Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2012
Randomized Controlled TrialThe effect of intraventricular thrombolysis in combination with low-frequency head motion after severe subarachnoid hemorrhage: interim analysis of safety, clot clearance rate and delayed cerebral ischemia.
The current clinical prospective randomized phase II study was initiated in order to analyze the effect of enhanced washout by discontinuous intraventricular thrombolysis in combination with low-frequency head-motion therapy on side effects, clot clearance rate, cerebral vasospasm and clinical outcome after severe subarachnoid hemorrhage (SAH). ⋯ The present study demonstrates that a combination of intraventricular thrombolysis and lateral rotational therapy is not associated with a higher complication rate. Furthermore, the therapy leads to a significant acceleration of the clot clearance rate.
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Acta Neurochir. Suppl. · Jan 2012
Randomized Controlled TrialConservative versus surgical management of idiopathic normal pressure hydrocephalus: a prospective double-blind randomized controlled trial: study protocol.
There is no level I evidence to indicate whether placement of a shunt is effective in the management of idiopathic normal pressure hydrocephalus (INPH), because no trial has as yet compared the placement of a shunt versus no shunt in a randomized controlled manner. We started recruiting patients into a prospective double-blind randomized controlled study aiming to provide class I evidence supporting or refuting the role of surgical management in INPH. Inclusion criterion was the diagnosis of probable INPH plus objective improvement of walking speed following 72 h of extended lumbar drainage. ⋯ Primary end point was to be an improvement in gait. Secondary end points were improvement in mental function or urinary function and incidence of complications. Final results are expected mid 2011.
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Acta Neurochir. Suppl. · Jan 2012
Randomized Controlled TrialOn the method of a randomised comparison of programmable valves with and without gravitational units: the SVASONA study.
The supremacy of low-pressure valves (LPV) in the therapy of patients with idiopathic normal pressure hydrocephalus (iNPH) has been proven by the Dutch NPH study. The downside of LPVs is the high rate of overdrainage complications. In the meantime gravitational units have been developed with the objective of minimising overdrainage complications. Do these gravitational units allow the same favourable outcomes as in the Dutch NPH study without overdrainage complications? The goal of this prospective randomised controlled multicentre trial is to compare the rate of overdrainage complications after shunt surgery with programmable valves with or without a gravitational unit. ⋯ The design of the SVASONA study was developed to be able to confirm the primary hypothesis. Thus, the method of the study should solve the dilemma of the Dutch NPH study by the randomised comparison of LPVs with and without gravitational units.
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Acta Neurochir. Suppl. · Jan 2012
Monitoring of the association between cerebral blood flow velocity and intracranial pressure.
Slow waves in intracranial pressure (ICP) are believed to originate from changes in cerebral blood volume secondary to adjustments in arteriolar diameter. Blood flow velocity (FV) signals recorded with transcranial Doppler ultrasound show similar oscillations. We investigated a continuous measure of FV/ICP association and its relationship to cerebral perfusion pressure (CPP), ICP, cerebral autoregulation (CA) and outcome after severe traumatic brain injury (TBI). ⋯ FIx correlated with ICP (Spearman's R = -0.40, p < 0.01), Mx (R = -0.54, p < 0.00005) and CPP (R = 0.34, p < 0.01), but not with PRx (p = 0.84). FIx was significantly associated with outcome after grouping into Glasgow Outcome Score (GOS) 1-3 or GOS 4-5 (Mann-Whitney p = 0.009). FIx may provide unique insights into the behaviour of the cerebral circulation during intracranial hypertension.
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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.