Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialParaspinal approach to the far lateral disc herniations: retrospective study on 42 cases.
Forty-two patients underwent surgery for far-lateral disc herniations. Average patient age was 45.1 years, 28 patients were male and 14 female. The level concerned most was L4-5 disc (55%). ⋯ It requires minimal soft-tissue and bone resection and the herniated disc is directly visualized. Moreover, it contains minimal manipulation of the neuro-vascular structures and avoids significant muscle retraction. However, it requires an adequate learning curve and good familiarity with microsurgical techniques.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialRe-defining the ischemic threshold for jugular venous oxygen saturation--a microdialysis study in patients with severe head injury.
Neurological change is more likely to occur when jugular venous oxygen saturation (SjvO2) is less than 50%. However, the value indicating cellular damage has not been clearly defined. We determined the critical SjvO2 value below which intracerebral extracellular metabolic abnormalities occurred in 25 patients with severe head injury. ⋯ Analysis of variance showed that there were rapid increases in glutamate, glycerol and lactate when SjvO2 dropped below 40, 43 and 45% respectively. Extracellular glucose decreased when SjvO2 dropped below 42%. Our findings suggested that the ischemic threshold for SjvO2 in patients with severe head injury is 45%, below which secondary brain damage occurred.
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1) Numerous of the so-called "unpredictable" post-operative complications are likely to be related to the lack of prevention or non-recognition of venous problems, especially damages to the dangerous venous structures, namely: the major dural sinuses, the deep cerebral veins and some of the dominant superficial veins like the vein of Labbé. 2) Tumors invading the major dural sinuses (superior sagittal sinus, torcular, transverse sinus)--especially meningiomas--leave the surgeon confronted with a dilemma: leave the fragment invading the sinus and have a higher risk of recurrence, or attempt at total removal with or without venous reconstruction and expose the patient to a potentially greater operative danger. Such situations have been encountered in 106 patients over the last 25 years. For decision-making, meningiomas were classified into six types according to the degree of sinus invasion. ⋯ Type V: this type can be recognized from type VI only by direct surgical exploration of the sinus lumen. Opposite wall to the tumor side is free of tumor, it is possible to reconstruct the two resected walls with patch. Type VI: removal of involved portion of sinus and restoration with venous bypass. 3) As 20% of the patients presenting with manifestations of intracranial hypertension due to occlusion of posterior third of the superior sagittal sinus, torcular, predominant lateral sinus or internal jugular vein(s) develop severe intracranial hypertension, venous revascularisation by sino-jugular bypass--implanted proximally to the occlusion and directed to the jugular venous system (external or internal jugular vein)--can be a solution.
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Acta Neurochir. Suppl. · Jan 2005
ReviewAssessment of health-related quality of life in persons after traumatic brain injury--development of the Qolibri, a specific measure.
Health-related quality of life (HRQOL) associated or not with the measurement of neuropsychological functioning is a relatively new outcome variable in the field of traumatic brain injury (TBI). In both cases, accuracy and precision are increased in outcome estimation. Validation of generic, cross-culturally (cc) administered HRQOL measures in persons after TBI is not yet well established. Disease-specific HRQOL instruments do not exist in an international context. The objective here is to present the TBI consensus group's (QOLIBRI-Group) approach in cc development of a specific HRQOL measure--the QOLIBRI (Quality of Life after Brain Injury). ⋯ In TBI patients, generic and disease-specific aspects of HRQOL need to be assessed with measures of adequate psychometric quality, applicable across different populations and cultural conditions. The QOLIBRI is a promising instrument for sensitive patient-centered specific outcome evaluation after TBI.
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Acta Neurochir. Suppl. · Jan 2005
Multicenter Study Clinical TrialQuantification of secondary CPP insult severity in paediatric head injured patients using a pressure-time index.
This paper describes and validates a new Cumulative Pressure-Time Index (CPT) which takes into account both duration and degree of cerebral perfusion pressure (CPP) derangement and determines critical thresholds for CPP, in a paediatric head injury dataset. Sixty-six head-injured children, with invasive minute-to-minute intracranial pressure (ICP) and blood pressure monitoring, had their pre-set CPP derangement episodes (outside the normal range) identified in three childhood age-bands (2-6, 7-10, and 11-16 years) and global outcome assessed at six months post injury. The new cumulative pressure-time index more accurately predicted outcome than previously used summary measures and by varying the threshold CPP values, it was found that these physiological threshold values (< or = 48, < or = 52 and < or = 56 mmHg for 2-6, 7-10, and 11-16 years respectively) best predicted brain insult in terms of subsequent mortality and morbidity.