Neurosurgery
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This study was undertaken to evaluate the effect of acute moderate hyperventilation on cerebral autoregulation in head-injured patients. ⋯ These results confirm the finding that dynamic autoregulation is disturbed in severe head injury and that moderate transient hyperventilation can temporarily improve the efficiency of the autoregulatory response, probably as a result of a transient increase in vascular tone.
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To quantitate the relief of intractable cancer pain by the use of intraventricular morphine administration. ⋯ Intraventricular morphine administration is a useful method for palliation of intractable cancer pain.
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To determine the frequency of unexpected major arterial occlusion and incomplete aneurysm clipping on intraoperative angiography after cerebral aneurysm clipping and to determine factors that predict these unexpected findings. ⋯ Intraoperative angiography detects unexpected arterial occlusions and residual aneurysms in 12% of cases and can decrease complications of aneurysm surgery, although the yield in unselected patients is low. The subgroup of patients with giant, basilar apex, and posterior communicating artery aneurysms has a significantly higher incidence of untoward findings and may benefit from increased usage of intraoperative angiography.
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Historical Article
Surgical neurology and clinical neurosciences in Edinburgh, Scotland.
Surgical neurology in Edinburgh started > 70 years ago with Norman Dott, after his apprenticeship with Harvey Cushing. It continued under the chairmanship of John Gillingham, until 1980, and then Douglas Miller, who merged the Departments of Surgical Neurology and Medical Neurology to form the Department of Clinical Neurosciences in 1986. Particular strengths of the Edinburgh program have been the management of intracranial aneurysms, stereotactic and functional neurosurgery, the management of head and spinal injury and stroke, and neuro-oncology.
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Despite detailed studies of the perforating arteries, their relationships with the leptomeningeal arteries are almost unknown. These relationships can be of great significance during neurosurgical operations. ⋯ From 4.8 to 100% of certain groups of the perforating vessels originated in the leptomeningeal arteries. Occlusion of a leptomeningeal artery that gives rise to the perforating vessel(s) may lead to superficial and deep infarcts in the same patient.