Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2008
Clinical TrialEffect of hyperbaric oxygen on patients with traumatic brain injury.
Hyperbaric oxygen therapy (HBOT) is the medical therapeutic use of oxygen at a higher atmospheric pressure. The United States Food and Drug Administration have approved several clinical applications for HBOT, but HBOT in traumatic brain injury (TBI) patients has still remained in controversial. The purpose of our study is to evaluate the benefit of HBOT on the prognosis of subacute TBI patients. ⋯ The GCS of the HBOT group was improved from 11.1 to 13.5 in average, and from 10.4 to 11.5 (p < 0.05) for control group. Among those patients with GOS = 4 before the HBOT, significant GOS improvement was observed in the HBOT group 6 months after HBOT. Based on this study, HBOT can provide some benefits for the subacute TBI patients with minimal adverse side effects.
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Acta Neurochir. Suppl. · Jan 2008
ReviewNovel treatments for cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
Cerebral vasospasm is a major cause of cerebral ischemia and poor outcomes in the setting of aneurysmal subarachnoid hemorrhage (SAH). Despite advances in diagnosis and treatment of SAH, the pathophysiology of vasospasm is still poorly understood and outcomes remain disappointing. Recent advances in understanding the role of hemoglobin in initiating an inflammatory cascade in the subarachnoid space open new avenues for therapy. Preliminary experimental and clinical evidence indicate that targets in the inflammatory and oxidative cascades hold promise in reducing the incidence and impact of cerebral vasospasm.
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Acta Neurochir. Suppl. · Jan 2008
Clinical TrialVentriculostomy for control of raised ICP in acute traumatic brain injury.
The aim of this study was to evaluate the effect of ventriculostomy on intracranial pressure (ICP), and related parameters, including cerebrospinal compensation, cerebral oxygenation (PbtO2) and metabolism (microdialysis) in patients with traumatic brain injury (TBI). ⋯ Ventriculostomy is a useful ICP-lowering manoeuvre, with sustained ICP reduction and related physiological improvements achieved in > 50% of patients.
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Acta Neurochir. Suppl. · Jan 2008
Clinical TrialLong-term outcomes following decompressive craniectomy for severe head injury.
Severe head injury is one of the commonest indications for neurosurgical intervention. For the neurosurgeon, the operative last resort in cases of generalised brain oedema of traumatic origin is the decompressive craniectomy. Is it possible to use predictive factors to ascertain what degree of success, in terms of both the acute and long-term outcome, is to be expected in patients who undergo this treatment? ⋯ The clinical outcome in patients with a severe head injury is to a great degree determined by the extent and type of the primary injury. When considering decompressive hemicraniectomy as a treatment for raised intracranial pressure following traumatic brain injury, the predictive factors detailed here should be taken into consideration.
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Acta Neurochir. Suppl. · Jan 2008
Comparative Study Clinical TrialRegional cerebral blood flow and oxygen metabolism in aneurysmal subarachnoid hemorrhage: positron emission tomography evaluation of clipping versus coiling.
We investigated early postoperative hemodynamic and metabolic values using positron emission tomography (PET) scanning in subarachnoid hemorrhage (SAH) patients treated with clipping or coiling, and evaluated usefulness of PET studies in predicting late ischemic events and neurological outcome in SAH patients. ⋯ A wide range of cerebral perfusion patterns including hyperemia were found in the CLIP group. Surgical manipulation of the brain significantly reduced oxygen metabolism in the operated frontal lobe. PET data alone may not have independent prognostic value for detecting delayed cerebral ischemia or in predicting neurological outcome.