RESUMEN
Time course of vasospasm in man has a big impact on clinical pisture, it also has an influence on the decision of surgery. The presence of acute stage of vasospasm is still under discussion. Many authors deny its existence. It is well known that positive decision about early operating has a crucial role in case of vasospasm Another problem is the aetiology of vasospasm. Inspite of many clinical and experimental investigations the aetiology of vasospasm remains unclear. The main problem is still the adequate therapy. This paper contains the updated knowledge about vasospasm, with the main accent on aetiology diagnosis and therapy.
Asunto(s)
Algoritmos , Vasoespasmo Intracraneal , Encéfalo/fisiopatología , Encéfalo/cirugía , Humanos , Procedimientos Neuroquirúrgicos/métodos , Vasoespasmo Intracraneal/etiología , Vasoespasmo Intracraneal/fisiopatología , Vasoespasmo Intracraneal/terapiaRESUMEN
Vasospasm is the most dangerous and common complication of subarachnoid haemorrhage (SAH) from ruptured brain aneurysms. The frequency of vasospasm is between 11 to 72% of SAH cases. One of the consequences of vasospasm is delayed neurological deficit (DND). Clinical diagnosis of vasospasm can course many diagnostic and therapeutic problems. This paper reviews the current developments concerning history, clinical picture and differential diagnosis of vasospasm.
Asunto(s)
Vasoespasmo Intracraneal/diagnóstico , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Hemorragia Subaracnoidea/complicaciones , Vasoespasmo Intracraneal/etiologíaRESUMEN
This paper reports a case of the rare entity of a cerebral metastasizing ependymoma of the thoracic spinal cord in a 8 year old boy.
Asunto(s)
Neoplasias Encefálicas/secundario , Ependimoma/patología , Invasividad Neoplásica , Neoplasias Torácicas/patología , Niño , Humanos , Imagen por Resonancia Magnética , MasculinoRESUMEN
In 45 cases of patients in the period from 1995 to 1999 for cervical discopathy, polymethacrylate bone cement was used as a stabilizing material. The duration of hospitalization ranged from 3 to 23 days (average 7,5 days). In 38 cases (84,4%) one-level fixation was performed, while two-level fixation was performed in 7 cases (15,6%). The observation period for the group in question ranged from 2 to 48 months. No complications associated with the stabilizing material used were discovered. On the basis of the material here presented it would appear justifiable to recommend this cement as a good and safe stabilizing material in patients operated for cervical discopathy using the anterior approach.
RESUMEN
BACKGROUND: The common occurrence of chronic subdural hematoma (CSDH) in older patients raises some diagnostic and therapeutic difficulties. Despite general agreement about the indication of operation, the extent of surgery is still discussed controversially. We have, therefore, reviewed operative findings and outcome in 104 patients with CSDH. METHODS: Retrospective analysis was performed by differentiating age < or = 60 years (n = 28) versus age > 60 years (n = 76) and burr hole craniostomy with a size range from 12-30 mm (n = 94) versus larger craniotomy (n = 10). All patients received closed-system drainage of the subdural space for 2-4 days. RESULTS: Four patients older than 60 years died within 30 days after surgery, two in each operative group. Excluding these postoperative deaths, 17 out of 92 patients (18.5%) after burr hole trepanation and one out of eight patients (12.5%) after craniotomy required reoperation due to rebleeding (n = 6), residual subdural fluid (n = 4), and residual thick hematoma membranes (n = 8). Eight patients, who had been initially treated by burr hole craniostomy despite preoperative detection of neomembranes by contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI), recovered without further intervention. Clinical outcome was good in both operative groups. The percentage of patients without or with only mild neurologic deficits at the time of discharge from the hospital was 72.3% in the burr hole and 70.0% in the craniotomy group, respectively. CONCLUSIONS: The clinical data of the present study suggest that burr hole craniostomy with closed-system drainage should be the method of choice for the initial treatment of CSDH, even in cases with preoperative detection of neomembranes. Craniotomy should be carried out only in patients with reaccumulating hematoma or residual hematoma membranes, which prevent reexpansion of the brain.
Asunto(s)
Hematoma Subdural/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Craneotomía/métodos , Hematoma Subdural/diagnóstico , Humanos , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
The authors present two cases of haematoma accompanying coagulopathies, treated successfully in the Department of Neurosurgery, Medical Academy in Gdansk. In the first case, haematoma occurred after trauma in a patient with haemophilia B, and in the other case in a patient treated with Syncumar for mitral valve implantation. The authors apply the strategy of treatment of patients with coagulopathies which should involve achieving of stable haemostasis, indispensable for positive result of the treatment.