Acta neurochirurgica
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Acta neurochirurgica · Jan 1994
Cause, distribution and significance of episodes of reduced cerebral perfusion pressure following head injury.
A group of 74 patients with head injury (54 severe, 17 moderate and 3 minor) had continuous monitoring of both arterial and intracranial pressure with computer-based registration of these pressures, cerebral perfusion pressure and other variables. In 60 patients cerebral perfusion pressure CPP fell below 60 mm Hg for periods of 5 minutes or longer. ⋯ There was a significant correlation between low CPP due to reduced arterial pressure and the Injury Severity Score (p < 0.001), suggesting that resuscitative measures may have been less than optimal in these cases. There was also significant correlation between the duration of low CPP and low arterial pressure and an adverse outcome from injury as assessed at 6, 12 and 24 months after injury (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta neurochirurgica · Jan 1994
Facial motor responses evoked by direct electrical stimulation of the trigeminal root. Localizing value for radiofrequency thermorhizotomy.
In Sweet's description of RF-thermocoagulation for trigeminal neuralgia, the trigeminal nerve was stimulated at 50 c/s to evoke paraesthesias, in order to check the electrode location before the thermolesion is made. In 1979, we changed the frequency to 5 c/s, so as to produce in addition twitches in the masticatory muscles (in stead of the less detectable tetanization produced by 50 c/s stimulation). Since then, we started to observe, also, twitches in the muscles innervated by the facial nerve. ⋯ So, getting EMR in the territory of the pain can be a helpful indicator for an accurate location of the electrode in the trigeminal root, according to its somatotopic organization. These EMR are hypothesized to be due to a trigemino-facial reflex. A preliminary intra-operative EMG study clearly shows that for EMR in the upper part of the face we are dealing with blink-like reflexes, whilst for EMR in the lower face, mechanisms still remain unclear and need further study to be understood.
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Acta neurochirurgica · Jan 1994
Historical ArticleGain and loss of the ability to compete. Some aspects of German neurosurgery up to 1939.
Sketchy biographies of 4 German neurosurgeons (Krause, Foerster, Stieda, Tönnis) demonstrate how neurosurgery in Germany rapidly developed and flourished from the end of the 19th century to the middle of the thirties. However, the dictatorship of Hitler, racial persecution, and the Second World War disturbed this promising development markedly and the aftermath was prolonged. It took many years to restore disrupted international relations and to regain the ability to compete in the scientific field.
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Acta neurochirurgica · Jan 1994
Subdural and depth electrodes in the presurgical evaluation of epilepsy.
From 1987 to 1992, invasive EEG studies using subdural strips, grids or depth electrodes were performed in a total of 160 patients with medically intractable epilepsy, in whom scalp EEG was insufficient to localize the epileptogenic focus. Dependent on the individual requirements, these different electrode types were used alone or in combination. Multiple strip electrodes with 4 to 16 contacts were implanted in 157 cases through burrholes, grids with up to 64 contacts in 15 cases via boneflaps, and intrahippocampal depth electrodes in 36 cases using stereotactic procedures. ⋯ We did not encounter any permanent morbidity or mortality in our series. In our experience, EEG-monitoring with chronically implanted electrodes is a feasible technique which contributes essentially to the exact localization of the epileptogenic focus, since it allows nearly artefact-free recording of the ictal and interictal activity. Moreover, grid electrodes can be used for extra-operative functional topographic mapping of eloquent brain areas.
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Acta neurochirurgica · Jan 1994
Statistical analysis of the factors affecting the outcome of extradural haematomas: 115 cases.
115 traumatic extradural haematoma cases who were treated surgically at Cerrahpasa Medical Faculty Neurosurgery Department between 1987 and 1992 are evaluated. When factors affecting the outcome were examined, a strong correlation was found between the result and Glasgow coma scale (GCS) (p < 0.00001). The existence of a fracture, the interval between onset of haematoma symptoms and intervention and the existence of an intracerebral haematoma together with contusion accompanying intradural haematoma, affect the outcome in a negative direction. There was no statistical correlation between the outcome and the age of patient, localization of the haematoma and aetiology.