Acta neurochirurgica. Supplement
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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
Randomized Controlled TrialRelationship of cerebral perfusion pressure levels to outcome in traumatic brain injury.
This study examined the relationship of cumulative percent time that cerebral perfusion pressure (CPP) fell below set thresholds to outcome in individuals with traumatic brain injury (TBI). The sample included 157 patients (16 to 89 years of age, 79%, male) admitted to an intensive care unit at an academic medical center who underwent invasive arterial blood pressure and intracranial pressure monitoring. CPP levels were recorded continuously during the first 96 hours of monitoring. ⋯ Patients experiencing less cumulative percent time below specific CPP thresholds were more likely to have better outcome at discharge (55 mm Hg, p = .004; 60 mm Hg, p = .008; 65 mm Hg, p = .024; 70 mm Hg, p = .016). Although differences in GOSE scores at six months were not significant, those with less time below CPP thresholds were more likely to survive. Accumulated episodes of low CPP had a stronger negative relationship with outcome in patients with more severe primary brain injury.
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Acta Neurochir. Suppl. · Jan 2005
Randomized Controlled TrialIntravenous magnesium sulfate to improve outcome after aneurysmal subarachnoid hemorrhage: interim report from a pilot study.
Magnesium sulfate (MgSO4) may be useful in preventing neurological injury after subarachnoid haemorrhage (SAH). In this randomized, double-blind study we evaluated the safety and efficacy of MgSO4 infusion to improve clinical outcome after aneurysmal SAH. ⋯ MgSO4 infusion after aneurysmal SAH is well tolerated and may be useful in producing better outcome. A larger study is required to confirm the neuroprotective effect of MgSO4.
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Acta Neurochir. Suppl. · Jan 2005
Randomized Controlled TrialMagnesium sulfate for brain protection during temporary cerebral artery occlusion.
We evaluated the effects of magnesium sulfate on brain tissue oxygen (PtO2) tension, carbon dioxide (PtCO2) tension and pH (pHt) in patients undergoing temporary artery occlusion for clipping of cerebral aneurysm. We studied 18 patients with aneurysmal subarachnoid hemorrhage. All patients received standard anesthetics using target controlled infusion of propofol (3 microg/ml) and remifentanil (10 ng/ml). ⋯ Following temporary artery occlusion, PtO2 and pHt decreased and PtCO2 increased in both groups. However, tissue hypoxia was less severe and the rate of PtO2 decline was slower in the magnesium group. Our data suggested that magnesium enhances tissue oxygenation and attenuates hypoxia during temporary artery occlusion.
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Acta Neurochir. Suppl. · Jan 2005
Randomized Controlled Trial Clinical TrialPercutaneous cervical nucleoplasty using coblation technology. Clinical results in fifty consecutive cases.
Conventional open cervical discectomy, with or without bony fusion, in common neurosurgical knowledge is considered the standard treatment for cervical disc herniation. Percutaneous procedures are minimally invasive and offer decreased morbidity, require no bone graft and promise shorter recuperation time. Nevertheless, candidates for a percutaneous procedure as inclusion criteria must complain of symptoms related to contained herniated disc or focal protrusion. ⋯ In the nucleoplasty group results were complete resolution of symptoms in 80% of cases, only 10% referred some residual cervical or radicular pain and are still under follow-up with a wait-and-see prospective. Patients who did not have a clinical resolution were treated with alternative traditional methods (10%). Despite the relative low cases number and the limited follow-up the encouraging results induce us to utilize this technique in well-selected cases.