Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialParaspinal approach to the far lateral disc herniations: retrospective study on 42 cases.
Forty-two patients underwent surgery for far-lateral disc herniations. Average patient age was 45.1 years, 28 patients were male and 14 female. The level concerned most was L4-5 disc (55%). ⋯ It requires minimal soft-tissue and bone resection and the herniated disc is directly visualized. Moreover, it contains minimal manipulation of the neuro-vascular structures and avoids significant muscle retraction. However, it requires an adequate learning curve and good familiarity with microsurgical techniques.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialLinear correlation between stable intracranial pressure decrease and regional cerebral oxygenation improvement following mannitol administration in severe acute head injury patients.
We investigated the relationship between stable decrease in intracranial pressure (ICP) following mannitol administration and variations in regional oxygenation (PtiO2) in severe traumatic brain injured (STBI) patients. ⋯ There is a strong negative correlation between stable decrease in ICP following mannitol administration and improvement in regional oxygenation around the peri-contusional area. The data suggest a potentially favourable interaction between mannitol therapy and cerebral internal milieu in STBI patients.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialConcept of "true ICP" in monitoring and prognostication in head trauma.
To propose a new coefficient, which contains information about both the absolute ICP and the position of the 'working point' on the pressure-volume curve. ⋯ The proposed variable is a powerful predictor of fatal outcome following head injury. It is sensitive to both the rising absolute ICP and the critical loss of cerebrovascular regulation.
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Acta Neurochir. Suppl. · Jan 2005
Controlled Clinical TrialThe importance of major extracranial injuries by the decompressive craniectomy in severe head injuries.
Neurosurgical therapy aims to minimise the secondary brain damage after a severe head injury. This includes the evacuation of an intracranial space occupying bleeding, the reduction of intracranial volumes, in hematocephalus an external ventricular drainage, and the conservative therapy in order to influence an increased intracranial pressure (ICP) and a decreased p(ti)02. ⋯ The prognosis after decompression depends on the clinical signs and symptoms on admission, the patients age and the existence of major extracranial injuries. Our guidelines for an indication for decompressive craniectomy after failure of conservative interventions and evacuation of space occupying hematomas include a patients age below 50 years without multiple trauma, a patients age below 30 years in the presence of major extracranial injuries, a severe brain swelling on CT scan, the exclusion of a primary brainstem lesion or injury and the intervention before irreversible brainstem damage and secondarily while monitoring ICP and p(ti)02 in an interval up to 48 hours after the accident before irreversible brainstem damage or generalised brain damage has occurred.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialFuzzy pattern classification of hemodynamic data can be used to determine noninvasive intracranial pressure.
The authors previously introduced a method in which intracranial pressure (ICP) was estimated using parameters (TCD characteristics) derived from cerebral blood flow velocity (FV) and arterial blood pressure (ABP). Some results suggested that this model might be influenced by the patient's state of cerebral autoregulation and other clinical parameters. Hence, it was the aim of the present study to improve the method by modifying the previously used global procedure in certain subgroups of patients. ⋯ The class structure of the model facilitates nICP assessment in heterogeneous patient groups and supports a stepwise extension of the target patient group without affecting the former validity.