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Cerebrospinal fluid drainage for thoracic and thoracic abdominal aortic aneurysm surgery

An aneurysm is a local bulging of a blood vessel that carries a risk of rupture. Surgery for an aortic aneurysm requires clamping the aorta, the biggest artery in the body. This reduces the supply of blood and oxygen to the spinal cord (ischaemia) and tissue damage can lead to the partial or incomplete paralysis of the lower limbs (paresis) and paraplegia (paralysis of the legs and lower part of the body). These deficits are frequently irreversible. The cerebrospinal fluid (CSF) pressure increases during clamping further decreasing the perfusion pressure of the spinal cord. As more of the blood supply to the spinal cord is interrupted, the likelihood of paraplegia is increased. Various treatments are used to reduce the ischaemic insult to the spinal cord including temporary blood shunts (such as distal atriofemoral bypass and re‐connection of intercostal and lumbar vessels), pharmaceutical interventions (to protect the heart and cerebral blood vessels), epidural cooling and CSF drainage. Draining CSF from the lumbar region may lessen the CSF pressure, improve blood flow to the spinal cord and reduce the risk of ischaemic spinal cord injury.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Proteins in cerebrospinal fluids (CSF) for early prediction of developing Alzheimer’s disease or other dementia in people with mild cognitive problems

The numbers of people with dementia and other cognitive problems are increasing globally. A diagnosis of dementia at early stage is recommended but there is no agreement on the best approach. A range of tests have been developed which healthcare professionals can use to assess people with poor memory or cognitive impairment. In this review, we have focused on the cerebrospinal fluid (CSF) diagnostic tests.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Proteins in blood and cerebrospinal fluids for early prediction of developing Alzheimer’s disease or other dementia in people with cognitive problems

The numbers of people with dementia and other cognitive problems are increasing globally. A diagnosis of the pre‐dementia phase of disease is recommended but there is no agreement on the best approach. A range of tests have been developed which healthcare professionals can use to assess people with poor memory or cognitive impairment. In this review, however, we have found that measuring protein in cerebrospinal fluid (CSF amyloid beta (Aβ40) or CSF Aβ42), as a single test, lacks the accuracy to identify those patients with mild cognitive impairment who would develop Alzheimer's disease dementia or other forms of dementia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

There is no evidence to indicate whether placement of a shunt to remove fluid is effective in the management of normal pressure hydrocephalus

Normal pressure hydrocephalus is a rare but potentially treatable cause of dementia. Since the condition was first described in 1965, it has conventionally been treated by placement of a shunt to remove cerebrospinal fluid (CSF) from the ventricles of the brain. No trial has yet compared the placement of a shunt versus no shunt in a randomized controlled manner. Nor have the long‐term outcomes of treated and untreated normal pressure hydrocephalus been compared. There is, therefore, no evidence for the use of shunts in the management of normal pressure hydrocephalus.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Endoscopic third ventriculostomy for idiopathic normal pressure hydrocephalus

Cerebrospinal fluid (CSF) is the fluid which circulates around the brain and spinal cord and through spaces called ventricles within the brain. It protects the brain, supplies nutrients and removes waste products. Normally, its production and reabsorption are tightly controlled. In idiopathic normal pressure hydrocephalus (iNPH), there is an increase in the volume of CSF for unknown reasons. This causes the ventricles to enlarge and eventually leads to damage to surrounding brain tissue. It usually occurs in older people. Its characteristic symptoms are deterioration in balance and gait, urinary incontinence and cognitive decline. It is one of the less common causes of dementia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Antibiotics to prevent infection of the brain coverings (meningitis) in patients with basilar skull fracture

Basilar skull fracture (7% to 15.8% of all skull fractures) places the central nervous system in contact with bacteria from the nose and throat and may be associated with cerebrospinal fluid leakage (occurring in 2% to 20.8% of patients). Blood or watery discharge from the nose or ears, bruising behind the ear or around the eyes, hearing loss, inability to perceive odours or facial asymmetry may lead physicians to the diagnosis of basilar skull fracture. Patients with a basilar skull fracture may develop meningitis and some doctors give antibiotics in an attempt to reduce this risk.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Spinal cord stimulation for cancer pain

People with cancer often experience pain. Cancer pain or cancer‐related pain is one of the worst factors for these patients. This type of pain tends to get worse as the cancer progresses. Despite better analgesics (pain killers) and techniques, cancer pain is still a problem for many people.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Interventions for idiopathic intracranial hypertension

We attempted to find all of the published randomised controlled trials (RCT, a type of rigorous study that compares one treatment option against another) that investigated any treatment for idiopathic intracranial hypertension (IIH) in any patient group. We looked at a number of outcomes including reduction in vision, improvement of headache and quality of life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Repeated lumbar or ventricular taps in newborns with intraventricular haemorrhage

Cochrane researchers reviewed the evidence about the effect of removal of cerebrospinal fluid (CSF) via lumbar or ventricular puncture and draining CSF via a needle inserted into the base of the spine or into a fluid‐filled cavity in the brain on improving rates of disability, death, and the need for a permanent surgical procedure in preterm infants who have had bleeding inside the cavities of the brain (intraventricular haemorrhage (IVH)).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Intraventricular streptokinase after intraventricular hemorrhage in newborn infants

There is no evidence of benefit from giving streptokinase to newborn babies after brain haemorrhage.Bleeding (hemorrhage) into the ventricles of the brain is a serious complication of premature birth and large hemorrhages often lead to hydrocephalus, the process by which fluid accumulates under pressure inside the brain, expanding the head excessively and damaging the brain tissue. The insertion of a valve and drainage system (ventriculoperitoneal shunt) is fraught with problems in this patient group and alternatives to this therapy are needed. A possible approach is to try to dissolve the blood clots initially blocking the reabsorption of fluid in the brain. Streptokinase is a "clot‐busting" agent that has been successfully used to unblock coronary arteries. The review found no good evidence that intraventricular injection of streptokinase to infants with large intraventricular hemorrhage or post‐hemorrhagic ventricular enlargement reduces the need for ventriculoperitoneal shunt or improves outcome.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Intraventricular antibiotics for bacterial meningitis in neonates

Infection of the membranes and the fluid surrounding the brain (meningitis) and of the fluid‐filled spaces in the brain (ventriculitis) may be caused by bacteria, especially gram‐negative bacteria. This type of infection is difficult to eradicate using safe doses of antibiotics given into the blood stream. In theory, intraventricular administration of antibiotics (administration of antibiotics into the fluid‐filled spaces in the centre of the brain) would produce higher antibiotic concentrations in the fluid in the brain than intravenous administration alone, and eliminate the bacteria more quickly. However, taps of the fluid‐filled spaces may cause harm as the needle has to penetrate the brain tissue. Only one trial was identified. In this trial enrolling infants with gram‐negative meningitis and ventriculitis, the use of intraventricular antibiotics in addition to intravenous antibiotics resulted in a three‐fold increased risk for mortality compared to standard treatment with intravenous antibiotics alone. Based on this result, intraventricular antibiotics should be avoided. Further trials comparing these interventions are not justified in newborn infants.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Distal aortic perfusion during thoracoabdominal aneurysm repair for prevention of paraplegia

Aneurysm of an artery is a localised abnormal dilation with a diameter of the artery at least one and a half times its normal size. Aneurysms in both the thoracic and abdominal aorta are termed thoracoabdominal aortic aneurysms (TAAA). Open surgical repair is effective in ensuring the survival of people with such aneurysms. Complications of paralysis of the legs and lower parts of the body (paraplegia) and partial paralysis affecting the lower limbs (paraparesis) can however develop during surgery and in the postoperative period, following apparently successful surgery. This is the result of inadequate blood flow to the spinal cord and the vulnerability of the spinal cord to ischaemic injury.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Treatment of acute cryptococcal meningitis in HIV infected adults, with an emphasis on resource‐limited settings

Despite the advent and increasingly wide availability of antiretroviral therapy for people with HIV/AIDS, cryptococcal meningitis remains a significant cause of death and illness amongst individuals with HIV infection in resource‐limited settings (poor countries). The ideal way to manage cryptococcal meningitis remains unclear. The main aim of this review was to determine the best treatment for cryptococcal meningitis in resource‐limited settings. In these settings, usually only Amphotericin and fluconazole are available. The authors didn't find any suitable studies that compared these two drugs. Because Flucytosine, which works well with Amphotericin, is often not available in poor countries, policy makers and government officials should consider using this drug for HIV treatment programmes. Future research into the management of cryptococcal meningitis in resource‐limited settings should focus on the most effective use of medications that are available in these settings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Body position and intake of fluids for preventing headache after a lumbar puncture

A lumbar puncture is a medical procedure performed with a needle and syringe used to take a sample of cerebrospinal fluid or to inject medications. Some people experience a side effect afterwards called post‐dural puncture headache (PDPH). This can be made worse by movement, sitting or standing, and can be relieved by lying down. PDPH limits people's mobility and daily activities, as well as causing unplanned expenses for both the patient and the health institution. Doctors sometimes advise their patients to remain in bed after a lumbar puncture and to drink a lot to prevent PDPH.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Newer, third generation cephalosporins versus conventional antibiotics for treating acute bacterial meningitis

Acute bacterial meningitis is a life‐threatening illness. Currently the evidence suggests that old and new antibiotics offer the same level of treatment. Bacteria which cause meningitis are often thought to be resistant to conventional (older) antibiotics, and so doctors often prescribe newer antibiotics (called third generation cephalosporins). Commencing treatment early is vitally important and the choice of antibiotic is often made without any knowledge of possible drug resistance. This review examined 19 studies with 1496 participants to see whether there is a difference in effectiveness between conventional and newer antibiotics. This review found no differences. Adverse effects in both approaches were similar, except for diarrhoea, which was more common in the cephalosporin group. Only three studies dealt with adults; the remaining studies recruited participants aged 15 years and younger. Therefore, we believe that the results probably pertain more to children. Conventional and newer antibiotics seem reasonable options for initial, immediate treatment. The choice may depend on availability, affordability and local policies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Childhood Brain Stem Glioma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of childhood brain stem glioma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: June 9, 2017

Primary CNS Lymphoma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of primary CNS lymphoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 21, 2016

Childhood Central Nervous System Embryonal Tumors Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of childhood medulloblastoma, nonmedulloblastoma embryonal tumors, and pineal tumors.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 18, 2017

AIDS-Related Lymphoma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of AIDS-Related Lymphoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: October 12, 2016

Childhood Ependymoma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of childhood ependymoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 7, 2017

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