Acta neurochirurgica
-
Acta neurochirurgica · Jan 1997
ReviewPrognostic factors in severely head injured adult patients with acute subdural haematoma's.
A medline search back to 1975 was undertaken to identify relevant papers published on subdural haematomas. The search was restricted, whenever possible, to adult age and comatose patients. Forty relevant reports were identified. ⋯ In terms of prognosis, the following parameters were found to be significant: age, time from injury to treatment, presence of pupillary abnormalities, GCS/motor score on admission, immediate coma or lucid interval, CT findings (haematoma volume, degree of midline shift, associated intradural lesion, compression of basal cisterns), post-operative ICP and the type of surgery. Improving the outcome of patients with acute subdural haematoma's is a difficult task. A small subpopulation of patients may have a benign course without surgical haematoma evacuation, but all comatose patients with an acute subdural haematoma should be treated in Centers where neurosurgical facilities and appropriate monitoring are available.
-
Acta neurochirurgica · Jan 1997
Comparative StudyComparison of serial S-100 and NSE serum measurements after severe head injury.
We investigated the time course of neuron specific enolase (NSE) and S-100 protein after severe head injury in correlation to outcome. We included 30 patients (GCS < 9), who had been admitted within 5 hours after injury, in a prospective study. Blood samples were taken on admission, 6, 12, and 24 hours and every 24 hours up to the fifth day after injury. ⋯ Four patients with increasing intracranial pressure showed a quick increasing concentration of NSE, in two patients the S-100 level showed a slower rise. The NSE serum levels did not correlate with intracranial pressure values. Our results show that the first serum concentration of S-100 seems to be predictive for outcome after severe head injury.
-
Acta neurochirurgica · Jan 1997
Comparative StudyPeriradicular therapy in lumbar radicular syndromes: methodology and results.
Periradicular therapy (PRT) has become popular in the treatment of lumbar radicular complaints, both primary, due to disc herniations (Group 1), and postoperative, following disc surgery (Group 2). However, hitherto reported data on 'periradicular injections' are more of a technical nature. The present study was designed to evaluate the therapeutic success of CT- versus fluoroscope-guided periradicular injections of local anaesthetics and corticoids, and to investigate the impact of imaging procedures on the results. ⋯ Long-term follow-up shows that there is no positive effect in those patients in whom the first two PRT attempts had failed. Thus, PRT represents a useful long-term therapeutic alternative for lumbar radicular syndromes, particularly when due to primary discogenic compression. CT-guided injection is superior to fluoroscope-assisted treatment for both its visualization and its longer-lasting effect.
-
Acta neurochirurgica · Jan 1997
Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part II: Clinical experiences.
The surgical aim in the treatment of symptomatic lumbar spinal stenosis is the relief of the patient's complaints by an adequate neural decompression. Unilateral laminotomy and bilateral spinal canal decompression represents such a safe, effective and minimally invasive surgical method. This technique has been successfully used in the operative treatment of 29 patients with symptomatic mono- or multisegmental lumbar stenosis. ⋯ Postoperatively, 25 of the 27 patients with neurogenic claudication (93%) demonstrated a marked improvement of the walking distance. The follow-up of 25 patients (mean follow-up time was 18 months) demonstrated an excellent result without pain in 7 patients (28%); a good outcome with mild residual pain, but a normal working capacity in 15 patients (60%); and a fair outcome with unchanged postoperative low-back pain but markedly improved working capacity and walking distance in 3 patients (12%). Postoperative morphometric evaluation as well as the clinical improvement of the patient's symptoms clearly demonstrated that bilateral ligamentectomy and recess decompression were adequately and successfully achieved via unilateral approach.
-
Acta neurochirurgica · Jan 1997
Comparison of changes in cerebral blood flow and cerebral oxygen saturation measured by near infrared spectroscopy (NIRS) after acetazolamide.
The present study compares the change of cerebral blood flow and HbO2 measured by near-infrared spectroscopy (NIRS) after administration of 1000 mg acetazolamide intravenously. CBF studies in 21 patients with ischaemic cerebrovascular disease were performed routinely with the 133Xenon technique. Additionally the local HbO2 was recorded by NIRS. ⋯ Assuming a threshold value of normal CBF reactivity of 30% and 4% HbO2 reactivity we found for NIRS a sensitivity of 0.88 and a specificity of 0.75. The results demonstrate that changes of CBF can be detected with NIRS and the algorithm of the used monitor is able to calculate the intracranial part of the signal. So, NIRS can be used as non-invasive screening method to test the cerebrovascular reserve capacity.