Neurosurgery
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To evaluate the indication of subsequent operations after failed microvascular decompression (MVD) for the treatment of trigeminal neuralgia, the intraoperative findings and long-term results of 16 subsequent operations are reported. ⋯ Subsequent MVD seems to have good long-term results. However, because of the significantly high incidence of complications, the indication for subsequent operations should be restricted to younger patients to avoid destructive procedures. In general, glycerol rhizolysis or radiofrequency rhizotomy may be the treatment of choice after failed MVD.
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The goal of this study was to critically evaluate the predictive efficacy of various clinical factors in spinal epidural abscess influencing outcome after surgical and/or medical treatment. ⋯ We conclude that long-term outcome after treatment of spinal epidural abscess can be predicted with the use of the proposed grading scheme. Surgical drainage plus parenterally administered antibiotics remains the recommended treatment, although medical treatment alone can also be used for certain patients.
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Impact of cerebral perfusion pressure and autoregulation on intracranial dynamics: a modeling study.
The aim of this work was to study the impact of acute cerebral perfusion pressure (CPP) changes and autoregulation on cerebral hemodynamics, intracranial pressure (ICP), and estimation of the pressure-volume index (PVI) and the possible involvement of these factors in the development of secondary brain damage. ⋯ The present study emphasizes the relevant role of CPP changes, elicited by acute arterial hypotension, in intracranial dynamics. To achieve intracranial stability, CPP should be maintained above 80 to 90 mm Hg. PVI is significantly affected by the active response of cerebral vessels. Hence, it may provide misleading information on craniospinal capacity if it is considered as an autonomous index: rather, it should always be considered together with information on CPP and the status of autoregulation.
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Biography Historical Article
Library: historical perspective. Harvey Cushing (1869-1939).
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We have employed bedside multimodality methods to assess the influence of a slow (20 min) bolus of hypertonic mannitol on cerebral hemodynamics in comatose patients with head injuries. ⋯ Bedside multimodality monitoring may provide a useful means for assessing the effects of therapy in the comatose patient. The mechanisms by which mannitol reduces intracranial pressure in patients with head injuries are discussed.