Browsing Neurosurgery by Title
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- ItemBinneaarse radio-isotoop angiografie karotis-kaverneuse fistels(Health and Medical Publishing Group (HMPG), 1975) Van Heerden, P. D. R.; Rose Innes, A. P.; Klopper, J. F.The use of intravenous radio isotope angiography in 3 cases of unilateral carotid cavernous sinus fistula is described. The lesion gives a characteristic image pattern distinguishable from that of arteriovenous malformation in this region. An abnormal registration of intense radioactivity is seen in the early phases, accurately localised to the cavernous sinus, with a distinctive sigmoid shaped configuration. Rapid disappearance of this accumulation of isotope follows, accompanied by a paradoxical apparent increase in blood flow to the ipsilateral hemicranium. This is attributed to the massively arterialised venous drainage. This technique of demonstrating the cerebral circulation dynamically is considered a valuable diagnostic supplement to the static scintiscan and to conventional roentgen arteriography in this lesion.
- ItemComparison of intrathecal and intravenous morphine for post-operative analgesia after single level spinal fusion surgery(Stellenbosch : Stellenbosch University, 2020-12) Vlok, Adriaan Johannes; Coetzee, Andre; Stellenbosch University. Faculty of Health Sciences. Dept. of Surgical Sciences: Neurosurgery.ENGLISH ABSTRACT: The purpose of this study was to evaluate the efficacy, safety and cost effectiveness of a 0.005mg/kg, up to a maximum of 0.45mg, dose of intrathecal morphine in first-time single level spinal surgery. The study was conducted, and results apply, to a tertiary care public service hospital in South Africa. This experimental intervention was compared to the institutional standard of care being the use of intravenous morphine via a patient-controlled device, administering 1mg of morphine intravenously every 7 minutes as required. Efficacy was measured with reference to validated scoring systems which included the Oswestry disability index, Roland Morris questionnaire, EQ-5 score and visual analogue scale (VAS) to assess pain, analgesia and disability in the post-operative phase and subsequent follow up. A standardised physiotherapy regime was used to mobilize patients and the patients was discharged directly to their homes, specifically skipping a step-down facility. Safety was assessed by monitoring the known side-effects of morphine (nausea, vomiting, pruritis), oxygen saturation, respiratory rate and sedation during the stay in the ICU. Inter alia, blood gases were analysed on 11 occasions within the first 24 hours. General patient follow-up occurred at 6 weeks, 3 and 6 months. The study was conducted in a prospective double-blind, randomized placebo controlled fashion. 40 patients were enrolled (20 per group). The time to discharge for the intrathecal morphine group (IT) was statistically significantly shorter (3.68 days) compared to 5.61 days for the patient-controlled analgesia (PCA) group. This translated into a 43.5% saving for general ward stay costs. VAS was assessed when lying still and moving and the difference between these values was used to quantify the intensity of pain. A significant difference was noted at 24 hours favouring the IT group. Significantly less supplemental analgesia was used in the IT group during the first 24 post-operative hours. No significant difference in side-effects were noted between the groups. The initially elevated mean PaCO2 in the IT group demonstrated a significant decrease from 4 hours up to 24 hours. An increase in mean respiratory rate was demonstrated from 10 hours onwards in both groups. Seven incidents of hypoxia (PaO2 < 8kPa) were observed (IT=4, PCA=3). The 7 incidents were explained by either a low FiO2 or a decrease in functional residual capacity (FRC) as proven by the A-a gradient. No overt sedation was clinically demonstrated at the time the PaO2 was less than 8.0 kPa. Six week, 3-month and 6-month follow-up demonstrated significant improvement in all scoring modalities in both groups. The intrathecal use of morphine had a direct effect on the μ-receptors in the spinal cord resulting in segmental analgesia allowing the patients to mobilize faster compared to the more central acting analgesic effects offered by intravenous morphine. The proposed dose proved to be safe with minimal side-effects, all of which were comparable to the PCA group. The application will be particularly useful in obese patients where the calculation of a safe intravenous dose can be challenging because of excess adipose tissue. When using IT or PCA morphine, supplemental oxygen is suggested for the first 4 hours post-operatively and continuous monitoring of respiratory rate, saturation and sedation should be done. Finally, it is recommended that it will be safer practice to reset the minimum cut-off value for saturation at a higher value than the conventional 90% level.
- ItemThe CRASH trial - The first large-scale randomised controlled trial in head injury(Health & Medical Publishing Group, 2001) Hartzenberg, B.; Nathoo, N.The CRASH Trial (Corticosteroid Randomisation after Significant Head injury) is a large-scale randomised controlled trial, among adults with head injury and impaired consciousness, of the effects of a short-term infusion of corticosteroids on death and on neurological disability.
- ItemEvaluation of locally manufactured patient-specific custom made implants for cranial defects using a silicone mould(Health and Medical Publishing Group, 2018) Vlok, A. J.; Naidoo, S.; Kamat, A. S.; Lamprecht, D.Background: Cranial vault defects can pose a significant problem for neurosurgeons where autologous bone is no longer available for cranioplasty. Numerous materials exist to create implants which include polymethyl methacrylate (PMMA) and titanium. A technique using 3-dimensional CT scan reconstruction of a cranial defect and creating a silicon mould which can be autoclaved in theatre to create a PMMA implant was developed. Objectives: The aim of this study is to evaluate the efficacy, cosmetic result, safety and cost-effectiveness of this procedure and compare this to existing techniques. Methods: An ambispective study was performed in patients requiring cranioplasty with a custom made implant. Patients were assessed for risk factors and cosmetic outcome, surgical technique was described and complications and cost compared to existing literature between 2010 and 2016. Results: Thirty retrospective and 30 consecutive prospective patients were recruited into the study. Overall sepsis rate was 8.3%. All septic cases had superficial sepsis of which 2 grafts were removed due to cerebrospinal fluid leakage resulting in wound breakdown. A 100% accurate implant to defect ratio was achieved leading to a high satisfaction rate. Average cost was 5 times cheaper than the closest market related product. Conclusion: Patient specific moulds using PMMA to create custom implants are safe, have excellent cosmetic results and are a very cost-effective option to manage cranial defects. Accurate planning strategies for large craniotomies, where bone will potentially be discarded, add to surgical effectiveness and cost-saving to the patient.
- ItemFunctional MRI in pre-surgical planning : case of study and cautionary notes(Cannon Medical Media Publication, 2012-09) Spottiswoode, Bruce S.; Du Plessis, S.; Gretschel, Armin; Lotz, Jan W.Background. Since its inception almost 20 years ago, functional magnetic resonance imaging (fMRI) has greatly advanced our knowledge of human brain function. Although the clinical applications of fMRI are still limited, there have recently been encouraging advances for its use in pre-operative functional cortical mapping to identify potentially eloquent areas prior to neurosurgery. Objectives. We explore the potential use of this emerging technique by presenting a neurosurgical case study, as performed at the Cape Universities Brain Imaging Centre (CUBIC), Tygerberg, Cape Town. We conclude with a brief summary of the potential pitfalls of this technique, as well as cautionary guidelines based on our experience. Methods and results. A 22-year-old male patient from Tygerberg Hospital underwent the successful resection of an anaplastic astrocytoma after fMRI presurgical planning at our facility. The subject was able to leave the ward unassisted. Conclusion. If consideration is given to the many limitations of this emerging technique, fMRI can be useful in aiding the neurosurgeon in pre-operative planning of his surgical approach.
- ItemInfluence of road speed restrictions on the incidence and severity of head injuries(HMPG, 1974-12) Rose Innes, A. P.; Le Roux, C. J. G.A comparative survey has been made of patients with head injuries admitted to hospital in 1973 and 1974, before and after the introduction of fuel saving measures, which included road speed restrictions. The severity and incidence of injury are shown to have decreased dramatically. It is concluded from this that the main cause of the improvement has been reduced road traffic speeds. A plea is made that they be permanently maintained.
- ItemPredicting outcome in severe traumatic brain injury using a simple prognostic model(Health & Medical Publishing Group, 2014-07) Sobuwa, S.; Hartzenberg, H. B.; Geduld, H.; Uys, C.Background. Several studies have made it possible to predict outcome in severe traumatic brain injury (TBI) making it beneficial as an aid for clinical decision-making in the emergency setting. However, reliable predictive models are lacking for resource-limited prehospital settings such as those in developing countries like South Africa. Objective. To develop a simple predictive model for severe TBI using clinical variables in a South African prehospital setting. Methods. All consecutive patients admitted at two level-one centres in Cape Town, South Africa, for severe TBI were included. A binary logistic regression model was used, which included three predictor variables: oxygen saturation (SpO2), Glasgow Coma Scale (GCS) and pupil reactivity. The Glasgow Outcome Scale was used to assess outcome on hospital discharge. Results. A total of 74.4% of the outcomes were correctly predicted by the logistic regression model. The model demonstrated SpO2 (p=0.019), GCS (p=0.001) and pupil reactivity (p=0.002) as independently significant predictors of outcome in severe TBI. Odds ratios of a good outcome were 3.148 (SpO2 ≥90%), 5.108 (GCS 6 - 8) and 4.405 (pupils bilaterally reactive). Conclusion. This model is potentially useful for effective predictions of outcome in severe TBI.