Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2002
Neuro-rehabilitation--a challenge for neurosurgeons in the century 21st concepts and visions of the WFNS-Committee on neurosurgical rehabilitation.
Patients with severe brain, spinal cord and peripheral nerve lesions today survive surgery. This, however, is quite often achieved at the burden of disabilities. Neuro-rehabilitation could improve significantly patient's quality of life (QoL). ⋯ The WFNS Committee can influence neurosurgeons to take over the challenge of neuro-rehabilitation to improve patient's outcome in respect to ICIDH-2 WHO classification. Delegates of all neurosurgical societies are kindly invited to join us.
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Acta Neurochir. Suppl. · Jan 2002
Multicenter Study Comparative StudyMulti-centre assessment of the Spiegelberg compliance monitor: interim results.
Analyses of a multi-centre database of 71 patients at risk of raised ICP showed that in head injured patients (n = 19) and tumour patients (n = 13) clear inverse relationships of ICP vs compliance exist. SAH patients (n = 5) appear to exhibit a biphasic relationship between ICP and compliance, however greater numbers of patients need to be recruited to this group. Patients with hydrocephalus (n = 34) show an initial decrease in compliance while ICP is less than 20 mmHg, thereafter compliance does not show a dependence upon ICP. ⋯ Preliminary time-series analyses of the ICP and compliance data is revealing evidence that the cumulative time compliance is in a low compliance state (< 0.5 ml/mmHg), as a proportion of total monitoring time, increases more rapidly than the cumulative time ICP is greater than 25 mmHg. Before trials testing compliance thresholds can be designed, we need to consider not just the absolute threshold, but the duration of time spent below threshold. A survey may be required to identify a consensus of what is the minimum duration of raised ICP above 25 mmHg needed to instigate treatment.
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Function of the nervous system has been the main domain of interest of an elite group of philosophers, scientists and physicians. This topic may only be understood within a historical perspective, since the progression of knowledge of the function of the nervous system has always paralleled the expansion of our understanding of the outer world and of biological organisms observed. ⋯ This article summarizes the basic principles and methods used in neurological function-based research. In order to elucidate the topic, the text was practically divided into three main sections: (1) historical perspective regarding functional research models in clinical and experimental neuroscience; (2) neurological function-based clinical studies in humans; and (3) experimental research models on animals.
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A recent randomized controlled trial in patients with ARDS showed the beneficial effect of mechanical ventilation according to the so called Open Lung Approach, consisting of low tidal volumes and elevated PEEP settings after performing recruiting maneuvers. However, neurosurgical patients were excluded from this and other ARDS trials due to concerns of intracranial deterioration. In this report, we present the clinical data of eleven patients with known intracranial pathology and concomitant ARDS which was treated according to the Open Lung concept. ⋯ Although two patients needed additional ICP treatment, no patient had to be withdrawn from Open Lung ventilation. In our series, Open Lung ventilation in neurosurgical patients with ARDS was a safe method to improve oxygenation. Careful ICP monitoring provided, there is no reason to withhold this modern ARDS treatment in the neurosurgical intensive care unit.