Acta neurochirurgica
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Acta neurochirurgica · Jan 1995
Criteria for conservative treatment of supratentorial acute subdural haematomas.
Without mortality, 31 patients underwent conservative treatment for traumatic supratentorial acute subdural haematoma (SDH). Later on six of them had the haematoma surgically evacuated mainly because of a deterioration of the Glasgow Coma Scale (GCS) scores. It was found that patients with a midline shift of less than 10 mm on the computed tomography (CT) scans and with a GCS score of 15 initially might be treated conservatively under close observation, reserving urgent craniotomy and evacuation of the SDH for those with deteriorating neurological conditions. ⋯ In such cases the GCS score worsened, and surgical evacuation of the SDH became necessary. A total hospital stay of 6 to 7 days may suffice for those who have become fully conscious. Repeat CT studies before discharge should be done and a close follow-up during the first 3 to 4 weeks is advisable.
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Acta neurochirurgica · Jan 1995
Case ReportsPeri-operative complications in adult moyamoya disease.
The incidence and causes of peri-operative haemodynamic complications in adult Moyamoya disease were examined by reviewing 55 surgically treated adult patients. Ninety-nine craniotomies were performed in these patients, and eight peri-operative complications (four infarctions, two haemorrhagic infarctions and two reversible ischaemic neurological deficits without a new lesion) were seen. ⋯ Surgical factors which might be responsible for the complications were noted in three cases. Sparing vital collateral vessels and minimum brain retraction as well as avoidance of non-surgical haemodynamic risk factors are considered to be essential to prevent peri-operative haemodynamic brain damage in adult Moyamoya disease.
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Nine cases of posttraumatic primary brain stem haematoma are described. All cases presented ocular and vegetative symptoms. Hyperextension was regarded as the most likely mechanism of injury. All patients were treated conservatively; half of them with a good outcome.
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Acta neurochirurgica · Jan 1995
Intra-arterial infusion of papaverine combined with intravenous administration of high-dose nicardipine for cerebral vasospasm.
The clinical effect of combination therapy with high doses of intravenous nicardipine and intra-arterial infusion of papaverine on symptomatic vasospasm after subarachnoid haemorrhage (SAH) was analysed retrospectively. In 66 of 122 patients who underwent early aneurysm surgery between 1990 and 1993, the intracranial haemodynamics were documented by transcranial Doppler (TCD) ultrasonography. 33 of these 66 patients received high dose nicardipine intravenously (Group I); the other 33 patients were not treated with calcium antagonists (Group II). ⋯ Although the mean flow velocity (MFV) was not different between the two groups, it was reduced significantly after papverine infusion. Our retrospective analysis suggests that symptomatic vasospasm can be treated effectively with the combination of intravenous high dose nicardipine and intra-arterial infusion of papaverine, and that the correct timing of the infusions is crucial.
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Acta neurochirurgica · Jan 1995
In vitro and in vivo efficacy of a rifampin-loaded silicone catheter for the prevention of CSF shunt infections.
Infection of cerebrospinal fluid (CSF) shunts is one of the major complications associated with their use and is usually managed by shunt removal, temporary insertion of an external drainage and implantation of a new shunt system. We have evaluated the efficacy of a rifampin-loaded silicone ventricular catheter to prevent bacterial colonization and infection in vitro and in an animal model. On the basis of an incorporation process a rifampin-loaded catheter was developed which is capable of releasing rifampin in bacteriocidal concentrations for 60 days and more. ⋯ Furthermore, in none of the materials obtained after sacrifice of the animals (catheter, brain tissue, CSF, blood) could the infecting bacteria be cultured, whereas in materials from animals with the unloaded catheter the infecting strains could always be cultured from the catheter and from surrounding brain tissue. The histological examination of catheter-adjacent tissue supported these findings. We conclude that a rifampin-loaded silicone ventricular catheter is capable of completely preventing bacterial colonization and infection by staphylococci as the main causative organisms in CSF shunt infections and should be further evaluated in clinical trials.