Abstract:
OBJECTIVE:The use of subdural drains after surgical evacuation of chronic subdural hematoma (CSH) decreases the risk of recurrence and has become the standard of care. Halfway through the controlled, randomized TOSCAN (Randomized Trial of Follow-up CT after Evacuation of Chronic Subdural Hematoma) trial, the authors' institutional guidelines changed to recommend subgaleal instead of subdural drainage. The authors report a post hoc analysis on the influence of drain location in patients participating in the TOSCAN trial. METHODS:The study involved 361 patients enrolled in the TOSCAN trial. The patients were stratified according to whether they received surgery before (cohort A) or after (cohort B) the change in institutional protocol. An intention-to-treat analysis was performed with surgery for recurrence as the primary endpoint. Secondary endpoints were outcome-based on modified Rankin Scale scores, seizures, infections, parenchymal brain injuries, and hematoma diameter. RESULTS:Of the 361 patients included in the analysis, 214 were stratified into cohort A (subdural drainage recommended), while 147 were stratified into cohort B (subgaleal drainage recommended). There was a 31.78% rate of crossover from the subdural to the subgaleal drainage insertion site due to technical or anatomical difficulties. No differences in the rates of reoperation (21.5% [cohort A] vs 25.17% [cohort B], OR 0.81, 95% CI 0.50-1.34, p = 0.415), infections (0.47% [cohort A] vs 2.04% [cohort B], OR 0.23, 95% CI 0.02-2.19, p = 0.199), seizures (3.27% [cohort A] vs 2.72% [cohort B], OR 1.21, 95% CI 0.35-4.21, p = 0.765), or favorable outcomes (modified Rankin Scale score 0-3) at 1 and 6 months (91.26% [cohort A] vs 96.43% [cohort B], OR 0.39, 95% CI 0.14-1.07, p = 0.067; 89.90% [cohort A] vs 91.55% [cohort B], OR 0.82, 95% CI 0.39-1.73, p = 0.605) were noted between the two cohorts. Postoperatively, patients in cohort A had more frequent parenchymal brain tissue injuries (2.8% vs 0%, p = 0.041). Postoperative absolute and relative hematoma reduction was similar irrespective of the location of the drain. CONCLUSIONS:Subgaleal rather than subdural placement of the drain did not increase the risk for reoperation for recurrence of CSHs, nor did it have a negative impact on clinical or radiological outcome. The intention to place a subdural drain was associated with a higher rate of parenchymal injuries.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Häni L,Vulcu S,Branca M,Fung C,Z'Graggen WJ,Murek M,Raabe A,Beck J,Schucht Pdoi
10.3171/2019.5.JNS19858subject
Has Abstractpub_date
2019-08-30 00:00:00pages
1-9eissn
0022-3085issn
1933-0693pii
2019.5.JNS19858pub_type
杂志文章abstract::OBJECTIVE Diffusion-weighted MRI was used to assess periprocedural lesion load after repair of unruptured intracranial aneurysms (UIA) by microsurgical clipping (MC) and endovascular coiling (EC). METHODS Patients with UIA were assigned to undergo MC or EC according to interdisciplinary consensus and underwent diffusi...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/2016.2.JNS152456
更新日期:2017-04-01 00:00:00
abstract::An elevated serum carcinoembryonic antigen (CEA) without evidence of neoplasia was noted in an 84-year-old woman. She subsequently developed a lytic skull lesion, which at surgery proved to be an atypical meningioma. Immunohistochemical analysis demonstrated that this tumor was producing CEA. This aggressive meningiom...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.82.3.0489
更新日期:1995-03-01 00:00:00
abstract:OBJECT:Given the virtual absence of histologically detected, clinically unsuspected disease in intervertebral disc specimens, some authors have advocated that histological examination be discontinued. However, the examination of intervertebral disc specimens remains common practice in most pathology laboratories. No co...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1998.89.3.0378
更新日期:1998-09-01 00:00:00
abstract::With the goal of developing a practical method of performing noninvasive measurements of flow in cerebrospinal fluid (CSF) shunts, transcutaneous thermal convection CSF shunt flow measurement was investigated using dimensional analysis, numerical modeling, and bench testing. Using appropriate manufacturing practices a...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2005.103.4.0366
更新日期:2005-10-01 00:00:00
abstract:OBJECT:The purpose of this paper was to define the general efficacy of and morbidity associated with stereoelectroencephalography using modem methods of imaging and to particularize the risks related to specific lobes of the brain. METHODS:All patients admitted to the Montreal Neurological Institute who had undergone ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2006.104.4.483
更新日期:2006-04-01 00:00:00
abstract:OBJECT:In the preceding article, the authors described the Hydrocephalus Outcome Questionnaire (HOQ), a simple, reliable, and valid measure of health status in children with hydrocephalus. In the present study, they present their initial experience in using the HOQ to quantify the health status in a typical cohort of c...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2004.101.2.0141
更新日期:2004-11-01 00:00:00
abstract:OBJECTIVE:Corpus callosotomy is a palliative procedure that is effective at reducing seizure burden in patients with medically refractory epilepsy. The procedure is traditionally performed via open craniotomy with interhemispheric microdissection to divide the corpus callosum. Concerns for morbidity associated with cra...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2019.9.JNS191769
更新日期:2019-12-13 00:00:00
abstract::The fissure separating the motor from the sensory cortex and the substantia gelatinosa capping the posterior horn of the spinal cord are still known by the name of the Italian anatomist Rolando, Luigi Rolando was born in Turin, Italy, in 1773 and died in 1831. His life was not easy, the first of his problems being the...
journal_title:Journal of neurosurgery
pub_type: 传,历史文章,杂志文章
doi:10.3171/jns.1995.83.5.0933
更新日期:1995-11-01 00:00:00
abstract:OBJECT:The severity of neurological impairment following traumatic brain injury (TBI) is exacerbated by several endogenous processes, including hyperglycemia, hypotension, and the generation of glutamate. However, in addition to controlling hyperglycemia, insulin has pleiotropic effects on tissue metabolism, which incl...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2010.4.JNS10263
更新日期:2011-01-01 00:00:00
abstract::This case illustrates the potential growth rate of an atypical meningioma in a pediatric patient, emphasizes one of the potential risks after therapeutic radiation, and underscores the importance of clinical evaluation and follow up of the symptomatic patient after tumor resection and radiation therapy. The authors re...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2004.100.5.0488
更新日期:2004-05-01 00:00:00
abstract::Bilateral trigeminal neuralgia occurred in 32 (11.9%) of 269 consecutive patients who were treated with radiofrequency electrocoagulation (RFE). This is a higher incidence than has been reported before and may be explained by the prospective nature of the present study, the long follow-up period, and the inclusion of ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1987.67.1.0044
更新日期:1987-07-01 00:00:00
abstract::Focal cortical dysplasia type II (FCD II) is a common histopathological substrate of epilepsy surgery. Here, the authors propose a sulcus-centered resection strategy for this malformation, provide technical details, and assess the efficacy and safety of this technique. The main purpose of the sulcus-centered resection...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2020.5.JNS20751
更新日期:2020-08-07 00:00:00
abstract:OBJECT:In the radiosurgical treatment of critically located lesions, the effort to minimize the risk of complication is essential. In this study the integration of diffusion-tensor (DT) imaging-based tractography was clinically applied to treatment planning for gamma knife surgery (GKS). METHODS:Seven patients with ce...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/jns.2005.102.4.0673
更新日期:2005-04-01 00:00:00
abstract::A reversible and presumably neurogenic form of myocardial dysfunction may occur following subarachnoid hemorrhage (SAH), but the relationship of this finding to electrocardiographic abnormalities remains unclear. To clarify this issue, serial electrocardiograms (ECGs, mean 6.2 per patient) and echocardiograms (mean 3....
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/jns.1995.83.5.0889
更新日期:1995-11-01 00:00:00
abstract:OBJECT:Atlantoaxial rotatory fixation (AARF) is an uncommon disorder of childhood in which resolution usually occurs spontaneously or after traction therapy. In a minority of children irreducible or chronic fixation develop, and the natural history then usually involves restriction of head on neck movement, abnormal he...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2004.100.3.0235
更新日期:2004-03-01 00:00:00
abstract::OBJECTIVEPituitary adenomas and the treatment required for the underlying neuropathology have frequently been associated with cognitive dysfunction. However, the mechanisms for these impairments remain the subject of much debate. The authors evaluated cognitive outcomes in patients treated with or without Gamma Knife ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2018.7.GKS181595
更新日期:2018-12-01 00:00:00
abstract:OBJECT:The authors assessed the efficacy and complications from gamma knife radiosurgery (GKS) for multiple sclerosis (MS)-associated trigeminal neuralgia (TN). METHODS:There were 15 patients with MS-associated TN (MS-TN). Treatment involved three sequential protocols, 70 to 90-Gy maximum dose, using a single 4-mm iso...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/jns.2002.97.supplement
更新日期:2002-12-01 00:00:00
abstract:OBJECT:Dilations of brain perivascular spaces (PVSs), also known as Virchow-Robin spaces, are routinely identified on magnetic resonance imaging studies of the brain and recognized as benign normal variants. Giant dilations occur only rarely and can be easily misdiagnosed as central nervous system tumors. The relevant ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2004.100.5.0820
更新日期:2004-05-01 00:00:00
abstract::Between 1975 and 1989, 25 children treated with myelomeningocele closure and shunting for hydrocephalus at the Children's Hospital of Pittsburgh developed progressive lower brain-stem dysfunction from their Chiari malformation. Retrospective univariate and multivariate analyses of these cases were undertaken to assess...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1992.77.6.0881
更新日期:1992-12-01 00:00:00
abstract:OBJECT:The aim of this study was to investigate the effects of moderate hyperventilation on intracranial pressure (ICP), jugular venous oxygen saturation ([SjvO2], an index of global cerebral perfusion), and brain tissue PO2 (an index of local cerebral perfusion). METHODS:Ninety-four tests consisting of 20-minute peri...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2002.96.1.0097
更新日期:2002-01-01 00:00:00
abstract::The authors present a case of spontaneous regression of a herniated cervical nucleus pulposus in a patient with myelopathy. This 37-year-old woman developed sudden quadriparesis; she had reported no history of trauma. Magnetic resonance (MR) imaging revealed a large disc herniation and increased signal intensity of th...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.1999.90.1.0138
更新日期:1999-01-01 00:00:00
abstract::The author, who was editor of the Journal of Neurosurgery from 1975 to 1985, recalls the history of the journal during the 15 hears beginning in 1965, when Dr. Louise Eisenhardt resigned as its first editor. In an addendum, he presents some thoughts on the future of neurosurgery and the role the journal should play in...
journal_title:Journal of neurosurgery
pub_type: 历史文章,杂志文章
doi:10.3171/jns.1994.80.5.0939
更新日期:1994-05-01 00:00:00
abstract:OBJECT:The aim of this study was to determine the usefulness of magnetic resonance (MR) imaging-documented extravasation as an indicator of continued hemorrhage in patients with acute hypertensive intracerebral hemorrhage (ICH). METHODS:The authors studied 108 patients with acute hyperintensive ICH. Imaging modalities...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1998.88.4.0650
更新日期:1998-04-01 00:00:00
abstract::Pericranium is frequently used in duraplasty and is considered superior to the many other alternatives because of its easy availability and because it offers a watertight dural closure while minimizing the problems of adhesion, infection, and rejection. Although the osteogenic potential of all periosteal tissues is re...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2001.95.2.0350
更新日期:2001-08-01 00:00:00
abstract::The successful treatment of a civilian gunshot wound of the vermis and pons is described. A large missile fragment was removed from a depth of 2 cm within the pons at the level of the facial colliculus. Despite initial coma and subsequent irregular respiration with sleep apnea, the patient survived. Neurological, radi...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1971.35.3.0342
更新日期:1971-09-01 00:00:00
abstract::A transoral, transsphenoidal microsurgical technique for exposing the pituitary stalk and gland of the rhesus monkey is described and illustrated. The technique has proved to be a safe and practical method for performing a variety of pituitary operations in a total of 37 animals. The procedures have included complete ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1977.47.5.0663
更新日期:1977-11-01 00:00:00
abstract::Susceptibility weighted imaging (SWI) is a relatively new imaging technique. Its high sensitivity to hemorrhagic components and ability to depict microvasculature by means of susceptibility effects within the veins allow for the accurate detection, grading, and monitoring of brain tumors. This imaging modality can als...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/2015.1.JNS142349
更新日期:2015-12-01 00:00:00
abstract::A 10-year-old boy had a sore throat, followed in 4 weeks by acute rheumatic fever and in 6 weeks by atlanto-axial dislocation. Reduction of the dislocation by means of a halo vest relieved his pain, but the cervical spine remained unstable after 3 months of immobilization and required an occiput-C1-2 fusion and rib gr...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1987.66.2.0286
更新日期:1987-02-01 00:00:00
abstract::Recent studies have suggested that a deficiency of alpha 1-antitrypsin may be a genetic risk factor for the development of intracranial aneurysms and arterial fibromuscular dysplasia. The authors report a 16-year-old girl with a history of lung disease who suffered a cerebral hemorrhage due to the rupture of a giant i...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1996.85.3.0503
更新日期:1996-09-01 00:00:00
abstract:OBJECT:Unlike their malignant counterparts, low-grade gliomas are associated with prolonged survival. However, these tumors have a propensity to progress after resection and ultimately undergo malignant degeneration. The factors associated with recurrence and malignant degeneration remain relatively unknown. The author...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2008.10.JNS08608
更新日期:2010-01-01 00:00:00