Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2011
Review Randomized Controlled TrialIntravenous magnesium sulfate after aneurysmal subarachnoid hemorrhage: current status.
Delayed ischemic neurological deficit or clinical vasospasm remained a major cause for delayed neurological morbidity and mortality for patients with aneurysmal subarachnoid hemorrhage (SAH). Magnesium is a cerebral vasodilator. In experimental model of drug or SAH-induced vasospasm, magnesium blocks voltage-dependent calcium channels and reverses cerebral vasoconstriction. ⋯ Using random effects model (Mantel-Haenszel, Robins-Breslow-Greenland), the pooled odds ratio for symptomatic vasospasm or delayed cerebral ischemia is, 0.620, 95% CI 0.389-0.987, statistically significant. Similarly, the pooled odds ratio for favorable outcome is 1.598, 95% CI 1.074-2.377, statistically significant. There are two multi-center phase III studies (IMASH and MASH2) being carried out to assess the clinical effects, in which IMASH has finished data collection on 30th June 2009.
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Acta Neurochir. Suppl. · Jan 2011
ReviewSurgical anatomy of the sacral hiatus for caudal access to the spinal canal.
The sacral hiatus is used for access to the spinal canal in many neurosurgical and anesthesiologic procedures. The aim of the present paper is to give a review of its anatomical characteristics relevant to permit correct and uncomplicated accesses. ⋯ The mean sacral space depth has been observed to be 4.6 mm in adults and 3.5 mm in infants. On the basis of anatomical measurements of the sacral hiatus, lower insertion angles have been suggested in infant with respect to adult subjects (21° vs. 58°).
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Acta Neurochir. Suppl. · Jan 2011
ReviewTreatment of post-hemorrhagic cerebral vasospasm: role of endovascular therapy.
In this review, the current role of intracranial angioplasty and intra-arterial vasodilators for post-hemorrhagic vasospasm is described with an emphasis on the rationale for its use and the supporting data from published scientific and clinical studies. Current clinical indications and specific techniques are highlighted. Special attention is given to the evolution of these techniques over time. A discussion of acute and chronic complications, short and long-term treatment results, device specific trends and controversies are outlined.
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Acta Neurochir. Suppl. · Jan 2011
ReviewMonitoring of the inflammatory response after aneurysmal subarachnoid haemorrhage in the clinical setting: review of literature and report of preliminary clinical experience.
Clinical and experimental studies showed a marked inflammatory response in aneurysmal subarachnoid haemorrhage (SAH), and it has been proposed to play a key role in the development of cerebral vasospasm (CVS). Inflammatory response and occurrence of CVS may represent a common pathogenic pathway allowing point of care diagnostics of CVS. Therefore, monitoring of the inflammatory response might be useful in the daily clinical setting of an ICU. The aim of the current report is to give a summary about factors contributing to the complex pathophysiology of inflammatory response in SAH and to discuss possible monitoring modalities. ⋯ Monitoring of the inflammatory response, in particular IL-6, might be a useful tool for the daily clinical management of patients with SAH and CVS.
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Acta Neurochir. Suppl. · Jan 2011
Review Historical ArticleA clinical review of cerebral vasospasm and delayed ischaemia following aneurysm rupture.
The continuation of a review of delayed vasospasm after aneurysmal subarachnoid haemorrhage, originally published in 1994 and partially updated at the ninth vasospasm conference in Turkey, is presented. Further online and physical searches have been made of the relevant literature. The incidence of delayed ischaemic deficit (DID) or symptomatic vasospasm reported in 1994 was 32.5% in over 30,000 reported cases. ⋯ It thus appears likely that delayed vasospasm is still common but less so, and that the overall outcome has improved. This may be due to the more widespread use of calcium antagonists and more effective fluid management. A number of other mechanical and drug treatments are also mentioned.