Acta neurochirurgica
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Acta neurochirurgica · Jan 1997
Changes in transcranial Doppler flow velocity waveform following inhibition of nitric oxide synthesis. Experimental study in anaesthetised rabbits.
Analysis of the transcranial Doppler blood flow velocity (FV) waveform is used clinically to detect changes in cerebral haemodynamic profile. Such changes may be initiated both by alterations in microvascular resistance and in the tone of the cerebral arteries. ⋯ A gradual decrease in cortical microcirculation preceded by a rapid reaction recorded in the TCD waveform implies that an increase in the tone of the great cerebral arteries is the predominant phenomenon seen during the acute phase of NO synthase inhibition.
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Acta neurochirurgica · Jan 1996
Case ReportsManagement of subarachnoid fluid collection in infants based on a long-term follow-up study.
We report the natural history and management of subarachnoid fluid collections in infants and their management based on a longterm follow-up study in 20 cases. These subarachnoid fluid collections were resolved spontaneously in 17 of 20 patients and only 3 by surgical intervention at the age of 2. In our 20 patients the natural history of subarachnoid fluid collection in infants was benign unless the patients sustained head trauma. ⋯ Head trauma may precipitate subdural haematoma in patients with subarachnoid fluid collection. All patients except one who underwent the placement of subdural-peritoneal shunt, attained normal psychomotor development in time. During the follow-up period of 3 to 10 years after resolution of the fluid collection, no patient has had a recurrence once it resolved.
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Acta neurochirurgica · Jan 1996
A critical assessment of clinical diagnosis of disc herniation in patients with monoradicular sciatica.
The diagnostic power or clinical parameters in the diagnosis of lumbar disc herniation in patients with monoradicular pain was evaluated in a prospective study with a 100% verification of the diagnosis. Eighty patients with monoradicular pain corresponding to the fifth lumbar or the first sacral nerve root were included. Pre-operatively a number of clinical parameters were recorded and compared to the intra-operative finding of a disc herniation. ⋯ The level of the disc herniation was correctly predicted in 93% of these cases by the location of the pain alone or supplemented by neurological signs. Apart from radicularly distributed pain, all parameters in the present study and in the literature had no or low diagnostic accuracy. Thus, in patients with monoradicular sciatica further clinical parameters do not add to the diagnosis of lumbar disc herniation.
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Acta neurochirurgica · Jan 1996
Case ReportsDirect anterior fixation of odontoid fractures with a hollow spreading screw system.
Direct fixation of odontoid fractures has the advantage of preserving rotation in the atlanto-axial motion segment. Early mobilisation of patients and minor intra-operative trauma increase the value of this technique. The original screw method of Nakanishi, Magerl, and Böhler, was improved by Knöringer who designed a double-threaded screw for direct fixation of dens axis fractures. ⋯ With the HSS system, ca. 12% postoperative complications, such as slight reduction of head rotation or neck pain, were found. These results are virtually equal to the results of the double-screw technique. Since a relatively simple technical procedure is required for placement of the screw, the HSS system can be recommended in all cases of odontoid fractures suitable for direct anterior fixation.
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Acta neurochirurgica · Jan 1996
Trigeminal neurinomas. A series of 111 surgical cases from a single institution.
Neurinomas arising from the trigeminal nerve are rare (0.1-0.4% of intracranial tumours: 1-8% of all intracranial neurinomas). A series of 111 trigeminal neurinomas operated on at the Institute of Neurosurgery "N. N. ⋯ Out of the 108 patients surviving surgery, long-term follow-up (min. 13 months, max. 33 years, average 13.5 years) was available in 98 cases. 84 patients (86.7%) showed good-to excellent results, with partial trigeminal deficit as the only surgical sequela. 13 patients (11.7%) had a symptomatic recurrence following incomplete tumour removal. Second surgery, ranging from 1.4 to 9 years (average 3.8 years) following the first operation, was judged radical in 9 cases (69.2), however, the rate of complications of repeated surgery was higher than that occurring after the first operation. The advent of microsurgery, together with the introduction of the techniques of skull base surgery and of modern diagnostic imaging tools, have improved surgical results in terms of increased radicality and reduced complications.