Search results for "intracranial pressure"

Inhalational or intravenous anesthetics for craniotomies? Pro inhalational.

2006

In neurosurgery, anesthesiologists and surgeons focus on the same target - the brain. The nature of anesthetics is to interact with brain physiology, leading to favorable and adverse effects. Research in neuroanesthesia over the last three decades has been dedicated to identifying the optimal anesthetic agent to maintain coupling between cerebral blood flow and metabolism, keep cerebrovascular autoregulation intact, and not increase cerebral blood volume and intracranial pressure.Sevoflurane is less vasoactive than halothane, enflurane, isoflurane, or desflurane. The context sensitive half-life is short and similar to that of desflurane, which translates into fast on and offset. Compared wi…

Acute Subdural Hematoma in Pigs: Role of Volume on Multiparametric Neuromonitoring and Histology

2008

Traumatic brain injury (TBI) is often complicated by acute subdural hemorrhage (ASDH) with a high mortality rate. The pathophysiological mechanisms behind such an injury type and the contribution of blood to the extent of an injury remain poorly understood. Therefore, the goals of this study were to establish a porcine ASDH model in order to investigate pathomechanisms of ASDH and to compare effects induced by blood or sheer volume. Thus, we infused 2, 5, and 9 mL of blood (up to 15% of intracranial volume), and we compared a 5-mL blood and paraffin oil volume to separate out effects of extravasated blood on brain tissue. An extended neuromonitoring was applied that lasted up to 12 h after …

Cisternostomy: A Timely Intervention in Moderate to Severe Traumatic Brain Injuries: Rationale, Indications, and Prospects.

2019

Traumatic brain injury (TBI) represents a major public health concern worldwide, with no significant change in its epidemiology over the last 30 years. After TBI, the primary injury induces irreversible brain damage, which is untreatable. The subsequent secondary injury plays a critical role in the clinical prognosis because without effective treatment it will provide additional tissue damage. The resulting scenario is the rise in intracranial pressure (ICP) with the development of progressive neurological deficits. Current optimal management is based on a progressive, target-driven approach combining both medical and surgical treatment strategies among which is decompressive hemicraniectom…

Invagination of the Sphenoid Sinus Mucosa after Endoscopic Endonasal Transsphenoidal Approach and Its Significance

2016

Objective To describe the clinical features of invagination of the sphenoid sinus mucosa (ISM) and compare them with other similar cases using a visual analog scale (VAS) to assess the various nasal symptoms and to discuss its clinical significance and means of prevention. Study design Retrospective chart review at a tertiary referral center. Methods Between 2010 and 2015, 8 patients who had undergone EETSA surgery displayed postoperative ISM. The comparison group consisted of 147 patients who underwent the same surgical procedures and were diagnosed with the same diseases. Pre- or postoperative paranasal sinus computed tomography (PNS CT) and VAS were performed and subsequently analyzed. R…

Deliberate Arterial Hypotension Does Not Reduce Intraocular Pressure in Pigs

1992

Among the accepted advantages of general anesthesia in ophthalmic surgery is improved control of intraocular pressure (IOP). Although standard textbooks advocate deliberate arterial hypotension to facilitate intraocular surgery by reducing IOP, scientific proof of such an effect is lacking. The authors investigated effects of induced arterial hypotension on IOP in an anesthetized porcine model. Forty-two piglets were anesthetized with piritramide, were placed in the prone position, and had the anterior chamber of one eye punctured with a small Teflon cannula to measure IOP. Six pigs were used in a pilot study to establish dose-response relationships for the hypotensive agents; 36 pigs were …

Hyperventilation in Severe Traumatic Brain Injury Has Something Changed in the Last Decade or Uncertainty Continues? A Brief Review

2021

Pathomechanism of Brain Oedema in Experimental Intracerebral Mass Haemorrhage

1988

The prognosis of intracerebral haemorrhage is extremely poor when arterial hypertension is present. We investigated elastance of the brain tissue and brain hydraulic conductivity in normotensive (MAP ~ 110 mmHg) and hypertensive (MAP ~ 170 mmHg/angiotensin infusion) cats following a stereotactically produced intracerebral haemorrhage. For 12 hours after the onset of haemorrhage we registered the course of ICP, subsequently the water content of cortex, white matter and basal ganglia as well as the interstitial concentration of serum proteins in the corresponding regions were determined (Evans-Blue, immunofluorescence). Hypertension was associated with a slight increase in ICP and tissue wate…

Poligono di Willis e perdite per mescolanza

2008

New method of bone reconstruction designed for skull base surgery

2008

The direct endonasal or transoral transclival approaches to the skull base permit effective, minimally invasive surgery along the clivus. Developing long-term, effective techniques to prevent cerebrospinal fluid (CSF) leaks and their consequences (infection and delayed healing) remains a major challenge. In this study we describe a method of bone reconstruction newly developed by us, which uses a custom designed silicone plug for bone replacement after minimally invasive skull base surgery with a low incidence of postoperative CSF leaks. German Landrace pigs were used to test the efficiency of the new technique. Twelve craniotomies were performed in six pigs using a subtemporal approach and…

Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU st…

2023

Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) a…