摘要:

&NA;Twenty patients with cerebral arteriovenous malformations (AVMs) were followed up by angiography. Of the 20 AVMs, 16 were nontreated and the remaining 4 were residual. The follow‐up periods between the two examinations were from 5 to 28 years, with a median interval of 15 years. At follow‐up, the size of the AVM had increased in 4 patients (20%), decreased in 4 (20%), totally regressed in 4 (20%), and was unchanged in 8 (40%). In cases of enlarged AVMs, the patients were all young: from 0 to 11 years old at first angiography and from 6 to 30 at second angiography. The decrease or total regression of the AVM occurred in older patients (over 30 years old at second angiography), and the AVMs were relatively small and fed by single or a few feeders. The patient's age and the size of AVM should be considered when operative indications are discussed. (Neurosurgery24: 68‐74, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Serious morbidity and hyperemic states continue to complicate the treatment of certain intracranial arteriovenous malformations (AVMs). Clinical and radiographic characteristics of 62 patients treated over 3 years were analyzed to determine if hyperemic complications (HCs) (defined as unusual perioperative edema or hemorrhage) and outcome could be predicted. Twenty‐five (40%) of the patients were less than 30 years old, 28 (45%) were between 30 and 50, and 9 (15%) were more than 50. A history of hemorrhage was found in 48%, and 34% presented with progressive deficits. Thirteen (21%) developed evidence of HCs; 51 (82%) ultimately had a good outcome, 4 (6%) had a poor outcome, and 7 (11%) died. The incidence of HCs was higher in patients whose AVMs recruited perforating vessels (53%) than those without (7%) (P< 0.001). The presence of preoperative angiographic steal carried a 35% risk of HCs whereas its absence carried a 13% risk (P< 0.05). The sum of the diameters of the feeding vessels was also predictiveP< 0.05). Outcome was clearly age‐related: good outcome was achieved in 92% of the patients less than 30 years old, 86% of those 30 to 50, and 44% of patients older than 50 (P< 0.05). Left hemispheric AVMs showed less morbidity than right (P< 0.05) as did those without perforating vessel recruitment (P< 0.07). HCs had a dramatic impact on outcome with 92% of patients without HCs having good outcome and 46% of those with HCs recovering well (P< 0.001). (Neurosurgery24:75‐79, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The alterations in metabolism and cerebral blood flow that occur following transient focal ischemia were studied in rabbits anesthetized with halothane and subjected to transient occlusion of an M2 segment of the middle cerebral artery (MCA). The parameters measured included intracellular brain pH and focal cortical blood flow (fCBF)—assessed by the umbelliferone technique—electrocorticograms, and cortical microcirculatory changes. A gradient of ischemia developed in the cortex between the patent and occluded vessels. Cortical sites with moderate and severely diminished flow were examined as a function of time before and after occlusion. Mean preocclusion fCBF was 50.8 ± 2.1 ml/100 g/min, and brain pH was 6.99 ± 0.04. Following occlusion, fCBF fell to 14.6 ± 2.3 ml/100 g/min, with an intracellular pH of 6.53 ± 0.03 in sites of severe ischemia in the territory of the occluded vessel. Sites between the patent and occluded branches revealed moderate changes in fCBF and intracellular pH of 26.7 ± 3.6 ml/100 g/min and 6.74 ± 0.03 ml/100 g/min, respectively. Sites adjacent to the patent M2 branch remained similar to baseline. Pretreatment intravenously with nimodipine, a dihydropyridine class of Ca2+channel antagonist, improved flow in the territory of the occluded segment of the middle cerebral artery to 30.6 ± 2.2 ml/100 g/min, while maintaining the brain pH at 6.83 ± 0.03. Similarly, at sites intermediate between the patent and occluded M2 segments of the MCA, cortical blood flow remained at 53.5 ± 4.0 ml/100 g/min, and the pH at 6.95 ± 0.04, in 10 animals pretreated with nimodopine. This effect was apparently achieved by blocking the secondary, ischemia‐induced vasoconstriction known to occur in areas of focal incomplete ischemia.The diphenylalkylamine class Ca2+channel blockers was examined using verapamil. This was found to be without significant effect. The vehicle carrying nimodopine was also without effect. To authenticate further the reliability of MCA occlusion, a separate group of animals was examined with cautery occlusion of the M2 segment of the MCA. Nimodopine had an effect in this group of animals identical to that caused by occlusion of the vessel with a clip. Visual inspection of the cortex in control and treated animals revealed a marked difference in the development of cortical pallor and microcirculatory changes. We conclude that nimodopine protects the conducting vessels against the secondary vasoconstriction known to occur in areas of focal incomplete ischemia, and thus increases collateral flow. This agent may have the potential for brain protection in areas of incomplete focal ischemia from occlusion of a single major vessel. (Neurosurgery24:80‐87,1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The authors report a patient with an aneurysm of the carotid siphon who underwent ligation of the cervical carotid artery. Six years after this procedure, the patient suffered a subarachnoid hemorrhage from an apparent de novo aneurysm. Pertinent literature is reviewed to determine the incidence of this occurrence, and congenital arteriosclerotic and hemodynamic factors causing aneurysm enlargement are discussed. (Neurosurgery24:88‐92,1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;An 18‐year‐old woman presented with visual disturbance and endocrine dysfunction (diabetes insipidus, delayed puberty, hypothyroidism, hypoadrenalism, and hyperprolactinemia). Computed tomography and enhanced cisternography showed a single hypothalamic mass, which proved at biopsy to be histiocytosis X. Further studies showed the disease to be restricted to the hypothalamus. The patient was treated with hormonal replacement therapy, but her visual acuity continued to worsen. Visual acuity improved after low‐dose irradiation of the pituitary fossa and hypothalamus, which also led to disappearance of the mass. This case shows that localized hypothalamic histiocytosis X can be diagnosed and treated successfully before other systems become involved. (Neurosurgery24:93‐95, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Aspergillusspecies are second only toCryptococcus neoformansas the most common cause of fungal infections of the central nervous system in immunocompromised patients. Survival following treatment ofAspergillusbrain abscess has been reported only 4 times. In each case, craniotomy was performed for abscess drainage. We present a case of long‐term survival following stereotactic drainage of a bilateralAspergillusbrain abscess. In all reported cases, including the present one, histological examination of the abscess contents established the correct diagnosis. Amphotericin B was used in combination with operation in 4 of the 5 cases of long‐term survival. (Neurosurgery24:96‐99, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;We present 6 patients with a definite diagnosis of von Recklinghausen's neurofibromatosis. All of them had aqueductal stenosis and hydrocephalus requiring surgical intervention because of clinical signs of increased intractranial pressure confirmed by pressure measurements. (Neurosurgery24:99‐101, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A 23‐year‐old Hispanic woman whose mother had died of a brain hemorrhage developed signs and symptoms of a brain stem lesion. These gradually progressed over the next 30 years. Her computed tomographic and magnetic resonance imaging scans show features typical of a cavernous angioma in the brain stem. Her daughter had a transient right hemiparesis at age 25, and at age 28 noted periorbital pain with twitching of the forehead and jaw. The daughter's computed tomographic and magnetic resonance imaging scans likewise suggest cavernous angioma of the brain stem. There has been only one other report of familial cavernous angioma of the brain stem, and that also involved a Hispanic family. Hispanics have a known predisposition to familial cavernous angioma, and this diagnosis should be considered when more than one person in a family develops brain stem symptoms. (Neurosurgery24:102‐105, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Intrasellar extradural placement of a detachable vascular balloon via a transsphenoidal approach was performed successfully in a patient with primary empty sella syndrome, relieving headache and visual field defect. This technique offers an alternative approach to other methods of treating symptomatic empty sella syndrome that require packing of the sella with fat, muscle, cartilage, or bone. (Neurosurgery24:105‐109, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Klüver‐Bucy syndrome is an uncommon constellation of behavioral abnormalities resulting from bilateral temporal lobe damage. The syndrome is rare in adults and even less commonly seen in children. In this paper we present a child with Klüver‐Bucy syndrome and bilateral temporal arachnoid cysts. (Neurosurgery24:110‐112, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID