No shinkei geka. Neurological surgery
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A case of growing skull fracture with rapid growth is presented. A 4-month-old male fell and struck the right side of his head. Skull X-ray just after injury showed a right parietotemporal linear skull fracture with the maximum width of 4 mm. ⋯ CT scan revealed subgaleal cerebral herniation surrounded by brain edema. He was operated 11 days after injury. It is thought that the contusional hematoma and following brain edema played an important role in the genesis of rapid growth of the skull fracture.
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The influences of continuous cerebrospinal fluid (CSF) drainage on vasospasm and hydrocephalus were analyzed retrospectively in 150 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms (32 cases of grade 1, 85 cases of grade 2, and 33 cases of grade 3 by the Hunt and Hess classification). One hundred and seven of these cases received CSF drainage (cisternal, ventricular, lumbar, or a combination of these). The volume of CSF drainage within the first week after onset was 975 +/- 513 ml (mean +/- SD). ⋯ Four of 43 cases with no drainage, 26 of 67 cases with a total drainage volume of less than 2000 ml, and 24 of 40 cases with a total drainage volume of more than 2000 ml developed hydrocephalus. There was a statistically significant dose-response (drainage volume-hydrocephalus) relationship (p less than 0.005, Mantel extension method). Vasospasm and hydrocephalus were statistically associated (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
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Prostaglandin (PG) E1 is a potent vasodilator on the peripheral vessels and also has an inhibitory action of platelet aggregation. Thus it is expected that PGE1 may be used for the treatment of cerebral vasospasm due to aneurysmal subarachnoid hemorrhage (SAH). Lipo-PGE1, lipid emulsified PGE1 less destroyed in the lung, has much longer half life time in the circulation than PGE1 which is rapidly inactivated in the lung. ⋯ The appearance and severity of symptomatic vasospasm were less in the Lipo-PGE1 treated group than the control, and the outcome of the Lipo-PGE1 treated patients with or without vasospasm improved significantly at 1 month follow-up examination. The cerebral blood flow (CBF) measurements were performed three times, at first (1st), second to third (2nd) and fourth to sixth (3rd) week after SAH. In the Lipo-PGE1 treated group, the 1st CBF measurement was done before administration of Lipo-PGE1 started and the 2nd examination was performed after the completion of administration.(ABSTRACT TRUNCATED AT 250 WORDS)
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In 30 patients undergoing neurosurgical intervention, the authors evaluated the hemodynamics in the circle of Willis by transcranial Doppler sonography. By avoiding confusion with collateral effects, the transcranial Doppler sonography yielded direct and more significant information concerning the intracranial hemodynamics than extracranial Doppler sonography. Therefore, it made possible to detect intracranial occlusive lesions with less false findings. ⋯ Transcranial Doppler sonography was considered to contribute to the establishment of a protocol for early diagnosis and treatment of vasospasm. Transcranial Doppler sonography was also utilized as a useful tool for classification of arteriovenous malformation from the viewpoint of hemodynamics, namely high-flow or low-flow and with or without steal phenomenon. Transcranial Doppler sonography appears sufficiently promising to justify further development and utilization in cerebrovascular surgery.
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Brainstem auditory evoked potentials (BAEP), somatosensory evoked potentials (SEP) and EEG were recorded sequentially in cat with mass-induced intracranial hypertension in correlation with mass volume, intracranial pressure (ICP), systemic blood pressure (BP) and size of the pupils. 1) As the intracranial pressure was raised by expansion of a supratentorial epidural balloon, suppression of cortical SEP (CSEP) and pupillary abnormality appeared first, EEG, waves IV and III of BAEP and wave III of short latency SEP (SSEP) were suppressed in this order. 2) As far as wave IV of BAEP remained and decompression was started within 30 minutes after peaks of CSEP completely suppressed, changes in P1 and N1 of CSEP were reversible. 3) Further raising of ICP was followed by loss of waves IV and III of BAEP and wave III of SSEP in this order. Simultaneously with loss of wave III in SSEP, systemic blood pressure dropped rapidly. ⋯ These results suggest that for the patient with disturbed consciousness caused by supratentorial mass lesion, decompressive procedure should be started before wave V of BAEP and brainstem components of SEP disappear. EP monitor seems to be useful clinical method for preventing irreversible change of the brain in patients with coma caused by supratentorial mass lesions.