Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 1999
System analysis of patient management during the pre- and early clinical phase in severe head injury.
Head injury with or without polytrauma is the most important cause of death and severe morbidity in an age bracket of up to 45 years. Two major factors are determining its outcome, the extent and nature of the primary irreversible brain injury, and the subsequently developing manifestations of secondary brain damage, which in principle can be prevented by the management procedures and therapeutical interventions. Therefore, a better outcome from severe head injury depends exclusively on a higher efficiency of the management and treatment in order to inhibit secondary brain damage. ⋯ The data flow during the investigation was maintained among others by regular conferences of the Study Group including the crew of documentation assistants at regular intervals. The presently reported phase-1 study was concluded in October 1997. It is followed by a phase-2 study with the attempt to collect prehospital- and early clinical management and care data in the catchment area on an epidemiological basis. (ABSTRACT TRUNCATED)
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Acta Neurochir. Suppl. · Jan 1999
ReviewA combined transorbital-transclinoid and transsylvian approach to carotid-ophthalmic aneurysms without retraction of the brain.
A series of 138 patients with 143 carotid-ophthalmic aneurysms (COAs) have been treated by direct surgical approach over the past 15 years. In 5 cases the COAs were bilateral and in 15 cases either one or more aneurysms were associated with a COA. Of the 143 COAs, 87 were small, 41 large and 15 were giant. ⋯ The latter approach provides ample space for proximal and distal control of the internal carotid artery (ICA) and makes it possible to deal with demanding large/giant COAs safely. In the series presented, there was no case of premature rupture of the aneurysm. Moreover, since we started using the described approach to COAs, retraction of the brain has not been necessary, regardless of the size of the aneurysm.
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Acta Neurochir. Suppl. · Jan 1999
ReviewIntracranial aneurysms and subarachnoid hemorrhage management of the poor grade patient.
Between 20 and 30% of patients who suffer cerebral aneurysm rupture are in poor clinical grade when first evaluated. Management of these patients is controversial and challenging but can be successful with an aggressive proactive approach that begins with in the field resuscitation and continues through rehabilitation. In this article we review the epidemiology, pathology and pathophysiology, clinical features, evaluation, surgical and endovascular management, critical care, cost, and outcome prediction of patients in poor clinical grade after subarachnoid hemorrhage.
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This paper briefly reviews some basic principles of neurosurgical intensive care of patients with aneurysmal subarachnoid hemorrhage. The importance of early identification of secondary insults are underlined. Special attention is paid to the newly introduced method for neurochemical monitoring by means of intracerebral microdialysis. It is concluded that a well functioning neurointensive care unit constitutes an important organisational frame for the detection, prevention and treatment of secondary insults, after aneurysmal subarachnoidal hemorrhage and that improved results can be expected by applying a modern neurointensive care strategy also for patients with aneurysmal subarachnoid hemorrhage.
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Acta Neurochir. Suppl. · Jan 1999
Case Reports Comparative StudyContinuous monitoring of cerebrospinal fluid acid-base balance and oxygen metabolism in patients with severe head injury: pathophysiology and treatments for cerebral acidosis and ischemia.
Continuous monitoring of cerebral acid-base balance and oxygen metabolism has been introduced in neurointensive care settings. The hypothesis of this study utilizing multimodal neuromonitoring modalities is that hyperventilation and hypothermia improve cerebral acidosis through prevention of cerebral ischemia aggravation in patients with severe head injury. ⋯ CSF acidosis caused by increased CSF PCO2, La and Py, and/or decreased HCO3- tended to associate with abnormal ICP and CPP, and desaturation indicated by CSF SO2, rSO2, and/or SjO2. Hypothermia rather than hyperventilation tends to improve cerebral acidosis and ischemia.