Neurosurgery
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This report describes our experience with the use of osmotic diuretics, governed by continuous monitoring of intracranial pressure (ICP), as the primary treatment for 12 consecutive patients suffering from an acute, supratentorial intracerebral hematoma. In all cases the hematoma, as shown by computed tomographic scan, had a long axis of greater than 4.0 cm. ⋯ There was one death during the 6-month follow-up period. With appropriate weighting to differences in admission status, statistical comparison of the patient outcome in the present series with that reported by McKissock et al. suggests that ICP monitoring can improve the outcome of conservatively (and perhaps surgically) treated patients.
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The relationship of charge density per phase, or QD/ph (expressed in units of microcoulombs per cm2 per phase of the charge-balanced wave form), and total charge (QDt) to neural damage has been investigated by light and electron microscopy after surface stimulation of the parietal cortex in normal cats. QD/ph values ranging from 40 to 400 were achieved by varying several stimulus parameters. ⋯ Although individual factors contributing to neural damage are isolated with difficulty, charge density and total charge seem to be predominant among the contributing parameters. In view of these findings, recommendations have been made for the selection of electrical stimulus parameters to be used in central nervous system prostheses.
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A case of cerebellar hemorrhage complicating the postoperative course of a patient who had undergone a cervical laminectomy in the sitting position is presented. The drop in cerebrospinal fluid pressure accompanying the procedure is thought to have had some role in the development of the hemorrhage.
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This paper describes a treatment protocol for threatened stroke in patients to carotid endarterectomy. The protocol includes the use of perioperative anticoagulation, intraoperative electroencephalographic (EEG) monitoring, and hypertension or barbiturates to protect the brain against documented ischemia intraoperatively. The rational and methods for protecting the patient from the threat of thromboembolism and cerebral ischemia during each of the periods of specific risk are discussed. The most unique feature of this protocol is the use of thiopental-induced EEG burst suppression for ischemia unresponsive to hypertension during carotid clamping, which has obviated the use of a potentially dangerous and cumbersome in-line arterial shunt.