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At least 685 records · Page 38Linked to original sources
PubMed1986

The future role of neurosurgery in the case of vascular diseases of the central nervous system.

On the basis of 2542 cerebro-spinal vascular diseases (933 aneurysms, 689 cerebro-spinal angiomas, 410 spontaneous intracerebral hematomas, 361 vascular bypass operations and 149 endarterectomies of neck vessels) the present situation and problems, as well as the future prospects of cerebral vascular neurosurgery are reviewed. It is expected that the main development will take place in the field of pathophysiology and pathochemistry of vascular diseases through the acquisition of data obtained not in experimental studies but in patients. This will refine the diagnosis and indications. It is not expected that the operative technique will undergo very substantial change. New methods in the application of laser and photosensitization techniques will be probably included in the technical armamentarium. Endovascular methods of treatment will be further developed and will lead to the limitation of the indications for direct operation. It is assumed that mortality and morbidity can be further reduced by improving the diagnosis and establishing the optimal lines of therapy.

Blood-Brain Barrier↗
PubMed1978

Significance of the ventricular fluid pressure wave form in the diagnosis of cerebral circulatory arrest and brain death.

The fluctuations in the absolute value of the ventricular fluid pressure (VFP) with simultaneous changes in the amplitude and frequency of the oscillations of the ventricular fluid wave form are described in seven patients who developed brain death following either a head injury or a cerebrovascular accident, and are compared with those observed in nineteen patients who survived similar brain pathology. The findings in the two groups were significantly different. It is suggested that VFP monitoring does provide reliable evidence of brain death even while the patient is on artificial respiration.

Adolescent↗
PubMed1994

Ultrasound-guided craniotomy for minimally invasive exposure of cerebral convexity lesions.

The authors describe a method of real-time ultrasound-guided craniotomy for an approach to cerebral convexity lesions. During surgery, a specially designed high frequency (7.5 MHz) sector probe with a thin (11 mm), extended tip is used to image the cerebral lesion through a single burr-hole. The distance between burr-hole and lesion and the direction of the target are then determined from the ultrasound images, and craniotomy is completed with the aid of these parameters. Errors in the preoperative planning of the approach, which might result in incorrect placement of the craniotomy, can easily be recognized and corrected at an early stage of the operation, before the craniotomy has been completed. This technique greatly improves the accuracy in placing craniotomy flaps. Since the risk of misplacing the craniotomy is virtually eliminated in lesions which are identifiable on ultrasound images, the technique allows the surgeon to keep the skull opening as limited as possible.

Brain Neoplasms↗
PubMed1979

Two-dimensional echo-encephalography. 1. Acoustic properties of some tissues and the characteristics of echo patterns obtained using equipment especially adapted for detection of these tissues.

In this paper the results of measurements of ultrasound velocity in, and density of, a number of normal and pathological tissues are given. From the results it can be concluded that intracranial pathological regions will often be detectable with ultrasound techniques, but is is not possible with any degree of certainty to localise precisely the morphological boundaries of these abnormal regions. Because, in the large majority of cases, the echoes from intracranial pathological structural changes are of weak intensity, a simple electronic device is described which, in conjunction with standard echo equipment, has been shown to be of use for better detection of these weak signals.

Brain↗
PubMed1979

Two-dimensional echo-encephalography. 2. Clinical use and reliability of two-dimensional echo-encephalography in neurology and neurosurgery.

More than two hundred patients with intracranial lesions were examined by means of B-scan echo equipment specially adapted for the detectionof weak reflections. An impression of the accuracy of the method is demonstrated by the results obtained in those patients where the diagnosis had been verified at surgery or autopsy. It appeared that B scanning is a quite reliable diagnostic method. It was found that intracranial tumours showed typical echo-patterns. Furthermore, we found that B scanning may be an important diagnostic aid in follow-up examinations of patients. However, the ultrasound technique as used by us has also a restriction: it is unsuited for the estimation of the precise extension of pathological areas and for the estimation of the nature of pathology.

Brain Diseases↗
PubMed1993

Blood flow velocity in the middle cerebral artery and carotid artery stump pressure during carotid endarterectomy.

Twenty-one patients undergoing carotid endarterectomy were investigated by simultaneous intra-operative measurements of carotid stump pressure (CSP) and transcranial Doppler (TCD) flow velocity in the middle cerebral artery. The relationship between the two methods was evaluated as well as the potential benefits of the intraoperative transcranial Doppler monitoring technique. Clamping of the carotid artery resulted in a significant decrease in TCD flow velocity in the ipsilateral middle cerebral artery as well as in CSP. There was no correlation between relative change in CSP and the simultaneously obtained relative change in TCD flow velocity during carotid clamping (r = 0.31, p = 0.26). The insertion of an intra-operative shunt was followed by an increase in flow velocity compared to the clamping value. One patient with clear TCD signs of a re-occlusion (a sudden decrease in flow velocity) during closure of the wound, demonstrated a thrombosis at re-exploration. TCD gives information of the collateral cerebral circulation during carotid clamping and is an alternative monitoring technique during carotid endarterectomy. The method is useful intraoperatively for detecting embolic events as well as thrombosis during wound closure. Further studies are necessary to clarify the critical change in flow velocity during clamping when the use of a peroperative shunt is indicated.

Aged↗
PubMed1990

On the management of neonatal tentorial damage. Eight case reports and a review of the literature.

From the history of 15 personal patients--8 reported here in extenso--and from 63 patients in the literature with the diagnosis of posterior fossa subdural haemorrhage during life, we discuss the possibility of detecting tentorial damage on computed tomography (CT) and ultrasound (US) scan. The association of a (peri)cerebellar haemorrhage with peritentorial bleeding around the straight sinus and a subdural haemorrhage between both occipital cerebral lobes is suggestive of tentorial laceration(s). Both coronal CT scan and sagittal US scan are very helpful in locating these haemorrhages near the falco-tentorial junction. The conservative management of one of our infants with very extensive but asymmetric posterior fossa haemorrhage, leading to resorptive hydrocephalus, is compared with both surgical and conservative treatment of patients from the literature. Two reasons that warrant neurosurgical intervention are: life-threatening brain-stem compression--as in one of our own patients--and acute obstructive hydrocephalus. Craniotomy of the posterior fossa within the neonatal period does not prevent later-onset resorptive hydrocephalus. The communicating nature of this latter process is adequately demonstrated by lumbar isotope cisternography. Finally, neonatal posterior fossa subdural haemorrhage is one of the many causes of cyst-like structures behind the cerebellum.

Arteries↗
PubMed1990

Intraoperative ultrasound (US) imaging. Comparison of pathomorphological findings in US and CT.

Experience with the use of intraoperative ultrasound (US) imaging in over 300 patients are presented in this paper and discussed with special reference to various pathomorphologies as well as their identifiability within the brain/intracranium. In 201 of these patients, the pathomorphological peculiarities in US could be compared with preoperative CT findings. As a general result, all investigated lesions could be identified during intraoperative US investigations with the exception of small aneurysms. Most of the lesions gave at least partly higher echosignals than normal brain tissue, except arachnoid cysts. Size and shape of lesions were comparable in US and CT with the exception of some gliomas; in the latter group, the diffuse image in US was more akin to the situation likely to be found by the surgeon during operation, whereas CT used to give a misleading picture of a more or less clearly delineated tumour. US allowed more accurate differentiation between intratumoural necrosis and cysts than CT: the latter was misleading in many instances. At the present state of development, real time US imaging does not allow a histopathological diagnosis. The ease of handling and the high quality of morphological imaging, however, warrant a number of practical applications in daily neurosurgical practice.

Brain↗
PubMed1993

Brain abscesses in neonates--report of three cases.

We report three newborns with brain abscesses. Two infants suffered from Serratia marcescens meningitis and one infant had enterococcal sepsis and meningitis. Brain abscesses were detected by cerebral sonography. Outcome in one infant with S. marcescens infection was poor. This patient developed multicystic encephalo-malacia and severe developmental retardation. In the other patient with S. marcescens infection surgical drainage of the abscess was performed. The outcome was good both in this infant and in the patient with enterococcal brain abscess.

Brain Abscess↗
PubMed1992

Intracranial blood flow velocities during seizures and generalized epileptic discharges.

In 51 children with different types of epilepsy, blood flow velocities in the middle cerebral artery were recorded continuously by transcranial Doppler sonography during a standard electroencephalogram of 30 min duration. In 16 children 33 epileptic seizures were recorded. During tonic seizures, the mean flow velocity increased to a maximum of 133%-191% (median 160%) of the baseline values. Tonic-clonic seizures were also accompanied by a velocity increase. During absence seizures the mean flow velocity decreased to a minimum of 46%-82% (median 71%) of the baseline values. Changes in cerebral metabolism and arterial blood pressure in the presence of disturbed autoregulation are thought to be factors causing these alterations. No alteration of the flow velocities occurred in cases of petit-mal status, electrical status epilepticus and in 35 children with generalized epileptic discharges of up to 5 s duration without clinical manifestations.

Adolescent↗
PubMed1996

A randomized trial comparing the effect of prophylactic intravenous fresh frozen plasma, gelatin or glucose on early mortality and morbidity in preterm babies. The Northern Neonatal Nursing Initiative [NNNI] Trial Group.

UNLABELLED: Seven hundred and seventy-six children born before 32 weeks gestation between 1990 and 1992 were randomly allocated within 2 h of birth to one of three groups: either prophylactic fresh frozen plasma (20 ml/kg followed by 10 ml/kg after 24 h); or a similar volume of an inert gelatin plasma substitute (Gelofusine); or control management with a maintenance infusion of 10% dextrose. The three groups were similar at trial entry. There were no statistically significant differences in the number of deaths before discharge (fresh frozen plasma 19.1%, gelatin 22.0% and control 17.8%). Death or disability amongst long-term survivors at 2 years of age is the primary trial outcome variable: this information is not yet available. Death before discharge from hospital or the presence of a cerebral ultrasound scan abnormality 1 or 6 weeks after birth in survivors was a pre-defined secondary outcome variable (although 176 long-term survivors never had a scan, largely because they never needed care in a unit staffed to provide prolonged respiratory support or a routine scan service). Of the children entered into the three arms of the trial, 43.0%, 37.5% and 42.3% respectively died or were known to have developed at least a minor cerebral ultrasound abnormality before discharge. The proportions dead or known to have developed a major scan abnormality (ventriculomegaly or a persisting parenchymal abnormality), were 22.7%, 27.0% and 23.3%. CONCLUSION: Neither early prophylactic volume expansion, nor a coagulation factor supplement, had any detectable effect on short-term outcome in this large multicentre open trial.

Brain Ischemia↗
PubMed1992

Osteopetrosis: brain ultrasound and computed tomography findings.

A case of osteopetrosis presenting with rare features of dysmorphism with proptosis due to hypoplasia of the orbits and the temporal bone is described. The case also had calcifications in the periventricular regions, the falx cerebri and the corpora colliculi. These features and sonographic findings of osteopetrosis have not been reported previously. The sensitivity and specificity of imaging modalities in the diagnosis of intracranial calcifications is discussed.

Brain↗
PubMed1991

Significance of ultrasound appearances in the neurological development and cognitive abilities of preterm infants at 5 years.

The developmental outcome at 5 years of age was studied in 93 preterm infants who had been prospectively examined for peri-ventricular leucomalacia (PVL). Standardised neurological examination and developmental assessment, including tests of cognitive function, were carried out. Major sequelae (n = 10) could be ascribed in most cases to the presence of large PVL lesions. Children with normal scans (n = 51), with isolated haemorrhage (n = 15) and with post-haemorrhagic ventricular dilatation (n = 3) had a favourable prognosis. Patients with small focal PVL changes (n = 16) had lower cognitive abilities on the McCarthy scale and presented more abnormal neuromotor signs and more attention deficits when compared to children with normal scans and isolated haemorrhage. Small focal PVL changes seem therefore to interfere with development at 5 years of age and might represent a morphological marker of a more diffuse brain injury. This study demonstrated also the effect of socioeconomic status on outcome at the age of 5 years.

Cerebral Hemorrhage↗
PubMed1994

Neonatal intracranial lesions following placental abruption.

A case-controlled study of the cerebral ultrasound appearances of neonates following placental abruption was undertaken. Twenty-nine index subjects (median gestation 29 weeks) were identified over a 2-year period with gestation- and sex-matched controls. Placental abruption was associated with a four-fold increased incidence of periventricular leukomalacia and extensive periventricular haemorrhage, without increased mortality. Ten infants (34%) developed cystic periventricular leukomalacia following placental abruption, compared with three (10%) in the control group. Intraventricular haemorrhage (excluding subependymal haemorrhage) and haemorrhage into the brain parenchyma occurred in 21 (72%) infants in the abruption group, compared with 14 (48%) in the control group (P < 0.05).

Abruptio Placentae↗
PubMed1990

Demonstration of perivascular echogenicities in congenital cytomegalovirus infection by colour Doppler imaging.

Two children with congenital cytomegalovirus infection and intracerebral echogenicities were investigated by computer sonography and colour Doppler imaging (CDI). By simultaneous imaging of brain tissue and CDI, blood flow within the stripe-like echogenicities of the basal ganglia was demonstrated. Using CDI the echogenicities were identified as the walls of thalamostriate vessels.

Basal Ganglia↗
PubMed1994

Elevated arterial blood pressure is associated with peri-intraventricular haemorrhage.

UNLABELLED: In a prospective study, brain ultrasound scans were performed in 42 newborns (median birth weight 1700 g, range 1020-3720 g; gestational age 32 weeks, 26-36) to reveal peri-intraventricular haemorrhage (PIVH) (grades I-IV) as well as echodensities (ED) and/or periventricular leucomalacia (PVL). ECG and arterial blood pressure were recorded on magnetic tape at 8-h intervals during the first 24 h of life for further computer analysis. Heart rate (HR) and its variability (HRV) indices RMSM (long-term variability) and RMSSD (short-term variability), together with their coefficients of variation, were computed. Systolic (SBP), diastolic (DBP), and mean blood pressures (MBP) were detected as average values for 2-min stationary segments together with the respective minima and maxima. The indices of variability and their coefficients of variation were computed for the arterial pressure. PIVH was found in 12 newborns and ED in 8 (of whom two developed PVL). The remaining 22 served as controls. Neither HR, HRV nor BP variability differed between the groups. DBP was higher in the group with PIVH (39 mmHg) when compared to both the controls (33 mmHg, P < 0.05) and the ED group (32 mmHg, P < 0.01). MBP behaved respectively (45 mmHg, 38 mmHg, 37 mmHg, P < 0.01). SBP behaved also similarly when gestational age and birth weight were used as covariates (57 mmHg, 48 mmHg, 47 mmHg, P < 0.01). CONCLUSION: Our results suggest that elevated diastolic, mean and systolic blood pressure are significantly associated with peri-intraventricular haemorrhage in preterm newborn infants.

Blood Pressure↗
PubMed1990

Interhemispheric fissure width in neonates on ECMO.

The neurosonograms of fifty-eight patients treated over a four-year period with ECMO support were retrospectively reviewed for analysis of changes in interhemispheric (IHF) width while on ECMO. To correlate these measurements with patterns of development of total body edema as reflected by chest wall thickening on portable chest radiographs, patients were divided into three categories based on the pattern and severity of body edema development. Patterns of IHF widening were compared between these categories, and to the pattern of development of chest wall edema within each category. Results indicate that IHF width tends to progressively increase during ECMO and that the pattern of IHF widening tends to parallel development of overall body edema. Additionally, IHF widening was found to resolve following termination of ECMO support, as demonstrated on follow-up cranial CT examinations. Our results suggest that IHF widening in infants on ECMO is an intracranial manifestation of the generalized edema accumulation that frequently occurs during ECMO.

Analysis of Variance↗