Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2002
Decompressive craniectomy following traumatic brain injury: ICP, CPP and neurological outcome.
Decompressive craniectomy is often the final option in the management of posttraumatic intracranial hypertension. Aim of this study was to investigate the effect of secondary decompression on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and neurological outcome. 62 patients decompressed after severe head injury were included in the retrospective study. Decompression was performed when ICP could not be controlled by non-surgical treatment. ⋯ ICP was significantly reduced to 9.8 +/- 1.3 mmHg by surgery and CPP improved to 78.2 +/- 2.3 mmHg. 12 hrs following decompression mean ICP rose to 21.6 +/- 1.7 mmHg again (CPP: 73.6 +/- 1.7 mmHg), but in the following period ICP could be kept below 25 mmHg in the majority of patients. 6 months after trauma 22.5% of the patients had died (except one all these patients were aged more than 50 yrs). 48.4% of patients survived with an unfavourable outcome (GOS 2 + 3), while 29.1% had a favourable outcome (GOS 4 + 5). Decompressive craniectomy is highly effective to treat otherwise uncontrollable intracranial hypertension and improves CPP. A satisfactory outcome, however, is only achieved under strict consideration of negative predictors (e.g. age).
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Acta Neurochir. Suppl. · Jan 2002
ICP and CBF regulation: a new hypothesis to explain the "windkessel" phenomenon.
The brain tamponade represents the final condition of a progressive intracranial pressure (ICP) increase up to values close to arterial blood pressure (BP) producing a reverberating flow pattern in the cerebral arteries with no net flow. This finding implies intracranial volume changes, therefore a full application of the Monro-Kellie doctrine is impossible. To resolve this contradiction, in eight pigs a reversible condition of brain tamponade was produced by infusing saline into a cerebral ventricle. ⋯ When ICP approached carotid BP values, reverberating BFV waves both at ICA and SS site were simultaneously observed. The arterial and venous reverberating waves appeared to be almost exactly superimposable, with a delay of about 40 msec. This synchronism between the pulsatile arterial and venous BFV indicates that the residual pulsation, still occurring at the arterial proximal level, is compensated by a passive compression-distension of the SS with no blood volume (that is net flow) crossing the intracranial vasculature.
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Acta Neurochir. Suppl. · Jan 2002
Intracranial compliance as a bed-side monitoring technique in severely head-injured patients.
A recently developed monitoring technology makes an on-line assessment of intracranial compliance (ICC) possible. Aims of our research: 1. Course and values of ICC (critical threshold: < 0.5 ml/mmHg) in episodes of pathological intracranial pressure (ICP) (> 20 mmHg) and reduced cerebral oxygenation (brain tissue PO2 (PtiO2) < 10 mmHg). 2. ⋯ In predicting adverse outcome, ICP was equal to ICC. The different ICC in each age class points to the need of age-adjusted thresholds. Further refinements of ICC technology are needed to improve ICC data quality and therefore become a useful tool in neuromonitoring.
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Acta Neurochir. Suppl. · Jan 2002
Appropriate analysis and presentation of data is a must for good clinical practice.
Good Clinical Practice (GCP) is defined as an international ethical and scientific quality standard for designing, conducting, monitoring, auditing, analyzing and reporting trials that involve the participation of human subjects. This paper focuses mainly on the issues that need attention at the time of statistical analysis and reporting of results. Findings from a review of published articles in Turkey are also presented. ⋯ The review of a stratified sample of research articles from 60 journals published in 1992 in Turkey revealed that in 56% of the cases the statistical methods were improper or inadequate. In 15% of the articles the authors failed to select an appropriate design for the proposed aim mentioned in the manuscript. Despite the recent improvements, the necessity and the value of performing and presenting research according to the international standards remains to be assimilated better by Turkish investigators.
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Disturbed cerebral autoregulation is believed to be associated with an unfavourable outcome following head injury. Previously, using ICP monitoring and transcranial Doppler ultrasonography, we investigated whether cerebral response to spontaneous variations in arterial pressure (ABP) or cerebral perfusion pressure (CPP) provide reliable information on cerebral autoregulatory reserve. In the present study we have correlated these methods with clinical findings. ⋯ Positive values of indices of autoregulation, expressing positive association between slow waves of CPP and blood flow velocity or ABP and ICP, indicate disturbed autoregulation. These indices correlate with unfavourable outcome following head injury and should be used to guide intensive therapy.