Five cases of traumatic aneurysms of cerebral arteries are presented, two located at the internal carotid artery, and three at peripheral arterial branches. The manifestation of the aneurysm was a delayed neurological deterioration due to bleeding from the aneurysm, 4-35 days (mean 21 days) after the head trauma; four patients had an intracerebral haematoma and one patient had a subarachnoid haemorrhage. One patient died from extensive cerebral injuries with the aneurysm untreated. In four cases the aneurysm was treated surgically. Three patients returned to their former occupation and one patient died from late septic complications. It is concluded that signs of delayed intracranial bleeding after a head trauma should raise the suspicion of an underlying traumatic aneurysm, and in addition to a CT-scan an angiography should be performed.
The rebound of intracranial pressure (ICP) occurring after decompression of an intracranial mass lesion was studied in an epidural balloon compression model. Intracranial morphology and brain tissue water content were assessed with magnetic resonance imaging (MRI). Fast and slow components of the transverse relaxation time (T2) were used as indicators of brain oedema development. During balloon compression a progressive prolongation of both the fast and the slow T2 components took place. Following deflation of the balloon both components increased rapidly, particularly the slow-T2. The MR scans displayed progressive occlusion of the aqueduct, and obliteration of the ambient and pontine cisterns. The changes in morphology and in water content after decompression had largely the same time course as the development of the rebound of ICP. In contrast, no changes in morphology and tissue water content occurred after hydrostatic brain compression achieved by subarachnoid fluid infusion. The findings suggest that the intracranial pressure rebound is caused by cerebral oedema accumulated during and particularly in the recirculation phase after an ischaemic injury of adequate intensity and adequate duration.
Extracerebral non-haemorrhagic collections of fluid and air causing significant impairment in the early period after intracranial surgery have received very little attention in the literature. Twenty-five fluid collections have been encountered, of which 17 appeared after intracerebral operations and were often in communication with the ventricular system. After extracerebral explorations supratentorial fluid collections accumulated in the Sylvian fissure or between the brain surface and the falx or tentorium in 5 cases, while a collection of fluid occurred infratentorially in the cerebellopontine angle in three cases. Intracranial air collections have been described more often after craniotomies, particularly after drainage of chronic subdural haematomas, but have not been recognized after intracerebral removal of tumours or in cases where exploration has been performed beyond the limits of the craniotomy in the presence of high intracranial pressure. Improvement after reoperation occurred most promptly in the cases with fluid collections, while additional factors often seem to play a more significant role in the cases with postoperative intracranial air.
This is a retrospective study of 134 patients operated on for solitary brain metastasis at the University Hospital in Uppsala, Sweden between 1963 and 1982. All the patients underwent postoperative radiation therapy. A statistical evaluation of different prognostic factors was made in order to create a prognostic model, a so-called risk profile, to be used for future patients. The most important factors for the making of risk profiles were found to be the "histological diagnosis" followed by the "location" in the brain, then the "state on admission" and the "age" at admission in that declining order. All these variables separately and together, i.e., as risk profiles, were matched against the outcome during survival as Karnofsky's scores and against the length of survival time. The results are shown in a diagram giving the surgeon grounds for his decision-making for or against operation and also for pre-operative information.
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