摘要:

&NA;A 53‐year‐old man presented with polydipsia, polyuria, lightheadedness on standing, and syncope. Visual field deficits suggesting left optic tract compression and pituitary dysfunction consisting of diabetes insipidus, hyperprolactinemia, and anterior pituitary insufficiency were diagnosed. On the computed tomography scan, an isodense, ring‐enhancing, parasellar mass was localized primarily in the suprasellar region and also extended into the sella. It was believed that the pituitary hormone hypersecretion and hyposecretion were due to hypothalamic dysfunction from the mass which was initially believed to be a craniopharyngioma. At surgery a Rathke's cleft cyst was resected. The unusual presentation of this Rathke's cleft cyst presenting as a hypothalamic lesion is discussed. (Neurosurgery24:424‐428, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Hematopoietic proliferations rich in plasma cells rarely occur within the central nervous system without the involvement of other organ systems. Depending on their histological pattern and cellular composition, several different terms, including plasmacytoma, plasma cell granuloma, hyalinizing plasmacytic granulomatosis, and inflammatory meningioma, are used for these lesions. We report a left temporal dural lesion composed of plasma cells, lymphocytes, histiocytes, and rare eosinophils with hyaline changes and a suggestion of follicle formation, which stained predominantly for IgG and kappa light chains. This lesion arose in an otherwise healthy 52‐year‐old woman. Free kappa light chains without a monoclonal peak were found in the urine. We are aware of only two other heterogeneous, predominantly plasmacytic, solitary dural lesions that were found to be monoclonal on immunohistochemical examination. The label atypical monoclonal plasma cell hyperplasia appears to suit the morphological characteristics of our lesion. We suggest that a spectrum of solitary plasmacytic lesions may occur within the central nervous system and that atypical plasma cell hyperplasias have the potential to evolve into plasmacytoma. The preneoplastic nature of this lesion and its potential for evolution to malignant myeloma should be considered when planning treatment and lifelong follow‐up for patients. (Neurosurgery24:429‐434, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Histologically identical cases of glioblastoma multiforme in two siblings are presented. The diagnoses were made within 2 months of each other. Current knowledge of familial brain tumors is reviewed. (Neurosurgery24:434‐439, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A case of successful combination chemotherapy using cisplatinum, vinblastine, and bleomycin (PVB therapy) to treat medulloblastoma disseminated by cerebrospinal fluid is presented. In this case, a locally recurrent tumor and several disseminated tumors were seen to decrease in size on CT examinations. Pain in the lower extremities and urinary incontinence improved during three courses of PVB therapy administered during a period of 9 weeks. These results suggest that combination PVB therapy may offer one of the treatments of choice for recurrent or disseminated medulloblastoma. (Neurosurgery24:439‐443, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Hyperthermia has significant potential as an adjuvant form of brain tumor therapy. Current intracranial hyperthermia methods, however, are limited in their ability to control spatiotemporal thermal distribution. A stereotaxic magnetic movement system that may be capable of heating discrete regions of brain to a preselected temperature is described. With this system, a ferromagnetic object (referred to as a thermoceptor) is directed through the brain by an external drive magnet. Real time thermoceptor position is monitored with biplanar fluoroscopy and superimposed on a preoperative magnetic resonance imaging scan using a computer. Once in position, the thermoceptor can be inductively heated by externally generated radiofrequency signals. Experiments on the magnetic drive and imaging aspects of this system have been conducted in vitro and in vivo. Mechanical studies of cadaver dog brains revealed that a mean force of 0.07 ± 0.03 N was required to move a 3‐mm diameter sphere through brain at a speed of <1 cm/15 s. A cranial phantom with mechanical properties similar to brain was constructed of gelatin and Plexiglas. With the use of a “neck loop” design drive magnet with a maximum magnetic field strength of 0.10 T, a 3 X 3 mm cylindrical neodymium iron boron thermoceptor was smoothly directed through the phantom in two dimensions. Additional experiments were conducted with a larger drive magnet in five anesthetized dogs. Neodymium iron boron and samarium cobalt thermoceptors of various shapes and sizes were placed into the cerebral cortex through a burr hole, then directed with the drive magnet. Fluoroscopy was used to follow the thermoceptor movements. Thermoceptors were moved smoothly through brain parenchyma in three dogs and in the subdural space in two dogs. All dogs tolerated the procedure well; none developed neurological deficits. Histological examination of the brains showed thermoceptor tracts, but no evidence of significant hemorrhage. These results demonstrate the technical feasibility of the magnetic drive aspect of the stereotaxic hyperthermia system. Plans for further research and development are outlined. (Neurosurgery24:444‐448, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;High upper thoracic sympathectomy using microsurgical techniques aided by electrical stimulation of the sympathetic chain is described. Use of the microscope facilitates identification and dissection of the sympathetic chain and minimizes the risk of pleural damage. Electrical stimulation of the sympathetic chain establishes the correct functional level for surgical excision. At the correct level, the threshold for piloerection, sudomotor response, and decrease in blood flow of the ipsilateral hand to electrical stimulation was minimal, and a six‐fold increase in stimulus current causing current spread was required to dilate the ipsilateral pupil. After identification of the proper level, surgical excision can be done without risking postoperative Horner's syndrome. Excision of the appropriate ganglia and intervening sympathetic chain with placement of surgical clips on the proximal and distal nerve stumps provides tissue for histological analysis, decreases the opportunity for regeneration, and facilitates localization on postoperative x‐rays. (Neurosurgery24:449‐452, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Head and spinal cord injuries are the leading causes of death and disability in the age group from 15 to 24. The Oregon Head and Spinal Cord Injury Prevention Program study sought to determine whether an educational assembly program would affect students' knowledge, attitude, and behavior. An observation study on shoulder belt use showed no increase in usage following the program. Seven Portland high schools (4 experimental, 3 control) participated in a questionnaire evaluation. Two weeks before and after the educational assemblies, 1,331 student surveys were distributed nonrandomly in classrooms. Presurveys were matched to postsurveys by student name, resulting in 626 matches. Survey items are grouped into three categories: knowledge, attitude, and behavior. The experimental schools demonstrated a statistically significant increase in knowledge (two‐tailedttest,p< 0.01), suggesting that knowledge had been imparted. No change was found in attitude or behavior. To produce changes in attitude and behavior a reinforcement program might be necessary. Evaluation of the impact of the program on incidence may be premature. (Neurosurgery24:453‐458, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID