Acta neurochirurgica
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Acta neurochirurgica · Jan 1999
Randomized Controlled Trial Clinical TrialPostoperative pain therapy after lumbar disc surgery.
This study was undertaken to determine whether a special postoperative pain administration of tramadol and diclofenac provides any benefits in patients who underwent microsurgical lumbar discectomy. ⋯ The results suggest that the application of tramadol and diclofenac during the first 48 hours after lumbar microdiscectomy results in a reduction in postoperative pain without complications. We suggest that the use of this combination can be a beneficial adjunct to lumbar disc surgery.
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Acta neurochirurgica · Jan 1999
Expansive suboccipital cranioplasty for the treatment of syringomyelia associated with Chiari malformation.
In order to treat syringomyelia associated with adult type Chiari malformation, the authors developed a method of expansive suboccipital cranioplasty (ESC) that involves enlarging the small posterior fossa to obtain a sufficient flow of cerebrospinal fluid (CSF). The relative effectiveness of ESC with the obex plugged and not plugged was also examined, as well as other factors influencing the operative results. Twenty patients without arachnoid adhesion at the major cistern underwent ESC without opening the arachnoid membrane at the major cistern. ⋯ Intra-arachnoid procedures are not necessary to facilitate restoration of CSF flow in patients without arachnoid adhesions, because ESC can release the CSF flow blockage in the major cistern even without plugging of the obex. An associated arachnoid adhesion at the major cistern or a long-standing syringomyelia with irreversible damage of the spinal cord results in a poor operative prognosis. When posterior fossa surgery fails, insufficient decompression or postoperative arachnoid adhesions at the major cistern as the cause of treatment's failure should be evaluated by CSF flow studies using phase contrast MR imaging.
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Acta neurochirurgica · Jan 1999
Comparative Study Clinical TrialAdvantage of intravenous anaesthesia for acute stage surgery of aneurysmal subarachnoid haemorrhage.
To investigate the clinical effects of intravenous anaesthesia on surgical procedure and the outcome in acute stage surgery for aneurysmal subarachnoid haemorrhage (SAH), pre-, intra-, and post-operative factors were analyzed to compare between inhalational (IA, n = 38) and intravenous (IVA, n = 37) anaesthesia. IVA significantly shortened the duration of surgery (p < 0.05) and the duration of hospital stay (p < 0.01). These results suggest that IVA may be more suitable than IA for acute stage surgery of aneurysmal SAH. These effects may be mainly caused by IVA's pharmakokinetics, by effects on intracranial homeostasis and metabolism, and neuroprotective properties.
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Acta neurochirurgica · Jan 1999
Comparative StudyThe effect of implementation of guidelines for the management of severe head injury on patient treatment and outcome.
The authors retrospectively analysed two groups of consecutive patients who were similarly matched for brain injury severity. From a total of 39 severe head injury patients, 23 were treated according to the Guidelines for the Management of Severe Head Injury with intracranial pressure (ICP) monitoring ("Guidelines group"). Such an approach allowed the maintenance of ICP within normal values, especially in patients with intraventricular ICP monitoring allowing the release of cerebrospinal fluid (CSF) from the ventricular system. ⋯ Furthermore, there was a 32% decrease in severe neurological disabilities in those patients in the Guidelines group. It seems that the implementation of "Guidelines" in the treatment of severe head injury, based on the result of our clinical study, reduces death and disability rates in patients with severe head injury. The administration of therapy based on the "Guidelines principles" and monitoring of ICP, can minimise the application of those therapeutic modalities (barbiturate coma and prolonged hyperventilation) which, in addition to favourable effects, may also have harmful effects on patients with severe head injury.
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Acta neurochirurgica · Jan 1999
Comparison between monopolar and bipolar electrical stimulation of the motor cortex.
Intra-operative neurophysiological techniques allow reliable identification of the sensorimotor region and make their anatomical and functional preservation feasible. Monopolar cortical stimulation has recently been described as a new mapping technique. In the present study this method was compared to the "traditional" technique of bipolar stimulation. ⋯ Contrary to the general clinical view, there is considerable overlapping of primary motor units over a cortical area much broader than the "classical" narrow motor strip along the CS. Bipolar cortical stimulation is more sensitive than monopolar for mapping motor function in the premotor frontal cortex. Both methods are equally sensitive for mapping the primary motor cortex.