Acta neurochirurgica
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Acta neurochirurgica · Jun 2010
Flow replacement bypass for aneurysms: decision-making using intraoperative blood flow measurements.
There is much debate regarding the optimal strategy for extracranial-intracranial (EC-IC) bypass for complex aneurysms. We introduce the concept of a flow replacement bypass which aims to compensate for loss of flow in the efferent vessels of the aneurysm. The strategy to achieve this utilizes direct intraoperative flow measurements to guide optimal revascularization by matching graft flow to demand. ⋯ Direct intraoperative measurement of flow deficit in aneurysm surgery requiring parent vessel sacrifice can guide the choice of flow replacement graft and confirm the subsequent adequacy of bypass flow.
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Acta neurochirurgica · Jun 2010
Transcranial color-coded duplex sonography allows to assess cerebral perfusion pressure noninvasively following severe traumatic brain injury.
Assess optimal equation to noninvasively estimate intracranial pressure (eICP) and cerebral perfusion pressure (eCPP) following severe traumatic brain injury (TBI) using transcranial color-coded duplex sonography (TCCDS). ⋯ TCCDS-based equation (ICP = 10.927 x PI - 1.284) allows to screen patients at risk of increased ICP and decreased CPP. However, adequate therapeutic interventions need to be based on continuously determined ICP and CPP values.
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Acta neurochirurgica · Jun 2010
Case ReportsDecompressive craniectomy for neurotrauma: the limitations of applying an outcome prediction model.
There is currently much interest in the use of decompressive craniectomy for patients with severe head injury. A number of studies have demonstrated that not only can the technique lower intracranial pressure but can also improve outcome. Whilst many patients who would otherwise have died or had a poor outcome now go on to make a good recovery, there is little doubt that complications can have a very significant impact on long term outcome. ⋯ This report illustrates the potential clinical applications and limitations of an outcome prediction model and demonstrates the impact that complications can have on eventual outcome.
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Acta neurochirurgica · Jun 2010
Is ventriculomegaly in idiopathic normal pressure hydrocephalus associated with a transmantle gradient in pulsatile intracranial pressure?
In patients with idiopathic normal pressure hydrocephalus (iNPH) and ventriculomegaly, examine whether there is a gradient in pulsatile intracranial pressure (ICP) from within the cerebrospinal fluid (CSF) of cerebral ventricles (ICP(IV)) to the subdural (ICP(SD)) compartment. We hypothesized that pulsatile ICP is higher within the ventricular CSF. ⋯ In this cohort of iNPH patients, we found no evidence of transmantle gradient in pulsatile ICP. The data gave no support to the hypothesis that pulsatile ICP is higher within the CSF of the cerebral ventricles (ICP(IV)) than within the subdural (ICP(SD)) compartment or the brain parenchyma (ICP(PAR)) in iNPH patients.
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Acta neurochirurgica · Jun 2010
Case ReportsReconstruction of vein of Labbé in temporo-occipital meningioma invading transverse sinus: technical report.
Meningiomas invading major venous sinuses and veins are not uncommon. However, meningiomas involving both the transverse sinus and vein of Labbé are exceedingly rare. Venous reconstruction can be challenging after radical removal of the meningioma which invades major venous sinuses and veins. In this report, we present reconstruction of vein of Labbé in the surgery of temporo-occipital meningioma invading the transverse sinus. ⋯ This is the first report in the literature in which the vein of Labbé was reconstructed in the surgery of temporo-occipital meningioma invading the vein of Labbé and transverse sinus together.