Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2005
ReviewMicrodialysis in traumatic brain injury--methodology and pathophysiology.
The application of clinical microdialysis to monitor changes in cerebral extracellular chemistry is now well established in several neurosurgical units worldwide. In neuro-intensive care the technique has been predominantly applied to patients with traumatic brain injury and subarachnoid haemorrhage. ⋯ This involves establishing the relationship between microdialysis and outcome, and the effect of therapeutic manoeuvres on the chemistry. This manuscript describes the place of microdialysis in traumatic brain injury in terms of the fundamental principles, methodology, pathophysiology and clinical application.
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Acta Neurochir. Suppl. · Jan 2005
Randomized Controlled TrialThe influence of mild hypothermia on ICP, CPP and outcome in patients with primary and secondary brain injury.
Aim of this study was to examine the hypothesis that only a subgroup of patients with lesser primary brain damage after severe head injury may benefit from therapeutic hypothermia. We prospectively analysed 72 patients with severe head injury, randomized into groups with (n = 37) and without (n = 35) hypothermia of 34 degrees C maintained for 72 hours. The influence of hypothermia on ICP, CPP and neurological outcome was analysed in the context of the extent of primary brain damage. ⋯ Patients with hypothermia and extracerebral hematomas (n = 14): GCS 5, ICP 13.2, CPP 78, GOS 5. Hypothermia decreased ICP and increased CPP regardless of the type of brain injury. Hypothermia was not able to improve outcome in patients with primary brain lesions but this pilot study suggests that it significantly improves outcome in patients with extracerebral hematomas.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialConcept of "true ICP" in monitoring and prognostication in head trauma.
To propose a new coefficient, which contains information about both the absolute ICP and the position of the 'working point' on the pressure-volume curve. ⋯ The proposed variable is a powerful predictor of fatal outcome following head injury. It is sensitive to both the rising absolute ICP and the critical loss of cerebrovascular regulation.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialParaspinal approach to the far lateral disc herniations: retrospective study on 42 cases.
Forty-two patients underwent surgery for far-lateral disc herniations. Average patient age was 45.1 years, 28 patients were male and 14 female. The level concerned most was L4-5 disc (55%). ⋯ It requires minimal soft-tissue and bone resection and the herniated disc is directly visualized. Moreover, it contains minimal manipulation of the neuro-vascular structures and avoids significant muscle retraction. However, it requires an adequate learning curve and good familiarity with microsurgical techniques.
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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.