Journal of neurosurgery
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Journal of neurosurgery · Jun 2000
Seven years of clinical experience with the programmable Codman Hakim valve: a retrospective study of 583 patients.
The goal of this study was to assess the value of the Codman Hakim programmable valve to settings in the range of 30 to 200 mm H2O. This valve can be adjusted noninvasively for cerebrospinal fluid (CSF) drainage. ⋯ Because one cannot know in advance which case will turn out to be complicated, the authors' preference is to use the Codman Hakim programmable valve for all conditions in which CSF should be drained.
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Journal of neurosurgery · Jun 2000
Comparative StudyHydrocephalus: comparison of clipping and embolization in aneurysm treatment.
In this retrospective study conducted at Atkinson Morley's Hospital and Middlesbrough General Hospital, the authors analyzed 100 matched patients who had suffered subarachnoid hemorrhage (SAH) to determine whether the technical procedure by which aneurysms are treated affects the development of chronic hydrocephalus. ⋯ The technical procedure used to treat aneurysms, whether clipping or embolization, does not significantly affect the development of chronic hydrocephalus. However, a larger sample of patients is needed for accurate comparisons and stronger conclusions.
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Journal of neurosurgery · Jun 2000
Intracerebral steal phenomenon associated with global hyperemia in moyamoya disease during revascularization surgery.
The collateral vessels in moyamoya disease appear to retain their ability to constrict during hypocapnia but not to dilate during hypercapnia. It has been claimed that hypercapnia, as well as hypocapnia, decreases the blood flow in regions perfused by collateral vessels, presumably because of intracerebral steal. If this holds true, the decrease in blood flow may be proportional to the global hyperemia in the brain. To establish appropriate hemodynamic control during revascularization surgery, the authors monitored the jugular bulb oxygen saturation (SjO2) intraoperatively, a method that could sensitively detect global hyperemia. ⋯ The observed association between a fall in rCBF and global hyperemia supports the intracerebral steal hypothesis and indicates that it is prudent to avoid excessive global hyperemia. The optimal range of CO2 for isoflurane is more restricted than that for propofol, presumably because isoflurane induces hyperemia by itself. Monitoring of SjO2 appears to represent the most practical technique for detecting global hyperemia as well as global ischemia, both of which may cause ischemic complications in moyamoya disease.
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Journal of neurosurgery · Jun 2000
Repeated radiosurgery for incompletely obliterated arteriovenous malformations.
The goal of this study was to define treatment results of repeated arteriovenous malformation (AVM) radiosurgery, namely AVM obliteration and complications. ⋯ When necessary, repeated AVM radiosurgery achieves obliteration with an acceptable risk. Despite the effects of previous irradiation, repeated radiosurgery required similar or slightly higher radiation doses to achieve the same in-field obliteration rates as those needed to obliterate an AVM that had not been treated by radiation previously.
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The increased use of computerized tomography (CT) and magnetic resonance (MR) technology has led to an increase in the detection of asymptomatic meningiomas, although the surgical indication for these tumors remains undetermined. The authors investigated the incidence of asymptomatic meningiomas and their clinical features. ⋯ Among patients older than age 70 years who underwent operation for asymptomatic meningioma, the neurological morbidity rate was 23.3%; it was 3.5% among younger patients. This indicates that the advisability of surgery in elderly patients with asymptomatic meningiomas must be considered very carefully.