Neurosurgery
-
Historical Article
Perspectives in international neurosurgery: neurosurgery in Ireland.
-
Pulmonary air embolism is recognized as a possible complication of neurosurgical procedures performed with the patient in the sitting position. A variety of preventive and therapeutic modalities have been proposed in the literature. We have used a consistent regimen consisting of precordial Doppler monitoring, measurement of end expiratory CO2, the semireclining position, and positive end expiratory pressure (PEEP). ⋯ This approach has given good results in 81 patients; there was significant air embolism in only 1 case (1.2%). We believe that PEEP is as important in the prevention as it is in the treatment of pulmonary air embolism. By flexibly adjusting the level of PEEP, one may recreate the hemodynamic equivalent of the prone position, thereby eliminating the risk of venous air embolism and simultaneously the need for right heart catheterization.
-
Enlarged veins in two vascular malformations blocked the cerebrospinal fluid outflow pathways, causing hydrocephalus. Both patients presented not with the usual clinical picture (hemorrhage, seizure, etc.), but with signs of increased intracranial pressure. ⋯ An arteriovenous malformation was responsible for the first patient's headache, and a venous varix was the causative lesion in the second patient. Hydrocephalus caused by a venous varix has not been reported before.