Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2016
Reduction of Cerebral Edema via an Osmotic Transport Device Improves Functional Outcome after Traumatic Brain Injury in Mice.
Traumatic brain injury (TBI), the foremost cause of morbidity and mortality in persons under 45 years of age worldwide, leads to about 200,000 victims requiring hospitalization and approximately 52,000 deaths per year in the United States. TBI is characterized by cerebral edema leading to raised intracranial pressure, brain herniation, and subsequent death. Current therapies for TBI treatment are often ineffective, thus novel therapies are needed. ⋯ Animals treated with a craniectomy plus an OTD had significantly better neurological function 2 days after TBI compared with those treated with craniectomy only. This study suggests that an OTD for severe brain swelling may improve patient functional outcome. Future studies include a more comprehensive neurological examination, including long-term memory tests.
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Acta Neurochir. Suppl. · Jan 2016
The Prediction of Shunt Response in Idiopathic Normal-Pressure Hydrocephalus Based on Intracranial Pressure Monitoring and Lumbar Infusion.
Intracranial pressure (ICP) monitoring and infusion studies have long been used in the preoperative workup of patients with suspected idiopathic normal-pressure hydrocephalus (iNPH). We have analysed the predictive values of different measures derived from both investigations, emphasising the differences between responders and nonresponders. ⋯ The combined use of ICP monitoring and lumbar infusion to forecast the response to shunting in patients with suspected iNPH did not improve the accuracy provided by any of them alone.
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Acta Neurochir. Suppl. · Jan 2016
The Correlation Between Intracranial Pressure and Cerebral Blood Flow Velocity During ICP Plateau Waves.
We previously showed that the flow-ICP index (Fix), a moving correlation coefficient between intracranial pressure (ICP) and cerebral blood flow velocity (CBFV), had marginally greater prognostic value for patients with traumatic brain injury (TBI) than an index of cerebral autoregulation (mean index, Mx). The aim of this study was to further examine the clinical and physiological relevance of Fix by studying its behaviour during ICP plateau waves in patients with TBI. Twenty-nine recordings of CBFV made during ICP plateau waves were analysed. ⋯ Unlike in our previous study, plotting Fix against CPP revealed a peak value in the range of "optimal" CPP, as indicated by the Mx versus CPP plot. The findings suggest that during periods of reduced CPP caused by plateau waves, the dynamic behaviour of Fix is similar to that of a measure of cerebral autoregulation. This conclusion needs to be verified against similar results obtained during episodes of supranormal CPP.
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Acta Neurochir. Suppl. · Jan 2016
Universal Bypass for Treatment of Symptomatic Moyamoya Disease or Moyamoya Syndrome. Analysis of a Personal Case Series on Behalf of the Italian Moyamoya Association.
Moyamoya (MM) is a very rare cerebrovascular disease, particularly in Caucasians. We describe the results of an Italian case series where the mainstay of treatment was a bypass or a combined approach. ⋯ The bypass/combined approach to MM appears to have a favorable risk profile and preventive effectiveness, particularly on TIAs and ischemic stroke.
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Acta Neurochir. Suppl. · Jan 2016
Case ReportsEmergency Non-occlusive High Capacity Bypass Surgery for Ruptured Giant Internal Carotid Artery Aneurysms.
Managing ruptured giant internal carotid artery (ICA) aneurysms in an emergency situation is very challenging. By reporting two cases, we discuss the role of the Excimer Laser-assisted Non-occlusive Anastomosis (ELANA) technique as an armamentarium for cerebrovascular surgeons dealing with giant ICA aneurysms presenting with subarachnoid hemorrhage (SAH). ⋯ Emergency ELANA bypass surgery is a useful instrument for managing patients with giant ICA aneurysms presenting with SAH. In experienced hands, the technique does not seem to carry increased risk and may expand the surgical options due to its non-occlusive nature.