摘要:

&NA;The authors report three patients with symptomatic postlaminectomy pseudomeningocele. At operation a loop of a nerve root was found to be trapped within the dural defect. All three patients exhibited a delayed onset of radicular symptoms and signs after disc surgery. The pseudomeningocele was demonstrated by computed tomography and myelography, but the entrapped root could be identified only at operation. (Neurosurgery19:405‐407, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Computed tomographic (CT) scans are performed on virtually all patients with severe head injury at the time of admission. Because of the time involved in obtaining these studies, the evacuation of significant intracranial mass lesions is delayed. To avoid such delays, the authors performed burr‐hole exploration for the diagnosis of intracranial hematomas before CT scans were obtained in 100 consecutive head‐injured patients with clinical signs of tentorial herniation or upper brain stem dysfunction upon admission to the emergency room. Patients in whom a hematoma was discovered had a craniotomy for evacuation of the clot; those in whom the exploration was negative had a CT brain scan immediately after operation. Burr‐hole exploration revealed extracerebral mass lesions in 56 patients. In 38 patients, the exploration was negative, and postoperative CT scanning showed no significant hematoma. Of 6 patients in whom the CT scan demonstrated extraaxial hematomas requiring surgical evacuation, 4 had subdural hematomas that were missed because the exploration was incomplete; 1 patient had an epidural hematoma and 1 had a subdural hematoma contralateral to a craniotomy on the side of a positive initial burr‐hole exploration. Our results indicate that the relatively small subgroup of head‐injured patients with early tentorial herniation or upper brain stem compression have a high incidence of immediate extraaxial hematomas and a low incidence of intracerebral hematomas. This is particularly true of patients over 30 years of age and those who suffer low speed trauma, such as falls and vehicle‐pedestrian accidents. (Neurosurgery19:408‐414, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Most reports regarding synovial cysts of the spinal canal have been presentations identifying an unusual pathological entity that is to be included in the differential diagnosis of cauda equina compression syndromes. Most of the 26 cases reported represent isolated examples of this pathological process. We present five cases of lumbar synovial cysts encountered in our practice in the past 8 years. Patients with lumbar synovial cysts do not demonstrate any predictable clinical picture. They may present with a unilateral sciatica or neurogenic claudication. Lumbar extension is usually restricted, whereas flexion is full. Mechanical signs of nerve root entrapment or lumbosacral plexus irritation are unimpressive. Neurological deficits are usually mild, if present. Radiological findings include degenerative spondylosis, spondylolisthesis, and a rounded posterolateral extradural mass of low attenuation value adjacent to a facet shown on computed tomographic scan. The etiology of lumbar synovial cysts is not known. Histological findings of myxoid degeneration, microcystic change, calcification, and hemosiderin deposits suggest that chronic microtrauma with occasional focal hemorrhage may play a major role in the etiology of the cysts. With resection of the cyst, the postoperative course is usually uneventful. Recurrences have not yet been encountered in our patients. (Neurosurgery19:415‐420, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;We present two cases of false aneurysm after carotid endarterectomy with primary arteriotomy closure. In both cases, infection appeared to be the precipitating cause. Both lesions were repaired with a saphenous vein patch graft, but infection in one patient persisted, and recurrence of a false aneurysm required ligation of the common carotid artery. There were no neurological sequelae in either patient. A review of the English language literature, our experience, and personal communications yielded 57 cases of false aneurysm. The overall incidence of false aneurysm after carotid endarterectomy was 0.30%. There was no significant difference in the incidence after endarterectomy alone and that after endarterectomy and patch grafting. A significant increase in neurological deficit occurred only when carotid ligation was used, with a morbidity/mortality of 50% in eight reported cases. Infection was the major cause of false aneurysm after endarterectomy; it occurred in 50% of cases closed primarily without patch grafting. Repair with a saphenous vein patch graft and monofilament synthetic suture, plus liberal use of antibiotics, should be considered in the treatment of this condition. (Neurosurgery19:421‐425, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Congenital neoplasms of the central nervous system are extremely rare, although they have been well documented since the earliest reports from the mid‐19th century. Medulloblastoma, other primitive neuroectodermal tumors, and various types of gliomas have comprised the majority of cases. This report describes a highly unusual infratentorial and supratentorial tumor presenting as a scalp mass in a neonate who experienced in utero distress. The supratentorial mass extended through a defect in the skull to the parietooccipital lobe, and the infratentorial aspect involved the 9th and 10th cranial nerves in the region of the cerebellopontine angle. A complex spindle cell neoplasm incorporating peripheral nerve sheath and vascular characteristics was further characterized by electron microscopy and immunohistochemistry. Based upon these studies, the tumor was interpreted as a congenital schwannoma with divergent vascular differentiation. The child has been tumor‐free for approximately 2 years after the initial operative procedure. (Neurosurgery19:426‐433, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Fibrosarcomas of dura mater are very rare tumors representing only 0.5% of all central nervous system sarcomas. A higher incidence of dural fibrosarcomas has been reported in patients with neurofibromatosis. We present a case of spinal dura mater fibrosarcoma in a patient without neurofibromatosis. The diagnostic and therapeutic strategy in the clinical management is discussed. (Neurosurgery19:434‐436, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Enchondroma is a benign cartilaginous tumor rarely found in the vertebral column. The authors report a case of a 24‐year‐old woman with upper extremity paresthesias and weakness secondary to bony destruction of multiple vertebral bodies by an enchondroma. The tumor was treated by block excision of the involved vertebral bodies followed by placement of a bone graft. (Neurosurgery19:437‐440, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Technical factors and surgical techniques in carotid endarterectomy remain a controversial subject. The use of an indwelling arterial shunt has theoretical advantages in assuring intraoperative hemispheric perfusion and affording a more relaxed surgical environment. There has been little clinical demonstration, however, of superior results with carotid shunting. Although champions of routine shunting argue that it is a benign protective intervention, the possibilities of distal embolization or intimal disruption exist. The authors report a case of cervical carotid dissection far distal to the operative site that they postulate resulted from intimal disruption after routine shunt placement. This devastating complication from an otherwise benign procedure prompts reconsideration of the benefits and risks of routine shunt placement. (Neurosurgery19:441‐445, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;A patient is reported who had spontaneous resolution of an acute traumatic subdural hematoma within 6 hours. In this period, clinical signs improved and computed tomography suggested disappearance of the hematoma. Magnetic resonance imaging demonstrated no real disappearance, but rather a redistribution of the blood. A rapid resolution like this has not been observed previously in the natural history of acute subdural hematoma. (Neurosurgery19:446‐448, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;A case of T‐1, T‐2 disc herniation is reported. The patient presented with diminished hand strength, medial arm and shoulder pain, and medial arm, forearm, and hand paresthesias. After surgical decompression and removal of a disc fragment, the patient made a complete recovery. Routine cervical myelography was considered inadequate in view of this patient's symptoms. High thoracic myelography followed by computed tomographic scanning should be considered for patients with this presentation. Improved diagnosis with myelography and computed tomography is discussed. (Neurosurgery19:449‐451, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID