Acta neurochirurgica. Supplement
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The authors report stereotactically created lesioning by radiofrequency or Cyberknife radiosurgery for patients with mental illness. ⋯ Authors suggest that stereotactic psychosurgery by RF and CKRS could be a safe and effective means of treating some medically intractable mental illnesses.
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Acta Neurochir. Suppl. · Jan 2008
Clinical TrialIntracranial pressure and cerebral oxygenation changes after decompressive craniectomy in children with severe traumatic brain injury.
There has been a resurgence of interest in decompressive craniectomy for traumatic brain injury (TBI), but the impact of craniectomy on intracranial pressure (ICP) and cerebral oxygenation has not been well described for diffuse injury in children. ⋯ In selected pediatric patients with TBI, craniectomy for diffuse brain swelling can significantly improve ICP and cerebral oxygenation control. The use of the procedure in appropriate settings does not appear to increase the proportion of disabled survivors.
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Acta Neurochir. Suppl. · Jan 2008
The QOLIBRI--towards a quality of life tool after traumatic brain injury: current developments in Asia.
There is no disease-specific health-related quality of life (HRQoL) tool devoted to traumatic brain injury (TBI). ⋯ TBI patients may now be assessed, beyond more "objective" measures including handicap and recovery, with a new measure of assessing the TBI patient's own opinion on his/her HRQoL, applicable across different populations and cultures. Validations in China Mainland, Hong-Kong, Taiwan, Japan, Egypt, Poland, Norway, Indonesia, and Malaya are on the way.
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Acta Neurochir. Suppl. · Jan 2008
Assessment of mitochondrial impairment and cerebral blood flow in severe brain injured patients.
We believe that in traumatic brain injury (TBI), the reduction of N-acetyl aspartate (NAA) occurs in the presence of adequate cerebral blood flow (CBF) which would lend support to the concept of mitochondrial impairment. The objective of this study was to test this hypothesis in severely injured patients (GCS 8 or less) by obtaining simultaneous measures of CBF and NAA. ⋯ Considering the direct link between energy metabolism and NAA synthesis in the mitochondria, this study showed that in the absence of an ischemic insult, reductions in NAA concentration reflects mitochondrial dysfunction.
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Acta Neurochir. Suppl. · Jan 2008
Evaluation of optimal cerebral perfusion pressure in severe traumatic brain injury.
Traumatic brain injury (TBI) is a major cause of death and disability. In the 2000 guidelines, one of the suggestions for TBI treatment was to maintain cerebral perfusion pressure (CPP) < or = 70 mmHg. But in the 2003 guidelines, the suggestion was changed to < or = 60 mmHg. ⋯ The patients < 50-year-old, with higher GCS level, with ICP monitoring, and with ICP levels < 20 mmHg had lower mortality rates and better prognosis (GOS) (p < 0.05 or 0.001). The patients in the GCS 3-5 subgroup had a significantly lower mortality and better prognosis if the CPP value was maintained higher than 70 mmHg (p < 0.05) The optimal CPP maintained < or = 60 mmHg did not fit in all STBI patients. Our study concludes that it is critical to maintain CPP substantially higher in lower GCS level patients.