摘要:

&NA;Although cystic gliomas of the brain stem can be readily aspirated using a stereotactic technique, they will frequently recur, resulting in progressive neurological deficit. Since standard neurosurgical approaches to cystic gliomas of the cerebral hemispheres and cerebellum are difficult to apply to brain stem lesions, modification of these techniques are necessary to provide cyst control with minimal morbidity and mortality. This report, based upon 12 procedures performed on 10 patients with gliomas of the mesencephalon, pons, and medulla, details an approach using aspiration, stereotactically placed cyst catheters, and/or intracavitary irradiation with colloidal chromium phosphorus‐32 in addition to external radiation therapy and chemotherapy. Cyst control without mortality or permanent morbidity was obtained in all patients using this multimodality approach. (Neurosurgery24:373‐378, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Five patients with tumors in the anterior skull base were surgically treated using the transbasal approach, which permits removal of the tumor, repair of the dura mater, and reconstruction of the skull base in a one‐stage procedure. By using autologous materials for the bone graft and pedunculated pericranial flap for the reconstruction, the intracranial structures are separated from the air‐filled nasal and paranasal cavities. No postoperative complications such as wound infection and leakage of cerebrospinal fluid were encountered. The use of this surgical technique makes it possible to extirpate brain tumors that heretofore have been considered unresectable. (Neurosurgery24:379‐384, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A surgical approach to the skull base was developed in cadavers and then used in the treatment of patients with complex aneurysms of the anterior circulation. The operative method involves removal of portions of the orbital rim, orbital roof, and sphenoid bone. By removing the orbital rim and a portion of the orbital roof, multidirectional viewing is possible. This is important when dealing with the anterior aspect of the cavernous sinus and anterior clinoid process, as must frequently be done when isolating the neck of an ophthalmic aneurysm. The optic canal is opened wide and the optic nerve mobilized, allowing resection of the dura propria covering the cavernous carotid artery. Clip placement is performed in an anteroposterior plane, thus lessening the chance for compromise of the internal carotid artery. The low approach alleviates brain retraction and the small flap minimizes brain exposure. The approach also allows preservation of the arterial and neural supply to the frontalis and temporalis muscles, thereby preventing postoperative cosmetic deficits. During the past year and a half, this approach has been employed in 25 patients with difficult aneurysms of the anterior circulation. The difficulties of these cases stemmed from their odd location, size, or complex anatomy. Although periorbital edema may have been more severe during the first postoperative week, overall improved cosmesis was achieved. (Neurosurgery24:385‐391, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Case records of 88 patients with low‐velocity gunshot injuries of the terminal spinal cord and cauda equina treated by laminectomy at Cook County Hospital between 1969 and 1987 were reviewed. Sixty‐one patients were operated upon within 72 hours of injury, 29 of whom (47.5%) experienced neurological improvement or pain relief. Twenty‐seven patients were operated upon at a later time for associated injuries, 13 of whom (48.1%) experienced neurological improvement or pain relief. When laminectomy was delayed for more than 2 weeks, either arachnoid adhesions (15%) or occult abscesses (17%) were observed. From this review as well as from the literature, it appears that the timing of laminectomy for gunshot injuries of the thoracolumbar and lumbosacral spine is not essential to neurological recovery. It appears, however, that adequate debridement of these injuries, performed as soon as the patient is stable from any associated injuries, may help to mitigate the late sequelae of arachnoiditis, infection, and pain syndromes in the lower extremities. (Neurosurgery24:392‐397, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Large pituitary tumors are still a common problem. Thirty consecutive patients underwent operative decompression and radiation therapy for large sellar and suprasellar tumors. They were studied prospectively in terms of their endocrine outcome. Ten of the patients had panhypopituitarism both before and after treatment. The other 20 patients had partial hormonal deficits prior to treatment. Ten (50%) of the 20 patients who had partial preoperative deficits went on to develop delayed onset of worsening in their endocrine function; 9 of the 10 developed panhypopituitarism, and 1 patient developed decreased thyroid function. The mean time from surgery until the onset of delayed worsening in endocrine function was 26.1 months. The mean age of those patients who developed delayed onset of worsening in pituitary function was significantly higher than that of those who did not develop further hormonal loss (40.5 ± 3.1 years versus 52.0 ± 4.1 years,P< 0.05). None of the 10 patients with delayed onset of worsening in pituitary function had anatomical evidence by computed tomographic scan of tumor recurrence. Delayed onset radiation effect is the most likely cause of the late onset of worsening in endocrine function. (Neurosurgery24:398‐400, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Four controlled trials and one case control study have presented data supporting the efficacy of perioperative administration of antibiotics in reducing the rate of infection following clean neurosurgical procedures. Their results are, for the most part, consistent with uncontrolled studies reported since 1980. Taken together, these studies clearly and consistently demonstrate the value of perioperative antibiotic prophylaxis in clean neurosurgical operations. (Neurosurgery24:401‐405, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Three cases are described of infants who developed malignant brain swelling (and in one case hemorrhage) after surgery for vein of Galen malformations. The cause for the brain swelling was felt to be due to hyperperfusion, or the “normal perfusion pressure breakthrough” syndrome. Although well‐described for cerebral parenchymal arteriovenous malformations, cases of this complication occurring in vein of Galen malformations have not previously been reported. It is concluded from these cases that infants with large arteriovenous shunts, as attested by cardiac failure and cerebral atrophy, have an increased risk of developing this complication. (Neurosurgery24:406‐410, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;An example of a traumatic extradural hematoma of the cervical spine that occurred in a 32‐year‐old man who suffered from chronic ankylosing spondylitis is reported. Progressive sensory and motor deficit ensued some 3 hours after the patient fell from a standing position. The patient landed on his back, striking his head on the floor. After being helped up, he was able to walk unassisted to a nearby chair, where he sat down until his left lower extremity—and shortly afterwards, the right one—became numb and weak. On admission, the patient was found to have tetraparesis that was more pronounced in the lower extremities and associated with incomplete sensation to pinprick at level T7‐T10. He also had painless distention of the urinary bladder. After a few hours, the weakness in his limbs increased and his sensory level rose to C5 bilaterally. A horizontal diastatic fracture across the vertebral body of C7 was discovered on plain x‐ray films of the spine, and an extradural hematoma extending dorsally from C5 to T1 was revealed by emergency magnetic resonance imaging. After an emergency decompressive cervical laminectomy and removal of the clot, the patient rapidly regained complete neurological function, except with regard to both the urinary bladder and the rectum, which remained abnormal for almost 7 weeks after the operation. (Neurosurgery24:410‐414, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;We report the diagnostic evaluation and treatment of a cystic paraspinal and epidural lesion originally thought to be a neurofibroma or an arachnoid cyst. Intraoperatively, the lesion was found to be an air cyst of the lung that was successfully ligated. (Neurosurgery24:414‐417, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Four patients with macroprolactinomas treated with bromocriptine had tumor growth and visual loss despite marked reduction in their serum prolactin levels. Explanations for this dissociation of tumor growth and prolactin measurement might include noncompliance. Patients treated with bromocriptine require periodic examination by computed tomographic scan or magnetic resonance imaging and neuro‐ophthalmological evaluation in addition to monitoring of serum prolactin. (Neurosurgery24:417‐423, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID