The early reimplantation of the patient's own skull bone combined to the employment of a programmable shunt system allowed us a dynamic adjustment of the intracranial pressure (ICP) changes. The combined treatment reduced the number of required surgical procedures, complications and unsatisfactory patient outcomes.

Slippage of an aneurysm clip as a result of insufficient clip-closing force cannot be predicted, even when using force-testing devices. Descriptions of intraoperative clip slippages are rarely found in the literature. The authors summarize four unusual cases in which titanium aneurysm clips slipped by a scissorslike mechanism during surgery. They analyze the possible factors implicated in such a dangerous situation and discuss corrective choices.

We studied the influence of the type of surgery (microsurgery or macrosurgery) and extent (complete resection with lobectomy, complete resection alone, partial resection with lobectomy or partial resection alone) on early postoperative results and survival time in 118 consecutive patients who underwent surgery for glioblastoma multiforme. Early results were assessed by the Karnofsky score at 4 weeks postoperatively. Survival was compared using Kaplan-Meier curves and Mantel statistics. The median survival time (MST) after microsurgery (12.1 months) was significantly longer than that after macrosurgery (7.3 months). The longer survival after microsurgery was, however, largely attributable to better early results and a consequently higher proportion of patients who could undergo radiotherapy. Complete resection was superior to partial resection. Additional lobectomy did not appreciably influence the early results and the MST in completely resected tumours. So the MST after complete resection in the microsurgical group without lobectomy was 12.6 months, with lobectomy 12.9 months. In the macrosurgical group the respective values were 7.4 months without and 8.2 months with lobectomy. In incompletely resected tumours lobectomy worsened the early results compared to incomplete resection alone and led to a shorter MST.

Twenty anesthetized rats were randomly assigned to a nimodipine-treated group or a control group of 10 rats each. Local cerebral blood flow (lCBF) was measured by means of a surface electrode using the hydrogen clearance technique. Systemic arterial pressure (SAP) was varied with administration of norfenefrine or by hemorrhage in order to obtain SAP/cerebral blood flow (CBF) curves under different conditions. In the control group, a typical autoregulation curve was obtained with an lCBF plateau between 70 and 120 mm Hg SAP. The nimodipine-treated animals, however, showed only a slight diminution in the slope of the curve but no real plateau, indicating impairment of CBF autoregulation. In another series, 20 anesthetized rats were randomly assigned to a treatment group or a control group of 10 animals each. Intravenous Evans blue dye was used as a tracer for blood-brain barrier (BBB) function. In both groups, SAP was raised to a level of 180 mm Hg with administration of norfenefrine for 6 minutes. Extravasation of significantly more Evans blue dye was observed in the nimodipine group than in the control group, indicating impairment of the BBB. It is concluded that nimodipine may impair CBF autoregulation, allowing damage to the BBB under hypertensive conditions.

No abstract