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Background: We aimed to test a new approach for repairing cerebrospinal fluid (CSF) leaks and to determine the demographic, diagnostic, and treatment factors associated with the successful management of intracranial complication. Owing to the high frequency of endoscopic surgeries and the low cost of medical care in Iran, we decided to report our experience of reconstruction after CSF leaks. Methods: We retrospectively reviewed our experience in the diagnosis and management of CSF rhinorrhoea in Iran between 2005 and 2012. The locations of all pre-repair leaks were identified using simple, readily available methods. The follow-up time ranged from 2 to 72 months. Results: Of the 37 participants, 59.5% were men and the mean age was 33 years. The success rate was 86.1%, and the most common aetiological factor was trauma (57%). The most common location was the ethmoidal fovea (45.9%), followed by the sphenoid sinus (24.3%), the cribriform plate (13.5%), and the posterior table of the frontal sinus (5.4%). Conclusions: Medical care in Iran has considerable budget restrictions. This study advocates a practical method of treatment for patients in similar circumstances, with a success rate of 86.1% when compared to the 90.6% achieved with other techniques.
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Objective: This study was designed to analyze the results from ICP and TCD monitoring in patients with traumatic brain injury (TBI) in order to further evaluate the clinical significance of noninvasive ICP monitoring with TCD. Methods:The monitoring and measurements with TCD were performed beside beds on the following day of surgery to record the spectral atlas and parameter of the middle cerebral artery (MCA) of suffering side in 32 patients with TBI. The values of ICP were recorded at the same time. The patients were divided into four groups according to ICP. The comparative analyses of results of TCD and ICP monitoring were carried out.Results:(1)Spectral atlas: The spectral atlas of Mild ICP Increase Group showed no visible differences from those of Normal ICP Group.A phenomenon of deepened notch before reaching D peak was found in some cases of Moderate ICP Increase Group while occurrence of single cusp peak and disappearance of S2 peak with decreased diastolic velocity were observed in Severe ICP Increase Group. (2) Parameter of TCD: With the increase of ICP,Vs,Vd and Vm were decreased accordingly with the most significant dropping in Vd while PI and RI were elevated gradually. Conclusion:This study suggests that TCD can be applied to monitor noninvasively ICP and indicate the significant increase of ICP in patients with TBI,but fail to detect mild increase of ICP. Spectral atlas is superior to parameters of TCD in judgment of increased ICP
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Objective To study the therapeutic effect of sub-hypothermia on 80 patients with diffusing axonal injury (DAI) and its prognosis.Methods All 80 patients with DAI were randomly divided into the sub-hypothermia group(40 cases)and the control group(40 cases). All patients'vital sign,intracranial pressure (ICP) and blood sugar were measured. 40 cases of the patients with DAI were treated by sub-hypothermia, the rectal temperate (RT) reached 32 0℃～35 0℃,sub-hypothermia lasted for 1～7 days; the control group was treated routine. According to Glasgow Outcome Scale (GOS), the prognosis of the patients was evaluated 3 months later.Results In comparison with the control group, increased ICP and raised blood sugar in sub-hypothermia group were significantly decreased (P
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To study the effect of measurement parameters and hydrocephalus on the pressure volume index(PVI), PVI study was performed in 5 normal and 5 kaolin-induced hydrocephalic cats. The effects of injection volume, speed, laterality and influence of increased intracranial pressure(ICP) in normal and hydrocephalic cats on the PVI value were evaluated. The results were as follows; 1) Larger injection volume, increased ICP by continuous infusion, and presence of ventriculomegaly made the PVI value significantly higher(p<0.01, p<0.001, p<0.05, respectively). 2) Rapid injection made the PVI value significantly lower(p<0.01). 3) Increase of ICP accentuated the effects of injection volume and speed significantly(p<0.01). 4) There was no difference between the PVI values measured with injection into the ipsilateral lateral ventricle and those measured with injection into the cantralateral lateral ventricle. 5) With the above results, it is considered advisable to perform the PVI study with constant injection volume, speed and ICP.
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Animals , Cats , Hydrocephalus , Lateral VentriclesABSTRACT
We studied the cardiovascular and intracranial pressure(ICP) effects of Vecuronium in cats with normal and artificially increased ICP. Under pentobarbital and nitrous oxide anesthesia, monitors for ICP, Mean Arterial Pressure(MAP), Heart Rate(HR), and Central Venous Pressure(CVP) were placed in the cats. The cats were then divided into two groups: one with normal ICP( N-ICP) (n=8) and the other with artificially increased ICP (AI-ICP) (n=8). In the AI-ICP group, a size 8F Foley catheter was placed in the epidural space through a 5 mm trephined hole on the right parietal area. In each group, ICP, MAP, HR, CVP, and Cerebral Perfusion Pressure(CPP) were measured after Vecuronium injection(80ug/kg)(CPP=MAP-ICP). Results showed no statistically significant changes in cats with N-ICP and AI-ICP.