Concussion Guidelines Step 1: Systematic Review of Prevalent Indicators, a special supplement of Neurosurgery, is available online with free full text access.
It is authored by Nancy Carney, PhD; Jamshid Ghajar, MD, PhD; Andy Jagoda, MD; Steven Bedrick, PhD; Cynthia Davis-O’Reilly, BSc; Hugo du Coudray, PhD; Dallas Hack, MD; Nora Helfand; Amy Huddleston, MPA; Tracie Nettleton, MS; and Silvana Riggio, MD.
Because of the lack of sufficient objective data from strong studies, concussion remains undefined. There was sufficient reliable information to compile the following:
The most prevalent indicators of concussion, observed in alert individuals (Glascow Coma Scale of 13 to 15) after a force to the head are:
- Observed and documented disorientation or confusion immediately after the event
- Impaired balance within 1 day after injury
- Slower reaction time within 2 days after injury
- Impaired verbal learning and memory within 2 days after injury
Key Findings – Among the studies included in the review:
- Loss of Consciousness (LOC) ranged from 1% to 14.3%
- Posttraumatic amnesia (PTA) ranged from 2% to 29.7%
- Retrograde amnesia ranged from 7.4% to 53.3%
- Disorientation/confusion ranged from 18% to 44.7%
- The prevalence of balance deficits ranged from 23.8% to 36.5% within 24 hours of injury and decreased to 19.2% to 24% by day 2.
- The prevalence of slowed reaction time ranged from 41.7% to 71.4% within 24 hours of injury.
- Findings indicated that in the majority of cases, cognitive deficits resolved within one week.
Click here for free access to the article and executive summary.
Clinical Neurosurgery Volume 61, Proceedings of the 2013 Congress of Neurological Surgeons Annual Meeting, San Francisco, California.
For the full, detailed list of proceedings that include Honored Guest Lectures, a Special Lecture and the Presidential Address, click here.
Clinical Neurosurgery is the official compendium of the platform presentations at the Congress of Neurological Surgeons Annual Meeting. Clinical Neurosurgery serves not only to summarize the proceedings of the Annual Meeting for all members, but also to advance scientific exchange beyond the confines of the meeting. Clinical Neurosurgery also includes the Program At-A-Glance and oral presentations for the upcoming CNS Annual Meeting that will take place Oct. 18 – 22 in Boston, Massachusetts.
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Additional episodes have been added to the Japanese and Russian Neurosurgery International Podcasts on iTunes. Each podcast episode is the scientific abstract from a published article translated into a foreign language and read by a native speaker. Use iTunes to download new and existing podcasts in your preferred language.
Free Article with CME: SEEG in Children and Adolescents With Difficult-to-Localize Refractory Focal Epilepsy
Background: Although stereoelectroencephalography (SEEG) has been shown to be a valuable tool for preoperative decision making in focal epilepsy, there are few reports addressing the utility and safety of SEEG methodology applied to children and adolescents.
Objective: To present the results of our early experience using SEEG in pediatric patients with difficult-to-localize epilepsy who were not considered candidates for subdural grid evaluation.
Methods: Thirty children and adolescents with the diagnosis of medically refractory focal epilepsy (not considered ideal candidates for subdural grids and strip placement) underwent SEEG implantation. Demographics, electrophysiological localization of the hypothetical epileptogenic zone, complications, and seizure outcome after resections were analyzed.
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Background: Trigeminal neuralgia is a relatively common neurosurgical pathology with multiple management options. Microvascular decompression (MVD) is nonablative and is considered the gold standard. However, stereotaxic radiosurgery (SRS) and percutaneous stereotaxic rhizotomy (PSR) are 2 noninvasive but ablative options that have rapidly gained support.
Objective: To use Medicare claims data in conjunction with a literature review to assess the usage, effectiveness, and cost-effectiveness of the 3 different invasive treatments for trigeminal neuralgia.
Methods: All of the claims of trigeminal neuralgia treatment were extracted from the 2011 5% Inpatient and Outpatient Limited Data Set. Current Procedural Terminology, 4th Edition/International Classification of Diseases, Ninth Revision codes for the 3 different surgical treatment modalities were used to further classify these claims. Kaplan-Meier survival curves in key articles were used to calculate quality-adjusted life years and cost-effectiveness for each procedure.
Free Editor Choice with CME: Solitaire AB Stent-Assisted Coiling of Wide-Necked Intracranial Aneurysms
Background: Endovascular treatment of intracranial aneurysms can be technically difficult when the neck is wide. The Solitaire AB stent (Covidien, Irvine, California), the only fully retrieved stent, assists in the coiling of wide-neck intracranial aneurysms.
Objective: To evaluate the mid-term angiographic follow-up of wide-necked aneurysms treated with the Solitaire AB stent.
Methods: SOLARE (SOLitaire Aneurysm Remodeling) is a consecutive, prospective study conducted in 7 European centers. A core laboratory evaluated the postoperative and mid-term (6 month ± 15 days) angiographic results by using the Raymond classification Scale. Recanalization was defined as worsening, and progressive thrombosis was defined as improvement in the Raymond scale score.