Acta neurochirurgica
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Acta neurochirurgica · Jan 1998
Four-year experience with the routine use of the programmable Hakim valve in the management of children with hydrocephalus.
Cerebrospinal fluid (CSF) over- and underdrainage symptoms are frequent sequelae of shunt placement in patients with hydrocephalus, sometimes requiring repeated operations. To achieve more adequate CSF drainage, the non-invasively programmable Hakim valve has been developed. Because the clinical experiences with this valve so far are confined to adults, we describe our experiences with the routine use of the programmable Hakim valve in childhood hydrocephalus. ⋯ In the majority of cases, the programmable Hakim valve allows the successful management of symptoms related to CSF over- and underdrainage by non-invasive change of the initial pressure setting of the valve. Therefore, the programmable Hakim valve should be considered as an alternative to non-programmable valves of advanced design.
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Sometimes charring or popping occurs and the bipolar blades get stuck to the vessel. ⋯ Experience with this instrument was still quite limited, but preliminary results were promising.
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Acta neurochirurgica · Jan 1998
Intraoperative facial nerve monitoring (IFNM) predicts facial nerve outcome after resection of vestibular schwannoma.
Intraoperative facial nerve monitoring (IFNM) is a suitable technique for intraoperative facial nerve identification and dissection, especially in large vestibular schwannomas (VS) (acoustic neuroma). To evaluate its feasibility for estimating functional nerve outcome after VS resection 60 patients underwent surgery using IFNM. Out of this group the last 40 patients were included in a prospective study evaluating the prognostic value of various IFNM parameters (proximal and distal absolute EMG amplitude, stimulation threshold, and proximal-to-distal amplitude ratio) for prediction of initial postoperative facial nerve function and recovery of function. ⋯ Two patients with initial mHB degree IV improved to mHB degree III despite intraoperative evidence of missing functional nerve integrity. Therefore, functional recovery cannot be predicted by IFNM in all cases of anatomical nerve preservation. We conclude that a minimum follow-up period of 1 year may still be advisable even in certain patients without evidence of intraoperative functional nerve integrity.
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It is usually defficult in clinical practice to establish factors affecting final outcome in patients suffering severe diffuse brain injury (SDBI), due to the absence of specific semiology. ⋯ Clinical evaluation, early CT findings, ICP values and their response to medical treatment and clinical complications were found to be related (p < 0.05) to final outcome (GOS).
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Acta neurochirurgica · Jan 1998
Diffuse axonal injury (DAI) is not associated with elevated intracranial pressure (ICP).
Traditionally, intracranial pressure (ICP) monitoring has been utilized in all patients with severe head injury (Glasgow coma score of 3-8). Ventriculostomy placement, however, does carry a 4 to 10 percent complication rate consisting mostly of hematoma and infection. The authors propose that a subgroup of patients presenting with severe head trauma and diffuse axonal injury without associated mass lesion, do not need ICP monitoring. Additionally, the monitoring data from ICP, MAP, and CPP for a comparison severe head injury group, and subgroups of DAI would be presented. ⋯ The authors conclude that ICP elevation in DAI patients without associated mass lesions is not as prevalent as other severe head injured patients, therefore ICP monitoring may not be as critical. The presence of an ICP monitoring device may contribute to increased morbidity. Of key importance, however, is an accurate clinical history and interpretation of the CT scan.