Bifrontal decompressive craniotomy for massive cerebral edema

1971 ◽  
Vol 34 (4) ◽  
pp. 488-493 ◽  
Author(s):  
Raymond N. Kjellberg ◽  
Alberto Prieto
Keyword(s):  
Cerebral Edema ◽  
Massachusetts General Hospital ◽  
Pseudotumor Cerebri ◽  
Toxic Encephalopathy ◽  
Brain Swelling ◽  
High Mortality Risk ◽  
Content Type ◽  
Decompressive Craniotomy ◽  
Post Traumatic ◽  
Mass Lesions

✓ A large bifrontal craniotomy was used in selected patients judged to carry an unusually high mortality risk due to brain swelling secondary to brain trauma. The procedure enabled exploration of both hemisphere convexities, evacuation of accumulated blood and necrotic brain, and decompression of swollen brain. This report reviews 73 cases operated on at the Massachusetts General Hospital since March, 1962; 18% of these patients survived. The largest experience was with post-traumatic cerebral edema, although intractable edema secondary to mass lesions, hemorrhage, toxic encephalopathy, and pseudotumor cerebri was also treated.

scholarly journals Decompressive craniotomy: prognostic factors and complications in 89 patients

2008 ◽  
Vol 66 (2b) ◽  
pp. 369-373 ◽  
Author(s):  
Rodrigo Moreira Faleiro ◽  
Luiz Carlos Mendes Faleiro ◽  
Elisa Caetano ◽  
Isabella Gomide ◽  
Cristina Pita ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Head Injury ◽  
Severe Head Injury ◽  
Traffic Accidents ◽  
Acute Subdural Hematoma ◽  
Brain Swelling ◽  
Decompressive Craniotomy ◽  
Independent Test ◽  
Post Traumatic ◽  
Subdural Effusions

Decompressive craniotomy (DC) is applied to treat post-traumatic intracranial hypertension (ICH). The purpose of this study is to identify prognostic factors and complications of unilateral DC. Eighty-nine patients submited to unilateral DC were retrospectively analyzed over a period of 30 months. Qui square independent test and Fisher test were used to identify prognostic factors. The majority of patients were male (87%). Traffic accidents had occurred in 47% of the cases. 64% of the patients had suffered severe head injury, while pupillary abnormalities were already present in 34%. Brain swelling plus acute subdural hematoma were the most common tomographic findings (64%). Complications occurred in 34.8% of the patients: subdural effusions in 10 (11.2%), hydrocephalus in 7 (7.9%) and infection in 14 (15.7%). The admittance Glasgow coma scale was a statistically significant predictor of outcome ( p=0.0309).

Intraoperative transdural functional mapping

1994 ◽  
Vol 80 (4) ◽  
pp. 756-758 ◽  
Author(s):  
Daniel L. Silbergeld
Keyword(s):  
Evoked Potentials ◽  
General Anesthesia ◽  
Somatosensory Evoked Potentials ◽  
Cerebral Injury ◽  
Brain Swelling ◽  
Content Type ◽  
Cortical Stimulation Mapping ◽  
Dural Opening ◽  
Mass Lesions ◽  
Fine Print

✓ During craniotomy for supratentorial intraparenchymal space-occupying lesions, with the patient either under general anesthesia or awake, a smaller durotomy designed to expose only the region of resection may be desirable because of brain swelling. Similarly, during repeat craniotomy or craniotomy following cerebral injury or infection, pial-dural adhesions increase the risk of damage to essential cortex, making a limited dural opening desirable. Intraoperative transdural somatosensory evoked potentials and transdural cortical stimulation mapping permit localization of functional cortex prior to durotomy. These techniques can be combined with intraoperative transdural ultrasonography to identify topographical landmarks and borders of mass lesions.

scholarly journals Brain Swelling and Ventricle Size

1983 ◽  
Vol 10 (2) ◽  
pp. 110-113 ◽  
Author(s):  
R.T. Ross
Keyword(s):  
Ct Scan ◽  
Cerebral Edema ◽  
Pseudotumor Cerebri ◽  
Respiratory Arrest ◽  
Cerebral Hypoxia ◽  
Ventricular Size ◽  
Brain Swelling ◽  
Computed Tomographic ◽  
Normal People ◽  
Ventricle Size

SUMMARY:Cerebral ventricle size was measured in one hundred normal people, age 10 to 50 years. The measurements were obtained from computed tomographic (CT) scan examinations, using the Huckman (1975) method. Normal ventricles were significantly bigger at age 45 than at age 15. These normals were compared to groups of patients with pseudotumor cerebri, water intoxication and cerebral edema, and cerebral hypoxia and edema due to cardio-respiratory arrest.The relative ventricular size was the same in the normal group and all three disease groups. Measurement of ventricle size from CT scan images is not even a crude index of cerebral edema in these three diseases.

Hemodynamic and metabolic concomitants of brain swelling and cerebral edema due to experimental cerebral infarction

1972 ◽  
Vol 36 (6) ◽  
pp. 728-744 ◽  
Author(s):  
Tetsuaki Teraura ◽  
John Stirling Meyer ◽  
Keizo Sakamoto ◽  
Kazuo Hashi ◽  
Peter Marx ◽  
...  
Keyword(s):  
Cerebral Edema ◽  
Pressor Response ◽  
Chloride Content ◽  
Brain Swelling ◽  
Content Type ◽  
Cerebral Anoxia ◽  
Vertebral Arteries ◽  
Uncoupling Of Oxidative Phosphorylation ◽  
Carotid And Vertebral Arteries ◽  
Experimental Cerebral Infarction

✓ Severe cerebral ischemia was produced in 25 baboons by clamping the carotid and vertebral arteries bilaterally for 10 minutes. Cerebral hemodynamics and metabolism were monitored throughout. Cerebral anoxia was less severe in animals in which a marked pressor response occurred due to ischemia of the vasomotor center, and a reversible type of brain swelling was usual. In those with more severe ischemic anoxia, progressive cerebral edema was a pathological entity. Evidence is presented that cerebral edema was caused by loss of autoregulation of cerebral blood flow (CBF) concomitant with hyperemia and an increase of water and chloride content of brain tissue. Cerebral edema began when CBF was reduced during occlusion and progressed for several hours after termination of occlusion. Evidence is adduced that uncoupling of oxidative phosphorylation may be an important concomitant of cerebral edema.

Cerebral edema, mass effects, and regional blood volume in man

1977 ◽  
Vol 46 (3) ◽  
pp. 282-289 ◽  
Author(s):  
Richard D. Penn ◽  
Diane Kurtz
Keyword(s):  
Blood Volume ◽  
Cerebral Edema ◽  
Regional Differences ◽  
Ct Scans ◽  
Pressure Gradients ◽  
Content Type ◽  
Local Reduction ◽  
Regional Blood Volume ◽  
Mass Lesions ◽  
The Brain

✓ The authors conducted quantitative analysis of computerized tomography (CT) scans to measure tumor size, cerebral edema, and regional blood volume in man. Mass lesions without edema caused a local reduction in blood volume. Cerebral edema also reduced blood volume in proportion to its severity. Consideration of the electrolyte changes and water shifts in white-matter edema suggested that the decrease in absorption coefficient seen in CT scans was due to the increase in water content. Thus, in cerebral edema separation of blood vessels as well as increased interstitial pressure decrease blood volume, and the regional differences in turn reflect pressure gradients within the brain.

Pseudotumor cerebri syndrome: venous sinus obstruction and its treatment with stent placement

2003 ◽  
Vol 98 (5) ◽  
pp. 1045-1055 ◽  
Author(s):  
Brian K. Owler ◽  
Geoffrey Parker ◽  
G. Michael Halmagyi ◽  
Victoria G. Dunne ◽  
Verity Grinnell ◽  
...  
Keyword(s):  
Stent Placement ◽  
Pseudotumor Cerebri ◽  
Venous Sinus ◽  
Stent Insertion ◽  
Benign Intracranial Hypertension ◽  
Content Type ◽  
Venous Sinuses ◽  
Pseudotumor Cerebri Syndrome ◽  
New Treatment ◽  
Fine Print

Object. Pseudotumor cerebri, or benign intracranial hypertension, is a condition of raised intracranial pressure in the absence of a mass lesion or cerebral edema. It is characterized by headache and visual deterioration that may culminate in blindness. Pseudotumor cerebri is caused by venous sinus obstruction in an unknown percentage of cases. The purpose of this study was to investigate the role of cerebral venous sinus disease in pseudotumor cerebri and the potential of endoluminal venous sinus stent placement as a new treatment. Methods. Nine consecutive patients in whom diagnoses of pseudotumor cerebri had been made underwent examination with direct retrograde cerebral venography (DRCV) and manometry to characterize the morphological features and venous pressures in their cerebral venous sinuses. The cerebrospinal fluid (CSF) pressure was measured simultaneously in two patients. If patients had an amenable lesion they were treated using an endoluminal venous sinus stent. Five patients demonstrated morphological obstruction of the venous transverse sinuses (TSs). All lesions were associated with a distinct pressure gradient and raised proximal venous sinus pressures. Four patients underwent stent insertion in the venous sinuses and reported that their headaches improved immediately after the procedure and remained so at 6 months. Vision was improved in three patients, whereas it remained poor in one despite normalized CSF pressures. Conclusions. Patients with pseudotumor cerebri should be evaluated with DRCV and manometry because venous TS obstruction is probably more common than is currently appreciated. In patients with a lesion of the venous sinuses, treatment with an endoluminal venous sinus stent is a viable alternative for amenable lesions.

Effect of stimulation of the medullary reticular formation on cerebral vasomotor tonus and intracranial pressure

1987 ◽  
Vol 66 (4) ◽  
pp. 548-554 ◽  
Author(s):  
Seigo Nagao ◽  
Tsukasa Nishiura ◽  
Hideyuki Kuyama ◽  
Masakazu Suga ◽  
Takenobu Murota
Keyword(s):  
Intracranial Pressure ◽  
Reticular Formation ◽  
Cerebral Blood Volume ◽  
Systemic Arterial Pressure ◽  
Brain Swelling ◽  
Dorsomedial Nucleus ◽  
Medullary Reticular Formation ◽  
Content Type ◽  
Fine Print ◽  
Stimulation Of

✓ The authors report the results of a study to evaluate the effect of stimulation of the medullary reticular formation on cerebral vasomotor tonus and intracranial pressure (ICP) after the hypothalamic dorsomedial nucleus and midbrain reticular formation were destroyed. Systemic arterial pressure (BP), ICP, and local cerebral blood volume (CBV) were continuously recorded in 32 cats. To assess the changes in the cerebral vasomotor tonus, the vasomotor index defined by the increase in ICP per unit change in BP was calculated. In 29 of the 32 animals, BP, ICP, and CBV increased simultaneously immediately after stimulation. The increase in ICP was not secondary to the increase in BP, because the vasomotor index during stimulation was significantly higher than the vasomotor index after administration of angiotensin II. The vasomotor index was high during stimulation of the area around the nucleus reticularis parvocellularis. In animals with the spinal cord transected at the C-2 vertebral level, ICP increased without a change in BP. These findings indicate that the areas stimulated in the medullary reticular formation play an important role in decreasing cerebral vasomotor tonus. This effect was not influenced by bilateral superior cervical ganglionectomy, indicating that there is an intrinsic neural pathway that regulates cerebral vasomotor tonus directly. In three animals, marked biphasic or progressive increases in ICP up to 100 mm Hg were evoked by stimulation. The reduction of cerebral vasomotor tonus and concomitant vasopressor response induced by stimulation of the medullary reticular formation may be one of the causes of acute brain swelling.

Intracranial pressure changes induced by sodium nitroprusside in patients with intracranial mass lesions

1978 ◽  
Vol 48 (3) ◽  
pp. 329-331 ◽  
Author(s):  
James E. Cottrell ◽  
Katie Patel ◽  
Herman Turndorf ◽  
Joseph Ransohoff
Keyword(s):  
Intracranial Pressure ◽  
Sodium Nitroprusside ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Intracranial Tumors ◽  
Cerebral Blood Vessels ◽  
Content Type ◽  
The Mean ◽  
Pressure Changes ◽  
Mass Lesions

✓ Because of the ability of sodium nitroprusside (SNP) to dilate cerebral blood vessels, intracranial pressure (ICP) should increase with its use. In patients with vascular intracranial tumors following SNP (0.01%) infusion, ICP increased from 14.58 ± 1.85 to 27.61 ± 3.33 torr (p > 0.0005) and cerebral perfusion pressure decreased from 89.32 ± 3.5 to 43.23 ± 4.60 torr (p < 0.0005) when the mean arterial pressure had reduced by 33%. These results suggest that SNP not be used in patients with raised ICP unless previous measures have been taken to improve intracranial compliance.

Prisoner’s insomnia prevalence, insomnia associated factors and interventions with sleep as an outcome: a review and narrative analysis

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Chris Griffiths ◽  
Farah Hina
Keyword(s):  
Narrative Analysis ◽  
Associated Factors ◽  
Behavioural Therapy ◽  
Post Traumatic Stress ◽  
Content Type ◽  
Cognitive Behavioural ◽  
High Prevalence ◽  
Randomised Control Trials ◽  
Post Traumatic ◽  
Anxiety Depression

Purpose Insomnia is highly prevalent in prisoners. The purpose of this paper is a review of research evidence on interventions with sleep as an outcome (2000 to 2020) and rates of insomnia prevalence and associated factors in prisons (2015 to 2020). Design/methodology/approach An internet-based search used Medline, PubMed, PsycINFO (EBSCOhost), Embase, Web of Science and Scopus. Seven interventions and eight sleep prevalence or sleep-associated factor papers were identified. Findings Intervention research was very limited and the quality of the research design was generally poor. Interventions such as cognitive behavioural therapy for insomnia (CBT-I), yoga and mindfulness can be beneficial in a prison setting. This review identified a high prevalence of insomnia in prisons across the world, which was supported by recent evidence. Factors associated with insomnia include anxiety, depression, post-traumatic stress disorder, personality disorder and pain. Research limitations/implications There is a need for appropriately powered randomised control trials of CBT-I in prisons and a need to use objective measures of sleep quality. Originality/value Due to a lack of an up-to-date review, this paper fulfils the need for a review of the evidence on interventions in prison settings with sleep as an outcome, rates of insomnia prevalence and associated factors in prisons.

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