Acta neurochirurgica
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Acta neurochirurgica · Feb 2005
Clinical TrialTelovelar approach to the fourth ventricle: operative findings and results in 16 cases.
The cerebellomedullary fissure as a corridor for exposure of the fourth ventricle without vermian splitting is enjoying increasing application as a technique for exposure, to avoid the complications related to vermian splitting. The purpose of this study is to describe the operative findings and the results in 16 fourth ventricular tumours removed via telovelar approach. The impact of the pathological nature of the lesion on the degree of tumour removal is also discussed. ⋯ Despite the panoramic view provided by the telovelar approach, the pathological nature of the lesion and vital neural tissue infiltration are limiting factors for total tumour removal. Total removal of tumours focally attached to critical areas in the fourth ventricle should not be attempted at the expense of patient's morbidity and mortality. To achieve optimum outcome, near total excision is acceptable in cases where complete removal may endanger function or life.
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Acta neurochirurgica · Feb 2005
The relationship of intracranial pressure Lundberg waves to electroencephalograph fluctuations in patients with severe head trauma.
Lundberg (or B) waves, defined as repetitive changes in intracranial pressure (ICP) occurring at frequencies of 0.5 to 2 waves/min, have been attributed to cerebral blood flow fluctuations induced by central nervous system pace-makers or cerebral pressure autoregulation. We prospectively recorded and digitalized at a frequency rate of 10 Hz (AcqKnowledge software) the following parameters in 6 brain injured patients: mean arterial pressure, heart rate, ICP, mean flow velocity of the middle cerebral artery (MFVMCA) (transcranial Doppler WAKI) and left and right spectral edge frequency (SEFl, SEFr) of continuous electroencephalogram (EEG) recordings (Philips technologies). ⋯ These result support the existence of a neuropacemaker at the origin of the Lundberg B waves. The change in cerebral electrical activity, resulting from cerebral pacemakers, could increase cerebral metabolic rate of oxygen (CMRO2) and thus lead to an increase in cerebral blood flow and secondarily of ICP through a change in cerebral blood volume.
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Acta neurochirurgica · Feb 2005
Case ReportsMultiple cystic cavernous angiomas associated with hemorrhage.
A 29-year-old man presented with impaired mental concentration and inability to remember. Magnetic resonance and computed tomography studies revealed multiple calcified cysts. ⋯ The histological diagnosis was cavernous angioma. The first report of multiple cystic cavernous angiomas is reported.
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Acta neurochirurgica · Feb 2005
Comparative StudySpinal epidural abscess: prognostic factors and comparison of different surgical treatment strategies.
Spinal epidural abscess (SEA) is a rare but potentially devastating disease requiring immediate surgical intervention and appropriate antibiotic treatment. The standard approach to decompress SEA is laminectomy. No report covers comprehensively the indications for the less invasive interlaminar approach, the usefulness of intra-operative ultrasonography and the suspected benefit of inserting a suction-irrigation drainage. ⋯ An interlaminar approach should be considered instead of laminectomy in lumbar SEA and in impending anterior column instability due to spondylitis. Intra-operative ultrasound is a beneficial aid for the determination of the extent of decompression during surgery and is practicable even through a narrow interlaminar bony window. The insertion of postoperative suction-irrigation drainage had no beneficial effect on outcome but bore the risk of epidural fluid congestion.
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Acta neurochirurgica · Feb 2005
Management of pituitary apoplexy: clinical experience with 40 patients.
Pituitary apoplexy is a rare major clinical event with neurological, neuro-ophthalmological, cardiovascular and hormonal consequences, resulting from an acute infarction of pituitary adenoma. We report our experience with a series of 40 patients presenting with pituitary apoplexy. ⋯ We present a large series of patients with pituitary apoplexy. Most subjects were operated, but six were treated conservatively. Almost all patients improved clinically, including those who were not operated, but hormonal deficiencies are very common.