China
Africa
Explore chapters and articles related to this topic
Stroke and Transient Ischemic Attacks of the Brain and Eye
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Surgical decompression and evacuation of cerebellar hemorrhage is usually indicated if the GCS score is lower than 14, the hematoma diameter is greater than 3 cm, the hematoma volume is higher than 7 cm³, or if there is obliteration of the fourth ventricle. An external ventricular drain is usually inserted if there is associated hydrocephalus.
Intracranial pressure management
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Eli Johnson, Yi-Ren Chen, Katie Shpanskaya, Jamshid Ghajar, Odette A. Harris
A 31-year-old man is involved in a motor vehicle collision with a tree and is found to have a Glasgow Coma Scale score of 3. He is rushed to the nearest hospital where imaging reveals extensive right frontal bone fracture, bilateral frontal contusions, and nasal fracture (Figure 24.1). The patient is considered for possible organ donation and transferred to another hospital, where he was noted to have movement on his right side. An external ventricular drain was placed to monitor the intracranial pressure and provide drainage. He subsequently undergoes a bilateral decompressive craniectomy. After an extended stay in the hospital, the patient returns home and is regularly seen by a neurologist for complications of his brain trauma. One month after discharge, the patient is noted to be alert and oriented ×3 with right cranial nerves III and VI palsy. He is able to follow simple and complex commands with no gross sensory or motor deficits.
Neurosurgery
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
In acute and emergency scenarios, surgeons will opt to insert an external ventricular drain (EVD). These are usually inserted into the frontal horn of the lateral ventricle. The drain reduces the ICP and provides a means to measure ICP but is only appropriate for short-term management given the risk of infection. If patients are likely to suffer from hydrocephalus long term or if they have a more insidious presentation, a shunt is inserted. Shunts permit the drainage of CSF to distal sites including peritoneum, atrium and pleura.
Incidental multifocal calcifying pseudoneoplasm of the neuraxis: case report and literature review
Published in British Journal of Neurosurgery, 2023
Jian-Qiang Lu, Kaiyun Yang, Kesava K. V. Reddy, Bill Hao Wang
Her CT angiogram showed a right middle cerebral artery (MCA) aneurysm that likely ruptured. On arrival in intensive care she had bilateral extensor posturing and small pupils with preserved corneal and cough/gag response. An external ventricular drain was placed. Given the shape of the aneurysm it was thought that open surgical clipping would be the best for the patient. On post admission day 3, her clinical status improved where she was localizing bilaterally with her arms. She was brought to the operating room for a right fronto-temporal craniotomy and clipping of the aneurysm. On reflecting the dura, we noticed numerous small nodules situated on the inside of the dura. These nodules appeared to have a whitish-tan color and surface texture appeared somewhat rough. Most of the nodules were estimated to be around 2–3 mm in maximal dimension with a few larger nodules measuring 3–4 mm. Retrospectively, we identified these nodules on the preoperative CT images with appropriating windows (Figure 1(A–C)). On CT, the lesions appeared separate from bone with different Hounsfield Units measurements. We excised one of the larger nodules located anterior-superiorly, overlying the frontal lobe (Figure 1(C)) for histology.
Intermediate surgical outcome in patients suffering poor-grade aneurysmal subarachnoid hemorrhage. A single center experience
Published in International Journal of Neuroscience, 2021
Anastasia Tasiou, Alexandros G. Brotis, Thanasis Paschalis, Christos Tzerefos, Eftychia Z. Kapsalaki, Theofanis Giannis, Alkiviadis Tzannis, Kostas N. Fountas
Seventeen cases (74%) underwent surgical clipping within 24 h from the initial symptom onset (Table 1). Nine cases (39%) had an intraparenchymal and/or a subdural hematoma associated with the ruptured aneurysm. An external ventricular drain (EVD) was inserted in 21 patients (91.3%). Elevated intracranial pressure was observed in 21 of our patients (91.3%). Seven patients (30.4%) developed persistent, medically intractable intracranial hypertension (ICP ≥30 mmHg), despite adequate CSF drainage through a previously inserted EVD. A standard pterional craniotomy (PT) was performed in ten (43.5%) patients, while thirteen (56.5%) underwent an extensive (more than 12 cm in its largest diameter), unilateral decompressive craniectomy (DC). Two patients (9%) developed post-hemorrhagic hydrocephalus, and a ventriculo-peritoneal shunt insertion was required. Five patients (21.7%) developed massive brain edema and finally succumbed to this.
Treatment strategies of ruptured intracranial aneurysms associated with moyamoya disease
Published in British Journal of Neurosurgery, 2021
Xu Zhao, Xiaofei Wang, Minqing Wang, Qinghu Meng, Chengwei Wang
A 46-year-old woman was hospitalized for a sudden onset of severe headache accompanied by vomiting. A CT scan revealed hemorrhage in the splenium of corpus callosum with intraventricular extension. An external ventricular drain was placed and the patient experienced progressive recovery. Then an angiography study indicated MMD with a peripheral aneurysm located at the distal PChA. Because endovascular embolization was technically difficult or impossible due to the tortuosity and small diameter of the parent artery, pure revascularization (left multiple burr holes) was performed about 2 months later when the hemorrhage was dissolved. The patient had no recurrent intracranial hemorrhage thereafter. A follow-up angiography performed 10 months after surgery showed disappearance of the aneurysm and Grade B collateral vessels provided by the procedure (Figure 2).