Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 1998
External lumbar drainage in uncontrollable intracranial pressure in adults with severe head injury: a report of 7 cases.
The retrospective results of external lumbar drainage in 7 adult patients with severe closed head injury and intracranial pressure (ICP) refractory to aggressive management strategies are presented. All patients had Glasgow Coma Scale (GCS) scores of 8 or less within 24 hours after admission and were treated by a staircase protocol including sedation, ventricular drainage, hyperventilation and mannitol. In three cases barbiturate drugs and an artificially induced hypothermia were used. ⋯ Three patients made a good functional recovery, 2 were severely disabled and 2 patients died. In none of the patients clinical signs of cerebral herniation occurred. We recommend additional external lumbar drainage in adults with severe head injury unresponsive to aggressive ICP control with open basilar cisterns and absent focal mass lesions on computerized-tomography scan before drainage.
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Acta Neurochir. Suppl. · Jan 1998
Subdural monitoring of ICP during craniotomy: thresholds of cerebral swelling/herniation.
It is possible to define thresholds for cerebral swelling or herniation during craniotomy. In 178 patients subjected to craniotomy for space occupying processes subdural ICP was measured before opening of dura. The subdural ICP was correlated to the degree of cerebral swelling or herniation after opening of dura. ⋯ These ICP thresholds are independent of the pathophysiology (SAH, cerebral tumor), the anaesthetic agent (isoflurane, propofol) and the PaCO2 level (< or = 4.0 kPa, > 4.0 kPa). Generally, a good correlation between the tactile estimation of dural tension and the tendency to cerebral swelling or herniation after opening of dura was found. However, in 8.5% the surgeons were unable to predict swelling/herniation.
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Acta Neurochir. Suppl. · Jan 1998
Increase in transcranial Doppler pulsatility index does not indicate the lower limit of cerebral autoregulation.
Transcranial Doppler pulsatility index was reported clinically to increase when cerebral perfusion pressure decreased, hypothetically marking the lower limit of cerebral autoregulation. We sought to investigate the relationship between pulsatility index, cerenbrovascular resistance, and cerebral perfusion pressure in various states of autoregulation in an animal model of moderate intracranial hypertension. ⋯ The increase in transcranial Doppler pulsatility index when cerebral perfusion pressure falls cannot be interpreted as a phenomenon able to mark the lower limit of cerebral autoregulation.
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Acta Neurochir. Suppl. · Jan 1998
Randomized Controlled Trial Clinical TrialTreatment of elevated intracranial pressure by infusions of 10% saline in severely head injured patients.
The management of intracranial pressure (ICP) is a factor in outcome of patients with head trauma. However, recent studies have revealed that the current strategies, which have been applied to control ICP for adequate cerebral perfusion, are unsatisfactory. Against this background, the efficacy of short-term infusions of hypertonic saline on ICP was investigated. ⋯ In the individual cases the temporal course of the parameters amplitude and decline interval depict a tendency toward lower and higher values, respectively, under conditions of a generally increasing ICP. As expected, the infusion of hypertonic saline reduces ICP in patients suffering from SHI. The pressure drop, duration and dynamic behaviour are suspected to depend both on the pressure level to reduce and concomitant medications.