Acta neurochirurgica
-
Acta neurochirurgica · Jan 1987
Percutaneous radiofrequency facet denervation in low-back and extremity pain.
The present series includes 47 patients (35 females 12 males) with an average observation time of 8 months after percutaneous lumbar facet denervation by radiofrequency electrocoagulation. All patients had static and kinetic lumbar pain; 90% of them had pain radiating into the legs. ⋯ Eight of the remaining 25 patients had satisfactory relief of pain at follow-up. The failures included all patients with previous multiple lumbar operations except for three.
-
Acta neurochirurgica · Jan 1987
Resistance to cerebrospinal fluid outflow and intracranial pressure in patients with hydrocephalus after subarachnoid haemorrhage.
Resistance to CSF-outflow (Rout) and intracranial pressure (ICP) were measured in 33 patients with hydrocephalus after subarachnoid haemorrhage (SAH). Eleven patients examined between 10 to 30 days after SAH had high pressure hydrocephalus (HPH). Twenty-two patients had normal pressure hydrocephalus (NPH). ⋯ Thus, early development of hydrocephalus after subarachnoid haemorrhage is associated with a high Rout and a high ICP, whereas late (more than one month) hydrocephalus may be associated with normal ICP and high Rout. Patients with NPH and a high Rout have frequent B-waves and should be shunted. Patients with a long interval from subarachnoid haemorrhage to the diagnosis of hydrocephalus often have a normal ICP, low frequency of B-waves, normal CSF-dynamics and need no shunting.
-
Coagulation disorders following acute head injury were investigated in 100 patients: 81 patients survived and 19 patients died. Disseminated intravascular coagulation (DIC) was seen in 24%, and occurred most frequently in acute subdural haematoma, followed by contusional haematoma and contusion. ⋯ Level of serum fibrin-fibrinogen degradation product (FDP) was correlated with the amount of damaged tissue. The factors which influenced the prognosis for life were evaluated by multivariate analysis: in 100 patients, activated partial thromboplastin time (APTT) was most closely correlated with the prognosis for life, but in 24 patients with DIC, level of serum fibrinogen was most closely correlated with it.
-
Acta neurochirurgica · Jan 1987
Evaluation of the calcium-antagonist nimodipine for the prevention of vasospasm after aneurysmal subarachnoid haemorrhage. A prospective transcranial Doppler ultrasound study.
70 consecutive patients admitted within four days after the first aneurysmal subarachnoid haemorrhage (SAH) were evaluated by daily transcranial Doppler ultrasound (TCD) measurement of the blood flow velocities (BFVs) of both middle cerebral arteries (MCAs) and by daily recordings of their clinical grade (Hunt and Hess). Patients with no or only little subarachnoid blood in the first CT after admission were classified as low-risk for the development of symptomatic vasospasm (VSP), and patients with big subarachnoid clots or thick layers of subarachnoid blood were graded as high-risk patients for symptomatic VSP. The first series of 33 patients received no nimodipine whereas the second series of 37 patients were treated with nimodipine 2 mg/h intravenously, starting within 24 hours after the SAH in the majority of patients. 7-14 days postoperatively, the intravenous dose was changed to oral nimodipine 60 mg/q4h for one week and then discontinued. ⋯ Nimodipine given within four days after the SAH did not prevent vasospasm evaluated by TCD, but it significantly reduced the severity of the vasoconstriction, especially in high-risk patients. It reduced significantly the incidence of DIND in high-risk patients and improved their functional outcome. Although nimodipine may have a reduced efficacy in preventing vasospasm after early operation of high-risk patients, it probably protects the brain by increasing its tolerance to focal ischaemia.
-
Acta neurochirurgica · Jan 1987
Stereotactic excision of deep brain lesions using probe guided brain retractor.
A probe guided brain retractor is described. The capability of it being guided by a probe allows it to be used for stereotactic excision of deep brain lesions. It can also be used with the ultrasound guided probe. Method of use with the stereotactic probe and early surgical experience is presented.