摘要:

&NA;Primary neoplasms of the choroid plexus in children are surgically treatable, and the encouraging results of surgical removal, even for carcinoma, justify an aggressive surgical approach, Forty cases operated on over a span of 45 years have been reviewed in detail, including a rereading of all microscopic slides. The prognosis for children with papilloma has been excellent. The 5‐year survival rate for children with carcinoma of the choroid plexus was 50%, and all deaths occurred within 7 months of operation. The patients whose carcinomas were totally removed had a better prognosis than did those with subtotal removal. (Neurosurgery25:327‐335, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The operative and magnetic resonance image (MRI) findings of 25 patients with the diagnosis of lipomyelomeningocele and/or tethered cord were compared. Postoperative MRI scans of eight patients, five of whom were in stable condition, were also compared with the preoperative studies. In this review there was one false negative MRI scan and four MRI scans in which the relationship of the lipoma to the conus or filum was not demonstrated accurately. In six patients, incidental intramedullary cystic lesions at the conus were identified by MRI scan. All eight postoperative (1 month to 2 years) scans demonstrated no change in the level of the conus from the preoperative study. MRI is an accurate screening modality in the initial diagnosis of occult spinal dysraphism. MRI was not useful in the postoperative evaluation of lipomyelomeningocele and the tethered cord, since the caudal, posterior displacement of the conus was unchanged in all studies. (Neurosurgery25:336‐340, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Between October 1982 and August 1987, 20 patients underwent magnetic resonance imaging (MRI) and subsequent surgical release of a tethered spinal cord. The tethering was caused by a thick filum terminale in 6 patients. On MRI scans, the conus medullaris was at L4 in 2 patients, at L2 in 3 patients, and the filum terminale appeared thick in 1 patient. The spinal cord was tethered to an intradural lipoma correctly demonstrated by MRI in 6 patients. Increased epidural fat was misdiagnosed as an intradural lipoma in one patient and a lipomatous stalk was not identified in 2 other patients. Scar tissue resulting from repair of a meningocele had tethered the cord in the remaining 8 patients. On MRI scans, the conus medullaris was located between L3 and S3; in 5 of the patients, scar tissue was apparent on the MRI scan. This correlative study supports the use of MRI as the initial, and possibly the only, imaging modality when a tethered spinal cord is suspected. Improved or more recent MRI techniques will help demonstrate these anomalies better. (Neurosurgery25:341‐346, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A modified Nucleotome (Surgical Dynamics, San Leandro, California) was used to aspirate blood clot in an in vitro model of intracerebral hematoma. This machine was successful in removing the clot at a reasonably rapid rate. It aspirates normal rat brain far more slowly. It therefore shows promise for being effective and safe in removing intracerebral hematomas in humans. (Neurosurgery25:347‐350, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Since June 1985 100 cranioplasties have been carried out using titanium mesh and acrylic. There have been no complications and no infections. Titanium mesh is virtually radiolucent. Titanium is nonmagnetic and is the most biocompatible metal known. (Neurosurgery25:351‐355, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Nine patients with dislocation of the cervical spinal with posterior ligamentous damage were treated with posterior internal fixation using a twisted pair of 22‐gauge titanium wires and iliac crest bone fusion. Fixation using the titanium wire was compared with fixation using stainless steel wire for differences in surgical insertion, long term stability of bony fusion, and postoperative magnetic resonance imaging (MRI) artifacts near the implanted wire. MRI of the cervical spine is valuable for diagnosing the acute and chronic consequences of traumatic cervical spinal injury by providing anatomic evaluation of both the spinal cord and the supporting bony/ligamentous structures in the neck. Because MRI is an accurate and sensitive noninvasive test, it is especially useful for the long‐term serial assessment of the region near the cervical dislocation site to detect the sequelae of spinal cord injury, including syrinx, arachnoid cyst, cord tethering, and persistent mechanical impingement on the spinal cord or spinal roots. Previous attempts at our institution to obtain useful MRI scans of the cervical region adjacent to stainless steel wires after posterior wire fixation have failed due to marked imaging artifacts arising from the ferromagnetic properties of these wires. Our substitution of biocompatible titanium wire (Titanium 6 A1‐4V ELI alloy, Specialty Steel and Forge, Leonia, New Jersey) for stainless steel wire produced identical immediate stabilization and ultimate bony fusion of the fracture and yielded minimal MRI artifacts overlying the immediately adjacent spinal cord and neural canal; however, the installation was technically more difficult, because of the titanium wire's greater stiffness. We believe that the implantation of a permancent fixation device in these patients should be made of an MRI‐compatible material, such as titanium wire, to allow serial imaging with MRI in their lifelong medical care. (Neurosurgery25:356‐362, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;In order to determine the extent of cervical spine immobilization provided by the thermoplastic Minerva body jacket (TMBJ) 20 healthy male subjects underwent analysis of cervical spine motion before and after TMBJ placement. Maximal cervical flexion/extension and lateral bending were measured from lateral and anteroposterior roentgenograms, respectively. Maximal cervical rotation was measured from overhead photographs. The TMBJ significantly limited flexion/extension at each level of the cervical spine, as well as rotation and lateral bending (P< 0.001). Flexion/extension at each cervical level was found to be equal to that allowed by the halo with body jacket at most levels and less at the occiput‐C1, C3‐C4, and C6‐C7 (as reported in studies using similar methodology). The present study suggests that the thermoplastic Minerva body jacket is a valuable option for rigid external immobilization of the cervical spine. (Neurosurgery25:363‐368, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Arachidonic acid is released from cellular phospholipid membranes after brain injury associated with vasogenic edema. Intracerebral injection of arachidonic acid results in rapid breakdown of the blood‐brain barrier, followed by an increase in brain water and sodium content. This effect is diminished by a 5‐lipoxygenase inhibitor, but is unaffected by indomethacin, an inhibitor of cyclooxygenase. Leukocytes are rich in 5‐lipoxygenase and mediate posttraumatic extracellular edema in other tissues. We sought to determine whether leukocytes are necessary for arachidonic acid‐induced vasogenic edema and whether they are the primary source of 5‐lipoxygenase activity. Intracerebral injection of arachidonic acid (10 &mgr;g) was performed in 21 rats divided into three groups. One hour after injection, the area of Evans blue stain extravasation on the corona slice through the needle tract was quantitated by polar planimetry and taken as a measure of blood‐brain barrier permeability. Control animals (n = 7) had a 3.44 ± 0.19 mm2area of Evans blue cortical stain. Rats (n = 7) pretreated with a lipoxygenase inhibitor (BW755C) had a significant decrease (P< 0.05) in the area of Evans blue extravasation (0.56 ± 0.14 mm2). In animals rendered severely leukopenic (<500 white blood cells/&mgr;l), Evans blue extravasation was not significantly different from that seen in the control animals. Intracerebral injection of saline or eicosapentaenoic acid showed only minimal staining along the needle tract (0.14 ± 0.08 mm2). We have confirmed the role of the 5‐lipoxygenase products in arachidonic acid‐induced vasogenic edema. The primary source of cerebral 5‐lipoxygenase activity does not appear to be in leukocytes and is most likely within the brain parenchyma. (Neurosurgery25:369‐372, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Microvascular endothelial cells were isolated from gerbil brain and cultured. These cells retained an endothelial‐specific marker, FVIII‐related antigen. Alkaline phosphatase activity was also present in early passage. Two weeks after plating, these cells were attached to the culture dishes and had become like cobblestones in appearance. Then, the addition of tumor necrosis factor at a concentration of 1000 U/ml or more suppressed the DNA synthesis activity of endothelial cells by about 70% and induced morphological changes in the cells, which developed a spindle‐like form and showed overlapping of cells, indicating loss of contact inhibition. The administration of interferon‐&tgr; induced no change. When a similar experiment was performed using culture supernatants of human glioma cells that had been cultured for a few days, DNA synthesis activity was suppressed by approximately 50% or more in 6 of 12 samples. The suppression of activity, however, was abolished by the addition of anti‐tumor necrosis factor antibody in these 6 cases, suggesting the presence of activity resembling that of the tumor necrosis factor in the culture supernatants. (Neurosurgery25:373‐377, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A retrospective review of 526 patients who underwent neurosurgery for nontraumatic conditions over a 5‐year period revealed 36 (6.8%) patients with endoscopically and or surgically documented postoperative gastrointestinal (GI) complications. Two patients had GI bleeding and perforation, and the remaining patients had bleeding only. Multivariate analysis indicated 5 factors that were of independent significance in predicting the development of postoperative GI complications. These factors included 1) inappropriate secretion of antidiuretic hormone, 2) preoperative coma (Glasgow Coma Score <9), 3) the presence of postoperative complications, 4) age ≥60 years, and 5) pyogenic infection of the central nervous system. Further analysis of the 36 patients with GI complications revealed that they could be divided into three groups with different clinical courses. In Group I (n = 10), all patients died as a result of their neurological conditions; GI complications were just preterminal events and did not require treatment. In Groups II (n = 11) and III (n = 15), GI complications were symptomatic and life‐threatening events, respectively. Eleven patients from Group III died as a direct result of the GI complications. Separate multivariate analyses based on the patients in Groups II and III revealed that preoperative coma was the only significant factor that predicted the occurrence of life‐threatening complications. Patients who are at high risk of developing postoperative GI complications can thus be identified, and intensive prophylaxis may be instituted. (Neurosurgery25:378‐382, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID