摘要:

&NA;Extravascular lung water (EVLW) was measured by the double‐indicator dilution method in 25 patients with hemorrhagic cerebrovascular diseases. EVLW had a significantly positive correlation with both alveolar‐arterial oxygen difference (AaDO2) and intrapulmonary shunt. The value of EVLW in the acute stage in 15 patients with increased AaDO2more than 20 mm Hg was 7.8 ± 2.2 ml/kg and that in the chronic stage 4 weeks after onset significantly decreased to 4.6 ± 0.7 ml/kg (P< 0.001). The value of EVLW in the acute stage in 10 patients with normal AaDO2less than 20 mm Hg was 4.7 ± 1.1 ml/kg and that in the chronic stage 4 weeks after onset was 4.5 ± 0.2 ml/kg. There was no significant difference between them. Pulmonary arterial blood pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac index, systemic vascular resistance index, and pulmonary vascular resistance index in the acute stage in the 25 patients were all within the normal range. Three patients with neurogenic pulmonary edema had markedly increased EVLW without abnormalities in pulmonary arterial blood pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac index, systemic vascular resistance index, and pulmonary vascular resistance index. From these facts, the main cause of the increase in EVLW cannot be explained by left ventricular failure, but can be explained by high permeability pulmonary edema. (Neurosurgery25:762‐768, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Transcranial Doppler techniques were used to monitor blood velocity in cerebral arteries continuously during 14 neurosurgical operations performed on 13 patients, including 12 craniotomies. Stable Doppler signals were obtained for prolonged periods of time, and they correlated with intraoperative events. Monitoring during spontaneous blood pressure and CO2variations allowed assessment of autoregulatory capacity. In particular, 5 of the 7 patients receiving craniotomy for aneurysmal subarachnoid hemorrhage had impaired autoregulation. A 30 to 50% decrease in Doppler velocities was seen in 7 patients after etomidate administration. Early experience suggests that transcranial Doppler monitoring during craniotomy is feasible and can indicate the effects of operative events on blood flow as well as provide an assessment of cerebral autoregulation. (Neurosurgery25:769‐776, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;We report on transcranial Doppler sonography with carbogen reactivity testing of flow velocity as applied to patients with normal pressure hydrocephalus. A subgroup can be differentiated that shows coexistent cerebrovascular disease, The surgical prognosis in these patients is bad. A flow chart demonstrating the proposed clinical examination is presented. (Neurosurgery25:777‐780, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Patients with intracranial disease are at risk of developing clinical deterioration due to a hyponatremic syndrome associated with an inappropriate degree of natriuresis, the “syndrome of inappropriate secretion of anti‐diuretic hormone (ADH)” or SIADH. To investigate the hypothesis that atrial natriuretic peptide (ANP) is related to the natriuresis in SIADH, serum samples were obtained from 8 neurosurgical patients with intracranial disease seen consecutively who fulfilled the traditional clinical and laboratory criteria for SIADH. In one patient with a hemorrhagic cerebral infarction an elevation of serum ADH (5.7 pg/ml: normal = 1 to 5 pg/ml) in association with a normal level of serum ANP (49.8 pg/ml; normal = 10 to 60 pg/ml) was seen. Six patients (2 with intracerebral hemorrhage and 1 with hemorrhagic cerebral infarction, I with aneurysmal subarachnoid hemorrhage, I with glioblastoma multiforme, and 1 with Creutz‐feldt‐Jakob disease) had elevated serum ANP levels (197.0, 112.0, 92.0, 432.0, 97.5, and 138.0 pg/ml, respectively) associated with either normal or low ADH levels (1.3, 2.5, 1.2, 0.7, 2.3, and 0.5 pg/ml, respectively). Another patient with an intracerebral hemorrhage had a normal serum ANP level (37.0 pg/ml) and undetectable ADH level (<0.5 pg/ml). In the 7 patients in whom either ADH or ANP alone was elevated, a reciprocal relationship was observed between serum ADH and ANP levels, which could be expressed in logarithmic form (correlation coefficient,r= 0.727). In the 6 patients in whom serum ANP level alone was elevated, a near linear relationship was observed between serum ANP levels and urine sodium excretion (r= 0.851). No such relationship was observed between serum ADH levels and urine sodium excretion (r= 0.249). The finding of elevated serum ANP with normal or low serum ADH and a correlation between serum ANP and urinary sodium excretion is more consistent with the original concept of cerebral salt wasting than with SIADH. The term. SIADH. describes at least three subtypes of the hyponatremic‐natriuretic syndrome in intracranial disease based on serum levels of ADH and ANP. (Neurosurgery25:781‐785, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Intraoperative brain mapping techniques were used to localize language cortex, sensorimotor pathways, and seizure foci in children with supratentorial brain tumors. The methods of direct cortical and subcortical stimulation, in addition to electrocorticography, enabled us to maximize tumor resection, minimize morbidity, and eradicate epileptogenic zones which were always adjacent to, but not involving, the tumor nidus. Language localization was found to be quite variable in the children tested and anatomically unpredictable based on the preoperative neurological or radiological examination. Physiological mapping techniques, therefore, appear to be safe, reliable, and very useful for operations on tumors located within or adjacent to eloquent brain regions in the pediatric population. (Neurosurgery25:786‐792, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;For surgery of upper basilar artery aneurysms, we have modified the temporopolar approach proposed by Sano by detaching the zygomatic arch to obtain a wide, shallow operating field. This approach seems to be suitable for anteriorly protruding, high‐positioned, or large aneurysms of the upper basilar artery. We have used this zygomatic temporopolar approach in 4 patients with such aneurysms and obtained satisfactory results. In this paper, we detail the operative procedure and emphasize certain technical points to minimize temporal lobe retraction and to prevent oculomotor and facial nerve injuries. (Neurosurgery25:793‐797, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;By using the zygomatic approach, temporal mesial and polar epileptic foci are easily accessible through an incision in the inferior temporal gyrus. In this approach, a major part of the superior and middle temporal gyrus is preserved, and there is no risk of postoperative dysnomia even on the dominant side for speech. Combined use of depth and subdural electrodes is advisable for precise determination of focus distributions throughout the mesial and lateral structures of the temporal lobe. We have applied this approach in 5 patients with satisfactory results. (Neurosurgery25:798‐801, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Gamma knife surgery employing a central dose of 70 Gy and a peripheral dose of 25 Gy caused progressive necrosis and shrinkage of a recurrent solitary metastasis of a cerebral hypernephroma, as verified by computed tomographic scan 2 and 4 months after treatment. Gamma knife surgery was an effective palliative treatment for this cerebral metastasis and was an alternative to craniotomy with microsurgical removal. (Neurosurgery25:802‐804, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Earlier, we conducted Phase I clinical trials to determine any acute toxicity of adoptive immunotherapy with intralesional injections of autologous lymphocytes expressing lymphokine‐activated killer (LAK) activity and recombinant interleukin‐2 (rIL‐2) in patients with malignant glioma. Within six weeks of craniotomy and intralesional injection of autologous LAK cells plus rIL‐2, 3 of 29 patients demonstrated a decline in clinical status and evidence on computed tomographic and magnetic resonance imaging scans of edema and mass of unknown character at the site of previous surgery and immunotherapy. Craniotomy was performed to remove the tissue and reduce intracranial pressure. Microscopic examination of the excised material indicated no new tumor growth within the resected mass, but rather that the tissue had the histological characteristics of a chronic sterile abscess including necrosis, fibrosis, and influx of inflammatory cells. Factors that may have contributed to this reaction in the 3 patients were age, Karnofsky score, the extent of tumor excision, and immune status. All 3 had also been treated with greater than average numbers of rIL‐2 activated lymphocytes that demonstrated significant in vitro LAK activity. The results suggest that in patients whose clinical status is good and who are not immunosuppressed by corticosteroids, the dose‐limiting toxicity of intraparenchymal immunotherapy with LAK cells plus rIL‐2 for glioma may be related to the total, absolute number of activated cells injected, and this toxicity develops over time and is manifested by development of a sterile abscess. (Neurosurgery25:805‐809, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A case of metastatic small cell carcinoma to the pineal body is reported and the clinical and radiological features of this rare tumor are discussed. A 66‐year‐old man presented with progressive dementia, gait disturbance, vertical gaze palsy. and convergence retraction nystagmus. Computed tomographic scan revealed a 2 × 3‐cm high‐density mass in the pineal region, which showed strong contrast enhancement. The tumor was resected through a right occipital transtentorial approach. The pathological diagnosis of the surgical specimens was small cell carcinoma. A systemic workup for the primary lesion subsequently revealed small cell carcinoma of the lung. Although occurring rarely, metastatic tumor should be considered in the differential diagnosis of pineal tumor in elderly patients. (Neurosurgery25:810‐813, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID