Acta neurochirurgica. Supplement
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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.
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Acta Neurochir. Suppl. · Jan 2005
Controlled Clinical TrialThe importance of major extracranial injuries by the decompressive craniectomy in severe head injuries.
Neurosurgical therapy aims to minimise the secondary brain damage after a severe head injury. This includes the evacuation of an intracranial space occupying bleeding, the reduction of intracranial volumes, in hematocephalus an external ventricular drainage, and the conservative therapy in order to influence an increased intracranial pressure (ICP) and a decreased p(ti)02. ⋯ The prognosis after decompression depends on the clinical signs and symptoms on admission, the patients age and the existence of major extracranial injuries. Our guidelines for an indication for decompressive craniectomy after failure of conservative interventions and evacuation of space occupying hematomas include a patients age below 50 years without multiple trauma, a patients age below 30 years in the presence of major extracranial injuries, a severe brain swelling on CT scan, the exclusion of a primary brainstem lesion or injury and the intervention before irreversible brainstem damage and secondarily while monitoring ICP and p(ti)02 in an interval up to 48 hours after the accident before irreversible brainstem damage or generalised brain damage has occurred.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialRe-defining the ischemic threshold for jugular venous oxygen saturation--a microdialysis study in patients with severe head injury.
Neurological change is more likely to occur when jugular venous oxygen saturation (SjvO2) is less than 50%. However, the value indicating cellular damage has not been clearly defined. We determined the critical SjvO2 value below which intracerebral extracellular metabolic abnormalities occurred in 25 patients with severe head injury. ⋯ Analysis of variance showed that there were rapid increases in glutamate, glycerol and lactate when SjvO2 dropped below 40, 43 and 45% respectively. Extracellular glucose decreased when SjvO2 dropped below 42%. Our findings suggested that the ischemic threshold for SjvO2 in patients with severe head injury is 45%, below which secondary brain damage occurred.