Neurochirurgia
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Intracranial hypertension which does not respond to customary hyperosmotic agents may successfully be treated with hypertonic saline. The absence of diuresis and the maintainance of intravascular volume are supposed to be the main advantages of hypertonic sodium chloride. Volume overload and toxic hyperosmolality from frequent application of such solutions are possible disadvantages. ⋯ Extrapolation of the curves demonstrated that the preinfusion state would have been reached after about 20 minutes. Osmolality remained increased by about 4 mosmol/kg 15 min after the bolus. Thus it appears that repetitive infusion of these amounts of hypertonic saline will cause no serious volume overload if 30 minutes intervals are kept, but osmolality should be checked before each bolus.
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We report the outcome of a retrospective study on the frequency of pulmonary embolism during the hospital stay in a series of 7,250 neurosurgical patients. Of 4,500 patients who underwent surgery 25 (0.55%) developed pulmonary embolism at some point after the operation while 5 of the 2,750 patients not operated on (0.18%) developed a fatal pulmonary embolism. ⋯ Meningioma was the most frequent intracranial tumor to be affected by this complication. We discuss the connection between thromboembolism and meningioma.
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Penetrating trauma to the cervical spine can result in major neurological deficits due to spinal cord damage. Discussed are four civilian cases of dramatic penetrating cervical injuries without spinal cord involvement. These injuries occurred in the anteroposterior direction, and the facial structures and/or vertebral bodies appeared to have provided some protection to the spinal cord. It is proposed that the cervical spinal cord may be less vulnerable to penetrating injuries in the anteroposterior plane due to incrementally collapsible compartments of facial soft tissue and bony sinus structures which can absorb kinetic energy and dissipate momentum.
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Transcranial doppler ultrasound (TCD) is suitable in the diagnosis of vasospasm in subarachnoid hemorrhage. The value of TCD in intracranial malformations and other neurosurgical disorders will be discussed. TCD is a screening-method in the diagnosis of brain death.
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Clinical, radiological, surgical and experimental observations make it possible to construct a rational theory of the segmental lumbar instability which explains the pathogenesis of spondylosis, of stenosis and of several cases of disc displacement as well. This theory helps us to choose the right surgical procedure. Spinal stenosis, degenerative spondylolisthesis and some cases of disc displacement are seen as part of a degenerative process with its starting point in regressive changes of the intervertebral disc and lateral joint. ⋯ In such cases, if decompression of the roots by laminectomy, facetectomy or discectomy is performed without fusion, the consequences are usually treated but not the main cause of the trouble, namely the instability. Finally, we describe a procedure which we prefer as the safest and best of all, using selected decompression by means of joint screws (spondylodesis) as suggested by F. Magerl (41-44).