Acta neurochirurgica
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Acta neurochirurgica · Jan 1999
Case ReportsEndovascular stent placement for cervical internal carotid artery aneurysm causing cerebral embolism: usefulness of neuroradiological evaluation.
We present a case of a cervical internal carotid artery aneurysm that caused cerebral embolism. This lesion was supposed to be a dissecting aneurysm due to blunt neck injury. ⋯ Intravascular ultrasound imaging was also useful for evaluation of the satisfactory stent deployment and identification of the neck of the aneurysm. We discuss effectiveness of endovascular stenting for cervical internal carotid artery aneurysm with intramural thrombus and the usefulness of a combination of the neuroradiological imaging before, during and after the interventional procedure.
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Acta neurochirurgica · Jan 1999
Interdisciplinary management results in 100 patients with ruptured and unruptured posterior circulation aneurysms.
The authors report on a series of 100 posterior circulation aneurysms managed by surgical and endovascular procedures. The series consisted of 41 elective admissions more than 14 days after SAH or for unruptured aneurysms and 59 acute admissions after subarachnoid haemorrhage (SAH). In this first interdisciplinary series after the introduction of electrolytically detachable coils, surgical clipping was maintained as treatment of choice in good grade patients while endovascular therapy was primarily offered for patients in poor clinical grade or if the aneurysm was judged difficult to be accessed surgically. ⋯ Size and shape do not appear to be a primary factor to favour one or the other modality. The hope that endovascular therapy improves the prognosis of poor grade patients with posterior circulation aneurysms probably has been overstated. The good results of endovascular treatment with small narrow-necked aneurysms on proximal arteries of the posterior circulation, as seen in the present series and as reported in the accumulating literature, suggest that in future surgical and endovascular treatment should be considered as alternatives in these special cases while in large and broad-necked aneurysms surgery should be considered first.
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Acta neurochirurgica · Jan 1999
Experimental study of intracisternal administration of tissue-type plasminogen activator followed by cerebrospinal fluid drainage in the ultra-early stage of subarachnoid haemorrhage.
This experimental study evaluated the effect of intrathecal injection of tissue-type plasminogen activator followed by cisternal drainage in the ultra-early stage of aneurysmal subarachnoid haemorrhage to prevent vasospasm. Twenty Japanese white rabbits were divided into five groups. Either tPA (groups A, B, and E) or saline (groups C and D) was injected intrathecally 1 hour (groups A, B, C, and D) or 21 hours (group E) after the intrathecal injection of blood. ⋯ Examination of the series of CSF samples (groups A and C) showed that fibrinolysis with tPA effectively cleared clots early. In the two groups treated with tPA and CSF drainage (groups A and E), early removal of subarachnoid clots reduced the degree of vasospasm. Early fibrinolysis with tPA and early removal of subarachnoid clots by drainage is effective for preventing vasospasm.
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Acta neurochirurgica · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative pain after lumbar disc surgery: a comparison between parenteral ketorolac and narcotics.
Lumbar discectomy is a common elective surgical procedure but many patients still experience postoperative back pain which may delay hospital discharge. We therefore evaluated the efficacy of a parenteral non-steroidal antiinflammatory agent, ketorolac, for the management of post-surgical pain. ⋯ These results suggest that ketorolac, when used with PRN narcotics, is more effective than PRN narcotics alone for postoperative pain following lumbar disc surgery. In addition, this strategy also may contribute to early discharge from hospital after lumbar disc surgery.
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Acta neurochirurgica · Jan 1999
Review Case ReportsSyringobulbia caused by delayed postoperative tethering of the cervical spinal cord - delayed complication of foramen magnum decompression for Chiari malformation.
Postoperative tethering of the high cervical spinal cord is a rare cause of neurological deterioration after foramen magnum decompression (FMD) with duraplasty for Chiari type I malformation. A review of the literature revealed that only 5 cases have been reported. This entity is not widely known to occur as a complication of the common surgical procedure for Chiari type I malformation. ⋯ Follow-up MR images provided significant information on the cervical spinal cord tethering after FMD with duraplasty for Chiari malformation. We encourage sharp surgical detethering and duraplasty with Gore-Tex to avoid retethering. Early recognition and treatment of this unusual but important complication are emphasized.