A comparison of equivolume, equiosmolar solutions of hypertonic saline and mannitol for brain relaxation in patients undergoing elective intracranial tumor surgery: a randomized clinical trial.

BACKGROUND: Hyperosmolar solutions have been used in neurosurgery to modify brain bulk and prevent neurological deterioration. The purpose of the study was to compare the effects of equivolume, equiosmolar solutions of mannitol and hypertonic saline (HTS) on brain relaxation and postoperative complications in patients undergoing elective intracranial tumor surgery. METHODS: In this prospective, randomized study, patients with American Society of Anesthesiologists physical status I to III scheduled to undergo a craniotomy for intracranial tumors were enrolled. Patients received a 3.75 mL/kg intravenous infusion of either 3.2% HTS (group HTS, n=36) or 20% mannitol (group M, n=38). The surgeon assessed the condition of the brain using a 4-point scale after opening the dura. Recorded measures included duration of surgery, blood loss, urine output, volume and type of infused fluids, hemodynamic variables, electrolytes, glucose, creatinine, predefined postoperative complications, and length of intensive care unit and hospital stays. RESULTS: Brain relaxation conditions in group HTS (score 1/2/3/4, n=10/17/2/7) were better than those in group M (score 1/2/3/4, n=3/18/3/14, P=0.0281). Patients in group M had higher urine output, received more crystalloids during surgery, and displayed lower central venous pressure and lower natremia at the end of surgery than did patients in group HTS. No significant differences in postoperative complications or lengths of intensive care unit and hospital stays were observed between the groups. CONCLUSIONS: Our results suggest that HTS provides better brain relaxation than mannitol during elective intracranial tumor surgery.

Rare case of a localized radial nerve amyloid neuropathy.

We report the case of a 55-year-old woman with a 6-month history of progressive paresis of the right radial nerve. Perioperative imaging detected a spindle-shaped expansion of the radial nerve caused by an isolated local deposit of amyloid (amyloidoma). The deposit was resected in 2 phases and the resulting defect was bridged by a sural nerve autograft. Overall internal and hematological examination did not reveal systemic amyloidosis or lymphoproliferative disorder. The reason for our report is that localized forms of amyloid neuropathy are very rare.

The potential benefit of intracarpal pressure measurement in endoscopic carpal tunnel syndrome surgery--an analysis of EMG findings and pressure values.

Endoscopic carpal tunnel syndrome surgery is a modern minimally invasive method of carpal tunnel decompression. However, the method does also have its critics, who emphasize that there is an increased rate of complications in comparison to open procedures. To further improve and optimize results of endoscopic surgery we used an intracarpal pressure sensor to verify the effect of carpal tunnel decompression. The endoscopic single portal approach was used in all cases. Median nerve conduction studies were performed prior to and 3 months after surgery. Two groups, those with pressure studies and those without, were then compared according to several EMG parameters such as: median nerve distal motor latency, amplitude of motor response, sensory nerve conduction velocity to the index finger, and amplitude of sensory nerve action potential. In both groups, we observed similarly significant improvements in all conduction parameters, except the amplitude of motor response, which did not change in either group, i.e. no difference in postoperative EMG between the two groups was observed. Despite this fact, intracarpal pressure measurement is still useful in localising the point in which the median nerve is compressed and provides valuable functional information on the level decompression achieved.

[Surgical treatment of brain abscess--retrospective analysis of the group of patients with brain abscess, treated at our department in last 12 years]. / Chirurgická lécba abscesu mozku--retrospektivní analýza souboru nemocných s diagnózou abscesu mozku, lécených na nasem pracovisti za posledních 12 let.

The authors retrospectively evaluated group of patiens treated at the Department of neurosurgery in Hradec Králové from 10/1993 to 10/2004 with the diagnosis of brain abscess. During this period, we treated 23 patients, 15 males and 8 women with the median age 48 years. Patiens with the iatrogenic etiology and those with pyocefalus and subdural and epidural empyema were excluded from this group. We provided 45 surgical procedures with total mortality 17,4 %.