Acta neurochirurgica
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Acta neurochirurgica · Dec 2003
Multicenter StudyTraumatic acute subdural haematomas of the posterior fossa: clinicoradiological analysis of 24 patients.
We report 24 patients with a traumatic acute subdural haematoma of the posterior fossa managed between 1997 and 1999 at 8 Italian neurosurgical centres. ⋯ acute posterior fossa subdural haematomas can be divided into two distinct groups: those patients admitted in a comatose state and those with a moderate/mild head injury on admission. Comatose patients present usually with signs of posterior fossa mass effect and have a high percentage of bad outcomes. On the contrary, patients admitted with a GCS of 8 or higher are expected to recover. In these patients the thickness of the haematoma (<1 cm) seems to be a guide to indicate surgical evacuation of the haematoma.
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Acta neurochirurgica · Dec 2003
Comparative StudyA new subdural probe for combined intracranial pressure (ICP) and cerebral blood flow (CBF) monitoring.
We report the development of a new subdural probe for combined intracranial pressure (ICP) and cerebral blood flow (CBF) monitoring with near infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution. For NIRS a conventional subdural ICP monitoring probe was supplied with two fiber bundles and 90-degree prisms. ⋯ With prototypes of the probe in two patients with intracerebral haemorrhage 18 comparative measurements obtained simultaneously with conventional NIRS (optodes placed on the skin) and the subdural NIRS probe were performed. The new subdural NIRS probe allows combined monitoring of ICP and cerebral hemodynamics in the brain directly, without the influence of extracerebral tissue.
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Acta neurochirurgica · Dec 2003
Comparative StudyMoyamoya disease and Moyamoya syndrome: experience in Europe; choice of revascularisation procedures.
To present our clinical experience in terms of disease presentation and choice of revascularisation procedure in our first group of 23 European Moyamoya angiopathy (disease and syndrome) patients. METHOD AND PATIENT SELECTION: Twenty three patients were diagnosed and treated from 1997-2001 in our neurosurgical department. All patients underwent preoperative angiography, colour Doppler examination, cranial MRI and/or CT scans, HMPAO-SPECT or H(2)(15)O PET (baseline and Diamox challenge) scans. Nineteen patients presented with child-juvenile Moyamoya angiopathy with an average age at presentation of 8 years (range 1-17 years), in 4 patients adult Moyamoya was diagnosed with a mean age at presentation of 34 years (range 23-40 years). ⋯ As territorial hemodynamic disorder seems to be a characteristic in Moyamoya disease and/or syndrome, judging from our experience with European patients in our series, and several reports hitherto, treatment with multiple revascularisation procedures is considered to be justified.
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Acta neurochirurgica · Dec 2003
Cerebral arteriovenous malformations: influence of angioarchitecture on bleeding risk.
To evaluate the angioarchitecture of cerebral arteriovenous malformations (cAVMs) with special regard to its influence on the risk of intracranial haemorrhage. ⋯ Various angiographic features were correlated with the occurrence of intracranial haemorrhage in patients with cerebral AVMs. In addition to the well-known factors influencing the bleeding risk of cAVMs like size, pattern of venous drainage and location within the brain our data demonstrate the importance to look at the diameter of the main feeder and the number of draining veins showing a better correlation.
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Acta neurochirurgica · Dec 2003
Asymptomatic shunt malfunction detected fortuitously by observation of papilloedema.
Significant shunt malfunction is nearly always followed by headache, nausea, vomiting, lethargy and/or visual disturbances. In many cases there are also signs of raised intracranial pressure on computed tomography (CT). In six hydrocephalic, shunt dependent children (8-14,5 years) with no or slight symptoms shunt malfunction was detected because of papilloedema. ⋯ In five children the oedema disappeared after shunt-revision without any visual reduction, but in one the visual deficit did not improve. Older children can have shunt malfunction leading to increased intracranial pressure, with no or discrete symptoms and no obvious ventricular dilatation but with asymptomatic papilloedema. Ophthalmoscopy can therefore be of great value at routine check up in these children.