Acta neurochirurgica
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Acta neurochirurgica · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialOsmotherapy for increased intracranial pressure: comparison between mannitol and glycerol.
Osmotic agents are still the most common treatment for controlling intracranial hypertension (ICH). Mannitol, glycerol, sorbitol, and hypertonic serum saline are the agents currently available. This work was designed to compare mannitol and glycerol in a similar population of brain injured patients, randomly divided into two groups of eight. ⋯ Both agents induced a statistically equally effective decrease on ICP and increase on CPP evaluated at one and two hours post infusion but the mean day mTIL showed a statistically significant difference in favour of glycerol. The possible explanations of this difference are discussed. According to our results mannitol would be most indicated as a bolus to control sudden rises in ICP whereas glycerol would be most indicated as a basal treatment.
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Acta neurochirurgica · Jan 1997
ReviewFollow-up computerized tomography (CT) scans in moderate and severe head injuries: correlation with Glasgow Coma Scores (GCS), and complication rate.
The wide availability of computerized tomography (CT) scan has popularized its use in initial and follow-up evaluations of head trauma patients. Follow-up CT scans of clinically stable patients, however, may not provide additional information, but could potentially subject the patients to secondary injuries. The authors investigated the correlation between CT scans and Glasgow coma score (GCS), and complication rate during follow-up CT scans in an attempt to dissuade clinicians from obtaining unnecessary follow-up CT scans. ⋯ Because of the correlation between the CT scan appearance and the clinical status, as well as the detrimental effect of mobilizing critically ill patients, the authors urge the use of follow-up CT scans only in patients with clinical deterioration unexplained by ICP changes alone.
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Acta neurochirurgica · Jan 1997
Case ReportsRuptured vertebrobasilar junction aneurysm associated with basilar artery fenestration.
A case of a ruptured saccular aneurysm arising from the proximal portion of a partially duplicated basilar artery in a 36-year-old woman is reported. CT and lumbar puncture confirmed subarachnoid haemorrhage. ⋯ The patient underwent successful clipping and coating of the aneurysm by a right lateral suboccipital osteoclastic approach. Embryological development, pathogenesis, diagnostic and therapeutic difficulties of this vascular malformation are discussed in this report.
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Acta neurochirurgica · Jan 1997
Case ReportsInitial and postoperative hyponatremia associated with pituitary adenoma: a case report.
This 67 year-old man experienced 3 episodes of symptomatic hyponatraemia. Radiological examination revealed a sellar lesion and the tumour was removed via the transsphenoidal route. Thereafter, he simultaneously developed intractable diabetes insipidus and serious hyponatraemia with persistent natriuresis. ⋯ The oral administration of salt gradually improved his hyponatraemia as well as the coincident symptoms. By the administration of a mineralocorticoid, fludrocortisone acetate, we succeeded in maintaining his serum sodium level without salt replacement. We discuss the mechanism(s) and treatment of hyponatraemia associated with pituitary tumour.
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Acta neurochirurgica · Jan 1997
Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part I: Anatomical and surgical considerations.
A unilateral laminotomy for bilateral access to the lumbar spinal canal was investigated in human cadaver spine specimens to test its practicability in the treatment of spinal stenosis. Micro-surgical decompression was performed by partial resection of the ipsilateral facet, the medial portion of the laminar arch, the contralateral facet and by complete removal of the ligamentum flavum. Anatomical, radiological and morphometrical studies on 4 adult cadaver spine specimens have proved the feasibility of this unilateral approach. Complete bilateral flavectomy and partial bilateral facetectomy were the essential surgical steps for an adequate operative decompression.