Miniature intravascular pCO2 sensors in neurosurgery

1975 ◽  
Vol 43 (2) ◽  
pp. 172-176 ◽  
Author(s):  
Julius Neumark ◽  
Ann Bardeen ◽  
Edith Sulzer ◽  
John P. Kampine
Keyword(s):  
Postoperative Period ◽  
Recovery Room ◽  
Spontaneous Respiration ◽  
Paired Comparisons ◽  
Average Difference ◽  
Awake Patient ◽  
Content Type ◽  
On Line ◽  
Fine Print

✓ In this study the authors compared PaCO2 measurements from a newly developed miniature intravascular pCO2 sensor for continuous on-line monitoring with those from a Radiometer bench instrument. In 10 patients undergoing craniotomy procedures, 84 paired comparisons were made. At the same time it was possible to follow continuously the trend of PaCO2 during deliberate hyperventilation, during the apneic period following hyperventilation, and during spontaneous respiration in the postoperative period. The comparisons showed an average difference in pCO2 of 1.62 ± SE 0.15 torr. The apneic threshold for PaCO2 after passive hyperventilation was lower than in the awake patient. After the period of apnea no hypoxemia occurred. In the recovery room the PaCO2 increased and the PaO2 decreased. The latter decreased to subnormal levels in two patients more than an hour postoperatively.

A method of estimating intracranial decompensation in man

1976 ◽  
Vol 45 (2) ◽  
pp. 155-158 ◽  
Author(s):  
Jerzy Szewczykowski ◽  
Pawel Dytko ◽  
Adam Kunicki ◽  
Jolanta Korsak-Sliwka ◽  
Stanislaw Sliwka ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Intracranial Pressure ◽  
Characteristic Feature ◽  
Computer System ◽  
Monitoring System ◽  
New Method ◽  
Icp Monitoring ◽  
Content Type ◽  
On Line ◽  
Fine Print

✓ A new method of estimating intracranial decompensation in man is described. An on-line computer system is connected to an intracranial pressure (ICP) monitoring system to compute regression plots of mean ICP vs standard deviation; standard deviation is used as a measure of ICP instability. Two zones with distinctly different slopes are a characteristic feature of these plots. It is thought that the changes of slope signify intracranial decompensation.

Posterolateral percutaneous endoscopic lumbar foraminotomy for L5—S1 foraminal or lateral exit zone stenosis

2003 ◽  
Vol 99 (3) ◽  
pp. 320-323 ◽  
Author(s):  
Yong Ahn ◽  
Sang-Ho Lee ◽  
Woo-Min Park ◽  
Ho-Yeon Lee
Keyword(s):  
Ligamentum Flavum ◽  
Leg Pain ◽  
Foraminal Stenosis ◽  
Fluoroscopic Guidance ◽  
Awake Patient ◽  
Content Type ◽  
Simple Alternative ◽  
The Mean ◽  
Fine Print

✓ The purpose of this study was to determine the efficacy and feasibility of posterolateral percutaneous endoscopic lumbar foraminotomy (PELF) for foraminal or lateral exit zone stenosis of the L5—S1 level in the awake patient. Twelve consecutive patients with L5—S1 foraminal stenosis and associated leg pain underwent PELF between May 2001 and July 2002. Under fluoroscopic guidance, posterolateral endoscopic foraminal decompression was performed using a bone reamer, endoscopic forceps, and a laser. Using this new technique, the authors removed part of the hypertrophied superior facet, thickened ligamentum flavum, and protruded disc compressing the exiting (L-5) nerve root. Clinical outcome was measured using the Macnab criteria. The mean follow-up period was 12.9 months. All the patients were discharged within 24 hours. Satisfactory (excellent or good) results were demonstrated in 10 patients. There was no complication. The PELF procedure provides a simple alternative for treating lumbar foraminal or lateral exit zone stenosis in selected cases. The authors found that the posterolateral endoscopic approach to the L5—S1 foramen was usually possible and that using a bone reamer to undercut the superior facet was effective.

Subtotal neonatal calvariectomy

1979 ◽  
Vol 51 (5) ◽  
pp. 691-696 ◽  
Author(s):  
Laurence W. Mabbutt ◽  
Vincent G. Kokich ◽  
Benjamin C. Moffett ◽  
John D. Loeser
Keyword(s):  
Postoperative Period ◽  
Surgical Margin ◽  
Regenerative Process ◽  
Bone Union ◽  
Histological Techniques ◽  
Content Type ◽  
Rate Of Development ◽  
Definite Pattern ◽  
Fine Print

✓ A subtotal calvariectomy was performed on rabbits between 10 and 14 days of age. The animals were allowed to grow and were then sacrificed serially so that the sutural and skeletal redevelopment could be analyzed through a combination of gross, radiographic, and histological techniques. The results indicate that calvarial regeneration is a progressive process with a definite pattern and rate of development. During the regenerative process, bone was deposited both at the surgical margin and as islands within the surgical defect. The eventual approximation of these areas of ossification produced multiple fibrous articulations. The majority of these articulations were obliterated by bone union, except for the midsagittal, coronal, and metopic sutures, which were re-established in their appropriate anatomical positions. The maintenance of dural integrity during the surgical phase and the regeneration and establishment of pericranial continuity during the postoperative period were believed to be important in the re-establishment of normal sutural and skeletal architecture.

Ventricular pressure monitoring during bilateral decompression with dural expansion

1999 ◽  
Vol 91 (6) ◽  
pp. 953-959 ◽  
Author(s):  
Do-Sung Yoo ◽  
Dal-Soo Kim ◽  
Kyung-Suck Cho ◽  
Pil-Woo Huh ◽  
Chun-Kun Park ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Initial Pressure ◽  
Ventricular Pressure ◽  
Decompressive Surgery ◽  
Brain Swelling ◽  
Content Type ◽  
Proper Patient Selection ◽  
Ventricular Puncture ◽  
The Mean ◽  
Fine Print

Object. The management of massive brain swelling remains an unsolved problem in neurosurgery. Despite newly developed medical and pharmacological therapy, the rates of mortality and morbidity caused by massive brain swelling remain high. According to many recent reports, surgical decompression with dural expansion is superior to medical management in patients with massive brain swelling. To show the quantitative effect of decompressive surgery on intracranial pressure (ICP), the authors performed a ventricular puncture and measured the ventricular ICP continuously during decompressive surgery and the postoperative period.Methods. Twenty patients with massive brain swelling who underwent bilateral decompressive craniectomy with dural expansion were included in this study. In all patients, ventricular puncture was performed at Kocher's point on the side opposite the massive brain swelling. The ventricular puncture tube was connected to the continuous monitor via a transducer device. The ventricular pressure was monitored continuously, during the bilateral decompressive procedures and postoperative period.The initial ventricular ICP was variable, ranging from 16 to 65.8 mm Hg. Immediately after the bilateral craniectomy, the mean ventricular ICP decreased to 50.2 ± 16.6% of the initial ICP (range 5–51.5 mm Hg). Additional opening of the dura decreased the mean ICP by an additional 34.5% and reduced the ventricular pressure to 15.7 ± 10.7% of the initial pressure (range 0–15 mm Hg). Ventricular pressure measured postoperatively in the neurosurgical intensive care unit was lowered to 15.1 ± 16.5% of the initial ICP. The ventricular ICP trend in the first 24 hours after decompressive surgery was an important prognostic factor; if it was greater than 35 mm Hg, the mortality rate was 100%.Conclusions. Bilateral decompression with dural expansion is an effective therapeutic modality in the control of ICP. To obtain favorable clinical outcomes in patients with massive brain swelling, early decision making and proper patient selection are very important.

Hypermetabolism in the acute stage of hemorrhagic cerebrovascular disease

1990 ◽  
Vol 72 (5) ◽  
pp. 710-714 ◽  
Author(s):  
Hajime Touho ◽  
Jun Karasawa ◽  
Hisashi Shishido ◽  
Toshitaka Morisako ◽  
Keisuke Yamada ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Respiratory Quotient ◽  
Intracranial Aneurysms ◽  
Acute Stage ◽  
Nitrogen Excretion ◽  
Content Type ◽  
Ruptured Intracranial Aneurysms ◽  
Urinary Nitrogen Excretion ◽  
Fine Print ◽  
Urinary Nitrogen

✓ Oxygen consumption carbon dioxide production , urinary nitrogen excretion, respiratory quotient, resting energy expenditure (REE), %REE, and the consumption rates of carbohydrate, fat, and protein (%CHO, %Fat, %Prot, respectively) were determined pre- and postoperatively by indirect calorimetry in 13 patients with ruptured intracranial aneurysms and 11 patients with hypertensive intracerebral hemorrhage in the acute stage. The preoperative urinary nitrogen excretion, respiratory quotient, REE, and %REE were, respectively (mean ± standard deviation): 171 ± 46 ml/min, 203 ± 56 ml/min, 10.3 ± 1.7 gm/day, 0.84 ± 0.01, 1397 ± 389 Cal/day, and 129% ± 8%. The values for REE, and %REE were all increased above normal levels. The %Prot was increased to 26.1% ± 9.1%. In the postoperative period, the urinary nitrogen excretion, REE, and %REE significantly increased to: 186 ± 44 ml/min, 229 ± 56 ml/min, 14.8 ± 2.9 gm/day, 1557 ± 384 Cal/day, and 141% ± 21%, respectively. The %Fat and %Prot also increased significantly, but the %CHO significantly decreased. Preoperatively, in the patients with ruptured intracranial aneurysms, there was a greater increase in %Prot in eight patients classified (according to Fischer) as having a Group 3 or 4 subarachnoid hemorrhage (SAH) on computerized tomography than in five patients classified as having a Group 1 or 2 SAH. In summary, increased metabolic expenditure, especially increased catabolism of protein and fat, is characteristic of accompanying hemorrhagic cerebrovascular disease, and there is an increase in consumption of fat and protein in the postoperative period. Lack of precise knowledge about the cause and consequences of these metabolic responses makes it impossible at present to judge the optimal extent of nutritional replacement. The hypermetabolic state should be taken into consideration when caring for these patients as it may cause weight loss, poor wound healing, and susceptibility to infection.

On-line monitoring of global cerebral hypoxia in acute brain injury

1993 ◽  
Vol 79 (2) ◽  
pp. 228-233 ◽  
Author(s):  
Julio Cruz
Keyword(s):  
Cerebral Oxygenation ◽  
Jugular Bulb ◽  
Cerebral Hypoxia ◽  
Oxyhemoglobin Saturation ◽  
Content Type ◽  
Head Injured ◽  
Scale Scores ◽  
On Line ◽  
Injured Patients ◽  
Fine Print

✓ Global cerebral oxygenation, perfusion pressure, and expired CO2 tension were continuously monitored in 69 adults with acute severe closed brain trauma. Cerebral oxygenation was assessed by continuous fiberoptic monitoring of jugular bulb oxyhemoglobin saturation, in conjunction with continuous monitoring of arterial oxyhemoglobin saturation. Jugular desaturation associated with arterial desaturation (hypoxemic cerebral hypoxia) was evaluated and managed. A total of 121 episodes of combined arterial and jugular desaturation were documented, 76 in the presence of gross abnormalities identified on chest roentgenograms. Prolonged episodes that did not respond promptly to treatment occurred 32 times in 12 patients, usually after the initial 72 hours posttrauma. The remaining 89 episodes promptly responded to treatment and occurred predominantly within the initial 72 hours. Profound but brief desaturation was not associated with neurological deterioration, while profound and prolonged desaturation was accompanied by significant decreases in Glasgow Coma Scale scores, even though intracranial pressure levels were not significantly different in these two groups. Global cerebral hypoxia that does not respond promptly to treatment appears to be independently deleterious to neurological function in severely head-injured patients.

Experimental lingual-basilar arterial microanastomosis

1971 ◽  
Vol 34 (4) ◽  
pp. 500-505 ◽  
Author(s):  
O. Howard Reichman
Keyword(s):  
Basilar Artery ◽  
Postoperative Period ◽  
Cerebral Perfusion ◽  
Early Postoperative Period ◽  
Arterial Spasm ◽  
Content Type ◽  
Factors Influencing ◽  
Arterial Inflow ◽  
Healing Phase ◽  
Fine Print

✓ A lingual-basilar artery microanastomosis was performed in 33 dogs; in 24, the cerebral arterial inflow was isolated to the lingual-basilar system. This experimental model demonstrated several factors influencing the use of extracranial vessels to enhance cerebral perfusion. The new lingual-basilar system increased in size to meet flow requirements formerly served by the normal vessels. Arterial spasm was present in the early postoperative period. Arteriography was detrimental if performed at the time of anastomosis or in the healing phase.

Monitoring of blood parameters following anterior cervical fusion

2000 ◽  
Vol 92 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Steffen K. Rosahl ◽  
Alireza Gharabaghi ◽  
Peter-Michael Zink ◽  
Madjid Samii
Keyword(s):  
Cervical Spine ◽  
Cell Count ◽  
Postoperative Period ◽  
White Cell Count ◽  
Anterior Cervical Fusion ◽  
Anterior Fusion ◽  
Cervical Fusion ◽  
Content Type ◽  
Cervical Spine Surgery ◽  
Fine Print

Object. Both C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) were measured prospectively in 51 cases in which uncomplicated cervical anterior fusion was performed. The object of the authors was to quantify the differences in the responses of these parameters recorded in the immediate postoperative period and to determine factors influencing their course. Methods. Nineteen one-level, 23 two-level, and nine three-level procedures for disc herniation and degenerative disease of the cervical spine were performed in 22 female and 29 male patients (mean age 49.2 years). Blood samples were obtained 1 day before as well as on 10 consecutive days and 3 months following anterior cervical fusion. Serum CRP level was measured using a fluorescence polarization immunoassay and ESR was determined from the same samples. Operative time, the number of blood transfusions, and drugs administered in the postoperative period were recorded. In addition, hemoglobin, hematocrit, red blood cell count, platelet count, white cell count, and axillary body temperature were checked daily. Conclusions. Monitoring of CRP level is superior to that of ESR for early detection of infections after cervical spine surgery. Although CRP was not related to any of the factors that have been proposed to explain its peak value variance in previous studies, individual acute-phase protein metabolism response to tissue affection appears to be a more decisive element in this respect.

Comparison of geometric distortion in digital angiography with and without a correction program

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 223-227 ◽  
Author(s):  
Zhen Zheng ◽  
Douglas Shearer ◽  
Georg Norén ◽  
Prakash Chougule ◽  
Gerhard Friehs
Keyword(s):  
Standard Deviation ◽  
Computer Program ◽  
Digital Images ◽  
Imaging System ◽  
Geometric Distortion ◽  
Average Difference ◽  
Content Type ◽  
X Ray ◽  
X Ray Imaging ◽  
Fine Print

✓ This study was conducted to evaluate the geometric distortion of angiographic images created from a commonly used digital x-ray imaging system and the performance of a commercially available distortion-correction computer program. A 12 × 12 × 12—cm wood phantom was constructed. Lead shots, 2 mm in diameter, were attached to the surfaces of the phantom. The phantom was then placed inside the angiographic localizer. Cut films (frontal and lateral analog films) of the phantom were obtained. The films were analyzed using GammaPlan target series 4.12. The same procedure was repeated with a digital x-ray imaging system equipped with a computer program to correct the geometric distortion. The distortion of the two sets of digital images was evaluated using the coordinates of the lead shots from the cut films as references. The coordinates of all lead shots obtained from digital images and corrected by the computer program coincided within 0.5 mm of those obtained from cut films. The average difference is 0.28 mm with a standard deviation of 0.01 mm. On the other hand, the coordinates obtained from digital images with and without correction can differ by as much as 3.4 mm. The average difference is 1.53 mm, with a standard deviation of 0.67 mm. The investigated computer program can reduce the geometric distortion of digital images from a commonly used x-ray imaging system to less than 0.5 mm. Therefore, they are suitable for the localization of arteriovenous malformations and other vascular targets in gamma knife radiosurgery.

Vertebral hydatid disease

1976 ◽  
Vol 44 (1) ◽  
pp. 72-76 ◽  
Author(s):  
Werner L. Apt ◽  
Juan L. Fierro ◽  
Ciro Calderón ◽  
Carlos Pérez ◽  
Patricio Mujica
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Postoperative Period ◽  
Long Term Results ◽  
Common Procedure ◽  
Laboratory Findings ◽  
Content Type ◽  
Surgical Interventions ◽  
Fine Print

✓ The authors present 27 cases of vertebral hydatidosis with clinical and laboratory findings. The most frequent location of the lesion was the lumbar spine. Principal neurological symptoms were paraparesis, sphincter disturbances, paresthesia and paraplegia. The average number of surgical interventions per patient was 2.6; the most common procedure was laminectomy with extirpation of the cyst and surgical toilet. The results of surgical treatment were generally good in the immediate postoperative period, but long-term results were poor.

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