Acta neurochirurgica. Supplement
-
Acta Neurochir. Suppl. · Jan 2005
Subtemporal approach to basilar bifurcation aneurysms: advanced technique and clinical experience.
The surgical treatment of basilar bifurcation aneurysms is challenging, and many of these aneurysms are currently treated by endovascular means. However, the complete closure of the aneurysm by surgical clipping still remains the best and most permanent cure for the aneurysm. The "gold standard", subtemporal approach was established and introduced by Drake and it has been adapted by the senior author Hernesniemi. We describe our present modified technique of this approach based on clinical experience. ⋯ The subtemporal approach is simple and safe in experienced hands, and should be considered the standard method to approach most basilar bifurcation aneurysms.
-
Authors present a seven years retrospective study on 85 cases of severe brain injuries (SBI) in children (GCS
-
The optimal therapy of sustained increase in intracranial pressure (ICP) is still controversial. The "Lund concept" is based on the physiological volume regulation of the intracranial compartments. In addition to its other functions the blood-brain barrier (BBB) is the most important regulator of brain volume. ⋯ Reduction of cerebral blood volume. The efficacy of the treatment protocol has been evaluated in experimental and clinical studies regarding the physiological and biochemical (utilizing intracerebral microdialysis) effects. The clinical experiences have been favourable.
-
Acta Neurochir. Suppl. · Jan 2005
Endovascular treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
Endovascular treatment by balloon angioplasty or intra-arterial papaverine infusion has been established as a valuable treatment option in patients with cerebral vasospasm refractory to maximal medical therapy. A summary of the indications, applications and limitations is provided for microcatheter guided selective papaverine infusion and transluminal balloon angioplasty in patients who sustain cerebral vasospasm following subarachnoid haemorrhage. Structured neuro-intensive and endovascular treatment of imminent vasospasm integrate papaverine administration and balloon angioplasty as complimentary rather than alternative techniques.
-
Acta Neurochir. Suppl. · Jan 2005
Clinical TrialPrediction of cerebral blood flow restoration after extracranial-intracranial bypass surgery using superficial temporal artery duplex ultrasonography (STDU).
We investigated the availability of superficial temporal artery (STA) duplex ultrasonography (STDU) for evaluating the improvement of cerebral hemodynamics after extracranial-intracranial (EC-IC) bypass. This study included 56 consecutive patients who underwent EC-IC bypass for occlusive disease of their cerebral arteries. STA duplex ultrasonography (STDU) was performed to measure the flow velocity, pulsatility index, and diameter of ipsilateral STA before and 14 days after EC-IC bypass. ⋯ STA mean flow velocity was significantly correlated with the rCBF 14 days after EC-IC bypass (R = 0.55, p < 0.0001). The post-surgical STA mean flow velocity cut-off value over 58.2 cm/sec yielded the highest diagnostic accuracy (sensitivity, 75%; specificity, 74%) for excellent rCBF value (> or =40 ml/100 g/min) after EC-IC bypass. The ipsilateral STA mean blood flow velocity is a highly sensitive parameter for predicting rCBF in the ipsilateral MCA territory after EC-IC bypass.