摘要:

&NA;The authors document their experience with the computerized tomographic (CT) scanner for evaluating gunshot wounds of the head. Only those patients who were considered to be operative candidates and who were neurologically stable were scanned. In the postoperative period, patients who were not scanned preoperatively and those whose condition did not improve were also scanned. In the preoperative period the CT scanner is useful for identifying and localizing missile tracks, bony and metallic fragments, intra‐ and extraparenchymal hematomas, intracranial air, and brain swelling. In the postoperative period the CT scanner may demonstrate retained bone fragments, edema, brain abscess, and intracranial air. The limitations of the CT scan in evaluating gunshot wounds include an inability to define vascular lesions such as traumatic aneurysms and post‐traumatic spasm. Metallic scatter from missile fragments may render certain CT cuts uninterpretable. In addition, the CT scan may appear minimally abnormal in spite of immediate and irreversible injury caused by a shock wave transmitted to brain stem structures. The CT scanner has superceded angiography as a diagnostic tool for evaluating gunshot wounds of the head because it is noninvasive and rapid, allows visualization of the entire head, can resolve very small lesions that produce little or no mass effect, can help to determine the nature of intracranial lesions, and may quantitate the amount of hemorrhage and edema. Because it enables physicians to visualize intracranial structures in three dimensions, the CT scan may precisely define missile tracks and contiguous lesions in a manner not heretofore possible with other diagnostic modalities. Thus, it is invaluable for the rational planning of surgical therapy.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;A total of 491 cranioplasties performed in a population of 1030 cases of penetrating head injury are reviewed. The morbidity rate was 5.5%, and the mortality rate was 0.2%. The clinical criteria of improving cosmetic defects and restoring craniocerebral protection are established, based on the location and size of the skull defect. Cranioplasty after penetrating head injury should be deferred for a minimum of 1 year to control morbidity. Complications of the original injury and surgical debridement increase the morbidity rate of cranioplasty. Post‐traumatic epilepsy is not related to skull defects per se; neither is it affected by cranioplasty. Acrylic is an acceptable cranioplasty material if there is strict adherence to good surgical technique.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Four children who had each undergone a transcallosal operation for a lesion in the anterior 3rd ventricle were studied extensively for behavioral abnormalities of the type that might follow a disruption of the corpus callosum. No such abnormalities were found. The operative technique used in these children is described.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;A technique of shunting the lateral ventricle to the superior sagittal sinus is described. It has been used in 36 adult patients; infection occurred in 2 patients (5.6%), and 2 patients required shunt revision (5.6%). The outcome of 18 patients with high pressure hydrocephalus could be validly evaluated, and successful control was achieved in 15 (83%). One of the 3 failures could have been avoided because shunting was undertaken before the ventricular fluid had cleared of blood. Four patients with normal or low pressure hydrocephalus were treated; only 1 had a successful result. This technique is suitable for patients with high pressure hydrocephalus and is of particular value in very ill or debilitated patients because of the rapidity with which it can be performed under local analgesia. Its use in normal or low pressure hydrocephalus must still be evaluated. In any event, the sagittal sinus is certainly a feasible alternate receptor site for ventricular shunting.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;From a series of 681 patients with lumbar disc disease treated between 1966 and 1978, 17 patients required surgical lysis of lumbar adhesive arachnoiditis, 8 having initially been operated upon by another surgeon. All patients had severe pain as a predominant feature, with pain being bilateral in 9 patients. Pain was the only major symptom in 3; the other 14 exhibited varying combinations of progressive neurological dysfunction. Three patients developed late symptoms after trauma, 8 to 21 years after back surgery. At operation, multisegmental arachnoiditis was found in 5 patients and anular or subtotal adhesions were found in 12. Complete lysis could not be obtained in 4 patients. Fourteen patients were treated with steroids at the time of operation. Follow‐up after lysis was less than 1 year for 5 patients but averaged 4.8 years for the remaining 12. During the 1st year after operation, 76% experienced improvement in pain (35%, good to excellent), and 71% experienced improvement in neurological status. Follow‐up after at least 1 year revealed 50% still enjoying pain relief (25%, good to excellent) and 45% experiencing neurological improvement. Pain relief persisted in 4 of 5 patients followed 5 years or more. The etiological role of myelography and lumbar disc surgery in arachnoiditis has probably been over‐rated. Arachnoiditis may be symptomatic or asymptomatic and may mask other, treatable lumbar lesions. More frequent intradural exploration for discrepancies between operative and myelographic findings might reveal, and benefit, more cases of spontaneous arachnoiditis mimicking lumbar disc disease.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Ventricular tumors of tuberous sclerosis are almost always hamartomas or benign tumors occurring predominantly in children or young adults. No clear gross or histological distinctions between the ventricular “candle gutterings” and “tumors” have been identified. The clinical presentation may be acute, with the sudden onset of increased intracranial pressure and possible serious morbidity (visual impairment) or death. When these tumors are surgically removed or decompressed, the prognosis for life seems to be quite good. Malignant change in these lesions is very rare.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Total microsurgical removal of 14 acoustic neuromas greater than 2 cm in diameter was performed through a unilateral suboccipital approach. Precise quantitative intracranial stimulation of the 7th nerve and recording of the evoked responses of the facial muscles were used to improve the identification and facilitate the dissection of the facial nerve. Preoperative evaluations, techniques, and results are discussed.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Details of an operative approach for low‐lying basilar aneurysms utilizing a combined supratentorial and infratentorial exposure with tentorial section are presented. This approach permitted the successful clipping of aneurysms of the caudal basilar artery in both of the cases presented. The advantages of this approach over the transclival, posterior fossa, and subtemporal approaches are discussed

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Two cases of oculomotor palsy occurring after head injury in a patient with an unsuspected pituitary adenoma are presented. A possible explanation for the appearance of this sign is suggested. The literature on post‐traumatic oculomotor palsy is briefly reviewed.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;A rare case of hydatid cyst of the skull is presented. The presenting symptom was an acute increase of the intracranial pressure. The patient was operated upon under emergency conditions with the diagnosis of a cystic lesion of the brain. After a brief review of the literature, the symptomatology of the disease is discussed. It is emphasized that radiological studies, especially plain x‐ray films of the skull, are most important in diagnosing the disease.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID