Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2002
Intraoperative monitoring of brain tissue oxygen and carbon dioxide pressure in peritumoural oedema by stereotactic placement of multiparameter microsensors.
Ischaemia may play an important role in peritumoural brain oedema and swelling, but little data exist so far on brain tissue oxygenation adjacent to a tumour mass. We have monitored brain tissue oxygen tension (ptiO2) and brain tissue CO2 tension (ptiCO2) in 19 patients undergoing craniotomy for resection of a brain tumour using a multiparameter sensor placed in the brain parenchyma. Accurate placement of this probe in the peritumoural area was accomplished with the aid of a 3-D neuronavigation system. ⋯ From these preliminary data, we conclude that ptiO2 is depressed in the peritumoural area, and improves following tumour resection. Stereotactic placement of sensors for intraoperative ptiO2 monitoring is feasible and may enhance data quality. Nevertheless, the high incidence of failures with this type of sensor remains a matter of concern.
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To investigate asymmetry of cerebra autoregulation in head-injured patients with lateral brain contusions. ⋯ Side-to-side difference in cerebral hemodynamic reserve of injured brain is a predictor of fatal outcome following head injury and correlates with the side of contusion or brain expansion.
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This investigation analyzed 22 xenon CT cerebral blood flow (CBF) studies from 18 severely head-injured patients (Glasgow motor score < 6) who underwent xenon CT scanning while brain tissue oxygen tension (PbtO2) was being monitored. CBF was determined both in a localized region of interest around the actual or estimated location of the tip of the PbtO2 probe and in the entire corresponding CT slice. ⋯ Very low values were significantly less common for global CBF than for rCBF. Further investigation is necessary to determine how probe placement near contused areas vs. in normal tissue affects our understanding of the relationship between rCBF, global CBF, PbtO2, and cerebral oxygen consumption.
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Acta Neurochir. Suppl. · Jan 2002
Surgery and outcome for aneurysmal subarachnoid hemorrhage in elderly patients.
The goal was to report treatment results of elderly patients (over 70 years) who underwent clipping of aneurysms after subarachnoid hemorrhage (SAH). ⋯ Advanced age does not preclude successful surgery for ruptured aneurysm. Most important factor for outcome was a good initial clinical status, though the majority of our patients presented with poor grades. Early surgical clipping and postoperative intensive care can attain a favorable outcome in a significant percentage of elderly patients.
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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.