Acta neurochirurgica
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Acta neurochirurgica · Jan 1995
In vitro and in vivo efficacy of a rifampin-loaded silicone catheter for the prevention of CSF shunt infections.
Infection of cerebrospinal fluid (CSF) shunts is one of the major complications associated with their use and is usually managed by shunt removal, temporary insertion of an external drainage and implantation of a new shunt system. We have evaluated the efficacy of a rifampin-loaded silicone ventricular catheter to prevent bacterial colonization and infection in vitro and in an animal model. On the basis of an incorporation process a rifampin-loaded catheter was developed which is capable of releasing rifampin in bacteriocidal concentrations for 60 days and more. ⋯ Furthermore, in none of the materials obtained after sacrifice of the animals (catheter, brain tissue, CSF, blood) could the infecting bacteria be cultured, whereas in materials from animals with the unloaded catheter the infecting strains could always be cultured from the catheter and from surrounding brain tissue. The histological examination of catheter-adjacent tissue supported these findings. We conclude that a rifampin-loaded silicone ventricular catheter is capable of completely preventing bacterial colonization and infection by staphylococci as the main causative organisms in CSF shunt infections and should be further evaluated in clinical trials.
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Acta neurochirurgica · Jan 1995
The use of computed tomography in the prediction of delayed cerebral infarction following acute aneurysm surgery for subarachnoid haemorrhage.
In order to predict the occurrence of cerebral infarction after aneurysmal surgery in patients with subarachnoid haemorrhage, we measured the amount of subarachnoid blood on initial and on postoperative computed tomograms. We used a reliable grading method to estimate the amount of blood on computed tomograms in 24 patients with infarction due to vasospasm and 45 patients without cerebral infarction, all of whom underwent aneurysmal surgery within 48 hours after the ictus. The total amount of subarachnoid blood on admission and on the day after operation was more in the cerebral infarction group than in the non-infarction group. ⋯ Therefore, we propose this range to be an indication for the occurrence of cerebral infarction in postoperative patients due to cerebral vasospasm. The presence of intracerebral haematoma and the amount of ventricular blood and their clearance by surgery were also estimated for the prediction of delayed cerebral infarction after aneurysmal surgery. However, they had no relation to the occurrence of cerebral infarction due to vasospasm.
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Acta neurochirurgica · Jan 1995
Case ReportsAtlanto-axial instability of a hypoplastic upper cervical spine. Case report.
The authors report on the development of myelopathy in a case of hypoplastic upper cervical spine with atlanto-axial instability. Its surgical treatment with transarticular screw fixation and interlaminar fusion is outlined.
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Thoracic percutaneous facet denervation has been employed for the treatment of thoracic zygapophysial joint pain. But the surgical anatomy of this procedure has been assumed to be the same as for lumbar medial branch neurotomy. To establish the anatomical basis for thoracic medial branch neurotomy, an anatomical study was undertaken. ⋯ Although the curved course remained essentially the same, the inflection occurred at a point superior to the superolateral corner of the transverse process. At no time during the dissection were nerves encountered crossing the junctions between the superior articular processes and transverse processes which have been the target points advocated for thoracic facet denervation. Rather, the results of this study indicate that the superolateral corners of the transverse processes are more accurate target points.
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An encapsulated fluid epidural haematoma in a 9-year-old boy was successfully evacuated by a simple burr hole procedure 5 months after a minor head injury. Clinicopathological findings suggested that chronic expansion of an initially unsuspected epidural haematoma occurred as a result of repeated haemorrhages from the haematoma membrane, resulting in an unusually long delayed appearance of clinical evidence. This case demonstrates that a chronic expanding process similar to that seen in chronic subdural haematoma needs to be considered as a possible complication of epidural haematoma and indicates an important role for the haematoma membrane in the chronic expansion of epidural haematoma.