Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2010
Randomized Controlled Trial Multicenter StudyIs it possible to minimize overdrainage complications with gravitational units in patients with idiopathic normal pressure hydrocephalus? Protocol of the randomized controlled SVASONA Trial (ISRCTN51046698).
Overdrainage is a common complication observed after shunting patients with idiopathic normal-pressure hydrocephalus (iNPH), with an estimated incidence up to 25%. Gravitational units that counterbalance intracranial pressure changes were developed to overcome this problem. We will set out to investigate whether the combination of a programmable valve and a gravitational unit (proGAV, Aesculap/Miethke, Germany) is capable of reducing the incidence of overdrainage and improving patient-centered outcomes compared to a conventional programmable valve (Medos-Codman, Johnson & Johnson, Germany). ⋯ One planned interim analysis for safety and efficacy will be performed halfway through the study. To detect the hypothesized difference in the incidence of overdrainage with a type I error of 5% and a type II error of 20%, correcting for multiple testing and an anticipated dropout rate of 10%, 200 patients will be enrolled. The presented trial is currently recruiting patients, with the first results predicted to be available in late 2008.
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Acta Neurochir. Suppl. · Jan 2010
Clinical TrialOutcome of patients with severe head injury after decompressive craniectomy.
Decompressive craniectomy is an operative option for the neurosurgeon in cases of generalized traumatic brain edema. While the outcome of patients after decompressive craniectomy is often poor, we tried to identify predictors of a favorable course of the injury. Therefore, 131 patients who received a decompressive craniectomy at the Unfallkrankenhaus Berlin (ukb) between September 1997 and September 2005 due to severe traumatic brain injury were followed up. ⋯ The results stress again that the prognosis after traumatic brain injury (TBI) with decompressive craniectomy (DC) is unfavorable. Age, midline shift, and status of the basal cisterns on cranial computed tomography (cCT) were associated with the long-term outcome. When weighing whether to initiate the last resort intervention of decompressive craniectomy, the predictive factors detailed here should be taken into consideration.
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Acta Neurochir. Suppl. · Jan 2010
Clinical TrialSurgical outcome following a decompressive craniectomy for acute epidural hematoma patients presenting with associated massive brain swelling.
Acute epidural hematomas (AEDH) are generally managed with rapid surgical hematoma evacuation and bleeding control. However, the surgical outcome of patients with serious brain edema is poor. This study reviewed the clinical outcome for AEDH patients and evaluated the efficacy of the DC, especially in patients with associated massive brain swelling. ⋯ In the favorable outcome group, almost all of the patients (98%) showed less than 12 mm of a midline shift. The influential factors may be age, GCS, pupil abnormalities, size, midline shift, basal cistern effacement, coincidence of contusion and swelling. We conclude that an A DC may be effective to manage the AEDH patients with cerebral contusion or massive brain swelling.
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Acta Neurochir. Suppl. · Jan 2010
ReviewNeuromodulation with pleiotropic and multimodal drugs -- future approaches to treatment of neurological disorders.
Neurologists are confronted with an ever-growing amount of new information regarding the intimate processes taking place in both normal and pathological brains. Concepts like neuroprotection, neurotrophicity, or anoikis and their clinical utility may be of dazzling complexity. ⋯ Since it is becoming more and more clear that using neuroprotective molecule with only one mechanism of action in disease treatment is a utopist idea, the research and use of multimodal drugs should be encouraged. It is not easy to find good therapeutic approaches to neurological disorders, especially if we do not have a deep understanding of all the basic endogenous biological processes, pathophysiological processes, and the links between them.
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Acta Neurochir. Suppl. · Jan 2010
Randomized Controlled TrialEffects of magnesium sulfate infusion on cerebral perfusion in patients after aneurysmal SAH.
A meta-analysis of current data suggests that magnesium sulfate infusion improves the outcome after aneurysmal subarachnoid hemorrhage through a reduction in delayed ischemic neurological deficit. Two multi-center randomized controlled trials are currently underway to investigate this hypothesis. The possible pharmacological basis of this hypothesis includes neuroprotection and vasodilatation. We aim to investigate the cerebral hemodynamic effects of magnesium sulfate infusion in aneurysmal subarachnoid hemorrhage patients. ⋯ Magnesium sulfate infusion, in the dosage of current clinical trials, did not increase cerebral blood volume and cerebral blood flow, as postulated by dilation of small vessels and/or collateral pathways.