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Hampus Olof Erixon Angelika Sorteberg Wilhelm Sorteberg Per Kristian Eide 《Acta neurochirurgica》2014,156(11):2059-2069
Background
Hydrocephalus (HC) after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequel. Proper selection of patients in need of permanent cerebrospinal fluid (CSF) diversion is, however, not straightforward. The aim of this study was to identify predictors of CSF shunt dependency following aSAH.Methods
We re-analyzed data acquired from aSAH patients previously enrolled in a prospective, controlled single-center clinical trial in which shunt dependency was not one of the end points. In the present study patients were allocated into two groups: those receiving a shunt (here denoted as shunt dependent) and those not receiving a shunt, based on a clinical decision process. Predictors of shunt dependency were identified by applying uni- and multivariable analysis. We tested a set of predefined possible risk factors based on the results of the clinical trial, including the impact of CSF drainage volume exceeding 1,500 ml during the 1st week after ictus.Results
Ninety patients were included in the study. Significant predictors of shunt dependency were poor clinical grade at admission [odds ratio (OR) 4.7, 95 % confidence interval (CI) 1.2–18.4], large amounts of subarachnoid blood (OR 3.8, 95 % CI 1.0–14.0), large ventricular size on preoperative cerebral computer tomographic (CT) scans (OR 1.0, 95 % CI 1.0–1.1), and CSF volume drainage exceeding 1,500 ml during the 1st week after the ictus (OR 16.3, 95 % CI 4.0–67.1). Age ≥70 years, larger amounts of intraventricular blood, vertebrobasilar aneurysm, and endovascular treatment tended to increase the likelihood of receiving a shunt. Outcome was not significantly different between shunted and non-shunted patients.Conclusions
In this cohort of patients with clinical grade aSAH at admission, larger amounts of subarachnoid blood and large ventricular size on preoperative cerebral CT, and CSF drainage in excess of 1,500 ml during the 1st week after the ictus were significant predictors of shunt dependency. Shunt dependency did not hamper outcome. 相似文献3.
Background
Fenestrations of intracranial arteries are variants resulting from incomplete fusion of vessels during development with unknown clinical significance. They are best visualised with 3D rotational angiography (3DRA).Objective
In a prospective consecutive series of patients with suspected aneurysms, 3DRA was performed to identify not only the potential bleeding source but also to assess the frequency and location of any fenestrations of intracranial arteries.Methods
In 287 consecutive patients with possible intracranial aneurysms (accidental discovery or previous history of SAH), 3DRAs were prospectively performed, and the location of subarachnoid haemorrhage was assessed by CT.Results
Of 174 patients presenting with SAH, 153 had saccular aneurysms, and in 21 cases (12.1 %), no source of bleeding was found. In 20 of these 21 patients with "unexplained SAH" (95.2 %) an arterial fenestration was detected in the neighbourhood of the clot. The incidence of fenestration in the 153 aneurysmal SAH patients was 22.9 %, and it was 23.3 % in 266 patients with intracranial aneurysms (113 accidental and 153 ruptured).Conclusions
Arterial fenestration was detected in 22.9 % of ruptured cerebral aneurysms, in contrast with 95.2 % in patients with unexplained SAH, the difference being statisctically significant (p?<?0.01). Fenestration is a developmental defect, a structural wall weakness possibly making the vessel prone to rupture. Its incidence of nearly 100 % may suggest a connection with idiopathic SAH. The presented data indicate that arterial fenestrations are generally overlooked, and they can be considered as one of the candidates for the source of idiopathic SAH. 相似文献4.
Fabio Santanelli di Pompeo Rosaria Laporta Benedetto Longo Michail Sorotos Annalisa Papa 《European journal of plastic surgery》2014,37(12):647-652
Background
Recurrence of breast cancer to latissimus dorsi (LD) flap donor site is a very rare condition, and as a result, few data are currently available on its possible causes. The aim of the study was to investigate the role of LD flap transfer in lymphangiogenesis and connection to the preexisting lymphatic network after mastectomy and axillary lymph node dissection and the lymphatic drainage involvement in local relapse to flap donor site.Methods
Lymphoscintigraphy was performed on subgroup of ten patients who had previously undergone modified radical mastectomy, axillary lymph node dissection, and pedicled LD flap reconstruction. Lymphatic drainage was imaged by static gamma camera acquisitions after two intradermal injections of 37 MBq 99mTc-Nanocoll® on residual breast skin and LD skin paddle, respectively.Results
In eight cases (80 %), the residual breast skin showed fast lymphatic drainage directed only toward the ipsilateral axilla, while in two cases (20 %), it was also seen to the internal mammary nodes. LD skin paddle showed slower drainage in all cases but 1, where no visible drainage was observed within 2 h after injection.Conclusions
Although a small case series is the study limitation, our findings suggested that the LD flap harvest can promote a preferential route of lymphatic drainage in the axillary region and could be involved in a metastatic spread to the dorsum because of the new tissue plane opening. The direct communication created between recipient and donor sites could have lead to cell cancer transfer to the donor site either by lymphatic or a contiguity pathway. Level of Evidence: Level V, diagnostic study. 相似文献5.
Artur Vetkas Tanel Lepik Tõnis Eilat Tõnu Rätsep Toomas Asser 《Acta neurochirurgica》2013,155(6):1107-1114
Background
Emotional disorders and decrease in health-related quality of life (HRQoL) are well-documented sequelae of aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to analyze the impact of emotional disorders on HRQoL in survivors of SAH.Methods
This was a retrospective study enrolling 114 SAH-survivors at 1–10 years (mean 4,5 years) after the disease. Emotional State Questionnaire (EST-Q) was used to measure emotional health and the Short Form Health Survey (SF-36) was used to assess HRQoL of the patients.Results
Most of the patients reported good recovery, but EST-Q results revealed high prevalence of emotional disorders after SAH. Almost half of the patients had higher than cut-off values indicating fatigue (47 %) and insomnia (46 %). About one third of SAH-patients had higher than cut-off scores demonstrating depression (30 %) and anxiety (31 %). The patients scored significantly lower in all scales of SF-36 as compared to age-matched general population. All EST-Q subscale results were significantly and negatively correlated with SF-36 scores. Fatigue was independently related to all SF-36 subscales and depression to most of the mental health component scores. Emotional symptoms alone were demonstrated to explain 23–47 % of the SF-36 subscale values, and more than half of the variance of mental health component score values were found to be explained by emotional disorders (53 %).Conclusions
Emotional disorders are frequent after SAH and significantly associated with impairment of HRQOL. Proper and timely screening tests are important to reveal development of emotional problems and improve QoL for the SAH-patients. 相似文献6.
Phoebe Y. Ling Zachary S. Mendelson Rohit K. Reddy Robert W. Jyung James K. Liu 《Acta neurochirurgica》2014,156(10):1879-1888
Background
Postoperative cerebrospinal fluid (CSF) leaks and headaches remain potential complications after retrosigmoid approaches for lesions in the posterior fossa and cerebellopontine angle. The authors describe a simple repair technique with an autologous fat graft-assisted Medpor Titan cranioplasty and investigate the incidence of postoperative CSF leaks and headaches using this technique.Methods
A retrospective chart review was conducted on all cases (n?=?60) of retrosigmoid craniectomy from September 2009 to May 2014 in patients who underwent fat graft-assisted cranioplasty. After obtaining a watertight dural closure and sealing off any visible mastoid air cells with bone wax, an autologous fat graft was placed over the dural suture line and up against the waxed-off air cells. The fat graft filled the retrosigmoid cranial defect and was then bolstered with a Medpor Titan (titanium mesh embedded in porous polyethylene) cranioplasty. A postoperative mastoid pressure dressing was applied for 48 h, and prophylactic lumbar drainage was not used. Factors examined in this study included postoperative CSF leak (incisional, rhinorrhea, otorrhea), pseudomeningocele formation, incidence and severity of postoperative headache, length of hospital stay, and length of follow-up.Results
No patients developed postoperative CSF leaks (0 %), pseudomeningoceles (0 %), or new-onset postoperative headaches (0 %) with the described repair technique. There were no cases of graft site morbidity such as hematoma or wound infection. Mean duration of postoperative hospital stay was 3.8 days (range 2–10 days). Mean postoperative follow-up was 12.4 months (range 2.0–41.1 months).Conclusions
Our multilayer repair technique with a fat graft-assisted Medpor Titan cranioplasty appears effective in preventing postoperative CSF leaks and new-onset postoperative headaches after retrosigmoid approaches. Postoperative lumbar drainage may not be necessary. 相似文献7.
Maria Zetterling Britt Edén Engström Steinunn Arnardottir Elisabeth Ronne-Engström 《Acta neurochirurgica》2013,155(11):2053-2062
Background
Somatotropic and thyroid hormones are probably important for the recovery after acute brain injury. Still, the dynamics of these hormones after spontaneous subarachnoid haemorrhage (SAH) is not well described. The purpose of this study was to investigate the relation between somatotropic and thyroid hormones and clinical factors after SAH.Methods
Twenty patients with spontaneous SAH were included prospectively. Serum concentrations of TSH, fT4, T3, IGF-1 and GH were measured once a day for 7 days after SAH. Hormone patterns and serum concentrations were compared to the severity of SAH, neurological condition at admission, clinical course and outcome of the patients.Results
During the first week after SAH, all patients showed increased GH and IGF-1 concentrations. In the whole group, concentrations of TSH increased, whereas T3 and fT4 decreased. There were no relations of serum concentrations of IGF-1 or GH to clinical condition at admission, clinical course or outcome of the patients. Half of the patients showed low T3 serum concentrations. A complicated course was associated with a deeper fall in TSH and T3 concentrations. There were negative correlations for mean concentrations of TSH and T3 versus WFNS grade and a positive correlation for T3 versus GOS after 6 months, indicating that low concentrations of TSH and T3 were connected to worse SAH grade and poor outcome.Conclusions
All patients showed increased GH and IGF-1 concentrations irrespective of the grade of SAH or clinical course. Patients with a complicated clinical course showed a more pronounced fall in TSH and T3 concentrations and low serum T3 concentrations were related to a more serious SAH and poor patient outcome. These results need to be studied further and they may contribute to the accumulated knowledge needed to understand the complex mechanisms influencing the unpredictable clinical course after SAH. 相似文献8.
Marcel A. Kamp Maxine Dibué Philipp Slotty Jr Hans-Jakob Steiger Daniel Hänggi 《Acta neurochirurgica》2013,155(8):1525-1530
Background
Several external and internal risk factors for cerebral aneurysm rupture have been identified to date. Recently, it has been reported that moon phases correlate with the incidence of aneurysmal subarachnoid hemorrhage (SAH), however, another author found no such association. Therefore, the present study investigates the influence of the lunar cycle on the incidence of aneurysmal rupture, the initial clinical presentation, and the amount of subarachnoid blood.Methods
Lunar phase and the particular day of the lunar cycle were correlated to the date of aneurysm rupture, aneurysm location, initial clinical presentation, and amount of subarachnoid blood assessed from CT scans of all patients treated for basal SAH in our department from 2003 to 2010.Results
We found no correlation between incidence of aneurysmal SAH, location of the aneurysm, initial clinical presentation, or amount of subarachnoid blood and the lunar cycle.Conclusions
The moon influences neither the incidence of aneurysmal SAH nor the grade of initial neurological deterioration or amount of subarachnoid blood. 相似文献9.
Purpose
Traumatic cervical spinal cord injuries (SCIs) frequently develop dural tears and resultant cerebrospinal fluid (CSF) leaks. They are not usually identified with advanced imaging, and there are no reports on managing CSF leaks after cervical trauma. Hence, the authors evaluated the incidence of CSF leaks after cervical SCIs and described how to predict and manage CSF leaks.Methods
An observational retrospective study was done confirming intraoperative CSF leaks among 53 patients with anterior cervical surgery after cervical spine trauma between 2004 and 2011.Results
Seven patients (13.2 %) had dural tears and resultant CSF leaks intraoperatively (M:F ratio of 6:1; mean age, 44.7 years). An initial poor American Spinal Injury Association (ASIA) scale was significantly associated with CSF leaks (p = 0.009). From magnetic resonance imaging (MRI), disruption of the ligamentum flavum was correlated with CSF leaks (p = 0.02). Intraoperative application of fibrin glue on the operated site, postoperative management through the early removal of the wound drain within the first 24 h and early rehabilitation were performed in patients with CSF leaks without perioperative insertion of a lumbar drain. During the follow-up period, none of the patients developed CSF-leak-related complications.Conclusion
The incidence of CSF leaks after traumatic cervical SCI is relatively higher than that of degenerative cervical spinal surgery. An initial poor neurological status and disruption of the ligamentum flavum on the MRI in patients were predictable factors of dural tears and CSF leaks. 相似文献10.
Hieronymus D. Boogaarts Mariana P. Duarte Conde Edith Janssen Willemijn F. M. van Nuenen Joost de Vries Rogier Donders Gert P. Westert J. André Grotenhuis Ronald H. M. A. Bartels 《Acta neurochirurgica》2014,156(9):1663-1667
Background
Several studies have included different co-morbid conditions in prediction models for stroke patients. For subarachnoid haemorrhage (SAH), it is not known whether the Charlson Co-morbidity Index (CCI) is associated with outcome. We evaluated if this index was associated with outcome in patients with ruptured intracerebral aneurysms.Methods
The data of all consecutive aneurysmal SAH (aSAH) patients treated at the Radboudumc, Nijmegen, The Netherlands and entered in the database were retrospectively analysed. Clinical condition at admission was recorded using the WFNS (World Federation of Neurological Surgeons Grading System) grade was collected, as were the age and treatment modality. The burden of co-morbidity was retrospectively registered using the CCI. Outcome was dichotomised on the modified Rankin Scale (mRS; 0–2, favourable outcome; 3–6, unfavourable outcome). A binary logistic regression analysis was performed.Results
Between 6th May 2008 and 31st July 2013, 457 patients were admitted because of non-traumatic SAH (aSAH). Seventy-seven (16.8 %) patients had no aneurysm. Of the 380 patients with aSAH, information on co-morbid conditions was available for 371 patients. Thirty-six of those 371 had no treatment because of: bad clinical condition in 34 (9.2 %), a non-treatable dissecting aneurysm in 1 (0.3 %) and the explicit wishes of another. Co-morbidity was present in 113 (31.5 %) patients. Binary logistic regression analysis revealed no added value of using the CCI in predicting the outcome (p?=?0.91).Conclusions
This study reports that the CCI is not associated with the outcome classified on the mRS at 6 months in patients after aSAH. The CCI has no added value in case-mix correction. 相似文献11.
Sivashanmugam Dhandapani Sudhir S. Pal Sunil K. Gupta Sandeep Mohindra Rajesh Chhabra Surender K. Malhotra 《Acta neurochirurgica》2013,155(2):237-246
Background
Elective temporary clipping (ETC) is increasingly used in surgery for aneurysms. This study was to assess whether the impact of ETC on intraoperative aneurysmal rupture (IAR) translates into neurological outcome.Methods
Patients who underwent surgery for ruptured anterior circulation aneurysms were prospectively studied for various factors related to ETC, IAR and neurological outcome at 3 months. Univariate and multivariate analyses were performed using SPSS20.Results
Of the total 273 ruptured aneurysm surgeries studied, IAR was observed in only six out of 132 aneurysms (4.5 %) who had ETC, compared with 78 out of 141 (55.3 %) without ETC (p?<?0.001). Aneurysms complicated by IAR had significantly longer clipping time (8.3 min) compared with those without IAR (1.9 min) (p?<?0.001). IAR had significant association with unfavorable outcome (38 % vs. 24 %) (p?=?0.02). Patients with ETC had significantly shorter clipping time (2.9 min) compared with those without ETC (4.8 min) (p?=?0.02). Unfavorable outcome was noted in 30 out of 132 with ETC (23 %), compared with 48 out of 141 without ETC (34 %) (p?=?0.04). This beneficial effect was nonsignificantly greater in younger and good clinical grade patients. While episodes of ETC within clipping time of 20 min did not show significant difference in outcome, repeated rescue clipping (45 % unfavorable outcome, p?=?0.048) and total clipping time of at least 20 min (75 % unfavorable outcome, p?=?0.008) had significant impact on outcome. In multivariate analysis, the use of ETC (p?=?0.027) and total temporary clipping less than 20 min (p?=?0.049) were noted to result in significantly better outcome, independent of other factors.Conclusions
The use of ETC decreased the occurrence of IAR and the total clipping time, thereby leading to significantly better outcome, independent of other factors. While repeated elective clipping within total clipping time of 20 min did not influence outcome, repeated rescue clipping and total clipping time of at least 20 min had significant impact on outcome. 相似文献12.
Marco Fontanella Salvatore Gallone Pier Paolo Panciani Diego Garbossa Roberto Stefini Nicola Latronico Elisa Rubino Nicola Marengo Alessandro Ducati Lorenzo Pinessi Innocenzo Rainero 《Acta neurochirurgica》2013,155(8):1511-1515
Background
The exact pathophysiology of the development and rupture of saccular aneurysms is still controversial. Several lines of evidence indicate a role for inflammatory processes. Similarly, abnormal angiogenesis might be related to aneurysm growth. Expression of angiogenesis factors is higher in patients harboring aneurysms. The aim of this study was to verify the association of two functionally active polymorphisms (+ 396 C>T and 18 bp microdeletion) in the vascular endothelial growth factor (VEGF) gene with both susceptibility to and clinical features of aneurysmal subarachnoid hemorrhage (SAH) in an Italian population.Method
Allelic and genotypic frequencies of the?+?396 C>T and the 18 bp microdeletion of the VEGF gene were determined in 200 patients and 200 healthy controls.Results
Both allelic and genotypic frequencies of the examined polymorphisms in the VEGF gene were not significantly different between cases and controls. Furthermore, the different VEGF genotypes did not seem to significantly modify the main clinical features of the disease.Conclusions
Our data suggest that the VEGF gene is not a major genetic risk factor for aneurysmal subarachnoid hemorrhage. 相似文献13.
Ui Jun Park Hyoung Tae Kim Won Hyun Cho Young Hwan Kim Tetsuro Miyata 《Surgery today》2014,44(11):2092-2097
Purpose
The aim of this study was to evaluate the clinical course and angiographic changes of spontaneous isolated superior mesenteric artery dissection (SISMAD) after conservative treatment.Methods
Twenty-four patients with SISMAD admitted from September 2006 through March 2013 were included in this study. The clinical characteristics, type and location of the dissection, clinical outcome and angiographic changes were analyzed retrospectively.Results
The median follow-up was 18.7 months (range 1.4–67.5 months). Eighteen patients (75 %) were symptomatic, and the median duration of abdominal pain was 2.5 days. All of the patients were treated conservatively. Follow-up computed tomography angiography showed complete remodeling in six patients (25 %), partial remodeling in four patients (17 %), no changes in nine patients (38 %), progression to total occlusion in four patients (17 %) and aneurysmal changes of the false lumen in one patient (4 %). Endovascular intervention was performed in the patient with aneurysmal changes. There was no mortality or morbidity related to the dissection.Conclusion
SISMAD represented variable angiographic changes, and its clinical course was benign in this study. For patients with SISMAD, if there is no evidence of bowel infarction, bleeding or aneurysmal changes, conservative treatment with close follow-up is sufficient and could reduce unnecessary endovascular interventions. 相似文献14.
Milo Stanišić John Hald Inge Andre Rasmussen Are Hugo Pripp Jugoslav Ivanović Frode Kolstad Jarle Sundseth Mark Züchner Karl-Fredrik Lindegaard 《Acta neurochirurgica》2013,155(2):323-333
Background
Chronic subdural haematoma (CSDH) is a common entity in neurosurgery with a considerable postoperative recurrence rate. Computerised tomography (CT) scanning remains the most important diagnostic test for this disorder. The aim of this study was to characterise the relationship between the recurrence of CSDH after treatment with burr-hole irrigation and closed-system drainage technique and CT scan features of these lesions to assess whether CT findings can be used to predict recurrence.Methods
We investigated preoperative and postoperative CT scan features and recurrence rate of 107 consecutive adult surgical cases of CSDH and assessed any relationship with univariate and multivariate regression analyses.Results
Seventeen patients (15.9 %) experienced recurrence of CSDH. The preoperative haematoma volume, the isodense, hyperdense, laminar and separated CT densities and the residual total haematoma cavity volume on the 1st postoperative day after removal of the drainage were identified as radiological predictors of recurrence. If the preoperative haematoma volume was under 115 ml and the residual total haematoma cavity volume postoperatively was under 80 ml, the probability of no recurrence was very high (94.4 % and 97.4 % respectively).Conclusions
These findings from CT imaging may help to identify patients at risk for postoperative recurrence. 相似文献15.
Jin-Ning Song Ming Zhang Dan-Dong Li Min Li Ji-Yang An Mao-Feng Cheng Xiao-Ye Guo 《Acta neurochirurgica》2014,156(5):941-949
Background
There are complex interactions between acetylcholine (ACh), the suppressor of cytokine signaling-3 (SOCS-3), and cytokines, however, little is known about their dynamic expression or their effects on cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH). Therefore, we aimed to describe and clarify the dynamic expression of SOCS-3 and cytokines after SAH, as well as the relationships between the levels of SOCS-3, cytokines, and ACh.Methods
The rat model of single cisterna magna injection was used to mimic acute SAH. The degree of CVS was indicated by lumen diameter and artery wall thickness under H&E staining. A semi-quantitative immunohistochemical analysis method was used to clarify the role of SOCS-3 in the CVS after SAH. We also measured the content of IL-6 and IL-10 in cerebrospinal fluid.Results
We found that SOCS-3 expression levels increased rapidly within 12 h after SAH, more slowly after 12 h, and did not reach a peak within 48 h. Interleukin 6 (IL-6) levels rapidly increased within 24 h after SAH, reached a peak 24 h after SAH, and decreased slightly at 48 h. IL-10 levels increased during the first 6 h after SAH, after which this increase tapered off. ACh treatment reduced IL-6 levels and resulted in elevated levels of SOCS-3, but had no effect on IL-10 expression. Furthermore, ACh treatment relieved basilar arterial vasospasm, whereas mecamylamine pretreatment counteracted the activity of ACh.Conclusions
Taken together, these data indicate that SOCS-3 was involved in vasospasm via an IL-6- and IL-10-related mechanism, and that CVS following SAH could be reversed by the intraventricular injection of ACh. 相似文献16.
Mehmet Dumlu Aydin Ayhan Kanat Osman Nuri Turkmenoglu Coskun Yolas Cemal Gundogdu Nazan Aydın 《Acta neurochirurgica》2014,156(7):1311-1317
Background
Cerebrospinal fluid (CSF) secretion may be increased in the early phases of subarachnoid hemorrhage (SAH), possibly via ischemic glossopharyngeal nerve discharges, and decreased due to glossopharyngeal nerve degeneration in the late phase of SAH; but this reflex pathway has not been definitively investigated. We studied the relationship between petrous ganglion of the glossopharyngeal nerve (GPN) and water vesicles of the choroid plexus (CP) in the early and late phases of SAH.Methods
This study was conducted on 30 rabbits, divided into four groups, with five rabbits in the control group (group I), five rabbits in the sham group (Group II), and 20 rabbits in the SAH group. In the SAH group, five of the animals were decapitated after 4 days of cisternal blood injections (Group III), and the other 15 animals were decapitated after 20 days of injections (Group IV). The Petrous Ganglia and CPs of lateral ventricles were removed and stained for stereological analysis.Results
The mean number of follicles per cubic millimeter was 5.3?±?1.2 the in control group (Group I), 4.5?±?0.9 in the sham group (Group II), 16.60?±?3.77 the in early decapitated group (Group III), and 4.30?±?0.84 in the late decapitated group (Group IV). The mean number of degenerated neuron density of petrous ganglions was 6?±?2, 50?±?6, 742?±?96, and 2.420?±?350 in the control (Group I), sham (Group II), early decapitated (Group III), and late decapitated group (Group IV), respectively. The mean number of water vesicles was statistically different after SAH between the early decapitated group (group III) and the late decapitated group (group IV) (P?<?0.05).Conclusions
We studied the relationship between petrous ganglion cells of the GPN and water vesicles of CP in the early and late phases of SAH, and found that CP vesicles are increased in the early phase of SAH due to irritation of GPN, and decreased in the late phase due to ischemic insult of the petrous ganglion and parasympathetic innervation of the CP. 相似文献17.
Deepti Bhargava Andrew Alalade Habib Ellamushi John Yeh Roger Hunter 《Acta neurochirurgica》2013,155(11):2129-2132
Background
Cerebrospinal fluid (CSF) drainage has been variably employed to lower intracranial pressure (ICP) in patients with severe head injury. The efficacy of this manoeuvre remains under-explored (Brain Trauma Foundation Recommendation—optional treatment). This work seeks to report the results of CSF drainage via external ventricular drain (EVD) in severe head injury in comparison to other treatment options.Methods
Retrospective observational comparative study of all consecutive patients admitted to a major trauma centre with severe traumatic brain injury over a period of 12 months.Results
Out of a total 139 patients, 33 had delayed elevation of ICP despite conventional medical therapy, 16 patients were treated with EVD insertion (4 placed under AxiEM image guidance [Medtronic]) and 17 received either decompressive craniectomy or barbiturate coma. Subsequently, two patients with decompression had further ICP elevation and needed EVD. Two patients with EVD had raised ICP—one underwent decompression and the other was treated with barbiturate coma. One patient with EVD developed infection, which was successfully treated. Patients treated with EVD had a lower risk of needing definitive treatment for ICP control, i.e. decompressive craniectomy or barbiturate coma.Conclusions
EVD was a safe and less invasive procedure, and achieved sustained control of ICP in this patient group. 相似文献18.
Maria Wostrack Nora Sandow Peter Vajkoczy Bawarjan Schatlo Philippe Bijlenga Karl Schaller Victoria Kehl Kathrin Harmening Florian Ringel Yu-Mi Ryang Benjamin Friedrich Michael Stoffel Bernhard Meyer 《Acta neurochirurgica》2013,155(4):579-586
Background
Aneurysmal subarachnoid haemorrhage (SAH) WFNS grade V is commonly known to be associated with high mortality and a very poor prognosis for survivors. Therefore, maximal invasive therapy is frequently delayed until any spontaneous improvement with or without an external ventricular drainage occurs. The aim of the study was to verify possible predictive factors and the probability of a favourable outcome in maximally treated patients.Methods
One hundred and thirty-eight consecutive patients with WFNS grade V SAH were admitted between 03/2006 and 12/2010. Thirty-five patients died before aggressive therapy could proceed. One hundred and three patients received maximal treatment and were retrospectively evaluated. The outcome was assessed at discharge and in the follow-up with the Glasgow Outcome Scale. Univariate and multivariate linear regression models were performed to find predictors for an unfavourable outcome.Results
Despite treatment, early mortality was 30 % (n?=?31). At discharge, the rate of both vegetative and severely disabled patients was 27 % (n?=?28). Favourable outcome at discharge was observed in 16 % (n?=?16) of cases, whereas in the follow-up it rose to 26 % (n?=?27). Multivariate full model regression identified intraventricular haematoma (IVH) and increasing age as independently predictive for poor outcome.Conclusions
Despite treatment, initial mortality and severe disability remain high. Nevertheless, a favourable outcome was achieved in 26 % of aggressively treated patients, rendering the withdrawal of maximal therapy for WFNS grade V SAH patients unacceptable today. In cases of old patients with IVH, the indication for aggressive therapy should be put in place more carefully due to a very poor prognosis. 相似文献19.
Shigeki Minami Chika Sakimura Naomi Hayashida Kosho Yamanouchi Tamotsu Kuroki Susumu Eguchi 《Surgery today》2014,44(1):137-141
Purpose
The aim of this study was to evaluate the chronological changes in the amount of drainage fluid after thyroidectomy, and to establish standard indications for the drain to be removed.Methods
We examined a cohort of 249 patients undergoing thyroid surgery. The patients were divided into four groups: a Graves’ group, a non-dissection group, a central-dissection group and a lateral-dissection group. The amount of drainage was measured every 6 h, and the drain was removed postoperatively when the drainage decreased in amount and contained serous fluid after a meal.Results
In all four groups, the most drainage occurred in the first 6 h after surgery. The total amount of drainage from the operation to the time of drain removal was significantly higher in Graves’ group and in the lateral-dissection group than in the other two groups. The median wound drainage significantly decreased from 12 to 18 h after surgery in all four groups. In the lateral-dissection group, the wound drainage significantly decreased again in the first 24–30 h.Conclusion
The findings of this study suggest that drains can be removed postoperatively if the drainage was less than 15 mL during a 6-h period and contain serous fluid. 相似文献20.
Paolo Gritti Luigi Andrea Lanterna Lidia Rotasperti Matteo Filippini Simone Cazzaniga Carlo Brembilla Tatyana Sarnecki Ferdinando Luca Lorini 《Journal of anesthesia》2014,28(5):687-695