Journal of neurosurgery
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Journal of neurosurgery · Mar 2008
Use of hemoglobin-based oxygen-carrying solution-201 to improve resuscitation parameters and prevent secondary brain injury in a swine model of traumatic brain injury and hemorrhage: laboratory investigation.
Traumatic brain injury (TBI) often occurs as part of a multisystem trauma that may lead to hemorrhagic shock. Effective resuscitation and restoration of oxygen delivery to the brain is important in patients with TBI because hypotension and hypoxia are associated with poor outcome in head injury. We studied the effects of hemoglobin-based oxygen-carrying (HBOC)-201 solution compared with lactated Ringer (LR) solution in a large animal model of brain injury and hemorrhage, in a blinded prospective randomized study. ⋯ The improved MAP, CPP, and PbtO(2) observed with HBOC-201 solution in comparison with LR solution indicates that HBOC-201 solution may be a preferable agent for small-volume resuscitation in brain-injured patients with hemorrhage. The use of HBOC-201 solution appears to decrease cellular degeneration in the brain area not directly impacted by the primary injury. Hemoglobin-based oxygen-carrying-201 solution may act by improving cerebral blood flow or increasing the oxygen-carrying capacity of blood, mitigating a second insult to the injured brain.
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Journal of neurosurgery · Mar 2008
Influence of cocaine on ruptured intracranial aneurysms: a case control study of poor prognostic indicators.
The purpose of this study was to determine whether cocaine use is a significant prognostic factor for outcome measures such as Hunt and Hess grade and Glasgow Outcome Scale (GOS) score among patients presenting with ruptured intracranial aneurysms (IAs). ⋯ Aneurysms were significantly smaller and ruptured at a younger age among cocaine users compared with nonusers. Although the poor clinical grade was not significantly different between the 2 groups, outcome was significantly worse in cocaine users.
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Journal of neurosurgery · Mar 2008
Long-term outcome following radical temporal bone resection for lateral skull base malignancies: a neurosurgical perspective.
Primary temporal bone malignancy is a rare form of tumor for which the therapeutic strategy remains controversial. In this study, the authors reviewed their experience with radical temporal bone resection (TBR) of such lesions and analyzed the long-term results to provide treatment recommendations. ⋯ The neurosurgical skull base technique could improve the probability of en bloc resection with a tumor-free margin for extensive temporal bone malignancies, which would cure a subset of patients. The active participation of neurosurgeons would improve patient care in this field.
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Journal of neurosurgery · Mar 2008
Risk of intraoperative ischemia due to temporary vessel occlusion during standard extracranial-intracranial arterial bypass surgery.
Standard extracranial-intracranial (EC-IC) arterial bypass surgery represents a well-recognized procedure in which the aim is to augment distal cerebral circulation. The creation of the bypass requires temporary occlusion of the recipient vessel. Thus, there exists controversy about the risk of standard EC-IC arterial bypass surgery causing ischemic complications due to temporary vessel occlusion. In this prospective study, the incidence of intraoperative ischemia was investigated in symptomatic patients with steno-occlusive cerebrovascular disease and existing hemodynamic insufficiency. ⋯ Temporary vessel occlusion during standard STA-MCA arterial bypass surgery carries a low risk of intraoperative ischemia when a strict perioperative management protocol is applied.
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Journal of neurosurgery · Mar 2008
Functional assessment of C-5 ventral rootlets by intraoperative electrical stimulation of the supraclavicular segment of the long thoracic nerve during brachial plexus surgery.
Anatomical and functional assessment of the intradural segment of the spinal nerves is imperative in brachial plexus surgery, as the repair of postganglionic elements in the setting of a confirmed nerve root avulsion is of no benefit. None of the current techniques to detect these avulsions can provide full information that ensures the functional status of the preganglionic segment of the roots. The objective of this study was to evaluate intraoperative electrical stimulation of the supraclavicular segment of the long thoracic nerve (LTN) as a method to differentiate C-5 nerve root extraforaminal rupture from its intradural avulsion. ⋯ Intraoperative electrical stimulation of the supraclavicular segment of the LTN is a useful complementary method to test the functional status of the C-5 ventral rootlets. If the test is positive (that is, a response is present) it is indicative of extraforaminal rupture of the root, and if negative, it is suggestive of its avulsion.