Neurochirurgia
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In 43 patients osmotherapy with Mannitol 20% and Sorbitol 40% was applied and the changes of the concentrations of lactate and pyruvate were tested in blood. The lactate level of both substances was increased. Sorbitol had the greater effect, and showed its maximum after one hour. ⋯ Therefore the coefficient of lactate to pyruvate is significantly raised. These results highlight the problems of osmotherapy, if the changes of metabolism, induced by the therapy, are not considered. Lactid acidosis, previously existing or a general acidosis, shock, diabetes mellitus and hepatic dysfunctions enhance the risk of osmotherapy especially with Sorbitol.
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Cosmetic aspects and protection of the brain from mechanical injuries are the most common indications for the repair of traumatic and operative cranial defects. We suggest two additional indications: Cranioplasty is not only important in the treatment of space-occupying fluid cysts, but also in preventing or overcoming hemisphere collapse with its resultant displacement of the midline structures. This complication was almost exclusively found in patients subjected to extensive lateral craniotomies and also led to psycho-organic syndromes with disturbances of mood and drive. ⋯ The recovery of the patients was almost complete after the repair of the cranial defect. Clinical improvement was due to restitution of physiological intracranial pressure state and re-expansion of the cerebral hemispheres as could be shown by computer tomography. The operative procedure of auto-, homo- and heteroplastic cranioplasty is described, with particular emphasis on the new technique with acrylic plastic, developed by the authors.
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The release of tissue thromboplastin after a severe brain injury can lead to a consumption coagulopathy. In a group of 83 patients with severe brain injury, platelet count, fibrinogen, prothrombin, partial thromboplastin time and thrombin time were investigated. The pathological laboratory findings in 14 were compatible with a consumption coagulopathy. These alterations were demonstrated during the first hours following trauma and represented an extra handicap for the patients who had to be treated surgically.
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The authors report on 200 cervical percutaneous cordotomies in 146 patients who were suffering from intractable pain. In order to assess the success rate and the incidence of relapse, the neurological findings immediately post-operatively were compared with the results of a later follow-up. The prospect of success in the treatment of pain appears to depend on the anatomical representation in the spino-thalamic tract of the region of the body which is involved. The incidence of complications and the mortality are compared with the observations of other authors and with the results of open cordotomy.