摘要:

&NA;The authors report a prospective, randomized 18‐month study on the effect of prophylactic antibiotic treatment in 152 hydrocephalic patients in whom clean shunt operations or revisions were done. The treated group received methicillin (totally 200 mg/kg) divided into six i.v. doses during 24 hours starting at the induction of anesthesia. Patients allergic to penicillin received erythromycin instead. Seventy‐nine patients received antibiotics, and 73 (the control group) received none. All patients were followed at least 6 months after operation or to their death. Eleven patients developed signs of infection, giving an overall infection rate of 7.2%; however, the infection occurred less than 1 month after the operation in only half of these. Six of the patients had septicemia, 4 had peritonitis, and 1 had meningitis. In the treated group, the infection rate was 8.9%; in the control group, the rate was 5.5%. There was no statistically significant difference. The prophylactic antibiotic regimen in this investigation did not reduce the infection rate connected with cerebrospinal fluid shunting procedures. (Neurosurgery17:1‐5, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;The authors report their personal experience with the administration of microdoses of morphine hydrochloride by the intraventricular route through a subcutaneous reservoir for the treatment of paraneoplastic painful syndrome of the cervicofacial region in 38 patients. The results obtained are very encouraging. (Neurosurgery) 17:6‐11, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;Appropriate treatment for intracranial mass lesions depends upon accurate histological diagnosis. Although both advanced generation computed tomographic and magnetic resonance scanners can detect small lesions within the brain stem, only the combination of these advanced imaging tools with stereotactic instrumentation permits safe and accurate pathological diagnosis of such lesions. We present the results of 13 operations performed on 12 patients with mass lesions of the pons and mesencephalon. A definitive diagnosis was obtained in all patients. Aspiration of necrotic tumors (3 patients), neoplastic or benign cysts (2 patients), and chronic hematomas (2 patients) resulted in immediate neurological improvement in 7 of these 12 patients. No morbidity or mortality related to surgery occurred in this series. Both the preoperative clinical and radiographic diagnoses were erroneous in 6 patients so that accurate histological diagnosis indeed altered subsequent therapy. A transfrontal approach to the midbrain and a transcerebellar approach to the lateral pons are described. The importance of accurate diagnosis, the possibility of definitive therapy in selected patients, and the encouraging benefits and safety of stereotactic surgery indicate that empiric treatment of mass lesions of the midbrain and pons is no longer justified. (Neurosurgery17:12‐18, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;The management of cystic supratentorial gliomas is hampered by lack of documentation of the natural history of these lesions and by a lack of evaluation of modes of surgical therapy. We analyzed these factors in 25 patients with solitary cysts operated upon over a 20‐year period. Two distinctive patterns of symptoms were seen: short duration (increased pressure and hemiparesis), most often heralding a malignant lesion, and long duration (commonly seizure disorder), associated more often with a benign pathological condition. Large solitary cysts were found in tumors of all histological grades. Surgical procedures included extirpation, biopsy/partial resection, cyst communication to ventricle or marsupi‐alization, burr hole aspiration, aspiration via an indwelling reservoir, and cyst‐peritoneal shunting. Radiotherapy, given in all cases, did not prevent cyst recurrence. Of the 25 patients, 76% are alive and remain cystfree at follow‐up intervals of 1 to 16 years (mean, 3.2). Five patients died from their tumors, with a mean survial of 33 months after decompression. In 7 of 8 patients with cysts largely or entirely within the basal ganglia or thalamus, successful operative cyst control was achieved. Patients with solitary cystic gliomas seem to have a favorable prognosis, and vigorous efforts to control cyst recurrence and limit disability are warranted. Analysis of our data suggests that craniotomy for tumor resection, cyst decompression, and tissue diagnosis is the initial procedure of choice. Cyst recurrence without major solid tumor should be controlled by computed tomography‐guided tap or shunt drainage. Reexploration is indicated when cyst reaccumulation is accompanied by clear regrowth of a solid component. (Neurosurgery17:19‐24, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;Primary intracranial rhabdomyosarcoma is rare. Twenty‐one cases with dismal outcomes have been reported. We add five children with this disease treated between 1977 and 1982. Their therapy consisted of surgical resection, craniospinal irradiation, and intravenous‐intrathecal chemotherapy. Two children have recovered, 21 and 67 months after diagnosis; the last is the longest survival reported in the literature. Two succumbed to tumor recurrence, and one died due to pulmonary embolism. The posterior fossa was invariably a site of tumor at presentation. Diagnosis with light microscopy can be elusive; electron microscopic and immunohistochemical evaluation are necessary to confirm the pathological condition. This is essential so that early, aggressive therapy can be instituted. These diagnostic and therapeutic techniques have led to a reevaluation of this malignancy and its prognosis. (Neurosurgery17:25‐34, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;Hypophosphatemia occurs in a variety of clinical conditions. It develops in parallel with phosphate depletion from body losses or more commonly as a sequel to the redistribution of phosphate from the extracellular to the intracellular compartment. Hypophosphatemia is a multisystem disturbance capable of involving the neurological, immunological, and muscular systems, among others. In this report, we describe five patients with severe head injury who developed marked hypophosphatemia (<1 mg/dl) within 24 hours of hospitalization. This fall in serum phosphate coincided with the induction of respiratory alkalosis consequent to mechanical ventilation. In four of the five patients, as acid‐base parameters returned to normal, serum phosphate values rose, in all instances reaching values greater than 2.5 mg/dl. Urinary phosphorus excretion, ordinarily negligible after hypophosphatemia induced by hypocapnia, was still present in Cases 1 and 4 (>600 mg/24 hours). This is unexplained by any of the known hormonal or fluid alterations that accompany head injury. These five patients developed severe, yet transient. hypophosphatemia that resolved upon correction of hyperventilation‐induced acid‐base abnormalities. We discuss the pathophysiology of this entity and the implications for the head trauma patient. (Neurosurgery17:35‐40, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;This study demonstrates residual mental deficits in patients who have apparently recovered after closed head injury. Twenty closed head injury patients were compared to 20 normal control subjects matched for age, sex, handedness, education, language, and IQ. All received a series of neuropsychological tests. Discriminant function analysis significantly differentiated the two groups. Correct classification of individuals as having suffered a head injury or not was 85%. The head injury patients did have primary impairment on tests of divided attention. Litigation was not a factor. We propose that this impairment of information processing reflects residual brain damage secondary to the closed head injury. (Neurosurgery17:41‐47, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;Thirteen patients with acute subdural and epidural hematomas were found to have fresh, unclotted blood at the time of surgical decompression several hours after injury. Computed tomographic (CT) scans of these patients demonstrated areas of hyperdensity, corresponding to clotted hematoma, admixed with areas of isodensity, corresponding to liquid blood. Active bleeding from identifiable loci was found in 11 patients, 4 of whom had massive hemorrhages. Clotting abnormalities ranging from slightly elevated laboratory test results to a full‐blown clinical picture of disseminated intravascular coagulation occurred in 8 patients. We describe the CT pictures of these “hyperacute” lesions, and we postulate that such CT presentations indicate either the presence of ongoing active intracranial bleeding or the onset of a coagulopathy complicating the management of these lesions. (Neurosurgery17:48‐56, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;The effects of three sequential injections of cisternal blood on ventricular size, cerebrospinal fluid (CSF) pressure, CSF formation rate, and CSF absorption rate were evaluated in adult rabbits. Autologous blood was injected into the cisterna magna on Days 1, 4, and 8 and ventriculocisternal perfusion was done on Day 15. Control animals received artificial CSF injection at these intervals. For each rabbit, the mean CSF pressure was higher after three injections of blood than before; 13 animals after blood injection had a mean CSF pressure of 15.59 ± 1.15 cm H2O (mean ± SE); before blood injection, their pressure had been 11.14 ± 1.43 cm H2O (all figures are means ± SE). This is a significant increase in pressure (P<0.01, paired t‐test). Further, the 13 rabbits with cisternal blood injection had a significantly higher CSF pressure than 5 control animals: 15.59 ± 1.15 vs. 10.50 ± 1.06 cm H2O. The animals with cisternal blood injection all developed some degree of hydrocephalus: the ventricle to brain percentage ratio was 9.84 ± 0.56 in blood‐injected animals and 2.38 ± 0.21 in control animals (P<0.01, two‐tailed t‐test). CSF formation and absorption rates were not significantly different after subarachnoid hemorrhage. The CSF formation rates were 9.85 ± 1.8 ų1/minute in the experimental group and 9.53 ± 1.9 ų1/minute in the control group; CSF absorption at the animal's opening pressure was 13.30 ± 2.06 ų1/minute in the animals with cisternal blood injection and 9.97 ± 2.4 ų1/minute in the control animals. Seven of 8 animals tested after blood injection had a pressure differential between ventricle and cistern, suggesting that relative aqueductal stenosis may play a part in the development of hydrocephalus after experimental subarachnoid hemorrhage. (Neurosurgery17:57‐62, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;Estimation of cerebrospinal fluid (CSF) outflow resistance (Ro) using a bolus injection method was carried out under normal conditions and in a state of artificially increased elastance produced by saline loading into the CSF space. These values of Ro were compared with Ro estimated by the steady state infusion method. Saline loading into the subarachnoid space decreased the buffering capacity significantly, as represented by the pressure‐volume index (PVI), which was lowered from 0.72 ml under normal conditions of 0.56 ml during saline loading. The estimated values of Ro under normal conditions and during saline loading were 90.6 and 133.6 mm Hg/ml/minute, respectively. The steady state infusion method yielded an Ro value of 166.3 mm Hg/ml/minute. Ro was therefore considerably underestimated by the bolus method when used under normal conditions of resting intracranial pressure. Moreover, its error was bigger when Ro was higher. On the other hand, during the course of saline loading, the estimated value of Ro using the bolus method was not significantly different from that estimated by the steady state infusion method, even in the higher range of Ro. Estimation of Ro by the bolus injection method was more reliable when the buffering capacity of the craniospinal space was reduced. (Neurosurgery17:63‐66, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID