Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Oct 2014
Blood pressure changes after aneurysmal subarachnoid hemorrhage and their relationship to cerebral vasospasm and clinical outcome.
Cerebral vasospasm (VS) and resulting delayed ischemic brain injury constitute the most severe secondary complication after subarachnoid hemorrhage (SAH). Identification of early clinical predictors of developing vasospasm and poor outcome has remained a major challenge in neurointensive care medicine. Aim of the present study was analyze the relevance of spontaneous changes in blood pressures and their predictive value for predicting vasospasm as well as adverse clinical outcome. ⋯ SAH leads to spontaneous and progressive elevations in mean arterial blood pressure. Vasospasm might be anticipated by identifying early elevations of mean arterial blood pressure. Finally, spontaneous elevations of mean arterial blood pressure correlate with poorer outcomes.
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Clin Neurol Neurosurg · Oct 2014
The midline suboccipital subtonsillar approach to the cerebellomedullary cistern and its structures: anatomical considerations, surgical technique and clinical application.
Lesions of the cerebellomedullary cistern lateral to the lower brainstem in an area extending from the foraminae of Luschka to the foramen magnum are rare and can be caused by various sources. There is no consensus on an ideal surgical approach. We describe the anatomical features and the surgical technique of the midline suboccipital subtonsillar (STA) approach to the cerebellomedullary cistern and its pathologies. ⋯ We recommend STA as a straightforward, easy-to-learn and therefore time-saving and safe procedure compared with other standard approaches to the cerebellomedullary cistern and its pathologies.