摘要:

&NA;The symptoms and signs of cerebrovascular insufficiency occur more frequently in the elderly population. It has often been assumed that individuals over 65 years of age are poor surgical candidates and that, therefore, prophylactic procedures should be withheld. The author reviews his experience with 25 elderly patients who had evidence of cerebrovascular insufficiency and lesions that were inaccessible to standard extracranial vascular surgical techniques. In this series, there were no deaths and there was only one neurological complication, which was a hypertensive hematoma that occurred during the immediate postoperative period. The only patient whose postoperative hospitalization was longer than 7 days was the individual who had the intracerebral hematoma. All patients with superficial temporal‐middle cerebral artery anastomoses underwent angiography immediately after operation, and all of these bypass grafts were found to be patent. Extracranial‐intracranial bypass grafting seems to be well‐tolerated by elderly individuals, with minimal morbidity and mortality. (Neurosurgery8:517‐519, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;The intravascular volume and cardiac status of two patients who were thought to be at high risk to develop ischemic symptoms while undergoing graded cervical internal carotid artery occlusion were monitored by a dye dilution technique. Based on information obtained from this multivariable quantitative cardiopulmonary monitoring, measures were taken to maintain normo‐ to hypervolemia and to maximize cardiac performance. These medical adjuncts were thought to decrease the possibility of ischemic deficits while gradual occlusion of the internal carotid artery was being performed. (Neurosurgery8:520‐524, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Twelve patients with communicating hydrocephalus were studied with a servocontrolled lumbar infusion technique to measure net cerebrospinal fluid (CSF) absorptive capacity and resting pressure. Each patient showed a significant absorptive reserve; the rate of CSF absorption exceeded the rate of formation over a physiological range of pressure. The size of the ventricles did not correlate with either the absorptive capacity or the resting pressure parameter, or both. The data suggest that communicating hydrocephalus does not reflect a simple imbalance between the rates of CSF formation and absorption. Other factors must be of etiological importance and are considered in the discussion. (Neurosurgery8:525‐530, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;In children, hypothalamic‐hypophyseal syndromes such as diabetes insipidus, precocious puberty, growth retardation, and panhypopituitarism can be due either to structural lesions or to functional disorders of the cerebral endocrine complex. When clinical and endocrinological parameters fail to distinguish between these etiologies, neuroradiographical diagnosis becomes extremely important. Although conventional intravenously enhanced computed tomography (IVCT) is satisfactory for the diagnosis of lesions larger than 1 cm, metrizamide CT cisternography (MCTC) greatly improves the diagnostic yield for smaller juxtapituitary masses in the suprasellar cistern, clearly defines their sizes and relationships with contiguous structures, and definitively confirms the diagnosis of empty sella syndrome. Six patients with endocrinopathies and normal or ambiguous IVCT findings are presented to illustrate how MCTC can influence their management and outcome without the patient discomfort and technical complexity associated with pneumoencephalography. (Neurosurgery8:531‐541, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;The authors report a series of 80 cases of traumatic subdural hygroma and discuss the clinical and radiological features, management, surgical results, and pathogenesis. Changes in mental status without focal signs of brain damage were noted in over 50% of the cases. A clinical course marked by stabilization without complete recovery of neurological function was found in over 40% of the cases of “simple hygroma.” The lumbar cerebrospinal fluid often showed hemorrhage and elevation of the protein content. Skull fractures were found in 39% of the cases, and subdural hygromas were associated with cerebral atrophy, cortical contusions, subdural hematomas, and overlying epidural hematomas, and overlying epidural hematomas. The characteristic angiographic and computed tomographic scan findings are discussed, as are surgical pathology and outcome. Several theories of pathogenesis are presented. The authors advocate simple burr hole drainage as the treatment of choice. Significant reaccumulation may occur occasionally. (Neurosurgery8:542‐550, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;We have used the rapid progression of post‐traumatic uncal herniation in spite of intensive medical therapy as the indication for twist drill trephination in the emergency department. During a 54‐month period, 51 trephinations were performed on 41 patients. The trephine was placed through the temporal bone ipsilateral to the dilated pupil, and the dura mater was opened to allow partial evacuation of a hematoma. All patients subsequently underwent craniotomy, autopsy, and/or cerebral computed tomography (CT). The trephination was diagnostically accurate for the absence or presence of an extracerebral hematoma in 42 of 51 trephinations (82%). In 6 of these cases the dilated pupil responded to partial hematoma evacuation by decreasing in size. In 3 of the 6 there was a marked overall improvement in neurological status subsequent to trephination. These 3 patients later recovered to an independent functional state. Only 23 of these 41 patients (56%) with herniation profiles actually had significant extracerebral hematomas. This fact emphasizes the inadvisability of taking this type of patient directly to the operating room without a diagnostic study. A rapidly performed CT scan is the obvious first choice. However, if there is any delay in obtaining this study or when uncal herniation occurs rapidly, a twist drill trephination can be of value in diagnosing the absence or presence of a treatable extracerebral hematoma. There were no complications related to this procedure in this group. (Neurosurgery8:551‐554, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Eleven cases of fracture or fracture/dislocation of the thoracolumbar or lumbar spine were studied to determine the effectiveness of three methods of management of the injuries. Ten of the patients had a neurological deficit as well as a spinal injury. All cases were studied by computed tomographic (CT) scanning of the injury site before and after treatment. CT scanning was found to be superior to linear tomography in determining the degree of canal compromise by bone at the injury site. Eight patients underwent operation, with the aims of achieving spinal stability in unstable injuries and of decompressing neural structures. These 8 patients had received Harrington distraction instrumentation (HDI) as an initial procedure. In those patients with fracture/dislocations from flexion‐rotation injuries and canal compromise resulting from bony malalignment, reduction of the fracture/dislocation by HDI resulted in stabilization of the spine and increase of the open canal area at the injury site. However, in those patients with canal compromise resulting from bursting fractures with retropulsed bone fragments, HDI did not reduce the bone fragments. Removal of the anterior vertebral body and the bone fragments. however, did result in significant improvement of the canal dimensions. A poor correlation was found between the degree of canal compromise as measured by the CT scanner and the resulting neurological deficit. Reasons for this are presented. Six of the 10 neurologically compromised patients, including 2 patients with stable bursting injuries and retropulsed bone fragments treated conservatively, had improved one grade on Frankel's classification by 3 months after injury. The rate and degree of recovery were not related to the degree of canal decompression achieved at operation. (Neurosurgery8:555‐561, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Cerebral ischemia occurs not only as a primary event but also as an important secondary phenomenon in many forms of brain insult. Many therapeutic regimens have been used empirically to combat various insults to the brain, and the barbiturates have received much attention lately. The present study demonstrates that pentobarbital administered before the onset of global ischemia ameliorates sodium and potassium losses from brain cell nuclei, which may be important in the etiology of the cell swelling seen in this model. Evidence is presented that this protective effect may occur through an energy‐dependent, cooperative process. (Neurosurgery8:562‐566, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;The authors present a new technique for tamponade of the nasopharynx after the performance of a transnasosphenoidal approach to the hypophysis. This technique consists of placing a Foley balloon catheter in each nasal cavity, extending to the nasopharynx. The position of the balloons and the adequacy of the amount of radiopaque substance used to fill them is determined with x‐ray films or a television image intensifier. Among the advantages of the method over tamponade with Vaseline‐covered gauze are: (a) better tamponade; (b) the possibility of testing the position and volume of tamponade; (c) the absence of trauma to the nasopharyngeal mucosa upon removal of the catheters after deflation of the balloons; (d) the availability of two airways for respiration in addition to the mouth; and (e) the absence of blood gas alterations and infections. (Neurosurgery8:567‐568, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;A young man incurred a head injury with transiently impaired consciousness, multiple skull fractures, and monocular blindness. After 3 weeks he developed an intracerebral hemorrhage, which resolved without operative intervention. One week later he presented with massive epistaxis from a traumatic aneurysm of the right cavernous carotid artery, which extended into the sphenoid sinus. This was treated successfully by gradual occlusion of the carotid artery. Theories of the pathogenesis of these lesions as well as the rationale for treatment are discussed. (Neurosurgery8:569‐573, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID