Acta neurochirurgica
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Acta neurochirurgica · Jan 2001
Review Case ReportsCoagulopathy induced spinal intradural extramedullary haematoma: report of three cases and review of the literature.
In a retrospective review of patients operated for coagulopathy induced spinal intradural-extramedullary haematoma the literature regarding coagulopathy induced spinal haemorrhage is reviewed and the etiology of these rare spinal subdural and subarachnoid haemorrhages is discussed. Spinal intradural haematomas are usually related to trauma or a previous lumbar puncture. ⋯ Coagulopathy induced spinal haemorrhage should be included in the differential diagnosis of acute paraparesis in patients with co-existent haematological disorders or undergoing anticoagulation therapy. Due to the often mixed subdural and subarachnoid bleeding patterns we have termed this entity spinal intradural-extramedullary haematoma.
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Acta neurochirurgica · Jan 2001
Comparative StudyThe effect of hair on infection after cranial surgery.
Reports of large series of patients who had undergone successful cranial neurosurgery without hair removal led part of our team to abandon the practice of shaving patients' heads pre-operatively. The aim of this study was to assess whether this change in routine, which was implemented in 1992, has affected the rate of postoperative infection in our cranial surgery patients. ⋯ Cranial surgery without hair removal is safe and does not increase the risk of surgical wound infection. Patients naturally prefer to keep their full head of hair. We believe that preoperative hair removal is not necessary in preparation for any type of cranial neurosurgery.
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Acta neurochirurgica · Jan 2001
Aggressive decompressive surgery in patients with massive hemispheric embolic cerebral infarction associated with severe brain swelling.
Massive hemispheric cerebral infarction, also known as malignant infarction, is characterized by rapid clinical deterioration due to brain swelling and downward transtentorial herniation, and is associated with a mortality of 80%. Early patient selection and establishment of the optimum therapeutic modality are important to improve the outcome. Early clinical, computed tomography (CT), and angiographic characteristics were analysed to identify patients with malignant infarction and external and internal decompression was performed, with unco-parahippocampectomy if needed, and the outcomes were compared with those of conservative treatment. ⋯ However, the mean Barthel Index scores of the survivors were not significantly different. An infarct volume of more than 240 cm3 on CT and angiographic recanalization of the occluded artery are predictors of fatal brain swelling after massive cerebral infarction. Decompressive surgical treatment dramatically improves the mortality of massive hemispheric infarction.
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Acta neurochirurgica · Jan 2001
Specificity of reinnervation and motor recovery after interposition of an artificial barrier between transected and repaired nerves in adjacency--an experimental study in the rat.
Non-specific re-innervation of target organs caused by misdirected axonal growth at the repair site is regarded as one reason for a poor functional outcome after peripheral nerve transsection and repair. This study investigates the rate of aberrant re-innervation and its influence on motor recovery in the rat sciatic nerve using artificial sheets as barrier between tibial and peroneal nerves. The sciatic nerve was transsected and repaired as follows: epineural sutures (A x 6), fascicular repair of tibial and peroneal nerves respectively (B x 8), and the same as in group B, but separating both nerves using an Integra-sheet with silicone (C x 8), or Integra without silicone (D x 8). ⋯ These findings were confirmed by a significantly higher rate of specific reinnervation of the soleus muscle using sequential retrograde double labelling technique. Results of this study suggest that an artificial sheet such as Integra bears the potential of preventing aberrant re-innervation between repaired adjacent nerves resulting in improved motor recovery. Clinically, this technique may be of importance for brachial plexus, sciatic nerve, and facial nerve repair.