Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2012
Association between ICP pulse waveform morphology and ICP B waves.
The study aimed to investigate changes in the shape of ICP pulses associated with different patterns of the ICP slow waves (0.5-2.0 cycles/min) during ICP overnight monitoring in hydrocephalus. Four patterns of ICP slow waves were characterized in 44 overnight ICP recordings (no waves - NW, slow symmetrical waves - SW, slow asymmetrical waves - AS, slow waves with plateau phase - PW). The morphological clustering and analysis of ICP pulse (MOCAIP) algorithm was utilized to calculate a set of metrics describing ICP pulse morphology based on the location of three sub-peaks in an ICP pulse: systolic peak (P(1)), tidal peak (P(2)) and dicrotic peak (P(3)). ⋯ Based on relative changes in variability of amplitudes of P(2) and P(3) we were able to distinguish between the combined groups NW + SW and AS + PW (p < 0.000001). The AS pattern can be differentiated from PW based on respective changes in the mean curvature of P(2) and P(3) (p < 0.000001); however, none of the MOCAIP feature separates between NW and SW. The investigation of ICP pulse morphology associated with different ICP B waves may provide additional information for analysing recordings of overnight ICP.
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Acta Neurochir. Suppl. · Jan 2012
Pressure reactivity index correlates with metabolic dysfunction in a porcine model of intracerebral hemorrhage.
We correlated oxygen, flow, and pressure indices of cerebrovascular reactivity (CR) with extracellular cerebral metabolite concentrations in a porcine model of intracerebral hemorrhage (ICH). ⋯ We found evidence for impaired CR in a porcine model of ICH. The findings suggest that, among other parameters of CR, positive PRx coefficients have the highest significance and could be associated with microdialysis alterations during hypoxic events.
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Acta Neurochir. Suppl. · Jan 2012
Influence of isoflurane on neuronal death and outcome in a rat model of traumatic brain injury.
In the developing brain agents clinically used for the purpose of analgosedation can cause severe neurodegeneration. In patients with TBI analgosedation is a first-line treatment for intracranial hypertension. At the same time, damaged neuronal networks undergo conformational changes and use developmental mechanisms to restore brain function. ⋯ Along with histological findings neurological outcome was worst as indicated by a higher score in the experimental group with deep sedation (mean ± SEM 4 h, 13.9 ± 0.6, n = 14 and 20 ± 0.7, n = 15; 48 h, 8.1 ± 0.6, n = 14 and 13.3 ± 0.6, n = 15). Although blood pressure was lower with deep sedation, no frank hypotension occurred. In our experiments deep sedation with high doses of isoflurane caused neurodegeneration and worse outcome compared with regular sedation.
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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
ReviewPeriduroscopy: general review of clinical features and development of operative models.
Myeloscopy is a useful approach for both diagnosis and treatment of back pain. However clinicians have underestimated its potential. From the nineties myeloscopy has been used only as a diagnostic tool, without any improvement of the technique. Racz's method is nowadays still used for the lysis of adherence by applying medical solutions without a direct vision inside the spinal channel. In 1998 we showed the limitations of Racz's approach, and in 1999 we developed a new technique, introducing a Fogarty balloon to remove the occlusions of the spinal canal and the resaflex for the lysis of adherence at low temperature (Raffaeli-Righetti technique). In this paper we report a general review of our experience with periduroscopy for the treatment of failed back surgery syndrome (FBSS) and spinal stenosis. ⋯ myeloscopy technique enlightens pain-triggering mechanisms otherwise unrevealed; it has specific therapeutic value, whereas on the diagnostic side it has not revealed relevant pathologies. Its effectiveness in FBSS patients is high, with the advantage of its relatively easy implementation, limited invasiveness and repeatability.