ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVEDespite the significant recent progress in cerebral monitoring, it is still difficult to quantify the extent of primary brain injury and ongoing secondary damage after head injury. The objective of our study was to investigate S-100B protein as a serum marker of brain damage after severe head injury.METHODSEighty-four patients with severe head injury (Glasgow Coma Scale score ≤8) were included in this prospective study. Venous blood samples for S-100B protein were obtained as soon as possible after admission and every 24 hours thereafter, for a maximum of 10 consecutive days. Serum levels of S-100B protein were compared with outcome after 6 months, clinical variables, and the category of the Marshall classification of initial computed tomographic findings.RESULTSPatients who died had significantly higher serum S-100B values compared with those who survived (median, 2.7 &mgr;g/L versus 0.54 &mgr;g/L;P< 0.0001, Mann-WhitneyUtest). Nineteen (58%) of 33 patients who died had peak S-100B values of 2 &mgr;g/L or higher, compared with 4 (8%) of the 51 surviving patients (P< 0.0005, Fisher’s exact test). There was also a strong correlation between S-100B values and computed tomographic findings. Logistic regression analysis in a model with age, Glasgow Coma Scale score, intracranial pressure, and computed tomographic findings revealed S-100B as an independent predictor of outcome. Persistent elevation of S-100B levels for 2 to 6 days, even in patients with favorable outcome, may reflect ongoing secondary damage after severe head injury.CONCLUSIONS-100B may be a promising serum marker for assessing the extent of primary injury and the time course of secondary damage after severe head injury.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVEIntracerebral hemorrhage occurring after removal of a chronic subdural hematoma (CSH) is a rare but usually devastating postoperative complication. In patients with CSH, we determined cerebral blood flow immediately after surgical decompression to clarify the pathogenic mechanism of this complication.METHODSIn 22 patients with unilateral CSH, a catheter was inserted into the hematoma cavity through a single burr hole without leakage of the contents. Cerebral blood flow was measured using single-photon emission computed tomography 1 day before surgery, immediately after rapid decompression by opening the catheter, and 3 days after surgery.RESULTSSingle-photon emission computed tomography imaging immediately after decompression demonstrated areas of hyperemia in nine patients (41%). In all nine patients, hyperemia was observed in the cortex beneath the CSH, and it disappeared on the 3rd postoperative day. The patients with hyperemia were significantly older than those without hyperemia. Other variables, including preoperative cerebral blood flow, intrahematoma pressure before decompression, and mean arterial blood pressure during decompression had no significant effect on the occurrence of hyperemia.CONCLUSIONIn elderly patients, rapid decompression of CSH frequently results in transient hyperemia in the cerebral cortex beneath the hematoma.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVEThe gold standard for documentation of surgical cure of a brain arteriovenous malformation (AVM) is a postoperative angiogram. Intraoperative angiography also has been used for assessing surgical obliteration of AVMs. The objective of this work is to determine the incidence of unexpected residual AVM in patients undergoing intraoperative angiography after brain AVM surgery, the incidence of false-negative intraoperative angiography, and whether there are any identifiable factors that would predict such an occurrence.METHODSPatient age and sex, AVM location and size, clinical presentation of the AVM, day of surgery after hemorrhage, whether embolization was performed preoperatively, presence of intraoperative brain swelling or substantial bleeding, and postoperative course were recorded prospectively on 34 consecutive patients who underwent surgery for brain AVMs. Intraoperative angiography was performed after the surgeon thought that the AVM was completely obliterated. The incidence of unexpected residual AVM and false-negative intraoperative angiography was determined. Factors predicting these findings were identified by multivariate analysis.RESULTSTwenty-five of 34 patients underwent intraoperative angiography to assess the extent of resection, and two patients underwent the examination to localize the AVM. Postoperative angiograms were obtained for 26 patients. Intraoperative angiography showed unexpected residual AVM in 2 (8%) of 25 patients. In two patients, intraoperative angiography was useful to locate a small AVM in the wall of a hematoma cavity. Three patients (18%) whose intraoperative angiograms had not shown AVM had postoperative angiograms that showed residual or recurrent AVM. One (11%) of nine patients who had only postoperative angiography had an unexpected residual nidus; the patient underwent a reoperation and successful resection. There were no significant clinical or radiological features that predicted the intraoperative angiographic finding of residual AVM or of false-negative intraoperative angiogram.CONCLUSIONIntraoperative angiography is useful to demonstrate residual AVM in about 8% of patients undergoing AVM resection. It can be used to localize small AVMs, but other methods for localization may be as useful and may avoid the risks and cost of additional angiography. Intraoperative angiography does not replace postoperative angiography to confirm AVM removal because of false-negative findings, which occurred in 18% of patients in this series.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVETo introduce a new method for osteoplastic anterolateral vertebrotomy without fusion to resect multilevel cervical ossification of the posterior longitudinal ligament.METHODSA multilevel vertebral column graft containing portions of the intervertebral discs is cut with a microsurgical saw from the anterolateral part of the vertebra via a thin lateral gutter placed in advance. A sufficiently wide oblique operative field is provided for resection of the ossified ligament with this method, and only a narrow bony defect remains after simple replacement of the vertebral graft. Postoperatively, patients are allowed to walk, usually within 2 to 3 days, wearing simple cervical collars.RESULTSTwelve patients underwent resection of the ossified ligaments in two to five vertebral bodies. Clinical results were satisfactory except in one patient, who died as a result of a pulmonary embolism that occurred 10 days after surgery. In all of the other patients, the vertebral column grafts were fused within a few months, and there were no graft-related problems. Postoperative lateral radiographs revealed that cervical alignment was preserved, with intervertebral mobility at the operated segment in flexion-extension views.CONCLUSIONThe osteoplastic anterolateral vertebrotomy method provided a sufficiently wide operative field for satisfactory resection of multilevel cervical ossification of the posterior longitudinal ligament, simplifying graft replacement and postoperative patient care. The cervical alignment was preserved.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVEThe purpose of this study was to determine the safety and efficacy of endoscopic aqueductoplasty in patients with hydrocephalus caused by aqueductal stenosis. The controversy of third ventriculostomy and aqueductoplasty is discussed.METHODSA series of 17 patients who underwent endoscopic aqueductoplasty is reported. Rigid rod-lens scopes were used for inspecting the aqueductal entry and performing balloon aqueductoplasty. With the aid of a 2.5-mm flexible endoscope, the aqueduct and fourth ventricle were explored and aqueductal membranous obstructions were perforated. Third ventriculostomies were performed simultaneously in nine patients. One aqueductal stent was inserted. In six patients, frameless computerized neuronavigation was used for an accurate approach to the aqueduct. The average duration of the endoscopic procedures was 59 minutes (range, 25–100 min).RESULTSThere was no endoscopy-related mortality. Surgical complications included an asymptomatic fornix contusion and two injuries to the aqueductal roof, which resulted in permanent diplopia due to dysconjugate eye movement (one patient) and transient trochlear palsy (one patient). In addition, two patients developed transient dysconjugate eye movements, and one patient had an asymptomatic epidural hematoma. Eleven patients showed improvement in their symptoms. The conditions of five patients were unchanged. One patient died of stroke 1 month after the operation. No patient required shunting. The ventricles decreased in size in nine patients and were unchanged in the remaining eight patients.CONCLUSIONEndoscopic aqueductoplasty is an effective alternative to third ventriculostomy for the treatment of hydrocephalus caused by short aqueductal stenosis. However, longer follow-up periods are necessary to evaluate long-term aqueductal patency after aqueductoplasty.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID