Neurology India
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The results of the International Subarachnoid Aneurysm Trial (ISAT) drew attention from both scientific and lay press, impacting the management of aneurysm patients significantly. In this review, the ISAT report was analyzed critically and the available literature was scrutinized stratifying the common criticisms as to the weak aspects of this study. The aim of ISAT was to compare the safety and efficacy of endovascular coiling with neurosurgical clipping for aneurysms, which were suitable for both treatments. ⋯ The outcome assessment scale, biases regarding patient selection and center participation criteria were further issues of criticism. The results of ISAT are not sufficient to provide a definitive answer as to the superiority of endovascular treatment over microsurgery, although coiling appears to produce less peri-procedural morbidity in a selected group of patients. An optimum outcome assessment should include a universally accepted scale and a detailed long-term angiographic outcome.
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Clinical Trial
Cerebral perfusion pressure management of severe diffuse head injury: effect on brain compliance and intracranial pressure.
Cerebral perfusion pressure management (CPPM) is an accepted modality of treatment of severe diffuse head injury (SDHI). However, CPPM has the potential to cause transcapillary exudation in the presence of a disrupted blood brain barrier and can lead to further increase of intracranial pressure (ICP) and worsening of compliance. ⋯ Elevating the CPP above 70mmHg does not either reduce the ICP or worsen the compliance. Monitoring changes in compliance should form an integral part of CPPM.
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The pathophysiological mechanisms and the salient features of normal perfusion pressure breakthrough (NPPB) are discussed on the basis of an operated case of arteriovenous malformation.
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Biography Historical Article
Prof. B. Ramamurthi: contributions to Indian neurosurgery (a personal tribute).