摘要:

&NA;To the accepted classification of three types of normal pressure, nontraumatic cerebrospinal fluid (CSF) fistulas, we would add “acquired.” This type of CSF fistula tends to occur from the middle cranial fossa because of the enlargement of “pitholes” that are normally present in its anterior medial aspect. The enlargement of these bony defects is due to normal intracranial pressure variations that, not uncommonly, create meningoceles and meningoencephaloceles. A portion of the floor of this area is aerated in up to 10% of the normal population by the lateral recess of the sphenoid sinus, the pterygoid recess. Thus, this area has the potential to act as a pathway between the middle fossa and the paranasal sinuses, allowing cerebrospinal fluid to pass into the sinuses. Isotope and computerized tomographic studies are helpful in the localization of such a CSF leak. Tomography of the base of the skull, however, is essential for the ideal definition of possible routes of fistulization. If there is any question of the presence of a middle fossa fistula, these studies can show whether the floor of this area is pneumatized and whether there are any defects in the floor. The treatment of such a fistula should include generalized reinforcement of the floor of the anterior middle fossa by a middle fossa approach. If any doubt exists as to the site of leakage (anterior or middle fossa), the minimal surgical procedure should include exploration of both areas via a frontotemporal craniotomy.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Severe head injury with resultant basilar skull fracture is the most common etiology for traumatic false aneurysm of the cavernous carotid artery and for traumatic carotid‐cavernous fistula. We present a case of false aneurysm and fistula that occurred as a complication of sphenoidotomy, fortunately a rare etiology of these two serious problems. Because of the current resurgence of trans‐sphenoidal surgery, it is of utmost importance that all neurosurgeons possess an accurate and detailed knowledge of the anatomy of the carotid artery and its intracavernous route.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Three cases of angiographically cryptic cerebrovascular malformations are presented and a review of the cases in the English literature is tabulated. The typical patient is a 30‐ to 40‐year‐old woman with a history of seizures and headache. There is no antecedent history suggesting hemorrhage. On nonenhanced computerized tomographic scans, these lesions are denser than normal brain. They enhance with contrast administration. The angiogram demonstrates an avascular mass. The history, physical findings, and radiographic studies suggest brain tumor. An accurate diagnosis requires operation and pathological examination of the lesion.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;We present a case of Nelson's syndrome in which the clinical, radiographic, and surgical findings are indicative of a discrete microadenoma rather than of diffuse pituitary hyperplasia. Ultrastructural analysis reveals this to be the first example of a sparsely granulated lesion in Nelson's syndrome and only the second such adrenocorticotropic hormonesecreting tumor reported. Unfortunately, there do not seem to be any firm ultrastructural features that differentiate between hyperplasia and discrete adenoma. Separation of the two entities may be important in delineating the pathogenesis and treatment of Nelson's syndrome; these are discussed.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;A case of embryonal carcinoma in the pineal region of a 17‐year‐old boy is presented. The tumor included elements of choriocarcinoma and endodermal sinus tumor, and the use of human chorionic gonadotropin and alpha‐fetoprotein as tumor markers is discussed. The markers were demonstrated both within the tumor and in the cerebrospinal fluid (CSF) and blood. The patient was treated with a postoperative program of irradiation and cancer chemotherapy, and at follow‐up examination 20 months after operation no signs of residual tumor were present. It is suggested that human chorionic gonadotropin and alpha‐fetoprotein should be measured in the blood and CSF before the treatment of midline tumors.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;The clinical presentation, radiological findings, and surgical management of two cases of meningioma arising from the velum interpositum without dural attachment are described. The true nature of these tumors was not suspected despite extensive preoperative diagnostic evaluation. A total removal was effected in both cases with the use of the operating microscope and a posterior fossa approach to the pineal region. A review of similar cases from the English literature is presented.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;We report the metastasis of a rectal carcinoid to the dura mater of the posterior fossa. The clinical presentation was unusual because of a 10‐year latent period between resection of the primary rectal tumor and symptoms and signs of the posterior fossa metastasis; the radiological findings were atypical of a metastasis. Gastrointestinal carcinoids, apudomas, and the concept of the APUD endocrine cell family are reviewed.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Two new cases of extradural hematoma associated with traumatic middle meningeal artery pseudoaneurysm are presented. Sixteen such cases have previously been reported in the literature. A 22‐year‐old man and a 17‐year‐old woman each developed marked neurological deficits after head injury. In each case percutaneous common carotid angiography demonstrated a conspicuous aneurysmatic sac on the middle meningeal artery, as well as displacement of major intracranial vessels and a surrounding avascular area. At operation the extradural clot was removed and the middle meningeal artery sac was verified. Both patients recovered uneventfully. Histological analysis of one of the specimens was performed.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;A rare complication of a ventriculoperitoneal shunt is reported. The peritoneal catheter extruded through the well‐healed abdominal incision. This is the first report of such an occurrence in an adult patient.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;This paper provides an overview of the current status of the management of cancer pain. The concept of “total care” of the patient with cancer incorporates an effort to eradicate or suppress the underlying malignancy, but when this is no longer feasible emphasis is shifted to symptom control to maximize the quality of remaining life. Even though the malignancy cannot be eradicated, an important first step in pain control is the diagnostic identification of the source of pain because it is preferable to treat the pain specifically rather than symptomatically. Alleviation of the patient's “total agony” requires treatment of the emotional as well as the physical component of pain. In addition, successful management is facilitated by attention to the social needs of both patient and family. Pharmacological therapy is the keystone of pain management; this includes the use of psychotropic agents and narcotic analgesics given orally on a regular schedule to prevent pain, rather than treating the pain after it has appeared. The hospice approach embodies the principles of pharmacological therapy and social, spiritual, and emotional support for the patient and family. These noninvasive methods have been shown to be effective in an increasing proportion of patients with advanced cancer, resulting in a decline in the need for neurosurgical intervention. However, in some patients conservative management fails and neurosurgical intervention should be considered. For those who are candidates for neurosurgical intervention, a wide variety of procedures is available. The selection of specific procedures depends on the source and severity of the pain and on the life expectancy and general condition of the patient.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID