摘要:

&NA;Factors seemingly influential in postoperative central nervous system infections were evaluated in 379 patients who sustained missile wounds to the head during the Iran‐Iraq War. The mean wound age was 49 hours. The site of injury and presence of retained bone and/or shell fragments did not have a significant effect on infection rate. Thirty‐three of 379 patients developed cerebrospinal fluid (CSF) fistulas of which 12 (36%) were associated with infection. The infection rate was 6 of 346 (1.7%) in the absence of CSF leaks. There was a statistically significant association between CSF fistula and infection. All 6 positive cultures in patients with CSF fistulas were gram‐negative. Thirty‐two patients died during the study, a mortality rate of 8.4%. The mortality rate from infection was 1.8%. Two hundred seventy‐seven of 347 patients were followed for a mean of 22 ± 17 months during which time 2 patients were readmitted with central nervous system infections, both due to CSF leakage. CSF fistulas were the main predisposing factor in postdebridement central nervous system infections in this study. (Neurosurgery25:923‐926, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The monoclonal antibody (MAb) Ki‐67 detects a nuclear antigen expressed by proliferating cells during the entire cell cycle. In contrast to conventional histological techniques, the use of MAb Ki‐67 on frozen sections or cytological smear preparations allows direct determination of the growth rate of tumors routinely. Sixty‐two pituitary adenomas were investigated by use of the MAb Ki‐67 in a two‐step avidin‐biotin‐peroxidase complex technique. The proliferation activity ranged from 0.1 to 2.8%. There was no significant difference between the proliferation and hormonal state of the adenomas. Adenomas for which there was histological evidence of dural infiltration, however, showed a statistically significant higher proliferation activity (P< 0.05) compared to noninvasive adenomas. (Neurosurgery25:927‐930, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Between 1980 and 1988, 8 patients with chordomas and 9 with low‐grade chondrosarcomas involving the cranial base were treated. All the patients were investigated preoperatively and postoperatively with computed tomographic or magnetic resonance imaging scans, according to a standard protocol. The tumors and the involved bony structures were surgically removed in one or more operations using different operative approaches. Ten patients underwent postoperative radiation therapy, either at our institution or prior to their referral to us.Total removalwas defined as the absence of identifiable tumor on magnetic resonance imaging or computed tomographic obtained 3 months postoperatively, and was accomplished in 9 patients. The ability to achieve total removal was greatly increased in patients with tumors that had not previously been operated on. We believe that these tumors must be treated by aggressive surgical resection when initially diagnosed, and this can be accomplished with low morbidity. The follow‐up period in our patients was too short to allow us to determine whether such total removals can result in a cure or in long‐term control of these formidable tumors. (Neurosurgery25:931‐941, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;We present our experience with the surgical treatment of olfactory groove meningiomas using a pterional approach. This approach provides the advantages of previous techniques, such as preserving the frontal brain and superior sagittal sinus, early devascularization of the tumor, and late dissection of tumor borders. Moreover, it also compensates for the shortcomings of other techniques, e.g., compression of frontal bridging veins, late dissection of dorsal tumor aspects involving vessels and optic nerves as well as facultative infection and cerebrospinal fluid fistula‐related complications caused by opening of frontal sinuses. To date, 11 patients were treated in this way. As we encountered no surgical complications in our series we are encouraged to present our procedure. (Neurosurgery25:942‐947, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A 39‐year‐old woman with secondary amenorrhea and visual field defects underwent craniotomy for a large pituitary tumor that was hormonally silent according to measurement of plasma hormone levels and immunohistochemical analysis. During the preoperative investigation, bromocriptine was administered for 1 month, but there was no change in the tumor size as seen on computed tomographic scans. One month after surgery, visual field defects recurred, and a tumor mass comparable to the preoperative state was found on computed tomographic scan. The tumor size gradually diminished during treatment with CV 205‐502, a tricyclic benzoquinoline which stimulates mainly D2receptors and is better tolerated than bromocriptine. The visual fields were completely normalized after 3 months of treatment with the drug, and surgical management of the tumor mass was no longer considered to be necessary. Thus, as in many similar cases, the hormonally silent pituitary tumor in this patient proved unresponsive to bromocriptine treatment. In contrast. the tumor was reduced by therapy with CV 205‐502, a drug that is better tolerated and might permit a more intense stimulation of D2receptors. (Neurosurgery25:948‐950, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Lesions of Meckel's cave are extremely uncommon and difficult to diagnose. The symptoms and signs are variable, and the lesion may not appear on routine roentgenographic or computed tomographic examination. A patient with a small epidermoid tumor of Meckel's cave that was diagnosed by magnetic resonance imaging is herein reported. The epidermoid appeared as a low‐intensity mass on the T1‐weighted image and as a high‐intensity mass on the T2‐weighted image. Coronal sections defined the anatomic relationship to the trigeminal nerve. Preoperative recordings of the trigeminal sensory evoked response may be predictive of postoperative recovery of neurological deficits. Furthermore, intraoperative recording was extremely useful in avoiding inadvertent neurological injury. Review of the literature confirms the rarity of this lesion and the usefulness of magnetic resonance imaging in diagnosing it, although based on a limited number of cases. (Neurosurgery25:951‐955, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The authors have treated a 20‐year‐old man with a dorsal intramedullary epidermoid cyst in whom magnetic resonance imaging was performed both before evacuation of the cyst and 3 months later. Intraspinal epidermoid tumors are rare, and the intramedullary location is quite uncommon. To our knowledge, this is the first description of magnetic resonance imaging of an intramedullary epidermoid cyst. The frequency, possibilities, and limits of surgical treatment of such intraspinal benign tumors are reviewed. (Neurosurgery25:955‐959, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The symptoms and clinical courses of 4 patients with neurofibromatosis and lesions of the brain stem identifiable on computed tomographic and/or magnetic resonance imaging scans are described. Two patients underwent biopsy and both had low‐grade astrocytomas with no evidence of anaplasia. Both received radiation and chemotherapy. The other 2 patients have been monitored without biopsy or treatment. Three patients are alive and clinically stable, having been followed up for an average of 4 years; neuroimaging studies have shown no change in their tumors. The fourth patient died of a supratentorial primitive neuroectodermal tumor. Imaging studies had shown no change in his brain stem lesion, which at autopsy was found to be a focal collection of fibrillary astrocytes. These data suggest that some patients with brain stem lesions and neurofibromatosis may have a prognosis distinctly different from that of the typical patient with a brain stem glioma. We recommend caution against aggressive operative and adjuvant therapy for brain stem lesions in patients with neurofibromatosis, unless progression of the lesion is documented clinically and/or by imaging. (Neurosurgery25:959‐964, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The authors present a case of a schwannoma associated with high division of the median nerve in a patient who had previously had a diagnosis of a ganglion. The case is presented and the literature concerning these 2 conditions is reviewed. (Neurosurgery25:965‐968, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Three cases of a mobile cauda equina schwannoma, preoperatively diagnosed by magnetic resonance imaging, are described. When dealing with tumors of the cauda equina, it is important to carry out a second magnetic resonance imaging scan after changes in posture, bearing in mind the possibility of mobility of the tumor. (Neurosurgery25:968‐971, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID