British journal of neurosurgery
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A prospective study on four groups of children undergoing a craniotomy over a 6-month period was carried out in order to assess the incidence of complications. All complications were graded according to their severity and the requirement for extra general anaesthetics also recorded. From this information it is possible to calculate the resource implications of craniotomy-related complications in a paediatric neurosurgical unit, as well as point to those areas of clinical practice where improvements in technique are most needed.
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Percutaneous spinal cord stimulation (SCS) (Medtronic model 3487A PISCES-Quad lead) was carried out in 10 patients with rest pain from advanced peripheral vascular disease of the lower limb, who were unsuitable for conventional treatment. Trial stimulation ranged from 1-20 weeks and was associated with pain relief in nine of the patients. Claudication distance was improved in six patients. ⋯ Pain relief was not dependent on circulatory changes, but it was more significant when the circulatory changes showed an impressive increase in the blood flow. The mechanism of these circulatory changes is probably by modulation of the sympathetic nervous system. Recognition of the optimal sitting of SCS may be critical in the clinical use of this technique, which seems to be a valuable option in the treatment of patients with advanced peripheral vascular disease (PVD).
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A patient with basilar artery rupture caused by a septic embolus originating from a mitral valve vegetation is reported. The pathogenesis, investigation and management of infected cerebral aneurysms are reviewed.
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Review Case Reports
Multiple postoperative intracerebral haematomas remote from the site of craniotomy.
A postoperative haemorrhage is a common and serious complication of a neurosurgical procedure. It usually occurs at the site of the surgery, but on occasion a postoperative haematoma is found at a distance from the previous craniotomy. Multiple postoperative haemorrhages are extremely rare. We report the case of a 63-year-old woman, operated on for the removal of a supratentorial astrocytoma, who developed in the early post-operative period multiple bilateral intracerebral haematomas without involvement of the surgical bed.
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We carried out a prospective study on patients admitted to busy neurosurgical units in Karachi and Quetta with penetrating craniocerebral injuries. Of the 100 patients, 52 died and 48 survived in spite of aggressive surgical management. ⋯ A review of current literature on pathophysiology and management is included and the importance of prehospital optimum care, and early transfer to the neurosurgical centre are emphasized. Since only two of the 35 patients with a GCS of less than five survived, with severe disabilities, utilizing resources in third world countries on the management of craniocerebral penetrating injuries in patients with a GCS less than 5 is questioned especially when organ donation is not possible.