摘要:

&NA;Midbrain lesions were found in 23 of 35 autopsied, head‐injured people. These lesions were interpreted as “primary” that is. occurring at the time of impact. This interpretation was concordant with the clinical data, although the difficulty in establishing the precise moment at which the lesions were initiated in any individual case was recognized. Correlative clinicopathological data in head‐injured people showed that midbrain damage could be determined by evoked potentials (EPs). In a total of 165 head‐injured patients, the early presence or absence of evidence for midbrain lesions on EP examination was a powerful prognostic indicator of death or recovery. respectively. Autopsy and HP data showed that midbrain damage almost always occurred in the presence of hemispheric injury, but this fact should not obscure either the high frequency of midbrain lesions in those dying of head injury or the great prognostic value of their presence or absence. (Neurosurgery9:613‐620, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;The authors review 25 cases of post‐traumatic subdural hygroma in adults and report the findings of computer tomography in 4 cases. There was marked diversity in the severity of injury and in chronicity. The site of the lesion was consistently delineated by angiography, but preoperative differentiation from subdural hematoma was possible only with computed tomography. The mortality was 28%. Good recovery occurred in 48%. The prognosis was best among younger patients with subacute or chronic lesions. (Neurosurgery9:621‐626, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Between April 1979 and April 1981, 20 near‐drowned children admitted to Childrens Hospital of Los Angeles with a Glasgow coma score of 3 underwent intracranial pressure (ICP) monitoring and brain resuscitative therapy. By the 3rd hospital day, 14 patients had developed ICP elevation above 20 torr. and 11 of these had sustained intracranial hypertension above 30 torr. Ten of these children died, and 4 remain in a persistent vegetative state. Of 6 patients whose ICP never exceeded 20 torr. 3 recovered completely, 1 died, and 2 remain without any cognitive function. The salvage rate for patients with normal ICP after near‐drowning accidents is significantly better than that for patients in whom the ICP is elevated (P= 0.017). Intracranial hypertension is associated with a uniformly bad outcome and is frequent in patients who die or suffer permanent, severe central nervous system damage after near‐drowning. (Neurosurgery9:627‐630, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Twenty‐two patients with C‐2 fractures involving the odontoid process were treated by immobilization in a halo device. Six had associated spinal cord injury (1 complete and 5 incomplete). and 16 had no spinal cord injury. The age of the patients ranged from 20 to 86 years, with a mean age of 53. There were 15 cases in which the fracture line went through the base of the odontoid process only (Type 2). 1 case with a Type 2 odontoid fracture associated with a Jefferson fracture. 4 in which the fracture line involved the body of C‐2 (Type 3). and 2 cases with a Type 3 odontoid fracture associated with a Jefferson fracture. Eighteen of the patients were followed for at least 6 months (the mean follow‐up period was approximately 2½ years) to determine the results of bony fusion and neurological improvement. Three patients died early: 1 had no spinal cord injury and died of an associated head injury; 2 had spinal cord injuries and died of respiratory failure. One was lost to follow‐up. Successful bony healing and stability at the fracture site as indicated by flexion and extension roentgenograms of the cervical spine were achieved in 10 (59%) of 17 patients treated with the halo ring and vest only. Early fusion was required in 1 patient. and late fusion was required in 5 patients. The remaining 2 patients refused operation. Improvement in neurological status was noted in all four surviving patients with spinal cord injury. and none of the patients without spinal cord injury developed a neurological deficit during the course of the halo treatment. The average duration of hospitalization was 27 days for those without spinal cord injury and 70 days for those with spinal cord injury. Complications related directly to the halo devices were few and minor and included scalp infection. pressure sores. loosening of the halo pins, and 1 case of osteomyelitis of the skull. We found that the halo device is useful for immobilizing the cervical spine even in the presence of diminished sensation over the trunk. Except for the presence of certain types of coexisting head injury, an absolute contraindication to its use has not been encountered. The major advantage of the halo vest is that it allows external maneuvering of bony injuries in all three planes followed by fixation when acceptable reduction is attained without the need for early operation in patients who may already be very ill. The halo vest also allows early mobilization of patients and early discharge from the hospital. (Neurosurgery9:631‐637. 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Seventy‐five patients with trigeminal neuralgia were treated by the injection of 0.2 to 0.4 ml of glycerol by the anterior percutaneous route into the trigeminal cistern. which was visualized by the aid of contrast medium (metrizamide). Eightysix per cent of the patients were completely free from pain after the treatment, which produced only minimal disturbance of facial sensitivity. No complications have been observed. It is suggested that glycerol acts mainly on partly demyelinated nerve fibers, which are assumed to be involved in the trigger mechanism. (Neurosurgery9:638‐646, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Håkanson's treatment of trigeminal neuralgia by injecting 0.2 to 0.4 ml of glycerol into the cerebrospinal fluid in Meckel's cave was carried out in 27 patients with trigeminal neuralgia, 3 with atypical facial neuralgia, and 1 with post‐traumatic facial neuralgia. Minor modifications of his technique are described based on our finding of a greater pain and sensory loss upon injection than he noted. We present evidence that glycerol is more toxic than its cryoprotectant effect would intimate and that it selectively eliminates those components of the compound action potential in the trigeminal rootlets customarily associated with pain. We conclude that the method is probably going to be an improvement over radiofrequency heating for the treatment of trigeminal neuralgia in many situations. (Neurosurgery9:647‐653. 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Eighl cases of optochiasmatic arachnoiditis secondary to tuberculous leptomeningitis were treated with microsurgical intervention at the Department of Neurosurgery of La Raza Medical Center of the Mexican Social Welfare Institute. All of the patients had been amaurotic before the operation and displayed complete recovery of their vision during the immediate postoperative period. Microsurgical and pharmacological (antituberculous chemotherapy and steroids) treat‐ ment can cure such patients. (Neurosurgery9:654‐660, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Between 1969 and 1979, 22 patients with medulloblastoma were treated by the same surgical group and radiation therapy group. The patients were divided into two groups because of the clinical availability in December 1974 of the computed tomographic (CT) scanner and of the operating microscope used in the initial surgical procedure. There were 11 patients in each group. The percentage of patients with a relapse‐free survival in the group treated between 1969 and 1974 (Group I) was 38% at 4 years. The survival in the 11 patients treated between 1974 and 1979 (Group 2) was 84% at 4 years. This improvement is statistically significant (P≤ 0.001). All patients received the same dose of radiation. Efforts to minimize the tumor burden by total surgical resection did not increase postoperative morbidity or mortality. These results are discussed, along with the relative impact of the CT scan, total resection at operation. and increased focus for radiation therapy on the improved outcome. (Neurosurgery9:661‐664. 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;The cytoplasmic fractions of schwannomas (acoustic neuromas). meningiomas, and neurofibromas were assayed for the presence of estrogen receptors. Specific estradiol binding was detected in 7 of 16 schwannomas. 7 of 10 meningiomas, and 1 of 6 neurofibromas. A nontumorous vestibular nerve was also studied and showed no estradiol binding. In the tumors, the concentration of the estradiol binding sites as estimated by saturation binding analysis covered a wide range of values (21 to 2430 fmol/g of tumor) but. overall, meningiomas contained the highest amount of estradiol binder. A Scatchard plot analysis of one of the schwannoma specimens demonstrated high affinity estradiol binding (Ka = 1.695 × 1010M−1). Although there were more females than males in each tumor category, the overall incidence of estradiol binding was similar in males (5 of 11. 45%) and in females (10 of 21, 48%r). In 5 cases, progestin binding was also measured and was delected in two meningiomas (both from female patients): one meningioma and two neurofibromas showed no progestin binding. A discussion is presented of the possible role of estradiol in the pathogenesis or modulation of meningeal and Schwann cell tumors as well as in the genetic disorder neurofibromatosis. (Neurosurgery9:665‐671, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Hematoporphyrin derivative accumulates in malignant brain tumors and. when activated by light. can produce a cytotoxic reaction. A system for utilizing this concept in the treatment of human malignant brain tumors has been developed and tested in a small series of patients. No significant adverse reactions have occurred, and further development and research are planned. (Neurosurgery9:672‐678, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID