Journal of neurosurgery
-
Journal of neurosurgery · Apr 1999
Improved survival after aneurysmal subarachnoid hemorrhage: review of case management during a 12-year period.
Based on the concept that unfavorable clinical outcome after aneurysmal subarachnoid hemorrhage (SAH), to a large extent, is a consequence of all ischemic insults sustained by the brain during the acute phase of the disease, management of patients with SAH changed at the authors' institution in the mid-1980s. The new management principles affected referral guidelines, diagnostic and monitoring methods, and pharmacological and surgical treatment in a neurointensive care setting. The impact of such changes on the outcome of aneurysmal SAH over a longer period of time has not previously been studied in detail. This was the present undertaking. ⋯ This study provides evidence that the prognosis for patients with aneurysmal SAH has improved during the last decades. The most striking results were a gradual reduction in mortality rates and improved clinical outcomes in patients with Hunt and Hess Grade I or II SAH and in those with intraventricular hemorrhage. The changes in mortality rates and the clinical outcomes of patients with Hunt and Hess Grades III to V SAH were less conspicuous, although reduced incidences of mortality were seen in some subgroups; however, few survivors subsequently appeared to attain a favorable outcome.
-
Journal of neurosurgery · Apr 1999
Randomized Controlled Trial Clinical TrialA prospective randomized double-blind controlled trial to evaluate the efficacy of an analgesic epidural paste following lumbar decompressive surgery.
Pain control can often be improved by local (as opposed to systemic) application of analgesic and/or anesthetic medication. The purpose of this study was to evaluate the efficacy of a single-dose epidural analgesic "paste" in the control of postoperative pain in patients who have undergone lumbar decompressive surgery. ⋯ Application of an analgesic paste directly to the epidural space during lumbar decompressive surgery significantly improves postoperative pain control, reduces prescribed analgesic drug consumption, and improves overall health perception for up to 6 weeks following surgery. The authors conclude that this postoperative pain control strategy is both effective and safe and may provide a new standard of pain management in patients undergoing lumbar discectomy or laminectomy.
-
Journal of neurosurgery · Apr 1999
Case Reports Comparative StudyMagnetic resonance cisternography used to determine precise topography of the facial nerve and three components of the eighth cranial nerve in the internal auditory canal and cerebellopontine cistern.
The detailed anatomy of intracranial structures has been studied mainly in cadavers, but the absence of cerebrospinal fluid and blood pressure in these models distorts normal spatial relationships. The authors investigated the rotation of the facial nerve (FN), superior vestibular nerve (SVN), inferior vestibular nerve (IVN), and cochlear nerve (CN) in the internal auditory canal (IAC) and cerebellopontine cistern in human volunteers and compared their results with those reported in cadaver studies. ⋯ It is more accurate to describe the CN and IVN as coursing beneath the SVN in either the IAC or cerebellopontine cistern, rather than stating that the three components rotate, as reported in cadaver studies. The MR cisternography studies provided quite detailed information about the topography of the four components and the relationship between the blood vessels and cranial nerves in the IAC and the cerebellopontine cistern.
-
Journal of neurosurgery · Apr 1999
Comparative StudyHow should a subarachnoid hemorrhage grading scale be determined? A combinatorial approach based solely on the Glasgow Coma Scale.
The purpose of this study was to present a combinatorial approach used to develop a subarachnoid hemorrhage (SAH) grading scale based on the patient's preoperative Glasgow Coma Scale (GCS) score. ⋯ The combinatorial approach, guided by the break points, is so simple and systematic that it can be used again in the future when revision of the grading scale becomes necessary after development of new and effective treatment modalities that improve patients' overall outcome.
-
Journal of neurosurgery · Apr 1999
Delayed neurological deterioration following resection of arteriovenous malformations of the brain.
The aim of this study was to analyze delayed neurological deficits following surgical resection of arteriovenous malformations (AVMs). ⋯ On the basis of their analysis of these complications, the authors recommend strict blood pressure control for patients with lesions measuring 4 cm or more in diameter (particularly those with a deep arterial supply). Thromboprophylaxis with aspirin and heparin is prescribed for patients with extensive venous drainage networks, and prophylactic nimodipine therapy and angiographic surveillance for vasospasm are suggested for patients in whom extensive dissection of proximal anterior or middle cerebral arteries has been necessary.