Acta neurochirurgica
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Acta neurochirurgica · Jan 1998
Comparative StudyA comparison between ventriculo-peritoneal and ventriculo-atrial cerebrospinal fluid shunts in relation to rate of revision and durability.
Results of 884 first-time shunts inserted in the time period from 1958 to 1989 are retrospectively evaluated, 1) to perform a durability analysis of a shunt based on Kaplan-Meyer method, 2) to compare the rate of revision for ventriculo-atrial (VA) and ventriculo-peritoneal (VP) shunts, 3) to compare the durability of a VA shunt with a VP shunt and 4) to do a stratified durability analysis comparing the VA and VP shunts in relation to the following background variables: shunt type, time period and age of the patient. Furthermore the specific complications related to VA and VP shunts are identified based on findings in the literature. Overall one-year shunt durability is 57% and five-year shunt durability is 37%. ⋯ Hence the apparent difference in revision rate between VA and VP shunts seems secondary to variations in follow-up time and variations in background variables. To supplement our statistical analysis we have performed a literature study to look at the specific complications associated with VA and VP shunts. It seems as if the specific complications in relation to the VA shunting method are more severe than in relation to the VP shunting method.
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Acta neurochirurgica · Jan 1998
ReviewMeningioma surgery in the elderly: a case-control study assessing morbidity and mortality.
To assess the morbidity and mortality of meningioma surgery in patients over age 65 and compare our results with matched controls and with the present literature on meningioma surgery in the elderly. ⋯ Our lower morbidity and mortality rates after meningioma surgery in the elderly may be a result of patient selection, surgical technique, or excellent pre- and post-operative care by the resident staff, anesthesiologists, and nurses. It suggests, however, that elderly patients can have meningioma surgery safely.
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Acta neurochirurgica · Jan 1998
Wrapping of solitary ruptured intracranial aneurysms, outcome at five years.
Previous follow up studies of patients who have had ruptured intracranial aneurysms treated by a wrapping technique have largely been in the pre-microsurgical era. Our objective was to ascertain whether wrapping aneurysms with the aid of the operating microscope provides protection against rebleeding in the short and long term. The study involved retrospective analysis of patients with ruptured aneurysms treated by wrapping over a six-year period. ⋯ Of the 15 patients who had a solitary ruptured aneurysm wrapped, none had rebled at one year follow up. One patient died of a myocardial infarction at 4 years, the remaining 14 patients had no episodes of rebleeding with all patients achieving Glasgow outcome scores of four or five at 5 years follow-up. Although surgical clipping of intracranial aneurysms is the definitive method of treatment, our findings suggest that wrapping of ruptured intracranial aneurysms with the aid of the operating microscope confers good protection against both early and late rebleeding in those cases considered 'unclippable'.
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Acta neurochirurgica · Jan 1998
Review Case ReportsCerebral aneurysm associated with persistent primitive olfactory artery aneurysm.
Persistent primitive olfactory artery is a rare vascular anomaly but has a clinical importance because of its high association with cerebral aneurysm. We describe a patient with bilateral persistent primitive olfactory arteries associated with an unruptured saccular aneurysm on the left persistent primitive olfactory artery. Seven reported cases with this anomalous artery including ours are reviewed and classified into two variants. ⋯ The aneurysm in variant 1 is located on the hair-pin curve at which an apparent arterial branch is sometimes absent. Two patients suffer from anosmia. Persistent primitive olfactory artery should be kept in mind because of its high association with intracranial saccular aneurysms and unique clinical presentation.
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Acta neurochirurgica · Jan 1998
Meta AnalysisThe association of tranexamic acid and nimodipine in the pre-operative treatment of ruptured intracranial aneurysms.
In the scope of a late intervention policy on ruptured intracranial aneurysms, on D.+12 on an average, we first used tranexamic acid, at moderate doses: 3 g orally or 1.5 g intravenously per day. We, subsequently, added nimodipine, usually 240 mg orally per day or 2 mg intravenously per hour. The medical treatment consisted of amply sufficient hydration, and in systematic and regular administration of analgesics and sedatives. ⋯ For several reasons, only a retrospective study was possible, to evaluate the results of our antifibrinolytic and calcium-blocking therapies, on rebleeding and pre-operative delayed ischaemia. We compared, therefore, similar cases from the literature, with our own cases, taking into consideration the clinical grades, the days of admission and of intervention, the moment of rebleeding and of delayed pre-operative ischaemia, etc. The following impressions emerge: (1) same effectiveness of moderate doses of tranexamic acid; (2) no increase of pre-operative delayed ischaemic complications, in comparison with patients not receiving antifibrinolytics but nimodipine; (3) important role of a devastating initial bleed and of operative complications; (4) difficulty of avoiding rebleeding at D.0, whatever the therapeutic measures, medical and/or surgical.