Acta neurochirurgica
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Acta neurochirurgica · Jan 1987
Comparative StudyThe role of ventricular and cisternal drainage in the early operation for ruptured intracranial aneurysms.
In a series of 177 patients with ruptured supratentorial aneurysms we studied retrospectively the results of early and delayed operation without aggressive removal of subarachnoid blood clots but ventricular and cisternal drainage. The early and delayed groups were comparable demographically and neurologically. The overall results for the early group were a good outcome in 65%, poor outcome in 10% and death in 24%, compared to 53, 20 and 27% respectively in the delayed group. ⋯ The mean amount of haemoglobin in the cerebrospinal fluid from cisternal drainage was 6.4 g, corresponding to about 40 ml of whole blood, during the 12-day period after SAH. The level was higher in patients with larger subarachnoid clots or with symptomatic vasospasm than in those with smaller clots or without such vasospasm. Early operation combined with ventricular and cisternal drainage is considered to be a useful surgical method for patient with a ruptured aneurysm.
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Acta neurochirurgica · Jan 1987
Epidural application of cortico-steroids in low-back pain and sciatica.
Seven women and nine men, aged 27-59 years (mean 45), with lumbar pain and sciatica had epidural blocks once with 80 mg of depo-medrol and lidocaine in individual doses. All had static and kinetic lumbar pain up to 16 years and all but four also pain radiating to the lower limbs. Radiculography was "negative" in all patients, but three exhibited minor neurological abnormalities. ⋯ In the remainder complaints were unaffected by the epidural injection. These discouraging results are not compatible with other reports, and a planned double-blind randomized investigation was abandoned. For the present category of patients (long-lasting complaints, previous "disc" operations) we found the epidural steroid injection useless.
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Acta neurochirurgica · Jan 1987
Percutaneous radiofrequency facet denervation in low-back and extremity pain.
The present series includes 47 patients (35 females 12 males) with an average observation time of 8 months after percutaneous lumbar facet denervation by radiofrequency electrocoagulation. All patients had static and kinetic lumbar pain; 90% of them had pain radiating into the legs. ⋯ Eight of the remaining 25 patients had satisfactory relief of pain at follow-up. The failures included all patients with previous multiple lumbar operations except for three.
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Acta neurochirurgica · Jan 1987
Resistance to cerebrospinal fluid outflow and intracranial pressure in patients with hydrocephalus after subarachnoid haemorrhage.
Resistance to CSF-outflow (Rout) and intracranial pressure (ICP) were measured in 33 patients with hydrocephalus after subarachnoid haemorrhage (SAH). Eleven patients examined between 10 to 30 days after SAH had high pressure hydrocephalus (HPH). Twenty-two patients had normal pressure hydrocephalus (NPH). ⋯ Thus, early development of hydrocephalus after subarachnoid haemorrhage is associated with a high Rout and a high ICP, whereas late (more than one month) hydrocephalus may be associated with normal ICP and high Rout. Patients with NPH and a high Rout have frequent B-waves and should be shunted. Patients with a long interval from subarachnoid haemorrhage to the diagnosis of hydrocephalus often have a normal ICP, low frequency of B-waves, normal CSF-dynamics and need no shunting.