Acta neurochirurgica
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Acta neurochirurgica · Nov 2011
Low-frequency sampling for PRx calculation does not reduce prognostication and produces similar CPPopt in intracerebral haemorrhage patients.
The cerebral pressure reactivity index (PRx) correlates with the outcome in intracerebral haemorrhage (ICH) patients and has been used to define an autoregulation-oriented "optimal cerebral perfusion pressure" (CPPopt). PRx has been calculated as a moving correlation coefficient between mean arterial pressure (MAP) and intracranial pressure (ICP) averaged over 5-10 s, using a 2.5- to 5-min moving time window, in order to reflect changes in MAP and ICP within a time frame of 20 s to 2 min. We compared PRx with a different calculation method [low-frequency PRx (L-PRx)], where rapid fluctuations of MAP and ICP are cancelled (waves with frequencies greater than 0.01 Hz). ⋯ L-PRx correlated with the outcome as good as PRx did. CPPopt could be identified in more patients using L-PRx. Slower MAP and ICP changes (in the range of 1-20 min) can be used for autoregulation assessment and contain important prognostic information.
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Acta neurochirurgica · Nov 2011
Case ReportsEnhanced analysis of intracerebral arterioveneous malformations by the intraoperative use of analytical indocyanine green videoangiography: technical note.
In cerebral arterioveneous malformations (AVMs) detailed intraoperative identification of feeding arteries, nidal vessels and draining veins is crucial for surgery. Intraoperative imaging techniques like indocyanine green videoangiography (ICG-VAG) provide information about vessel architecture and patency, but do not allow time-dependent analysis of intravascular blood flow. Here we report on our first experiences with analytical indocyanine green videoangiography (aICG-VAG) using FLOW 800 software as a useful tool for assessing the time-dependent intraoperative blood flow during surgical removal of cerebral AVMs. ⋯ Effects of stepwise vessel obliteration on velocity and direction of AVM blood flow can be objectified. High quality of visualization, however, is limited to the site of surgery. Colour-encoded aICG-VAG with FLOW 800 enables intraoperative real-time analysis of arterial and venous vessel architecture and might, therefore, increase efficacy and safety of neurovascular surgery in a selected subset of superficial AVMs.
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Acta neurochirurgica · Nov 2011
Comparative StudyOsteoplastic decompressive craniotomy--an alternative to decompressive craniectomy.
In spite of various degrees of brain expansion, decompressive surgery is usually carried out using decompressive craniectomy (DC). After craniectomy it is necessary to perform cranioplasty, which prolongs hospitalization and is not always without complications. Hence, in situations when cranial decompression is indicated, but DC would be too radical, we do not remove the bone flap, and we perform so-called osteoplastic decompressive craniotomy (ODC). The technique is detailed. ⋯ Our limited study shows that ODC is effective in the treatment of intracranial hypertension in the selected subgroup of patients in whom DC would be too radical. The main advantage of this method is the elimination of further cranioplasty.
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Acta neurochirurgica · Nov 2011
Use of long autologous nerve grafts in brachial plexus reconstruction: factors that affect the outcome.
Using grafts directed to distal targets in brachial plexus reconstruction has the advantage over proximal targets of avoiding axonal dispersion. A long graft (more than 10 cm) is needed to reach most distal targets. The objective of this article is to identify factors associated with good versus poor outcomes in a clinical series of long grafts used for distal brachial plexus reconstruction. ⋯ The results of a series of distal brachial plexus target reinnervations with long grafts is presented and analyzed. According to them, time from trauma to surgery and an adequate postoperative rehabilitation are important predictors of outcome.