Outcome prediction in moderate and severe traumatic brain injury: a focus on computed tomography variables.

Background: With this study we aimed to design validated outcome prediction models in moderate and severe traumatic brain injury (TBI) using demographic, clinical, and radiological parameters.

Methods: Seven hundred consecutive moderate or severe TBI patients were included in this observational prospective cohort study. After inclusion, clinical data were collected, initial head computed tomography (CT) scans were rated, and at 6 months outcome was determined using the extended Glasgow Outcome Scale.

Pulsed radiofrequency treatment for trigeminal neuralgia.

Background: Pulsed radiofrequency (PRF) treatment is defined as the delivery of short pulses of radiofrequency via a needle tip, which does not result in an actual thermal lesions. There are mixed views regarding the use of PRF for trigeminal neuralgia (TN). In our opinion, one of the main reasons for the contrasting views is the insufficient PRF dose employed in previous studies.

The use of laminectomy for the placement of a percutaneous spinal cord stimulation electrode.

Objective: The placement of a percutaneous electrode for trial stimulation to evaluate the effectiveness of spinal cord stimulation can be impossible because of epidural adhesions from previous spinal surgeries. The authors would like to describe a combination of techniques in order to place a percutaneous lead for a test phase.

Materials And Methods: Technical report of an illustrative case where a partial laminectomy was used to assist a percutaneous lead placement.

Percutaneous thoracic intervertebral disc nucleoplasty: technical notes from 3 patients with painful thoracic disc herniations.

Symptomatic thoracic disc herniation is an uncommon condition and early surgical approaches were associated with significant morbidity and even mortality. We are the first to describe the technique of percutaneous thoracic nucleoplasty in three patients with severe radicular pain due to thoracic disc herniation. Two of the patients experienced more than 75% pain relief and one patient experienced more than 50% pain relief.

Computed tomography and outcome in moderate and severe traumatic brain injury: hematoma volume and midline shift revisited.

Intracranial lesion volume and midline shift are powerful outcome predictors in moderate and severe traumatic brain injury (TBI), and therefore they are used in TBI and computed tomography (CT) classification schemes, like the Traumatic Coma Data Bank (TCDB) classification. In this study we aimed to explore the prognostic value of lesion volume and midline shift in moderate and severe TBI as measured from acute cranial CT scans. Also, we wanted to determine interrater reliability for the evaluation of these CT abnormalities.

Near-normal gait pattern with peroneal electrical stimulation as a neuroprosthesis in the chronic phase of stroke: a case report.

In recent years, the use of functional electrical stimulation (FES) of the peroneal nerve has increased as an alternative for an ankle-foot orthosis (AFO) to treat stroke-related drop foot. We present a chronic stroke patient demonstrating an almost normal gait pattern with peroneal FES as a neuroprosthesis. A 60-year-old survivor of a right hemisphere infarction 21 months ago, who regularly used a polypropylene AFO, was provided with a surface-based peroneal FES device for severe drop foot.

Long-term results of the neuroendoscopic management of colloid cysts of the third ventricle: a series of 90 cases.

Background: The endoscopic removal of third ventricular colloid cysts has been developed as an alternative to microsurgical transcortical-transventricular and transcallosal approaches.

Objective: To examine the value of endoscopic technique by reviewing the large number of endoscopically treated patients with long-term follow-up in 2 neurosurgical centers.

Methods: A retrospective chart review was conducted for all patients admitted for resection of a third ventricular colloid cyst to the Radboud University Nijmegen Medical Centre (Nijmegen, The Netherlands) and the Hôpital Henri Mondor (Paris, France) between 1994 and 2007.

GFAP and S100B are biomarkers of traumatic brain injury: an observational cohort study.

Background: Biomarker levels in blood after traumatic brain injury (TBI) may offer diagnostic and prognostic tools in addition to clinical indices. This study aims to validate glial fibrillary acidic protein (GFAP) and S100B concentrations in blood as outcome predictors of TBI using cutoff levels of 1.5 μg/L for GFAP and 1.

Prediction of the need for an MRI after surgical treatment of symptomatic lumbar herniated disc at discharge: evaluation of the necessity for regular visits at the outpatient clinic.

Background: Surgical treatment of symptomatic lumbar disc herniations has been well established. The need for regular postoperative visits at the outpatient clinic has never been evaluated. In this study, factors predicting the need for magnetic resonance imaging, denoting an unfavorable outcome needing further evaluation, were evaluated.

The development of a screening instrument to select patients at risk of residual complaints after lumbar disc surgery.

Aim: A considerable number of patients who undergo surgery for a lumbosacral radicular syndrome (LRS) continue to experience disability, pain, and loss of work capacity. The goal of the study is to develop a brief screening instrument to identify these patients at risk of residual complaints.

Methods: In a prospective study of 277 patients, the predictors for the outcomes disability, pain, and loss of work capacity were investigated.

A haemodialysis patient with back pain: brown tumour as a cause of spinal cord compression under cinacalcet therapy.

A 43-year-old haemodialysis patient was admitted to hospital because of paroxysmal pain in the upper abdominal region radiating to the back. Laboratory tests showed severe hyperparathyroidism [intact parathyroid hormone (iPTH) 69 pmol/L; reference range: 1.3-6.

Overview of the clinical applications of vagus nerve stimulation.

Vagus nerve stimulation (VNS) has become an established therapy for difficult-to-treat epilepsy during the past 20 years. The vagus nerve provides a unique entrance to the brain. Electrical stimulation of this structure in the cervical region allows direct modulative access to subcortical brain areas, requiring only minimally invasive surgery with low risks involved.

Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study.

Object: As many as 40% of shunts fail in the first year, mainly due to proximal obstruction. The role of catheter position on failure rates has not been clearly demonstrated. The authors conducted a prospective cohort study of navigated shunt placement compared with standard blind shunt placement at 3 European centers to assess the effect on shunt failure rates.

The rationale of postoperative radiographs after cervical anterior discectomy with stand-alone cage for radicular pain.

Object: Cervical anterior discectomy with stand-alone cage (CADC) placement is a known treatment for cervical radiculopathy due to a herniated intervertebral disc or an osteophyte. Routine radiographs are obtained at regular postoperative intervals, but the consequences of routinely obtained radiographs are not known. In this study, the authors evaluated whether postoperative plain radiographs influenced the medical or surgical treatment of patients who underwent CADC placement.

Outcome prediction in mild traumatic brain injury: age and clinical variables are stronger predictors than CT abnormalities.

Mild traumatic brain injury (mTBI) is a common heterogeneous neurological disorder with a wide range of possible clinical outcomes. Accurate prediction of outcome is desirable for optimal treatment. This study aimed both to identify the demographic, clinical, and computed tomographic (CT) characteristics associated with unfavorable outcome at 6 months after mTBI, and to design a prediction model for application in daily practice.

The status of the fourth ventricle and ambient cisterns predict outcome in moderate and severe traumatic brain injury.

Computed tomography (CT) of the head has become the diagnostic tool of choice, particularly for moderate and severe traumatic brain injury (TBI). Various CT characteristics are associated with outcome, and may therefore be used as outcome predictors. One of the most prominent predictors appears to be the status of the basal cisterns.

Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?

Context: A wide range (15-56%) of prevalences of anterior pituitary insufficiency are reported in patients after traumatic brain injury (TBI). However, different study populations, study designs, and diagnostic procedures were used. No data are available on emergency-department-based cohorts of TBI patients.

Minimally invasive placement of epidural plate electrodes under local anaesthesia in spinal cord stimulation.

In the treatment of pain syndromes of different aetiologies a change has occurred from destructive interventions to stimulation procedures. Spinal cord stimulation is the best known example of this treatment strategy. It is used often in patients with persistent neuropathic pain syndromes in an extremity, for instance following low back surgery.

The role of different imaging modalities: is MRI a conditio sine qua non for ETV?

Objective: To describe the different imaging modalities used for the diagnosis and classification of hydrocephalus, their role in defining the optimal treatment of hydrocephalus and to define the optimal preoperative diagnostics for endoscopic third ventriculocisternostomy (ETV).

Methods: An overview on available imaging modalities for hydrocephalus will be given and their pros and cons discussed. In addition, different aspects of the treatment of hydrocephalus by shunts and by ETV will be highlighted.

Reduced work capacity after lumbar disc surgery: the role of cognitive-behavioral and work-related risk factors.

A significant number of patients who have had surgery for lumbosacral radicular syndrome still have a reduced work capacity several months later. In a prospective cohort study of 182 people who underwent lumbar disc surgery, we determined the predictive value of preoperatively measured cognitive-behavioral and work-related factors on work capacity 6 months after surgery. Logistic regression analyses indicated that these factors independently predicted work capacity 6 months after surgery.

Increased GFAP and S100beta but not NSE serum levels after subarachnoid haemorrhage are associated with clinical severity.

Assessment of initial disease severity after subarachnoid haemorrhage (SAH) remains difficult. The objective of the study is to identify biochemical markers of brain damage in peripheral blood after SAH. Hospital admission S100beta, glial fibrillary acidic protein (GFAP) and neuron-specific enolase (NSE) serum levels were analysed in 67 patients with SAH.

Continued disability and pain after lumbar disc surgery: the role of cognitive-behavioral factors.

Cognitive-behavioral factors are considered important in the development of chronic disability and pain in patients with low back pain. In a prospective cohort study of 277 patients undergoing surgery for lumbosacral radicular syndrome, the predictive value of preoperatively measured cognitive-behavioral factors (fear of movement/(re)injury, passive pain coping, and negative outcome expectancies) for disability and pain intensity at 6 weeks and 6 months after surgery was investigated, taking into account the effect of possible confounding variables. Higher levels of cognitive-behavioral factors were found to be associated with a worse outcome at both 6 weeks and 6 months.

Use of a tubular retractor system as a minimally invasive technique for epidural plate electrode placement under local anesthesia for spinal cord stimulation: technical note.

Objective: To improve the technique of placement of large plate electrodes for spinal cord stimulation with a minimally invasive approach using the METRx tubular retractor system (Medtronic Sofamor Danek, Minneapolis, MN). This dilating system splits the paravertebral musculature, avoiding the need to strip these muscles from the spine. The technique described makes it possible to perform the procedure (currently, it is most frequently performed using general anesthesia) with local anesthesia and sedation, allowing test stimulation, and with little intraoperative or postoperative discomfort for the patient.