Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2002
Metabolic suppressive therapy as a treatment for intracranial hypertension--why it works and when it fails.
Thirty years after its first description metabolic suppressive therapy is still controversial in patients with intractable intracranial hypertension. In this study high dose propofol was used to induce metabolic suppression. The effects on intracranial pressure (ICP) and the cerebral metabolic rates for oxygen and glucose (CMRO2 and CMRGlc) are reported. ⋯ In studies with normal metabolic ratio, ICP reduction was associated with a reduction in CMRO2. In studies with hyperglycolysis, ICP reduction was poor but CMRGlc decreased significantly. In conclusion, intact CO2R, normal or only moderately elevated ICP and normal MR are predictive of ICP reduction with high dose propofol after head injury.
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Acta Neurochir. Suppl. · Jan 2002
Combined intrathecal baclofen and morphine infusion for the treatment of spasticity related pain and central deafferentiation pain.
Complex pain syndromes due to spasticity and central deafferentation often fail to respond to medical therapy and create challenging problems in the pain management. So far, only spasticity associated musculosceletal pain has been reported to respond to intrathecal baclofen application [1, 2]. ⋯ Intrathecal baclofen and morphine application proved to be effective in spasticity related and central deafferentation pain and should therefore be considered in the management of these patients.
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Acta Neurochir. Suppl. · Jan 2002
ICP and CBF regulation: a new hypothesis to explain the "windkessel" phenomenon.
The brain tamponade represents the final condition of a progressive intracranial pressure (ICP) increase up to values close to arterial blood pressure (BP) producing a reverberating flow pattern in the cerebral arteries with no net flow. This finding implies intracranial volume changes, therefore a full application of the Monro-Kellie doctrine is impossible. To resolve this contradiction, in eight pigs a reversible condition of brain tamponade was produced by infusing saline into a cerebral ventricle. ⋯ When ICP approached carotid BP values, reverberating BFV waves both at ICA and SS site were simultaneously observed. The arterial and venous reverberating waves appeared to be almost exactly superimposable, with a delay of about 40 msec. This synchronism between the pulsatile arterial and venous BFV indicates that the residual pulsation, still occurring at the arterial proximal level, is compensated by a passive compression-distension of the SS with no blood volume (that is net flow) crossing the intracranial vasculature.
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Acta Neurochir. Suppl. · Jan 2002
Natural history of unruptured intracranial aneurysms: risks for aneurysm formation, growth, and rupture.
Several studies concerning risk factors for SAH and for subsequent rupture of an unruptured aneurysm have been published, but not risk factor studies for formation and growth rate of aneurysms. Because less than half of all aneurysms ever rupture, it is essential to know risk factors separately both for aneurysm formation and for its growth. Before 1979, unruptured aneurysms were not operated on in Helsinki. ⋯ Female gender (adjusted odds ratio, 4.73; 95% CI, 1.16-19.38) and current smoking (4.07, 1.09-15.15) were the only significant (p < 0.05) independent risk factors for de novo aneurysm formation. Cessation of smoking is very important for these patients. It is recommended that unruptured aneurysms be operated on irrespective of their size and of patients' smoking status, in people aged < 50 to 60 years.
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Acta Neurochir. Suppl. · Jan 2002
Decompressive craniectomy following traumatic brain injury: ICP, CPP and neurological outcome.
Decompressive craniectomy is often the final option in the management of posttraumatic intracranial hypertension. Aim of this study was to investigate the effect of secondary decompression on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and neurological outcome. 62 patients decompressed after severe head injury were included in the retrospective study. Decompression was performed when ICP could not be controlled by non-surgical treatment. ⋯ ICP was significantly reduced to 9.8 +/- 1.3 mmHg by surgery and CPP improved to 78.2 +/- 2.3 mmHg. 12 hrs following decompression mean ICP rose to 21.6 +/- 1.7 mmHg again (CPP: 73.6 +/- 1.7 mmHg), but in the following period ICP could be kept below 25 mmHg in the majority of patients. 6 months after trauma 22.5% of the patients had died (except one all these patients were aged more than 50 yrs). 48.4% of patients survived with an unfavourable outcome (GOS 2 + 3), while 29.1% had a favourable outcome (GOS 4 + 5). Decompressive craniectomy is highly effective to treat otherwise uncontrollable intracranial hypertension and improves CPP. A satisfactory outcome, however, is only achieved under strict consideration of negative predictors (e.g. age).