摘要:

&NA;A retrospective study of spinal epidural abscess spanning 10 years and encompassing 40 patients was done. Epidemiology, clinical features, laboratory findings, radiographic imaging, therapy, and outcome were examined and compared with previous series. An increasing incidence of the disease (up to 1.96 patients per 10,000 admissions per year) and an older, more debilitated population (67% having factors predisposing them to infection) were discovered. Over half of the population was studied with magnetic resonance imaging, which was found to be equally as sensitive (91%) as myelography with computed tomography (92%). Magnetic resonance imaging offers the advantages of being noninvasive and able to delineate other entities, which makes it the imaging modality of choice. Preoperative paralysis and neurological deterioration from normal were identified as poor prognostic features. Of 7 patients with preoperative paralysis, 5 died, and the rest failed to recover neurological function. Eleven patients with initially normal neurological exams deteriorated in the hospital before surgical intervention. Eight of these patients were being treated with appropriate antibiotics; 2 became paralyzed despite more than 3 weeks of antibiotic therapy. Only 3 of these 11 patients recovered fully. Immediate surgical decompression combined with antibiotics remains the treatment of choice. (Neurosurgery27:177‐184, 1990)

ISSN:0148-396X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;A review of our recent experience with spinal epidural abscess (SEA) reveals several important changing concepts in diagnosis, etiology, management, and outcome. All cases of SEA seen by our service from August 1975 to July 1989 were reviewed retrospectively, and 29 patients were identified (19 men and 10 women, aged 13‐78 years). Abscesses were located in the lumbar (n = 21), thoracic (n = 7), and cervical (n = 1) epidural spaces. Gram‐positive organisms were the infectious agent in 72% of the cases, andStaphyloccus aureuswas the sole agent in 45% other agents were Gram‐negative aerobes (n = 5), a Gram‐negative anaerobe (n = 1),Mycobacterium tuberculosis(n = 1), andSporotrichum schenckii(n = 1), the last occurring in a young woman with acquired immune deficiency syndrome. Seventeen patients had concomitant extraspinal infections. Diagnosis was confirmed by myelography, computed tomography, or magnetic resonance imaging. All patients underwent operative decompression and debridement; 2 required a second procedure for persistent infection. The most common operative findings were pus and granulation tissue in the epidural space (52%); the preoperative course correlated poorly with operative findings. The wound was closed primarily in 84% of cases. Postoperative intravenous antibiotic courses for the bacterial abscesses ranged from 1.5 to 6 weeks (median, 2 weeks), followed by antibiotics given orally for 0 to 6 weeks. Two patients died perioperatively. Neurological outcome was good in 21 patients and fair in 6 (mean follow‐up, 1.4 years). Over the last 50 years the spectrum of organisms causing SEA has broadened, and the distinction between acute and chronic SEAs has minimal clinical significance. In addition, magnetic resonance imaging has come to have an adjunctive diagnostic role. Treatment by operative debridement, primary wound closure, and short courses of antibiotics given intravenously and orally has a consistently good result, and prognosis has markedly improved. (Neurosurgery27:185‐192, 1990)

ISSN:0148-396X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Twelve children with pathologically confirmed, well‐differentiated spinal cord astrocytomas were studied, and correlations among the degree of resection, pathological characteristics, and time of recurrence were examined. Eight tumors were sampled for biopsy or subtotally resected, and 4 were thought to have been totally removed. Clinical recurrence was seen in 4 of 12 patients, 2 of whom died of their disease. The time to recurrence was 1, 2, 2, and 35 years, respectively. The other 8 children remain free of symptoms, with follow‐up ranging from 6 months to 35 years (mean, 8.8 years). In 3 of 8 patients who underwent biopsy or subtotal resection, the tumor recurred, and 2 patients died, whereas there was one recurrence in the patients in whom a “total” resection had been obtained. The histologically well‐differentiated nature of the lesions correlated well with the relatively prolonged clinical course seen in this series during the period of observation. The relatively long clinical courses seen in our limited series should be considered before high‐risk therapy for spinal cord astrocytomas in children is implemented. The presence of four pilocytic astrocytomas in this group was of special interest, and it seems likely that these discrete neoplasms can be distinguished from the more infiltrating fibrillary astrocytic neoplasms by magnetic resonance imaging with enhancement with gadopentetate dimeglumine. (Neurosurgery27:193‐196. 1990)

ISSN:0148-396X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Meningiomas and neurofibromas are the most common intradural extramedullary tumors of the foramen magnum and cervical spine. Many of these tumors are located ventral or ventrolateral to the spinal cord and medulla. Posterior approaches, although adequate for the management of most of these tumors, can sometimes result in incomplete removal of the tumor and exacerbation of the neurological deficits. Although the transoral and transcervical approaches provide a direct route to the tumor, the exposure of the lateral margins in the case of large tumors is inadequate. In addition, because of the removal of vertebral bodies, subsequent fusion may be necessary. In the present report, an extreme lateral approach to the foramen magnum and cervical spine for the removal of intradural tumors is described. The approach provides a lateral exposure of the tumor‐cord/stem interface, thus permitting safe dissection without retraction of the cord. The entire longitudinal and lateral extent of the tumor and also its extradural extension can be can be managed by this approach. This approach can be considered in such a group of patients harboring entirely ventral or recurrent tumors for which the conventional posterior approach has failed. Six patients who underwent this procedure are described to illustrate its application. (Neurosurgery27:197‐204, 1990)

ISSN:0148-396X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Compression of the cerebral peduncle against the tentorial incisura contralateral to a supratentorial mass, the so‐called Kernohan's notch. can be a cause of false localizing motor signs. The authors present a case of Kernohan's notch secondary to a traumatic extradural hematoma. The patient developed an oculomotor palsy and a dense motor deficit ipsilateral to the extra‐axial hematoma. Magnetic resonance imaging in the postoperative period clearly showed the midbrain lesion. The motor deficit and 3rd nerve palsy subsequently resolved. (Neurosurgery27:205‐207, 1990)

ISSN:0148-396X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Tissue tear hemorrhages (TTHs) are often seen on high‐resolution computed tomographic scans after closed head injury. Generally, TTHs have been thought to be visible manifestations of more severe forms of diffuse axonal injury and thus portend a poor prognosis. Computed tomographic scans from 600 patients with head injuries were reviewed: 48 (8%) were found to have TTHs. The clinical spectrum of TTHs was characterized. No direct relationship could be established between either the presence or the number of TTHs and the severity and/or outcome from the head injury in this group, except that patients with TTHs in both the brain stem and the corpus callosum uniformly had a poor outcome. Magnetic resonance imaging provided more sensitive information than computed tomography in evaluating TTHs. (Neurosurgery27:208‐213, 1990)

ISSN:0148-396X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Between 1987 and 1988, we utilized magnetic resonance imaging (MRI) in the diagnosis of seven cases of “subacute” pituitary apoplexy. that is, intra‐adenomatous pituitary hemorrhage associated with clinical symptoms atypical of acute pituitary apoplexy. These symptoms lasted longer than 24 hours and included visual changes in four patients, headache in five, and seizures, endocrine dysfunction, and oculomotor palsy in one each. Estimates of the ages of the hemorrhages were also possible based on characteristics on the MRI scan and ranged from 48 hours to more than 14 days. Four of our seven patients underwent transsphenoidal decompression at which time the presence of intratumoral hemorrhage was confirmed. The remaining three patients have been followed as outpatients with serial MRI examinations and have shown improvement in clinical symptoms and stabilization of the radiological picture. From our series of patients, it is now apparent that the MRI scan is an invaluable tool in identifying this subacute form of intra‐adenomatous pituitary hemorrhage and has proven especially useful as a means of therapeutic planning and follow‐up care in patients presenting with symptoms not typical of classic pituitary apoplexy. (Neurosurgery27:214‐219, 1990)

ISSN:0148-396X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;This study presents a new and simplified method of creating cingulate gyrus lesions by using stereotaxis guided by magnetic resonance imaging (MRI). Previous methods have utilized ventriculogram‐guided stereotaxis requiring indirect cingulate gyrus localization and general anesthesia. With the present technique a BRW stereotactic frame was applied with the patient under local anesthesia. An MRI scan was performed using a T1 signal (TR, 600 ms; TE, 30 ms) in the coronal plane with 5‐mm thick sections spaced every 6 mm. The coronal slice 24 mm posterior to the anterior tip of lateral ventricle was identified. The center of each (right and left) cingulate gyrus was identified as a target area, and appropriate coordinates were determined. Approach parameters were calculated for the right and left gyri using an azimuth of 45° and 315°, respectively, and a declination of 45°. A radiofrequency electrode was stereotactically placed so that the electrode tip was at a target point which was the center of the cingulate gyrus. A radiofrequency lesion (75°, 60 seconds) was made in each hemisphere's cingulate gyrus. Four patients with intractable terminal cancer pain have been initially treated in this manner. The lesions were well‐localized on postoperative MRI scans. There have been no complications except for perilesional edema for 10 days in 1 patient (treated with longer radiofrequency settings that have subsequently been modified). Short‐term pain relief in cancer patients was dramatic: morphine (intravenous 14 to 40 mg/h or oral 60 mg every 4 hours) preprocedure to oral oxycodone (1 to 2 tablets q4‐6h) or oral morphine (4 to 8 mg every 4 to 6 hours) postprocedure. The use of MRI‐guided stereotaxis to make cingulate gyrus lesions is an improvement that potentially allows the routine creation of these lesions as a standard cancer pain treatment. The technique is simple, uses local anesthesia, and appears to be effective and safe. (Neurosurgery27:220‐223, 1990)

ISSN:0148-396X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;The clinical and histopathological features of 19 patients with tumors involving the septum pellucidum are presented. These tumors predominantly affected young adults, and the clinical manifestations were usually the results of raised intracranial pressure related to obstructive hydrocephalus, mental abnormality, epileptic seizures, or a combination of these. Seventeen of the tumors grew mainly in the lateral and third ventricles, and the other 2 grew both into the lateral ventricle and the cerebral parenchyma. The direction of cellular differentiation of the tumor cells varied from patient to patient and consisted of 8 neurocytomas, 1 mature neuronal tumor with ganglionic and small round neuronal cells, 3 subependymomas, 3 subependymal giant cell astrocytomas, 2 pilocytic astrocytomas, 1 malignant astrocytoma, and 1 teratoma with embryonal carcinoma. These tumors were considered to have arisen from the multipotential cells in the subependymal plate or germ cell rests in the lateral ventricular wall, especially in the septum pellucidum. Because of the relatively inert biological behavior and histological features of most of these tumors, we favor the malformative theory of their origin. Either total or an extensive excision of the tumors in this series, which had developed mainly in the ventricular system, provided long‐term survival in many cases. (Neurosurgery27:224‐230, 1990)

ISSN:0148-396X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Forty patients with malignant supratentorial gliomas were treated with surgery, intra‐arterial infusions of 1‐(2‐hydroxyethyl) chloroethylnitrosourea, and radiation therapy. The median duration of survival was 12 months: it differed according to the histological subtype (over 30 months for patients with anaplastic astrocytomas or anaplastic oligoden‐droglioma and 10.5 months for glioblastoma;P= 0.0025). Serious complications of monocular blindness and leukoencephalopathy were observed in four patients (10%). (Neurosurgery27:231‐234, 1990)

ISSN:0148-396X    

出版商:OVID    

年代:1990

数据来源: OVID