British journal of neurosurgery
-
Randomized Controlled Trial
Effects of fluid therapy following aneurysmal subarachnoid haemorrhage: a prospective clinical study.
Blood transfusions and intravenous fluids are commonly employed as rescue therapy for delayed cerebral ischaemia following aneurysmal subarachnoid haemorrhage (aSAH). We sought to determine effects of various fluid supplements on clinical outcome in patients following aSAH. Clinical events and laboratory data of 160 aSAH patients were prospectively collected as part of 2 randomised controlled trials. ⋯ Colloid fluids (OR 2.53/L/day, p = 0.025) promoted unfavourable outcome at 6 months (OR 4.45, p = 0.035), while crystalloids decreased unfavourable outcome (OR 0.27/L/day, p = 0.005). Associations between synthetic colloids and crystalloids with GOS at 6 months were dose-related. Intravenous fluid therapy using synthetic colloids or blood transfusions may be associated with increased unfavourable outcome following aSAH.
-
Multicenter Study
Epidemiology of ventriculostomy in the United States from 1997 to 2001.
Ventriculostomy is a common practice in neurosurgery, but the annual trend of this procedure in the United States has not been reported in the literature. This study evaluates the annual trend during a recent 5-year period. Between 1997 and 2001, a retrospective review was undertaken concerning all patients in the Nationwide Inpatient Sample (NIS) who had undergone ventriculostomy. ⋯ Patient and hospital demographic characteristics were consistent during the study period. By extrapolation of the data, the prevalence of ventriculostomy in the United States averaged 24,380 per year. This study is the first to comprehensively document data concerning the epidemiology of this common procedure.
-
Spontaneous intracranial hypotension (SIH) is an uncommon clinical entity that is often diagnosed after a delay, or it is misdiagnosed due to the variety of clinical presentations and the associated radiological findings. We present here a case of SIH associated with chronic subdural haematoma (SDH) and subarachnoid haemorrhage. Following the diagnosis of the SIH, the patient underwent injection of an epidural blood patch for the SIH and burr hole trephination was done for treating the chronic subdural haematoma.
-
Chronic subdural haematoma (cSDH) is one of the most frequent neurosurgical entities. Current treatment options include burr hole craniostomy, twist drill craniostomy or craniotomy. While burr hole craniostomy is the most often used technique, there are no studies analysing the use of one vs. two burr holes in respect to recurrence rates and complications. ⋯ Patients with one burr hole had a statistically significant (p < 0.05) higher recurrence rate (29 vs. 5%), longer average hospitalization length (11 vs. 9 days) and higher wound infection rate (9% vs. 0%). A multivariate regression analysis identified the number of holes as single predictor for postoperative recurrence rate (r(2) = 0.12; p < 0.001). In this study, the treatment of cSDH with one burr hole only is associated with a significantly higher postoperative recurrence rate, longer hospitalization length and higher wound infection rate.
-
The primary aim of this study was to assess whether there exists a relationship between lumbar cerebrospinal fluid (CSF) pressure and intracranial blood flow velocities as measured by transcranial Doppler sonography (TCD) in children with scaphocephaly. Another aim was to compare pre- and postoperative TCD. Using a transducer, lumbar CSF pressure (LP) was assessed in 21 children with scaphocephaly. ⋯ There was no association between LP and PI and RI indices. In children with scaphocephaly a higher LP can be expected with age. Moreover, TCD is not a reliable tool in predicting abnormal LP values.