摘要:

&NA;The incidence, embryology, anatomical features of the site of junction, associated abnormalities, and survival of the 79 craniopagi reported from 1496 to 1987 have been reviewed. All craniopagi upon whom sufficient information is available have been classified on the basis of the deepest shared anatomical structure. (Neurosurgery21:769‐781, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The world's surgical experience on the division of craniopagi is reviewed, and a new case is reported. The problems, including ethical considerations, that must be addressed in selecting patients for operation and in preparing for the procedure are discussed in detail. Hemodynamic stability and the problem of intraoperative gravitational distortion of the brain are addressed. The importance of careful planning is stressed. Survival of the 31 craniopagi after operation is discussed in relation to types of junction. (Neurosurgery21:782‐791, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;In a review of 48 children who underwent temporal lobectomy for temporal lobe epilepsy, 16 patients had mass lesions in the temporal lobe. These mass lesions consisted of 12 tumors, 3 vascular malformations, and 1 arachnoid cyst. In 9 of 10 patients where the hippocampus was present in the pathological specimen and was not involved by tumor, there was concomitant mesial temporal sclerosis. All 16 patients have been followed for more than 1 year. Nine are free of seizures, with 4 of these 9 still on medication. Seven patients have had a greater than 50% reduction in seizures. (Neurosurgery21:792‐797, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The clinical features, diagnosis, and management of 23 posterior fossa epidermoid cysts and 9 petrous apex lesions presenting to one unit over a period of 20 years are summarized. Of the epidermoid cysts, 13 were entirely infratentorial, but the other 10 had an additional supratentorial component. Presenting symptoms and signs were usually long‐standing and at onset had often been vague and nonspecific. With time, however, a variety of neurological deficits that depended on the site of the lesion developed. These were generally combinations of cerebellopontine (CP) angle and jugular foramen syndromes, deafness, facial palsy, and motor weakness. Diagnostic procedures have changed greatly over the review period. Computed tomography and magnetic resonance imaging have replaced air encephalography and contrast ventriculography. The better preoperative localization of these lesions allows rational planning of the surgical approach required for optimal tumor exposure, which is essential for any attempt at total excision, considering the large size of the majority of these tumors when diagnosed. We favor operation through a posterior fossa craniectomy for those tumors restricted to the CP angle or 4th ventricle, but routinely use a combined supra‐ and infratentorial approach if the lesion has a more rostral component. The infiltrating nature of epidermoid cysts within the cranium compromises the extent of excision if neurological deficit is not to be increased, but we attempt as complete an excision of tumor and capsule as possible in the hope that many years will pass before symptoms recur. Cholesterol granulomas seem to respond well to simple cavity drainage and have shown no tendency to recur. (Neurosurgery21:798‐805, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The efficacy of three operative approaches to the cavernous sinus (CS) and the possibilities of vascular and cranial nerve reconstruction in and around the CS were studied in 50 cadaver specimens (25 heads). The lateral operative approach was through the lateral wall, between Cranial Nerves V1and IV, or between Cranial Nerves V1and V2. The superior approach was through the superior wall of the CS after removing the anterior clinoid process and unroofing the optic canal. The inferior approach followed the petrous internal carotid artery (ICA) into the CS after an extradural subtemporal exposure or after a combined subtemporal and infratemporal fossa exposure. The different exposures of the spaces of the CS and of the intracavernous structures provided by the superior and the lateral approaches were complementary. The exposure provided by the inferior approach was minimal; however, the junction of the petrous and cavernous ICA was best exposed by this route. The combined subtemporal and infratemporal fossa approach exposed the petrous ICA (for proximal control or for reconstruction) with the greatest ease and with the least temporal lobe retraction. The combination of the superior and lateral approaches and the complete mobilization of the intracavernous ICA facilitated its repair after experimental lacerations. Lacerations of either the inferior and the inferomedial aspects of any portion of the cavernous ICA or of the anterior surface of the posterior vertical segment of the artery were the most difficult to repair. End‐to‐end anastomosis was more difficult with the posterior third of the artery than with the anterior two‐thirds. A vein graft with an average length of 3.5 cm could be sutured from the petrous to the supraclinoid ICA to bypass the cavernous ICA, with an average occlusion time of 45 minutes. End‐to‐end technique was judged better for the proximal anastomosis, but end (graft)‐to‐side anastomosis was easier to perform at the distal end because of the location of the ophthalmic artery. Resuture of Cranial Nerves III and VI could not be performed in fresh cadavers if the gap exceeded 0.3 cm. In 3 specimens, the exposure of Cranial Nerve VI in the posterior fossa through the petrous apex and in the orbital apex was followed by graft placement (bypassing the CS). The complex anatomy of the cranial nerves at the apex of the CS was also defined in 10 specimens. Surgeons who perform operations in and around the CS for neoplastic and vascular lesions will find these studies useful. (Neurosurgery21:806‐816, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The pineal hormone melatonin (MLT) is secreted in a circadian rhythm with high serum levels during nighttime and low serum levels during daytime. Several authors have reported an altered secretion pattern of MLT in patients with pineal tumors and have proposed that MLT may be used as a tumor marker. In nine patients, a pineal region tumor was diagnosed by computer‐assisted tomography. Before and after surgical removal of the tumor, several day‐ and nighttime serum samples were collected and MLT concentrations were estimated by radioimmunoassay. Before operation, five patients presented a normal circadian pattern of MLT secretion. In the remaining four subjects, MLT levels were undetectable or at the limit of detection, with no signs of a circadian secretion pattern. Eight patients were reexamined after tumor resection, when all but one had undetectable or very low MLT levels. The remaining subject, with a pineomesencephalic pilocytic astrocytoma, dislocating but not involving the pineal gland, presented a normal circadian secretion pattern of MLT after operation; in this case, tumor resection was possible without damaging the pineal gland. Thus, before operation, MLT deficiency rather than exaggerated serum levels may be used as a marker for pineal tumors that destroy the pineal gland. After tumor resection, serum MLT may serve to demonstrate complete pinealectomy. (Neurosurgery21:817‐824, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;A technique to guide brain tissue sampling in experimental focal ischemia is described. This technique allows visual identification for accurate metabolic analysis of regions with variable tissue perfusion. After 2.5 hours of unilateral middle cerebral artery occlusion (MCAO) in the rat, intravenous infusion of the vital dye, neutral red (NR), identified three distinct regions: (a) an intensely stained region consisting of the entire contralateral hemisphere and the medial ipsilateral hemisphere; (b) a blanched region in the lateral ipsilateral hemisphere; and (c) a zone of intermediately stained tissue interposed between the medial and lateral ipsilateral regions. Close regional correlation between NR staining and the iodoantipyrine intensity of adjacent brain slices suggests that NR distribution is a qualitative indicator of brain perfusion. Using the NR staining pattern to guide tissue dissection for metabolite analysis of high energy phosphates (adenosine triphosphate and phosphocreatine) and glucose‐related metabolites showed that the blanched region contained ischemic tissue, whereas values from the contralateral cortex resembled those of control tissue. The intermediately stained region exhibited a gradient of metabolic perturbation. Tissue near intensely stained regions resembled control tissue, and tissue near blanched regions resembled ischemic tissue. These results confirm the concept of a metabolic penumbra. When present, it occupies only the most medial area of the intermediate region at 2.5 hours after MCAO. (Neurosurgery21:825‐830, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Hemispheric disconnection syndrome is a rarely reported sequela of aneurysm rupture. Serial neurobehavioral examinations of such a patient after clipping of a right pericallosal artery that had bled into a large portion of the corpus callosum disclosed defects in interhemispheric transfer of information and competitive movements between the left and right extremities. Although the patient's postoperative memory deficit subsequently resolved, his disconnection syndrome persisted and was primarily responsible for his disability despite otherwise normal neurological findings. We studied a second patient with a hematoma in the genu of the corpus callosum secondary to an arteriovenous malformation (AVM). Although the second patient also exhibited postoperative memory problems, her hemispheric disconnection symptoms were minimal and commensurate with a more circumscribed corpus callosum lesion. Neurobehavioral sequelae of aneurysm or AVM rupture involving the anterior circulation, which may be overlooked in the absence of a detailed examination, can produce persistent disability in many patients. (Neurosurgery21:831‐838, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The authors present a patient with a large arteriovenous malformation in the temperoparietooccipital region of the dominant hemisphere that caused seizures, a homonymous hemianopia, and broad neuropsychological disturbances probably caused by a cerebral steal syndrome. There was no history of hemorrhage. Surgical resection resulted in marked improvement of neuropsychological function and disappearance of the hemianopia. The authors discuss the pre‐ and postoperative neuropsychological findings, the pathogenesis of the steal phenomenon, and the indications concerning the resection of this large and deep‐seated arteriovenous malformation in a functionally important region of the left hemisphere. They state that surgical resection is the method of choice. (Neurosurgery21:839‐842, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The early transient postirradiation effects in the central nervous system are well known; however, no specific means of objective follow‐up have been devised. The xenon (133Xe) inhalation technique for measurement of regional cerebral blood flow (rCBF) is easily reproducible. Serial rCBF measurements corresponding to the clinical presentation and course of the early postirradiation syndrome have not been previously reported. It is our belief that the global decline in rCBF identified in these patients represents a generalized metabolic derangement induced by whole brain irradiation rather than primary vascular changes. A distinction between tumor recurrence and the early transient postirradiation effects can be made utilizing this technique. It also provides a reproducible monitor of the clinical and metabolic impact of radiotherapy for brain tumors. A series of seven such patients is presented with appropriate case histories and graphic representations of the serial rCBF measurements. (Neurosurgery21:843‐848, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID