Abstract:
OBJECTIVE:We examined the incidence of perioperative fever and its relationship to outcome among patients enrolled in the Intraoperative Hypothermia for Aneurysm Surgery Trial. METHODS:One thousand patients with initial World Federation of Neurological Surgeons grades of I to III undergoing clipping of intracranial aneurysms after subarachnoid hemorrhage were randomized to intraoperative normothermia (36 degrees C-37 degrees C) or hypothermia (32.5 degrees C-33.5 degrees C). Fever (> or =38.5 degrees C) and other complications (including infections) occurring between admission and discharge (or death) were recorded. Functional and neuropsychologic outcomes were assessed 3 months postoperatively. The primary outcome variable for the trial was dichotomized Glasgow Outcome Scale (good outcome versus all others). RESULTS:Fever was reported in 41% of patients. In 97% of these, fever occurred in the postoperative period. The median time from surgery to first fever was 3 days. All measures of outcome were worse in patients who developed fever, even in those without infections or who were World Federation of Neurological Surgeons grade I. Logistic regression analyses were performed to adjust for differences in preoperative factors (e.g., age, Fisher grade, initial neurological status). This demonstrated that fever continued to be significantly associated with most outcome measures, even when infection was added to the model. An alternative stepwise model selection process including all fever-related measures from the preoperative and intraoperative period (e.g., hydrocephalus, duration of surgery, intraoperative blood loss) resulted in the loss of significance for dichotomized Glasgow Outcome Scale, but significant associations between fever and several other outcome measures remained. After adding postoperative delayed ischemic neurological deficits to the model, only worsened National Institutes of Health Stroke Scale score, Barthel Activities of Daily Living index, and discharge destination (home versus other) remained independently associated with fever. CONCLUSION:These findings suggest that fever is associated with worsened outcome in surgical subarachnoid hemorrhage patients, although, because the association between fever and the primary outcome measure for the trial is dependent on the covariates used in the analysis (particularly operative events and delayed ischemic neurological deficits), we cannot rule out the possibility that fever is a marker for other events. Only a formal trial of fever treatment or prevention can address this issue.
journal_name
Neurosurgeryjournal_title
Neurosurgeryauthors
Todd MM,Hindman BJ,Clarke WR,Torner JC,Weeks JB,Bayman EO,Shi Q,Spofford CM,IHAST Investigators.doi
10.1227/01.NEU.0000341903.11527.2Fsubject
Has Abstractpub_date
2009-05-01 00:00:00pages
897-908; discussion 908issue
5eissn
0148-396Xissn
1524-4040pii
00006123-200905000-00023journal_volume
64pub_type
杂志文章,多中心研究,随机对照试验相关文献
NEUROSURGERY文献大全abstract::THE DIRECT ENDONASAL transsphenoidal approach to the sella with the operating microscope was initially described more than 20 years ago. Herein, we describe the technique, its evolution, and lessons learned over a 10-year period for treating pituitary adenomas and other parasellar pathology. From July 1998 to January ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000327025.03975.BA
更新日期:2008-10-01 00:00:00
abstract::The paraclinoid area is investigated anatomically for possible microneurosurgical approaches to the C3 segment of the internal carotid artery and to structures in the vicinity of the anterior siphon knee. Removal of the anterior clinoid process reveals a tight connective tissue ring that fixes the internal carotid art...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:
更新日期:1988-05-01 00:00:00
abstract:BACKGROUND:Acromegaly is a disorder characterized by hypersecretion of growth hormone caused by a growth hormone-secreting pituitary adenoma. OBJECTIVE:To evaluate the long-term efficacy and safety of repeat transsphenoidal surgery for persistent or recurrent acromegaly. METHODS:We retrospectively reviewed records fo...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/NEU.0b013e3181ec4379
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVE:To assess the role that neuronavigation plays in assisting endoscopic transsphenoidal reoperations for recurrent pituitary adenomas. METHODS:During a 45-month period, 19 endoscopic endonasal transsphenoidal reoperations were performed for recurrent pituitary adenomas. In 11 of 19 patients, the procedure was ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-200207000-00020
更新日期:2002-07-01 00:00:00
abstract::Delayed ischemic neurological deficit (DIND) remains a major unsolved problem in the management of aneurysmal subarachnoid hemorrhage (SAH). For many years, the complications reported with acute aneurysm surgery caused surgeons to operate late after SAH. In a 42-month-period, we managed 146 patients with aneurysm and/...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-199201000-00003
更新日期:1992-01-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the relative socioeconomic costs of benign cranial base tumors treated with open surgery and gamma knife radiosurgery. METHODS:In a retrospective study, we studied 174 patients with benign cranial base tumors, less than 3 cm in diameter (or volume less than 30 ml), admit...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000209892.42585.9B
更新日期:2006-05-01 00:00:00
abstract:OBJECTIVE:The surgical benefit to pseudo-occlusion of the internal carotid artery (ICA) is controversial. Because the benefit of carotid endarterectomy for pseudo-occlusion of the ICA remains uncertain, we examined the use of carotid stenting as a possible alternative treatment for this condition. METHODS:Twenty cases...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000222650.09509.DE
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVE:To determine the prevalence of depressed and anxious mood states in patients with cervical spondylotic myelopathy (CSM), a degenerative spine condition with symptoms of neck pain, numb clumsy hands, gait difficulties, sphincter dysfunction, and impotence. To examine the relation between mood and functional de...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000166664.19662.43
更新日期:2005-08-01 00:00:00
abstract:OBJECTIVE:We present our microsurgical lateral orbital approach for intraorbital lesions, with special emphasis on the microanatomy of the orbit. METHODS:Among 26 patients, such lesions included tumors of the lacrimal glands, cavernous angioma, meningioma, neuroma, and other tumors. These intraorbital lesions were rem...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-199612000-00018
更新日期:1996-12-01 00:00:00
abstract:OBJECTIVE:To test the concept that endovascular angioscopy can assist surgical intracranial aneurysm clipping by providing an endoluminal view of the aneurysm-parent vessel complex. METHODS:A carotid bifurcation aneurysm was surgically created in a dog at the lingual artery origin. A balloon catheter was inflated prox...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-199909000-00032
更新日期:1999-09-01 00:00:00
abstract:OBJECTIVE:Intracranial dural arteriovenous fistulae (DAVFs) can present as disabling intracranial hemorrhage. The aim of this study was to investigate the independent effects of specific demographic and clinical variables on hemorrhagic presentation in patients with DAVFs. METHODS:All patients with DAVFs evaluated at ...
journal_title:Neurosurgery
pub_type: 临床试验,杂志文章
doi:10.1227/01.neu.0000317311.69697.fc
更新日期:2008-03-01 00:00:00
abstract::A 60-year-old woman presented with a history of headache and rapidly progressive complete bilateral ophthalmoplegia. Her endocrine function was normal. Radiographic studies revealed signs of diffuse destruction of the sella turcica by a tumor without suprasellar extension. Biopsies of the lesion within the sphenoid si...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
abstract:OBJECTIVE:To identify the CCM3 gene in a population of 61 families with a positive family history of cerebral cavernous malformations (CCM), 8 of which had suggestive linkage to the CCM3 locus. METHODS:We searched for mutations within the CCM3 interval using a high-throughput screening technique, temperature-gradient ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000180811.56157.e1
更新日期:2005-11-01 00:00:00
abstract:INTRODUCTION:Isolated spinal aneurysms are rare; only a few have been reported. To the best of our knowledge, this series represents the largest experience with four ruptured spinal aneurysms, all of which were treated surgically. METHODS:Clinical information from the hospital charts and diagnostic images of four pati...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000186010.34779.10
更新日期:2005-12-01 00:00:00
abstract:BACKGROUND:Achieving seizure control in patients with low-grade temporal lobe gliomas or glioneuronal tumors remains highly underappreciated, because seizures are the most frequent presenting symptom and significantly impact patient quality-of-life. OBJECTIVE:To assess how the extent of temporal lobe resection influen...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1227/NEU.0b013e31823c3a30
更新日期:2012-04-01 00:00:00
abstract:BACKGROUND:The benefits of intravenous thrombolysis for acute ischemic stroke are still limited. OBJECTIVE:To evaluate the safety and efficacy of double-lumen balloon catheter-based reperfusion therapy with or without intra-arterial thrombolysis for acute occlusion of intracranial arteries. METHODS:Fifty-nine patient...
journal_title:Neurosurgery
pub_type: 杂志文章,多中心研究
doi:10.1227/01.NEU.0000380954.29925.CE
更新日期:2010-09-01 00:00:00
abstract:OBJECTIVE:Brain responses from concussive impacts in National Football League football games were simulated by finite element analysis using a detailed anatomic model of the brain and head accelerations from laboratory reconstructions of game impacts. This study compares brain responses with physician determined signs ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000186950.54075.3b
更新日期:2005-11-01 00:00:00
abstract:OBJECTIVE:Vascular remodeling via apoptotic mechanisms is an important factor in vascular diseases. c-Jun amino-terminal kinase (JNK) is a member of the mitogen-activated protein kinase family and initiates apoptosis mainly via phosphorylation of the c-Jun transcription factor. We performed this study to clarify the ro...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-200210000-00027
更新日期:2002-10-01 00:00:00
abstract::STRESS ULCERS OCCUR frequently in intensive care unit patients who have intracranial disease. After major physiological stress, endoscopic evidence of mucosal lesions of the gastrointestinal tract appears within 24 hours of injury; 17% of these erosions progress to clinically significant bleeding. Gastrointestinal hem...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1097/00006123-199708000-00017
更新日期:1997-08-01 00:00:00
abstract:OBJECTIVE:A number of publications suggest that there are seasonal influences on the incidence of subarachnoid hemorrhage (SAH). Most series agree on a peak incidence during springtime. Meteorological influences have been assumed to be obvious explanations for seasonal variations. Furthermore, the perceived clustering ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000325864.91584.c7
更新日期:2008-05-01 00:00:00
abstract::As an adjuvant to surgery, radiation therapy has consistently proven to be the most successful form of treatment for primary and secondary malignant brain tumors and possibly for inoperable benign tumors. Because the risk of radiation necrosis of normal brain limits the amount of radiation that can be given by externa...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1227/00006123-198112000-00022
更新日期:1981-12-01 00:00:00
abstract:OBJECTIVE:Because more women with cerebrospinal fluid shunts are surviving to child-bearing age, neurosurgeons, obstetricians, and other health care professionals require information about the care of these patients, especially during pregnancy and delivery. The purpose of this study was to gather comprehensive data fr...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1097/00006123-199809000-00030
更新日期:1998-09-01 00:00:00
abstract::A high degree of variability in energy expenditure has characterized the metabolic response to traumatic brain injury. A goal of parenteral or enteral repletion in this population is the precise estimation of caloric requirement to avoid complications associated with overfeeding and underfeeding. The first aim of this...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-199208000-00009
更新日期:1992-08-01 00:00:00
abstract:OBJECTIVE:We report 81 patients with a traumatic intracerebellar hemorrhagic contusion or hematoma managed between 1996 and 1998 at 13 Italian neurosurgical centers. METHODS:Each center provided data about patients' clinicoradiological findings, management, and outcomes, which were retrospectively reviewed. RESULTS:A...
journal_title:Neurosurgery
pub_type: 杂志文章,多中心研究
doi:10.1097/00006123-200201000-00004
更新日期:2002-01-01 00:00:00
abstract:OBJECTIVE:The results of the surgical treatment of osteomyelitis with expandable titanium cages and either allograft or autograft are presented. METHODS:Thirty-six patients with vertebral osteomyelitis are presented. There were 7 cervical, 17 thoracic, 4 thoracolumbar (involving T12-L1), 5 lumbar, and 3 lumbosacral (i...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000336332.11957.0B
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Minimum clinical important difference (MCID) has been adopted as the smallest improvement in patient-reported outcome needed to achieve a level of improvement thought to be meaningful to patients. OBJECTIVE:To use a common MCID calculation method with a cost-utility threshold anchor to introduce the concept...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000462079.96571.dc
更新日期:2015-03-01 00:00:00
abstract:OBJECTIVE:The success of subthalamic nucleus (STN) surgery for Parkinson's disease depends on accuracy in target determination. The objective of this study was to determine which of the following techniques was most accurate and precise in identifying the location for stimulation in STN deep brain stimulation surgery t...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000316289.75736.55
更新日期:2008-02-01 00:00:00
abstract::An original stereotactic radiosurgical approach coupling a) Talairach's stereotactic methodology, b) a specially devised mechanical system, and c) a linear accelerator is detailed. The authors present their preliminary results on 66 patients with nonsurgical intracranial arteriovenous malformations. The doses delivere...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198903000-00001
更新日期:1989-03-01 00:00:00
abstract:OBJECTIVE:Socioeconomic changes have imposed many administrative demands on neurosurgeons, including managing facilities such as the intensive care unit without absolute authority and maintaining referrals, marketing in an increasingly competitive environment, effecting change within stubborn hospital systems, negotiat...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000318180.80040.d0
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVE AND IMPORTANCE:Intracranial solitary fibrous tumors have been described previously, but intraventricular solitary fibrous tumors are extremely rare. We present what is, to our knowledge, the first reported case of solitary fibrous tumor in the third ventricle. CLINICAL PRESENTATION:A 63-year-old man presente...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000097555.75899.c3
更新日期:2004-01-01 00:00:00