摘要:

&NA;The records of 488 patients who underwent neurosurgical procedures in the sitting position were reviewed with special attention to the development of complications related to this operative position. The complications encountered included air embolus, pneumocephalus, subdural hematoma, compressive peripheral neuropathy, and orthopedic and dermatological problems. The 30‐day operative mortality was 2.5%. These complications and methods of prevention, diagnosis, and treatment are discussed in detail, and the literature concerning the sitting position in neurosurgery is reviewed. (Neurosurgery14:649‐658, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Dimethyl sulfoxide (DMSO) has shown promise as a drug for the treatment of intracranial hypertension. In this report, we describe our experience in six patients, two who received a bolus administration of 10% DMSO and four who received a 20% solution titrated against the intracranial pressure (ICP). Five of the patients in this series suffered from severe head injury, and one had a cortical venous thrombosis associated with pregnancy. The first two patients were treated with a rapid infusion of a 10% solution of DMSO. Initially, the ICP was satisfactorily controlled using this method. Over time, however, fluid overload, severe electrolyte disturbances, and an ultimate loss of ICP control occurred. In subsequent patients, a 20% solution titrated against the ICP was used. Although ICP control was better achieved using this method of administration, problems with fluid management and electrolytes occurred again despite a high level of vigilance. In addition, because of the solvent properties of DMSO and its propensity over time to dissolve most standard intravenous infusion systems, mechanical difficulties in its administration were encountered in all six patients. The mechanism of action of DMSO is not well understood. It differs from the barbiturates, but acts too rapidly to function solely as a diuretic. The drug is extremely complex to use, and difficulties with its administration may make its risks ultimately greater than its potential benefits. Until more laboratory data are available concerning its use and better delivery systems are developed, neurosurgeons are cautioned against treating intracranial hypertension with DMSO. (Neurosurgery14:659‐663, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Microfascicular double ligation and interligature heat sealing has been clinically successful in relieving neuroma pain. In rats. we found that this technique had no effect on the abnormal activities (such as mechanosensitivity and spontaneous activity) of single myelinated axons from neuromas or on their conduction velocity distribution. Assuming that the clinical success of this method is not fortuitous, we challenge the prevailing theory of the relationship between these abnormal unit activities and pain. (Neurosurgery14:664‐669, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Hakim's hypothesis, which explains the brain's adaptation to pressure in hydrocephalus and the enlargement of ventricular volume, was studied with computed tomographic (CT) scanning. The critical element in the theory is that brain water decreases when there is a pressure gradient within brain tissue. Extraaxial hematomas uniformly increase the CT density of adjacent brain tissue, and this is best explained by water shifts out of the tissue. In hydrocephalus cases studied early after shunting (10 days or less), a decrease in ventricular volume is accompanied by an overall decrease in the CT density of the brain. These CT changes support Hakim's view of the brain as a sponge that can change its hydration under pathological conditions. (Neurosurgery14:670‐675, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;The P‐300 component of evoked potentials to a rare tone was measured in normal volunteers and in patients with closed head injuries who either were confused (in posttraumatic amnesia) or had recovered from posttraumatic amnesia and were oriented at the time of recording. The latency of this component, which reflects cortical processing of stimuli, varied reliably, with the degree of orientation being longest for confused patients and shortest for normal subjects. On the basis of these data, we suggest that the P‐300 latency can be used as a physiological index of cognitive function in patients with closed head injury. (Neurosurgery14:676‐678, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Twenty‐eight evaluable children with the diagnosis of brain stem glioma were treated with 5‐fluorouracil and CCNU before posterior fossa irradiation (5500 rads); during irradiation, the children received hydroxyurea and misonidazole, The treatment was well tolerated, and minimal toxicity was produced. The median relapse‐free survival was 32 weeks, and the median survival was 44 weeks. Analysis of covariates showed that, in patients between the ages of 2 and 19 years, survival was longest in the older children (P< 0.02). Tumor histology, sex, extent of operation (if any), Karnofsky score, and radiation dose did not correlate with survival. (Neurosurgery14:679‐681, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Electrical stimulation was applied to the L‐5 and L‐6 dorsal root ganglia of 14 monkeys with concurrent monitoring of cortical and intralaminar thalamic evoked potentials. Both responses were decreased by root stimulation, although cortical suppression required current levels 50 to 100% higher. The evoked potentials remained suppressed for periods of up to 60 minutes after 10‐ to 15‐minute stimulation of the lumbar root electrodes. There was no increase in the duration of transmission block with longer stimulation periods. These results and available clinical data suggest that a local conduction block may be responsible for the pain relief produced by peripheral electrical stimulation. Further studies to identify more precisely the neural systems affected are required. (Neurosurgery14:682‐687, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;The purpose of this study was to document the changes in the cerebral and systemic circulations that result from various doses of naloxone. Twenty‐four dogs were anesthetized with 0.8% isoflurane and 70% nitrous oxide (1.3 minimal anesthetic concentration). Thirteen of the dogs received bolus injections of naloxone at logarithmically increasing doses 30 minutes apart. Blood flow to the brain and other organs was determined using the radioactive microsphere technique. Electrical activity was measured by electroencephalography (EEG). High dose naloxone increased both cerebral blood flow (CBF) and cerebral metabolism. The changes in CBF were most pronounced in structures containing a large amount of gray matter, particularly the cerebral cortex, brain stem, and cervical spinal cord. The increase in blood flow was proportionately greater than the increase in the cerebral metabolic rate of oxygen, and EEG activity was unchanged. Naloxone did not produce any significant cardiovascular changes or alterations in myocardial, renal, hepatic, stomach, jejunum, or temporalis and paraspinous muscle flow. Accordingly, it seems that naloxone may have direct cerebral vasodilator properties. (Neurosurgery14:688‐696, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;This randomized prospective study was designated to test the hypothesis that intraoperative and postoperative administration of a potent antiinflammatory steroid (dexamethasone) would reduce patients' postoperative pain. The hypothesis is based on the concept that inflammation is associated with a lowering of the threshold for nociceptive sense organs and that the inflammatory process is responsible, at least in part, for postoperative pain. The quantity of narcotics requested by the patients during the first 72 hours of the postoperative period was used as the measure of their postoperative pain. Patients treated with steroid who underwent lumbar laminotomy and discectomy used considerably less narcotic during the postoperative period than those not treated with steroid (Pvalue < 0.01). Less difference was noted in patients who underwent laminectomy, and no statistically significant difference was noted for those who underwent anterior discectomy. It is concluded that the use of an antiinflammatory steroid during and after operation significantly reduces the immediate postoperative pain after lumbar discectomy and may be useful in the postoperative management of other surgical procedures. (Neurosurgery14:697‐700, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;The quality of survival after severe and moderate head injury is highly dependent on the adequacy of cognitive recovery. The intellectual sequelae of head injury impede social and occupational reintegration more than physical disabilities do. The present study examines the course of cognitive recovery from the time of admission to 1 year after trauma. Included in the study were 68 patients with severe or moderate head injury who were 15 to 55 years old. The severity of injury was determined by the Glasgow coma scale. For this analysis, the data from tests of general intellect, language, verbal and nonverbal memory, and fine motor coordination were utilized. Standard scores (Z scores) were calculated for each test using the available normative data. Evaluation at discharge or 3 months after injury revealed I.Q. scores about 1.5 standard deviations (SD) below the mean, whereas language functioning was 4 SD, verbal memory was 5 SD, nonverbal memory was 5 SD, and fine motor coordination was 3 to 5 SD below the mean. All cognitive functions showed improvement over a 1‐year period. Most of the recovery in linguistic functioning occurred during the first 6 months after trauma. This study suggests that all patients sustain significant mental sequelae after severe or moderate head injury. In spite of significant improvement during the 1st year, patients continue to have marked impairment in cognitive functions. (Neurosurgery14:701‐708, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID