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Biomedical subjects

G Caruselli

Publications and source records attributed to G Caruselli.

At least 19 recordsLinked to original sources
PubMed1982

Mass lesions of the frontal lobes in acute head injuries. A comparison with temporal lesions.

Contusions and lacerations of the frontal lobes are very frequent; 43.4% in the whole series of traumatic brain mass lesions. Clinical ICP, CT scan data and neuropathological findings in patients with such lesions are analysed and correlated. Moreover, the clinical features and the outcome of frontal masses undergoing surgery are also compared with similar lesions located in the temporal lobes. Frontal lesions cannot be differentiated on purely clinical grounds and the factors governing the outcome in both lactations are the same. On the whole, surgical indications nowadays seem to be rather rare; only lesions behaving truly as expanding lesions with obvious intracranial hypertension benefiting from surgery. Brain contusion-laceration syndromes in general can no longer be considered separate entities. Neither should they be included in the miscellaneous group of "traumatic intracranial mass lesions", since the pathophysiological significance of purely extracerebral effusions is entirely different. Traumatic contusions and lacerations and/or intracerebral haematomas, whether frontal or located elsewhere, should instead, be considered in the context of head injuries of a different degree of gravity, as having collateral features which, on occasion, may call for surgical management.

Adolescent↗
PubMed1982

External ventricular drainage in the management of posterior fossa tumors in children and adolescents.

External ventricular drainage (EVD) was used before and after posterior fossa operations in 62 children and adolescents. In all cases, the removal of the tumor (midline in 47 and laternal in 15) was attempted; total removal was achieved in 41. The overall mortality was 6.5% (4 patients). Only 25% of the survivors needed permanent cerebrospinal fluid (CSF) shunting. EVD seems, therefore, to be effective in controlling preoperative intracranial hypertension and in securing a smooth postoperative course. Preoperative CSF shunting seems to be necessary or advisable only in particular circumstances.

Adolescent↗
PubMed1981

CSF withdrawal for the treatment of intracranial hypertension in acute head injuries.

Long-term ICP recording was carried out in 151 acute head injury patients- 131 comatose patients admitted to ICU, and 20 non-comatose patients harbouring intracerebral mass lesions (lacerations or haematomas) in whom a decision to operate was doubtful. CSF withdrawal was used in 39 cases: by intermittent subtraction in 23 patients, and by continuous ventricular drainage (VD) in the remainder. In the acute stage, within 72 hours or injury, CSF subtraction proved of little use in influencing ICP or clinical time course. Conversely, at a latter stage, CSF withdrawal either by repeated intermittent subtraction or by continuous VD could very often control raised ICP. However, some patients had to undergo permanent shunting eventually. Elevated ICP was also safely controlled in four out of eight patients with intracerebral mass lesions and stationary symptoms. Such patients recovered quickly, and operation was avoided.

Acute Disease↗
PubMed1980

Intracranial hypertension in severe head injuries.

Long-term ICP monitoring was carried out in a series of 124 patients with severe head injuries admitted to the Intensive Care Unit. Forty-nine percent of patients were admitted within six hours of injury. Most of them were referred by Community Hospitals. Only patients with diffuse brain lesions or patients operated on for mass lesions and remaining in a coma state after operation are taken into account. Altogether, 46 patients survived, but 15 of them remained severely disabled or in a vegetative state, and 78 died. Twenty-four percent of the whole series succumbed to fulminationg intracranial hypertension. The average survival in this group was 5.1 days. Twenty-nine percent died after exhibiting different levels of intracranial hypertension ranging from 20 to 50 mm Hg. In this group the role of extracerebral complications as a cause of death should not be underestimated. Death caused by cerebral lesions with ICP not exceeding 15 mm Hg was exceedingly rare in the first 72 hours. Normal or fairly raised ICP does not rule out the risk of devastating intracranial hypertension: reliable and harmless P/V tests are needed. All patients who survived after showing sustained intracranial hypertension exceeding 50 mm Hg were under 20 years of age. In the present series the results of treatment of intracranial hypertension were, on the whole, rather disappointing.

Adolescent↗
PubMed1980

Intrinsic third ventricle craniopharyngiomas with normal pressure hydrocephalus.

Two observations of intrinsic third ventricle craniopharyngiomas, both involving males in the fifth decade, are reported. Histologically, the tumours, one entirely solid and the other one chiefly cystic, were composed of squamous epithelium with microcysts and no calcifications. In the literature primary third ventricle craniopharyngiomas are considered to be exceedingly rare. However, if a more precise preoperative diagnosis, using computerised axial tomography, were made as a matter of routine, to verify third ventricular masses, it might demonstrate that these tumours are more common than previously believed. In both cases striking clinical pictures of normal pressure hydrocephalus were observed. The relations between intracranial pressure, CSF circulation and ventricular size are discussed. On mechanical grounds, it is very difficult to explain the poastoperative reduction in ventricular size, since there was no significant change in intracranial pressure.

Autopsy↗
PubMed1980

Traumatic cerebral mass lesions: correlations between clinical, intracranial pressure, and computed tomographic data.

After surveying the different phases of their previous experience with the diagnosis and management of traumatic cerebral mass lesions, the authors analyze the correlation between clinical, computed tomographic (CT), and intracranial pressure (ICP) data in 29 patients with traumatic intracerebral hematomas and/or brain lacerations. Clinically, the patients are classified in three groups: (a) deeply comatose patients (Glascow coma scale (GCS), 4 to 5); (b) patients with intermediate disturbances of consciousness (GCS, 6 to 10); and (c) patients with minor impairment of consciousness (GCS, more than 10). Sixteen patients were operated upon. Operation was ineffective in the patients who were already deeply comatose in the first hours after injury, even though elevated ICP was definitely reduced after operation in some of them. Conversely, patients with well-limited lesions, moderate disorders of consciousness, and persisting intracranial hypertension despite medical therapy seemed to be good candidates for delayed operation by limited procedures. In patients with intermediate disturbances of consciousness and no tendency to improvement or deterioration, ICP monitoring correlated with CT scan appearance may be of practical use for making the decision to operate. However, most cases diagnosed on CT scan have a benign course; the patients recover uneventfully with conservative management. In such patients careful clinical observation is usually sufficient. (Neurosurgery, 7: 337-346, 1980).

Adolescent↗
PubMed1979

Intracranial pressure time course in primary intracerebral hemorrhage.

The course of intracranial pressure (ICP) over time was studied in 66 hypertensive and/or altherosclerotic patients harboring intracerebral hematomas. Patients with no disturbance of consciousness showed normal or only slightly elevated pressure. Conversely, most patients in deep coma exhibited high pressure with a tendency to rise further no matter what treatment was used. In the remaining patients with intermediate disturbances of consciousness, no definite correlation was found between ICP, clinical condition, and outcome. In all of the patients who underwent operation, the postoperative course of ICP over time was also studied and seemed to depend to a certain extent on the timing of the operation.

Adult↗
PubMed1978

The reliability of computerized axial tomography in the diagnosis of infratentorial mass lesions. A neurosurgical appraisal.

The accuracy of CAT in the diagnosis of infratentorial expanding lesions is analysed on the basis of 224 personal cases. The posterior fossa lesions are classified in four groups according to the reliability of CAT as the only pre-operative examination. The present indications for conventional neuroadiological procedures are also outlined. Particular emphasis is laid on the information supplied by CAT in postoperative follow up to detect both immediate and delayed complications.

Adult↗
PubMed1977

Long-term intracranial pressure monitoring in comatose patients suffering from head injuries. A critical survey.

On the basis of a series of 75 patients, the practical use of Icp continuous long-term recording in severe head injuries without mass lesions or remaining deeply comatose after surgical procedures is critically analyzed. ICP monitoring alone seems to be not essential for prognosis. Conversely it is of much greater use as a guide to management (respirator treatment, osmotics, CSF drainage). If the pros and cons of the procedure are carefully weighed, it would appear that, for the time being, ICP long-term monitoring is justified only in comatose patients on intensive care.

Adolescent↗
PubMed1977

Aneurysm of the superior cerebellar artery.

A case of aneurysm of the superior cerebellar artery with subarachnoid hemorrhage is reported. The saccular aneurysm located in the tegmental region, with a clear-cut neck, was successfully clipped by an occipital transtentorial approach.

Adult↗
PubMed1977

Giant spinal extradural cyst.

A case of giant extradural cyst in a 13-year-old girl is described. The cyst was formed by the arachnoid membrane which extruded through a wide lumbar dural defect. It extended from the midthoracic region down to the sacral canal. At operation a large portion of the cystic wall was removed, but the dural defect was not repaired. Two spino-peritoneal shunts were left in place to drain both the intradural and the extradural spaces. The treatment has proved successful during the 20 months that the patient has been observed.

Adolescent↗