[Treatment of lumbar disk prolapse].
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Humans↗
Biomedical subjects
T Lundar
Publications and source records attributed to T Lundar.
[Head and neck injuries during soccer games].
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Brain Injuries↗
[Head injuries].
Severe head injury is a common finding in patients with multiple injuries. Exclusion of intracranial haematoma and the need for neurosurgical intervention is based on clinical findings and CT scans. In other respects, patients with severe head injuries should be treated with sedation and moderate hyperventilation (PaCO2 3.5-4.5 kPa). Clinical evaluation is difficult. Indication for administration of osmotic dehydrating agents or barbiturates is based on clinical findings and repeated CT scans. Further valuable information in the handling of the individual patient can be obtained by continuous monitoring of intracranial pressure, recording of evoked responses or transcranial Doppler ultrasound recordings.
Adolescent↗
Occurrence and management of fractured peripheral catheters in CSF shunts.
A series of 716 children underwent 2065 cerebrospinal fluid shunt procedures. Shunt failure due to fracture of the peripheral drain occurred 60 times, 38 times in ventriculo-atrial and 22 times in ventriculo-peritoneal shunts. The break occurred most commonly 2-4 cm above the neck incision in cardiac and just cephalad to the clavicle in abdominal drains. Fifty-nine ruptures occurred in Pudenz catheters (which were used in 82% of the shunts) and 1 occurred in a Holter drain (used in 17%). The fractured atrial catheters remained in situ (5/38) or were dislodged into the right cardiac ventricle (14/38), pulmonary arteries (9/38), right atrium (5/38) or hepatic veins (3/38). Two of the ruptured drains could not be located. Removal by a percutaneous transvascular snare technique was attempted in 27 cases and was successful in 24.
Adolescent↗
[Neurointensive monitoring. Experiences with neurophysiological examinations].
Multimodal-evoked responses and EEG are used as a routine in many intensive care units and have proved their diagnostic and prognostic significance in a series of studies on comatose patients and patients with severe head injuries. The article includes a brief description of the methods, and of their use and interpretation in neurointensive medical care.
Brain Injuries↗
[Meningoencephalocele].
A total of 52 children with meningoencephalocele were operated during a 23 year period. The anomaly was located frontally in nine children, occipitally in 34 children and infratentorially in nine children. Because of progressive hydrocephalus, 18 children underwent shunt procedures shortly after the initial surgical correction. The prognosis was related to the localization and the content of the cell sac, and to additional congenital anomalies. Nine children died and five are severely disabled. For 38 children the result is good, with no major disabilities. In the case of children with meningoencephalocele the possibility of surgical correction should be considered shortly after birth.
Encephalocele↗
[Pseudotumor cerebri].
Pseudotumor was diagnosed in six patients aged three to 38 years during an eight year period. The diagnosis was based on headache, choked disks and normal cerebrospinal fluid and CT scans. Other symptoms were visual impairment, VIth nerve palsy and ataxia. Sagital sinus trombosis was excluded by angiography or magnetic resonance imaging. Pharmacological treatment with digitoxin, acetazolamide, furosemide or corticisteroids reversed clinical symptoms and signs in two patients. In the other four, shunt surgery with cerebrospinal fluid diversion to the right atrium or the peritoneal cavity rapidly reversed clinical symptoms and signs.
Adolescent↗
Fatal cardiopulmonary complications in children treated with ventriculoatrial shunts.
During the years from 1965 to 1986, 716 children underwent a total of 2065 shunt procedures in our department. Of these, 1298 were ventriculoatrial (VA). Until 1979, Pudenz VA shunts were almost exclusively used as the primary procedure as well as in revisions. Since 1980, mini-Holter VA shunts have been implanted as a second choice, usually in cases with repeated distal failure in ventriculoperitoneal (VP) shunts. Observation time for children with VA shunts is therefore from 10 to 23 years for the great majority. The cumulative death rate for all patients is 24% (175/716), 9% (64/716) being tumor patients who eventually died as a result of their neoplasm. Most of the other deaths were caused by shunt infection or occurred in a group of children where shunts had been implanted for palliative reasons and where follow-up was only sporadic. Among the 450 children with VA shunts, 15 fatal complications occurred that were directly related to the atrial catheter, resulting in an accumulated incidence of 3% of such serious side effects from VA shunting. Three of these 15 fatal cases presented with nonspecific signs of cardiopulmonary failure following 10-21 years' shunting, and they died from irreversible pulmonary hypertension within a few months. A fourth case of late cor pulmonale has done unexpectedly well and has improved considerably while receiving anticoagulant therapy for over a period of 3 years.
Adolescent↗
Management of pediatric pontine gliomas.
We present 36 consecutive patients with intrinsic glioma of the pons. Tumors with exophytic expansion were excluded. There were 16 females and 20 males, ranging in age from 2 to 13 years, median 6 years. The most common presenting symptoms were cranial nerve dysfunction, unsteadiness of gait, and hemiparesis. Computed tomography (CT) showed a hypodense (17/21) or isodense (4/21) expansion of the pons. Five tumors had areas of contrast enhancement. Following information about prognosis and possible types of management, parents decided for or against radiation therapy: twenty-four children underwent irradiation and 12 did not. Median survival among children receiving a full course of irradiation was 280 days, compared to 140 days in an equivalent group of non-irradiated children. Hemiparesis presenting without cranial nerve symptoms and contrast enhancement on CT scan were poor prognostic factors, whereas sex, age, and duration of symptoms at diagnosis were unrelated to prognosis.
Adolescent↗
Steady-state lumbar infusion tests in the management of children with craniosynostosis.
Sixty lumbar steady-state infusion tests were used as a guideline in the management of 30 children with craniosynostosis during a 3-year period. The primary decompressive procedure was performed during the same anesthetic period and was made more extensive in cases with pathological outflow resistance (Ro) values. In 11 children with scaphocephaly the test revealed normal to moderately increased cerebrospinal fluid (CSF) Ro. In 6 children with oxycephaly, 4 with trigonocephaly or combined forms, especially in 7 children with syndromic forms, the need for decompressive surgery was usually more obvious. Also, many of these demonstrated severely increased CSF outflow resistance (above 12 mmHg/ml per min). Spinal infusion tests were particularly helpful in the management of severe syndromic or familial cases where the indication for repeat or further extensive decompression was sometimes difficult to assess on clinical and radiological grounds.
Cerebrospinal Fluid↗
Shunt failure caused by valve collapse.
Shunt failure due to collapse of the Mini-Holter valve was observed 13 times in 11 out of 179 children with an implanted Mini-Holter ventriculo-peritoneal (VP) or ventriculo-atrial (VA) shunt during a 10 year period. Intussusception of the proximal or distal end of the valve thus caused a shunt failure rate of 6% of the children in this series. Two children experienced this complication twice. All collapsed valves were part of a VP shunt system. Because of this experience use of the mini valve was abandoned and an adult Holter valve was implanted in children over the age of one month. Breakdown of this particular valve has not occurred in 102 children and two hundred adults with the adult Holter shunt system.
Cerebrospinal Fluid Shunts↗
[Liver transplantation in fulminant hepatic failure].
The prognosis for patients suffering from fulminant hepatic failure is still poor. The possibility of performing liver transplantation has improved the outcome for the patient. The article presents three cases illustrating some of the difficulties in selecting patients for transplantation, and discusses clinical and laboratory monitoring of patients with fulminant hepatic failure and criteria for selecting patients for liver transplantation.
Adult↗
[Acute intracranial hematomas in full term neonates].
During at two-year period, six full term neonates were operated in order to evacuate large intracranial haematomas. They were all critically ill at the time of surgical intervention, but responded well to neurosurgery. The clinical results after 9-28 months follow-up are very gratifying. When anisocoria with unilateral fixed, dilated pupil, hemiplegia or failure of spontaneous ventilation occurs, there is limited time for diagnostic CT scans and evacuation of the haematoma.
Age Factors↗
[Brain tumors in children].
Brain tumour was diagnosed by computer tomography or magnetic resonance imaging in 100 children aged 0 to 19 years. They consecutively underwent primary surgical treatment during the years 1984 to 1988. Non-neoplastic lesions and operations for residual tumours are not included. 54 tumours were localized supratentorially. 72% of these were benign or low grade malignancies. 46 tumours had an infratentorial localisation. 59% of these were high grade malignancies. Children tolerate major-neurosurgical procedures better than adults and restitution is usually favourable. 42 children with high grade malignancies underwent postoperative radiotherapy. Per- and postoperative mortality in this series was 1%. 80 children are alive. 62 of these are in excellent condition after a median observation time of 40 months.
Adolescent↗
[Torkildsen's operation--50 years later].
Arne Torkildsen performed the first ventriculocisternostomy in 1937. During the last 25 years hydrocephalic patients have been treated with standard ventriculoatrial or ventriculoperitoneal shunts. Since pneumoencephalography and ventriculography, have been replaced by CT scanning, often no differentiation is made between communicating and non-communicating hydrocephalus. Today we realize that most shunted individuals become shunt-dependent for the rest of their lives. During a two year period we performed eight ventriculocisternostomies after aqueduct obstruction had been proven by ventriculography or by combined CT and magnetic resonance studies. In five of the patients this gave a satisfactory long term result. Since this procedure does not lead to serious cardiopulmonary complications nor overdrainage, the Torkildsen procedure is still a good alternative to ventriculoperitoneal or ventriculoatrial shunts in patients with proven non-communicating hydrocephalus.
Adolescent↗
Pseudotumour cerebri-neurosurgical considerations.
Pseudotumour was diagnosed in six patients aged 3-38 years during an 8 years period. The diagnosis was based on headache, papilloedema, normal CT scan and cerebrospinal fluid (CSF) composition. Additional clinical symptoms were nausea, VIth nerve palsy, ataxia, blurred vision and frank visual reduction over time. Sagittal sinus thrombosis was ruled out by angiography or magnetic resonance imaging. In five of the six patients lumbar steady state infusion tests were performed to evaluate intracranial hydrodynamics and CSF resorbtion. All patients demonstrated a markedly increased opening pressure (range 13 to 48 mm Hg). CSF outflow resistance ranged from upper normal to pathologically increased levels (8-19 mm Hg/ml/min). Combined epidural intracranial pressure/middle cerebral artery blood velocity monitoring in 3 patients revealed a great number of B waves and a labile cerebral vasomotor state. Pharmacological treatment was tried with digitoxin, acetazolamide, furosemide and/or corticosteroids. Two patients did well on long-term treatment with digitoxin and furosemide, respectively. In the other four patients the clinical development was unsatisfactory on medical treatment alone. They were subsequently operated with implantation of a lumboperitoneal, cisternoatrial or cisternoperitoneal shunt. Shunting rapidly reversed clinical signs and symptoms, except for a partial persistent visual loss in an 18 years old boy who had experienced symptoms for 3 years resistant to pharmacological treatment.
Adolescent↗
Continuous recording of middle cerebral artery blood velocity in clinical neurosurgery.
Intracranial pressure, arterial blood pressure, and middle cerebral artery blood velocity were monitored for periods from 1 to 10 days in 30 neurosurgical intensive care patients. The recordings revealed rapid changes in the cerebral perfusion and gave insight into individual cerebral haemodynamic states. Twenty patients consistently showed CO2 reactivity within normal limits, between 2.5 and 5% per mm Hg (19-38% per kPa). Severely impaired CO2 reactivity, considerably below 1% per mm Hg (7.5% per kPa) was observed in four patients. Three of these patients died, while the fourth patient survived in a persistent vegetative state. Seven patients demonstrated pressure-passive blood velocity changes throughout the observed CPP range. The four patients with severely impaired CO2 reactivity all belonged to this group. The recordings from three of the remaining 23 patients showed signs of MCA blood velocity autoregulation with a lower regulatory limit of about 40-45 mm Hg. This observation is in keeping with findings from electromagnetic flowmetry on brain arteries in the neurosurgical operating field, and supports blood velocity measurements as a relevant index of brain perfusion in clinical neurosurgery and neuro-intensive care settings.
Blood Flow Velocity↗
Determination of ventricular fluid outflow resistance in patients with ventriculomegaly.
Resorption of the ventricular fluid was studied by measuring ventricular fluid outflow resistance during steady state 1.5 and 5.0 ml/min infusions in 26 patients with substantial enlargement of the supratentorial ventricular system. This test may avoid unnecessary use of shunts, but a shunt could be introduced during the same procedure.
Adolescent↗