摘要:

OBJECTIVE:The corpus callosum is the major commissural pathway connecting the hemispheres of the human brain. It is particularly important, because various tumors and vascular lesions can be located in and around the corpus callosum, and it is a route through which pass several surgical approaches. Performing accurate surgery in this region and avoiding damage to normal structures require that the neurosurgeon have adequate knowledge of the anatomy of the intricate blood supply to this area.METHODS:In 20 cadaver brains, the arteries of the corpus callosum were examined under the operating microscope, with particular attention to the origin, course, anastomoses, number, and caliber of the arteries.RESULTS:In all specimens, the pericallosal and posterior pericallosal arteries were found to be the main sources of blood supply to the corpus callosum. In 80% of the specimens, the anterior communicating artery gave rise to either a subcallosal artery or a median callosal artery, each of which made a substantial contribution to the blood supply of the corpus callosum. A detailed examination of the anatomic features of all the main arteries of supply revealed anastomoses within the callosal sulcus that formed the pericallosal pial plexus. This network supplied the corpus callosum, the radiation of the corpus callosum, and the cingulate gyrus.CONCLUSION:Familiarity with the details of the vascularity of the corpus callosum is crucial when performing surgery in this region. The additional, significant data described expands the knowledge of this anatomy, which can enhance the surgeon's ability to accomplish a more accurate and successful exploration.

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

OBJECTIVE:We have undertaken a retrospective analysis of 38 patients who were operated on for 40 meningiomas of the craniocervical junction between September 1977 and August 1995 to determine which factors influenced resectability, complications, and postoperative outcomes.METHODS:Radiological examinations, clinical data, and operation notes were evaluated, and additional follow-up information was obtained from outpatient examinations, telephone calls, and questionnaires.RESULTS:Four groups could be distinguished according to dural attachment as follows: 1) 15 spinocranial meningiomas originated from the spinal canal and extended intracranially; 25 craniocervical meningiomas of intracranial origin were divided into 2) meningiomas of the lower clivus (10 patients with 11 tumors), 3) lateral meningiomas (11 patients with 12 tumors), and 4) posterior meningiomas (2 patients). Standard midline or lateral suboccipital approaches with opening of the foramen magnum and laminectomy of the involved cervical segments were sufficient for the great majority of tumors. In seven instances only, drilling the posterior third of an occipital condyle was needed. Twelve of 15 spinocranial meningiomas and 13 of 25 craniocervical meningiomas could be removed totally. One patient underwent ventriculoperitoneal shunting only. With a rate of 63% of totally removed and 30% of subtotally removed meningiomas in this region, we observed clinical recurrences for two patients only. Complications were encountered in 30% of patients, predominantly with recurrent and/or infiltrative oren plaquemeningiomas. Whereas motor weakness and gait ataxia tended to improve postoperatively, cranial nerve deficits usually remained unaltered.CONCLUSION:The relationship of the tumor to neighboring structures, i.e., the vertebral artery in particular, determines its resectability. We recommend using extreme caution with recurrent oren plaquemeningiomas and tumors associated with extensive arachnoid scarring.

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

OBJECTIVE:We conducted a retrospective analysis of the clinical features of angiographically diagnosed unruptured intracranial aneurysms that were treated conservatively and subsequently ruptured.METHODS:At our center, we reviewed the angiographic and clinical features of 25 patients with subarachnoid hemorrhage caused by previously unruptured aneurysms.RESULTS:Eleven of the 25 patients died, including 1 patient who had undergone surgery. Ten patients had single aneurysms, and 15 had multiple aneurysms. Thus, multiple aneurysms were significantly more common than single aneurysms. The associated disease was cerebral infarction in 12 patients, previous subarachnoid hemorrhage from different aneurysm in 8 patients, intracerebral hemorrhage in 3 patients, and other conditions in 2 patients. Aneurysm size was able to be evaluated after rupture in 20 patients. At initial diagnosis, 16 aneurysms measured less than 5 mm in maximum diameter; the size of most aneurysms had increased by the time of rupture, although the aneurysm size remained less than 5 mm in five patients. No relationship was found between aneurysm rupture and patient age, aneurysm size at initial diagnosis, or time interval from diagnosis to rupture. The incidence of aneurysm rupture in patients with cerebrovascular disease, although higher than the incidence in patients with other underlying disease, was not significant.CONCLUSION:We conclude that small unruptured intracranial aneurysms measuring less than 5 mm are susceptible to the risk of rupture, so that radical treatment or careful follow-up examination should be considered.

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

OBJECTIVE:To evaluate the usefulness of pre- and post-therapeutic computed tomographic (CT) findings in predicting hemorrhagic complications, we retrospectively examined 35 patients treated with intra-arterial thrombolytic therapy for middle cerebral artery (MCA) occlusion.METHODS:The presence or absence of early CT findings (loss of the insular ribbon, obscuration of the lentiform nucleus, and cortical effacement) and the presence and location of extravasation of contrast medium were evaluated on pre- and post-therapeutic CT scans, respectively. According to the angiographic occlusive site, the patients were classified into the following three groups: Group 1 (n = 13), MCA trunk occlusion involved lenticulostriate arteries; Group 2 (n = 11), occlusion of the MCA trunk without involvement of the lenticulostriate arteries; Group 3 (n = 11), occlusion of a branch of the MCA. Hemorrhagic complications (hemorrhagic transformation and/or massive brain swelling) were evaluated by reviewing CT scans obtained 3 to 14 days after thrombolytic therapy.RESULTS:No patient without extravasation (n = 17) showed hemorrhagic complications, and extravasation is the most useful finding in predicting hemorrhagic complications. There was significant correlation between extravasation and hemorrhagic complications (P< 0.01). In Groups 1 and 2, there was also significant correlation between early CT findings and hemorrhagic complications (P< 0.01), indicating that early CT findings are also useful in predicting hemorrhagic complications. In Group 1, 10 of 13(76.9%) patients had both early CT findings and extravasation, and 6 of these 10 patients had hemorrhagic complications with clinical deterioration, suggesting the difficulty of thrombolytic therapy in this group. On the contrary, in Group 2, 8 of 11 (72.7%) patients had neither early CT findings nor extravasation and none of these 8 patients had hemorrhagic complications. In Group 3, however, early CT findings and extravasation had no correlation. Because the affected area was small in this group, it was difficult to evaluate cortical effacement. Although negative early CT findings did not always mean absence of extravasation and hemorrhagic complications in this group, the patients with hemorrhagic complications did not clinically deteriorate because of the small affected area.CONCLUSION:Hemorrhagic complications could be predicted by evaluation of angiographic occlusive site and pre- and post-therapeutic CT findings.

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

OBJECTIVE:Our surgical results of middle fossa arachnoid cysts are presented, and advantages and disadvantages of cystoperitoneal shunting are discussed.METHODS:Seventy-seven patients with middle fossa arachnoid cysts, including 20 cases of asymptomatic cyst, were treated by cystoperitoneal shunting. In cases associated with subdural hematoma, the cystoperitoneal shunt was preceded by irrigation of the hematoma. Follow-up periods ranged from 8 months to 16 years(mean, 7.7 yr).RESULTS:In all cases, postoperative computed tomography and magnetic resonance imaging revealed subsequent expansion of the surrounding brain, concomitant with either the disappearance of or a marked decrease in the size of the cyst. Patients who initially presented with headaches, hemiparesis, choked discs, and diplopia were cured postoperatively. Head enlargement presented preoperatively did not progress after shunting. Mental retardation and behavior problems, however, remained unchanged postoperatively, even though the cyst had disappeared. One cystoperitoneal shunt became infected, and shunt malfunction developed in eight patients. Four of the eight patients presented acute signs and symptoms of intracranial hypertension when the shunt malfunctioned, although the concurrent increase in cyst size was slight and ventriculomegaly was not seen. The observed condition in these four patients could be considered shunt dependency.CONCLUSION:Cystoperitoneal shunting is a valid method of achieving obliteration of the cyst and clinical improvement and seems to feature low operative risk and few complications. It should be noted, however, that some patients experience shunt dependency after cystoperitoneal shunting.

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

OBJECTIVE:The purpose of this study was to analyze the available clinical data on postoperative intracerebral hemorrhages that occur in locations remote from the sites of craniotomy.METHODS:The findings of 37 cases of postoperative intracerebral hemorrhages occurring remote from the craniotomy sites were reviewed (5 from our records and 32 from the literature).RESULTS:Remote postoperative intracerebral hemorrhages presented within the first few hours postoperatively in 78% of the patients and were not related to the types of lesions for which the craniotomies were performed. Supratentorial procedures that produced infratentorial hemorrhages involved operations in the deep sylvian fissure and paraclinoid region in 81% of the patients and hemorrhages in the cerebellar vermis in 67% of the patients. Infratentorial procedures that produced supratentorial hemorrhages were performed with the patient in the sitting position for 87% of the patients. The remote supratentorial hemorrhages that occurred were superficial and lobar in 84% of the patients, as opposed to deep and basal ganglionic, which are classic locations for hypertensive hemorrhages. Remote intracerebral hemorrhages occurring after craniotomies were not associated with hypertension, coagulopathy, cerebrospinal fluid drainage, or underlying occult lesions. These hemorrhages commonly led to significant complications; 5 of 37 patients(14%) were left severely disabled, and 12 of 37 patients (32%) died.CONCLUSIONS:Remote intracerebral hemorrhage is a rare complication of craniotomy with significant morbidity and mortality. Such hemorrhages likely develop at or soon after surgery, tend to occur preferentially in certain locations, and can be related to the craniotomy site, operative positioning, and nonspecific mechanical factors. They do not seem to be related to hypertension, coagulopathy, cerebrospinal fluid drainage, or underlying pathological abnormalities.

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1996

数据来源: OVID