Zentralblatt für Neurochirurgie
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Zentralbl. Neurochir. · Jan 2000
Case ReportsHead injury monitoring using cerebral microdialysis and Paratrend multiparameter sensors.
Following head injury complex pathophysiological changes occur in brain metabolism. The objective of the study was to monitor brain metabolism using the Paratrend multiparameter sensor and microdialysis catheters. ⋯ The combination of microdialysis catheters and Paratrend sensors enabling the monitoring of substrate delivery and brain metabolism, and the detection of secondary metabolic insults has the potential to assist in the management of head-injured patients.
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The present study describes 15 cases of intracranial infections developed in a group of in patients with missile brain wound (MBW), during the war in Croatia in the region of East Slavonia. ⋯ The liberal use of post-contrast CT of the brain within the first 2 months after injury, especially if performed early in the clinical course, can lead to a prompt diagnosis of most of "early intracranial infections". The surgical procedures in order to prevent wound CSF fistula/dehiscence development are absolutely necessary. The immediate scalp and dural wound repair in case of wound complications are absolutely indicated and if needed, the procedures can be repeated. However, it seems that retained fragments are not responsible for an increased rate of intracranial infection.
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Zentralbl. Neurochir. · Jan 2000
Comparative Study[Clinical experience with various shunt systems in normal pressure hydrocephalus].
In patients with normal pressure hydrocephalus in the late stage conventional differential valves have the disadvantage that they open abruptly while changing the body position to the vertical line and that they can therefore induce a suction on the ventricles of the atrophic brain. Can these disadvantages and overdrainage complications be minimized by hydrostatic valves? In 117 patients diagnosed for normal pressure hydrocephalus we have implanted 47 Cordis Standard Valves (CSV), 20 Cordis Orbis Sigma Valves Type I (OSV) and 50 Miethke Dual Switch Valves (DSV). 95 patients (36/19/40) could be re-evaluated by means of a control examination. Normal pressure hydrocephalus was graduated according to the results of the intrathecal infusion test in an early and late stage. ⋯ The course of the disease in patients with normal pressure hydrocephalus is influenced by the stage of the disease--degree of cerebral atrophy--and also by the implanted valve type. The high amount of overdrainage complications and subdural hematomas in the Cordis Orbis Sigma Valve Type I group is an argument against its use. Our clinical experiences with the Miethke Dual Switch Valve show that this hydrostatic valve is of advantage for patients with a normal pressure hydrocephalus.
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Zentralbl. Neurochir. · Jan 2000
Comparative StudyNear-infrared spectroscopy--not useful to monitor cerebral oxygenation after severe brain injury.
Since its development more than twenty years ago, non-invasive near-infrared-spectroscopy (NIRS) has been widely used to monitor cerebral oxygenation. Despite of its growing number of users, the diagnostic value of near-infrared spectroscopy still remains unclear, especially in case of acute brain injury and long-term neuromonitoring, necessary during intensive care therapy. To evaluate quality and sensitivity of NIRS measurements compared to invasive ICP-, CPP- and regional brain tissue--pO2 (p(ti)O2) monitoring, 31 patients, suffering from severe brain injury due to subarachnoid hemorrhage or severe head injury, were studied. ⋯ Only induced hyperoxia (FiO2 = 1.0) revealed a significant correlation between both parameters (r = 0.67, p < 0.01). Lower or no correlation was found after changing paCO2 and administration of mannitol. The high failure rate and the limited sensitivity does not make the clinical use of near-infrared spectroscopy suitable as a part of neuromonitoring after acute brain injury at the present time.
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Zentralbl. Neurochir. · Jan 2000
Prognostic significance of advanced neuromonitoring after traumatic brain injury using neural networks.
While the therapeutic impact of tissue oxygenation (PtiO2) supplementing ICP-monitoring is proven by several clinical studies, its prognostic value is not well studied. In the following study artificial neural networks (ANN) were used to analyze the accuracy of outcome prediction after traumatic brain injury (TBI) for different combinations of clinical data and parameters derived from neuromonitoring. The total group included 95 patients suffering from TBI. ⋯ A combination of all parameters lead to results lying between the above results. The results indicate that prediction of outcome can be improved by combining clinical and neuromonitoring data. The prognostic value of ICP might be superior to that of PtiO2.