Acta neurochirurgica. Supplement
-
Acta Neurochir. Suppl. · Jan 1999
ReviewA combined transorbital-transclinoid and transsylvian approach to carotid-ophthalmic aneurysms without retraction of the brain.
A series of 138 patients with 143 carotid-ophthalmic aneurysms (COAs) have been treated by direct surgical approach over the past 15 years. In 5 cases the COAs were bilateral and in 15 cases either one or more aneurysms were associated with a COA. Of the 143 COAs, 87 were small, 41 large and 15 were giant. ⋯ The latter approach provides ample space for proximal and distal control of the internal carotid artery (ICA) and makes it possible to deal with demanding large/giant COAs safely. In the series presented, there was no case of premature rupture of the aneurysm. Moreover, since we started using the described approach to COAs, retraction of the brain has not been necessary, regardless of the size of the aneurysm.
-
This paper briefly reviews some basic principles of neurosurgical intensive care of patients with aneurysmal subarachnoid hemorrhage. The importance of early identification of secondary insults are underlined. Special attention is paid to the newly introduced method for neurochemical monitoring by means of intracerebral microdialysis. It is concluded that a well functioning neurointensive care unit constitutes an important organisational frame for the detection, prevention and treatment of secondary insults, after aneurysmal subarachnoidal hemorrhage and that improved results can be expected by applying a modern neurointensive care strategy also for patients with aneurysmal subarachnoid hemorrhage.
-
Acta Neurochir. Suppl. · Jan 1999
Case Reports Comparative StudyContinuous monitoring of cerebrospinal fluid acid-base balance and oxygen metabolism in patients with severe head injury: pathophysiology and treatments for cerebral acidosis and ischemia.
Continuous monitoring of cerebral acid-base balance and oxygen metabolism has been introduced in neurointensive care settings. The hypothesis of this study utilizing multimodal neuromonitoring modalities is that hyperventilation and hypothermia improve cerebral acidosis through prevention of cerebral ischemia aggravation in patients with severe head injury. ⋯ CSF acidosis caused by increased CSF PCO2, La and Py, and/or decreased HCO3- tended to associate with abnormal ICP and CPP, and desaturation indicated by CSF SO2, rSO2, and/or SjO2. Hypothermia rather than hyperventilation tends to improve cerebral acidosis and ischemia.
-
Acta Neurochir. Suppl. · Jan 1999
Case Reports Comparative StudyMonitoring by subcutaneous microdialysis in neurosurgical intensive care.
Microdialysis is an in vivo sampling technique which provides a powerful approach to monitoring metabolic events. We have performed a study to determine the feasibility and effectiveness of subcutaneous microdialysis in monitoring patients on the Neurosurgical Intensive Care Unit (NICU). A microdialysis probe was placed in the subcutaneous fat of the anterior abdominal wall and perfused with Ringer's solution. ⋯ In one patient, following an apparently brief period of hypoxia, there was a prolonged disturbance of tissue chemistry. Another patient with obesity had significantly higher concentrations of dialysate glucose, lactate and glutamate. Monitoring by subcutaneous microdialysis on intensive care units is feasible, reveals unexpected changes in tissue metabolism and might be an important adjunct for the interpretation of intracerebral data.
-
Acta Neurochir. Suppl. · Jan 1999
Glucose and lactate metabolism after severe human head injury: influence of excitatory neurotransmitters and injury type.
The survival of traumatized brain tissue depends on energy substrate delivery and consumption. Excitatory amino acids produce a disturbance of ion homeostasis and thus, increase energy demand. In head-injured patients, massive release of glutamate has been reported, especially in patients with focal contusions. ⋯ The interrelationship was more pronounced in diffusely injured brain (normal CT appearance) compared to the contused tissue. The results demonstrate that glutamate clearly influences the release of lactate following injury, supporting the hypothesis that glutamate "drives" glycolysis in astrocytes. The strong positive correlation between glutamate and glucose might indicate an effect of glutamate upon glucose uptake by cells which differs according to the type of injury.