Surg Neurol
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BACKGROUND Decompressive craniectomy in the treatment of posttraumatic brain swelling is not generally accepted. Until now the efficacy of operative decompressive craniectomy in posttraumatic brain swelling of children appeared more promising. However, the criteria for such procedures remain unclearly defined. ⋯ CONCLUSIONS ICP monitoring, together with CCT examination, simultaneous recording of TCD, and systemic parameters, will reveal a patient at risk at a time when impending damage due to uncontrollable ICP may still be prevented. The simultaneous assessment of cerebral blood flow by transcranial doppler (TCD), in this situation, proves most valuable. It improves the guidelines of patient selection for decompressive craniectomy, in the presence of conservatively uncontrollable ICP.
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The rates of seizure activity associated with surgical treatment of chronic subdural hematoma (CSH) reported in the literature has varied greatly. The efficacy of prophylactic anticonvulsive medication (ACM) has been debated and its use been erratic. With improved diagnosis, reduction of associated morbidity impacts greatly on the mortality rate, and so the use of ACM may be important to the patient with CSH. ⋯ The onset of new seizures was found in 17 (18.5%) of 92 patients and was associated with increases in morbidity and mortality. Patients who received prophylactic ACM demonstrated a significant decrease in the occurrence of seizures, and we therefore recommend the use of phenytoin prophylaxis in patients treated surgically for chronic subdural hematoma.
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Appropriate therapy of brainstem lesions is guided by accurate diagnosis. Because the majority of brainstem lesions are not amenable to surgical resection, stereotactic biopsy is an attractive method of obtaining pathological tissue. ⋯ The data suggest that, in adult patients, brainstem lesions are of varied pathology and stereotactic biopsy can provide adequate tissue for diagnosis. The data also suggest that the diagnosis of brainstem glioma in children can often be made without submitting the patient to the risk of surgery.