Acta neurochirurgica
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Acta neurochirurgica · Jan 1995
Comparative StudyBedside measurement of the third ventricle's diameter during episodes of arising intracranial pressure after head trauma. Using transcranial real-time sonography for a non-invasive examination of intracranial compensation mechanisms.
Using transcranial real-time sonography, changes in the axial diameter of the third ventricle during manoeuvres, which increased intracranial pressure (ICP), were measured in 28 patients with moderate to severe head injury. The measurements were correlated with ICP measured by epidural pressure monitoring. ⋯ We interpret that poor outcome as a measurable inability for the brain to expel cerebrospinal fluid into extracerebral compartments during increased ICP. Transcranial real-time sonography may provide additional information about intracranial cerebral fluid dynamics and compliance.
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Acta neurochirurgica · Jan 1995
Case ReportsPeri-operative complications in adult moyamoya disease.
The incidence and causes of peri-operative haemodynamic complications in adult Moyamoya disease were examined by reviewing 55 surgically treated adult patients. Ninety-nine craniotomies were performed in these patients, and eight peri-operative complications (four infarctions, two haemorrhagic infarctions and two reversible ischaemic neurological deficits without a new lesion) were seen. ⋯ Surgical factors which might be responsible for the complications were noted in three cases. Sparing vital collateral vessels and minimum brain retraction as well as avoidance of non-surgical haemodynamic risk factors are considered to be essential to prevent peri-operative haemodynamic brain damage in adult Moyamoya disease.
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Nine cases of posttraumatic primary brain stem haematoma are described. All cases presented ocular and vegetative symptoms. Hyperextension was regarded as the most likely mechanism of injury. All patients were treated conservatively; half of them with a good outcome.
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Acta neurochirurgica · Jan 1995
Percutaneous jugular placement of ventriculo-atrial shunts using a split sheath. Technical note.
The percutaneous placement of ventriculo-atrial (V-A) shunts for treatment of hydrocephalus has been previously reported by several authors as a simplified procedure. However, this technique did not avoid the use of a distal connector between the outlet catheter and the atrial one, which may lead to a disconnection. A technique of percutaneous V-A shunt insertion using a split sheath is described and illustrated with a series of 22 patients. ⋯ All the patients' clinical conditions improved. We are encouraged to use this V-A technique more frequently as a method of choice in the treatment of adult hydrocephalus or when the peritoneal cavity is inaccessible in children. The use of a split sheath is successful in reducing the operating time and avoiding the use of a distal connector.
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Acta neurochirurgica · Jan 1995
CT and clinical criteria for conservative treatment of supratentorial traumatic intracerebral haematomas.
In search of guidelines for the management of traumatic intracerebral haematomas (TICHs) with slight mass effects on computed tomography (CT) scans, the author reviewed the records of 29 patients who did not undergo surgery and 11 patients who did. It is found that patients with a TICH volume of less than 15 ml, a midline shift of less than 5 mm, an open perimesencephalic cistern on CT scans, a Glasgow Coma Scale (GCS) score of 12 or more, and an absence of lateralizing signs may be treated conservatively and expected to make a good recovery. On the other hand, with zero mortality and satisfactory outcomes, the patients under-going early surgery tended to have a TICH volume of more than 15 ml, a midline shift of more than 5 mm, an obliterated perimesencephalic cistern on CT scans, a GCS score of less than 12, and the presence of lateralizing signs. However, the position of such features as the criteria of early operation for a TICH is weakened by the retrospective nature of this study because some surgical patients, free of lateralizing signs in particular, might have managed to do well without craniotomy.