Acta neurochirurgica
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Acta neurochirurgica · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialProspective comparative study of the effectiveness of epidural morphine and ropivacaine for management of pain after spinal operations.
Evaluation of the effectiveness of local application of morphine or ropivacaine for treatment of local and radicular pain after lumbar disc operations. Critical review of the literature about the possibilities of management of postoperative pain after spinal operations. ⋯ Local application of 5 mg morphine sulfate is effective in prevention or reduction of postoperative lumbar and radicular pain after lumbar disc operations. Ropivacain is less effective. The routine application of epidural morphine at the end of spinal operations can be recommended. It also can be justified to try to prolong the morphine effect by mixing it into a paste as described by Needham and by Hurlbert, and to irrigate the operative field with ropivacaine at the end of the operation.
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Acta neurochirurgica · Jan 2003
Case ReportsInfection-related atlantoaxial subluxation in two adults: Grisel syndrome or not?
Grisel's syndrome involves the subluxation of the atlanto-axial joint from inflammatory ligamantous laxity following an infectious process in the head or neck. It is a rare disease usually affecting children, but infrequent adult cases do occur. Today, due to the widened use of antibiotics and availability of MR imaging, some cases presenting with neck pain, resulting from the infectious inflammation of C1 and C2 but without pronounced subluxation, can be a challenging problem for most neurosurgeons. ⋯ The subluxation is reduced in holter or skeletal traction. This paper reports two cases of infection-related atlanto-axial subluxation in two adults. The literature on this subject is briefly reviewed.
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Acta neurochirurgica · Jan 2003
Case ReportsLate hydrocephalus in a case of wandering bullet into the pineal region.
We report a patient in whom a bullet in the brain migrated into the pineal region causing hydrocephalus 3 months later. In patients undergoing surgical removal of intracerebral or intraventricular bullets, it is recommended to obtain an x-ray or CT scan on the day of operation. Late hydrocephalus may occur several months after migration of the bullet due to scar tissue.
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Acta neurochirurgica · Jan 2003
Effects of intraventricular infusion of vascular endothelial growth factor on cerebral blood flow, edema, and infarct volume.
Therapeutic cerebral angiogenesis, utilizing angiogenic factors to enhance collateral vessel formation within the central nervous system, is a potential method for cerebral revascularization. A prior dose-response study determined that intracerebroventricular infusion of vascular endothelial growth factor (VEGF) increases vascular density with minimal associated brain edema at a concentration of 5 microg/ml. The purpose of this study was to assess effects of intracerebroventricular infusion of VEGF (5 microg/ml) on cerebral blood flow, infarct volume, and brain edema after ischemia. ⋯ Intracerebroventricular infusion of VEGF(165) (5 microg/ml) decreases infarct volume and brain edema after temporary MCAO without a significant increase in cerebral blood flow. These results indicate that VEGF may have a direct neuroprotective effect in cerebral ischemia.