摘要:

&NA;Surgical frames, kneeling attachments, and special operating tables for lumbar spinal surgery are designed to promote good positioning, lower the intraabdominal pressure, and reduce epidural bleeding. The frame reported here fulfills these objectives and produces either lumbar spinal extension to reduce paraspinal muscle tension or mild flexion to distract the neural arches. The new frame unit is made of lightweight fiberglass and aluminum, weighing only 14 lb (6.5 kg), and utilizes the hydraulic elevator pump of the operating table as a means to raise or lower the frame. Thus, adjusting the horizontal plane of the lumbar spine requires no separate crank system. The anterior tibial cushions, lying in hemicylindrical troughs, and the ergonomically designed cushions for chest and buttocks improve the distribution of body weight. A new, fully adjustable, cushioned face rest is used to maintain the neck in a neutral position, with the patient placed fully face‐down. (Neurosurgery20:266‐269, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Three cases of machete wounds to the head are described. The resulting injuries from this unusual mode of trauma varied in severity and included transection of a previously placed ventriculoperitoneal shunt. Complications of these injuries resulted from delayed and inadequate treatment. (Neurosurgery20:270‐272, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Autogeneic split or free skull bone grafts harvested at the time of operation were used to repair large or complex skull defects in 19 children; in 2 children, autogeneic fresh rib grafts were also used. Follow‐up examinations for periods of 1 and 7 years showed that the use of autogeneic grafts is superior to the use of materials such as acrylic or metals for cranioplasty in children. (Neurosurgery20:273‐280, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;We evaluated 42 patients with neurological deficits after civilian gunshot wounds to the spine. Thirty‐five of these patients (the study population presented here) received their initial and follow‐up care at Louisiana State University Medical Center in Shreveport over a 4‐year period. Each patient had incurred a single gunshot wound to the spinal cord or cauda equina with an accompanying neurological deficit. The patient population was divided into three groups. Group 1 patients had incurred a complete motor and sensory loss below the injury (20 patients (57%)). Group 2 patients had incurred incomplete spinal cord injuries (9 patients (26%)), whereas Group 3 patients had cauda equina injuries (6 patients (17%)). Myelography was performed for all Group 2 and 3 patients as well as Group 1 patients in whom the trajectory of the bullet did not explain a higher level of neurological injury (3 patients (15%)). A decompressive operation was performed in the patients whose myelography showed neural compression. Three patients in Group 1 (15%), 5 patients in Group 2 (56%), and 5 Group 3 patients (83%) underwent operation. All 3 Group 1 patients who underwent operation had some improvement of nerve root function postoperatively. All operated Group 2 and 3 patients had improvement of myelopathic or radicular function postoperatively. All began improving within several days of operation, implying a cause and effect relationship. None of the 17 nonoperated Group 1 patients improved neurologically, whereas 3 of the 4 nonoperated Group 2 patients improved. The single nonoperated Group 3 patient improved neurologically. It is concluded that patients with incomplete neurological injuries after civilian gunshot wounds to the spine can expect radicular or myelopathic improvement. Decompressive operation is indicated in selected cases with unexpected radicular injuries or incomplete myelopathic injuries with myelographic evidence of neural compression. A stepwise improvement in neurological function over that expected without operation should be realized in these cases. (Neurosurgery20:281‐285, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;A recurrent malignant glioma was treated with cisplatin delivered directly into the tumor. The drug was delivered via 68 small catheters distributed evenly throughout the tumor area. Each catheter was connected to an osmotic minipump that delivered 0.5 &mgr;l of drug solution each hour for 10 days. There were no side effects from the catheter implantation, chemotherapy, or catheter removal. Although the chemotherapy halted progression of the tumor, it recurred, and the patient died 6 months after treatment. (Neurosurgery20:286‐291, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Visual hallucinations were the presenting symptom in three patients with pituitary adenoma. One patient reported only simple unformed hallucinations, which are a well‐documented phenomenon occurring in lesions compressing the optic nerves and chiasm. The other two patients, however, experienced complex formed visual hallucinations believed to be of the release type. No evidence of seizure activity responsible for the hallucinations was found; the mechanism producing them is discussed with correlation to operative findings and electrophysiological studies. (Neurosurgery20:292‐296, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;It is well established that low cerebrospinal fluid (CSF) pH and high CSF lactate concentration indicate the development of brain acidosis after severe human head injury. However, there is no direct evidence that tissue acidosis actually occurs. We measured brain extracellular pH (pHe) in three patients undergoing operation for the evacuation of acute subdural hematomas. A pH‐sensitive polymer membrane electrode was inserted 500 &mgr;m into the cerebral cortex close to the damaged area. The pHe values obtained were correlated with ventricular CSF acid‐base parameters and extension of the brain lesion. The CSF pH was higher than the pHe in all cases; the pHe was particularly low in areas of contusion or compression by mass lesion. The effect of focal brain tissue acidosis on clinical course after severe head injury is discussed. (Neurosurgery20:297‐301, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Intravenously enhanced computed tomography (CT) was used in patients in whom the differential diagnosis between recurrent herniated disc and postoperative scar was considered. Enhanced CT images demonstrated postoperative herniated discs more accurately than clinical criteria, myelography, or plain or postmetrizamide CT. The scar tissue shows contrast enhancement, but recurrent disc herniation does not. Therefore, contrast‐enhanced CT is considered to be a valuable aid in distinguishing between recurrent disc herniation and hypertropic scar formation. (Neurosurgery20:302‐309, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Two cases of isolated central nervous system angiitis presenting as spontaneous intracranial hemorrhage are reported. The usefulness and limitations of cortical/leptomeningeal biopsy in this condition is described. Emphasis is placed on the clinical awareness of this unusual association to ensure early recognition and prompt management with immunosuppressive therapy. (Neurosurgery20:310‐315, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;A case of acute posttraumatic myelopathy resulting from hemorrhage into synovial cysts bilaterally at the C‐6, C‐7 facet joints is presented. The pathogenesis of synovial cysts remains unclear, although reports in the literature have implicated trauma leading to cyst enlargement. Hemorrhage into the cavity of the synovial cysts resulted in epidural compression of the spinal cord in this patient. Because spinal synovial cysts cannot be unequivocally diagnosed preoperatively, other more common conditions must be considered in the differential diagnosis. Radiographic analysis including plain films, computed axial tomography, and metrizamide myelography are of value in establishing a neurological diagnosis. Surgical decompression and excision of the lesion may result in significant neurological improvement. (Neurosurgery20:316‐318, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID