摘要:

&NA;Eleven cases of cervical neurinomas with an extradural component were operated on with control of the vertebral artery as the first step of the surgical procedure. The lateral anterior approach was used first in each case with excellent results. In the case of hourglass tumors (seven cases), a complementary posterior approach was performed to remove the intradural portion. Primary control of the vertebral artery in cases of extradural or hourglass neurinoma is a logical and safe procedure in the attempt to achieve complete and bloodless tumor removal. (Neurosurgery16:591‐594, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;The object of this study was to determine whether the addition of information on brain stem reflexes improves the prognostic precision of the Glasgow coma scale for patients with severe head trauma. The study is based on 109 patients with a Glasgow coma score of 7 or less during the first 24 hours after injury. The average age was 23 years. The patients were classified into three groups according to their actual outcome after 6 months: dead, 44 patients; persistent vegetative state and severe disability. 13 patients; moderate disability and good recovery, 52 patients. We then compared, by means of multiple group logistic regression, the prognostic ability of motor responses alone using the Glasgow criteria and of brain stem reflexes via an original approach. We showed that the predictive capabilities of brain stem reflexes were greater than those of motor responses. Although closely related (r = 0.68), the use of these two parameters in a single scale, the Glasgow‐Liege scale, improves the precision of prognosis, especially for those head trauma patients with initial and complete loss of consciousness. Age was also revealed to be an important factor for outcome prediction. (Neurosurgery16:595‐601, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;Extradural hematomas (EDHs) do not always require surgical evacuation. We report a subgroup of conscious patients harboring EDHs who were referred for computed tomographic (CT) scanning several days after head injury with neurological signs that were static or improving. Twelve patients with EDHs 12 to 38 ml in volume were offered nonsurgical management and were followed by serial CT scanning. All patients made a complete neurological recovery and showed resolution of the hematoma on CT scanning over a period of 3 to 15 weeks. The features that may make an extradural hematoma suitable for conservative treatment are discussed. (Neurosurgery16:602‐606, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;We describe a patient with a gunshot wound to the brain that traversed the left cerebellar hemisphere and terminated in the left lateral midpons. The clinical findings, operative course, neuroradiographic features, and evoked potential data are correlated with the functional anatomy of the pons. It is possible to demonstrate that a local lesion in the lateral pons causes a hemiparesis, worse in the upper extremity, thus suggesting a somatotopic localization of the pontine corticospinal tract not previously described. (Neurosurgery16:607‐611, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;Facial muscle responses in patients with hemifacial spasm undergoing microvascular decompression operations were recorded. Two peripheral branches of the facial nerve were stimulated and the electrical responses of muscles innervated by these branches were studied to see how the lateral spread of activity that is known to be present in these patients was affected by decompressing the facial nerve. In some of the patients the hemifacial spasm ceased when the dura mater was opened, in some it ceased when the arachnoid was opened, and in others the spasm persisted until the offending vessel was dissected away from the nerve. The lateral spread of activity elicited by antidromic stimulation of a branch of the facial nerve was less affected by opening of the dura mater or arachnoid: it usually persisted until the blood vessel that had been compressing the facial nerve was removed and reappeared when the vessel that had been compressing the facial nerve was allowed to slip back onto the nerve. This seems to indicate that microvascular decompression of the facial nerve is effective in alleviating hemifacial spasm because it removes the actual cause of the disorder rather than simply causing local injury to the nerve as a result of the procedure. (Neurosurgery16:612‐618, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;Neonatal herpes simplex encephalitis (HSE) can represent a difficult diagnostic problem when it occurs without concomitant mucocutaneus lesions and usually requires brain biopsy for diagnosis. Asymptomatic for the initial 2 to 4 weeks of life, the three infants we describe with localized HSE came to medical attention only because they developed persistent seizures and other nonspecific symptoms. Lumbar spinal fluid obtained from these children at clinical presentation showed an encephalitic pattern. Radionuclide brain scans revealed focal uptake of isotope in a variety of cortical areas, and electroencephalograms (EEGs) demonstrated repetitive, high amplitude, polyphasic sharp waves arising from analogous regions. Computed tomography (CT) showed nonspecific ill‐defined areas of low density or contrast enhancement that did not correlate well with radionuclide, EEG, or clinical findings in two neonates. No infant had predominant temporal lobe involvement. Because these data suggested a multifocal, encephalitic process, all three infants underwent brain biopsy. A widespread infiltration of leukocytes and macrophages was observed in each specimen, and abundant intranuclear inclusions were present. Electron microscopy revealed abundant herpesvirus particles, and herpes simplex virus (HSV) was subsequently isolated from each sample. From our observations and our review of the literature, we propose the following criteria as indications for brain biopsy: Brain biopsy is warranted to rule out HSE when a neonate presents with seizures, cerebrospinal fluid mononuclear pleocytosis with a negative gram stain, and focal, cortical disease on EEG and radionuclide scan. Additionally, a history of maternal genital HSV infection is helpful but may be absent, the child may have an asymptomatic interval after birth, the CT data can be nonspecific, and, in contrast to adults and older children, neonates with HSV typically lack temporal lobe involvement. Early diagnosis combined with prompt institution of appropriate antiviral therapy could reduce the mortality and morbidity from this destructive illness. (Neurosurgery16:619‐624, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;Three case reports of spinal vascular tumors illustrate the need for well‐organized and thorough neuroradiological and neurosurgical planning to achieve an initial cure without delay and to avoid inadequate operative procedures. (Neurosurgery16:625‐629, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;Prior work has shown that the intracarotid infusion of sodium dehydrocholate can produce prolonged reversible blood‐brain barrier (BBB) disruption. Associated with barrier disruption is the occasional presence of behavioral seizure activity. Electroencephalographic changes were monitored in 32 rats after BBB disruption by the left internal carotid artery infusion of sodium dehydrocholate. The electroencephalogram (EEG) was monitored for 3 hours after disruption in 20 animals, and the remaining 12 animals were followed for 24 hours. The EEG was also monitored in 8 additional control animals: 4 had undergone carotid artery infusion with normal saline, and 4 had received sodium dehydrocholate intravenously. The 20 rats monitored for up to 3 hours postinfusion were found to have varying grades of BBB disruption as measured by the presence of Evans blue staining of the brain. EEG alterations in this group included decreased amplitude and slowing as well as the presence of spike activity over the disrupted and the nondisrupted hemispheres. The more extensive the disruption, the more severe the EEG changes. In animals with minimal to moderate disruption, the EEG usually returned to base line levels within 3 hours after infusion. Animals with marked disruption usually had bilaterally flat EEGs before the end of the observation period. The remaining 12 animals were followed for 24 hours postinfusion. Of 9 animals surviving 24 hours, 1 animal had a decrease in amplitude over the disrupted hemisphere; in the remaining 8 animals, the spontaneous EEG was unchanged from predisruption levels except for occasional spikes in 2 animals. Animals infused with intracarotid saline or intravenous sodium dehydrocholate demonstrated no EEG changes or Evans blue staining. BBB disruption subsequent to the intracarotid infusion of sodium dehydrocholate is associated with EEG changes that reflect the extent of disruption. These changes may, in part, be due to the penetration of dehydrocholate through the permeable BBB and its subsequent physiological effects on neural structures. (Neurosurgery16:630‐638, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;Sodium dehydrocholate was applied topically to the right hemispheric cortex of eight rats and the electrocorticogram was monitored from both the treated cortex and the homotopic cortex of the contralateral hemisphere. All animals developed blood‐brain barrier (BBB) disruption in the treated cortex as evidenced by cortical staining with systemically administered Evans blue dye. Spike activity developed in three of eight animals after the topical application of dehydrocholate. The subsequent intravenous injection of sodium dehydrocholate provoked spike activity in both hemispheres in all eight animals. Dependent and independent spike activity was recorded in the nondisrupted hemisphere. The intravenous administration of gamma‐aminobutyric acid (GABA) resulted in alterations in spike activity in four of five animals because of penetration of the GABA through the altered BBB. These findings demonstrate that sodium dehydrocholate can result in increased BBB permeability when applied directly to the cortical surface. Spike activity subsequent to the topical application of dehydrocholate can be enhanced by systemic loading with dehydrocholate. Spike activity occurring over the nontreated cortex (secondary focus) represents interhemispheric propagation of spike activity from the disrupted hemisphere (primary focus). The lack of Evans blue staining in the actively discharging secondary focus suggests that spike activity does not account for the increases in BBB permeability observed with dehydrocholate treatment. (Neurosurgery16:639‐643, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;A retrospective analysis of 50 consecutive patients treated with chemonucleolysis and 50 treated with microlumbar discectomy was carried out. Similar clinical criteria for the diagnosis of “virgin” herniated lumbar discs were used. All patients had low back or radicular pain unrelieved by a minimum of 4 weeks of conservative therapy. Physical findings included a positive straight leg raising sign, weakness of the appropriate muscle groups, and a sensory loss or evidence of depressed reflexes. All had myelograms or computed tomographic scans demonstrating an extradural defect. Compensation cases were eliminated. Results demonstrated a 90% marked improvement in the microdiscectomy category and a 58% marked improvement in the chemonucleolysis group. Four per cent of the microdiscectomy patients were unimproved, and 18% of the chemonucleolysis group required a subsequent surgical procedure. The average postoperative hospital stay was 3 days for both groups. Because of the necessity for reoperations in the chemonucleolysis group, chemonucleolysis seemed less cost‐effective than microdiscectomy. (Neurosurgery16:644‐649, 1985)

ISSN:0148-396X    

出版商:OVID    

年代:1985

数据来源: OVID