Journal of neurosurgery
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Journal of neurosurgery · Dec 1994
Effect of stable xenon inhalation on intracranial pressure during measurement of cerebral blood flow in head injury.
Xenon-enhanced computerized tomography (CT) is well suited for measurements of cerebral blood flow (CBF) in head-injured patients. Previous studies indicated divergent results on whether inhalation of xenon may cause a clinically relevant increase in intracranial pressure (ICP). The authors employed Xe-enhanced CT/CBF measurements to study the effect of 20 minutes of inhalation of 33% xenon in oxygen on ICP, cerebral perfusion pressure (CPP), and arteriovenous oxygen difference (AVDO2) in 13 patients 3 days (mean 1 to 5 days) after severe head injury (Glasgow Coma Scale score < or = 7). ⋯ Individual variations were observed indicating possible individual tolerance, possible influence of type and extent of the cerebral injury, disturbances in cerebrovascular reactivity, and possible influence of medication. These effects of xenon suggest that hyperventilation should be ensured in patients with evidence of reduced compliance or high ICP. On the other hand, inhalation of stable xenon is not believed to pose a risk because no signs of cerebral oligemia or ischemia were indicated in the AVDO2 values.
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Journal of neurosurgery · Dec 1994
Biography Historical ArticleArchival correspondence regarding the origin of the Harvey Cushing Society: the American Association of Neurological Surgeons.
Behind the scenes in the origin of the Harvey Cushing Society, now known as the American Association of Neurological Surgeons, there were many interesting political factors occurring, which appeared in correspondence and were preserved and later forwarded by William P. Van Wagenen to the Harvey Cushing Section of the Yale Medical Library. This correspondence, circa 1931, provides an interesting account of the aspirations of young neurosurgeons who wished to gain societal status, without offending the giants of the Society of Neurological Surgeons.
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Journal of neurosurgery · Dec 1994
The superior wall of the cavernous sinus: a microanatomical study.
The superior wall of the cavernous sinus was studied in 30 specimens obtained from 15 cadaver heads fixed in formalin. Trapezoidal in shape, the superior wall of cavernous sinus is limited laterally by the anterior petroclinoid ligament, medially by the dura of the diaphragma sellae, anteriorly by the endosteal dura of the carotid canal, and posteriorly by the posterior petroclinoid ligament. An interclinoid ligament bisects the wall, dividing it into two triangles: the carotid trigone anteromedially and the oculomotor trigone posterolaterally. ⋯ This clinoid segment of the artery, still extracavernous, is surrounded by two fibrous rings: a distal ring formed by fibers of the superficial dural layer and a proximal ring related to the deep dural layer. Below the proximal ring, the internal carotid artery becomes intracavernous; above the distal ring, the artery is continuous with its supraclinoid segment. The complex dural anatomy of the superior wall, its fibrous rings, and the clinoid space in relation to a superior surgical approach to the cavernous sinus are discussed.