Acta neurochirurgica
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Acta neurochirurgica · Jan 1994
Clinical Trial Controlled Clinical TrialEffects of prophylactic intrathecal administrations of nicardipine on vasospasm in patients with severe aneurysmal subarachnoid haemorrhage.
Calcium antagonists are currently most widely used for chronic cerebral vasospasm after aneurysmal subarachnoid haemorrhage (SAH). However, the vasodilatory effects of systemically administered calcium antagonists can be limited secondary to hypotension. We previously compared intrathecal and intravenous routes of administration of nicardipine. ⋯ Nine patients complained of headache probably secondary to nicardipine induced vasodilation. Two patients suffered from meningitis, both were successfully treated. Intrathecal administration nicardipine appears to be effective in the treatment of vasospasm, but side effects were significant.
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Acta neurochirurgica · Jan 1994
Vasospasm diagnosis: theoretical sensitivity of transcranial Doppler evaluated using 135 angiograms demonstrating vasospasm. Practical consequences.
The authors inspected 135 angiograms (A zero) demonstrating vasospasm (VS) after aneurysm (An) rupture. There were 54 anterior communicating artery (ACoA), 38 internal carotid artery (ICA) and 43 middle cerebral artery (MCA) ruptured aneurysms. VS was searched for on each A zero in distal branches of MCA (M2) proximal MCA (M1), ICA, anterior cerebral artery (A1) and pericallosal artery (A2). ⋯ If M1 and ICA are insonated TCD sensitivity would be 61% after ACoA, 95% after ICA and 88% after MCA An rupture. TCD sensitivity would be almost perfect with a reliable and constant A1 insonation but that hypothesis is today purely speculative. An additional A zero appears to be necessary to establish VS diagnosis, mainly after ACoA An rupture when a discrepancy is observed between normal TCD data and delayed clinical worsening.
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Acta neurochirurgica · Jan 1994
Comparative Study Clinical Trial Controlled Clinical TrialFavourable influence of opening the lamina terminalis and Lilliequist's membrane on the outcome of ruptured intracranial aneurysms. A study of 197 consecutive cases.
Opening of the lamina terminalis and Lilliequist's membrane--by facilitating CSF circulation in the basal cisterns--favourably influences the outcome in patients with ruptured intracranial aneurysms. This has been demonstrated by the analysis of a series of 197 consecutive cases of ruptured intracranial aneurysms.
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Acta neurochirurgica · Jan 1994
Bovine bone grafting in occipito-cervical fusion for atlanto-axial instability in rheumatoid arthritis.
Bovine bone chips (Surgibone) were used in occipito-cervical fusion in nine patients with atlanto-axial instability due to rheumatoid arthritis. The patients were examined with CT 12-15 months after surgery. Graft resorbtion was observed in one patient. ⋯ One patient was revised, and at the grafted site a bony bridge was found. In conclusion, the use of bovine chips in posterior occipito-cervical fusion will not lead to predictable bone union. However, there seem to be exceptions to that rule.
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Acta neurochirurgica · Jan 1994
Duration of symptoms as a predictor of outcome after lumbar disc surgery.
Retrospectively 93 consecutive patients operated on for lumbar disc herniation were studied in order to evaluate the prognostic value of symptoms (lumbar pain and sciatica) and sick-leave. Surgical results were evaluated 1-3 years postoperatively by a questionaire. The duration of the present attack of sciatica and sick-leave prior to surgery was significantly longer in the group with unsatisfactory outcome compared to the group with satisfactory outcome. ⋯ Patients who returned to the same type of work had a preoperatively statistically significant shorter duration of present sick-leave, compared to the patients who had changed the type of work and the patients who did not return to work. The patients with duration of their present sick-leave of less than 6 months had a significantly higher percentage of returning to the same type of work compared to patients with duration of their present sick-leave of 6-12 months and more than 12 months. We conclude that the duration of sciatica and sick-leave before the operation has value as predictive factors concerning the over-all result after surgery for lumbar disc herniation.