Monitoring retraction pressure on the brain

1987 ◽  
Vol 66 (2) ◽  
pp. 270-275 ◽  
Author(s):  
Kazuhiro Hongo ◽  
Shigeaki Kobayashi ◽  
Akira Yokoh ◽  
Kenichiro Sugita
Keyword(s):  
Cerebrospinal Fluid ◽  
Strain Gauge ◽  
Cranial Nerves ◽  
Head Position ◽  
Cerebrospinal Fluid Drainage ◽  
Content Type ◽  
Attenuation Rate ◽  
Brain Retraction ◽  
The Brain ◽  
Fine Print

✓ The problem of minimizing tissue damage during brain retraction was studied both experimentally in dogs and clinically with the aid of newly designed strain-gauge retractor. The pressure required to obtain a specific exposure decreased gradually with time. The average time for a 50% reduction in retraction pressure was 6.6 minutes in the earlier trials of repeated retraction. The attenuation rate of retraction pressure gradually decreased when retraction of the same area was repeated. The lower the head position of the dog, the larger was the amplitude of brain retraction pressure. Clinical studies demonstrated that: 1) cerebrospinal fluid drainage was effective in decreasing the retraction pressure required; 2) use of multiple retractors reduced the pressure applied by each retractor; and 3) retraction pressure could be monitored when the strain-gauge retractors were applied to arteries and cranial nerves.

A physiological sealant for cerebrospinal fluid leaks

1977 ◽  
Vol 46 (2) ◽  
pp. 215-219 ◽  
Author(s):  
Gerald D. Silverberg ◽  
Christina B. Harbury ◽  
Edward Rubenstein
Keyword(s):  
Cerebrospinal Fluid ◽  
Histological Examination ◽  
Content Type ◽  
Cerebrospinal Fluid Leaks ◽  
The Brain ◽  
Fine Print ◽  
Csf Leaks

✓ A combination of concentrated platelets, thrombin, and fibrinogen was used to adhere a pericranial graft to surgically produced cerebrospinal fluid (CSF) fistulas in dogs. This sealant successfully stopped leakage of CSF in all fistulas produced in both acute and chronic preparations. All control animals leaked CSF acutely. In chronic control animals the CSF leaks sealed spontaneously but the grafts were not well incorporated. Histological examination of the grafts and underlying brain showed no injury to the brain or meningeal vessel from exposure to the platelet glue. Good fibrous union of the grafts to the dura was confirmed.

Composition of isolated edema fluid in cold-induced brain edema

1979 ◽  
Vol 51 (1) ◽  
pp. 70-77 ◽  
Author(s):  
Jurjen Gazendam ◽  
K. Gwan Go ◽  
Annie K. van Zanten
Keyword(s):  
Cerebrospinal Fluid ◽  
White Matter ◽  
Brain Edema ◽  
Vasogenic Edema ◽  
Colloid Osmotic Pressure ◽  
Freezing Damage ◽  
Content Type ◽  
Edema Fluid ◽  
The Brain ◽  
Fine Print

✓ Edema fluid isolated from cats with cold-induced brain edema was subjected to analysis of electrolyte content, enzyme activities, colloid osmotic pressure and the radioactivity of intravenously injected 99mTc-labeled albumin. The findings corroborate the essential features of vasogenic edema, such as its origin from the blood plasma, its rapid propagation into the white matter of the brain as contrasted with the delayed spread into gray matter, and its contribution to composition of cerebrospinal fluid. Moreover, the elevated activities of cellular enzymes and K+ content of edema fluid point to the admixture with cellular contents due to the freezing damage.

The effects of raised ICP on lymph flow in the cervical lymphatic trunks in cats

1984 ◽  
Vol 60 (3) ◽  
pp. 577-581 ◽  
Author(s):  
James A. Love ◽  
Ronald A. Leslie
Keyword(s):  
Cerebrospinal Fluid ◽  
Steady State ◽  
Subarachnoid Space ◽  
Lymphatic System ◽  
Cranial Nerves ◽  
Lymph Flow ◽  
Content Type ◽  
Large Molecules ◽  
Csf Pressure ◽  
Fine Print

✓ Lymph was collected from cervical lymphatic trunks of anesthetized cats under conditions of normal cerebrospinal fluid (CSF) pressure and again when the CSF pressure was elevated by infusing artificial CSF into the subarachnoid space at the cisterna magna. There was an immediate increase in lymph flow on initiation of the CSF infusion, but this increase was not maintained although the CSF infusion continued. Lymph protein concentrations fell when the CSF infusion started and remained depressed while the infusion of CSF continued. It is postulated that under steady-state conditions much of the CSF leaving the subarachnoid space via the cranial nerves enters the capillaries from the extravascular spaces, and that large molecules from the CSF, such as proteins, return to the blood via the lymphatic system.

Intermittent versus continuous brain retraction

1983 ◽  
Vol 58 (6) ◽  
pp. 918-923 ◽  
Author(s):  
Akira Yokoh ◽  
Kenichiro Sugita ◽  
Shigeaki Kobayashi
Keyword(s):  
Power Spectrum ◽  
Brain Damage ◽  
Strain Gauge ◽  
Full Recovery ◽  
Content Type ◽  
Dog Brain ◽  
Brain Retraction ◽  
Retraction Force ◽  
Fine Print

✓ Brain damage due to retraction was studied morphologically and physiologically in the dog brain. Two methods of retraction were compared using a retractor with a strain gauge: 1) continuous retraction; and 2) intermittent retraction. Total retraction time was 60 minutes for each method. Brain damage started to appear at a retraction force of 30 gm with continuous retraction, and increased in proportion to the force used. The power spectrum of the electrocorticogram showed full recovery after the release of retraction when the retraction force was less than 40 gm. With intermittent retraction, the damage was morphologically minimal with a retraction force of less than 50 gm, and recovery of the power spectrum of the electrocorticogram was prompt in comparison with continuous retraction. The results indicate the superiority of intermittent over continuous retraction.

Spontaneous rupture of a metastatic brain tumor into the ventricular system

1971 ◽  
Vol 34 (3) ◽  
pp. 412-416
Author(s):  
Robert H. Wilkins ◽  
Wang-Kuen Wu
Keyword(s):  
Cerebrospinal Fluid ◽  
Brain Tumor ◽  
Spontaneous Rupture ◽  
Ventricular System ◽  
Metastatic Brain Tumor ◽  
Content Type ◽  
Surgical Exposure ◽  
First Case ◽  
The Brain ◽  
Fine Print

✓ Two cases are reported in which spontaneous rupture of a metastatic brain tumor occurred into the ventricular system, leading to the dissemination of the tumor contents in the cerebrospinal fluid. The site of rupture was demonstrated by ventriculography in the first case and by surgical exposure in the second. These cases support the assumption that metastatic neoplasms within the brain may rupture into the ventricular system and spread via the cerebrospinal fluid pathways.

A micromanipulator for precise control of a brain retractor

1991 ◽  
Vol 74 (6) ◽  
pp. 1009-1010 ◽  
Author(s):  
Takeshi Hasegawa ◽  
Kiyotoshi Yamano ◽  
Tadao Miyamori ◽  
Yoshitaka Hamada
Keyword(s):  
Blood Vessels ◽  
Cranial Nerves ◽  
Brain Structures ◽  
Content Type ◽  
Safe Method ◽  
Precise Control ◽  
Brain Retraction ◽  
Fine Print

✓ A new microsurgical device for delicate brain retraction is described. The device, a micromanipulator with a holder for a brain spatula fixed at the end of a self-retaining retractor arm, allows smooth, steady, fine displacement of the retractor tip (“minimal sliding retraction”), operated by the surgeon's two fingers. This has proved to be a useful and safe method of retraction for critical brain structures such as blood vessels, cranial nerves and aneurysm domes in deep microsurgical fields.

The Transoral Approach for the Management of Intradural Lesions at the Craniovertebral Junction: Review of 7 Cases

Neurosurgery ◽  
1991 ◽  
Vol 28 (1) ◽  
pp. 88-98 ◽  
Author(s):  
Alan H. Crockard ◽  
Chandra N. Sen
Keyword(s):  
Cerebrospinal Fluid ◽  
Cranial Nerves ◽  
Craniovertebral Junction ◽  
Transoral Approach ◽  
Cerebrospinal Fluid Leakage ◽  
Main Difficulty ◽  
Fibrin Adhesive ◽  
Vertebral Arteries ◽  
Brain Retraction ◽  
The Brain

Abstract The main difficulty in dealing with intradural lesions located ventrally in the region of the craniovertebral junction (CVJ) is related to their relative inaccessibility. Posterolateral approaches involve some manipulation of the brain stem and provide limited access because of the necessity of working between the cranial nerves. Even then, the view of the ventral midline and across is limited. The transoral approach, which has been widely used for the management of extradural lesions in this area, is also useful for the treatment of intradural lesions. It provides an unimpeded although somewhat restricted, view of the ventral aspect of the CVJ without the need for brain retraction. The cranial nerves and vertebral arteries are not interposed between the surgeon and the lesion. The risks of cerebrospinal fluid leakage and infection are greatly diminished by the use of fibrin adhesive and prolonged diversion of the cerebrospinal fluid. The use of this approach, together with its technical difficulties and results, in the management of seven purely intradural lesions located ventrally at the CVJ, is discussed.

Norepinephrine in cerebrospinal fluid of patients with cerebral vasospasm

1982 ◽  
Vol 56 (3) ◽  
pp. 344-349 ◽  
Author(s):  
Taku Shigeno
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebral Arteries ◽  
Cerebral Aneurysms ◽  
Fluorometric Method ◽  
Content Type ◽  
Highly Sensitive ◽  
Secondary Phenomenon ◽  
Lumbar Cerebrospinal Fluid ◽  
The Brain ◽  
Fine Print

✓ The content of norepinephrine (NE) in the ventricular, basal cisternal, and lumbar cerebrospinal fluid (CSF) was determined in 19 patients with ruptured cerebral aneurysms at different intervals according to the presence or absence of vasospasm. Twelve were operated on within 3 days after subarachnoid hemorrhage (SAH), prior to the occurrence of vasospasm. Postoperatively, CSF was continuously drained from a basal cistern or lateral ventricle. Norepinephrine was assayed by the highly sensitive automated fluorometric method. The concentration of NE increased in all sites of CSF sampling along with the appearance of vasospasm. Above all, the cisternal CSF of patients with vasospasm contained significantly higher NE (0.246 ± 0.049 ng/ml, mean ± SEM) compared to those without vasospasm (0.075 ± 0.001 ng/ml) (p < 0.001). However, since this increase cannot be considered to be high enough locally to constrict cerebral arteries, this might be only a secondary phenomenon due to release of NE into CSF from various sources in the brain.

The plated bayonet: a new instrument to facilitate surgery for intra-axial neoplasms of the spinal cord and brain stem

1993 ◽  
Vol 78 (3) ◽  
pp. 505-507 ◽  
Author(s):  
Fred J. Epstein ◽  
Memet Ozek
Keyword(s):  
Spinal Cord ◽  
Brain Stem ◽  
Cranial Nerves ◽  
Neoplastic Tissue ◽  
Content Type ◽  
Small Incision ◽  
New Instrument ◽  
The Brain ◽  
Fine Print

✓ A new instrument for use in surgically treating intra-axial neoplasms of the spinal cord and brain stem is described. The plated bayonet allows neoplastic tissue in the spinal cord to be separated from functioning neural elements without perforating the adjacent spinal cord. In addition, the plated bayonet facilitates exposure through the very small incision necessary to remove tumors of the brain stem without damaging cranial nerves or other vital structures.

Diffuse cerebrospinal gliomatosis

1978 ◽  
Vol 49 (2) ◽  
pp. 303-307 ◽  
Author(s):  
Nobuyuki Kawano ◽  
Yoshio Miyasaka ◽  
Kenzoh Yada ◽  
Hideo Atari ◽  
Kenichi Sasaki
Keyword(s):  
Spinal Cord ◽  
Tumor Cells ◽  
Clinical Picture ◽  
Cranial Nerves ◽  
Gliomatosis Cerebri ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ A case of diffuse cerebrospinal gliomatosis is presented, with widespread involvement of the brain, cranial nerves, and spinal cord. This case showed a far more extensive distribution of tumor cells than previously reported cases of gliomatosis cerebri. The clinical picture and oncogenesis of gliomatosis cerebri is briefly discussed.

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