Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2008
Clinical TrialLong-term outcomes following decompressive craniectomy for severe head injury.
Severe head injury is one of the commonest indications for neurosurgical intervention. For the neurosurgeon, the operative last resort in cases of generalised brain oedema of traumatic origin is the decompressive craniectomy. Is it possible to use predictive factors to ascertain what degree of success, in terms of both the acute and long-term outcome, is to be expected in patients who undergo this treatment? ⋯ The clinical outcome in patients with a severe head injury is to a great degree determined by the extent and type of the primary injury. When considering decompressive hemicraniectomy as a treatment for raised intracranial pressure following traumatic brain injury, the predictive factors detailed here should be taken into consideration.
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Acta Neurochir. Suppl. · Jan 2008
Comparative Study Clinical TrialRegional cerebral blood flow and oxygen metabolism in aneurysmal subarachnoid hemorrhage: positron emission tomography evaluation of clipping versus coiling.
We investigated early postoperative hemodynamic and metabolic values using positron emission tomography (PET) scanning in subarachnoid hemorrhage (SAH) patients treated with clipping or coiling, and evaluated usefulness of PET studies in predicting late ischemic events and neurological outcome in SAH patients. ⋯ A wide range of cerebral perfusion patterns including hyperemia were found in the CLIP group. Surgical manipulation of the brain significantly reduced oxygen metabolism in the operated frontal lobe. PET data alone may not have independent prognostic value for detecting delayed cerebral ischemia or in predicting neurological outcome.
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Acta Neurochir. Suppl. · Jan 2008
Cerebrovascular reactivity and autonomic drive following traumatic brain injury.
The autonomic nervous system exerts tonic control on cerebral vessels, which in turn determine the autoregulation of cerebral blood flow. We hypothesize that the impairment of cerebral autoregulation following traumatic brain injury might be related to the acute failure of the autonomic system. ⋯ Following traumatic brain injury, autonomic failure and cerebrovascular autoregulation impairment are both associated with fatal outcome. Impairment of cerebrovascular autoregulation and autonomic drive are interdependent phenomena. With some refinements, HRV might become a tool for screening patients at risk for cerebral autoregulation derangement following TBI.
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Acta Neurochir. Suppl. · Jan 2008
Preliminary report of the clot lysis evaluating accelerated resolution of intraventricular hemorrhage (CLEAR-IVH) clinical trial.
Brain hemorrhage is the most frequent fatal form of stroke and has the highest level of morbidity of any stroke subtype. For patients with both intracerebral hemorrhage and intraventricular hemorrhage (IVH), expected mortality is 50-80%. No validated, efficacious treatment exists for humans, but animal models demonstrate substantial physiologic and functional benefits associated with rapid, near-complete removal of blood from either the ventricle or intracerebral location (i.e., approximately 80% removal over 48 h). The purpose of the CLEAR-IVH trial (Parts A and B) is to evaluate safety and efficacy of using multiple injections of low-dose rt-PA to accelerate lysis and evacuation of IVH. ⋯ Preliminary analyses show that use of low-dose rt-PA can be safely administered to stable IVH clots and may increase lysis rates.
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Acta Neurochir. Suppl. · Jan 2008
Are head injury guidelines changing the outcome of head injured children? A regional investigation.
Secondary pathophysiological CPP insult is related to outcome after head injury, and improved management would be expected to reduce secondary brain insult. Paediatric head injury management guidelines have been published in recent years, by SIGN (2000), RCPCH (2001), NICE (June 2003), and jointly by Critical/Intensive Care Societies (C/ICS July 2003). We investigated whether outcome of children's head injury (and total burden of secondary CPP insult) has changed (1) annually; (2) before and after the introduction of any HI guidelines, and (3) following other service changes. ⋯ The most recent paediatric HI guidelines appear to have reduced the burden of secondary insult, but more time is required to determine if this will be reflected in improved outcomes.