Acta neurochirurgica
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Acta neurochirurgica · Jan 2000
Informed consent in neurosurgery: patients' recall of preoperative discussion.
Informed consent (IC) is an important principle of modern medicine and the quality of the process is likely to receive increasing attention in future due to complex surgical procedures and a development of social mistrust for medical treatment. Medico-legal action is also becoming an important influence on IC, in particular the extent of warning to be given about the degree of risk. Evaluation of IC, however, encounters various problems. One key element of a knowledgeable decision is an analysis based on the disclosed risks. ⋯ The general principles of memory apply and have implications in states of emotional arousal. Whereas education and age, unlike in previous reports, did not appear to influence recall, thus indicating that we had succeeded in tailoring IC to the individual, recall rate was low in most cases. Physicians should highlight the discrepancy and conflict between the requirements for the defence of medical practice in the law courts and the actual interests of patients. They should promote research to establish what really is 'appropriately informed consent'.
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Acta neurochirurgica · Jan 2000
Spinal subdural and epidural haematomas: diagnostic and therapeutic aspects in acute and subacute cases.
The diagnosis of spontaneous spinal haematomas mainly depends on magnetic resonance imaging. This study evaluates the MRI characteristics of spinal epidural and subdural haematomas. The results were correlated with medical history, coagulation abnormalities and therapeutic outcome to provide guidelines for early diagnosis and treatment of spinal epidural and subdural hematomas. ⋯ Spontaneous spinal hematomas are frequently located in the thoracic spine. Subdural spinal haemorrhage is more frequent than epidural. Epidural haemorrhage is frequently located dorsal to the spinal cord because of the tight fixation of the dura to the vertebral bodies.
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Acta neurochirurgica · Jan 2000
Percutaneous controlled radiofrequency rhizotomy in the management of patients with trigeminal neuralgia due to multiple sclerosis.
Between the years 1974 and 1999, 1,672 patients with medically intractable trigeminal neuralgia (TN) were treated by percutaneous controlled radiofrequency (RF) rhizotomy by the senior author and co-workers at the Department of Neurosurgery, Ankara University School of Medicine. Sixteen hundred cases (95.7%) were found to have idiopathic TN, while 72 cases (4.3%) were classified as symptomatic. In the latter group, TN was found to be caused by multiple sclerosis (MS) in 17 cases (23.6%), one of whom had bilateral TN. ⋯ All 17 patients (100%) were classified to have done well with RF rhizotomy. Satisfactory results and good long-term pain control were obtained in patients having TN due to MS with percutaneous controlled RF rhizotomy. The authors propose that RF rhizotomy may be a safe and effective procedure in the neurosurgical armamentarium for the treatment of patients having TN due to MS.
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Acta neurochirurgica · Jan 2000
Comparative StudySystemic and cerebral haemodynamics during craniotomy under mild hypothermia in patients with acute subarachnoid haemorrhage.
Mild hypothermia provides cerebral protection against ischaemic insults in various animal models. We compared systemic and cerebral oxygenation between mild hypothermic and normothermic management in 60 patients with acute subarachnoid haemorrhage who underwent clipping of cerebral aneurysms. ⋯ The balance between oxygen supply and demand systemically and in the brain may worsen during aneurysm surgery for patients with acute subarachnoid haemorrhage under mild hypothermia. Oxygenation of the brain and the whole body should be monitored closely during this surgery, and adequate circulatory assistance is recommended under mild hypothermia.
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Acta neurochirurgica · Jan 2000
Lumbar intervertebral disc herniation following experimental intradiscal pressure increase.
An experimental biomechanical model of overload and rupture of the annulus fibrosus (AF) and lumbar disc herniation was achieved by increasing intradiscal pressure while keeping disc height constant in 69 motion segments at the L4-L5 level excised from cadaveric spines. The experiments were made on 53 specimens in neutral posture and on 16 specimens in flexion posture. ⋯ The herniated lumbar intervertebral disc model by intradiscal pressure increase makes possible these assertions: * The correlation between the degree of AF degeneration and the RIP is significant: the maximum RIP corresponds to a non-degenerated AF and the less RIP can tear only a degenerated AF; so disc herniation only occurs to discs with torn AF. * AF breaking is more often paramedian, left or right. The place of AF breaking was paramedian in 70.3% cases, median in 9.45% cases and posterolateral in 20.25% cases.