This study evaluates the 7-year outcome of lumbar disc surgery and the predictive value of pre- and perioperative risk factors. The 7-year follow-up rate of a sample of 122 patients was 93% (n = 114). Six per cent of the patients had undergone repeat surgery. Approximately 90% reported that they were satisfied with having undergone surgery. The clinical outcome was evaluated in 96 patients (54 men and 42 women) by means of patient-scores (VAS) of low back and leg pain, and a Clinical Overall Score (COS). In multivariate regression analyses, women were shown to have poorer outcome than men. Preoperative psychological distress and impaired fibrinolytic activity were predictors of poor 7-year outcome. Age, weight, smoking habits and physical fitness had no statistically significant prognostic value. Whether the patients were operated for one or two herniated discs, or whether surgery involved a full or partial laminectomy, did not influence the outcome significantly.

Lumbar cerebrospinal fluid (CSF) pressure was recorded in 116 adult neurosurgical patients in the lateral and sitting positions. The level of zero CSF pressure while in the sitting position (ZPS) and hydrostatic indifferent point (HIP) for lateral and sitting positions were determined and referred to the craniospinal axis. In control patients ZPS was located mainly at the upper cervical region, and showed nearly the same variation and frequency distribution as CSF pressure in the lateral position when efforts were made to reduce sources of error and there was no orthostatic change in CSF filling pressure. Under these circumstances ZPS may be used as a variable comparable from one subject to another. In control patients the HIP was located between C-6 and T-5. In 25 hydrocephalic patients, shunting resulted in a mean caudal shift of ZPS of 244 mm, and a mean pressure fall of 126 mm H2O in the lateral position. This difference was due to a caudal shift of HIP on shunting. A caudally located ZPS was found in patients with complete cervical subarachnoid block. Prevention and treatment of CSF leakage cranial to HIP is discussed.

Gross mechanical shift of the brain and herniation across the falx and/or tentorium accounted for infarction in a majority of cases in our study. The overall death rate was 43.8% and this result suggests that PTCI is an indication of a poor clinical outcome, especially among patients with associated subdural hematoma, brain swelling/edema and tSAH.

The cranial compartment contributed 37% and the spinal compartment 63% to the total compliance of the craniospinal space in the horizontal body position. In the erect position the values were almost reversed, the cranial compartment contributing 66% and the spinal compartment 34%. The total compliance was almost unaffected by body position. The pulsatile volume of cerebrospinal fluid (CSF) moving between the cranial and spinal compartments was about 1 ml in the horizontal position. The corresponding pulsatile change in cerebral blood volume was calculated to be 1.6 ml. A craniospinal block increased the intracranial pressure amplitude by 110% in the horizontal position. The volume of CSF moving between the cranial and spinal compartments when sitting up and lying down, was about 3 ml. The pulsatile and postural flow rate of CSF may reach about 200 ml/min. High CSF flow velocity may impair the protective coating of CSF around the brain and thus contribute to herniation.

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Gross mechanical shift of the brain and herniation across the falx and/or tentorium accounted for infarction in a majority of cases in our study. The overall death rate was 43.8% and this result suggests that PTCI is an indication of a poor clinical outcome, especially among patients with associated subdural hematoma, brain swelling/edema and tSAH.

No abstract

Internal carotid artery (ICA) blood flow, mean arterial blood pressure (MABP), intracranial epidural pressure (EDP), and arterial blood gases were measured during spontaneous, generalized epileptic seizures in man. Concomitant with the clinical seizure there was a nearly threefold increase in ICA blood flow mainly caused by a rapid fall in cerebrovascular resistance (CVR). As changes in arterial blood gases after 30–45 sec of apnea and convulsions were moderate, the initial fall in CVR was attributed to local cerebral changes of either metabolic or neurogenic nature. Changes in MABP showed two different patterns during seizures, pattern 1 with a transient increase in pressure, and pattern 2 with a marked fall followed by an overshoot in pressure. The fall in MABP was probably caused by a Valsalva effect or a central nervous system vasodepressor response.