Abstract:
:Shunt systems with differential pressure valves are prone to the complications of overdrainage. A programmable valve permits adjustment of the opening pressure of the valve. In this paper the authors report the incidence of subdural fluid collections in a randomized trial of programmable compared with conventional valves, and they describe methodologies used in management of this complication. A multiinstitutional, prospective, randomized trial of the Codman Hakim programmable valve and conventional fixed-pressure valves was undertaken. Two classes were defined: "new" and "replacement" valves. Randomization of the type of valve in each group was performed at each study site. Clinical and radiological studies were required at fixed intervals over a 104-week period. All complications were reported. The experimental valves were required to be reprogrammed after magnetic resonance imaging studies, but all other decisions regarding pressure setting were left to each investigator. Three hundred seventy-seven patients were randomized; 194 were treated with a programmable valve and 183 with a fixed-pressure valve. The two groups were statistically similar in demographic composition, as were the "new" and "replacement" categories. The investigators made 540 valve pressure changes (five per patient; range one-41 changes). More than half of the reprogramming adjustments were made in the first 3 months postplacement; 70% were made within 6 months. More than half of all reprogramming adjustments were required in a group of 30 patients. Four treatment modalities were observed: 1) 30% of the fluid collections resolved spontaneously (25% in the patients with programmable valves and 36.3% in those with conventional valves) and were largely found to be hygromas in infants and children; 2) four subdural fluid collections were unresolved and under observation; 3) the subdural hematoma was drained and the shunt removed (in 8.3% of patients with the programmable valve and 36.3% of those with the control valve); 4) the pressure of programmable valve was raised in 58% of patients (seven of 12), and this increase in opening pressure was a feature used by investigators to affect treatment. There was no significant difference in the incidence of subdural fluid collections between the programmable and fixed-pressure valve treatment groups. The programmable feature provided a considerable advantage in treatment when subdural collections occurred.
journal_name
Neurosurg Focusjournal_title
Neurosurgical focusauthors
Carmel PW,Albright AL,Adelson PD,Canady A,Black P,Boydston W,Kneirim D,Kaufman B,Walker M,Luciano M,Pollack IF,Manwaring K,Heilbrun MP,Abbott IR,Rekate Hdoi
10.3171/foc.1999.7.4.2subject
Has Abstractpub_date
1999-10-15 00:00:00pages
e7issue
4issn
1092-0684pii
070407journal_volume
7pub_type
杂志文章abstract::OBJECTIVE The American Association of Neurological Surgeons launched the Quality Outcomes Database (QOD), a prospective longitudinal registry that includes demographic, clinical, and patient-reported outcome (PRO) data, to measure the safety and quality of neurosurgical procedures, including spinal surgery. Differing ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2017.10.FOCUS17553
更新日期:2018-01-01 00:00:00
abstract::Cerebral revascularization procedures have been used in the clinical management of actual or threatened cerebral ischemic states and unclippable cerebral aneurysms. An alternative to a low-flow bypass graft (for example, with the superficial temporal artery) is the use of high-flow grafts created using the saphenous v...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/FOC/2008/24/2/E5
更新日期:2008-01-01 00:00:00
abstract::Hypothalamic hamartomas (HHs) are developmental malformations associated with a range of neurological problems, including intractable seizures. There is increasing evidence of the epileptogenicity of the hamartoma and of the inhomogeneous distribution of the epileptic abnormalities within the malformation. The managem...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2010.11.FOCUS10241
更新日期:2011-02-01 00:00:00
abstract::Optical imaging of intrinsic signals (OIS) is a well-established neuroimaging modality by which functional cortical activity is mapped by detecting activity-related changes in cortical light reflectance. Light reflectance changes are detected by a charged-coupled device camera that captures images of the exposed corte...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2002.13.4.2
更新日期:2002-10-15 00:00:00
abstract::Incidental findings pose considerable management dilemmas for the treating physician and psychological burden for the respective patient. With an aging population, more patients will be diagnosed with asymptomatic internal carotid artery stenosis. Patients will have to be counseled with regard to treatment options acc...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2011.9.FOCUS11222
更新日期:2011-12-01 00:00:00
abstract::Peritumoral cysts (those arising immediately adjacent to the tumor mass) are frequently associated with benign and malignant tumors of the brain and spinal cord (syringomyelia). The cystic component of central nervous system (CNS) tumors and associated peritumoral cysts are often the cause of clinical symptoms. Becaus...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2007.22.5.10
更新日期:2007-05-15 00:00:00
abstract:OBJECT:The management of pediatric intraventricular tumors is highly dependent on identification of the tumor type. Choroid plexus papillomas, a common intraventricular tumor in children, can be difficult to distinguish radiographically from choroid plexus carcinomas and other common pediatric central nervous system (C...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:
更新日期:2005-06-15 00:00:00
abstract::Patients taking antithrombotic agents are very common in neurosurgical practice. The perioperative management of these patients can be extremely challenging especially as newer agents, with poorly defined laboratory monitoring and reversal strategies, become more prevalent. This is especially true with emergent cases ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2017.8.FOCUS17447
更新日期:2017-11-01 00:00:00
abstract:OBJECT:Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study was to evaluate the efficacy and role of gamma knife surgery (GKS) in the treatment of these lesions. METHODS:The authors conducted a review of cases in which GKS was performed at the Un...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2003.14.5.10
更新日期:2003-05-15 00:00:00
abstract::Epidermoid cysts or tumors comprise 1% of intracranial tumors with a predilection for the cerebellopontine angle or parasellar cisterns. These tumors are derived from an ectopic ectodermal implant seeded between fusing ectodermal surfaces. This results in a benign proliferation of stratified squamous epithelium along ...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2016.1.FocusVid.15466
更新日期:2016-01-01 00:00:00
abstract::Our understanding of glioblastoma multiforme (GBM), the most common form of primary brain cancer, has been significantly advanced by recent efforts to characterize the cancer genome using unbiased high-throughput sequencing analyses. While these studies have documented hundreds of mutations, gene copy alterations, and...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2009.10.FOCUS09212
更新日期:2010-01-01 00:00:00
abstract:OBJECT:Convection-enhanced delivery (CED) is an increasingly used novel local/regional delivery method targeted directly to tissue. It relies on a continuous pressure gradient for distribution of therapeutic agents into the interstitial space, with administration of the infusate over a few days. Cintredekin besudotox (...
journal_title:Neurosurgical focus
pub_type: 临床试验,杂志文章
doi:
更新日期:2006-04-15 00:00:00
abstract::The authors describe a surgical technique for the correction of symptomatic degenerative lumbar scoliosis. Using a single, unilateral, interbody cage placed on the concave side of the coronal deformity, combined with a dorsal decompression and instrumented posterolateral fusion, this technique has resulted in excellen...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2009.12.FOCUS09281
更新日期:2010-03-01 00:00:00
abstract:OBJECT:Using strict biochemical remission criteria, the authors assessed surgical outcomes after endoscopic transsphenoidal resection of growth hormone (GH)-secreting pituitary adenomas and identified preoperative factors that significantly influence the rate of remission. METHODS:A retrospective review of a prospecti...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2010.7.FOCUS10153
更新日期:2010-10-01 00:00:00
abstract::Interventional neuroradiology is a less invasive modality than open neurosurgery for the treatment of a wide range of neurovascular disorders. Refinements in technique and improvements in the design of microcatheters, guide wires, and embolic materials have yielded superior clinical outcomes and provided an impetus to...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2003.15.4.7
更新日期:2003-10-15 00:00:00
abstract::Dumbbell tumors of the cervical spine can present considerable management challenges related to adequate exposure of both intraspinal and paraspinal tumor components, potential injury to the vertebral artery, and spinal stability. This video demonstrates the microsurgical removal of a large cervical dumbbell schwannom...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2014.V3.FOCUS14257
更新日期:2014-09-01 00:00:00
abstract:OBJECTIVE:Frailty has been recognized as a predictor of adverse surgical outcomes across multiple surgical disciplines, but until now the relationship between frailty and intracranial meningioma surgery has not been studied. The goal of the present study was to determine the relationship between increasing frailty (det...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2020.7.FOCUS20324
更新日期:2020-10-01 00:00:00
abstract:OBJECT:The object of this study was to evaluate facial nerve outcomes in the surgical treatment of large vestibular schwannomas (VSs; ≥ 2.5 cm maximal or extrameatal cerebellopontine angle diameter) based on both the operative approach and extent of tumor resection. METHODS:A PubMed search was conducted of English lan...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2012.7.FOCUS12199
更新日期:2012-09-01 00:00:00
abstract::Cervical dural arteriovenous fistulas (dAVFs) are a rare cause of intracranial subarachnoid hemorrhage (SAH) but should be considered when other sources are not found. Subarachnoid hemorrhage caused by dAVF is thought to occur as a result of venous hypertension in most cases. The clinical presentation, acute onset of ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/FOC.2009.26.1.E4
更新日期:2009-01-01 00:00:00
abstract::OBJECTIVE Commercially available processed nerve allografts have been shown to be inferior to autografts in previous animal studies. The authors hypothesized that combining different processing and storage techniques will result in improved nerve ultrastructure preservation, lower immunogenicity, and minimized cellula...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2017.1.FOCUS16462
更新日期:2017-03-01 00:00:00
abstract::Arteriovenous malformations (AVMs) of the posterior fossa are complex neurovascular lesions that are less common than their supratentorial counterparts, accounting for < 15% of all AVMs. The majority of patients with these lesions present with intracranial hemorrhage, a factor that has been consistently shown to incre...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2009.2.FOCUS0914
更新日期:2009-05-01 00:00:00
abstract::Giant cerebral aneurysms may be treated through a variety of options, including aneurysm trapping with concurrent bypass. This video describes the case of a large, recurrent, left middle cerebral artery aneurysm that was treated using a high flow, radial artery bypass graft, from the external carotid artery to the lef...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2015.V1.FOCUS14548
更新日期:2015-01-01 00:00:00
abstract::The goals of this study were to analyze the effect of pallidotomy on parkinsonian tremor and to ascertain whether an association exists between microrecording findings and tremor outcome. Forty-four patients with Parkinson's disease (PD) who had drug-induced dyskinesia, bradykinesia, rigidity, and tremor underwent pos...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.1997.2.3.5
更新日期:1997-03-15 00:00:00
abstract::Central skull base lesions in the upper retroclival and petroclival regions can be challenging to access because of their location anterior to the brainstem. Several transpetrosal approaches have been developed to access the petroclival junction, including anterior petrosal (anterior petrosectomy), posterior petrosal ...
journal_title:Neurosurgical focus
pub_type: 临床试验,杂志文章
doi:10.3171/FOC.2008.25.12.E5
更新日期:2008-01-01 00:00:00
abstract::OBJECTIVE Tectal gliomas constitute a rare and inhomogeneous group of lesions with an uncertain clinical course. Because these supposedly benign tumors are frequently followed up by observation over many years, the authors undertook this analysis of their own case series in an effort to demonstrate that the clinical c...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2018.3.FOCUS1850
更新日期:2018-06-01 00:00:00
abstract::OBJECT Cushing's disease (CD) is a potentially lethal neuroendocrinopathy that often requires specialized multidisciplinary treatment to achieve optimized outcomes. The authors analyzed data pertaining to patient, hospital, and admission characteristics as they relate to outcomes following transsphenoidal surgery (TSS...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2014.11.FOCUS14694
更新日期:2015-02-01 00:00:00
abstract:OBJECT:The relatively stationary anatomy of the intracranial compartment has allowed the development of stereotactic radiosurgery as an effective treatment option for many intracranial lesions. Difficulty in accurately tracking extracranial targets has limited its development in the treatment of these lesions. The abil...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2001.11.6.9
更新日期:2001-12-15 00:00:00
abstract::Since its inception, one of the major issues in transsphenoidal surgery has been the adequate visualization of anatomical structures. As transsphenoidal surgery evolved, technical advancements improved the surgical view of the operative field and the orientation. The operating microscope replaced Cushing's headlight a...
journal_title:Neurosurgical focus
pub_type: 历史文章,杂志文章,评审
doi:10.3171/foc.2005.19.6.4
更新日期:2005-12-15 00:00:00
abstract::Lumbar nerve root anomalies are uncommon phenomena that must be recognized to avoid neural injury during surgery. The authors describe 2 cases of nerve root anomalies encountered during mini-open transforaminal lumbar interbody fusion (TLIF) surgery. One anomaly was a confluent variant not previously classified; the a...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2013.2.FOCUS1349
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:Convection-enhanced delivery (CED) and osmotic pump delivery both have been promoted as promising techniques to deliver drugs to pediatric diffuse intrinsic pontine gliomas (DIPGs). Correspondingly, the aim of this study was to understand how infusate molecular weight (MW), duration of delivery, and mechanism...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2019.10.FOCUS19703
更新日期:2020-01-01 00:00:00