Acta neurochirurgica
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Acta neurochirurgica · Jan 1986
Case ReportsPneumocephalus and tension pneumocephalus after posterior fossa surgery in the sitting position: a prospective study.
Thirty patients subjected to posterior fossa surgery in the sitting position were evaluated postoperatively by CT scans in order to assess the true incidence of pneumocephalus and subsequent development, if any, of tension pneumocephalus. This prospective survey shows that the postoperative incidence of intracranial air was 100%, while no progression towards tension pneumocephalus producing severe neurological deterioration was observed. It can thus be claimed that, although the sitting position may favour the development of tension pneumocephalus also other factors contribute to its pathogenesis. Finally, neither nitrous oxide nor temperature play any significant role in the development of this complication.
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Chronological changes in diffuse brain swelling and brain oedema were studied in repeated CT studies following a closed head injury. These findings were compared with changes in intracranial pressure (ICP). The grades of diffuse brain swelling were classified into mild, moderate and marked according to the CT findings. ⋯ Brain oedema first appeared 24 hours post injury and did not reach its maximum size and distribution before days 5-8. Thus, these two events can be clearly separated. The intracranial pressure reflected the course of the brain swelling and was not very high during the presence of maximum oedema.
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Acta neurochirurgica · Jan 1986
Enhanced cisternal drainage and cerebral vasospasm in early aneurysm surgery.
Enhanced cisternal drainage was performed following early aneurysm surgery in patients with Hunt and Kosnik grades I-III, to effect continuous wash-out of subarachnoid blood clots and reduce symptomatic vasospasm. Following extensive evacuation of the cisternal blood clots, the Liliequist's membrane was opened extensively and a third ventriculostomy was effected by opening the lamina terminals. The drainage effect was considered as poor, moderate or fair, depending on the average amount of CSF drainage/day. ⋯ Nine patients who developed symptomatic vasospasm were treated by hypertensive/hypervolemic therapy (HHT). The HHT was effective in 7 patients with fair and moderate CSF drainage and ineffective in 2 patients with poor a drainage effect. It seems, that enhanced post-operative cisternal drainage can reduce the incidence of symptomatic vasospasm and be of benefit to the outcome of early aneurysm surgery.
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Acta neurochirurgica · Jan 1986
Clinical observations on the relationship between cerebrospinal fluid pulse pressure and intracranial pressure.
A method is described for monitoring the relationship between CSF pulse pressure and ICP in clinical patients. Highly significant linear relationships were found during 65 continuous ICP recordings in 58 patients. The slope value of this relationship showed a positive correlation with the elastance coefficient, a volume-pressure parameter assessed by bolus injection. ⋯ This phenomenon was ascribed to an increase in the pulsatile variation in cerebral blood volume. It is concluded that, under certain conditions, the intracranial volume-pressure relationship can be continuously monitored by means of CSF pulse pressure analysis. The findings during plateau waves suggest that the pulse pressure also reflects the state of the cerebral vasomotor tone.