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At least 667 records · Page 37Linked to original sources
PubMed1985

Intraoperative ultrasonography through a burr-hole.

Intraoperative ultrasound diagnosis through a burr-hole was performed in 22 cases using a 5 MHz electronic sector-scanning transducer. The pathology along with the landmarks, such as ventricles and the interhemispheric fissure, were visualized. In two cases, a second burr-hole was placed nearby, and aspiration of the fluid was accomplished under real-time ultrasonic monitoring using the first hole as an acoustic window. Our results suggest a possibility of ultrasound-guided stereotactic surgery of the brain through twin burr-holes.

Biopsy, Needle↗
PubMed1996

Intracranial calcification in Raine syndrome.

We report the fourth case of a patient recognised with Raine syndrome, a distinct lethal sclerosing bone dysplasia, and we describe the association with intracranial calcification demonstrable by ultrasound and CT.

Abnormalities, Multiple↗
PubMed1995

Real-time ultrasound imaging of cerebral lesions during "target point" stereotactic procedures through a burr hole. Technical note.

Stereotactic burr-hole procedures like biopsies of brain tumours based on CT scan or MRI and angiographic data have so far usually been carried out without real-time ultrasound image control. Intra-operative real-time ultrasound imaging was carried out during twelve target-point stereotactic procedures via a single standard burr-hole using a new slender ultrasound transducer with a diameter of 8 mm. The technical parameters of the transducer are: frequency range of 5 < - > 3.5 MHZ, phased array sector scan, 90 degree sector. The transducer has a bayonet-like configuration and can be sterilized. Sufficient quality of the images was achieved in these twelve cases with different pathological entities such as malformation cysts (3 cases), gliomas (7 cases), one metastasis and one intracerebellar haemorrhage. Moreover, co-ordinate values may be calculated from the ultrasound images generated peroperatively, allowing the surgeon to choose additional targets. Colour flow mapping provides the visualization of vascular structures. For the beginner stereotaxy may be easier to learn using ultrasound real-time imaging.

Biopsy↗
PubMed1993

The treatment of hydrocephalus in preterm infants with intraventricular haemorrhage.

The hospital charts and clinical course of forty-one patients requiring one or more ventricular drainage procedures for hydrocephalic complications of neonatal intraventricular haemorrhage were evaluated retrospectively. All drainage procedures were performed on patients with intraventricular haemorrhage with ventricular dilatation (Grade III [25 patients]) and intraventricular and intraparenchymal haemorrhage (Grade IV [16 patients]) who were medical management failures. Twenty-six ventricular reservoirs (Rickham or McComb reservoirs) were placed in neonates weighing less than 1500 grams, allowing for a safe but intermittent ventricular access. Eighteen of these reservoirs were subsequently converted to ventriculoperitoneal shunts. Thirty-two percent of the patients incurred a shunt and/or reservoir infection and 59% required a shunt revision during the first year of life. There was no mortality related to the neurosurgical interventions. These results compare favorably with the published literature. No grade IV patients achieved a normal functional level, while 10 grade III patients did. The incidence of severe developmental delay (44% versus 28%) and death (38% versus 12%) was greater in the grade IV than the grade III patients. The placement of ventricular reservoirs is acceptable as an alternative to the early placement of ventriculo-peritoneal shunts. This approach may reduce the incidence of shunt infection as well as noninfectious shunt complications.

Brain Damage, Chronic↗
PubMed1990

Changes in the levels of neuropeptide Y-LI in the external jugular vein in connection with vasoconstriction following subarachnoid haemorrhage in man. Involvement of sympathetic neuropeptide Y in cerebral vasospasm.

NPY is a putative neurotransmitter mainly co-localized with noradrenaline in sympathetic fibers which innervate the cerebral vasculature. The origin of most of the perivascular NPY fibers seems to be in the superior cervical ganglion. To investigate involvement of Neuropeptide Y (NPY) mechanisms in subarachnoid haemorrhage (SAH), twenty patients with SAH were investigated. NPY-LI (-like immunoreactivity) levels in the external jugular vein were assessed using radioimmunoassay in blood samples collected post-operatively (or after SAH in non-surgical patients) on days 1,2,3, 5,7 and 9. These levels were compared with the clinical course and blood flow velocity changes monitored with ultrasonic Doppler equipment from both middle cerebral arteries (MCA) and both internal carotid arteries (ICA). Compared to NPY-LI levels in 14 controls (mean 116 +/- 3 pmol/1), increased levels (up to 253 pmol/l) and a close relationship between velocities and NPY-LI levels were found in a subpopulation of the SAH patients. When comparing the mean haemodynamic index (V MCA/ipsilateral V ICA) and mean NPY-LI levels in each of the 20 patients, a correlation of r = 0.75, p = 0.0001 was found. Increased NPY-LI were found (131 +/- 8 pmol/l) when simultaneous Doppler velocity recordings showed vasoconstriction (Haemodynamic index greater than 5) compared with samples taken when the haemodynamic index was less than 5, p less than 0.05. When MCA velocity exceeded 120 cm/sec. increased levels were found (129 +/- 9 pmol/l) compared with the conditions when MCA velocity was less than 120 cm/sec (113 +/- 5 pmol/l), p = 0.06. The results indicate a possible NPY involvement in cerebral vasoconstriction after SAH.

Adult↗
PubMed1992

CT-guided stereotactic biopsy aided by Doppler ultrasonic vascular monitoring.

The use of a 20 MHz pulsed Doppler technique during stereotactic brain tumour biopsies is described. By means of a miniaturized ultrasonic probe the tissue planned for biopsy was investigated for vessel signals. Out of 41 patients, with this technique a flow-pulse curve in front of the biopsy cannula was registered in 14 cases. In 9 cases one pulse curve was determined and in 5 cases two or more flow curves were found, indicating the presence of arterial vessels. The depth of the vessels signal could be localized and this area avoided for biopsy sampling. In a series of 41 stereotactic biopsies carried out in this way there was no intra-operative haemorrhage or postoperative haematoma.

Adolescent↗
PubMed1992

Intracranial haemodynamics in Takayasu's arteritis.

The cerebral circulation was assessed in two cases of Takayasu's arteritis by angiography of the aortic arch, cerebral blood flow single photon emission computed tomography (SPECT) and transcranial Doppler sonography (TCD). In both cases, disease of the major brachiocephalic arteries affected flow in the vertebrobasilar system and circle of Willis. Basilar artery flow was permanently reversed in one case, with vertebrovertebral shunting and subclavian steal. In the other case, focally reduced cerebral hemisphere flow resulted from watershed between vascular territories. The complex collateral and haemodynamic changes produced by multi-vessel involvement in Takayasu's arteritis suggest that therapeutic approaches should be based on assessment of end-organ perfusion rather than on structural angiographic changes.

Adult↗
PubMed1988

Transcranial Dopplersonography of the vertebro-basilar system.

This is the first investigation of distances, angles and locations of the vascular system in the posterior fossa. The distances from the skin surface of the neck, where a Doppler probe is positioned for transforaminal insonation, to the brainsystem have been measured in sagittal MRI pictures. The mean distance from the insonation point to the beginning of the basilar artery (BA) is 66.6 mm in males, 58.8 in females. The distance to the end of the BA is 90.0 and 80.4, respectively. These distances are relevant for locating the vertebral and basilar arteries. The insonation angles to the VA and BA range from 20 degrees to 30 degrees. Correlations with Doppler findings are discussed.

Adult↗
PubMed1986

The electrocardiogram in preterm infants with intraventricular hemorrhage and apnea.

To determine the relationship of electrocardiographic changes to both intraventricular hemorrhage (IVH) and neonatal apnea, continuous electrocardiographic monitoring, serial electrocardiograms, and cranial echoencephalograms were obtained on 41 consecutive preterm neonates with birth weight below 1,250 g. Nineteen patients (46%) were diagnosed as having an IVH within the first postnatal week. Six patients died while still requiring mechanical ventilation. Of the 35 surviving infants, 21 experienced apnea. Though the QRS axis was significantly different in the two groups, in both groups it was within the normal range. Of note, 69% of those surviving neonates with IVH experienced apnea, while 53% of those surviving without IVH had apnea. Unlike adult patients with subarachnoid hemorrhage, there are no characteristic electrocardiographic changes in preterm neonates with IVH. Therefore, the neonatal electrocardiogram could not be used to predict neonatal apnea. Continuous electrocardiographic monitoring was useful in detecting transient arrhythmias and episodes of bradycardia in apneic infants. Infants with IVH appeared to be at higher risk for neonatal apnea than their non-IVH peers. The authors stress the importance of continuous electrocardiographic monitoring in all preterm neonates at risk for IVH.

Apnea↗
PubMed1990

Practical application of intraoperative ultrasound imaging.

Intraoperative real-time ultrasound imaging (US) was used in over 500 patients to investigate which of the previously considered applications are of practical use in everyday neurosurgery. During all intraoperative applications for a wide variety of pathological conditions, small deep-seated as well as subcortically located lesions were detected with accuracy; in many instances they could be approached through smaller surgical exposures. US guidance was accurate in 209 cases for the stereotactic introduction of needles or endoscopes into various lesions: thus burrhole evacuation was performed on 148 intracerebral haematomas; in 16 patients endoscopic biopsy and resection of ventricular tumours was performed as well as biopsies of 39 hemispheric brain tumours and aspiration of a brain abscess in 6 instances. Seventy six gliomas were investigated by US imaging; the frequently unclear boundary between tumour and surrounding oedema was not better visualized than with CT or MRI. Moreover, US imaging for the detection of residual tumour towards the end of operation was unreliable. Postoperative imaging through burrholes or other cranial defects was mostly of unacceptably low quality for therapeutic decision making.

Biopsy↗
PubMed1990

Haemodynamic aspects of clinical cerebral angiography. Concurrent two vessel monitoring using transcranial Doppler ultrasound.

To overcome the technical limitations which have precluded noninvasive Doppler ultrasound in investigation of rapid cerebral haemodynamic responses in two cerebrovascular beds at the same time, we have modified a commercial 2 MHz pulsed Doppler instrument with online spectrum analysis. Two probes are activated intermittently, recording eight averaged Doppler-shifted spectra from each probe sequentially. Concurrent recordings of blood velocity in both middle cerebral arteries were performed during 25 selective iohexol carotid angiography runs in 13 patients with near normal cerebral vasculature. The technique permitted the differentiation between the specific responses confined to the recipient vascular bed, and the general responses occurring in remote brain areas as well. The specific response to iohexol was biphasic; a significant decrease in blood velocity occurred less than 4 s after the bolus entry, probably due to the high viscocity of iohexol. Between 4 and 12 s. blood velocity was significantly increased, reflecting the cerebrovascular response to hypertonic solutions. The blood velocity on the opposite side increased from less than 4 s through 45 s after iohexol. This concurs with studies using electromagnetic flowmetry, and suggests that these general responses are elicited by anxiety, discomfort and pain. Thus, no general responses were seen during angiography under general anaesthesia. Eight patients investigated during catheter flushing with normal saline showed a biphasic specific response reciprocal to that due to iohexol. A significant blood velocity peak occurred less than 4 s after the bolus entry, followed by a decrease between 4 and 60 s. The saline injections produced no pain and evoked no significant general response.

Adolescent↗
PubMed1987

Correlation of echoencephalographic findings and neurodevelopmental outcome: intracranial hemorrhage and ventriculomegaly in infants of birth weight 1,000 grams or less.

Echoencephalograms were obtained for 118 of 121 successive infants who were admitted to the Stanford intensive care nursery, weighed 1,000 g or less at birth, and survived long enough for at least one study to be performed. Eighty-eight of these infants survived and were followed up for 1 to 3 years; psychometric testing (Bayley Scales of Infant Development, Stanford-Binet Intelligence Scale, or both) was performed on 81% of these infants. Subependymal-intraventricular hemorrhages or intraparenchymal hemorrhages were associated with impaired development, but ventriculomegaly was not. The absence of echoencephalographic abnormalities did not exclude the possibility of impaired development in many infants. Periventricular leukomalacia was not observed. These data support independent scoring of subependymal-intraventricular hemorrhages, intraparenchymal hemorrhages, and ventriculomegaly, rather than use of combined scales for prognostic purposes.

Brain Damage, Chronic↗