Neurosurgery
-
By conducting a review of clinical outcomes for patients with aneurysms treated using current microneurosurgical techniques and intensive care unit management, we determined that grading systems based only on the clinical condition of the patient failed to produce a significant stratification of outcome between individual grades of patients. We hypothesized that outcome prediction for patients surgically treated for intracranial aneurysms could be improved by including factors other than clinical condition that were also strongly associated with outcome. ⋯ This new grading system is easy to apply, separates patients into groups with markedly different outcomes, and is comprehensive, allowing for more accurate prediction of surgical outcome for both unruptured and ruptured cerebral aneurysms.
-
Comparative Study
Comparison of brain temperature with bladder and rectal temperatures in adults with severe head injury.
The purpose of this study was to compare brain temperature (Tbr) with conventional indicators of core body temperature (i.e., rectal temperature [Tre] and bladder temperature [Tbl]), in adults with severe head injury. ⋯ Tbl and Tre often underrepresent Tbr after traumatic brain injury, particularly when the patient is hypo- or hyperthermic.
-
Some adult patients with moyamoya disease have been treated successfully by indirect revascularization alone, although surgical indications and hemodynamic changes for these patients have not been fully explored. To examine surgical indications for this procedure, we studied the regional cerebral blood flow (rCBF) and angiographic findings in adult patients with moyamoya disease preoperatively and postoperatively. ⋯ We conclude that for the surgical treatment of adult patients with moyamoya disease, indirect procedures, mainly encephaloduroarteriosynangiosis, are recommended for patients with lower rCBF and no or negative vascular reactivity in the noninfarcted cortices, as well as for those who have no indication for the direct procedure. It is possible to determine these indications by a xenon-133 inhalation single photon emission computed tomographic study including an acetazolamide challenge test.
-
To examine the relationship of the clinoid segment of the internal carotid artery to the structures in the roof of the cavernous sinus and to determine whether this segment is neither intradural nor intracavernous, as recently proposed. ⋯ The clinoid segment is intracavernous, being located within a collar of dura in which venous tributaries of the cavernous sinus course. The implications of these findings for surgery are reviewed.
-
Randomized Controlled Trial Clinical Trial
Effect of 5% albumin solution on sodium balance and blood volume after subarachnoid hemorrhage.
Subarachnoid hemorrhage (SAH) predisposes patients to excessive natriuresis and volume contraction. We studied the effects of postoperative administration of 5% albumin solution on sodium balance and blood volume after SAH. We also sought to identify physiological variables that influence renal sodium excretion after SAH. ⋯ Supplemental 5% albumin solution given to maintain CVP values of >8 mm Hg prevented sodium and fluid losses but did not have an impact on blood volume in our patients, who were hypervolemic in base line measurements. The natriuresis that occurs after SAH may be mediated in part by elevations of GFR. In addition to acting as a colloid volume expander, 5% albumin solution lowers the GFR and promotes renal sodium retention after SAH. These properties may limit the amount of total fluid required to maintain a given CVP value and hence may minimize the frequency of pulmonary edema.