Contralateral approach to resection of a parafalcine meningioma--a technical note.

A case of resection of a large parafalcine frontal meningioma via a contralateral transfalcine approach is described. The predominantly left-sided tumour was debulked from the right parafalcine approach with the benefit of avoiding manipulation of ipsilateral swollen brain. This approach enabled complete tumour resection and resolution of motor deficit.

Fatal bilateral subdural haematoma after epidural anaesthesia for pregnancy.

CSF leak after epidural anaesthesia should be suspected after persistent headaches, which are worse on standing, suggestive of low pressure and CSF overdrainage. Subdural haemorrhage after CSF leak is a recognised complication; if suspected a CT Brain should be performed. An epidural blood-patch, and if necessary haematoma evacuation, can help prevent an unfortunate and tragic outcome.

Hyperventilation following head injury: effect on ischemic burden and cerebral oxidative metabolism.

Objective: To determine whether hyperventilation exacerbates cerebral ischemia and compromises oxygen metabolism (CMRO2) following closed head injury.

Design: A prospective interventional study.

Setting: A specialist neurocritical care unit.

Pressure autoregulation and positron emission tomography-derived cerebral blood flow acetazolamide reactivity in patients with carotid artery stenosis.

Objective: Testing autoregulation is of importance in predicting risk of stroke and managing patients with occlusive carotid arterial disease. The use of small spontaneous changes in arterial blood pressure and transcranial Doppler (TCD) flow velocity can be used to assess autoregulation noninvasively without the need for a cerebrovascular challenge. We have previously described an index (called "Mx") that achieves this.

Diffusion limited oxygen delivery following head injury.

Objective: To use a range of techniques to explore diffusion limitation as a mechanism of cellular hypoxia in the setting of head injury.

Design: A prospective interventional study.

Setting: A specialist neurocritical care unit.

Positron emission tomographic cerebral perfusion disturbances and transcranial Doppler findings among patients with neurological deterioration after subarachnoid hemorrhage.

Objective: After aneurysmal subarachnoid hemorrhage, approximately 30% of patients experience delayed neurological deficits, related in part to arterial vasospasm and dysautoregulation. Transcranial Doppler (TCD) ultrasonography is commonly used to noninvasively detect arterial vasospasm. We studied cerebral perfusion patterns and associated TCD indices for 25 patients who developed clinical signs of delayed neurological deficits.

Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates.

Objective: To investigate the effect of hyperventilation on cerebral blood flow in traumatic brain injury.

Design: A prospective interventional study.

Setting: A specialist neurocritical care unit.

Correlation between cerebral blood flow, substrate delivery, and metabolism in head injury: a combined microdialysis and triple oxygen positron emission tomography study.

Microdialysis continuously monitors the chemistry of a small focal volume of the cerebral extracellular space. Conversely, positron emission tomography (PET) establishes metabolism of the whole brain, but only for the duration of the scan. The objective of this study was to apply both techniques to head-injured patients simultaneously to assess the relation between microdialysis (glucose, lactate, lactate/pyruvate [L/P] ratio, and glutamate) and PET (cerebral blood flow [CBF], cerebral blood volume, oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen) parameters.

Measurement of brain tissue oxygenation performed using positron emission tomography scanning to validate a novel monitoring method.

Object: The benefits of measuring cerebral oxygenation in patients with brain injury are well accepted; however, jugular bulb oximetry, which is currently the most popular monitoring technique used has several shortcomings. The goal of this study was to validate the use of a new multiparameter sensor that measures brain tissue oxygenation and metabolism (Neurotrend) by comparing it with positron emission tomography (PET) scanning.

Methods: A Neurotrend sensor was inserted into the frontal region of the brain in 19 patients admitted to the neurointensive care unit.