Journal of neurosurgery
-
Journal of neurosurgery · Mar 1998
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialDutch Normal-Pressure Hydrocephalus Study: randomized comparison of low- and medium-pressure shunts.
The goal of this prospective study was to compare outcome after placement of a low- or medium-pressure shunt in patients with normal-pressure hydrocephalus (NPH). ⋯ Outcome was better for patients who had an LPV shunt than for those with an MPV shunt, although most differences were not statistically significant. The authors advise that patients with NPH be treated with an LPV shunt.
-
Journal of neurosurgery · Mar 1998
Comparative StudyAugmented neuronal death in CA3 hippocampus following hyperventilation early after controlled cortical impact.
Minimizing secondary injury after severe traumatic brain injury (TBI) is the primary goal of cerebral resuscitation. For more than two decades, hyperventilation has been one of the most often used strategies in the management of TBI. Laboratory and clinical studies, however, have verified a post-TBI state of reduced cerebral perfusion that may increase the brain's vulnerability to secondary injury. In addition, it has been suggested in a clinical study that hyperventilation may worsen outcome after TBI. ⋯ Aggressive hyperventilation early after TBI augments CA3 hippocampal neuronal death; however, it did not impair functional outcome or expand the contusion. These data indicate that CA3 hippocampal neurons are selectively vulnerable to the effects of hyperventilation after TBI. Further studies delineating the mechanisms underlying these effects are needed, because the injudicious application of hyperventilation early after TBI may contribute to secondary neuronal injury.
-
Journal of neurosurgery · Mar 1998
Case ReportsDepressed skull fracture overlying the superior sagittal sinus as a cause of benign intracranial hypertension. Case report.
The use of surgical treatment for depressed skull fractures that are located over major venous sinuses is a matter of controversy. However, if clinical and radiological findings of sinus obliteration and related intracranial hypertension are present, surgical decompression is indicated. ⋯ The role of radiological investigation in the detection of venous sinus flow and indications for surgical treatment are discussed. If venous sinus flow obstruction is revealed in the presence of signs and symptoms of intracranial hypertension, surgery is indicated as the first line of treatment.
-
Journal of neurosurgery · Mar 1998
Comparative Study"Threshold-level" multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal motor tracts: description of method and comparison to somatosensory evoked potential monitoring.
Numerous methods have been pursued to evaluate function in central motor pathways during surgery in the anesthetized patient. At this time, no standard has emerged, possibly because each of the methods described to date requires some degree of compromise and/or lacks sensitivity. ⋯ This novel method for intraoperative monitoring of spinal motor conduction appears to meet all of the goals outlined above. Although the risk of postoperative motor deficit is relatively low for the majority of spine surgeries (for example, a simple disc), high-risk procedures, such as tumor resection, correction of vascular abnormalities, and correction of major deformities, should benefit from the virtually immediate and accurate knowledge of spinal motor conduction provided by this new monitoring approach.
-
Journal of neurosurgery · Mar 1998
Comparative StudyExternal hydrocephalus after aneurysm surgery: paradoxical response to ventricular shunting.
The authors sought to investigate the mechanisms and pathophysiological effects of subdural fluid collection after surgery for aneurysmal subarachnoid hemorrhage (SAH). ⋯ The results indicate that for most patients in the SAH group, subdural fluid collection represented "external hydrocephalus" rather than simple "subdural hygroma." Decreased absorption of cerebrospinal fluid because of SAH and surgically created tears in the arachnoid membrane communicating with the subdural space were factors in the development of external hydrocephalus. The authors believe that differentiating external hydrocephalus from subdural hygroma is extremely important, because VP shunt placement can be used to treat the former but could worsen the latter.