Acute subarachnoid hemorrhage (SAH) is a serious condition that affects not just the brain, but multiple other organ systems as well (1). Despite a steady reduction of mortality from acute SAH in recent years, from over 50% to approximately 35%, this...

Objective: Acute subdural hematomas (aSDH) are severe traumatic brain injuries. Older patients have a higher mortality rate. In the present study the computed tomography (CT) and neurological deficits caused by aSDH were used as prognostic factors to define the outcome and surgical treatment indication in older patients. Methods: The affect of the Glasgow Coma Scale (GCS) score on initial presentation, pupil abnormalities, parenchymal lesions, SDH-thickness, midline shift and intracranial pressure (ICP) in the outcome of older patients (≥65 years old) admitted to our hospital between 1993 and 2006 with aSDH was evaluated. The outcome was assessed with the Glasgow Outcome Scale (GOS). The data were collected retrospectively. Statistical analysis was performed with Chi-square test and ANOVA. Results: Older patients have a high mortality after aSDH. A low GCS score (3–8), pupil abnormalities, the presence of contusions and subarachnoid bleeding, midline shift>aSDH thickness as well as a highly elevated ICP>40 mmHg are unfavorable factors in the prognosis of aSDH. Conclusion: Patients with a GCS of 13–15 can be observed clinically (the expected outcome is very good). Comatose patients (GCS 3–8) with bilateral dilatation of the pupils should not be operated (very high mortality rate). If the GCS score is <13 and both pupils or only one are reactive to light and the midline shift10 mm and aSDH thickness>midline shift, surgery is also indicated. If in the same patient group midline shift>SDH thickness and ICP>40 mmHg, surgery is not indicated. Einleitung: Akute subdurale Hämatome (aSDH) sind sehr ernsthafte Verletzungen des Neurokraniums. Ältere Patienten haben eine höhere Mortalität. Computertomografische Kriterien als auch das klinische Bild der Patienten mit aSDH werden in dieser Studie als prognostische Parameter evaluiert. Ziel war es, diejenige Gruppe der Patienten zu definieren, die von einer chirurgischen Intervention profitieren würden. Methoden: Der Glasgow Coma Skalenwert (GCS), die Pupillenreaktion, Parenchymläsionen, SDH-Dicke, Mittellinienverlagerung und intrakranieller Druck wurden in der Studie einbezogen. Das Alter der Patienten betrug >65 Jahre. Alle Patienten wurden in unserer Klinik in den Jahren von 1993–2006 behandelt. Das Outcome wurde anhand der Glasgow Outcome Scale (GOS) evaluiert. Die Daten wurden retrospektiv erhoben. Die statistische Auswertung wurde ANOVA und Chi-Quadrat-Analyse durchgeführt. Ergebnis: Bei einem GCS-Wert von 3–8, Pupillenreaktionsstörungen, Vorhandensein von Kontusionen oder subarachnoidalem Blut, Mittellinienverlagerung, die größer als die Dicke des SDH war, sowie einem erhöhten intrakraniellen Druck von >40 mmHg ist die Prognose bei älteren Menschen mit a SDH schlecht. Zusammenfassung: Patienten mit einem GCS-Wert von 13–15 können stationär beobachtet werden, da die zu erwartende Prognose sehr gut ist. Komatöse Patienten (GCS 3–8) mit beidseitiger fehlender Lichtreaktion der Pupillen sollten nicht operiert werden, da die Prognose sehr schlecht ist. Bei einem GCS-Wert von<13 und beidseitiger oder einseitiger Pupillenreaktion und einer Mittellinienverlagerung von SDH-Dicke ist und der intrakranielle Druck>40 mmHg beträgt, sollte jedoch von einer Operation Abstand genommen werden.

Background Olfactory groove meningiomas remain surgically challenging. The common microsurgical approaches suffer from late exposure of the neurovascular structures. Conversely, the pterional approach has the advantage of early dissection of the posterior neurovascular complex. Methods We reviewed the records of patients treated for olfactory groove meningioma in our department between 1991 and 2010. A total of 61 patients underwent removal of olfactory groove meningiomas via the pterional approach. These included 58 primary and 3 recurrent tumors. Mean overall follow-up time was 122 months. Results Early exposure and dissection of the internal carotid artery, middle cerebral artery, anterior cerebral artery, and optic nerve was feasible in all cases. Complete tumor removal was achieved in 60 patients. Morbidity and mortality rates were 26% and 1.6% respectively. Postoperative complications included epileptic seizures (five patients) and cerebrospinal fluid (CSF) leak (two patients). During follow-up, we recorded three tumor recurrences. Conclusions The pterional approach appears to be an excellent solution for the treatment of olfactory groove meningiomas. Its foremost advantage is early visualization of the posterior neurovascular complex. Moreover, it allows frontal sinus preservation and timely tumor devascularization and avoids excessive brain retraction. The pterional view is familiar to most neurosurgeons and therefore the transition to this technique is fairly straightforward.

Objective. The aim of our prospective study was to investigate the applicability and the diagnostic value of near-infrared spectroscopy (NIRS) in SAH patients using the cerebral oximeter INVOS 5100C.Methods. Measurement of cerebral oximetry was done continuously after spontaneous SAH. Decrease of regional oxygen saturation (rSO₂) was analyzed and interpreted in view of the determined intrinsic and extrinsic factors. Changes of rSO₂values were matched with the values of ICP, tipO₂, and TCD and the results of additional neuroimaging.Results. Continuous measurement of rSO₂was performed in nine patients with SAH (7 females and 2 males). Mean measurement time was 8.6 days (range 2–12 days). The clinical course was uneventful in 7 patients without occurrence of CVS. In these patients, NIRS measured constant and stable rSO₂values without relevant alterations. Special findings are demonstrated in 3 cases.Conclusion. Measurement of rSO₂with NIRS is a safe, easy to use, noninvasive additional measurement tool for cerebral oxygenation, which is used routinely during vascular and cardiac surgical procedures. NIRS is applicable over a long time period after SAH, especially in alert patients without invasive probes. Our observations were promising, whereby larger studies are needed to answer the open questions.