Use of the one-piece shunting system in adults.
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Biomedical subjects
Publications and source records attributed to M H Savitz.
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In 12 cases of closed head injury without fracture or hematoma, but with clinical signs of increased intracranial pressure (ICP) and brain stem compression and with computed tomographic (CT) scan evidence of cerebral edema and contusion, subgaleal shunts were inserted for immediate decompression of the ventricular system and continuous drainage of hemorrhagic cerebrospinal fluid (CSF). Three patients with fixed dilated pupils and no reflexes or spontaneous respiration on admission did not improve and expired within 72 h. Nine patients who manifested Cushing's triad (bradycardia, bradypnea, and hypertension) shortly after admission made significant recovery and underwent catheter removal 1 wk later; 8 were able to be discharged home after extended periods of physiotherapy. No complications, postoperative hemorrhage or infection, were recorded.
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A program of antimicrobial prophylaxis for neurosurgical patients was implemented at three community hospitals after review of the previously recorded cases of postoperative sepsis and the antibiotic sensitivity of the prevailing pathogen, Staphylococcus. No primary wound infections occurred in a series of 1000 consecutive operations. The rational basis for prophylactic antibiotics is discussed.
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Hitchcock's original method of hypothermic subarachnoid irrigation employed both temperature and osmolarity. Spinal cooling was then abandoned in favour of intrathecal injection of normothermic hypertonic salilne. Modifications of the procedure that followed have continued to accept hyperosmolarity as the factor causing pain relief. Fifty patients were treated by a technique evolved to enhance the effect of hypothermia while avoiding the complications associated with hyperosmolar solutions. For the cases of terminal carcinoma and others considered to be poor surgical risks, the results have been quite satisfactory. For non-neoplastic painful syndromes, rapid perfusion cooling of the subarachnoid space offers an alternative therapeutic approach.
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A series of 227 needle procedures monitored by serial CT scans was performed by free-hand technique on 147 patients at two suburban hospitals over a 10 year period. Under local anesthesia, 75 suspected brain tumors were biopsied; 52 intracerebral hematomas were evacuated, and 28 cerebral abscesses were drained. There was one complication of postoperative hemorrhage.
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