[Show abstract][Hide abstract] ABSTRACT: The head-shaking method combined with cisternal irrigation has been proposed to be effective in preventing cerebral vasospasm after subarachnoid hemorrhage (SAH) by facilitating rapid washout of the clot from the subarachnoid space. This study was conducted to evaluate the effectiveness of this method.
The inclusion criteria included the following: 1) Fisher Grade 3 SAH on admission computerized tomography (CT) scans; 2) aneurysm secured within 48 hours of SAH onset; and 3) no focal deficit and ability to obey commands within 24 hours postsurgery. Two hundred thirty patients treated between 1994 and 2002 fulfilled the criteria. Because only one machine was available and it required I month of maintenance every other month, 114 patients underwent irrigation combined with the head-shaking method (head-shaking group), whereas the remaining 116 patients received cisternal irrigation alone (control group). There were no significant differences in sex, age, site of aneurysm, or preoperative grade between the two groups. The incidence of symptomatic vasospasm with or without infarction, cerebral infarction on CT scans, and permanent ischemic neurological deficit was 25.7, 17.7, and 8.8%, respectively, in the control group and 15.2, 4.5, and 2.7% in the head-shaking group. The difference was statistically significant for symptomatic vasospasm, cerebral infarction, and permanent ischemic neurological deficit (p < 0.05). In a multivariate backward stepwise logistic regression analysis, absence of head shaking was the only variable that was predictive of permanent ischemic neurological deficit (p = 0.061). The outcomes evaluated using the modified Rankin Scale were better in the head-shaking group (p = 0.051).
The head-shaking method significantly reduced the incidence of symptomatic vasospasm, cerebral infarction, and permanent ischemic neurological deficit and improved the clinical outcomes in patients who underwent cisternal irrigation therapy after aneurysmal SAH.
No preview · Article · Mar 2004 · Journal of Neurosurgery
[Show abstract][Hide abstract] ABSTRACT: We report a case of a bilateral vertebral dissecting aneurysm associated with subarachnoid hemorrhage. Proximal ligation of the vertebral artery on the ruptured side combined with wrapping of the contralateral dissection failed to prevent fatal rebleeding. Since enlargement of the contralateral dissection was observed by postoperative angiography, rupture of the growing contralateral dissecting aneurysm may have caused rebleeding. Hemodynamic changes following the occlusion of one vertebral artery might have led to enlargement and subsequent rupture of the contralateral dissection. Direct wrapping was unable to prevent enlargement of the dissection, so radical surgery including bilateral vertebral artery occlusion combined with vascular reconstruction may be the treatment of choice for this type of lesion.
No preview · Article · Apr 2002 · No shinkei geka. Neurological surgery
[Show abstract][Hide abstract] ABSTRACT: We compared recent clinical results for the severe subarachnoid hemorrhage (WFNS Grade IV and V) with data obtained five years ago. Thirty-one patients (38.3%) among 81 cases of subarachnoid hemorrhage were rated as WFNS Grade IV or V from July 1993 to June 1994 (Former Group). In the 81 patients from July 1998 to June 1999, 33 patients (40.7%) were rated as Grade IV or V (Latter Group). In the Former Group, the patient was promptly controlled under deep sedation in the emergency room. After the angiogram, emergent craniotomy for neck clipping was performed, and cisternal irrigation with 60,000 units of urokinase in 500 ml of physiological saline was undertaken for 7-10 days. Induced hypertension was started when the neurological deterioration was observed. In the Latter Group, decompressive craniectomy was added in all severe patients. The fluid for cisternal irrigation was modified to urokinase and ascorbic acid in mock cerebrospinal fluid. The initiation of cerebral vasospasm was continuously monitored with transcranial doppler, and intraarterial fasudil infusion was performed when cerebral vasospasm was noticed. Among the 31 patients in the Former Group, 19 patients were treated surgically. The outcome of these patients at hospital discharge was MD 3, SD 8, VS 3, D 5 in the Glasgow Outcome Scale. In the 21 surgically treated patients among 33 of the Latter Group, the outcome was GR, 4; MD, 5; SD, 2; VS, 8; and D, 2. The population who can live independently (GR+MD) was 15.8% in the Former Group and 42.9% in the Latter Group. Control of intracranial pressure in the initial stage, early detection and aggressive treatment of cerebral vasospasm, and development of intravascular treatment were considered to have contributed to this improvement of clinical results.
No preview · Article · Jan 2001 · Surgery for Cerebral Stroke
[Show abstract][Hide abstract] ABSTRACT: Expanded polytetrafluoroethylene (ePTFE) can be used as a dura substitute but is associated with leakage of cerebrospinal fluid (CSF) through the suture line. Fibrin glue alone may not prevent this problem. This new method for sealing the suture line in ePTFE membrane uses an absorbable polyglycoic acid mesh soaked with fibrinogen fluid placed on the suture line. Thrombin fluid is then slowly applied to the wet mesh, forming a large fibrin membrane reinforced by the mesh over the suture line. Only one of 33 patients in whom this technique was used had CSF leakage, whereas 12 of 59 patients in whom a dural defect was closed with ePTFE alone showed postoperative subcutaneous CSF collection (p < 0.05). Our clinical experiences clearly show the efficacy of the mesh-and-glue technique to prevent CSF leakage after artificial dural substitution. Mesh and glue can provide an adequate repair for small dural defect. The mesh-and-glue technique may also be used for arachnoid sealing in spinal surgery.
No preview · Article · Apr 1999 · Neurologia medico-chirurgica
[Show abstract][Hide abstract] ABSTRACT: A 63-year-old male with a preexisting chronic subdural hematoma presented with progressive confusion and left hemiparesis as well as high fever. Subdural empyema was strongly suspected. At surgery, the empyema was encapsulated by definite inner and outer membranes. Cultures isolated from the subdural fluid and from an abscess of his left thigh yielded methicillin-resistant Staphylococcus aureus. A pulsed-field gel electrophoresis showed these two strains were genetically identical. Hematogenous infection of a preexisting subdural hematoma is an extremely rare cause of subdural empyema.
No preview · Article · Dec 1998 · Neurologia medico-chirurgica