摘要:

&NA;This report reviews the angiographic evaluation of 41 patients who underwent a carotid endarterectomy at Henry Ford Hospital. Postoperative angiograms were performed after 48 endarterectomies. Changes included the development of postoperative intimal flaps, common carotid stenosis, carotid occlusions, areas of corrugation, surface irregularities, and postendarterectomy dilatation. The development of dilatation, or the pantaloon effect, on the endarterectomized segment contributed to the limited use of angioplastic procedures. The benefits derived from a postoperative angiogram include the objective evaluation of the endarterectomized segment, the demonstration of a potentially complicating problem such as intimal flaps that could lead to restenosis, and recognition of the possible development of associated local problems. The procedure can be done with limited risks to the patients and in competent hands has low morbidity and mortality. (Neurosurgery10:151‐161, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;In view of the widely divergent opinions regarding the necessity for operation in cases of asymptomatic and multiple cerebral aneurysms, an attempt is made to derive the true lifetime risk of rupture for a cerebral aneurysm in the asymptomatic patient. Prevalence data from autopsy and angiographic studies are utilized to derive a lifetime incidence for the rupture of such asymptomatic aneurysms. A decremental life table analysis method is used. The case of multiple asymptomatic aneurysms in a patient with another symptomatic aneurysm must be considered separately. Implications of these calculations are drawn regarding operation for unruptured or incidental aneurysms. (Neurosurgery10:162‐166, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;The effect of furosemide in the intraoperative reduction of intracranial pressure was measured in 25 patients undergoing the operative repair of a ruptured intracranial aneurysm. Seven patients with similar intracranial lesions served as controls. A single bolus of 80 mg of furosemide was administered intravenously after the induction of anesthesia, and sequential measurements were made of intracranial pressure, mean arterial pressure, and arterial blood gases. A mean decrease of intracranial pressure of 56% was measured in the furosemide‐treated patients, whereas the control patients demonstrated a mean decline of subarachnoid pressures of 18%. These changes are significant at theP< 0.005 confidence level, whereas changes in mean arterial pressure, mean arterial pCO2, and base line arterial pCO2were statistically insignificant. This study suggests that intravenous furosemide is a quick, dependable, and effective mechanism for the intraoperative reduction of intracranial pressure in the postsubarachnoid hemorrhage aneurysm patient. (Neurosurgery10:167‐169, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Fifty cerebellar hemispheres from 25 adult cadavers were examined. The posterior inferior cerebellar artery (PICA), by definition, arose from the vertebral artery. The vertebral artery was present in 49 and the PICA was present in 42 of the 50 hemispheres. Forty‐one of the 42 PICAs arose as a single trunk and 1 arose as a duplicate trunk. The PICA was divided into five segments: the anterior medullary segment lay on the front of the medulla; the lateral medullary segment coursed beside the medulla and extended to the origin of the glossopharyngeal, vagal, and accessory nerves; the tonsillomedullary segment coursed around the caudal half of the cerebellar tonsil; the telovelotonsillar segment coursed in the cleft between the tela choroidea and the inferior medullary velum rostrally and the superior pole of the cerebellar tonsil caudally; and the cortical segment was distributed to the cerebellar surface. Thirty‐seven of the 42 PICAs bifurcated into a medial and a lateral trunk. The medial trunk supplied the vermis and the adjacent part of the hemisphere, and the lateral trunk supplied the cortical surface of the tonsil and the hemisphere. The PICA gave off perforating, choroidal, and cortical arteries. The cortical arteries were divided into vermian, tonsillar, and hemispheric groups. Sixteen of the 42 PICAs passed between the rootlets of the accessory nerve, 10 passed between the rootlets of the vagus nerve, 13 passed between the vagus and the accessory nerves, 2 coursed rostral to the glossopharyngeal nerve, and 1 passed between the glossopharyngeal and the vagus nerves. (Neurosurgery10:170‐199, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;We observed a consistent and marked hypertensive response during trigeminal rhizotomy with methohexital anesthesia in 11 consecutive patients. Percutaneous trigeminal rhizotomy should not be regarded as a benign surgical procedure in view of the potential morbidity associated with such acute hypertension. We recommend that patients undergoing this operation be continuously monitored. (Neurosurgery10:200‐202, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Levels of indomethacin‐sensitive, glass‐adherent, preculture‐sensitive, and lymphocyte‐mediated immunoregulatory activity were measured in peripheral blood mononuclear cells from 12 patients with intracranial astrocytomas. The levels of regulatory cell function were determined in assays of T cell immunocompetence as judged by phytohemagglutinin (PHA)‐induced in vitro lymphocyte DNA synthesis. Of 6 patients studied before surgical exploration and diagnosis, 6 exhibited significantly depressed levels of PHA responsiveness in association with significantly increased levels of regulatory cell function by glass‐adherent, preculture‐sensitive and/or indomethacin‐sensitive cells. Six patients were studied after diagnosis and treatment. Of those, 2 in remission had normal levels of immune function in association with normal levels of regulatory cell activity, whereas 2 of 4 patients who had recurrent disease had significantly depressed T cell function in association with increased glass‐adherent, preculture‐sensitive and/or indomethacin‐sensitive regulatory cell activity. Although some alterations in lymphocyte‐mediated suppressor cell activity were seen in 2 patients, those changes could not be correlated with impaired T cell function as measured in the PHA stimulation assay. The changes in regulatory cell function could not be correlated with levels of immune complexes in patient sera. These data suggest that increased levels of regulatory cell function by glass‐adherent, preculture‐sensitive and/or indomethacin‐sensitive cells alone or in conjunction with lymphocyte and T cell depletion are a primary determinant of impaired immunocompetence in glioma patients. (Neurosurgery10:203‐209, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;To circumvent time constraints inherent in indicator clearance measurements of cerebrospinal fluid absorption, investigators have used the relationship between CSF pressure at steady state and the rate of infusion of mock CSF, in both patients and experimental animals, to evaluate the bulk absorption rate of CSF. This latter approach requires a mathematical model of the effect of CSF pressure on CSF bulk flow. Two such models—a fixed resistance and a variable resistance model of CSF flow through arachnoid villi—have been used in both clinical and laboratory settings. In this study, the relationship between steady state CSF pressure and mock CSF infusion rate was assessed using both mathematical models. We studied two patients, three cats, and seven baboons. Values of CSF outflow resistance calculated according to both models as well as other parameters of CSF bulk flow estimated on the basis of both models were all in the range expected from other studies. The data from these experiments do not provide justification for preferring one model over the other. Depending on the experimental or clinical situation, some of the assumptions behind both models may not be valid. Multiple direct measurements of the rates of CSF absorption and formation over a wide range of CSF pressures in individual subjects will be necessary to validate either the variable or the fixed resistance model or to suggest a more appropriate model. Until such information is available, it is probably reasonable to use both approaches for the analysis of mock CSF infusion data. CSF bulk flow parameters calculated on the basis of either the variable or the fixed resistance model should never be taken as absolute, but should be evaluated critically in the context of the clinical or experimental situation. (Neurosurgery10:210‐223, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;The permeability of the blood‐brain barrier (BBB) to methotrexate, Na+, and Cl−was studied in rats treated with the membrane‐active antifungal agent amphotericin B. Enhancement of brain uptake of methotrexate was expected as amphotericin B increases the permeability of lipid membranes, including tumor cell membranes. However, amphotericin B had no effect on the BBB permeability to methotrexate, Na+, and Cl−. This may have been because the amphotericin B acted only on the luminal and not on the abluminal brain capillary membrane, leaving the BBB intact. (Neurosurgery10:224‐226, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;We studied the effect of the opiate antagonist naloxone on the recovery of cats injured with a 400‐g‐cm impact injury to T‐9. The animals were evaluated by recording somatosensory evoked potentials and performing weekly neurological examinations. Several dose schedules were followed. Six of eight cats that received an intravenous or intraperitoneal bolus of naloxone (10 mg/kg) 45 minutes after injury regained the ability to walk. Recovery occurred in only one of five animals that were treated with an infusion of naloxone, 10 mg/kg/hour, and in none of five animals given 1 mg/kg as a bolus. Because these results are not related to any observed change in blood pressure, we believe that naloxone may be achieving its effect through the preservation of spinal cord blood flow, as well as other mechanisms that have yet to be defined. (Neurosurgery10:227‐231, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;The sitting prone position is compared with the standard laminectomy prone position and the sitting up position for posterior fossa surgery. We measured central venous pressure and airway pressure with the patient in different positions to determine the comparative efficacy of the sitting prone position. On a linear average, the central venous pressure increased by 6.83 cm H2O and the airway pressure increased by 3.16 cm H2O when the patient was changed from the supine to the standard prone position under general anesthesia; with a change from the standard prone position to the sitting prone position, the central venous pressure decreased by 10.45 cm H2O and the airway pressure decreased by 3.66 cm H2O. However, comparing the sitting prone position for posterior fossa surgery with the sitting up position, there was no statistically significant difference in central venous or airway pressure. (Neurosurgery10:232‐235, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID