Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialSurgical radio-frequency epiduroscopy technique (R-ResAblator) and FBSS treatment: preliminary evaluations.
Failed back surgery syndrome represents a heterogeneous situation that suggests a fibrosis or neuroinflammatory genesis. The social cost related to this issue are enormous. Several surgical techniques have been applied to FBSS patients with controversial effectiveness. In 1998 we evaluated the efficiency and limits of epiduroscopy treatment; it proved to be effective in 75% of cases, but in 45% of cases it needed to be repeated after 12 months. Therefore we subjected 14 patients, who had previously experienced a short temporary benefit by using a traditional epiduroscopic approach, to a new epiduroscopy fibrolysis using a radio-frequency device named "R-Resablator Epiduroscopy". Clinical evaluation was performed before myeloscopy and after 1-3-6 months. After myeloscopy, 93% of patients reported a general improvement. Among the latter, pain was reduced by 90% in 8 patients, by 60-70% in 5, and by less than 30% in 1. ⋯ It can be concluded that RF-Epiduroscopy offers greater therapeutic benefit than traditional epiduroscopy or other surgical techniques. Furthermore, RF-Epiduroscopy is more easily performed and repeated.
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Authors present a seven years retrospective study on 85 cases of severe brain injuries (SBI) in children (GCS
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Acta Neurochir. Suppl. · Jan 2005
Accurate data collection for head injury monitoring studies: a data validation methodology.
BrainIT is a multi centre, European project, to collect high quality continuous data from severely head injured patients using a previously defined [6] core data set. This includes minute-by-minute physiological data and simultaneous treatment and management information. It is crucial that the data is correctly collected and validated. ⋯ Advances in patient care require an improved evidence base. For accurate, consistent and repeatable data collection, robust mechanisms are required which should enhance the reliability of clinical trials, assessment of management protocols and equipment evaluations.
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Acta Neurochir. Suppl. · Jan 2005
Contribution of raised ICP and hypotension to CPP reduction in severe brain injury: correlation to outcome.
The aim of this study was to determine to what degree hypotension and ICP contribute to the reduction of cerebral perfusion pressure (CPP), particularly in light of the shift in emphasis to CPP management by the use of pressors. The study population consisted of severely head injured patients extracted retrospectively from the Traumatic Coma Data Bank and compared with 139 patients from the Smith Kline component of the American Brain Injury Consortium database where outcome was available. The percentage time that ICP exceeded 20 mm Hg and CPP less than 60 mm Hg was computed for 5 days post injury. ⋯ In the first cohort, hypotension was the predominant factor leading to CPP reduction. With use of the CPP concept of treatment, the major contribution to CPP shifted to ICP and arterial hypotension played less of a role. Overall, CPP management has been associated with improved outcome.
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Acta Neurochir. Suppl. · Jan 2005
Subtemporal approach to basilar bifurcation aneurysms: advanced technique and clinical experience.
The surgical treatment of basilar bifurcation aneurysms is challenging, and many of these aneurysms are currently treated by endovascular means. However, the complete closure of the aneurysm by surgical clipping still remains the best and most permanent cure for the aneurysm. The "gold standard", subtemporal approach was established and introduced by Drake and it has been adapted by the senior author Hernesniemi. We describe our present modified technique of this approach based on clinical experience. ⋯ The subtemporal approach is simple and safe in experienced hands, and should be considered the standard method to approach most basilar bifurcation aneurysms.