Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Multicenter Study
Stroke in Indonesia: a first large prospective hospital-based study of acute stroke in 28 hospitals in Indonesia.
Stroke is an increasing cause of morbidity and mortality in Indonesia. Data on clinical patterns of hospitalized Indonesian stroke patients are still not available. This study is a part of ASNA (ASEAN Neurological Association) Stroke Epidemiological Stu dy aimed to investigate clinical profile of stroke in seven ASEAN countries with the same protocol. ⋯ The most common risk factors were hypertension, heart disease, cigarette smoking and diabetes mellitus. Recurrent stroke was found in nearly 20% of patients. Ischemic stroke was the most frequent and the majority of the study subjects were discharged alive and improved.
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The pathophysiology of sinus vein thrombosis (SVT) is still controversial in patients and experimental animals, the microcirculatory alterations in particular. This study was designed to develop a new sinus vein thrombosis model and to further elucidate pathophysiological events such as the relationship between local and regional cerebral blood flow and haemoglobin oxygen saturation (HbSO2), changes of the microvasculature, leukocyte behaviour and brain tissue damage. ⋯ Microcirculatory alterations and brain tissue damage from SVT in the Mongolian gerbil depend on the SSS occlusion site. The newly established mongolian gerbil sinus-vein thrombosis model has advantages compared to previously reported sinus-vein thrombosis models such as easy handling, easy technique, highly reproducibility, and good observation of microcirculatory event. The model allows for studies of cerebral low-flow conditions such as expected to occur in an ischaemic penumbra zone.
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Clinical Trial
Intraoperative wake-up procedure with propofol and laryngeal mask for optimal excision of brain tumour in eloquent areas.
This is the first thesis describing a new technique for awake craniotomy using a laryngeal mask. Awake craniotomy with propofol infusion has become increasingly popular for the optimal excision of brain tumours located in eloquent areas. During awake craniotomy, tracheal intubation is not performed and propofol infusion is limited to within doses which render the patient just sedated. ⋯ Following completion of the tumour excision, general anaesthesia is re-induced at a sufficient dose of propofol. The laryngeal mask can be temporarily removed and repositioned with ease, if necessary. In our experience, this technique is applicable for the optimal excision of brain tumours, especially in patients who are very obese or those who have very large lesions.
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Seven patients with schwannomas of the jugular foramen were included our study in Samsung Medical Center between 1995 and 1999. Patients with neurofibromatosis were excluded. The records of the seven patients (six surgical case and one nonsurgical case) were retrospectively reviewed. ⋯ Persistent cerebrospinal fluid collection was improved with lumboperitoneal shunt. The surgical approaches of each case should be tailored according to their shape and the clinical manifestation. We obtain acceptable outcomes from one-stage operation.
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Surgery of meningiomas involving dural sinuses leaves the surgeon confronted with a dilemma: leave the fragment invading the sinus and have a higher risk of recurrence, or attempt a total removal with or without venous reconstruction and expose the patient to a potentially greater operative danger. The authors report a series of 80 meningiomas (72 of the sagittal sinus, 5 of the transverse sinus and 3 of the torcular) in whom gross total removal was achieved in all but 7 cases (i.e., 91%), and venous reconstruction attempted in a majority. In total, 70 patients (87.5%) had a good outcome and resumed their previous activities. ⋯ Three patients (3.6%) died from brain swelling; all with meningioma totally occluding the sinus and in whom resection was achieved without sinus reconstruction. There were two recurrences (2.5%) in this series which has a mean follow-up of 8.5 years. The conclusion is to favour, whenever possible, total removal with sinus reconstruction, using a patch for meningiomas with partial sinus invasion and a venous bypass for those with total sinus occlusion.