Acta neurochirurgica
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Acta neurochirurgica · Jan 1998
Clinical analysis of internal carotid artery aneurysms with reference to classification and clipping techniques.
An intraoperative classification of intradural internal carotid artery (ICA) aneurysms not related to the arterial division but based on their operative presentation and clipping techniques is introduced. On the basis of the surgeon's view of the operative field via the pterional approach in 156 operated intradural ICA aneurysms in 143 patients, these aneurysms were classified according to their location in relation to the long axis of the ICA as either proximal, middle or distal in type and also according to their relation to the cross section of the ICA as either lateral, medial, ventral or dorsal in type. Numerically the largest in frequency is the middle type of aneurysm by axial location and the lateral type of aneurysms by cross sectional location. ⋯ Furthermore, the forward clipping was useful for proximal type aneurysms and the reversed clipping for distal type aneurysms. For the middle type aneurysms clipping was performed bidirectionally. This classification includes all types of the ICA aneurysms located at any points along its long axis and on its cross section, and is useful for planning safe and exact clipping of the ICA aneurysms.
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Monitoring of comatose patients in the neurosurgical intensive care unit (NICU) is constantly extended by the development of new methods for monitoring of cerebral function, metabolism and oxygenation. To simplify the interpretation of the rising number of parameters, and to avoid data overflow, a multimodal cerebral monitoring (MCM) system has been developed for the acquisition, display, on-line analysis and recording of physiological parameters from multiple bedside data sources. This article describes the technical details and the design of this computerized data acquisition system for variable applications in clinical patient monitoring and research. ⋯ The MCM system has become a valuable tool for monitoring of comatose patients. The simultaneous display of trend graphs of various monitoring parameters and the online processing of histograms improved the survey of the patient's condition in the ICU. Recorded data were analysed offline and contribute to a consecutively increasing data bank.
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Acta neurochirurgica · Jan 1998
Transverse microincisions of the outer layer of the dura mater combined with foramen magnum decompression as treatment for syringomyelia with Chiari I malformation.
Numerous surgical procedures have been proposed for treatment of syringomyelia associated with Chiari I malformation, but the optimal treatment has not yet been uniformly standardised. The main aim of the surgical treatment of syringomyelia/Chiari I complex is directed toward restoration of physiological cerebrospinal fluid dynamic at the craniovertebral junction. ⋯ Postoperative Magnetic Resonance showed a decrease in size of the syrinx in seven patients. These results suggest that foramen magnum decompression combined with transverse microincisions of the outer layer of the dura 1) is an effective and safe treatment option for syringomyelia and Chiari I malformation, 2) corrects the circulatory disturbances of cerebrospinal fluid dynamic, 3) leads to a decrease in size of the syrinx and to a significant improvement in neurological signs and symptoms, 4) avoids complications of intradural approaches and syringosubarachnoid shunting.
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Acta neurochirurgica · Jan 1998
Four-year experience with the routine use of the programmable Hakim valve in the management of children with hydrocephalus.
Cerebrospinal fluid (CSF) over- and underdrainage symptoms are frequent sequelae of shunt placement in patients with hydrocephalus, sometimes requiring repeated operations. To achieve more adequate CSF drainage, the non-invasively programmable Hakim valve has been developed. Because the clinical experiences with this valve so far are confined to adults, we describe our experiences with the routine use of the programmable Hakim valve in childhood hydrocephalus. ⋯ In the majority of cases, the programmable Hakim valve allows the successful management of symptoms related to CSF over- and underdrainage by non-invasive change of the initial pressure setting of the valve. Therefore, the programmable Hakim valve should be considered as an alternative to non-programmable valves of advanced design.
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Sometimes charring or popping occurs and the bipolar blades get stuck to the vessel. ⋯ Experience with this instrument was still quite limited, but preliminary results were promising.