摘要:

&NA;Sixty‐four patients who were operated on within 4 days after acute subarachnoid hemorrhage are included in this study. All patients underwent preoperative computed tomographic (CT) scanning, and the amount and distribution of subarachnoid blood clot were noted. Operation was carried out by the frontobasal lateral approach, and the subarachnoid clot was removed by microsurgical suction‐irrigation after clipping of the aneurysm. Immediate postoperative CT scanning was performed to evaluate the completeness of the subarachnoid blood clot removal. The presence or absence of postoperative vasospasm was determined with angiography performed between the 7th and 10th postoperative days. All patients were, of course, also evaluated for evidence of neurological deterioration. Approximately two‐thirds of the patients in this series showed high density subarachnoid blood clot on the preoperative CT scan. The postoperative CT scans showed that it was possible to remove the majority of the blood clot except that located in the frontal interhemispheric fissure, the posterior part of the insular cistern on the approached side, and all of the insular cistern on the contralateral side. There was no spasm or only mild spasm in any site where the blood clot had been successfully removed. Delayed neurological deficits occurred only in those cases in which subarachnoid blood clot remained in the cisterns. These results suggest that it is possible to prevent intracranial arterial spasm and associated neurological deterioration by early operation and removal of clotted blood from the subarachnoid space. (Neurosurgery10:301‐307, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Aneurysms of the bifurcation of the middle cerebral artery (MCA) can be approached through a small incision in the anterior portion of the superior temporal gyrus. The pterion and the lateral aspect of the lesser wing of the sphenoid bone are removed. The aneurysm is approached, using microsurgical techniques, by following the main divisions of the MCA to the parent trunk and the base of the aneurysm. Once the parent vessel and the origin of the major divisions are clearly identified, it is usually preferable to dissect and mobilize the entire aneurysmal complex to elucidate the anatomy and prepare the neck for clipping. This approach offers the advantages of minimal brain retraction and minimal manipulation of the main trunk and perforators of the MCA. In addition, it allows a more complete exposure of the aneurysmal complex and facilitates dissection behind the aneurysm, which is more difficult when the aneurysm is approached from the front by opening the sylvian fissure medially to laterally. A potential disadvantage of this method is that proximal control is not obtained until the base of the aneurysm is reached, but this has not been a problem in our experience. Other disadvantages are the need for a slightly larger bone flap and the potentially increased risk of epilepsy. This approach is not suitable when the main trunk of the MCA is short and the aneurysm is in front of the insula. It is also not recommended for the rare cases in which the aneurysm points back over the insula. During a 6‐year period, this approach was used in 49 of 58 cases of MCA aneurysm. The only deaths in this group occurred in patients who were in deep coma before operation. Two patients were made worse by operative complications, and 2 more worsened as a result of postoperative vasospasm. There was a significant incidence of thrombophlebitis and pulmonary embolism in this series. (Neurosurgery10:308‐313. 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;An overview of intravascular interventional embolic materials is presented. The physicochemical and biological properties of the monomer isobutyl 2‐cyanoacrylate are discussed with specific details regarding therapeutic applications. (Neurosurgery10:314‐316, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;A review of the medical records at The Hospital for Sick Children in Toronto, Ontario, from 1967 through 1980 showed that, of the 94 cases of dermoid cyst of the skull treated at this institution by the neurosurgical staff, 25 were located over the anterior fontanelle. This is the largest single group of cases reported to date. The children were 2 months to 13 years of age, but two‐thirds were treated before their 1st birthday. Females outnumbered males 2:1, and all of the patients presented with a nontender swelling over the anterior fontanelle, which had been present from birth. The lesions were treated by a variety of surgical approaches, all of which were curative. None of the lesions has recurred. The most interesting finding was that all but 2 of the children were white, in contrast to all previously published series. This confirms our belief that the racial incidence of dermoid cysts of the anterior fontanelle is a reflection of the general population. A review of previously published cases and the pathology and embryology of the lesion is included. (Neurosurgery10:317‐323, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;This paper describes a stereotactic CO2laser system for the removal of intra‐axial, intracranial neoplasms. The volume of the neoplasm is transferred into stereotactic space by computer reconstruction of data derived by computed tomography (CT) performed under stereotactic conditions. The tumor volume is sliced in a plane orthogonal to the surgical approach, and slices at specific distances from the focal point of the stereotactic frame are displayed on a graphics monitor in the operating suite along with a cursor representing the position of the surgical laser. Laser vaporization of sequential slices of the tumor results in a cavity, the formation of which is monitored by anteroposterior and lateral roentgenograms. Fifteen stereotactic laser procedures have been performed on 13 patients, and the results are discussed. By this method, it is theoretically possible to remove all of an intracranial neoplasm detected by CT scanning. (Neurosurgery10:324‐331, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Surgery is the accepted form of treatment of meningioma; the role of radiotherapy has not been clearly established. With this in mind, we have reviewed our experience with radiation therapy in the management of meningiomas at New York University Medical Center. Sixty‐eight patients fell into three groups. Forty‐three (Group A) underwent operation followed by radiation therapy, 14 patients (Group B) had radiation for recurrence after operation, and 11 patients (Group C) had radiation therapy as the primary treatment. In Group A, 41 of 43 are alive. During a follow‐up of 1 to 10 years, only 2 have deteriorated. Five of 14 Group B patients showed neurological improvement and 7 showed deterioration, including 5 who died of tumor. All 11 patients in Group C are alive with follow‐up periods of 3 to 6 years; 9 of these show improvement in neurological function. Eleven patients had malignant meningioma, of whom 8 are alive and stable. We present 4 case reports, including computed tomographic scans that show evidence of tumor necrosis after radiation therapy. Pathological verification of tumor necrosis is presented in 1 case. We believe that radiation therapy has an established role in the treatment of incompletely excised, recurrent, or malignant meningiomas and, in some cases, as the initial management of meningiomas. Indications for treatment and guidelines are presented. (Neurosurgery10:332‐339, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Over a 7‐year period (February 1974 through February 1981), 318 patients underwent the implantation of cerebellar stimulation systems for the reduction of spasticity (98%) or epilepsy (2%). A total of 518 procedures were carried out to implant and maintain the equipment during this period. Fourteen patients developed infections in the tissue around their implanted systems, which represented 4.4% of the patients or 2.7% of the procedures performed.Staphylococcus aureuswas the infectious agent in 7 cases (50%), the clinical features of which occurred usually within 1 month.Staphylococcus epidermidisinfected 5 patients with features presenting late (more than 2 years) after the initial implantation. The management involved antibiotic therapy for 2 weeks in all 14 patients. In 12 patients, the entire system was removed, with 100% eradication of the infection. In the other 2 patients, the radio receiver and lead wires up to but not including the cerebellar electrode pads were removed. One of these 2 patients has been free of infection for 4 years. The other had S.aureuscultured from removed electrode pads after 6 weeks. Of the 14 cases, morbidity was severe in only 1 patient. Seven patients underwent reimplantation 6 weeks after the infection. (Neurosurgery10:340‐343, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Nimodipine is a new calcium antagonist that has been advocated as a specific treatment for the cerebral vasospasm accompanying subarachnoid hemorrhage in humans because of reports that it selectively inhibits the constriction of cerebral arteries in vitro. Because calcium antagonists may have specific blocking actions, whereas the origin of vasospasm is likely to be multiplex, the effect of nimodipine on the contractions of isolated canine basilar arteries that are produced by serotonin, prostaglandin F2&agr;, thrombin, and whole blood was studied. The results demonstrate that nimodipine significantly inhibits the contractile responses induced by these diverse agonists whether it is given before or after the agonist. The findings suggest that, in canine cerebral arteries, a common calcium influx channel is involved in the responses elicited by a variety of receptor mechanisms and afford a rationale for the use of nimodipine in the treatment of the cerebral ischemia that often follows cerebral hemorrhage. (Neurosurgery10:344‐348, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Cisplatin, a chemotherapeutic agent used to treat tumors in many parts of the body, does not reach brain tissue during systemic injection because of the blood‐brain barrier and protein binding in the blood. To allow hydrophilic drugs, such as cisplatin, to reach brain neoplasms with minimal body toxicity, we tested chronic intracerebral microperfusion into the extracellular space of the brain in normal rats. Small stainless steel cannulas connected to osmotic minipumps were stereotactically placed in the midline cerebellum or frontal cortex, and cisplatin was pumped into the brain at the rate of 0.9 μg/hour for periods of up to 7 days. Brain tissue was then analyzed for the total platinum content, at 1‐mm intervals from the cannula tip, using atomic absorption spectroscopy. The results of the animal studies show that a platinum concentration of 2 ng/mg of tissue, wet weight, can be maintained over a 1‐cm region of brain. If all of the extracellular platinum has remained in the active cisplatin form, then this would be equivalent to a drug concentration of 10 μM.Cisplatin at this constant level has been shown to have a therapeutic effect against various tumor lines in vitro. To extend these results to human brain neoplasms, we estimate that one cannula would be sufficient to treat a 1‐cm tumor or a larger tumor that could be surgically reduced. For inoperable tumors of up to 2 cm in diameter, a multiple cannula system would be required to yield the 10 μMconcentration throughout. For larger inoperable tumors, local infusion will not produce high enough drug levels. In conclusion, chronic intracerebral microinfusion can be used to produce adequate and sustained therapeutic drug levels over a considerable region of tissue without the problem of systemic toxicity. (Neurosurgery10:349‐354, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Albino rabbits with experimental brain edema produced by a combined cryogenic and metabolic 6‐aminonicotinamide lesion were administered intravenous dimethyl sulfoxide in varying concentrations and doses in the following manner: Subgroup A (concentration response) received a 1.0‐g/kg bolus as a 10%, 20%, 30%, or 40% solution. Subgroup B (dose response) received as a 20% solution a 1.0‐g/kg bolus, 1.5‐g/kg bolus, or 2.0‐g/kg infusion. Simultaneous recording of intracranial pressure (ICP), systolic arterial pressure (SAP), and central venous pressure and electroencephalography were performed while the animals were being mechanically ventilated at a constant PaCO2(38 to 42 torr). There was significant lowering of ICP when compared to pretreatment values in Subgroup A in the 10% subset at 30 minutes (p< 0.05) and in the 20% subset at 5 (p< 0.05) and 30 (p< 0.05) minutes. ICP was not significantly decreased in the 30% and 40% subsets. All animals of Subgroup B displayed significant reductions of ICP when compared to their pretreatment values. There was no significant change in SAP in either subgroup. (Neurosurgery10:355‐359, 1982)

ISSN:0148-396X    

出版商:OVID    

年代:1982

数据来源: OVID