AndTo the memory of my mother, Rahma.ii ACKNOWLEDGMENTSThanks go first to my advisor, Dr. Judith Marcoux, who supported me in this endeavor. I have always appreciated the trust she has shown in me. Thanks also to the program director of the neurosurgery residency at McGill University, Dr. Jeffrey Atkinson, who has given me the opportunity to have the time for the master study. I also thank the head of the neurosurgery department, Dr. Kevin Petrecca, who supported me to have the funding of this project, and to Mr. Kelvin Mok, the biomedical engineer at the neuronavigation unit, who was the key point for correspondence for the equipment supply, and who spared his time to help with the training of using the AxiEM navigation system. This project has been made possible by the funding provided by the Medtronic Surgical Technology Neurosurgery, which has provided the navigation system and the disposable kits plus the cost paid to the Research Institute of the Montreal University Hospital Centre. The authors report no conflict of interest concerning the methods used in this study or the findings specified in this paper, and have no personal financial or institutional interest in any of the materials, or devices described in this thesis. iv ABSTRACTExternal ventricular drain (EVD) placement is one of the most frequently performed neurosurgical procedures. Inaccuracies in the drain positioning and the need for multiple passes using the classic freehand insertion technique are increasingly reported in the literature. The problem is seen most frequently in the severe traumatic brain injury (TBI) population. Many proposed methods were discussed to improve the placement accuracy and none gained enough support to be implemented in EVD placement. The purpose of this study is to evaluate the use of electromagnetic neuronavigation guidance to aid EVD insertion to improve the accuracy and minimize the number of passes in severe TBI patients. The navigation was applied prospectively for all new severe TBI patients who required ventricular catheter placement over a year period, and this was compared to a retrospective cohort of severe TBI patients who had EVD inserted freehand in the preceding year. Fifty-four cases were recruited, 35 (64.8%) had their EVD placed using the freehand technique and 19 (35.2%) using navigation guidance. In the navigation group, the placement accuracy was as follows: 94.7% (18/19) achieved a grade 1 and 5.3% (1/19) a grade 2, while none were in
ABSTRACT:Object:Interhemispheric subdural hematomas (IHSDHs) are thought to be rare. Surgical management of these lesions presents a challenge as they are in close proximity to the sagittal sinus and bridging veins. IHSDHs are poorly characterized clinically and their exact incidence is unknown. There are also no clear guidelines for the management of IHSDH.Methods:This is a retrospective review of all admitted patients with a diagnosis of traumatic brain injury over a 4-year period at a Level I trauma centre. Clinical characteristics of all patients with subdural hematoma (SDH) and IHSDH were collected.Results:Of 2165 admissions, 1182 patients had acute traumatic SDHs, 420 patients had IHSDHs (1.9% of admissions and 35.5% of SDH), 35 (8.3% of IHSDH) were ≥8 mm in width. IHSDH was isolated in 16 (3.8%) of the cases. Average age was 61.7 ± 21.5 years for all IHSDHs and 77.1 ± 10.4 for large IHSDH (p < 0.001). For large IHSDH, a transient loss of consciousness (LOC) occurred in 51.5% of individuals, post-traumatic amnesia (PTA) in 47.8% of cases, and motor weakness in 37.9% of patients. Five of the large IHSDH patients presented with motor deficits directly related to the IHSDH, and weakness resolved in four of these five individuals. None were treated surgically. Progression of IHSDH width occurred in one patient.Conclusion:IHSDHs are often referred to as rare entities. Our results show they are common. Conservative management is appropriate to manage most IHSDHs, as most resolve spontaneously, and their symptoms resolve as well.
LE JOURNAL CANADIEN DES SCIENCES NEUROLOGIQUESSuppl. 2 -S39 population. Emergency care appears to be delivered in a timely fashion. Both centers participate in research registries focused on collecting data related to tSCI, surgical interventions, and patient outcomes. Registries are valuable research tools that allow for an alternative way to examine the quality of care their patients receive. P.077A Concussion-U educational presentation improves knowledge and attitudes of concussion amongst elite female high-school hockey players Background: Research has suggested that female athletes have a higher incidence of concussion compared to their male counterparts. As such, programs designed to improve knowledge and attitudes of concussion should target this high-risk population. Previous work demonstrated the effect of a novel Concussion-U educational presentation on knowledge and attitudes of concussion amongst male Bantam and Midget AAA hockey players. The objective of this study was to determine if the same presentation was effective in improving the knowledge and attitudes of concussion in a cohort of elite female hockey players. Methods: 26 elite female high-school aged (14-17) hockey players from the province of New Brunswick consented to participate in the study. Each participant completed a modifi ed version of Rosenbaum and Arnett's Concussion Knowledge and Attitudes Survey questionnaire immediately before and after a Concussion-U educational presentation. Results were compared across the two time-points to assess the effectiveness of the presentation. Results: Concussion knowledge and attitude scores signifi cantly (p < .001) increased from pre-presentation to post-presentation by 12.5% and 13.4%, respectively. Conclusions: A Concussion-U educational presentation resulted in increased knowledge and improved attitudes towards concussion in elite female hockey players. Future research should examine the long-term retention of these improvements. Background: Indigenous populations are disproportionately affected by traumatic brain injury (TBI). These populations rely on large jurisdiction surveillance efforts to inform their prevention strategies, which may not address their needs. This study describes the TBI determinants of a Quebec indigenous population, the Cree served by the Terres-Cries-de-la-Baie-James health region, and compares them to the determinants of two neighbouring health regions and the entire Province of Quebec. Methods: We conducted a retrospective population-based cohort study of incident TBI hospitalizations, stratifi ed by the aforementioned health regions, in Quebec from 2000-2012. MED-éCHO administrative data were used for case fi nding. A sub-analysis of the Terres-Cries-de-la-Baie-James adults was completed to assess for determinants of TBI severity and outcomes. Regression models, multiple imputations and a sensitivity analysis were used to account for biased associations. Results: 172 incident TBI hospitalizations occurred in the Terres-Cries-de-laBaie-James region from 2000-2012. ...
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