ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;To determine whether treatment with hyperbaric oxygen (HBO) or dimethyl sulfoxide (DMSO) could mitigate the fatal effects of cerebral ischemia, we anesthetized 68 gerbils with ketamine, ligated the right carotid artery (CA), and placed a snare occluder around the left CA. After 48 hours, 30 gerbils that were neurologically normal or had suffered only mild deficits were subjected to left CA occlusion without anesthesia for periods of 2 to 60 minutes. The onset of circling, posturing, falling, and lethargy began immediately; seizures and coma ensued 4 to 5 minutes later and persisted until release of the left CA occluder. All gerbils recovered after 2‐minute staged bilateral CA occlusions. The mortality rate was 33% after both 5‐ and 10‐minute occlusions and 100% after 20‐ and 60‐minute bilateral occlusions. Twelve gerbils were placed in an HBO chamber (100% oxygen at 1.5 atmospheres) for 15 minutes during 20‐minute bilateral occlusion; only 2 died (16% mortality rate). Thus, HBO therapy conferred significant protection against death from untreated ischemia (P< 0.001). Histological examination showed that the extent of patchy bilateral ischemic neuronal damage was much less in surviving gerbils that received HBO therapy than in those that died after 20‐minute occlusions. Fourteen gerbils were treated with DMSO, 2.5 g/kg intraperitoneally, during 5‐ or 10‐minute bilateral CA occlusion; 12 died (86% mortality rate). Thus, DMSO provided no protection against fatal cerebral infarction; in fact, the results in the 10‐minute reperfusion group suggest that DMSO may have a deleterious effect. (Neurosurgery18:528‐532, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;The extent of treatment for the victims of gunshot wounds to the brain remains quite controversial, particularly when these patients present with extensive neurological dysfunction. We propose guidelines regarding the degree and aggressiveness of therapy. The factors that seem to have a significant impact on the patient's final outcome are the neurological examination at the time of admission, the radiological findings, and the motivation for the shooting. Thus, the authors propose a nonsurgical line of therapy for comatose patients with unilateral or bilateral cerebral gunshot wounds where bone or metal fragments are visualized away from the bullet path on computed tomography scan, particularly when these individuals are suicide victims. (Neurosurgery18:533‐537, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Intracranial hemorrhage (ICH) is a life‐threatening complication of hemophilia. Seven of the 288 hemophiliacs living in Israel suffered eight episodes of ICH during the years 1972 to 1982. All episodes occurred in hemophilia A patients, with a higher incidence among patients with factor VIII inhibitor. Diagnosis was confirmed by computed tomographic scan in seven of the eight episodes. Four of the 7 patients died despite adequate factor replacement and supportive therapy, probably due to a conservative and hesitant neurosurgical approach. The correction of factor VIII to hemostatic level alone is inadequate in the majority of cases, and there is sudden deterioration in the patient's condition and death. Operation is strongly recommended when no improvement is noted within a few hours. (Neurosurgery18:538‐541, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;A total of 28 cases of cervical spine dislocation with bilateral locking of facets treated between 1976 and 1984 were analyzed to determine whether treatment modality had any effect on outcome based on cord or root function. Motor vehicle accidents were responsible for 19 cases; the most common levels of dislocation were C‐5, C‐6 and C‐6, C‐7, with 10 each. Twenty patients were admitted with complete myelopathies. Ten patients whose dislocations were successfully reduced with traction had no neurological changes, but 1 reduced elsewhere deteriorated from a C‐5 to C‐2 level. Eleven of these patients underwent posterior cervical fusions after delays of 1 to 17 days (mean = 6.3); 2 died, and 1 patient achieved slight root return. Seven underwent anterior decompression and fusion or combined anterior and posterior approaches after delays of 9 to 120 days. One patient died in the postoperative period, 1 had substantial recovery of cord function, and 5 had recovery of root function. There was no operation or improvement in 2 patients. Eight patients had incomplete myelopathies; 4 were initially reduced, with 2 improving slightly as a result. Three patients underwent posterior fusions with foraminotomies with minimal improvement. Five had anterior or combined approaches; these patients improved at least one neurological grade each, including 3 who became newly ambulatory. All 24 surviving patients achieved spinal stability, although it occurred slightly earlier in the anterior fusion groups. Surgical approaches designed to provide spinal stability and restore the normal anatomy of the spinal canal and neural foramina may be of functional benefit in the management of these dislocations. (Neurosurgery18:542‐547, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Nuchal muscle autografts of two different sizes were transplanted into rat brain parenchyma (intraparenchymal, 1.5 × 1.5 × 1 mm) and onto the surface of the brain stem (intraventricular, 2 × 2 × 1 and 1.5 × 1.5 × 1 mm). The vasculature of the transplants retained its permeability to proteins. Exogenous, intravenously injected horseradish peroxidas (HRP) and endogenous immunoglobulins (IgG) crossed the vessels of the grafts to enter the surrounding brain tissue 1 and 3 months after transplantation. HRP infiltrated about 0.46 to 4.6 mm into the extracellular spaces around the grafts 60 minutes after its intravenous injection. The penetration of HRP depended on the size and age of the graft. Infiltration was greater in 1‐month‐old rats with slightly larger intraventricular grafts than in those with smaller grafts. There was a tendency for the penetration of HRP to be greater from 1‐month‐old grafts than from 3‐month‐old grafts, but the difference was not statistically significant, except for the horizontal vector of spread in the intraparenchymal group. Although endogenous IgG infiltrated the surrounding brain tissue, its penetration was very limited in comparison with that of HRP. The results suggest that muscle grafts could be used as a readily available and accessible means of circumventing the blood‐brain barrier selectively and focally. (Neurosurgery18:548‐554, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Approximately 3 to 4 times a year, a tumor with suprasellar extension escapes classification on high resolution coronal and transaxial computed tomography. When arteriography failed to determine the diagnosis, the differential choices were usually meningioma or pituitary adenoma. The authors report the use of sagittal reformatted images in this differential diagnosis and conclude that these images may aid in the distinction between pituitary tumors with suprasellar extension and meningiomas located in this area. (Neurosurgery18:555‐558, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Complete gross and microscopic neuropathological examinations of 25 children who died with meningomyelocele, the Arnold‐Chiari malformation, and hydrocephalus revealed a wide range and frequency of associated central nervous system malformations. The most remarkable of these anomalies were hypoplasia or aplasia of cranial nerve nuclei (20%), demonstrable obstruction of cerebrospinal fluid flow within the ventricular system (92%), cerebellar dysplasia (72%), a disorder of migration of cortical neurons (92%), fusion of the thalami (16%), agenesis of the corpus callosum (12%), and complete or partial agenesis of the olfactory tract and bulb (8%). The anomalies associated with posterior neural tube closure defects can no longer be considered secondary, but rather must be considered part of a spectrum of malformations caused by an unidentified primary insult to the central nervous system. The frequency and pattern of brain malformations associated with neural tube defects of some children with meningomyelocele suggest that such malformations may seriously affect intellectual outcome. (Neurosurgery18:559‐564, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;The present study attempted long term hemodynamic maintenance in 16 adult brain‐dead patients, 14 with head injury and 2 with cerebrovascular accidents. In addition to respiratory and fluid management, 10 were treated wth continuous infusion of epinephrine to maintain systolic blood pressure above 90 mm Hg. The remaining 6 patients each received a continuous infusion of synthetic arginine vasopressin (ADH) at a rate of 1 or 2 units/hour (285 ± 45 microunits/kg/minute) simultaneously with epinephrine. The 10 patients treated with epinephrine alone all succumbed to cardiac arrest within 48 hours of brain death, with a mean survival time of 24.1 ± 17.2 hours. In the patients who received simultaneous ADH infusion, a minimal dose of epinephrine of no more than 0.5 mg/hr in most instances sufficed to maintain blood pressure. Their mean survival time after brain death was remarkably prolonged to 23.1 ± 19.1 days. In brain death, ADH plays a critical role in hemodynamic maintenance, and ADH administration permits long term hemodynamic stabilization of brain‐death patients, offering increasing opportunities for organ transplantation. (Neurosurgery18:565‐567, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Four children with intrinsic cerebellar peduncle lesions (three benign astrocytomas and one histiocytic encephalitis) are reported. Each patient underwent a resection of mass lesions through posterior fossa craniotomy with microsurgical techniques and a surgical laser. None showed permanent neurological deficits postoperatively. A brief anatomical consideration of cerebellar peduncle lesions and the surgical approach used are described. (Neurosurgery18:568‐575, 1986)

ISSN:0148-396X    

出版商:OVID    

年代:1986

数据来源: OVID