Acta neurochirurgica
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Acta neurochirurgica · Jan 1985
Case ReportsMicrosurgical anatomy around the origin of the ophthalmic artery with reference to contralateral pterional surgical approach to the carotid-ophthalmic aneurysm.
The supraclinoid segments of the internal carotid artery (ICA) and their surrounding structures were examined under magnification in 25 adult cadavers. Attention was paid to anatomical variations and relationships concerning ipsilateral and contralateral pterional microsurgical approaches to these regions, especially to the origin of the ophthalmic artery. Eighty-four percent of the ophthalmic arteries arose from the supraclinoid segment of the ICA. ⋯ This study supports the usefulness of the contralateral pterional approach to the origin of the ophthalmic artery and the medial aspect of the supraclinoid segment of the ICA. This approach could be useful in certain cases of carotid-ophthalmic aneurysm. The authors' experience with the contralateral pterional approach to carotid-ophthalmic aneurysms is also described.
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The brain-type isoenzyme of creatine kinase was determined in serum (S) and cerebrospinal fluid (CSF) in 37 patients with severe head injury, and a correlation was made with the Glasgow coma score and Glasgow outcome score. All patients with normal S-CKBB and CSF-CKBB activities had a coma score of 15, i.e., no neurological deficits, at six hours after the trauma and a good outcome. ⋯ The outcome was still good for five of these patients, while six were moderately disabled, two were severely disabled, and two died. There was no correlation between the individual CKBB-values and the outcome.
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Among retroperitoneal injuries in lumbar disc surgery ureteral transection is a rare complication and only 8 cases have been reported so far. They are analysed and a ninth case is added and described. ⋯ The anatomical relationship of the lumbar spine and retroperitoneal structures is illustrated by CT scans. Factors contributing to these injuries and ways of recognizing and preventing complications are discussed.
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3 patients attempted suicide by a powder-activated cattle skull impacting tool (Slauthterer's gun). While captive bolt pre-slaughter stunning in pigs and ruminants is safe, two of the patients remainded conscious after the shot and survived. Despite much lower impact velocity (less than 50 m/sec) these self-inflicted brain lesions are as serious as "low velocity" (less than 300 m/sec) penetrating gunshot wounds, mainly because of impaction of bone fragments and the dynamic energy possessed by the bolt.
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Acta neurochirurgica · Jan 1985
Epidural monitoring of the intracranial pressure in severe head injury characterized by non-localizing motor response.
Recent studies on prognostic variables and the intensive care of head injuries enabled us to select 64 patients and administer a standard treatment protocol to prevent secondary brain injury. All the patients were in coma with a flexor motor pattern as the best response between 6 and 24 hours after the accident and/or decompressive surgery. Continuous epidural intracranial pressure (ICP) monitoring was used in all patients to control the effect of positioning, analgetics, hyperventilation and osmotherapy. ⋯ A subsequent further rise to 40 mm Hg signified a very high risk of progression towards brain tamponade. The majority of the patients (71%) with a maximum ICP increase of less than 40 mm Hg had an acceptable recovery. After 6-12 months, the outcome in this series of patients was 48% with a good/moderate recovery, 14% with severe deficits and 38% dead/vegetative.