Abstract:
:Common intracranial complications following head injury are meningitis, usually associated with a basilar skull fracture or open-depressed skull fracture; delayed hematoma; hydrocephalus; and vascular injuries. Prophylactic antibiotics are not recommended for the management of basilar skull fractures. The best means of preventing infection from open-depressed skull fractures is operative debridement and thorough irrigation, though recent evidence suggests that select cases can be safely managed without operation. Serial CT scans should be obtained in severely head-injured patients to identify delayed hematomas. CT and MRI scans obtained several weeks or months after severe head injury frequently reveal enlarged ventricles, though only a small percentage of these patients have clinical hydrocephalus. Those that do, often benefit from a shunt. Vascular injuries frequently are not detected until ischemic symptoms develop hours or days after the injury. Recommended treatment for intimal tears or dissection is full anticoagulation, but in those with cerebral contusions or other intracranial lesions, this may present an unacceptable risk for intracranial hemorrhage. Pulmonary infections frequently occur following head injury, and can be associated with admission to the ICU and intubation. A large percentage of these infections are caused by enteric gram-negative organisms, and aggressive treatment with appropriate antibiotics is necessary. Aspiration of gastric contents is common in head-injured patients and is frequently complicated by bacterial superinfection. The routine use of antacids and H2 blocking agents leads to bacterial colonization of the stomach with anaerobes and gram-negative aerobes. Thus, empiric therapy for aspiration pneumonia should include clindamycin. Sinusitis is a frequent cause of fever and leukocytosis in patients with nasotracheal or nasogastric tubes in place for several days and often subsides spontaneously with removal of the tubes. Pulmonary edema is often caused by excessive fluid administration during resuscitation of these patients, and can be avoided by monitoring central venous pressures. Pulmonary edema may also be caused by ARDS, excessive catecholamine release, or primary cardiac failure. Most of these patients will benefit from early intubation and PEEP. Pulmonary emboli most often originate from deep venous thrombi, and there is increasing evidence that prophylaxis with low-dose heparin and pulsating boots can significantly reduce the incidence of both complications. Erosive gastritis is found in the majority of severely head-injured patients and may be due to ischemia of the gastric mucosa as well as gastric hyperacidity.(ABSTRACT TRUNCATED AT 400 WORDS)
journal_name
Neurosurg Clin N Amjournal_title
Neurosurgery clinics of North Americaauthors
Marion DWsubject
Has Abstractpub_date
1991-04-01 00:00:00pages
411-24issue
2eissn
1042-3680issn
1558-1349journal_volume
2pub_type
杂志文章,评审abstract::With careful patient selection, timely neuroendovascular therapy can improve the clinical outcome of patients suffering from cerebrovascular ischemic disease. The current indications, techniques, recent experiences, limitations, and future directions of balloon angioplasty and local intra-arterial/intravenous thrombol...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:2000-01-01 00:00:00
abstract::This article defines open myelomeningocele and describes its development in the embryo. The anatomic features of the neural placode, pia-arachnoid, and dorsal versus ventral roots are well described. The surgical technique and prenatal and postnatal care are detailed. Anomalies associated with open myelomeningocele ar...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1995-04-01 00:00:00
abstract::Cranioplasty following craniectomy for trauma is a common, safe neurosurgical procedure that restores the natural cosmesis and protective barrier of the skull and may be instrumental in normalizing cerebrospinal fluid dynamics after decompressive surgery. Understanding the factors influencing patient selection and tim...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2016.11.008
更新日期:2017-04-01 00:00:00
abstract::Our present treatment strategy for treating pineal region tumors is shown in Figure 5. We believe that stereotactic biopsy should be the first procedure in pineal region tumors so that a histologic diagnosis can be obtained. Based on the biopsy findings, the appropriate subsequent therapy, whether microsurgery, fracti...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章
doi:
更新日期:1992-01-01 00:00:00
abstract::Tentorial meningiomas are encountered relatively infrequently, but it is nonetheless important to be aware of their variable clinical presentations and the need for individualized preoperative assessment and surgical management. The challenges presented by these lesions are due in large part to the complexity and vari...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1994-04-01 00:00:00
abstract::This article describes details of the application of computer modeling of cerebral blood circulation. A brief review of the different computer modeling techniques and the current models used today for predicting surgical options for bypass surgery are presented. The use of phase contrast MR for estimating intracranial...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章
doi:
更新日期:2001-07-01 00:00:00
abstract::Inadequate healing is an important mechanism for aneurysm development and recanalization after embolization. Matrix coils have been shown by experimental studies to enhance vascular repair and fibrosis, thus reducing the risk of recanalization. The clinical application of Matrix coils represents the transition from pu...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2005.03.001
更新日期:2005-07-01 00:00:00
abstract::Positron emission tomography (PET) scanning provides a sensitive means of detecting and characterizing regional changes in brain metabolism and receptor binding in movement disorders. PET allows the quantitative examination of regional cerebral blood flow, regional glucose and oxygen metabolism, and brain pharmacology...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1998-04-01 00:00:00
abstract::Diffusion tensor magnetic resonance imaging (DTI) is a relatively new technology that is popular for imaging the white matter of the brain. This article provides a basic and broad overview of DTI to enable the reader to develop an intuitive understanding of these types of data, and an awareness of their strengths and ...
journal_title:Neurosurgery clinics of North America
pub_type: 历史文章,杂志文章,评审
doi:10.1016/j.nec.2010.12.004
更新日期:2011-04-01 00:00:00
abstract::The pelvic incidence defines the amount of lordosis required in the lumbar spine, and a lumbar lordosis within 11° of the pelvic incidence defines alignment of the lumbo-pelvic region. Pelvic tilt is a compensatory mechanism that allows patients to achieve sagittal balance in the setting of decreased lumbar lordosis w...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2018.03.003
更新日期:2018-07-01 00:00:00
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journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1992-07-01 00:00:00
abstract::Meningioma, nerve sheath tumors, and filum terminale ependymoma account for over 90% of primary intradural extramedullary tumors in adults. The demographics, radiological evaluation, and surgical techniques employed for their removal are reviewed in this article. The authors' approach to intraspinal tumors with extras...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1990-07-01 00:00:00
abstract::Proximal junctional failure (PJF) should be distinguished from proximal junctional kyphosis, which is a recurrent deformity with limited clinical impact. PJF includes mechanical failure, and is a significant complication following adult spinal deformity surgery with potential for neurologic injury and increased need f...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2013.01.001
更新日期:2013-04-01 00:00:00
abstract::The spectrum of neurologic disease that complicates human immunodeficiency virus (HIV) is extremely broad. This article deals with those HIV-related diseases that may occur with a frequency of more than 1% and are of potential neurosurgical importance: those that result from a direct involvement of the nervous system ...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1992-04-01 00:00:00
abstract::Endovascular management has become the treatment of choice for carotid-cavernous fistulas regardless of the fistula type. The endovascular method offers numerous options that render it capable of treating each fistula type by choosing an adequate technique. This advantage along with the advancement in the field has le...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2014.04.011
更新日期:2014-07-01 00:00:00
abstract::The indications for the surgical management of supratentorial cavernous malformations are outlined and the results following operation are presented in this article. Surgery is indicated for most patients who present with seizures, neurologic deficit, or headache. The surgical approaches to lesions in the cerebrum are...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1999-07-01 00:00:00
abstract::Shunt failure remains a disheartening complication of shunt surgery. The number of adjustable factors in attempting to reduce the rate is small. The clinical presentation and timing of shunt malfunction are well documented. Although the shunt design trials have been negative to date, valves have important effects that...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:2001-10-01 00:00:00
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journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2016.05.010
更新日期:2016-10-01 00:00:00
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journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2020.06.004
更新日期:2020-10-01 00:00:00
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journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2007.10.001
更新日期:2008-01-01 00:00:00
abstract::In the hands of the inexperienced, endoscopic carpal tunnel release bears a substantial risk for neurovascular injury. For those thoroughly trained in this technique, it is a fast and elegant but also more expensive way to achieve carpal tunnel release. If performed uneventfully, it minimizes trauma and avoids a subst...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2008.07.023
更新日期:2009-01-01 00:00:00
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journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章
doi:
更新日期:1996-04-01 00:00:00
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journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2012.01.006
更新日期:2012-04-01 00:00:00
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journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2005.08.001
更新日期:2005-10-01 00:00:00
abstract::Intracranial metastases are the single most costly neurologic ailment. This article provides the clinician with detailed statements of the patterns of their appearance and tumors of origin. Most common causative cancers are of lung, breast, or melanoma origin. Aggressive therapies carry with them the risk of nervous s...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1996-07-01 00:00:00
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journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2017.05.013
更新日期:2017-10-01 00:00:00
abstract::This review provides historical and recent perspectives related to passive immunotherapy for high-grade gliomas. The authors discuss approaches that use lymphokine-activated killer cells, cytotoxic T lymphocytes, and monoclonal antibodies. ...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2012.04.008
更新日期:2012-07-01 00:00:00
abstract::This article describes the presentation of tussive headaches in the adult population. Posterior headaches can also occur in patients with basilar invagination, and they may require occipital cervical fusion. Lower cranial nerve dysfunction is another common presenting symptom in adult Chiari patients. Almost 25% of sy...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.nec.2015.07.001
更新日期:2015-10-01 00:00:00
abstract::The major changes in health care delivery today further cloud the perspectives of patient autonomy, participation, and justice and the ideals of the virtuous practice of medicine. A Workable Integrative Negotiation approach with COAST permeating the medical setting and health agenda, however, can help promote effectiv...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1995-10-01 00:00:00
abstract::There is no clear plane between the dura and arachnoid in situ. Instead of the virtual subdural space, there is a dura-arachnoid interface layer, which is structurally the weakest throughout the meninges. An extravasation of blood within the dural border layer splits it, leaving a few tiers of dural border cells over ...
journal_title:Neurosurgery clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:2000-07-01 00:00:00