No shinkei geka. Neurological surgery
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Review Case Reports
[Use of intracerebral microdialysis in severe traumatic brain injury].
Brain microdialysis (MD) is a well-established technique to monitor the chemistry of the extracellular space in the brain during neurointensive care. MD may be useful in severe cases of traumatic brain injury (TBI) in which monitoring of intracranial pressure and cerebral perfusion pressure is required. Lactate/pyruvate (L/P) ratio, glucose, glutamate, and glycerol can be measured using a bedside device. ⋯ Our preliminary results indicate that MD L/P ratios are higher and more fluctuated in poor outcome patients compared to those in favorable outcome patients. MD in association with other brain monitoring techniques is safe and may be useful in preventing and relieving secondary ischemic injury, predicting outcome and guiding therapy after severe TBI. However, the value of MD as a tool in routine neurointensive care decision-making remains unclear.
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With the increase in terrorist activity in recent times, the number of blast injuries has also increased in civilian and military settings. In a recent war, the number of patients who suffered blast traumatic brain injury (bTBI) increased, so treatment of bTBI is currently a very important issue. Blast injury is complicated and can be divided into 4 categories: primary, secondary, tertiary, and quaternary. ⋯ Such studies have so far shown that blast waves can cause damage to the brain tissue and cognitive deficits; however, detailed investigations on this topic are still required. Treatment of bTBI patients may require clinical knowledge and skills related to intensive care, neurology, and neurosurgery. Moreover, further research is required in this field.
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Review
[Operative neurosurgery: personal view and historical backgrounds. 6. Positioning, instruments].
Important points of positioning and instruments at the time of performing microneurosurgery according to the traditional Zuerich school style were presented based on the experience of ca. 1,000 surgeries/year for around 13.5 years. Most of the instruments and equipment had been taken over from the time of Prof. Yaşargil. ⋯ For the same reason, foot pedals for the bipolar coagulator, drilling and trepanation should be stepped by other than the surgeon, so that he can concentrate on the tip the of instrument for precise maneuvering. As tissue destruction apparatus, we prefer to use CUSA to laser, as the former enables preservation of blood vessels at the time of tissue destruction and suction by appropriate power application. Besides these, the followings items were discussed: scissors (blunt tips), Lyla retractor (variously tapered tips and fixation or holding at the other peripheral end), drilling (turning direction adjustable, cutting and diamond burr) etc.
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A case report of penetrating head injury due to 8 nails and a review of multiple penetrating head injury by nails were described. The patient who was a 48-year-old man with a history of for psychiatric care was transferred to our emergency room on May 2007. He had shot his head with 8 nails using a nail-gun in a suicide attempt. ⋯ Penetrating head injury with nail-gun use is sometimes seen, but cases with multiple nails are rare. Operative strategies were discussed in the review. It also suggested the need for the care of mental or background problems.