Subject(s)
Adenoma/drug therapy , Dacarbazine/analogs & derivatives , Pituitary Neoplasms/drug therapy , Pituitary Neoplasms/metabolism , Somatostatin/analogs & derivatives , Adenoma/metabolism , Adenoma/pathology , Clinical Trials as Topic/methods , Dacarbazine/therapeutic use , Humans , Pituitary ACTH Hypersecretion/drug therapy , Pituitary ACTH Hypersecretion/pathology , Pituitary Neoplasms/pathology , Somatostatin/metabolism , Somatostatin/therapeutic use , Temozolomide , Treatment OutcomeSubject(s)
Neural Tube Defects/complications , Skin Diseases/complications , Urinary Incontinence/complications , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Neural Tube Defects/diagnosis , Neural Tube Defects/diagnostic imaging , Neurosurgical Procedures , Skin Diseases/diagnosis , Skin Diseases/diagnostic imaging , Spinal Cord/abnormalities , Spinal Cord/pathology , Tomography, X-Ray Computed , Urinary Incontinence/diagnosis , Urinary Incontinence/diagnostic imaging , Urodynamics/physiologySubject(s)
Aneurysm, Infected/etiology , Aneurysm, Ruptured/etiology , Endocarditis, Subacute Bacterial/complications , Adult , Aneurysm, Infected/microbiology , Aneurysm, Ruptured/microbiology , Aneurysm, Ruptured/pathology , Anti-Bacterial Agents/therapeutic use , Endocarditis, Subacute Bacterial/drug therapy , Endocarditis, Subacute Bacterial/pathology , Humans , Male , Tomography, X-Ray Computed/methodsABSTRACT
The incidence of haemorrhagic complications of intracranial pressure monitoring (ICPM) has previously been reported. However, in these studies, the techniques employed to access the inside of the cranium varied. While 3-mm essentially blind 'twistdrill' craniostomies have been used, their role has been limited for fear of haemorrhagic sequelae. This has also restricted their use in clinical applications other than ICPM. We conducted a prospective observational study looking at haemorrhagic complications of the twistdrill in order to determine its safety and whether it has a role in other clinical settings. Over the period January 1994-February 2001, 941 patients had 1032 twistdrill procedures. There were 550 (58.4%) male patients and 391 (41.6%) female. The age range was 3 months to 93 years (median age 35 years). Only four procedures (0.38%) caused clinically significant bleeds attributable to the twistdrill --all of which were managed conservatively without requiring surgical evacuation. We conclude that twistdrill craniostomies are safe and that their use could be extended to other neurosurgical procedures and potentially to ICPM in non-neurosurgical centres.
Subject(s)
Craniotomy/adverse effects , Surgical Instruments/adverse effects , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Craniotomy/instrumentation , Equipment Design , Female , Humans , Infant , Intracranial Hemorrhages/etiology , Male , Middle Aged , Postoperative Hemorrhage/etiologyABSTRACT
A case is reported describing a complication of an unsuccessful attempt to aspirate the reservoir of a ventriculoperitoneal shunt system with a suspected shunt infection. This arose due to a misunderstanding of the anatomy of the shunt and resulted in an intracerebral haematoma. The complications of cerebrospinal fluid shunting and the difficulty in the diagnosis thereof are outlined. We discuss the role and method of shunt tapping in diagnosing shunt problems before reviewing the literature describing the rationale. The variation in shunt design is emphasized. Guidelines are then proposed not to dissuade physicians from tapping shunts but to ensure that the procedure is performed safely and in collaboration with neurosurgical units.