Journal of neurosurgery
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Journal of neurosurgery · Apr 1984
ReviewSome inquiries in neuroanesthesia and neurological supportive care.
Complications of performing neurosurgery in the sitting position have been well defined, and include cardiac and respiratory effects, air embolism, and pneumocephalus. Prophylactic measures and early diagnosis allow prompt therapy with minimal residual sequelae. ⋯ Patients with cerebrovascular disorders frequently have multisystem disease, and careful preanesthetic assessment and preparation ensure a more stable intraoperative and postoperative course. Many chemical and mechanical reactions follow an ischemic hypoxic insult, but appropriate therapeutic intervention and early establishment of cardiorespiratory support measures have shown promise in improving the neurological outcome in these patients.
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The spinal canals of 11 patients with various pathological conditions, both benign and malignant, were examined intraoperatively using real-time ultrasonography. The spinal cords in eight of these patients with lesions causing cord compression were seen to oscillate rhythmically over each mass with a frequency corresponding to the patient's arterial pulsations. ⋯ Spinal cord motion, as described, has important implications for neurosurgery, since it contradicts the previously held belief that oscillations of the spinal cord or dura mater imply a "free" or noncompressed spinal cord. Furthermore, spinal cord motion may play a role in the degradation of computerized tomography images of the cord, since these movements are maximized at the areas with the most severe pathology.