摘要:

&NA;The long‐term results obtained in a series of 174 patients operated on for spinal meningiomas are critically analyzed. This series was similar to those of other authors with regard to age, sex, location of the tumors, and clinical presentation. Before surgery, about 70% of the patients were included in Groups I and II (mild neurological impairment), and about 30% of the patients were classified in Groups III and IV (significant to severe neurological impairment, up to paraplegia). Complete tumor removal was achieved in 96.5% of the patients, and surgical mortality was about 1%. Microsurgical technique, which was adopted in the last 29 cases, proved to be very effective in reducing undue damage to the spinal cord and in minimizing the postoperative neurological deficits. Of the 174 patients who underwent surgery, 156 underwent late follow‐up study for an average of 15 years (2 patients died in the immediate postoperative period, and 16 patients were lost to follow‐up). Twenty‐nine patients died of causes unrelated to the spinal meningioma; of the remaining 126 patients, 92% were categorized in Groups I and II, and only 8% in Groups III and IV. The rate of recurrence was 6% (9 patients) among the 150 patients who had complete tumor removal, and the rate of regrowth was 17% (1 patient with anaplastic meningioma) among the 6 patients treated by subtotal removal. The early diagnosis of the disease and the use of microsurgical technique appeared as the most relevant factors for further improvement of the surgical results. (Neurosurgery125:153‐160, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A retrospective analysis of the cases of 173 patients operated on for aneurysms and admitted to a neurosurgical service early after subarachnoid hemorrhage was conducted with respect to white blood cell (WBC) count and highest daily temperature. Daily trends for the development of clinically significant vasospasm (VSP) as well as mortality during the hospitalization were analyzed. An admission WBC count greater than 15 × 109/I was associated with 55% mortality as opposed to 25% mortality for those with a lower WBC count. The mortality of those with a temperature greater than 37.5°C on Day 0 was 60%, compared with 35% for those with a lower temperature. A WBC count greater than 15 × 109/1 on Day 0 was associated with a VSP rate of 40%; a lower WBC count was associated with a VSP rate of 30%. Day 0 temperatures >37.5°C were associated with a VSP rate of 40%, while patients with lower temperature had a VSP rate of 30%. By Day 6, the patients with temperatures >37.5°C had a VSP rate of 60%, double that of the VSP rate of those with temperatures <37.5°C. WBC count was apparently more closely linked to the chance of dying than the chance of developing VSP. The development of fever after a few days is related to both increased mortality and increased chance of developing VSP. (Neurosurgery25:161‐165, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A consecutive series of 118 patients operated on for ruptured intracranial arterial aneurysms was studied. Ninety‐six of them could be adequately examined with a battery of psychological tests and computed tomographic scans 1 year after a subarachnoid hemorrhage. Seventeen orthopedic control patients with no history of brain damage were also tested. The pattern of cognitive deficits was strongly related to the findings on the computed tomographic scans. Patients with left lateral infarctions had deficits on performances requiring verbal efficiency, including memory and classification tasks, whereas patients who had right lateral infarctions were poor on a visuoconstructional task (the copying of Rey's Figure). These deficits were pronounced when lateral infarction was associated with diffuse brain damage. Patients with frontal medial infarctions had low scores on memory tests: the inefficiency in verbal fluency, categorical reasoning, and memory was related to diffuse brain damage. The patients who had no infarctions did not differ significantly from the control group. Cognitive impairments after left lateral and frontal medial infarctions, as well as diffuse brain damage, correlated with the Glasgow Outcome Scale. (Neurosurgery25:166‐172, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;This experiment was designed to study the effects of intravascular volume expansion with crystalloid and colloid agents on intracranial pressure (ICP) and computerized electroencephalographic (EEG) data in dogs with cerebral vasogenic edema. A liquid nitrogen cold lesion was produced in the right parietal lobes of 30 anesthetized mongrel dogs. ICP data from an intraventricular catheter, hemodynamic data, and EEG power data were recorded continuously during the course of the experiment. Six hours after creation of the liquid nitrogen cold lesion, each dog was infused with one of the following treatments: 1) no treatment (control); 2) 5% dextrose in water (D5W) (30 ml/kg/h); 3) 0.9% NaCI (30 ml/kg/h): 4) hetastarch (10 ml/kg/h); and 5) hetastarch (30 ml/kg/h). The animals were treated for 2 hours, killed, and the brains examined and measured for water content. During the D5W infusion, ICP increased significantly (141%) but the EEG power data did not change. During the normal saline infusion, ICP increased significantly (91%) and the EEG power data showed marked deterioration. Both hetastarch infusions produced no change in ICP and demonstrated an improvement in the EEG power data (P< 0.001). These data suggest that crystalloid infusions may have profound deleterious effects in the presence of brain edema, but colloids do not, and should be considered in the fluid management of patients with cerebral edema. (Neurosurgery25:173‐179, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Despite the widespread availability of image‐guided stereotactic biopsy, the need for such procedures in patients with “clear‐cut” clinical and radiographic diagnoses is still frequently discussed. In an attempt to ascertain the incidence of unexpected pathological findings, 100 consecutive stereotactic biopsies have been reviewed. Twelve patients were found to have diagnoses of pathological conditions that preoperatively were considered unlikely, or not considered at all. The details of these “diagnostically discordant” cases are discussed. (Neurosurgery25:180‐184, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;In this study of 72 patients who had histologically verified thalamic astrocytomas, 44 patients underwent stereotactic serial biopsy, 22 underwent stereotactic resection of the neoplasm, and an additional 6 patients underwent stereotactic biopsy followed by stereotactic resection of the tumor at a later date. Of the 50 patients who underwent stereotactic biopsy, 3 were neurologically worse after the procedure (morbidity, 6%), and 3 additional patients with Grade 4 astrocytomas who preoperatively were rapidly deteriorating neurologically, died within 30 days of the procedure. Of the 28 patients who underwent stereotactic resection, 14 were neurologically improved after the procedure, 10 were unchanged, and 4 were worse. One additional patient died 10 days postoperatively. Thirty‐four patients had Grade 4 astrocytomas: 27 underwent stereotactic biopsies. The mean survival after biopsy and irradiation for patients with Grade 4 astrocytomas was 21.4 weeks. The mean survival was 62 weeks in 7 patients with Grade 4 astrocytomas who underwent stereotactic resection and radiation therapy. The mean survival time after biopsy and radiation therapy for patients who had Grade 3 and Grade 2 lesions was 54.4 weeks and 91 weeks, respectively. Twenty‐three patients had pilocytic astrocytomas; 8 underwent stereotactic biopsies, and 19 underwent stereotactic resection of the tumor (4 of these underwent biopsy prior to resection). There was no neurological morbidity, but one patient died after resection. Many of those who underwent resection were deteriorating due to an enlarging tumor mass or recurring cyst, and had undergone more conservative therapies such as biopsy and radiation. Even though stereotactic biopsy is appropriate in many patients harboring thalamic astrocytomas, selected patients with significant mass effect from solid tumor or recurring cyst can benefit from stereotactic resection. (Neurosurgery25:185‐195, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The contents of 14 cysts that were located within human intracranial tumors were obtained at surgery by needle aspiration. These tumor cyst fluids (TCFs) were mostly derived from glial tumors (10 cases). TCFs from one metastasis from a mammary carcinoma, one cystic meningioma, one hemangioblastoma, and a cystic acoustic neurinoma were also included. These TCFs were added to primary cultures of human gliomas, established human glioma cell lines, and normal human arachnoid cells in culture. The presence of proliferation‐promoting factors in all cyst fluids could be demonstrated. On the basis of the response patterns of the cultures, it was possible to distinguish different levels of growth autonomy and growth factor sensitivity among these cultures and to speculate about varying degrees of cellular autocrine activation. The TCFs appear to contain factors that are not normally present in fetal calf serum, which is a regular constituent of most cell culture media. Some primary cultured cells as well as cell lines react in an oversensitive manner to the addition of TCFs. (Neurosurgery25:196‐201, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Adoptive immunotherapy utilizing human recombinant interleukin 2 (rIL‐2) in conjunction with lymphokine‐activated killer cells has shown some efficacy in the treatment of various types of cancers, particularly renal carcinoma and melanoma. Intravenous administration of rIL‐2, with or without lymphokine‐activated killer cells, produces a variety of serious side effects and approximately one‐third of the patients experience a decrease in neurological status. Our previous investigations in animals have indicated that a single intravenous injection of rIL‐2 can compromise the integrity of the blood‐brain barrier (BBB). The present study examined the histopathological effect and BBB changes in rats which occur after a single intracerebral injection of rIL‐2, its excipient, or saline into the parietal lobe. Animals were killed at various intervals up to 8 days (1 hour after intravenous injection of horseradish peroxidase), and the brain tissue was sectioned and processed for light microscopy. All animals showed increased cerebrovascular permeability for horseradish peroxidase due to traumatic BBB disruption at 4, 12, and 24 hours after injection. Extravasation of horseradish peroxidase persisted at 3 and 8 days only in animals injected with rIL‐2. Injections of rIL‐2 led to an increased leukocytic infiltration into the injection site, perivascular cuffing, and localized edema by 24 hours, which continued to increase over the 8‐day study period. These results suggest that a single injection of human rIL‐2 into the brain of rats induces an influx of leukocytes into the brain and may contribute to the cellular events that perpetuate a trauma‐induced compromise in the integrity of the BBB. (Neurosurgery25:202‐208, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A major technical challenge to the use of interstitial hyperthermia in malignant brain tumors is the production of a well‐defined, uniform hyperthermal field. In theory, A 915‐MHz microwave antenna should allow fewer antennas to be used and cause less mechanical brain damage; however, standard radiation afterloading catheters require antennas to be 12 cm long; this is clearly impractical for intracranial use. Since alumina ceramic (A12O3) catheters permit short microwave antennas (3‐5 cm in length) to function properly in neural tissue, it is important to test the biocompatibility of alumina for use in combined interstitial microwave hyperthermia and brachytherapy. A 5‐mm length of alumina catheter was implanted into the brains of 15 white rats. The animals were killed at 3. 7, 14, 28, and 56 days. Histological examination revealed only minor mechanical damage and no encapsulation until I month; even then, the glial wall was only a few cell layers thick. Five animals received implants and were killed at similar intervals for x‐ray microanalysis with the scanning electron microscope. No migration of aluminum into the brain was detected when compared with two control animals that did not receive implants and an alumina blank. Although we measured 50% attenuation of the radiation from iridium‐192 sources in alumina catheters as compared with conventional ones, alumina catheters can still be used for interstitial radiation by increasing either the activity of the seeds or the duration of treatment. (Neurosurgery25:209‐213, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Repair of cranial defects for brain protection and aesthetics is currently a surgical problem for which there is no completely satisfactory solution. Material used for repair of cranial defects should ideally be incorporated by the body and provided a blood supply. No substance to date, including autologous bone, consistently achieves this. Hydroxylapatite is a polycrystalline, nonresorptive, biocompatible ceramic that allows osseous tissue ingrowth and ultimate transformation into vascularized bone. The authors have used granular hydroxylapatite successfully for reconstructing calvarial defects, but have experienced problems with migration of granules, prolonged mobility, and, in one patient, resorption of an underlying supporting bone graft. The use of hydroxylapatite in block form precludes most of these problems. Porous block or strips are easily contoured and can be fixed at the margin of the calvarial defect, providing immediate stability. Ingrowth of osteoblastic and fibrous tissue provides added strength and stability. This paper describes our experience with porous hydroxylapatite blocks for reconstructive cranioplasty. (Neurosurgery25:214‐217. 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID