Search Results

You are looking at 21 - 30 of 56 items for :

  • "cerebral perfusion pressure" x
  • Neurosurgical Focus x
  • Refine by Access: all x
Clear All
Full access

Minimally invasive treatment for intracerebral hemorrhage

Emun Abdu, Daniel F. Hanley, and David W. Newell

treatment are preventing further hemorrhage, reducing ICP, controlling cerebral perfusion pressure, and reducing mass effect when possible. Deep lesions (that is, those in the basal ganglia or brainstem) have a dismal prognosis, and open surgical evacuation does not appear to improve the patient's outcome compared with medical management. Historically, there has been no role for open surgery in such cases. 32 Surgery is believed to save lives by decreasing ICP in select patients, but it does not necessarily result in restoration of meaningful functional status. In

Full access

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Geoffrey Appelboom, Stephen D. Zoller, Matthew A. Piazza, Caroline Szpalski, Samuel S. Bruce, Michael M. McDowell, Kerry A. Vaughan, Brad E. Zacharia, Zachary Hickman, Anthony D'Ambrosio, Neil A. Feldstein, and Richard C. E. Anderson

cerebral perfusion pressure decrease . Pediatr Neurosurg 30 : 62 – 69 , 1999 10.1159/000028765 7 Bayir H , Adelson PD , Wisniewski SR , Shore P , Lai Y , Brown D , : Therapeutic hypothermia preserves antioxidant defenses after severe traumatic brain injury in infants and children . Crit Care Med 37 : 689 – 695 , 2009 10.1097/CCM.0b013e318194abf2 8 Berger MS , Pitts LH , Lovely M , Edwards MS , Bartkowski HM : Outcome from severe head injury in children and adolescents . J Neurosurg 62 : 194 – 199 , 1985 10.3171/jns.1985

Full access

Cerebral pressure autoregulation in traumatic brain injury

Leonardo Rangel-Castilla, Jaime Gasco, Haring J. W. Nauta, DaviD O. Okonkwo, and Claudia S. Robertson

Hg–wide sROR range (50–150 mm Hg) can be reduced to a 10 mm Hg–wide autoregulation range in severe TBI. For each individual patient, this autoregulatory range can also change during the intensive care unit stay. Cerebral perfusion pressure and ICP management should therefore be individually tailored, and optimal CPP and cerebral autoregulation should be reassessed throughout the treatment course. How to Restore Impaired Cerebral Autoregulation in a Patient With TBI Hyperventilation In a patient with TBI, hyperventilation improves autoregulation, but this

Full access

Beta blockers exposure and traumatic brain injury: a literature review

Timothy Y. Tran, Irie E. Dunne, and John W. German

level; 3) preservation of cerebral perfusion pressure (60–70 mm Hg for adults and 40–55 mm Hg for children and adolescents); 4) avoidance of cerebrospinal drainage; 5) use of early nutrition; and 6) use of mechanical ventilation to promote normal oxygenation and ventilation. In part the protocol advocated by the group from Lund emphasizes the use of metoprolol, a selective beta1- antagonist, and clonidine, an alpha2-agonist, which are used to limit the posttraumatic hyperadrenergic stress response. These investigators advocate the use of these agents to limit the

Full access

The Extracranial–Intracranial Bypass Trial: implications for future investigations

Matthew C. Garrett, Ricardo J. Komotar, Maxwell B. Merkow, Robert M. Starke, Marc L. Otten, and E. Sander Connolly

stenosis or the presence of arterial occlusion does not accurately predict the hemodynamic status of the distal circulation. 33 Although stenoses of the extracranial carotid artery resulting in reductions in luminal diameter ≥ 50–70% are known to reduce the distal pressure in some cases, 10 collateral circulation can maintain normal cerebral perfusion pressure and normal flow in many of these patients. Up to 60% of patients with complete occlusion of the carotid artery may have no evidence of hemodynamic compromise in the distal circulation. 32 Third, the study

Full access

Quality of life after hemicraniectomy for traumatic brain injury in adults

A review of the literature

Shabbar F. Danish, Dean Barone, Bradley C. Lega, and Sherman C. Stein

H ead injury is a major cause of morbidity and mortality worldwide. Trauma itself is the leading cause of death in the first 4 decades of life, with traumatic brain injury being implicated in at least half the cases. 13 One of the fundamental pathophysiological processes after traumatic brain injury is the development and propagation of an escalating cycle of brain swelling and an increase in ICP. The goals of the clinical management of severe head injury consist of interrupting this cycle by controlling ICP and maintaining cerebral perfusion pressure and

Full access

Complications of decompressive craniectomy for traumatic brain injury

Shirley I. Stiver

surgery ( Fig. 5 ). In the study by Aarabi et al., 1 subdural hygromas developed in 25 (50%) of 50 patients after a mean of 8 days following decompressive craniectomy. Hygromas are generally ipsilateral to the skull defect with volumes ranging from 10 to 120 ml (mean 51 ml). 1 While most authors favor a mechanism of altered CSF dynamics to account for the occurrence of hygromas, others have suggested that increased cerebral perfusion pressure that accompanies decompressive craniectomy may play a role. 45 F ig . 5. Subdural hygroma. Noncontrast CT image of a

Full access

Therapeutic hypothermia in acute ischemic stroke

Leonid I. Groysman, Benjamin A. Emanuel, May A. Kim-Tenser, Gene Y. Sung, and William J. Mack

evaluated the use of moderate hypothermia (33°C core body temperature) in 25 patients with severe MCA stroke. Cooling was achieved within 14 ± 7 hours after the onset of symptoms by using cooling blankets and cold saline infusions. The purpose of this study was to control ischemic cytotoxic edema by maintaining moderate hypothermia for 48–72 hours. Continuous monitoring of ICP, brain temperature, and cerebral perfusion pressure was performed. During the hypothermia period, ICP was well controlled, although rewarming was associated with rebound intracranial hypertension

Full access

Endovascular recanalization of symptomatic flow-limiting cervical carotid dissection in an isolated hemisphere

Clemens M. Schirmer, Basar Atalay, and Adel M. Malek

embolic in the majority of cases, but hemodynamic compromise is also another considerable proportion. 29 , 43 In our Case 1, the deficit was not fixed but rather fluctuated directly in relation to cerebral perfusion pressure. A decrease in the systolic blood pressure below 120 mm Hg dynamically prompted the development of a reversible neurological deficit. Cohen et al. 9 reported that angiographic parenchymography or perfusion MR imaging can be used to determine the extent of salvageable ischemic penumbra to select the patients who would potentially benefit from a

Free access

Transcranial MR-guided focused ultrasound sonothrombolysis in the treatment of intracerebral hemorrhage

Stephen J. Monteith, Neal F. Kassell, Oded Goren, and Sagi Harnof

. As a result the cerebral perfusion pressure is compromised leading to ischemia, particularly in watershed zones due to decreased perfusion. This increases neurological injury further by enlarging the area of cell death. The Need for Minimally Invasive Therapies The role of surgical intervention for the treatment of spontaneous ICH is unclear. Current management generally consists of supportive care with reversal of coagulopathy, management of hypertension, and placement of an external ventricular drain in patients with hydrocephalus. Results of the STICH