Neurosurgery
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The sitting prone position is compared with the standard laminectomy prone position and the sitting up position for posterior fossa surgery. We measured central venous pressure and airway pressure with the patient in different positions to determine the comparative efficacy of the sitting prone position. On a linear average, the central venous pressure increased by 6.83 cm H2O and the airway pressure increased by 3.16 cm H2O when the patient was changed from the supine to the standard prone position under general anesthesia; with a change from the standard prone position to the sitting prone position, the central venous pressure decreased by 10.45 cm H2O and the airway pressure decreased by 3.66 cm H2O. However, comparing the sitting prone position for posterior fossa surgery with the sitting up position, there was no statistically significant difference in central venous or airway pressure.
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The effect of furosemide in the intraoperative reduction of intracranial pressure was measured in 25 patients undergoing the operative repair of a ruptured intracranial aneurysm. Seven patients with similar intracranial lesions served as controls. ⋯ These changes are significant at the P less than 0.005 confidence level, whereas changes in mean arterial pressure, mean arterial pCO2, and base line arterial pCO2 were statistically insignificant. This study suggests that intravenous furosemide is a quick, dependable, and effective mechanism for the intraoperative reduction of intracranial pressure in the postsubarachnoid hemorrhage aneurysm patient.
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Historical Article
Perspectives in international neurosurgery: neurosurgery in Honduras.
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The nerve allograft response between closely and distantly related inbred strains of rats was investigated. Lewis rats (RTl1) and Fischer rats (RTl1) have only minor histocompatibility differences, whereas Buffalo rats (RTlb) and ACI rats (RTla) differ from Lewis rats at the major histocompatibility locus. Lewis rats served as the recipient animals; the other three strains of rats provided donor nerves. ⋯ By contrast, with skin allografts, sensitization occurred early with all strains (Day 10), even when the animals differed only at the minor histocompatibility loci. Histological changes were similar in all three donor strains (Fischer, Buffalo, ACI). The strain of origin of the nerve could not be deduced by an unbiased examiner.
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Håkanson's treatment of trigeminal neuralgia by injecting 0.2 to 0.4 ml of glycerol into the cerebrospinal fluid in Meckel's cave was carried out in 27 patients with trigeminal neuralgia, 3 with atypical facial neuralgia, and 1 with post-traumatic facial neuralgia. Minor modifications of his technique are described based on our finding of a greater pain and sensory loss upon injection than he noted. We present evidence that glycerol is more toxic than its cryoprotectant effect would intimate and that it selectively eliminates those components of the compound action potential in the trigeminal rootlets customarily associated with pain. We conclude that the method is probably going to be an improvement over radiofrequency heating for the treatment of trigeminal neuralgia in many situations.