Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2010
Significance of monitoring the initial intracranial pressure on hematoma irrigation with trephination therapy for acute subdural hematomas in critical conditions.
Acute subdural hematoma (ASDH) patients presenting in a severe condition tend to have poor outcomes due to the significant brain edema required to maintain the ICP at less than 20-25 mmHg. This study compared the surgical outcomes of 16 critically ill patients with ASDH who underwent hematoma irrigation with trephination therapy (HITT) based on their initial ICP values. The initial mean GCS score upon admission was four. ⋯ All six patients who showed an initial ICP greater than 60 mmHg died despite intensive care. Eight patients who showed an initial ICP less than 40 mmHg had a favorable outcome, but two patients deteriorated due to a traumatic cerebrovascular disorder. It seems that the initial ICP monitoring with HITT for ASDH patients in critical condition may be an important factor for predicting both surgical outcome and clinical course.
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Acta Neurochir. Suppl. · Jan 2010
Treatment of complex intracranial aneurysms of anterior circulation using multiple clips.
To evaluate the efficacy of multiple clip application for the occlusion of complex intracranial aneurysms, analyzing the technique and outcome of big and giant cerebral aneurysms clipped in our institution. ⋯ The "multi" clip method for the treatment of complex intracranial aneurysms can be a safe and effective method where a single clip cannot obtain complete neck closure. Proper preoperative understanding of the three-dimensional anatomy of the aneurysm and appropriate preoperative planning and selection of suitable clipping method, using an appropriate combination of clips, definitely can reduce the morbidity and mortality in these patients.
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Acta Neurochir. Suppl. · Jan 2010
Serine protease inhibitor attenuates intracerebral hemorrhage-induced brain injury and edema formation in rat.
Our previous studies have demonstrated that thrombin plays an important role in intracerebral hemorrhage (ICH)-induced brain injury and edema formation. We, therefore, examined whether nafamostat mesilate (FUT), a serine protease inhibitor, can reduce ICH-induced brain injury. Anesthetized male Sprague-Dawley rats received an infusion of autologous whole blood (100 microL), thrombin (5U/50 microL) or type VII collagenase (0.4 U/2 microL) into the right basal ganglia, the three ICH models used in the present study. ⋯ FUT attenuated ICH-induced changes in 8-OHdG and thrombin-reduced brain edema. FUT did not increase collagenase-induced hematoma volume. FUT attenuates ICH-induced brain edema and DNA injury suggesting that serine protease inhibitor may be potential therapeutic agent for ICH.
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Acta Neurochir. Suppl. · Jan 2010
The effects of tetrahydrobiopterin on intracerebral hemorrhage-induced brain injury in mice.
Tetrahydrobiopterin (BH4) is an essential cofactor for nitric oxide synthase (NOS) and is presently used clinically to treat forms of phenylketonuria. BH4 has been reported to restrain superoxide generation of NOS and chemically reduce superoxide. However, there has been no report concerning the effects of BH4 in intracerebral hemorrhage (ICH). ⋯ Our data demonstrates that ICH caused significant neurological deficit that is associated with brain edema. Treatment with BH4 did not reduce brain edema and neurological deficits at 24 h after ICH in mice. Further study is required to investigate the long-term effect of BH4 in ICH-induced brain injury.