Journal of neurosurgery
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Journal of neurosurgery · Sep 1995
Impact of traumatic subarachnoid hemorrhage on outcome in nonpenetrating head injury. Part I: A proposed computerized tomography grading scale.
The presence of traumatic subarachnoid hemorrhage (tSAH) on admission computerized tomography (CT) scans obtained from patients suffering from severe, nonpenetrating head injury has been shown to be associated with a worse outcome than the injury alone would warrant. However, no previous study has provided a simple means of relating the amount of tSAH, its location, or other abnormal findings on initial head CT scans to outcome in patients with non-penetrating head injury. In this study, admission head CT scans from 252 patients with tSAH, treated at a single institution, were reviewed to ascertain thickness of the tSAH; its location; evidence of mass lesion(s); shift of midline structures (< or = 5 mm vs. > 5 mm); basal cistern effacement; and cortical sulcal effacement. ⋯ Further analysis comparing CT grades and admission postresuscitation Glasgow Coma Scale (GCS) scores was highly significant. Patients with lower CT grades had better admission GCS values and discharge GOS scores than those with higher CT grades. From their experience, the authors conclude that their CT grading scale is simple and reliable and relates significantly to outcome at the time of discharge from acute hospitalization.
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Journal of neurosurgery · Sep 1995
Case ReportsControlled lumbar drainage in pediatric head injury.
A retrospective study of external lumbar subarachnoid drainage in 16 pediatric patients with severe head injuries is presented. All patients had Glasgow Coma Scale scores of 8 or lower at 6 hours postinjury and were initially treated with ventriculostomy. Five patients required surgical evacuation of focal mass lesions. ⋯ Two patients died, most likely from uncontrolled ICP before the lumbar drain was placed. It is concluded that controlled external lumbar subarachnoid drainage is a useful treatment for pediatric patients with severe head injury when aggressive medical therapy and ventricular cerebrospinal fluid evacuation have failed to control high ICP. Selected patients with elevated ICP, which may be a function of posttraumatic cerebrospinal fluid circulation disruption and/or white matter cerebral edema, can be treated with this modality, which accesses the cisternal spaces untapped by ventriculostomy.
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Journal of neurosurgery · Sep 1995
En bloc petrosectomy using a Gigli saw for petroclival lesions. Technical note.
The authors report a new technique for en bloc petrosectomy using a Gigli saw as an alternative to drilling the petrous bone in the combined supra- and infratentorial approach or the transpetrosal-transtentorial approach. It is simple and easy and avoids postoperative cosmetic deformity. This technique has been performed in 11 petroclival lesions without injuring the semicircular canals, the cochlea, or the facial nerve.
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A prospective study of intrathecal catheter reliability was performed at Rush-Presbyterian-St. Luke's Medical Center. All 102 patients who had baclofen administered chronically for spasticity via an implanted drug pump were included. ⋯ Survival analysis demonstrated a steady rate of malfunction up to 80 months, with the mean time to first failure recorded at 20 months. Kinks, holes, breaks, dislodgments, and disconnections were the most common complications. On the basis of their research the authors conclude that the thin-walled silastic catheter does not perform well and that larger, thick-walled catheters should be used.
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Journal of neurosurgery · Aug 1995
Review Case ReportsParadoxical progression of tuberculous lesions during chemotherapy of central nervous system tuberculosis. Report of four cases.
The peculiar phenomenon of paradoxical progression during the treatment of central nervous system tuberculosis is discussed. A few cases with this phenomenon were reported in the past, and the authors have treated four such cases. ⋯ All four patients underwent ventriculoperitoneal shunt insertion during the course of treatment. The authors discuss the significance of the changes in the lesions and management of such cases, and review the literature.