Acta neurochirurgica
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Acta neurochirurgica · Jan 1999
Brain death and organ donation in Germany: analysis of procurement in a neurosurgical unit and review of press reports.
A prospective study was undertaken to determine the number of potential organ donors in a neurosurgical intensive care unit and to record the actual number of organ donations. The reasons for refusal of organ donations were analysed with respect to the controversial public discussion of the brain death concept and the transplantation law in Germany. ⋯ In Germany, the relatives refusal rate in organ donation is continuously high, presumable due to a depressing 39% of press reports rejecting the brain death concept, and resulting in a very low number of organ donations. There is hope that the transplantation law which has finally passed German parliament in 1997, confirming the brain death concept as well as the legal principle of prior consent by the donor or consent by the relatives will eventually result in an increase of organ donation especially when supported by an educational campaign which is embodied in the transplantation law.
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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.
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Acta neurochirurgica · Jan 1999
Expansive suboccipital cranioplasty for the treatment of syringomyelia associated with Chiari malformation.
In order to treat syringomyelia associated with adult type Chiari malformation, the authors developed a method of expansive suboccipital cranioplasty (ESC) that involves enlarging the small posterior fossa to obtain a sufficient flow of cerebrospinal fluid (CSF). The relative effectiveness of ESC with the obex plugged and not plugged was also examined, as well as other factors influencing the operative results. Twenty patients without arachnoid adhesion at the major cistern underwent ESC without opening the arachnoid membrane at the major cistern. ⋯ Intra-arachnoid procedures are not necessary to facilitate restoration of CSF flow in patients without arachnoid adhesions, because ESC can release the CSF flow blockage in the major cistern even without plugging of the obex. An associated arachnoid adhesion at the major cistern or a long-standing syringomyelia with irreversible damage of the spinal cord results in a poor operative prognosis. When posterior fossa surgery fails, insufficient decompression or postoperative arachnoid adhesions at the major cistern as the cause of treatment's failure should be evaluated by CSF flow studies using phase contrast MR imaging.
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Acta neurochirurgica · Jan 1999
Comparative Study Clinical TrialAdvantage of intravenous anaesthesia for acute stage surgery of aneurysmal subarachnoid haemorrhage.
To investigate the clinical effects of intravenous anaesthesia on surgical procedure and the outcome in acute stage surgery for aneurysmal subarachnoid haemorrhage (SAH), pre-, intra-, and post-operative factors were analyzed to compare between inhalational (IA, n = 38) and intravenous (IVA, n = 37) anaesthesia. IVA significantly shortened the duration of surgery (p < 0.05) and the duration of hospital stay (p < 0.01). These results suggest that IVA may be more suitable than IA for acute stage surgery of aneurysmal SAH. These effects may be mainly caused by IVA's pharmakokinetics, by effects on intracranial homeostasis and metabolism, and neuroprotective properties.