摘要:

&NA;A new model of subacute compression of the spinal cord is described. Using an expanding epidural mass, a gradual, progressive, and highly reproducible neurological deficit was induced in rats over a 7‐day period, resulting in paraplegia. Studies of spinal cord edema, disruption of the blood‐spinal cord barrier, and somatosensory evoked responses, as well as histopathological and microangiograpical studies, revealed a marked similarity to changes produced in other spinal compression models and in humans. The model may serve to answer some fundamental questions regarding the pathophysiology and efficacy of various treatment modalities of spinal cord compression. (Neurosurgery24:860‐863, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Multi‐level cervical spondylosis and ossification of the posterior longitudinal ligament (OPLL) are well‐documented causes of myelopathy. The choice of surgical procedures remain controversial. Between January 1983 and December 1987, we have performed anterior cervical vertebrectomy in 45 patients with cervical myelopathy caused by multi‐level spondylosis and OPLL. They consisted of 19 patients with cervical spondylosis, 12 with OPLL, and 14 with combined lesions of both cervical spondylosis and OPLL. There were 32 men and 13 women. The mean age was 55 years, ranging from 35 to 70 years. In all of our 45 patients, anterior vertebrectomy, discectomy, removal of posterior osteophytes and OPLL, and interbody fusion were done for progressive myelopathy refractory to conservative treatment. In 2 of 45 patients, 5 vertebral bodies were resected; in 3 patients, 4 vertebral bodies were resected; in 12 patients, 3 vertebral bodies were resected, in 19 patients, 2 vertebral bodies were resected; and in 9 patients, 1 vertebral body was resected. Thirty‐nine of 45 patients (87%) had good results. Neurological signs did not improve in 5 patients (11%). One patient died because of agranulocytosis secondary to treatment with antibiotics. In conclusion, cervical cord compression caused by lesions located principally in the anterior aspect of the spinal canal may be completely relieved via anterior vertebrectomy, discectomy, removal of the calcified ligament, and fusion. (Neurosurgery24:864‐872, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The effects of positive end‐expiratory pressure (PEEP) on central venous and intracranial (ICP) pressures were evaluated in 10 patients with posterior fossa tumors, in both supine and sitting positions. With patients in the supine position, intrathoracic PEEP‐dependent venous hypertension was clearly transmitted to the intracranial compartment but without intracranial hypertension. On the contrary, with patients in the sitting position PEEP had no influence in almost half of our patients. In patients with radiological or clinical signs of increased ICP, however, the combination of head flexion and rotation with institution of PEEP caused a dangerous increase in ICP, even when the patients were in the sitting position. The need for early withdrawal of cerebrospinal fluid in these patients is stressed. (Neurosurgery24:873‐877, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Intracranial extradural pressure (ICP) was monitored by using a miniaturized transducer for an average period of 8 days after direct operation in 55 patients with ruptured cerebral aneurysms. Acute stage operation and drainage of cerebrospinal fluid were simultaneously performed in most of the patients. In many grade I patients with satisfactory cisternal drainage, ICP was monotonously stable, with faint pressure waves. When the drained fluid volume decreased or drainage was removed, however, ICP was elevated moderately, with associated pressure waves present. There were no A‐waves observed in any of the patients. Decreases of mean ICP and disappearance of pressure waves were found 2 to 3 hours after infusion of 200 or 300 ml of 10% glycerol or 20% mannitol in patients without drainage or with an inadequate drain, but were not found in patients with a good drain. In a patient showing diffuse severe vasospasm, a rapid elevation of ICP caused by marked brain edema was observed. In patients with residual aneurysms or incompletely clipped aneurysms, ICP increased immediately after rupture of these aneurysms. The daily mean ICP was higher in patients with a clinically poor condition and/or severe subarachnoid hemorrhage on admission than in those with a good condition and/or mild subarachnoid hemorrhage, in spite of a functional drain. There was a poor outcome in about half of the patients showing maximum daily mean ICP >30 mm Hg or frequent B‐waves. No complications caused by ICP monitoring were found. Because of the relatively less invasive methodology lack of complications, good insight into intracranial conditions and prediction of prognosis, intracranial extradural pressure monitoring was considered to be useful in the management of patients following aneurysmal surgery. (Neurosurgery24:878‐883, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Transcranial Doppler (TCD) ultrasonography was used to perform multiple examinations of 24 patients who sustained cranial injuries, 23 of whom progressed to death. In the 20 of these 23 patients for whom an adequate TCD signal could be obtained, a characteristic reverberating wave form pattern was observed, with an associated net flow velocity of <10 cm/sec in all cases. In the last patient in our study group, a reverberating pattern was also identified, however, a net flow velocity of >20 cm/sec was associated with functional recovery. Correlations of neurological function, TCD tracings, and net flow velocities permitted identification of characteristic hemodynamic changes that preceded cerebral circulatory arrest. Early changes included decreased flow velocity as well as an increase in pulse pressure. Late changes consisted of a persistent increase of pulse pressure with the appearance of retrograde flow velocities during diastole. In the end stage, complete diastolic retrograde flow velocities were found. These gave rise to the characteristic reverberating pattern mentioned earlier. Identification of flow velocity reversal alone, however, proved to be inadequate for making the diagnosis of brain death. Evaluation of net flow velocity (calculated at bedside) was found to be a more sensitive determinant of brain death and closely paralleled the patients' neurological function. (Neurosurgery24:884‐889, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The increasing use of microsurgical decompression for trigeminal neuralgia has created a need for more detailed anatomical information about the approach. To define better this anatomy, 10 cerebellar specimens obtained at autopsy were examined, and intraoperative findings in 30 patients with trigeminal neuralgia were analyzed. Since the infratentorial subdural space on the tentorial cerebellar surface is exposed to explore the trigeminal nerve in the infratentorial lateral supracerebellar approach, attention was directed to the following: the anterolateral margin of the cerebellar hemisphere, bridging veins on the tentorial surface, superior petrosal veins, and relationships between blood vessels and the trigeminal nerve. The lateral mesencephalic segment of the superior cerebellar artery at or near the bifurcation often compressed the nerve laterally at more than one point. With this approach, the relationship of the superior cerebellar artery to the nerve could be observed from the medial side of the tentorial surface. The infratentorial lateral supracerebellar approach is discussed and compared to Dandy's cerebellar route. (Neurosurgery24:890‐895, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A 54‐year‐old woman who had symptoms of intermittent meningeal irritation and hypopituitarism was found to have a sellar mass histologically consistent with pseudotumor. The lesion appears to have originated in the sphenoid sinus and subsequently to have spread intracranially, causing bony erosion. To our knowledge, this is the first description of pseudotumor occurring as a sellar mass. (Neurosurgery24:896‐901, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Involuntary cervical movements that result in cervical spondylosis and secondary myelopathy have not been adequately emphasized in the literature. We present two patients with cerebral palsy and long histories of involuntary movements who developed cervical myelopathy. We use these illustrative cases to emphasize that in the presence of underlying neurological symptoms and signs due to advanced cerebral palsy, any recent worsening should provoke a higher index of suspicion for myelopathy. The mechanics of neck movements and surgical treatment are discussed. (Neurosurgery24:902‐905, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Fibrous dysplasia of the cervical spine is rare. No prior reports have discussed odontoid fractures in the setting of fibrous dysplasia. We describe a 26‐year‐old man who suffered a traumatic odontoid fracture in an area of preexisting fibrous dysplasia. The patient was treated conservatively in a sterno‐occipito‐mandibular immobilizer brace with a good result. A review of fibrous dysplasia is presented. Alternative methods of diagnosis and treatment options in our patient are discussed. (Neurosurgery24:905‐909, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Stickler's syndrome, an autosomal dominant connective tissue disorder, is characterized by progressive ophthalmic, orofacial, and skeletal abnormalities. Epiphyseal dysplasia is seen in this syndrome and affects the spine, causing anterior vertebral body wedging and Schmorl's node formation. These spinal abnormalities are usually asymptomatic. We report here the first case of thoracic disc herniation and paraplegia associated with Stickler's syndrome. (Neurosurgery24: 909‐912, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID