm was successfully treated by permanent occlusion of the parent vessel using a detachable balloon. GSAs should be identified prior to treatment in view of their particular management requirements.
Asunto(s)
Arteria Carótida Interna/diagnóstico por imagen , Circulación Cerebrovascular/fisiología , Aneurisma Intracraneal/diagnóstico por imagen , Adulto , Circulación Colateral/fisiología , Embolización Terapéutica/métodos , Humanos , Aneurisma Intracraneal/fisiopatología , Aneurisma Intracraneal/terapia , Masculino , Puente/diagnóstico por imagen , Periodo Posoperatorio , Radiografía , Lóbulo Temporal/diagnóstico por imagenRESUMEN
The objective of the investigation was to report on the health-related quality of life (HRQoL) of patients diagnosed with skull base tumours using the Short Form Health Survey questionnaire (SF-36). Those patients suffering with vestibular schwannoma were examined to determine the effect facial nerve function had on their quality of life. It took place at the tertiary referral centre at the Department of Clinical Neurosciences, Western General Hospital, Edinburgh. A prospective study of 70 consecutive patients was taken, who harboured the following tumours: 54 vestibular schwannomas, 13 meningiomas, two haemangioblastomas and one hypoglossal schwannoma. Patients were interviewed using the short form 36 (SF-36) questionnaire. Facial nerve function was assessed in those patients who had vestibular schwannomas. The entire cohort of live skull base patients were assessed after a median follow-up time of 38.4 months. Patients with vestibular schwannoma treated conservatively with interval MRI had a quality of life similar to t he normal population. Those who underwent surgery had a significant difference in two of the SF-36 domains. No statistically significant correlation was found at final assessment between the degree of facial nerve functioning and any of the domains of SF-36. Patients with non-vestibular tumours had an impaired HRQoL in seven of the eight domains. Patients with skull base tumours have a significant impairment of their HRQoL. A conservative policy of follow up with interval MRI for patients with small vestibular schwannomas may therefore be more appropriate to preserve their HRQoL. Facial nerve outcome has little influence on quality of life in vestibular schwannoma patients.
Asunto(s)
Calidad de Vida , Perfil de Impacto de Enfermedad , Neoplasias de la Base del Cráneo/rehabilitación , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neuroma Acústico/patología , Neuroma Acústico/rehabilitación , Neuroma Acústico/cirugía , Estudios Prospectivos , Escocia , Neoplasias de la Base del Cráneo/cirugía , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
Nerve repair by entubulation has re-emerged recently as a possible means of enhancing the microenvironment at the site of repair by inclusion within the tube of various trophic factors. To this end, a modification of the vein-graft technique has been used by turning it inside out before repair, to expose the adventitial surface to the regenerating axons. A comparative study of standard vein grafting versus the inside-out technique was carried out in two equal-sized groups of inbred Lewis rats. Jugular vein isografts were derived from litter mates. The sciatic nerve was transected and repaired by entubulation using the standard vein graft in one group and the inside-out graft in the other group. Morpho-metric and electrophysiological assessment were carried out 3 months after repair. When the animals were assessed it was found that both the standard-vein-graft group and the inside-out group exhibited a reduction in all of the morphometric and electrophysiological variables when compared to normal nerves. The mean axon diameter, fibre diameter and myelin sheath thickness were, however, found to be greater in the group that underwent the inside-out repair. The superior morphometric results seen in the inside-out group were not matched by improved electrophysiological performance. It is concluded that the use of the inside-out technique confers no functional benefit over standard vein grafting.