Clinical Neuroscience

[Intravenous perfusion anaesthesia in neurosurgey part two]

HUDVÁGNER Sándor1, SZENOHRADSZKY Katalin1, VIDA Gabriella1, DÓCZI Tamás1

NOVEMBER 20, 1996

Clinical Neuroscience - 1996;49(11-12)

[A retrospective analysis of 1300 neurosurgical perfusion narcoses performed by means of intravenously administered propofol-fentanyl-vecuron proved the advantage of this technique over traditional procedures. It decreased the recovery time, the incidence of postoperative nausea and vomiting, and muscle fibrillation. Propofol did not elevate either raised or normal intracranial pressures. Moreover, a trend reduction of raised ICP was observed. The incidence of cardiovascular complications was also reduced. Patients, especially the elderly, had a quick, subjectively well-tolerated induction of sleep and recovery. Comparison of parameters of propofol general anaesthesia with those of "combined balanced narcosis" and "perfusion ataranalgesia” statistically proved the significantly advantage of this new method. The conclusion has been drawn that propofol was a most appropriate drug for neurosurgical anaesthesia. ]

AFFILIATIONS

  1. Pécsi Orvostudományi Egyetem, Idegsebészeti Klinika, Pécs

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

[Repeated stroke, psychotic episode - primary antiphospholipid syndrome?]

CSIBRI Éva, FARKAS Márta

[The antiphospholipid syndrome described some 10 years ago is characterized by a predisposition to arterial and venous thrombosis and the presence of antiphospholipid antibodies. It is often associated with systemic lupus erythematosus, but its primary forms are also well known. Its clinical features are well known in neurology as well as in psychiatry. In this paper we present a case report with therapeutic implications. We discuss the importance of reccurent stroke at a young age in association with the possibility of a rare manifestation of antiphospholipid syndrome: organic brain disease, appearing in the form of schizoaffective psychopathological symptoms.]

Clinical Neuroscience

[Cluster headache and its treatment]

JELENCSIK Ilona

[Cluster headache, one of the most painful conditions known, is encountered infrequently in clinical practice. It is characterized by recurrent, unilateral attacks of severe intensity, brief duration and often accompanied by signs and symptoms of autonomic dysfunction. The actual cause of the pain has not been fully elucidated, but most authors believe that the pain arises as a result of a local vasodilatation with a release of certain neuropeptides to the perivascular tissues, resulting in sterile neurogenic inflammation and oedema. Aetiology is absolutely unknown. Treatment can be given as prophylaxis and/or as a symptomatic acute therapy for individual attacks. In the prophylaxis of episodic cluster headache ergotamine, calciumentry blockers, serotonin inhibitors and steroids are used. In chronic cluster headache lithium is the drug of choice, but verapamil may also be tried. Acute therapy has included ergotamine, oxygen inhalation and sumatriptan. Rarely, surgical intervention may be considered.]

Clinical Neuroscience

[Experiences with sumatriptan in the treatment of Cluster headache]

JELENCSIK Ilona, BOZSIK György, ÁFRA Judit, ERTSEY Csaba

[Subcutaneously administered sumatriptan 6 mg is rapid, effective and well-tolerated for the acute treatment of cluster headache. Efficacy is maintained in long-term use. The authors report the results of the 5HT1 receptor agonist sumatriptan autoinjector in the treatment of 350 attacks in 20 cluster patients. After 20 minutes post injection the complete dissolution of headache was reported in 95% of the attacks. Slight and transient side-effects were experienced therefore non of the patients were discouraged from using the autoinjector device again. It is essential in the improvement of the quality of life of patients suffering from cluster headache.]

Clinical Neuroscience

[Quantitative monitoring of EEG variability following subarachnoid hemorrhage]

JUHÁSZ Csaba, VESPA Paul, NUWER R. Marc, MARTIN Neil

[Cerebral vasospasm causing focal ischemia is a frequent complication following subarachnoid hemorrhage. Monitoring of EEG may help to reveal hemispheric dysfunction in the postoperative period. Continuous monitoring of EEG was performed on 8 bipolar channel in 30 patients with subarachnoid hemorrhage during the first two weeks after aneurysm rupture. Computerized trend analysis of 8–16 hours long periods was made. Variability of relative alpha power was evaluated visually on a 4 grade scale and it was also measured quantitatively. EEG data were compared with daily transcranial Doppler values and clinical state. Symptomatic vasospasm was detected in 16 patients while other neurological complications developed in a further 4 cases during monitoring. Significant decrease of variability was observed in all of them. This change developed 1-2 days before other signs of vasospasm in 10 patients. The onset of variability decrease was unilateral in 4 cases. No remarkable decrease of variability was found in patients without neurological complication. Our data confirm that EEG monitoring is a useful tool for sensitively detecting deterioration of brain function. Relative alpha variability is an indicative EEG parameter that can signify hemispheric dysfunction caused by ischemia in an early subclinical stage, when still no Doppler signs of vasospasm or deterioration of clinical symptoms occur.]

Clinical Neuroscience

[Post-traumatic ischemic stroke in childhood]

VELKEY Imre, LOMBAY Béla

[A report is given about two children with post-traumatic ischemic stroke. In the first case a blunt head injury, in the second case a minor cervical trauma caused the ischemic cerebrovascular episodes. The diagnosis was made after repeated CT scans by the help by sonography. The possible traumatic origin of acute hemiparesis due to ischemic stroke in children is emphasized. ]

All articles in the issue

Related contents

Clinical Neuroscience

[Rehabilitation possibilities and results after neurosurgical intervention of brain tumors ]

DÉNES Zoltán, TARJÁNYI Szilvia, NAGY Helga

[Objectives - Authors examined the rehabilitation possi­bi­lities, necessities, and results of patients after operation with brain tumor, and report their experiences. Method - Retrospective, descriptive study at the Brain Injury Rehabilitation Unit, in National Institute for Medical Rehabilitation. Patients - Patients were admitted consecutively after rehabilitation consultation, from different hospitals, following surgical intervention of brain tumors, between 01 January 2001 and 31 December 2016. Patients participated in a postacute inpatient rehabilitation program, in multidisciplinary team-work, leaded by Physical and Rehabilitation Medicine specialist included the following activities: rehabilitation nursing, physical, occupational, speech, psychological and neuropsychological therapy. Results - At the rehabilitation unit, in the sixteen-year period 84 patients were treated after operation with brain tumor. Patients arrived at the unit after an average of 41 days to the time of the surgical intervention (range: 10-139 days), and the mean length of rehabilitation stay was 49 days (range: 2-193 days). The mean age of patients was 58 years (20-91), who were 34 men and 50 women. The main symptoms were hemiparesis (64), cognitive problems (26), dysphagia (23), aphasia (16), ataxia (15), tetraparesis (5), and paraparesis (1). The mean Barthel Index at the time of admission was 35 points, whereas this value was 75 points at discharge. After the inpatient rehabilitation, 73 patients improved functionally, the status of 9 patients did not show clinically relevant changes, and 2 patients deteriorated. During the rehabilitation 10 patients required urgent interhospital transfer to brain surgery units, 9 patients continued their oncological treatment, two patients continued rehabilitation treatment at another rehabilitation unit, and after rehabilitation 73 patients were discharged to their homes. Conclusions - Inpatient rehabilitation treatment could be necessary after operation of patients with brain tumor especially when functional disorders (disability) are present. Consultation is obligatory among the neurosurgeon, rehabilitation physician and the patient to set realistic rehabilitation goals and determine place and method of rehabilitation treatment, but even at malignancies cooperation with oncological specialist also needed. Authors’ experience shows benefits of multidisciplinary rehabilitation for patients after brain tumor surgery. ]

Clinical Neuroscience

[Post-operative management of primary glioblastoma multiforme in patients over 60 years of age]

DARÓCZI Borbála, SZÁNTÓ Erika, TÓTH Judit, BARZÓ Pál, BOGNÁR László, BAKÓ Gyula, SZÁNTÓ János, MÓZES Petra, HIDEGHÉTY Katalin

[Background and purpose - Optimal treatment for elderly patients with glioblastoma multiforme is not well defined. We evaluated the efficacy of post-operative radiotherapy with or without concomitant and/or adjuvant temozolomide in patients aged ≥60 years to assess survival and identify prognostic factors of survival. Methods - A retrospective analysis of overall survival and progression-free survival in patients with newly diagnosed glioblastoma multiforme aged ≥60 years treated with postoperative radiotherapy with or without temozolomide chemotherapy was conducted at our institutions. Prognostic factors were determined by univariate and multivariate analyses. Results - Of 75 study participants (54.7% male; median age at first diagnosis, 65.1 years), 29 (38.7%) underwent gross total resection, whereas others underwent partial resection or biopsy only. All but 1 patient received radiotherapy. Twenty patients received concomitant temozolomide only. Adjuvant temozolomide (1-50 cycles) was administered in 42 patients; 16 received ≥6 cycles. Median overall survival was 10.3 months. One- and 2-year overall survival rates were 42.6% and 6.7%, respectively. Median progression-free survival was 4.1 months. Radiochemotherapy was generally well tolerated. Median overall survival was 15.3 and 29.6 months for patients who received 6-12 cycles and >12 cycles of adjuvant temozolomide, respectively. There were no significant differences in overall survival between age groups (60-64, 65-69, and ≥70 years). Adjuvant temozolomide, Karnofsky performance status ≥70, and additional surgery after progression were significant prognostic factors of longer overall survival (p<0.05). Conclusions: Radiochemotherapy, including ≥6 cycles of adjuvant temozolomide, was safe and prolonged survival of glioblastoma patients aged ≥60 years. Aggressive therapy should not be withheld from patients aged ≥60 years with good performance status because of age.]

Clinical Oncology

[Treatments of brain tumors in adults – an up-date]

BAGÓ Attila György

[Maximal safe resection is the fi rst step in the complex neurooncological therapy of adult brain tumors. Surgical management of brain tumors, including the surgical innovations (neuronavigation, intraoperative imaging, awake craniotomy, intraoperative electrophysiology) providing more radical resection with the safe preservation of neurological functions will be presented. In case of malignancy the surgery is followed by radiation and chemotherapy. In this review we describe the postoperative adjuvant therapeutical modatilites available for primary and metastatic tumors, emphasizing the modern chemotherapy of high grade gliomas and stereotactic radiosurgery of brain metastases. As a conclusion we summerize the guidelines and modalities for the most common adult brain tumors, according to histological type and grade.]

Clinical Neuroscience

[Intraoperativ electrophysiological monitoring during neurosurgery on eloquent structures]

FEKETE Gábor, NOVÁK László, ERÕSS Loránd, FABÓ Dániel, BOGNÁR László

[Objective - We summarize our experiences on intraoperative electrophysiological monitoring during neurosurgical procedures on eloquent neuronal structures. Patients, methods - Sixty patients were enrolled retrospectively in our study with pathologies involving eloquent neuronal structures. They were operated between May 2011. and March 2012. at the University of Debrecen, Department of Neurosurgery and at the National Institute of Neurosciences. Patients underwent standard preoperative examinations due to the primary pathology. In all cases we used intraoperative electrophysiological monitoring. We had 22 cases with cranial nerve monitoring, 10 cases with cauda monitoring, 16 cases with motor system monitoring, six cases with complex spinal cord monitoring, three degenerative spine reconstructions and 3 awake surgeries. Results - We found that with the use of intraoperative electrophysiology we could make these neurosurgical procedures safer, and were able to optimize the extent of resection in the cases of oncological pathologies. Conclusions - Our experiences as well as the international literature suggests that in certain high risk neurosurgical procedures intraoperative electrophysiology is indispensible for safe and optimally extended operation.]

Clinical Neuroscience

[Effects of Propofol and Thiopental on median nerve somatosensory evoked potentials and cerebral blood velocity]

MÉSZÁROS István, KASÓ Gábor, BÜKI András, HUDVÁGNER Sándor, PFUND Zoltán, DÓCZI Tamás, NAGY Ferenc

[Effects of induction doses of thiopental and propofol on median nerve somatosensory evoked potentials and cerebral blood flow velocity were investigated in 50 patients suffering from degenerative lumbar spine diseases before operation and during anaesthesia. The propofol influences the cerebral electric activity and the blood flow velocity to a less extend than thiopental. Based on our results we prefer to employ propofol during neurosurgical procedures when using intraoperativ somatosensory evoked potentials and/or transcranial Doppler monitoring. ]