Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2002
Detection of secondary insults by brain tissue pO2 and bedside microdialysis in severe head injury.
We evaluated bedside cerebral on-line microdialysis for early detection of cerebral hypoxia in patients with traumatic brain injury. 24 severely head injured patients (Glasgow Coma Score < or = 8) were studied. Patients underwent continuous brain tissue PO2 (PtiO2) monitoring using the LICOX (GMS mbH, Germany) microcatheter device. The catheter was placed into the non-lesioned frontal white matter within 32.2 (7-48) hrs post injury. ⋯ Before cerebral hypoxia, glucose decreased significantly. Glutamate was unchanged when no hypoxia or impending hypoxia occurred but increased 3-4 fold before a hypoxic episode appeared. We conclude that early metabolic detection of cerebral hypoxia before a critical decrease in brain tissue PtiO2 is seen and possibly allows earlier changes in treatment (e.g. reduction of hyperventilation therapy).
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Acta Neurochir. Suppl. · Jan 2002
Intraoperative monitoring of brain tissue oxygen and carbon dioxide pressure in peritumoural oedema by stereotactic placement of multiparameter microsensors.
Ischaemia may play an important role in peritumoural brain oedema and swelling, but little data exist so far on brain tissue oxygenation adjacent to a tumour mass. We have monitored brain tissue oxygen tension (ptiO2) and brain tissue CO2 tension (ptiCO2) in 19 patients undergoing craniotomy for resection of a brain tumour using a multiparameter sensor placed in the brain parenchyma. Accurate placement of this probe in the peritumoural area was accomplished with the aid of a 3-D neuronavigation system. ⋯ From these preliminary data, we conclude that ptiO2 is depressed in the peritumoural area, and improves following tumour resection. Stereotactic placement of sensors for intraoperative ptiO2 monitoring is feasible and may enhance data quality. Nevertheless, the high incidence of failures with this type of sensor remains a matter of concern.
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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
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
Continuous cerebral compliance monitoring in severe head injury: its relationship with intracranial pressure and cerebral perfusion pressure.
Cerebral Compliance describes the ability of cranial content to accommodate volume variations. Intracranial vascular compartment is thought to be one of the most important determinants of Compliance. Cerebral perfusion pressure (CPP) has a significant influence upon the calibre of cerebral vessels and consequently, upon blood volume. ⋯ At CPP > or = 60 mmHg Compliance decreased with CPP (R2 = 0.83). In the range of low CPP vasoparalysis is impending. However, when ICP is pathological, at high CPP our results may express vasodilatation instead of expected vasoconstriction from normal autoregulation.