Acta neurochirurgica
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Acta neurochirurgica · Aug 2005
A morphometric analysis of the foramen magnum region as it relates to the transcondylar approach.
The transcondylar approach is being increasingly used to access lesions ventral to the brainstem and cervicomedullary junction. Understanding the bony anatomy of this region is important for this approach. The purpose of this study was to conduct a morphometric analysis of the hypoglossal canal (HC), occipital condyle (OC) and the foramen magnum (FM) as it pertains to the transcondylar approach. ⋯ The occipital condyle is frequently being drilled to expose lesions ventral to the brainstem. From our study, it is evident that the occipital condyle can be safely drilled for a distance of 12 mms from the posterior margin before encountering the hypoglossal canal. In 20% of the skulls the occipital condyle protrudes significantly into the foramen magnum. Wide and sagittally inclined occipital condyles, medially protruberant occipital condyles along with a foramen magnum index of more than 1.2 will require much more extensive bony resection than otherwise. With the availability of recent imaging techniques, it is possible to anticipate the extent of bony resection required in an individual case by using the above mentioned morphometric features.
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Acta neurochirurgica · Aug 2005
Timing of aneurysm surgery in subarachnoid haemorrhage--an observational study in The Netherlands.
There is still lack of evidence on the optimal timing of surgery in patients with aneurysmal subarachnoid haemorrhage. Only one randomised clinical trial has been done, which showed no difference between early and late surgery. Other studies were observational in nature and most had methodological drawbacks that preclude clinically meaningful conclusions. We performed a retrospective observational study on the timing of aneurysm surgery in The Netherlands over a two-year period. ⋯ In this observational study we found no significant difference in outcome between early and late operation for patients in good clinical condition on admission. For patients in poor clinical condition on admission outcome was significantly better after early surgery. The optimal timing of surgery is not yet settled. Ideally, evidence on this issue should come from a randomised clinical trial. However, such a trial or even a prospective study are unlikely to be ever performed because of the rapid development of endovascular coiling.
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Acta neurochirurgica · Aug 2005
Comparative StudyEffect of awake Carotid Endarterectomy under local anaesthesia on peri-operative blood pressure: blood pressure is normalised when carotid stenosis is treated under local anaesthesia.
Carotid Endarterectomy can be performed under local, regional or general anaesthesia. One of the most important effects of the type of anaesthetic used is on the systemic blood pressure. Although variations in blood pressure during and following carotid endarterectomy have been studied previously, the effects of awake carotid endarterectomy under local anaesthesia on blood pressure and its comparison with similar procedures under similar types of anaesthesia have not. ⋯ The study provides evidence about the effect of carotid endarterectomy on the systemic blood pressure and its variations when performed under different types of anaesthesia. There is significant post-operative reduction in both the systolic and diastolic blood pressure values and the intraoperative fluctuation is minimal when local anaesthesia is used. Further studies are required to find out how this affects the long-term blood pressure and clinical outcome of the patient.
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Acta neurochirurgica · Aug 2005
Case ReportsFusiform aneurysm of the vertebral artery presenting with hemifacial spasm treated by microvascular decompression.
We report a rare case of symptomatic hemifacial spasm caused by a fusiform vertebral artery aneurysm. A 59-year-old woman presented with left hemifacial spasm of 18 months duration. ⋯ Microvascular decompression of the facial nerve with moving of the aneurysm resulted in complete relief of the hemifacial spasm. No enlargement of the aneurysm was shown on follow-up for a period of 6 years.
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Acta neurochirurgica · Jul 2005
Multicenter StudyContinuous cerebral compliance monitoring in severe head injury: its relationship with intracranial pressure and cerebral perfusion pressure.
Cerebral compliance expresses the capability to buffer an intracranial volume increase while avoiding a rise in intracranial pressure (ICP). The autoregulatory response to Cerebral Perfusion Pressure (CPP) variation influences cerebral blood volume which is an important determinant of compliance. The direction of compliance change in relation to CPP variation is still under debate. The aim of the study was to investigate the relationship between CPP and compliance in traumatic brain injured (TBI) patients by a new method for continuous monitoring of intracranial compliance as used in neuro-intensive care (NICU). ⋯ Low CPP levels are confirmed to be detrimental for intracranial compliance. Moreover, when ICP was pathological, indicating unstable intracranial equilibrium, a high CPP level was also associated with a low volume-buffering capacity.