Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2005
Endovascular treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
Endovascular treatment by balloon angioplasty or intra-arterial papaverine infusion has been established as a valuable treatment option in patients with cerebral vasospasm refractory to maximal medical therapy. A summary of the indications, applications and limitations is provided for microcatheter guided selective papaverine infusion and transluminal balloon angioplasty in patients who sustain cerebral vasospasm following subarachnoid haemorrhage. Structured neuro-intensive and endovascular treatment of imminent vasospasm integrate papaverine administration and balloon angioplasty as complimentary rather than alternative techniques.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialPrediction of cerebral blood flow restoration after extracranial-intracranial bypass surgery using superficial temporal artery duplex ultrasonography (STDU).
We investigated the availability of superficial temporal artery (STA) duplex ultrasonography (STDU) for evaluating the improvement of cerebral hemodynamics after extracranial-intracranial (EC-IC) bypass. This study included 56 consecutive patients who underwent EC-IC bypass for occlusive disease of their cerebral arteries. STA duplex ultrasonography (STDU) was performed to measure the flow velocity, pulsatility index, and diameter of ipsilateral STA before and 14 days after EC-IC bypass. ⋯ STA mean flow velocity was significantly correlated with the rCBF 14 days after EC-IC bypass (R = 0.55, p < 0.0001). The post-surgical STA mean flow velocity cut-off value over 58.2 cm/sec yielded the highest diagnostic accuracy (sensitivity, 75%; specificity, 74%) for excellent rCBF value (> or =40 ml/100 g/min) after EC-IC bypass. The ipsilateral STA mean blood flow velocity is a highly sensitive parameter for predicting rCBF in the ipsilateral MCA territory after EC-IC bypass.
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Acta Neurochir. Suppl. · Jan 2005
Endoscopic carpal tunnel release surgery: retrospective study of 390 consecutive cases.
Endoscopic carpal tunnel release (ECTR) surgery was developed by Okutsu and Chow in 1989. Many reports indicated that the endoscopic technique reduces postoperative morbidity with minimal incision, minimal pain and scarring, a shortened recovery period and high level of patient satisfaction. To evaluate these reports, a retrospective study was conducted with 390 procedures of two-portal Chow technique for idiopathic carpal tunnel syndrome. ⋯ The mean DML and SVC values at final follow-up were 3.8 msec and 42.3 m/s, respectively. In conclusion, ECTR can be used in the carpal tunnel syndrome and is a reliable alternative to the open procedure with excellent self-report of patient satisfaction. Reduced recovery period with minimal tissue violation and incisional pain can be expected.
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The term internal neurolysis means removal of fibrotic tissue inside a nerve trunk. Unfortunately the term was used for procedures with complete isolation of fascicles with all consequences like damage of links between the fascicle and impairment of blood supply. The conclusion based on some negative experiences that all surgery within a nerve trunk has to be avoided cannot be accepted. ⋯ It stops immediately if this aim is achieved or continues with resection and reconstruction if an irreparable damage is present. It is better to use terms that describe exactly what was done and abandon the ill-defined term "internal neurolysis". Fibrosis of the paraneurium remains outside the epineurium but causes the same consequences as fibrosis of the epineurium.
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Acta Neurochir. Suppl. · Jan 2005
Survey of traumatic brain injury management in European Brain-IT centres year 2001.
The aim of this study was to obtain basic knowledge about the current local conditions and neurointensive care of traumatic brain injury (TBI) in the new multi-centre collaborative BrainIT group. ⋯ There seemed to be an agreement on neurointensive care policies within the BrainIT group. The suggested order of treatment was generally in accordance with published guidelines although the suggested order and combinations of different treatments varied. Variation of treatment within the range of prescribed standards provides optimal conditions for an interesting future analysis of treatment and monitoring data in reality using the BrainIT database.