Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Comparative Study Clinical Trial
Comparison of craniotomy and craniectomy in patients with acute subdural haematoma.
Despite the increasing acceptance of craniectomy in patients with traumatic brain injury, the value of early decompressive craniectomy in patients with acute subdural haematoma is still under debate. In this retrospective study, we reviewed 180 patients with traumatic acute subdural haematoma, 111 of whom were treated with haematoma evacuation via craniotomy and 69 of whom were treated with early decompressive craniectomy. ⋯ Age and clinical signs of herniation were significantly associated with an unfavourable outcome, regardless of the type of surgery. Decompressive craniectomy did not seem to have a therapeutic advantage over craniotomy in traumatic acute subdural haematoma.
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Comparative Study Clinical Trial
Therapeutic hypothermia for severely head-injured patients with acute subdural haematoma.
The benefit of hypothermia therapy for severely head-injured patients has been a matter of controversy, and the appropriate indications have yet to be clarified. The authors have employed mild hypothermia to treat severe acute subdural haematoma (ASDH) patients postoperatively as a means of controlling intracranial pressure. The potential roles of hypothermia in the treatment of severe ASDH patients are discussed. ⋯ However, the benefit of hypothermia was seen only in ASDH patients without associated cerebral contusion, and no significant protective effect of hypothermia was seen in ASDH patients with contusion. Hypothermia may be a useful postoperative therapeutic modality for severe ASDH without concomitant cerebral contusion. A future prospective study is warranted to support the conclusions of this retrospective study.
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Comparative Study Clinical Trial
Lidocaine infiltration of the scalp does not completely abolish increased intraocular pressure due to skull pin insertion.
Insertion of skull pins results in haemodynamic perturbations, which can be blunted by local anaesthetic infiltration of the pin sites. No study has assessed the effects on intraocular pressure. General anaesthesia was induced in 71 patients undergoing cervical spine surgery with attachment of Gardner Wells tongs to the skull. ⋯ Insertion of pins increased intraocular pressure in both groups (from 8.4+/-2.7 to 14.2+/-3.0 mmHg in group I, and from 8.8+/-2.3 to 12.7+/-2.7 mmHg in group II, P < 0.001), which persisted even at 60 s but the increase was significantly greater in group I. Insertion of pins significantly increased blood pressure in group I only. We conclude that lidocaine infiltration at the skull pin sites for Gardner Wells tong attachment fails to completely abolish increased intraocular pressure.