摘要:

&NA;A group of 11 patients with a variety of lesions affecting the 3rd ventricle have been treated using a direct transcallosal interfornicial approach to the region. In 3 patients, no attendant hydrocephalus was present. In an effort to minimize potential cortical injury related to the approach, we studied the venous anatomy in the region of the coronal suture. Based on this study, appropriate flap placement and interhemispheric entry points were defined. Although no lasting, clinically apparent morbidity was observed in any of the 11 cases, we performed more sophisticated studies of the interhemispheric transfer of somesthetic and perceptual motor tasks, as well as psychometric testing related to parameters of intelligence and memory, 3 to 8 months postoperatively in 6 cases. The results and clinical material indicate that this surgical technique is a safe, feasible alternative in the management of a wide spectrum of pathological lesions within this region. A transcallosal, interfornicial approach offers excellent visualization of the entire 3rd ventricle without the dependence on hydrocephalus or an extensive extra‐axial mass to enhance the exposure. With proper planning and technique. it may be accomplished with a minimum of physiological consequence. (Neurosurgery10:547‐554. 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Twenty patients undergoing intracranial aneurysm clipping were anesthetized with doses of thiopental sufficient to produce electroencephalographic burst suppression, nitrous oxide, oxygen, and morphine sulfate. Diuresis was induced with a combination of furosemide and mannitol. The cardiovascular effects of this anesthetic technique were studied. The central venous, pulmonary artery, pulmonary artery wedge, and systemic arterial blood pressures and the cardiac output were determined. The cardiac index and the systemic and pulmonary vascular resistance were calculated. The systemic blood pressure remained unchanged throughout the procedure except during the period of induced hypotension. The cardiac index decreased on the average from 3.3 during the control period to 2.15 litres/minute/m2after the induction of anesthesia and diuresis (P< 0.05). During sodium nitroprusside‐induced hypotension, there was a further decrease in the cardiac index to 1.81 litres/minute/m2(P< 0.05). Changes in the cardiac index were associated with a significant decrease in the central venous and pulmonary artery wedge pressures (from 2.5 to 0.1 and 5.9 to 0.2 torr, respectively) and an increased systemic vascular resistance. Cardiovascular performance recovered quickly after termination of the induced hypotension and remained stable in the postoperative period. This anesthetic technique seems to be useful in the surgical repair of intracranial aneurysms. (Neurosurgery10:555‐562, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Seven of 120 aneurysm patients admitted to the Henry Ford Hospital from October 1978 to August 1981 had giant internal carotid artery aneurysms that were treated by a combined internal carotid artery occlusion and extracranial‐intracranial anastomosis. Three of these patients developed postoperative ischemic complications during the progressive closure of the carotid artery. These complications included the transient onset of syncope, hemiparesis, hemisensory deficits, and dysphasia. These complications resolved after the clamp was reopened and/or intravenous heparin was given. The possible mechanisms involved in the development of ischemia included the development of emboli at the occlusion site or inadequate flow originating from the area of the anastomosis. Prolonged occlusion of the vessel over a 7‐ to 10‐day course with concurrent administration of intravenous heparin is recommended. (Neurosurgery10:563‐570, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;T‐lymphocyte subpopulations (Tg or “suppressor cells” and Tm or “helper cells”) in the peripheral blood of 16 patients with malignant intracranial gliomas were analyzed. The number of Tm‐lymphocytes was very close to normal in both preand postoperative samples, whereas Tg‐lymphocytes were significantly increased preoperatively (18.55 ± 1.11 vs. 12.72 ± 1.19,p< 0.001) and were still slightly higher than normal after operation and radiation treatment. These preliminary findings suggest a possible role of T‐suppressor lymphocytes in the impairment of cell‐mediated immunocompetence that has been observed repeatedly in patients with malignant gliomas. (Neurosurgery10:571‐573, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Brain stem tumors constitute about 10 to 20% of all pediatric brain tumors. The clinical manifestations are protean and may be produced by malignant as well as benign lesions. Although the computed tomographic (CT) scan has contributed considerably in the diagnosis of these lesions, it is not possible to differentiate these tumors from viral encephalitis of the brain stem, vascular malformations, and other benign lesions. Over the years, biopsy of brain stem lesions has been considered a low yield and high risk procedure. In one of the recent series, the incidence of nondiagnostic biopsy approached 20% and major deterioration of cranial nerve function also occurred in 20% of the cases. Traditionally, suboccipital craniectomy and biopsy of the floor of the 4th ventricle has been used. This is usually associated with aggravation of cranial nerve deficits. Review of pathological specimens indicates that brain stem gliomas most often involve the pons, with predominantly unilateral involvement, and frequently fill in part of the cerebellopontine angle. On this basis, we have recently used a retromastoid approach on five patients with brain stem tumors to obtain biopsies from the ventrolateral pons and the cerebellopontine angle. A diagnosis was made in each case without complication. Minimal morbidity might be anticipated from this approach, as all cranial nerve nuclei are far away from the biopsy site. The biopsy of brain stem lesions is extremely important because aggressive therapeutic decisions may be made only after a histological diagnosis has been made. In one of our cases, a diagnosis of medulloblastoma was made in a patient with a clinical and CT scan diagnosis of brain stem glioma; this diagnosis changed the treatment plan. The retromastoid approach for the biopsy of brain stem tumors is a safe procedure with minimal morbidity and a high diagnostic yield. (Neurosurgery10:574‐579. 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;A protocol has been developed to use the GE 8800 scanner and its resident programs to calculate stereotactic coordinates. which has made it possible to use any stereotactic apparatus without modifying the apparatus in order to introduce a cannula into any lesion visualized on a computed tomographic (CT) scan to biopsy tumors. drain abscesses. implant radioisotopes. etc. The CT scanning is done in a routine fashion except that a lateral ScoutView. with the planes of each CT slice indicated, is included. Once the CT scan has been completed, resident programs for measuring distances are used to establish a zero point on a reference plane, from which all other coordinates can be defined. The stereotactic procedure is done at a separate time in the operating room, using the coordinates derived from the CT scan. The ScoutView image is compared to the lateral x‐ray film taken during the stereotactic procedure to establish the location of the targets. It has been estimated that the accuracy of this system is 3 mm. Abscesses less than 1 cm in diameter deep within the cerebral hemisphere have been accurately aspirated and tumor biopsies have been successfully taken. (Neurosurgery10:580‐586, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Central and lateral stenoses of the lumbar neural canal are relatively less common causes of chronic pain in the lumbar back and the legs. However, their incidence is much higher than was previously thought. Accurate anatomical diagnosis was difficult until the advent of high resolution computed tomographic scanning. Appropriate decompressive surgery can now be designed and “guided” by the scans and the clinical syndrome. New or highly modified surgical procedures are now being used with good to excellent clinical results in as high as 80% of the cases depending upon the technique chosen. Many of these cases are failed back surgical cases and those whose diagnoses were not established by standard means, e.g., plain films, myelography, low resolution tomography, discography, etc. The good results reported here include patients with pain and disorders of long standing. (Neurosurgery10:587‐592, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Infarction in the vertebrobasilar system is uncommon in children. Cerebellar infarction presenting as a posterior fossa mass lesion is distinctly rare. We recently treated a 13‐year‐old boy with such a lesion as a complication of basilar artery migraine. A review of the literature on vertebrobasilar infarction in children is presented and the therapeutic alternatives in cerebellar infarction are discussed. (Neurosurgery10:593‐596, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;We report a case of shunt malfunction despite a working flushing device and free cerebrospinal fluid flow from the ventricular catheter. The ventricular end of the catheter had been placed in the cistern of the transverse fissure. (Neurosurgery10:597‐599, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;The fatal rupture of a previously unruptured giant middle cerebral artery aneurysm occurred 13 days after an extracranial‐intracranial bypass had been carried out, before definitive aneurysm surgery. Alterations in blood flow adjacent to the aneurysm after the bypass may have led to the fatal hemorrhage. After a preliminary extracranial‐intracranial bypass procedure, there should be no undue delay in the direct attack on a giant aneurysm, regardless of its mode of presentation. (Neurosurgery10:600‐603, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID