Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2011
Evidenced Based Guidelines for the Management of Good Grade Subarachnoid Haemorrhage Patients in Leeds, UK.
Aneurysmal Subarachnoid Haemorrhage (SAH) is a common neurosurgical condition with high morbidity and mortality, with our trust treating over 120 patients annually. Although there are recommendations for the management of some aspects of subarachnoid haemorrhage, a comprehensive guideline document has not been produced. Our guidelines seek to address all aspects of acute patient care in our neurosurgical unit, using evidence based medicine with a multi-disciplinary team to produce care pathways establishing a standard of care for our patients.
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Acta Neurochir. Suppl. · Jan 2011
Post-treatment with SR49059 improves outcomes following an intracerebral hemorrhagic stroke in mice.
Intracerebral hemorrhage (ICH) is a devastating stroke subtype characterized by severe brain edema formation leading to cerebral blood flow compromise and parenchymal damage. Arginine vasopressin (AVP), a non-peptide antidiuretic hormone, has recently been implicated as a modulator of brain edema following injury. In this study, we investigated the effects of SR49059, a highly specific AVP V1a receptor antagonist, on brain injury outcomes following ICH, specifically assessing the ability of SR49059 in reducing brain edema and improving neurobehavioral deficits. ⋯ The study found that SR49059 significantly reduced cerebral edema at 24 and 72 h post-ICH injury and improved neurobehavioral deficits at 72 h. Our study suggests that blockage of the AVP V1a receptor is a promising treatment target for improving ICH-induced brain injury. Further studies will be needed to confirm this relationship and determine future clinical direction.
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The lack of radiation, high soft tissue contrast and capacity for multiplanar and three-dimensional imaging have made magnetic resonance imaging (MRI) the imaging modality of choice for evaluating spinal cord diseases. In diagnostic imaging of the spine, MRI is clearly superior to both conventional radiography (CR) and computed tomography (CT) and it should be preferred as first diagnostic examination when degenerative spine pathologies are suspected. ⋯ Both "container" and "contents" of the spine should be primly evaluated. Finally, a correlation between clinical and radiological features seems to be mandatory for selecting the correct therapeutic choice, since the reliability of the MRI as potential prognostic indicator has been demonstrated.
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Acta Neurochir. Suppl. · Jan 2011
Treatment of symptomatic lumbar spinal degenerative pathologies by means of combined conservative biochemical treatments.
Research in spine surgery has proposed new soft and less invasive techniques. These are the results of our experience with oxygen-ozone therapy, which we could experiment within the Italian National Health System over 3 years. A total of 1,920 patients were admitted on the basis of unselected enrolment because of lumbosciatic pain. ⋯ The perceived quality of result for this minimally invasive procedure makes oxygen-ozone therapy an interesting weapon in the hands of doctors. Furthermore, if the technique loses its clinical effectiveness, it can be repeated without harm for the patient, and costs for the health organization are notably very low, above all if compared to surgical procedures. We underline the need that this treatment should be performed in protected structures, in operative rooms, under anesthesiologic control, and in the hands of specialists.
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Acta Neurochir. Suppl. · Jan 2011
Multiparametric characterisation of the perihemorrhagic zone in a porcine model of lobar ICH.
To describe early perihemorrhagic changes after lobar intracerebral hemorrhage (ICH) using multiparametric neuromonitoring [intracranial pressure (ICP), cerebral blood flow (CBF), tissue oxygenation (PbrO2), microdialysis (MD)]. ⋯ We established a reproducible cortical ICH model using multiparametric neuromonitoring. Subtle changes in ICP were observed. No evidence for the existence of a perihemorrhagic ischemic area was found, hypothetically because of the small hematoma size. Individual animals underwent critical PbrO2 and CBF decreases with consecutive metabolic derangement. The effect of larger hematoma volumes should be evaluated with this setup in future studies to study volume-dependent deterioration.