T. Kuurne

Acute surgery for intracerebral haematomas caused by rupture of an intracranial arterial aneurysm: A prospective randomized study

SummaryIn a randomized prospective study, 15 patients with an intracerebral haematoma caused by an intracranial aneurysm were treated concervatively and 15 operated on as an emergency. Mortality was 12/15 (80%) in the conservative group and 4/15 (27%) in the surgical group. The difference is statistically significant. The deaths in the conservative group were caused by both the primary haematoma and rebleeding. The results suggest that intracerebral haematomas caused by rupture of an intracranial aneurysm should be evacuated immediately, and that the aneurysm should be clipped at the same operation.

Subdural effusions re-appearing after shunts in patients with non-tumoural stenosis of the aqueduct

SummaryThree patients shunted for non-tumoural stenosis of the aqueduct suffered from progressive clinical symptoms about four months after the shunting. Computed tomography (CT) showed bilateral subdural effusions. The effusions were evacuated, and the shunts revised. One month later all patients suffered from symptoms of increased intracranial pressure, and CT showed enlargement of the supratentorial cerebral ventricles. The effusions had disappeared. After shunt revision the symptoms decreased again. The fluctuation in the ventricular size, the thickness of the subdural effusions, and the clinical deterioration were related to the change in the opening pressure of the shunt valve in all patients. Patients with large supratentorial cerebral ventricles (Evans index over 0.40) should be monitored by intraventricular pressure recording in order to select the exact opening pressure of the shunt valve before inserting a relieving shunt; a clinical check-up and a CT examination should be carried out about three months after the operation in order to investigate any changes in the function of the shunt.

Lack of correlation between ventricular fluid pressure and arterial blood pressure in severe brain injuries.

SummaryIn ten patients with severe brain injury, arterial blood pressure was recorded continuously by means of an arterial catheter, concomitantly with a recording of ventricular fluid pressure by means of a catheter in one lateral ventricle. The purpose of the study was to test whether there was a correlation between blood pressure and intracranial pressure. There was no consistent correlation. Intracranial pressure cannot be gauged from arterial blood pressure recordings, and it seems futile to monitor arterial blood pressure continuously in brain injured patients. Only when the brain was already dead or dying was there a reliable correlation between arterial blood pressure and ventricular fluid pressure.