Articles: brain-injuries.
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Craniotomy with a mechanical twist drill is a standard, minimally invasive procedure in neurosurgery, widely used for the drainage of chronic subdural hematomas and the placement of ventricular drains. Nevertheless, the use of a standard twist drill trephine bears the risk of causing cerebral lesions. ⋯ The described modified mechanical twist drill enables fast, easy, and safe craniotomy without jeopardizing the advantages of a mechanical twist drill. Therefore, it can be recommended particularly for difficult emergency conditions.
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The aim of this study was to analyze the effect of early surgical management protocol and other important clinical features on the prognosis of patients suffering from war missile skull base injuries. ⋯ Although the wounds were associated with a high mortality rate, this study showed that there are major differences in prognosis of patients with war missile skull base injuries with respect to certain presenting clinical features.
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Arch Phys Med Rehabil · Sep 1998
Long-term survival of children and adolescents after traumatic brain injury.
To obtain information on long-term mortality risk and life expectancy after traumatic brain injury (TBI), to improve planning and for counseling patients and their families. In contrast to the literature for spinal cord injury and other disabilities, there have been few such reports for TBI. ⋯ The chief predictors of mortality were basic functional skills such as mobility and self-feeding. After the initial high-risk period, mortality risk for TBI was much lower than for similarly functioning persons with cerebral palsy (a comparison group), although after 10 years the two sets of mortality rates had largely converged. For high-functioning persons, life expectancies were only 3 to 5 years shorter than for the general population. By contrast, the remaining life expectancy for those without mobility 6 months after injury was only 15 years.
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Post-traumatic vasospasm after severe head injury is now a well known entity. However, all studies available in the literature have evaluated only the anterior cerebral circulation. We evaluated the incidence of basilar artery vasospasm in patients with severe head injury. ⋯ Basilar artery blood flow velocity is higher in patients with severe head injury. Patients with diffuse brain injury have a particularly high velocity. Thus, it may be an easy method to assess the severity of head injury. The temporal profile of basilar artery vasospasm needs to be established in severely head-injured patients to assess its clinical utility.
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The methods of monitoring the injured brain in intensive care have relied mainly on intermittent measurement. There is now increasing clinical interest in newer continuous forms of bedside monitoring that can help direct therapy earlier and more precisely. This article reviews continuous methods of monitoring cerebral perfusion, oxygenation, brain chemistry and function.