Journal of neurosurgery
-
Journal of neurosurgery · Mar 2004
Randomized Controlled Trial Clinical TrialSuccessful use of the new high-dose mannitol treatment in patients with Glasgow Coma Scale scores of 3 and bilateral abnormal pupillary widening: a randomized trial.
The authors evaluated long-term clinical outcomes in selected acutely comatose patients with severe diffuse brain swelling and recent clinical signs of impending brain death who received a novel high-dose mannitol treatment compared with those who received conventional-dose mannitol in the emergency room. ⋯ Ultra-early high-dose mannitol administration in the emergency room is the first known treatment strategy significantly to reverse recent clinical signs of impending brain death, and also to contribute directly to improved long-term clinical outcomes for these patients who have previously been considered unsalvageable.
-
Journal of neurosurgery · Mar 2004
Open reduction of pediatric atlantoaxial rotatory fixation: long-term outcome study with functional measurements.
Atlantoaxial rotatory fixation (AARF) is an uncommon disorder of childhood in which resolution usually occurs spontaneously or after traction therapy. In a minority of children irreducible or chronic fixation develop, and the natural history then usually involves restriction of head on neck movement, abnormal head position, and progressive facial asymmetry. The conventional management in these cases has been a posterior fusion. ⋯ In the authors' opinion, open reduction provides the best possibility of normal facial development and return of axial movement in cases of AARF.
-
Journal of neurosurgery · Mar 2004
Clinical TrialPoor-grade aneurysmal subarachnoid hemorrhage: relationship of cerebral metabolism to outcome.
The majority of patients with poor-grade subarachnoid hemorrhage (SAH), that is, World Federation of Neurosurgical Societies (WFNS) Grades IV and V, have high morbidity and mortality rates. The objective of this study was to investigate cerebral metabolism in patients with low- compared with high-grade SAH by using bedside microdialysis and to evaluate whether microdialysis parameters are of prognostic value for outcome in SAH. ⋯ Microdialysis parameters reflected the severity of SAH. The L/P ratio was the best metabolic independent prognostic marker of 12-month outcome. A better understanding of the causes of deranged cerebral metabolism may allow the discovery of therapeutic options to improve the prognosis, especially in patients with high-grade SAH, in the future.
-
Journal of neurosurgery · Mar 2004
Case ReportsAdding or repositioning intracranial electrodes during presurgical assessment of neocortical epilepsy: electrographic seizure pattern and surgical outcome.
The aim of this study was to investigate changes in electroencephalography (EEG) patterns obtained from added or repositioned electrodes after those initially implanted had failed to indicate the true local ictal onset zone. The authors focused on the following matters: rationale for adding or repositioning electrodes, topographic and frequency characteristics of ictal onset before and after adding or repositioning electrodes, the effect of the procedures, and the relationship between changes in intracranial EEG onset patterns and surgical outcomes. ⋯ The addition or reposition of intracranial electrodes with a short-term interval should be considered in selected patients. Spatial restriction of the ictal onset rhythm identified on repeated evaluation is the most important predictor of a good surgical outcome.
-
Vascular complications related to lumbar disc operations are rare but extremely fatal conditions. The authors analyzed data retrospectively obtained in 13 patients with vascular complications that occurred during lumbar disc operations performed between January 1990 and January 2002. ⋯ Despite its low incidence, iatrogenic vascular injury related to lumbar disc surgery is a possible complication. During lumbar disc operations early diagnosis of vascular injuries and urgent transperitoneal surgery can save patients' lives.