Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2002
Application of a dual channel peroneal nerve stimulator in a patient with a "central" drop foot.
Dropped foot is a common mobility problem amongst patients after a cerebro vascular accident. The condition arises from paresis of the muscles that control the foot movement during the swing phase of gait. If the abnormal movement is not compensated for, it results in a significant decrease in the mobility and hence quality of life. ⋯ Stimulation occurs via small bipolar electrodes which are placed subepineural. After successful tests on animals we have now started the two channel peroneal nerve stimulator implantation in patients. The preliminary results of the first implants are presented.
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Acta Neurochir. Suppl. · Jan 2002
Appropriate cerebral perfusion pressure during rewarming after therapeutic hypothermia.
This study evaluated the cerebral ischemic parameters during the rewarming period after therapeutic hypothermia to determine the critical cerebral perfusion pressure (CPP) threshold to avoid ischemic deterioration. Cat experimental head injury was induced by inflation of an epidural rubber balloon to maintain intracranial pressure at 30 mmHg under hypothermia. During the rewarming period, CPP was maintained at > or = 120 mmHg, 90 mmHg, and 60 mmHg by controlling the blood pressure. ⋯ Animals with CPP = 60 mmHg also showed increased extracellular glutamate concentration and histological ischemic damage (mitochondrial swelling). CPP of 60 mmHg during the rewarming period is associated with irreversible ischemia, which indicates continuation of cerebral vasoconstriction. Therefore, a CPP of greater than 90 mmHg is required to avoid cerebral ischemia.
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Acta Neurochir. Suppl. · Jan 2002
Clinical manifestations, character of aneurysms, and surgical results for unruptured cerebral aneurysms presenting with ophthalmic symptoms.
Cases with unruptured cerebral aneurysms presenting with visual symptoms were investigated about their site, size, symptom, operative methods and results. ⋯ These results suggest that in cases with unruptured large or giant aneurysms presenting with ophthalmic symptoms, especially in IC cavernous or IC ophthalmic aneurysms, parent artery occlusion + EC/IC bypass is the safest operative procedure.
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Acta Neurochir. Suppl. · Jan 2002
Simultaneous measurement of local cortical blood flow and tissue oxygen saturation by Near infra-red Laser Doppler flowmetry and remission spectroscopy in the pig brain.
In the current study we evaluated the combined use of Near-infrared Laser-Doppler flowmetry (NiLDF) and Remission Spectroscopy (RS) for measurement of regional perfusion and oxygen saturation of the cerebral cortex. An epidural probe for combined measurements of NiLDF and RS was placed above the parietal or frontal cortex of nine anesthetized juvenile pigs. Cerebral perfusion pressure (CPP) was stepwise decreased by intracisternal infusion of artificial CSF at clamped arterial blood pressure (baseline, CPP50, CPP40, CPP30 mmHg, ischemia). ⋯ Linear regression analysis resulted in a significant correlation (p < 0.001) for changes in regional perfusion during CPP decrease and reperfusion, as measured with CMS and NiLDF (r = 0.92, n = 39). A significant correlation was also found for tissue oxygen saturation--as measured with RS--and cerebral venous oxygen saturation (r = 0.85, n = 67). Although the problem of spatial variability remains to be solved, the combined use of NiLDF and RS allows continuous and non-invasive monitoring of changes of key parameters of oxygen metabolism within the cerebral cortex.
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Acta Neurochir. Suppl. · Jan 2002
Neuro-rehabilitation--a challenge for neurosurgeons in the century 21st concepts and visions of the WFNS-Committee on neurosurgical rehabilitation.
Patients with severe brain, spinal cord and peripheral nerve lesions today survive surgery. This, however, is quite often achieved at the burden of disabilities. Neuro-rehabilitation could improve significantly patient's quality of life (QoL). ⋯ The WFNS Committee can influence neurosurgeons to take over the challenge of neuro-rehabilitation to improve patient's outcome in respect to ICIDH-2 WHO classification. Delegates of all neurosurgical societies are kindly invited to join us.