Acta neurochirurgica
-
Acta neurochirurgica · Jan 1993
Case ReportsMassive cerebral air embolism following cardiopulmonary resuscitation. Report of two cases.
Cerebral air embolism can occur in a number of situations. We report two cases of massive cerebral arterial air embolism following cardiopulmonary resuscitation, and its mechanism is discussed.
-
Acta neurochirurgica · Jan 1993
Effect of recombinant tissue plasminogen activator on clot lysis and ventricular dilatation in the treatment of severe intraventricular haemorrhage.
Twelve patients with severe intraventricular haemorrhage (IVH) underwent intraventricular thrombolysis with recombinant tissue plasminogen activator (rtPA). External ventricular drainage was performed in all patients within 24 hours of haemorrhage. Fibrinolytic therapy was started within 24 hours from the onset of symptoms in ten cases, and in two further cases after 48 hours and 5 days, respectively. ⋯ During the period of treatment, the level of consciousness, as classified according to the Glasgow Coma Scale, improved from a mean value of 7 to 12. One fatal case of meningitis most probably due to the ventriculostomy was the only complication related to the treatment. This method of treatment might improve the prognosis in patients in whom a large intraventricular haematoma volume, ventricular dilatation, and impaired cerebrospinal fluid circulation are major determinants for the outcome.
-
Acta neurochirurgica · Jan 1993
Blood flow velocity in the middle cerebral artery and carotid artery stump pressure during carotid endarterectomy.
Twenty-one patients undergoing carotid endarterectomy were investigated by simultaneous intra-operative measurements of carotid stump pressure (CSP) and transcranial Doppler (TCD) flow velocity in the middle cerebral artery. The relationship between the two methods was evaluated as well as the potential benefits of the intraoperative transcranial Doppler monitoring technique. Clamping of the carotid artery resulted in a significant decrease in TCD flow velocity in the ipsilateral middle cerebral artery as well as in CSP. ⋯ TCD gives information of the collateral cerebral circulation during carotid clamping and is an alternative monitoring technique during carotid endarterectomy. The method is useful intraoperatively for detecting embolic events as well as thrombosis during wound closure. Further studies are necessary to clarify the critical change in flow velocity during clamping when the use of a peroperative shunt is indicated.
-
Acta neurochirurgica · Jan 1993
Experimental study of venous circulatory disturbance by dural sinus occlusion.
Using a newly devised model of dural sinus occlusion, we investigated the pathophysiology of venous haemorrhage as well as venous circulatory disturbance. The superior sagittal sinus (SSS) and diploic veins (DV) were occluded in 16 cats. Intracranial pressure (ICP), cerebral blood volume (CBV) and regional cerebral blood flow (rCBF) were measured for 12 hours after the occlusion. ⋯ These data suggest that dural sinus occlusion may lead to an increase in CBV and cerebral water content resulting in intracranial hypertension and decreased rCBF. The brain oedema in this model seemed to be mainly hydrostatic oedema, and might also be contributed by cytotoxic oedema. The additional occlusion of cortical veins might be essential in the development of haemorrhage in this model, and the blood-brain barrier was also disrupted in these areas.
-
Acta neurochirurgica · Jan 1993
Long-term results after percutaneous retrogasserian glycerol rhizotomy in patients with trigeminal neuralgia.
We have evaluated the long-term results of percutaneous retrogasserian glycerol rhizotomy (PRGR) in 60 patients with classical trigeminal neuralgia. Complete initial pain relief was achieved in 93% of the patients. Numbness was initially reported by 3/4 of the patients and at follow-up by 1/3, while long-lasting dysaesthesias were an important side effect in 38% of previously untreated patients. ⋯ We are unable to identify predictors of recurrent neuralgia after PRGR, although major recurrences were more common in patients with unchanged facial sensation postoperatively. In conclusion, PRGR offers safe and reliable relief of pain in patients with trigeminal neuralgia. In spite of the high incidence of recurrence and of long-lasting dysaesthesias it is, in our opinion, the method of choice in the elderly, and particularly suitable for patients at high risk.