By Anish Bhardwaj, Jeffrey R. Kirsch
The scientific administration of sufferers with acute mind and spinal twine damage has developed considerably with the appearance of recent diagnostic and healing modalities. Editors Bhardwaj and Kirsch give you administration of Acute mind and Spinal wire damage, a brand new stand-alone connection with aid ultra-modern neurologists and neurosurgeons retain abreast of all of the contemporary developments in mind and spinal wire harm. Divided into 5 sections, mind harm, ischemic stroke, intracerebral and subarachnoid hemorrhage, hectic damage and scientific administration of spinal twine accidents, this article offer you a precis of the most up-tp-date clinical technology for the medical administration of sufferers with acute mind and spinal wire accidents.
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Extra resources for Acute Brain and Spinal Cord Injury: Evolving Paradigms and Management (Neurological Disease and Therapy)
Considerations include the extent of temporal decompression and whether or not the sagittal sinus is left protected by a thin strip of bone. Some surgeons ligate and transect the anterior sagittal sinus and the falx in an attempt to avoid falcine injury to the outwardly herniating brain and to allow for full expansion of the edematous brain. However, some contend that sinus sacrifice simply eliminates a conduit for fluid egress, increasing venous pressure and exacerbating cerebral edema (33). Bitemporal craniectomies have been described but are not widely practiced, owing to the small degree of cranial decompression offered.
TECHNICAL CONSIDERATIONS Craniectomy While a detailed review of surgical techniques is beyond the scope of this chapter, we briefly review the classes of craniectomy and discuss bone flap replacement and complications, as these issues will be encountered by neurosurgeons and neurocritical care specialists alike. Three types of secondary cranial decompression are generally discussed: unilateral, bilateral, and temporal decompression. No experimentally validated criteria exist to guide neurosurgeons in their choice of procedure, but some empirically derived conclusions may be drawn.
2). This increased intravascular blood volume can increase ICP. When CPP is restored, pial arterioles can constrict and ICP will often decrease (67). Monitoring Consensus has emerged regarding indications for placing an ICP monitor in patients with TBI; this is based on the identification of groups at risk for developing intracranial hypertension. At highest risk are patients with GCS scores below 8 and abnormal CT scans; up to 60% of these patients develop elevated ICP readings (68). While patients with GCS scores below 8 with normal-appearing CT scans on admission have a 10% to 15% chance of developing elevated ICPs, a subgroup with a 60% chance of intracranial hypertension does exist: those who Cerebroprotective Strategies 27 present with age over 40 years, systolic blood pressure less than 90 mmHg, and unilateral or bilateral motor posturing (44,68,69).