Acta neurochirurgica
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Acta neurochirurgica · Jan 1994
Penetrating craniocerebral shrapnel injuries during "Operation Desert Storm": early results of a conservative surgical treatment.
A follow-up study is presented of the initial neurosurgical treatment of 20 patients who sustained penetrating craniocerebral injuries during "Operation Desert Storm". Fifteen of these patients had received intracranial debridement through a craniectomy and five patients had received care of scalp wounds only. Following treatment and stabilisation in a frontline hospital, these patients were transferred to the Riyadh Armed Forces Hospital for further evaluation and management. ⋯ No patient died or developed a seizure disorder. These results suggest that re-operation for removal of retained fragments is unnecessary. It is concluded that the initial treatment of shrapnel wounds of the brain should be to preserve maximal cerebral tissue and function either by limiting the wound debridement performed through a craniectomy or by care of scalp wounds only.
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Acta neurochirurgica · Jan 1994
Intracranial meningiomas: analysis of recurrence after surgical treatment.
Recurrence of intracranial meningiomas after surgery has long been recognized, but there is still no consensus about factors responsible for recurrence. To better understand such factors, we analysed data on 276 patients with meningiomas who were treated at our institution from 1976 to 1990 (mean follow-up = 5.1 years). Effects of sex, tumour histology, tumour site, and radiotherapy on recurrence were closely studied. ⋯ We found that radiotherapy did not decrease "recurrence" or "regrowth" regardless of when administered, either at first resection or on recurrence. This was true for benign as well as malignant meningiomas. However, due to the small number in our series, we cannot conclude that radiotherapy has no beneficial role in the treatment of meningiomas.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta neurochirurgica · Jan 1994
Comparative StudyParameters in electrode positioning in thoracic percutaneous facet denervation: an anatomical study.
The purpose of the present study was to verify if needle placement in thoracic percutaneous facet denervation (PFD), based on bony landmarks, and under fluoroscopic guidance, would lead to constant anatomical positioning; and hence to an adequate placement at the assumed target, i.e., the medial branch of the dorsal ramus of the spinal nerve; and furthermore to determine if interpretation of the needle position by CT is more reliable than by fluoroscopy. The procedures were carried out bilaterally at all 12 levels on two cadavers, simulating the clinical setting as much as possible. In 44 cases the position of the needles was determined on hard copies of fluoroscopic images, 1.5 mm interval CT-images, surface-photographs, and on counterstained 25 microns sections obtained by a multirange heavy duty cryomicrotome. ⋯ The correlation between fluoroscopic images and sections was poor. The correlation between CT and sections was better, except for the mediolateral direction. The results of the present study suggest that "pure" anatomical positioning based on bony landmarks analogous to those used in the lumbar region is not reliable enough for thoracic PFD, and that corrections after electrostimulation substantially contribute to obtaining an adequate position of the needle.
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Acta neurochirurgica · Jan 1994
Cause, distribution and significance of episodes of reduced cerebral perfusion pressure following head injury.
A group of 74 patients with head injury (54 severe, 17 moderate and 3 minor) had continuous monitoring of both arterial and intracranial pressure with computer-based registration of these pressures, cerebral perfusion pressure and other variables. In 60 patients cerebral perfusion pressure CPP fell below 60 mm Hg for periods of 5 minutes or longer. ⋯ There was a significant correlation between low CPP due to reduced arterial pressure and the Injury Severity Score (p < 0.001), suggesting that resuscitative measures may have been less than optimal in these cases. There was also significant correlation between the duration of low CPP and low arterial pressure and an adverse outcome from injury as assessed at 6, 12 and 24 months after injury (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta neurochirurgica · Jan 1994
Ultrasound-guided craniotomy for minimally invasive exposure of cerebral convexity lesions.
The authors describe a method of real-time ultrasound-guided craniotomy for an approach to cerebral convexity lesions. During surgery, a specially designed high frequency (7.5 MHz) sector probe with a thin (11 mm), extended tip is used to image the cerebral lesion through a single burr-hole. ⋯ This technique greatly improves the accuracy in placing craniotomy flaps. Since the risk of misplacing the craniotomy is virtually eliminated in lesions which are identifiable on ultrasound images, the technique allows the surgeon to keep the skull opening as limited as possible.