Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2012
Late decompressive craniectomy as rescue treatment for refractory high intracranial pressure in children and adults.
The purpose of this study was to determine the prognosis of children and adults in whom decompressive craniectomy (DC) was used as a rescue treatment to lower refractory high intracranial pressures if maximal conservative therapies failed. Data of DC patients were retrospectively reviewed. Three-month and 1-year outcomes were evaluated (modified Rankin Score). ⋯ Eleven suffered from traumatic brain swelling, in 10 the primary pathological condition was intracranial hemorrhage, arteriovenous malformation bleeding or subarachnoid hemorrhage. All 13 survivors (62%) had a favorable outcome after 1 year (mRS≤3), 8 (38%) lacked any disabilities at all. Therefore, decompressive craniectomy offers a chance for a favorable outcome in uncontrollable ICP.
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Acta Neurochir. Suppl. · Jan 2012
Case ReportsAn uncommon case of Idiopathic Intracranial Hypertension with diagnostic pitfalls.
We report on an unusual case of Idiopathic Intracranial Hypertension (IIH) in a woman of normal weight. Papilledema and increased intracranial pressure are symptoms of cerebral venous sinus thrombosis or idiopathic intrancranial hypertension. Because of the different treatment strategies, it is important to keep these two diseases separate. We show that the use of different imaging methods is an important tool in obtaining an effective diagnosis.
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Acta Neurochir. Suppl. · Jan 2012
Biography Historical ArticleModeling of CSF dynamics: legacy of Professor Anthony Marmarou.
The mathematical model of cerebrospinal fluid (CSF) pressure volume compensation, introduced by Anthony Marmarou in 1973 and modified in later studies, provides a theoretical basis for differential diagnosis in hydrocephalus. The Servo-Controlled Constant Pressure Test (Umea, Sweden) and Computerised Infusion Test (Cambridge, UK) are based on this model and are designed to compensate for inadequate accuracy of estimation of both the resistance to CSF outflow and elasticity of CSF pressure volume compensation. Dr. ⋯ Marmarou demonstrated that only around 30% of cases of elevated ICP in patients with TBI could be explained by changes in CSF circulation. The remaining 70% of cases should be attributable to vascular components, which have been proposed as equivalent to raised brain venous pressure. Professor Marmarou's work has had a direct impact in the field of contemporary clinical neurosciences, and many of his ideas are still being investigated actively today.
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Acta Neurochir. Suppl. · Jan 2012
Comparative StudyComparison of a new brain tissue oxygenation probe with the established standard.
Continuous bedside brain tissue oxygenation (p(br)O(2)) monitoring using the Licox system is an established method for detecting secondary ischemia in comatose patients with acute brain injury. The purpose of the current study was to compare the newly introduced Raumedic p(br)O(2) probe with the established standard. ⋯ Our data suggest that the p(br)O(2) measurements of the two systems cannot be interchanged. Although we were unable to determine which system delivers more valid data, we do think that more rigorous testing is necessary before implementing the new probe in clinical routine.
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Acta Neurochir. Suppl. · Jan 2012
Non-invasively estimated ICP pulse amplitude strongly correlates with outcome after TBI.
An existing monitoring database of brain signal recordings in patients with head injury has been re-evaluated with regard to the accuracy of estimation of non-invasive ICP (nICP) and its components, with a particular interest in the implications for outcome after head injury. ⋯ When compared between patients who died and who survived mean nAmp showed the greatest difference, suggesting its potential to predict mortality after TBI.