Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2002
Case ReportsIs the rupture of cerebral berry aneurysms influenced by the perianeurysmal environment?
To evaluate contact between cerebral berry aneurysms and the perianeurysmal environment and to study the influence this contact has on aneurysm rupture. ⋯ Aneurysms exhibit contact with their perianeurysmal environment as soon as they reach a size that exceeds their allowance given by the local subarachnoid space. The contact with the environment was found to be an additional determinant parameter in the evolution of cerebral berry aneurysms and their risk to rupture.
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Acta Neurochir. Suppl. · Jan 2002
Glial and neuronal serum markers after controlled cortical impact injury in the rat.
The aim of this study was to investigate the time course and the correlation of glial fibrillary acidic protein (GFAP), protein S-100B, and neuron specific enolase (NSE) serum levels to the severity of traumatic brain injury in rats. Male Wistar rats (n = 65 S-100B, NSE group and n = 55 GFAP group) underwent a severe cortical impact injury (100PSI, 2 mm deformation). Blood samples were drawn directly after trauma, 1 h, 6 h, 12 h, 24 h, and 48 h post trauma as well as in sham operated animals directly after craniotomy, after 6 h and 48 h. ⋯ S-100B and GFAP showed no relationship to trauma severity. Serum levels of GFAP, S-100B and NSE are significantly elevated in the early phase after experimental traumatic brain injury. In this experimental model of cortical impact injury only NSE, but not GFAP and S-100B serum levels are time-dependently correlated with the severity of cortical impact.
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A recent randomized controlled trial in patients with ARDS showed the beneficial effect of mechanical ventilation according to the so called Open Lung Approach, consisting of low tidal volumes and elevated PEEP settings after performing recruiting maneuvers. However, neurosurgical patients were excluded from this and other ARDS trials due to concerns of intracranial deterioration. In this report, we present the clinical data of eleven patients with known intracranial pathology and concomitant ARDS which was treated according to the Open Lung concept. ⋯ Although two patients needed additional ICP treatment, no patient had to be withdrawn from Open Lung ventilation. In our series, Open Lung ventilation in neurosurgical patients with ARDS was a safe method to improve oxygenation. Careful ICP monitoring provided, there is no reason to withhold this modern ARDS treatment in the neurosurgical intensive care unit.
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Acta Neurochir. Suppl. · Jan 2002
Clinical outcome following ultra-early operation for patients with intracerebral hematoma from aneurysm rupture--focussing on the massive intra-sylvian type of subarachnoid hemorrhage.
Of 250 patients admitted with aneurysmal subarachnoid hemorrhage (SAH) from 1994 to 2000, 16 had massive intra-sylvian hematomas. To predict the useful determinants of the clinical outcome for such patients we analyzed our last 16 cases. The study was performed in 2 parts. ⋯ The results in part 1 showed that 3 out of the 5 patients had poor outcome with symptomatic vasospasm. While in Part 2, seven returned to work, 2 had minimal and 1 had severe neurological deficits with symptomatic vasospasm, and 1 died. We therefore suggest that ultra-early surgery with ventriculostomy and postoperative management in the ICU is the most useful determinant to improve the clinical outcome in the treatment of SAH patients with massive intra-sylvian hematoma.
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Acta Neurochir. Suppl. · Jan 2002
Case Reports Comparative StudyPresentation and management of patients with initial negative 4-vessel cerebral angiography in subarachnoid hemorrhage.
The importance of repeat-angiography in patients with acute subarachnoid hemorrhage (SAH) and initial negative angiography has been reviewed in the light of our patient population (19 patients with initial negative angiography/168 patients with SAH). The type of SAH i.e., nontraumatic perimesencephalic SAH versus focal or generalized non perimesencephalic SAH, as well as the amount and distribution of blood on the initial CT examination are important factors in decision making. 3D-Angio-CT, in 3/5 patients, and MR-angiography (MRA) in 1/5 patients were complementary non-invasive methods to diagnose aneurysms on repeated examinations. Repeat-cerebral angiography confirmed the source of hemorrhage in 3 patients.