摘要:

&NA;The anatomy needed to plan microoperative approaches to the lateral ventricles was examined in 20 cadaveric cerebral hemispheres. The neural, arterial, and venous structures in the walls of the lateral ventricles and the relationship of the lateral ventricles to the third ventricle and basal cisterns were examined. The operative approaches to the lateral ventricle are reviewed. (Neurosurgery19:685‐723, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;The effects of pulsatile and nonpulsatile perfusion on local cerebral blood flow (CBF) and on computerized mapping (CME) of electroencephalograms (EEG) in nonischemic and ischemic brain were studied using a canine stroke model. Nine anesthetized mongrel dogs were placed on normothermic right atrial‐femoral artery cardiopulmonary bypass at a flow of 100 ml/kg/minute. Local CBF measurements and CME data were collected during nonpulsatile perfusion and maximal pulsatile perfusion. The stroke model was then produced, and local CBF measurements and CME data were again collected during nonpulsatile and pulsatile perfusion. In the nonischemic brain, local CBF increased 19%, from 32 ± 10 to 38 ± 11 ml/100 g/minute (P< 0.01), when perfusion was changed from nonpulsatile flow (pulse pressure < 4 mm Hg) to pulsatile flow (pulse pressure 39 ± 11 mm Hg). In the ischemic brain, local CBF increased 55%, from 11 ± 5 to 17 ± 7 ml/100 g/minute (P< 0.01), when perfusion was changed from nonpulsatile (pulse pressure < 3 mm Hg) to pulsatile (pulse pressure 36 ± 7) flow. EEG power data, expressed as a power ratio index (PRI = low frequency power/high frequency power), improved significantly, from 110 ± 33 to 101 ± 41 (P< 0.01) with pulsatile perfusion. These data demonstrate the importance of pulsatile blood flow in ischemic brain. (Neurosurgery19:724‐731, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Aneurysms were induced in the rat common carotid artery by using the milliwatt cardon dioxide laser to weld an adventitia patch over a hole. This technique proved to be effective and reliable as demonstrated by the 100% incidence of aneurysm formation at the patch site in 28 rats killed 1 week or later after the procedure. It is suggested that this technique may be used to produce intracranial aneurysms in experimental animals due to the minimal vessel manipulation required. (Neurosurgery19:732‐734, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;This study evaluated quality of life in 78 patients with closed head injury (CHI) 2 to 4 years postinjury. Using both interview data and mean data from the Sickness Impact Profile questionnaire, impaired quality of life was observed in the areas of psychosocial functioning, social role functioning, leisure activities, and, to a lesser extent, physical functioning, during chronic phases of recovery. Relatives and close friends reported by means of the Katz Adjustment Scale that the CHI patients showed a series of negative behavioral symptoms 2 to 4 years postinjury. These data suggest that CHI patients may experience impaired quality of life in a number of domains well beyond the acute postinjury phases. An attempt was also made to compare patients' and relatives' reports of patient quality of life. Preliminary analyses indicated modest correspondence between relatives' and patients' ratings of some areas of postinjury dysfunction, including cognitive and behavioral slowing and social withdrawal. (Neurosurgery19:735‐743, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Stereotactic lesions for the treatment of tremor and rigidity in patients with Parkinson's disease are occasionally followed by neglect of the use of contralateral extremities for spontaneous movement when there are no specific sensory or motor deficits. A group of patients with neglected extremities was compared with a group of patients in which thalamotomy did not produce neglect. Neglect was shown by changes in motor performance, somatosensory evoked potentials (SEP) and electroencephalographic frequency induced by the lesion, as well as radiological evidence of brain atrophy and place and extension of lesions. Reaction time to both auditory and somatosensory stimuli was significantly increased only in the extremities contralateral to the lesion of patients with neglect; tremor decreased equally in both groups, and other motor abilities remained unchanged. P‐200 component of SEP decreased in amplitude and increased in latency only in cases with neglect, particularly ipsilateral to the lesion; early components and mean electroencephalographic frequency remained unchanged. Brain atrophy was significant in patients with neglect, particularly for the posterior portion of the 3rd ventricle. No differences in size and location of the lesions were found between the groups. Results indicate that this type of neglect is not secondary to lesions in specific sensory of motor pathways, but to lesions of structures coupling sensorimotor functions and the process of attention and that midline thalamic nuclei atrophy precipitates the neglect, perhaps by critically decreasing the amount of reticulothalamocortical projections engaged in selective attention. (Neurosurgery19:744‐751, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Testing of potential therapies for spinal cord injury has been significantly hampered by the unavailability of a standardized, reproducible animal model with predictable outcome at a given force of injury (dose‐response). The rat was selected in the development of this model in preference to larger animals for economy and availability; this permits use of large numbers of animals to increase statistical validity. In the experiments reported in this article, a static load method (weight placed gently on cord) of inducing cord injury was evaluated. A total of 198 Sprague‐Dawley rats were used. Under general anesthesia, a one‐level laminectomy was carried out at T‐12 with the dura mater intact. Weights varying from 80 to 150 g were lowered onto the dorsal surface of the intact dura mater for durations of 0 to 300 seconds. Recovery of motor function was assessed for up to 8 weeks using two behavioral tests, a modified Tarlov scale and an inclined plane test of hind limb motor function. A statistically significant relationship was found between force of injury and motor recovery as measured by the Tarlov scale, but this did not correlate with inclined plane performance; the duration that the weight rested on the cord did not influence outcome. Pathologically, there was variation in the extent of damage for a given injury load. A semiquantitative pathological assessment of cord injury showed a statistically significant correlation between pathological score and behavioral deficit as measured by the Tarlov scale, but this did not correlate with inclined plane performance. In view of these deficiencies, the static load technique does not seem to be an ideal model for spinal cord injury research. (Neurosurgery19:752‐762, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;A mathematical model was constructed to predict motor performance in rats for 8 weeks after spinal cord injury. The model is based on experimental data generated from an investigation of the static‐load technique of inducing cord injury and was derived using multiple linear regression. The regression coefficients for weight of the injury‐producing load were statistically significant (P< 0.001), and it was found that the weight of the load contributes over 95% of the posttrauma motor deficit, whereas the time duration of the load resting on the cord contributes less than 5% to the deficit. Sex, pretrauma motor performance, and pretrauma body weight are insignificant covariates. The model may be used to establish expected motor deficits and to derive dose‐response curves. (Neurosurgery19:763‐766, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Immunocomplexes (IC) in serum were analyzed in 54 patients with subarachnoid hemorrhage (SAH) from ruptured arterial aneurysms. A previous study had shown that patients with SAH and vasospasm had a significantly higher incidence of ICs in the blood than patients without vasospasm. The aim of the present study was to study how the IC content varied with time and compare this pattern with the clinical picture. Forty‐two patients presented clinical or radiological signs of cerebral vasospasm during their hospital stays, whereas 12 patients showed no such signs. The patients with vasospasm had a significantly higher amount of ICs in serum than those without vasospasm. In 37 patients with vasospasm, the changes of IC content during the 1st weeks after SAH correlated well with the clinical course. Data indicated that a high IC content preceded the onset of vasospasm and a low content preceded clinical improvement. This observation supports the idea that the presence of ICs might be the cause and not the result of vasospasm. (Neurosurgery19:767‐771, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;A series of 105 operative cases of thoracic and lumbar spine trauma is presented. All patients underwent an anterior decompression and fusion via the lateral extracavity approach with or without an accompanying posterior internal stabilization procedure (modified Weiss springs or Harrington distraction rods). All patients were allowed to plateau neurologically before reconstructive spine surgery was performed. The patient's neurological grade at the time of surgery and after recovery was assessed according to a seven‐grade scale presented herein. None of the 34 patients with a motor and sensory complete myelopathy recovered any function below the level in injury. Of the 10 motor‐complete patients with some sensory perception, 4 improved neurologically; however, only 1 of these improved to a state of limited ambulation. The rest remained nonambulatory. Of the 33 patients with significantly disabling incomplete motor and sensory myelopathies, 17 improved to a level of minimal neurological deficit; only 3 patients were left nonambulatory. Of the 21 patients whose physical finding demonstrated a minimal neurological deficit preoperatively, 17 recovered to a normal neurological state. Seven patients were neurologically normal preoperatively and were unchanged postoperatively. Reconstruction of the spine with an anterior decompression and an accompanying stabilization procedure, when appropriate, leads to a better neurological outcome than that expected with either a conservative, nonoperative approach or an operative posterior stabilization approach. (Neurosurgery19:772‐778, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;The records of 24 patients with malignant gliomas treated with carotid infusion of cisplatin and 1,3‐bis(2‐chloroethyl)‐1‐nitrosourea (BCNU) are reviewed for risk factors that might suggest the development of a permanent neurological deficit after infusion. Permanent neurological deficits were seen with doses of cisplatin as low as 69 mg/m2, although doses as high as 100 mg/m2were tolerated by other patients. All 3 patients who developed permanent neurological deficits received fixed doses of cisplatin of 150 mg and supplied only 2 major intracranial branches from the infused carotid artery. In none of these patients was a filter used in the infusion line. Other risk factors identified in 2 of the 3 patients were diffuse neoplasm involving the region of the internal capsule and the use of an infusion pump rather than a pulsatile bolus infusion technique. The development of a permanent neurological deficit appeared unrelated to the dose of BCNU within the range utilized, and preinfusion administration of corticosteroids did not prevent neurological deficit. These possible risk factors should be considered in the future development of protocols for arterial infusion therapy of malignant gliomas. (Neurosurgery19:779‐783, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID