Abstract:
OBJECT:Ventricular infection after ventriculostomy placement carries a high mortality rate. Responding to ventriculostomy infection rates, a multidisciplinary performance improvement team was formed, a comprehensive protocol for ventriculostomy placement was developed, and the efficacy was evaluated. METHODS:A best-practice protocol was developed, including hand hygiene before the procedure; prophylactic antibiotics; sterile gloves changed between preparation, draping, and procedure; hair removal by clipping for dressing adherence; skin preparation using iodine povacrylex (0.7% available iodine) and isopropyl alcohol (74%); full body and head drape; full surgical attire for the surgeon and other bedside providers; and an antimicrobial-impregnated catheter. A checklist of critical components was used to confirm proper insertion and to monitor practice. Procedure-specific infection rates were calculated using the number of infections divided by the number of patients in whom an external ventricular drainage (EVD) device was inserted × 100 (%). Data were reported back to providers and to the committee. Bundle compliance was monitored over a 4-year period. RESULTS:At the authors' institution, 2928 ventriculostomies were performed between the beginning of the fourth quarter of 2006 and the end of the first quarter of 2012. Although the best-evidence bundle was applied to all patients, only 588 (20.1%) were checklist monitored (increasing from 7% to 23% over the study period). The infection rate for the 2 quarters before bundle implementation was 9.2%. During the study period, the rate decreased quarterly to 2.6% and then to 0%. Over a 4-year period, the rate was 1.06% (2007), 0.66% (2008), 0.15% (2009), and 0.34% (2010); it was 0% in 2011 and the first quarter of 2012. The overall EVD infection rate was 0.46% after bundle implementation. CONCLUSIONS:Bundle implementation including an antimicrobial-impregnated catheter dramatically decreased EVD-related infections. Training and situational awareness of appropriate practice, assisted by the checklist, plus use of the antibiotic-impregnated catheter resulted in sustained reduction in ventriculitis.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Kubilay Z,Amini S,Fauerbach LL,Archibald L,Friedman WA,Layon AJdoi
10.3171/2012.11.JNS121336subject
Has Abstractpub_date
2013-03-01 00:00:00pages
514-20issue
3eissn
0022-3085issn
1933-0693journal_volume
118pub_type
杂志文章abstract::OBJECTIVEThe authors' aim in this study was to evaluate placement accuracy and clinical outcomes in patients who underwent implantation of deep brain stimulation devices with the aid of frame-based stereotaxy and intraoperative MRI after induction of general anesthesia.METHODSThirty-three patients with movement disord...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2017.7.JNS171166
更新日期:2018-12-01 00:00:00
abstract::Are spinal schwannomas as benign as we think? To what extent do patients recover? Are patients prone to develop late complications such as cystic myelopathy or symptomatic spinal deformity? Is their life expectancy compromised? In an effort to answer these questions, the authors analyzed the long-term outcome for 187 ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.83.4.0621
更新日期:1995-10-01 00:00:00
abstract::To characterize the temporal course of radiosurgical lesions, 19 cats were irradiated in an animal linear accelerator radiosurgical device. The animals were followed clinically and, at 3.5, 6, 12, 18, 23, 29, and 63 weeks, were studied with gadolinium-enhanced magnetic resonance (MR) imaging. They were then sacrificed...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1994.80.6.1046
更新日期:1994-06-01 00:00:00
abstract:OBJECT:Hospital readmission within 30 days of discharge is a major contributor to the high cost of health care in the US and is also a major indicator of patient care quality. The purpose of this study was to investigate the incidence, causes, and predictors of 30-day readmission following craniotomy for malignant supr...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.1.JNS131264
更新日期:2014-05-01 00:00:00
abstract::A patient with findings of bilateral cortical blindness and a unilateral carotid bruit is reported. A persistent trigeminal artery allowed emboli from a unilateral ulcerated internal carotid plaque to affect the visual cortex bilaterally. The angiographic findings and a brief discussion of this anomalous artery are pr...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.52.5.0709
更新日期:1980-05-01 00:00:00
abstract:OBJECT:The prognostic significance of tumor grade and resection and the efficacy of prophylactic radiation remain controversial in the management of intracranial ependymoma. The outcomes in patients with intracranial ependymoma treated at the Kyoto University Hospital were reviewed retrospectively, and prognostic signi...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2005.103.1.0031
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVE:Two-session Gamma Knife surgery (GKS) has recently been demonstrated to be an effective and less-invasive alternative for large brain metastases not treatable by microsurgical resection. This raises the clinical question of whether the 2-session GKS strategy further improves treatment outcomes for patients wi...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2019.7.JNS191193
更新日期:2019-10-18 00:00:00
abstract::Twenty-nine patients consecutively admitted with a diagnosis of communicating hydrocephalus underwent continuous intracranial pressure (ICP) monitoring; pressure-volume studies; and measurement of resistance to outflow of cerebrospinal fluid (Rout). The two latter calculations were made by the bolus injection and pres...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1986.64.1.0045
更新日期:1986-01-01 00:00:00
abstract::The authors review their 2-year experience with a rhinoseptal transsphenoidal approach to skull-base tumors of various pathologies involving both the sphenoid and cavernous sinuses. Eight patients with cranial nerve palsies attributable to compression of the contents of the cavernous sinus and/or optic canal are inclu...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1990.73.4.0513
更新日期:1990-10-01 00:00:00
abstract::The authors report a case in which sellar and suprasellar osteogenic sarcoma developed 10 years after radiation therapy for pituitary adenoma. The literature is reviewed and the rarity of this condition discussed. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1976.44.1.0088
更新日期:1976-01-01 00:00:00
abstract::Autologous blood (0.3 to 5.0 ml) was introduced into the lumbar subarachnoid space of nine monkeys. Serial spinal cord arteriography was performed at frequent intervals over a 24-hour period. Magnification techniques permitted direct measurement of the anterior spinal artery and posterior spinal vein. Neither immediat...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1977.47.1.0064
更新日期:1977-07-01 00:00:00
abstract::Identification of blunt carotid injury prior to the development of ischemic symptoms requires aggressive screening of patients at risk. The treatment of these lesions has centered around long-term anticoagulation therapy. However, studies have revealed that many of these lesions persist despite medical treatment, as d...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1997.87.6.0825
更新日期:1997-12-01 00:00:00
abstract:OBJECT:Skull bone regeneration induced by transforming growth factor-beta1 (TGFbeta1)-containing gelatin hydrogels (TGFbeta1-hydrogels) was investigated using a rabbit skull defect model. Different strengths of TGFbeta1 were examined and compared: different TGFbeta1 doses in gelatin hydrogels with a fixed water content...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2000.92.2.0315
更新日期:2000-02-01 00:00:00
abstract::Schwannomas of the brain parenchyma are extremely rare, occurring mostly in children and young adults. Fewer than 50 cases have been reported in the English-language literature. Isolated temporal lobe epilepsy is a rare presentation of intracerebral schwannomas, with only 2 reported cases. The authors present the case...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2012.3.JNS111043
更新日期:2012-07-01 00:00:00
abstract::By the time Harvey Cushing entered medical school, nerve reconstruction techniques had been developed, but peripheral nerve surgery was still in its infancy. As an assistant surgical resident influenced by Dr. William Halsted, Cushing wrote a series of reports on the use of cocaine for nerve blocks. Following his resi...
journal_title:Journal of neurosurgery
pub_type: 传,历史文章,杂志文章
doi:10.3171/2010.11.JNS10804
更新日期:2011-05-01 00:00:00
abstract::Patients with hereditary hemorrhagic telangiectasia (HHT) are at risk for the development of cerebral arteriovenous malformations (AVMs). The authors report a case of a spontaneously regressing cerebral AVM in a patient with HHT. The lesion was diagnosed on the basis of findings on screening magnetic resonance imaging...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2006.105.5.428
更新日期:2006-11-01 00:00:00
abstract::A small group of spinal arteriovenous malformations (AVM's) most commonly present in children or young adults, are characterized by a large size, high flow, the presence of multiple feeders, and frequent extension to paraspinous structures. Cardiac output requirements may be significantly increased by these so-called ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1989.70.4.0628
更新日期:1989-04-01 00:00:00
abstract::A technique is described in which spinal fracture repositioning, decompression, and stabilization are achieved by a combination of hook-rod and pedicle screw fixation. This straightforward technique is useful for performing acute decompression in patients with partial neurological deficits and multisystem injuries. A ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:
更新日期:2000-01-01 00:00:00
abstract::A 48-year-old laborer presented with a 1-year history of low-back pain radiating into the posterior aspects of both thighs. Two weeks before admission, acute exacerbation resulted in signs and symptoms of compressive radiculopathy at L-5. Myelography revealed concentric constriction of the lower thecal sac due to abun...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1982.57.4.0559
更新日期:1982-10-01 00:00:00
abstract::The fibrinolytic activity in cerebrospinal fluid has been monitored by determination of levels of fibrin split products (FSP) in 23 patients with ruptured intracranial aneurysms. In 20 of these 23, FSP was found in the cerebrospinal fluid (CSF), with levels ranging from 10 to 80 micrograms/ml. Eleven of the 23 patient...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.52.4.0453
更新日期:1980-04-01 00:00:00
abstract::OBJECTIVE Skull base chondrosarcoma is one of the most intractable tumors because of its aggressive biological behavior and involvement of the internal carotid artery and cranial nerves (CNs). One of the most accepted treatment strategies for skull base chondrosarcoma has been surgical removal of the tumor in conjunct...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2017.1.JNS162000
更新日期:2018-05-01 00:00:00
abstract::The interaction between oxyhemoglobin (oxyHb) and 5-hydroxytryptamine (5-HT) was investigated in an experimental model of isolated canine internal and common carotid arteries with insertion of stainless steel cannulae. Extraluminal application of 10(-5) M oxyHb induced marked and long-lasting vasoconstriction in the i...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1988.69.2.0263
更新日期:1988-08-01 00:00:00
abstract::The lateral extracavitary approach to the spine was used for resection of displaced bpne and disc located anterior to the dura in 62 patients with traumatic lesions of the thoracic and lumbar spine. Fifty-two patients had closed vertebral fractures and 10 had gunshot wounds. The spinal cord was involved in 44 patients...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1976.45.6.0628
更新日期:1976-12-01 00:00:00
abstract:OBJECT:The authors assessed clinical outcomes of patients with treated spinal dural arteriovenous fistulas (DAVFs) and investigated prognostic factors. METHODS:Thirty consecutive patients with spinal DAVFs were treated at the authors' institution during the past 15 years: seven underwent surgery; seven underwent surge...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2001.94.2.0199
更新日期:2001-04-01 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:OBJECT:The application accuracy of the Neuromate neurosurgical robot has been validated in vitro but has not been evaluated in vivo for deep brain stimulation (DBS) electrode implantations. The authors conducted a study to evaluate this application accuracy in routine frame-based DBS procedures, with an independent sys...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.9.JNS14256
更新日期:2015-01-01 00:00:00
abstract::OBJECTIVE The Agency of Healthcare Research and Quality (AHRQ) has defined Patient Safety Indicators (PSIs) for assessments in quality of inpatient care. The hypothesis of this study is that, in the treatment of unruptured cerebral aneurysms (UCAs), PSI events are less likely to occur in hospitals meeting the volume t...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2017.5.JNS162778
更新日期:2018-08-01 00:00:00
abstract:OBJECTIVE:The optimal margin size in postoperative stereotactic radiosurgery (SRS) for brain metastases is unknown. Herein, the authors investigated the effect of SRS planning target volume (PTV) margin on local recurrence and symptomatic radiation necrosis postoperatively. METHODS:Records of patients who received pos...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2017.9.JNS171735
更新日期:2018-04-20 00:00:00
abstract:OBJECTIVE:Decision-making for intracranial tumor surgery requires balancing the oncological benefit against the risk for resection-related impairment. Risk estimates are commonly based on subjective experience and generalized numbers from the literature, but even experienced surgeons overestimate functional outcome aft...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2020.4.JNS20643
更新日期:2020-06-12 00:00:00
abstract:OBJECT:Survivin, one of the apoptosis inhibitor proteins, has been detected in most cancers in humans. In addition, two splice variants (survivin-2B and survivin-deltaEx3) have been identified. The authors investigated the transcription levels of survivin messenger (m)RNA and its splice variants in nine tumor cell line...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2003.99.4.0738
更新日期:2003-10-01 00:00:00