Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2011
Case ReportsFeasibility of intraoperative MRI guidance for craniotomy and tumor resection in the semisitting position.
Intraoperative magnetic resonance imaging (iMRI) has emerged as a reliable and useful tool in intracranial brain tumor surgery. Patient placement in a semisitting position may be advantageous in certain cases, but has so far seemed incompatible with conductance of iMRI-guided procedures. ⋯ The iMRI-guided brain tumor resection is feasible in combination with semisitting patient positioning. However, special safety precautions must be followed.
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J Neurosurg Anesthesiol · Jul 2011
Assembly of a multichannel video system to simultaneously record cerebral emboli with cerebral imaging.
Stroke remains a significant risk of carotid revascularization for atherosclerotic disease. Emboli generated at the time of treatment either using endarterectomy or stent-angioplasty may progress with blood flow and lodge in brain arteries. Recently, the use of protection devices to trap emboli created at the time of revascularization has helped to establish a role for stent-supported angioplasty compared with endarterectomy. ⋯ A significant challenge in assessing the efficacy of these devices is precisely determining when emboli are dislodged in real time. To address this challenge, we devised a method of simultaneously recording fluoroscopic images, transcranial Doppler data, vital signs, and digital video of the patient/physician. This method permits accurate causative analysis and allows procedural events to be precisely correlated to embolic events in real time.
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J Neurosurg Anesthesiol · Jul 2011
Effect of autologous blood transfusion on cerebral cytokine expression.
Autologous blood transfusion (ABT), for example, by means of cell saver equipment, is used to reduce the need for allogenic blood transfusion in patients with high perioperative blood loss. This study investigated the effect of blood/extracorporal surface interaction during withdrawal and retransfusion of shed autologous blood on cerebral inflammation in rats. Rats subjected to hypotension with cerebral ischemia served as positive controls. ⋯ ABT by itself did not provoke an inflammatory reaction in the healthy brain. However, in combination with cerebral ischemia the induction of a broad spectrum of inflammatory parameters indicates an inflammatory reaction of the hippocampus beginning after 6 hours and being most pronounced after 24 hours. Therefore, this study shows that cerebral inflammation is not induced by ABT after contact with extracorporal surfaces in rats.
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J Neurosurg Anesthesiol · Jul 2011
ReviewPRO: the "Lund concept" for treatment of patients with severe traumatic brain injury.
Two different main concepts for the treatment of severe traumatic brain injury have been established during the last 15 years, namely the more conventional concept recommended in well-established guidelines (eg, the US Guideline, European Guideline, Addelbrook's Guideline from Cambridge) on the one hand, and the Lund concept from the University Hospital of Lund, Sweden on the other. Owing to the lack of well-controlled randomized outcome studies comparing these 2 main therapeutic approaches, we cannot conclude that one is better than the other. This study is the PRO part in a PRO-CON debate on the Lund concept in the present journal. ⋯ Although conventional guidelines are restricted to clinical data from meta-analytic surveys, the physiological approach of the Lund therapy finds support in both experimental and clinical studies. It offers a wider base and can also give recommendations regarding fluid therapy, lung protection, optimal hemoglobin concentration, temperature control, the use of decompressive craniotomy, and ventricular drainage. This study puts forward arguments in support of the Lund therapy.