Acta neurochirurgica
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Acta neurochirurgica · Jan 1995
Percutaneous jugular placement of ventriculo-atrial shunts using a split sheath. Technical note.
The percutaneous placement of ventriculo-atrial (V-A) shunts for treatment of hydrocephalus has been previously reported by several authors as a simplified procedure. However, this technique did not avoid the use of a distal connector between the outlet catheter and the atrial one, which may lead to a disconnection. A technique of percutaneous V-A shunt insertion using a split sheath is described and illustrated with a series of 22 patients. ⋯ All the patients' clinical conditions improved. We are encouraged to use this V-A technique more frequently as a method of choice in the treatment of adult hydrocephalus or when the peritoneal cavity is inaccessible in children. The use of a split sheath is successful in reducing the operating time and avoiding the use of a distal connector.
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Acta neurochirurgica · Jan 1995
CT and clinical criteria for conservative treatment of supratentorial traumatic intracerebral haematomas.
In search of guidelines for the management of traumatic intracerebral haematomas (TICHs) with slight mass effects on computed tomography (CT) scans, the author reviewed the records of 29 patients who did not undergo surgery and 11 patients who did. It is found that patients with a TICH volume of less than 15 ml, a midline shift of less than 5 mm, an open perimesencephalic cistern on CT scans, a Glasgow Coma Scale (GCS) score of 12 or more, and an absence of lateralizing signs may be treated conservatively and expected to make a good recovery. On the other hand, with zero mortality and satisfactory outcomes, the patients under-going early surgery tended to have a TICH volume of more than 15 ml, a midline shift of more than 5 mm, an obliterated perimesencephalic cistern on CT scans, a GCS score of less than 12, and the presence of lateralizing signs. However, the position of such features as the criteria of early operation for a TICH is weakened by the retrospective nature of this study because some surgical patients, free of lateralizing signs in particular, might have managed to do well without craniotomy.
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Acta neurochirurgica · Jan 1995
Continuous monitoring of jugular bulb oxygen saturation in comatose patients--therapeutic implications.
Comatose patients run a high risk of developing cerebral ischaemia which may considerably influence final outcome. It would therefore be extremely useful if one could monitor cerebral blood flow in these patients. Since there is a close correlation between the arteriovenous difference of oxygen and cerebral blood flow, it was a logical step to place a fiberoptic catheter in the jugular bulb for continuous measurement of cerebrovenous oxygen saturation. ⋯ Likewise, insufficient cerebral perfusion pressure and severe vasospasm were found to be important causes of desaturation episodes. In many instances, tailoring of ventilation or induced hypervolaemia and hypertension were capable of reversing these low flow states. The new method of continuous cerebrovenous oximetry is expected to contribute to a better outcome by enabling timely detection and treatment of insufficient cerebral perfusion.
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Acta neurochirurgica · Jan 1995
Influence of aneurysm location on the development of chronic hydrocephalus following SAH.
The incidence of chronic hydrocephalus was analysed in a series of 204 patients with aneurysmal subarachnoid haemorrhage (SAH). Its development was significantly related to the quantity of subarachnoid blood, but even more to the location of the haemorrhage and to the aneurysm site. Hydrocephalus was more frequent in patients under poor initial condition. ⋯ Surprisingly, in our series a shunt was never needed in patients with aneurysms of the middle cerebral artery (MCA). SAH from an aneurysm of the internal carotid artery (ICA) also never caused a shunt-dependent hydrocephalus except in cases with accompanying intraventricular haemorrhage. The percentage of chronic hydrocephalus was relatively high (19%) in patients with anterior communicating artery (ACoA) aneurysms but definitely highest in patients with an aneurysm of the vertebrobasilar (VB) system (53%).
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Acta neurochirurgica · Jan 1995
The haemodynamic effect of transcranial Doppler-guided high-dose nimodipine treatment in established vasospasm after subarachnoid haemorrhage.
Eleven patients (7 females) with aneurysmal subarachnoid haemorrhage (SAH) and transcranial Doppler (TCD) signs of vasospasm during prophylactic intravenous nimodipine treatment (2 mg/h) were treated with TCD-guided high-dose (4 mg/h) intravenous nimodipine. The patients were followed clinically and with serial TCD investigations. Increasing nimodipine to high-dose treatment led to a reduction of the abnormally elevated mean flow velocities (FV) in all patients. ⋯ The individual effect of nimodipine treatment can be monitored by the use of serial TCD investigations. TCD-guided high-dose nimodipine treatment appears to be an effective treatment in SAH patients developing vasospasm despite prophylactic standard dose treatment. The data give support for a direct vascular effect of nimodipine on cerebral vasospasm.