Acta neurochirurgica
-
Acta neurochirurgica · Jan 1994
Penetrating craniocerebral shrapnel injuries during "Operation Desert Storm": early results of a conservative surgical treatment.
A follow-up study is presented of the initial neurosurgical treatment of 20 patients who sustained penetrating craniocerebral injuries during "Operation Desert Storm". Fifteen of these patients had received intracranial debridement through a craniectomy and five patients had received care of scalp wounds only. Following treatment and stabilisation in a frontline hospital, these patients were transferred to the Riyadh Armed Forces Hospital for further evaluation and management. ⋯ No patient died or developed a seizure disorder. These results suggest that re-operation for removal of retained fragments is unnecessary. It is concluded that the initial treatment of shrapnel wounds of the brain should be to preserve maximal cerebral tissue and function either by limiting the wound debridement performed through a craniectomy or by care of scalp wounds only.
-
Acta neurochirurgica · Jan 1994
Duration of symptoms as a predictor of outcome after lumbar disc surgery.
Retrospectively 93 consecutive patients operated on for lumbar disc herniation were studied in order to evaluate the prognostic value of symptoms (lumbar pain and sciatica) and sick-leave. Surgical results were evaluated 1-3 years postoperatively by a questionaire. The duration of the present attack of sciatica and sick-leave prior to surgery was significantly longer in the group with unsatisfactory outcome compared to the group with satisfactory outcome. ⋯ Patients who returned to the same type of work had a preoperatively statistically significant shorter duration of present sick-leave, compared to the patients who had changed the type of work and the patients who did not return to work. The patients with duration of their present sick-leave of less than 6 months had a significantly higher percentage of returning to the same type of work compared to patients with duration of their present sick-leave of 6-12 months and more than 12 months. We conclude that the duration of sciatica and sick-leave before the operation has value as predictive factors concerning the over-all result after surgery for lumbar disc herniation.
-
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)
-
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.
-
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.