Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialEffects of moderate hyperventilation on cerebrovascular pressure-reactivity after head injury.
In volunteers, hyperventilation improves autoregulation. However, in head-injured patients, hyperventilation-induced deterioration and improvement of autoregulation have been reported. We have re-examined this question using an index of pressure reactivity. ⋯ This suggests that patients with disturbed pressure-reactivity may improve, whereas patients with intact pressure reactivity remain largely unchanged. Our data suggest that the response of pressure reactivity to hyperventilation is heterogeneous. This could be due to hyperventilation-induced changes in cerebral metabolism, or the change in CPP.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialBasilar bifurcation aneurysms. Lessons learnt from 40 consecutive cases.
Basilar bifurcation aneurysms are lately treated frequently with endovascular technique. Microsurgical clipping occlusion technique has, however, still its solid position because of its completeness. ⋯ The authors suggest following strategies and tactics for safe and secure occlusion of aneurysms of this location: pterional approach, selective extradural anterior clinoidectomy SEAC, no transection of the posterior communicating artery, isolation of perforating arteries at the time of neck clipping with oxycellulose and combination of the use of fenestrated clip and conventional clip (especially for aneurysms projected posteriorly), controlled hypotension (systolic pressure of around 100 mmHg), temporary clipping (trapping) procedures of usually less than 15 min. All these are aimed for prevention of intraoperative premature rupture, and of injury of perforating arteries and for complete occlusion of aneurysms in the narrow depth of the operative field.
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Acta Neurochir. Suppl. · Jan 2005
ICM+: software for on-line analysis of bedside monitoring data after severe head trauma.
ICM software was developed in 1986 in Warsaw, Poland and has been in use at the University of Cambridge Neurocritical Care Unit for 10 years collecting data from bed-side monitors in nearly 600 severely head injured patients and calculating secondary indices describing cerebral autoregulation and pressure-volume compensation. The new software ICM+ includes a much extended calculation engine that allows easy configuration and on-line trending of complex parameters. The program records raw signals, and calculates time trends of summary parameters. ⋯ All this allows complex information coming off the bed-side monitors to be summarized in a concise fashion and presented to medical and nursing staff in a simple way that alerts them to the development of various pathological processes. The system provides a universal tool for clinical and academic purposes. Its flexibility and advanced signal processing is specialized for the needs of multidisciplinary brain monitoring.
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Acta Neurochir. Suppl. · Jan 2005
Comparative StudyLateral supraorbital approach as an alternative to the classical pterional approach.
The standard pterional approach has been used to approach aneurysms of the anterior circulation and the basilar tip, suprasellar tumors, cavernous lesions. The senior author (JH) established a lateral supraorbital approach as an alternative to the pterional approach after continuous trial and error. We describe the techniques of this approach based on clinical experiences. ⋯ This approach is simpler, faster, safer and less invasive than the classical pterional approach.
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Acta Neurochir. Suppl. · Jan 2005
Pulse and mean intracranial pressure analysis in pediatric traumatic brain injury.
We investigated the relationship between the intracranial pulse pressure (ICPpp) and the mean intracranial pressure (ICP(M)) in pediatric patients with traumatic brain injury (TBI). ⋯ Although there is an underlying linear relationship between ICPpp and ICPM, nonlinear patterns are also present. Further research is required to determine if specific nonlinear ICPpp-ICPM patterns correlate with clinically significant information.