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  • 1
    ISSN: 0942-0940
    Keywords: Intracranial pressure ; cerebral blood flow ; somatosensory evoked potentials ; tentorial herniation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Intracranial pressure (ICP) differences, change of local blood flow (CBF) using the hydrogen clearance technique, change in the somatosensory evoked potential (SEP) to median nerve stimulation and pupillary size were investigated during progressive elevation of the ICP (using an extradural balloon) in 6 anaesthetized baboons. CBF was measured in the frontal cortex, somatosensory cortex, thalamus (nucleus ventralis posterior lateralis—VPL), medial lemniscus (ML), lateral lemniscus (LL) and caudate nucleus (CN). Conduction along the somatosensory pathway between C 2 at the neck and VPL was compared with conduction between VPL and primary somatosensory cortex. The amplitude of the cortical SEP was also studied. ICP gradients between hemispheres developed as the pressure was increased to in excess of 50 mm Hg. CBF was significantly reduced from control in the cortex and VPL on the side ipsilateral to the balloon at 50 mm Hg ICP. A significant decrease in ML flow occurred bilaterally at 70 mm Hg ICP. Conduction time was increased significantly between the right VPL and cortex at a pressure of 50 mm Hg. The amplitude of the cortical response was significantly reduced at 30 mm Hg on the right side and 50 mm Hg on the left. Aniscoria occurred at 50 mm Hg ICP and the pupils became dilated at 70 mm Hg. The SEP was possibly more sensitive than the pupillary reactions as an indication of tentorial herniation in these experiments.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 73 (1984), S. 251-257 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 79 (1986), S. 132-138 
    ISSN: 0942-0940
    Keywords: Intracranial pressure ; supratentorial mass lesions ; transtentorial herniation ; pupillary change ; auditory brain-stem responses
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This study was carried out to investigate the effects of an expanding supratentorial mass on auditory brain-stem responses (ABRs). A balloon was inserted into the supratentorial epidural space of seven baboons (in two cases, in the right occipital area; in five cases, in the right temporal area). The balloons were inflated at a rate of 0.2 ml/minute to increase intracranial pressure (ICP). ICP (right frontal epidural pressure) and blood pressure (BP) were continuously recorded. Recordings of ABRs (vertex to mastoid on both sides) were made serially. Pupillary changes were also recorded. At 30mmHg ICP, the amplitude of wave V on the right side was observed to be significantly attenuated (p〈0.02). At 50 mm Hg ICP, the latency of wave V on the right side was significantly prolonged compared with that at 30mmHg ICP (p 〈 0.02). At 70mmHg ICP, significantly decreased amplitude of wave V on the left side was also observed (p〈0.02, from the control), associated with significant increased latency of wave IV on the right side (p〈0.01, from the control; p 〈0.05, from 50 mm Hg ICP). Finally, waves IV and V on both sides substantially disappeared at 100 mm Hg ICP. Anisocoria appeared in four animals at 30–50 mm Hg (mean ±SD; 45±8.7) ICP. The amplitude of wave V was significantly decreased in these circumstances (p〈0.05). Bilaterally fixed pupils occurred in five animals at 70–100 mm Hg (mean±SD; 76 ±12) ICP. wave IV latencies on both sides were significantly prolonged (p〈0.02 right; p〈0.05, left) and disappearance of wave V (four out of five on the right side, three out of five on the left side) was observed in these circumstances. These findings suggest that serial measurement of ABRs can be useful for evaluation of the progress of transtentorial herniation.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 93 (1988), S. 149-153 
    ISSN: 0942-0940
    Keywords: Lhermitte-Duclos disease ; dysplastic gangliocytoma ; magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A 31 year old female was admitted with a one month history of left foot drop and diplopia. CT of the posterior fossa revealed gross displacement of the 4th ventricle by a large non-enhancing cerebellar mass but gave no indication of its nature. MRI sequences showed two masses within the left cerebellar hemisphere extending into the vermis and demonstrated a very unusual septation within the lesion. In addition both cerebellar tonsils were displaced below the foramen magnum and there was a syrinx extending from C 2 to the conus. At operation a demarcated lesion was excised from the apparently normal surrounding cerebellar tissue and proved histologically to be Lhermitte-Duclos disease. We believe that these are the first diagnostic magentic resonance images of this condition.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 98 (1989), S. 115-117 
    ISSN: 0942-0940
    Keywords: Small acoustic neuroma ; investigation ; outcome ; hearing preservation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors report their experience in the surgical management of small (less than 1.5 cm diameter) acoustic neuromas. Twenty-nine patients were treated. They had suffered symptoms of unilateral eighth nerve dysfunction on average for 37 months. High resolution CT with iv contrast was the primary investigation. In equivocal cases, air meatography was performed. All operations were performed by the senior author (LS). All tumours were totally removed, there were no deaths and all patients had an excellent result. There were 6 complications (CSF leak 3; meningitis 2; deep venous thrombosis 1). The facial nerve was preserved in 26 cases (and functioned adequately in all) and. the cochlear nerve in 62%. In 4 cases with hearing pre-operatively, the decibel loss was the same or less post operatively. In 8 cases speech discrimination remained above 35%.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 0942-0940
    Keywords: Subarachnoid haemorrhage ; arterial avulsion ; nimodipine ; brain protection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Acute subarachnoid haemorrhage was produced in baboons by a transorbital vessel avulsion technique. Half the animals were pretreated with an intravenous infusion of the calcium antagonistic nimodipine, in a dosage comparable with clinical levels. The severity of the haemorrhage, as measured by changes in intracranial pressure, cerebral perfusion pressure, cerebral blood flow and reactivity, and evoked potentials, was not greater in the group receiving nimodipine. Changes in extracellular K+ and pH were much less marked in animals receiving nimodipine. It is suggested that nimodipine (a) has a protective effect at a cellular level against the ionic changes of ischaemia, (b) does not alter the mechanical severity of subarachnoid haemorrhage.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 0942-0940
    Keywords: Aneurysmal subarachnoid haemorrhage ; bedside xenon cerebral blood flowmetry ; clinical grading ; outcome prediction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Ninety-six patients with aneurysmal subarachnoid haemorrhage underwent serial measurement of regional cerebral blood flow throughout the period of their treatment over the period of 5 years (1983 to 1988). A portable bedside xenon cerebral blood flow machine was used in this study and the initial slope index (ISI) values showed a clear relationship between reduction of cerebral blood flow and deteriorating clinical grade. Furthermore, serial measurements showed a statistically significant relationship between drop of cerebral blood flow, at anytime during the course of the disease, and fatal or less than satisfactory outcome.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 0942-0940
    Keywords: Ischaemia ; cerebral function ; cerebral blood flow ; haemodilution ; hypercapnia ; intracerebral steal
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The direct cortical response (DCR) and associated local cerebral blood flow was recorded from the primate cerebral cortex during a period of focal ischaemia induced by middle cerebral artery occlusion (MCAO). The DCR was lost when local blood flow fell below 20ml/ 100g/min but began to recover as collateral flow increased. Hypercapnia demonstrated a loss of local vascular reactivity following MCAO, but isovolaemic haemodilution still proved effective in increasing blood flow to these areas. The reduction in blood oxygen content induced by haemodilution did not impair cerebral function but the reduction in whole blood viscosity did exacerbate cerebral susceptibility to hypercapnia-induced intra-cerebral steal.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 40 (1978), S. 307-313 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors describe a sphenoid ridge meningioma, with coexistent secondary carcinoma from bronchus evident on histological examination.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 41 (1978), S. 7-22 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The technical problems of surgery for anterior circle aneurysm have in large measure been solved. The problem of reduced perfusion to the brain which characterises the patient with aneurysmal subarachnoid haemorrhage in a poor clinical condition demands more subtle physiological handling. It appears likely that maintenance of an intact cell membrane and blood brain barrier may be aided by the exhibition of pre and post-operative steriods, and that concentration on regional perfusion should be the main aim in post-operative management of such cases. This demands maintenance of adequate blood volume, avoidance of platelet stickiness, and utilisation of the pathological paralysis of autoregulation to improve flow to ischaemic zones by hypertensive agents if necessary. The possibility that early operation with evacuation of blood from the basal cisterns may in the end prevent the vascular damage and disordered vaso-reactivity which encourages the development of transient ischaemic deficits, is a concept which has to be actively pursued. The problem is a continuing one which has bedevilled aneurysm surgery for 25 years, but the omens suggest that a solution is appreciably nearer at hand.
    Type of Medium: Electronic Resource
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