Biomedical subjects
Publications and source records attributed to G Parenti.
The cerebral AVMs have a considerable hemodynamic complexity and the transcranial doppler sonography may now provide noninvasively accurate hemodynamic information about these vascular lesions. It provides hemodynamic data like blood flow velocity on feeding arteries, intracranial steal phenomena, cerebral autoregulation disease as illustrated in 19 patients.
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Three cases of penetrating cranio-cerebral injuries are reported. Two were caused by steel hooks shot by rotating blades: in one of these, the foreign body penetrated the brain through the eye-ball and in the second case the main injury was caused by a careless of extraction. In the third case, the foreign body, a key, penetrated the left parasagittal rolandic area following an under-water injury. All three patients were submitted to surgery and had good neurological recovery without complications of infection or seizures.
76 patients affected by acute ischemic encephalopathy due to i.c.a. occlusion have been examined through a Doppler nosography, in order to evaluate the influence of the type of collateral circle on the neurologic damage. Collateral circles between the external and internal carotid arteries were established through the ophthalmic artery in 80% of cases (A) and through the Willis circle in 70% of cases (B). Those two types of compensation do not seem to have prognostic value with regard to disability; on the contrary a remarkable difference was observed in the type of pathology (A = Stroke 40%, RIA 60%; B = 77%, RIA 23%).
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SSEPs were monitored during 38 procedures for aneurysms of the middle cerebral artery. In 13 selected patients intraoperative barbiturate protection with sodium thiopental was performed during temporary M1 occlusion. Combined EEG monitoring, showing burst suppression typical pattern of electrical cortical activity, allows a minimal dosage (3-6.5 mg/kg) of thiopental to achieve brain protection. Any patient with TYPE I SSEP changes had a new postoperative neurological deficit. Five patients during temporary middle cerebral artery clipping showed TYPE II SSEP changes and only one, not achieving burst suppression EEG pattern, had transient postoperative neurological deficit. In two other patients, a progressive worsening of TYPE II SSEP was observed; this was due to excessive brain retraction without brain protection and had a prolonged postoperative neurological deficit. Four patients showed TYPE IV SSEP changes during temporary M1 occlusion, one of whom was a 52-year-old woman, who, in spite of brain protection with thiopental, had serious postoperative neurological sequelae. In this patient N20 amplitude and central conduction time did not have full recovery to the preocclusive values. This study suggests that combined electrophysiological monitoring may reduce complications due to excessive retraction of cerebral tissue, make temporary clipping safer and improve the results of middle cerebral artery aneurysm surgery.