ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;We have operated on 16 cases of arteriovenous malformation (AVM) in and around the sylvian fissure. We call these lesions “sylvian fissure AVMs” and classify them into four subdivisions, namely, pure, lateral, medial, and deep AVMs. By others, they have been variously called AVMs of the basal ganglia, insula, anterior choroidal artery, frontal lobe, or temporal lobe. These sylvian fissure AVMs showed similar angiographic findings: the feeders in all cases were branches of the middle cerebral artery; in some cases, additional feeders from the anterior and posterior choroidal and posterior communicating arteries were present also. We describe the characteristic features of these AVMs from the anatomical and surgical points of view. The surgical results were satisfactory in 15 cases (no additional neurological deficits), and 1 patient died. (Neurosurgery21:7‐14, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Magnetic resonance imaging (MRI) was performed in 15 patients with small to very large supratentorial arteriovenous malformations (AVMs). Unlike non‐contrast infused computed tomographic (CT) scanning, MRI demonstrated the AVM in all cases. The nidus had a characteristic honeycomb appearance, and in all cases feeding arteries and deep or superficial draining veins were demonstrated without intervening bone artifact. The relationship of the AVM to surrounding cortical areas, deep nuclei, important white matter tracts, and the ventricular system was well appreciated. These characteristics make MRI useful for the diagnosis of cerebral AVMs and add to the accuracy of systems that grade operability on the basis of the angiographic demonstration of size, location, depth, arterial supply, and venous drainage. In many cases, based on the MRI appearance of the AVM and its relationship to important brain structures, the lesion can be deemed inoperable or unsuitable for other forms of treatment, making angiography unnecessary. Thus, the superior anatomical and morphological resolution of MRI, the lower false‐negative rate, and the independence from x‐ray and contrast material make MRI more useful than CT scanning for the diagnosis of AVMs and as an aid in the management of specific cases. (Neurosurgery21:15‐20, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Forty‐two patients with supratentorial gliomas not involving the basal ganglia (extraganglionic) were studied pre‐ and postoperatively with computed tomographic (CT) scans to evaluate the effect of the extent of surgical resection on the immediate postoperative results. Thirty‐three patients (79%) had malignant astrocytic gliomas (glioblastoma or anaplastic astrocytoma), 4 patients (10%) had well‐differentiated astrocytomas, and 5 (12%) had oligodendrogliomas. The median age was 58 years, and the median Karnofsky rating was 70. There was no operative mortality. Six patients (14%) had surgical complications. A gross total resection was defined as the absence of any abnormal enhancement on the postoperative CT scan. A nearly gross total resection had been accomplished when less than 10% of the preoperatively enhancing mass was still seen. A partial resection was indicated by the presence of more than 10% of the enhancing lesion on the postoperative CT scan. A gross total or nearly gross total resection was accomplished in 36 patients (86%), and an improved or stable postoperative neurological status was present in 35 of these patients (97%). In contrast, the rate of neurological morbidity after a partial resection was 40%. Supratentorial extraganglionic gliomas, regardless of their histological type, generally were well‐circumscribed lesions except at the level of the ventricular wall, where glioblastomas and anaplastic astrocytomas blended with the subependymal white matter from which they seemed to arise. (Neurosurgery21:21‐26, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Eight cases are presented to summarize our experience with patients initially evaluated for the new onset of either seizure activity or focal transient neurological deficits. Each was found to have a normal computed tomographic (CT) scan with and without iodinated contrast infusion. All subsequently returned with a CT scan indicative of a glioma 2 weeks to 39 months later. The apparent reasons for the difficulty in early diagnosis of glioma in certain instances are discussed. A review of the literature with an analysis of the conglomerate data is presented. These cases probably represent a subset of gliomas undergoing anaplastic dedifferentiation from relatively benign to more malignant forms. Recommendations for clinical and radiographic follow‐up are outlined. (Neurosurgery21:27‐32, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;A 6‐year‐old girl developed a glioblastoma in the basal ganglia and brain stem 5 years after surgical excision and local irradiation (5460 cGy) for craniopharyngioma. Clinical and histological details are presented, and the literature on radiation‐induced gliomas is reviewed. (Neurosurgery21:33‐38, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Based on accumulating evidence of the role of xanthine oxidase (XO) in generating oxygen free radicals and causing tissue damage during ischemia, we examined the possible role of XO in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage (SAH). After inducing SAH in dogs by two autologous blood injections 2 days apart, chronic vasospasm of the basilar artery was reliably produced. There was a 3.5‐fold elevation in uric acid (UA), the product of XO, in the cerebrospinal fluid (CSF) of these animals. Parenteral administration of allopurinol (i.v., 25 mg/kg, every 6 hours), a specific blocker of XO, successfully abolished the elevation in CSF uric acid levels due to SAH. However, angiographic vasospasm measured on Day 7, morphological changes observed by electron microscope, and elevated CSF prostaglandin levels were not altered by the treatment. It can be concluded that the observed activation of the enzyme XO, which is a well‐known source of oxygen free radicals in ischemia in various organs, is not playing a major role in the pathogenesis of chronic cerebral vasospasm in this animal. (Neurosurgery21:39‐44, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Cerebrospinal fluid (CSF) lactate concentration is known to increase during the acute phase after severe head injury. To determine the influence of glycemia or cerebral ischemia on this lactate increase, we studied 69 head‐injured patients aged 28.7 ± 15.4 (SD) years with a mean Glasgow coma score of 5.7 ± 1.7 (SD). They were intubated, paralyzed, and artificially respired. We measured lactate and glucose concentrations in ventricular CSF (VCSF), arterial blood, and jugular bulb blood for 5 days. Samples were obtained within 12 hours after injury and at regular 12‐hour intervals. These patients were not treated for hypo‐ or hyperglycemia. Cerebral blood flow (CBF) was also measured within 12 hours and at 12‐ to 48‐hour intervals. Hyperglycemia was found consistently within 12 hours after injury (224 ± 98 mg/dl,P< 0.001), and mild hyperglycemia persisted during the entire period of study. The VCSF glucose course was parallel to that in blood (the initial VCSF glucose value was 128 ± 37 mg/dl.P< 0.001). The blood lactate value was also elevated during the first 12 hours (4.2 ± 2.0 mmol/litre,P< 0.001), normalizing within 24 to 36 hours. The VCSF lactate course was independent from that of the blood lactate value. It was significantly elevated within 12 hours after injury (5.3 ± 2.6 mmol/litre,P< 0.001) and remained so during the 5 days of study. A high initial VCSF glucose value was associated with a high initial VCSF lactate value. However, a high VCSF lactate concentration was present even when the glucose value was close to the normal level. Arterial‐venous differences (AVDs) of glucose and lactate indicated an uptake of glucose by the brain and a washout of lactate from the brain during the 5 days of study. Cerebral ischemia, as evidenced by low CBF or high arterial‐venous difference of oxygen or both, was uncommon in this study. When it occurred, it was not related to a high VCSF lactate concentration. Short term hyperglycemia after severe head injury may be related to a “stress” response to injury. Hyperglycemia coupled with impaired oxidative metabolism may be the cause of the initial high blood lactate value. The VCSF lactate increase outlasts the acute responses to injury. Increased VCSF lactate concentrations may reflect a dysfunctional cellular metabolism caused by the injury itself, aggravated by secondary insults. Although it is possible that hyperglycemia potentiates brain lactic acidosis after head injury, the high VCSF lactate value seems to be unrelated to global ischemia. VCSF lactic acidosis seems to be due to an inability of the central nervous system cells to metabolize the excess or even normal levels of substrate. (Neurosurgery21:45‐50, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Of 215 patients with severe head injuries, 33 (15%) closed head injury patients who talked before their conditions deteriorated to a Glasgow coma scale score of 8 or less were identified. Of this select group, 15 died (45%), but none of the remaining were left in a vegetative state and 14 patients had a “favorable” outcome (42%). Twenty‐five patients (76%) underwent surgical decompression. In these 25 patients, 14 subdural hematomas, 4 epidural hematomas, and 7 intracerebral contusions and hematomas were the initial surgical lesions. Twenty of the 25 patients were operated on within 4 hours (16 within 2 hours) of their neurological deterioration. Eleven of the 25 surgically treated died, for a mortality rate of 44%. All 15 deaths were studied further. Autopsies with examination of the brain were performed in 13 patients. Five patients died with severe brain injuries not complicated by iatrogenic factors, and 4 patients died of severe associated injuries. Iatrogenic factors significantly complicated the deaths of 6 patients (40%). It is concluded that most patients who “talk and deteriorate” have sustained very serious life‐threatening injuries. Intracranial hematomas are the most frequent cause of this situation, and rapid diagnosis and decompression is the most important factor in salvaging these patients. (Neurosurgery21:51‐55, 1987)

ISSN:0148-396X    

出版商:OVID    

年代:1987

数据来源: OVID