Acta neurochirurgica
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Acta neurochirurgica · Jul 2005
Trigeminocardiac reflex during skull base surgery: mechanism and management.
We study the occurrence and management of the trigeminocardiac reflex (TCR) during neurosurgical procedures for lesions of the skull base. ⋯ Due to the intracranial course of the trigeminal nerve several surgical procedures at the anterior, middle and posterior skull base may elicit the trigeminocardiac reflex. Continuous monitoring of hemodynamic parameters allows the surgeon to interrupt surgical manoeuvres immediately upon the occurrence of the TCR. This technique is sufficient for the heart rate and the arterial blood pressure to return to normal levels without the necessity of additional anticholinergic medication.
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Acta neurochirurgica · Jul 2005
Comparative StudyIntracranial pressure changes during fluid percussion, controlled cortical impact and weight drop injury in rats.
In traumatic brain injury research, the fluid percussion injury (FPI) model in the rat is widely used. The injury is graded based on indirect criteria, such as the extracranial pressure wave and/or physiological responses to the injury. We designed this study to investigate if the extracranially monitored pressure in the FPI-device corresponded to the actual intracranial situation. Severe controlled cortical impact (CCI) and severe weight drop injury (WDI) were studied for comparison. ⋯ The extracranial pressure pulse appears to be a good estimate of the intraventricular pressure pulse generated during FPI. Severe CCI and WDI generated intraventricular pressure pulses of much lower magnitude than FPI, explaining the lesser degree of brain stem involvement in the former models.
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Acta neurochirurgica · Jun 2005
Factors affecting the outcome of decompressive craniectomy for large hemispheric infarctions: a prospective cohort study.
Although surgical decompression of large hemispheric infarction is often a life-saving procedure, many patients remain functionally dependent. The aims of this study were to identify specific factors that can be used to predict functional outcome, thus establish predictive criteria to reduce poor surgical results. ⋯ We view decompressive craniectomy for space-occupying large hemispheric infarction as a life-sparing procedure that sometimes yields good functional outcomes. A dominant hemispheric infarction should not be an exclusion criterion when deciding to perform this operation. Early operation and careful patient selection based on the above-mentioned factors may improve the functional outcome of surgical management for large hemispheric infarction.
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Acta neurochirurgica · Jun 2005
Haemorrhagic complications and the incidence of asymptomatic bleeding associated with stereotactic brain biopsies.
Stereotactic brain biopsy is a routinely used technique for the diagnosis of brain lesions. Due to its minimally invasive nature, the potential risks associated with this procedure are sometimes underestimated. We have retrospectively analyzed the incidence of symptomatic and asymptomatic haemorrhagic complications associated with stereotactic biopsies. Various variables that may contribute to such complications have been retrospectively analyzed. ⋯ Stereotactic brain biopsy was associated with a low incidence of symptomatic haemorrhagic complications, morbidity and mortality, and a high diagnostic yield. About half of the haemorrhagic complications were asymptomatic. Lesions located in the brainstem had a higher rate of complications. No other clinical, radiographic, or pathological variables were found as predictors of increased risk for haemorrhage.