Clinical neurology and neurosurgery
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This anatomic study describes how to optimize the use of the endoscope in the cerebellar pontine angle (CPA) through a retrosigmoid approach. Unlike the microscope, that only permits visualization of structures directly ahead, the endoscope can see 'around the corner', also showing the structures down narrow. Nevertheless, to use the endoscope it is necessary to insert it into the CPA that is full of neurovascular structures which limit its movements. ⋯ The limits of view offered by each trajectory as well as the neurovascular structures together with the obstacles encountered on each route have been described. The systematic adoption of three different endoscope trajectories at the CPA level permits to view from different angulation the same structure as well as its relationships with the surrounding nerves and vessels. Considerable experience on cadavers should have already been obtained with the endoscope prior to any application in the operating room.
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Clin Neurol Neurosurg · Sep 2002
Clinical TrialMild hypothermia therapy for patients with severe brain injury.
The authors present a group of patients with severe head injuries in which deliberate mild hypothermia was carried out together with the standard treatment protocol according to the European Brain Injury Consortium. Thirty patients with severe head injuries with Glasgow Coma Scale (GCS) score of 3-8 were enrolled into the study. The subjects were divided into two groups. ⋯ Mean normothermia CPP value of 72+/-3 mmHg significantly increased (P value 0.0007) during this time to 80+/-4 mmHg with unchanged systolic arterial pressure (P value 0.9013). There were no cardiac or coagulopathy-related complications. Our results showed that mild therapeutic hypothermia could be useful in improving the outcome and neurological recovery in patients with severe head injuries.