摘要:

CT-guided sterotactic biopsy is now an accepted method of tissue sampling in intracranial mass lesions but many surgeons still practise freehand burrhole biopsy. This study compares two groups of patients who had either stereotactically guided (n= 153) or freehand (n= 217) biopsy. Stereotactic biopsy has a lower incidence of both mortality (2.6%) and morbidity (1.3%) than freehand (7.8 and 7.8%) while diagnostic accuracy is 92.1 and 64.9%, respectively. The success rate for stereotactic biopsy is independent of the size and depth of the lesion while freehand biopsy is most successful for large, superficial lesions but its success never exceeds 88%. The stereotactic technique is superior to the freehand for all intracranial biopsies regardless of size or site.

ISSN:0268-8697    

DOI:10.3109/02688699109002859

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Direct treatment of brainstem cavernous haemangiomas (cavernomas) naturally represents a considerable surgical challenge due to the close proximity of vital structures. The results of such treatment have only rarely been described. We report our experience in the management of seven patients with cavernomas of the brainstem treated by microsurgical resection. All patients presented with neurological symptoms directly attributable to one or more episodes of brainstem haemorrhage. CT scan examination in all cases revealed either obvious haematoma or a focal region of high density within the pons or medulla; calcification in and around the lesion was detected in two patients. MRI scanning was performed in four of our cases and was strongly suggestive of the diagnosis of cavernoma with evidence of both recent and older haemorrhage as evidenced by haemosiderin deposits. Cerebral angiography failed to disclose abnormal vessels to the cavernoma in any instance, although interestingly a co-existent but separate cerebellar venous malformation was observed in two of our cases. Surgery was performed between 19 days and 3 months following the most recent haemorrhage. Microsurgical removal of both haematoma and underlying cavernoma was accomplished either via a median suboccipital or retromastoid craniectomy, with an appropriate incision being made into that part of the brainstem most directly overlaying the lesion. Significant improvement in neurological function has followed in all seven cases. Although the natural history of symptomatic cavernous haemangiomas is incompletely understood, the favourable results obtained in our patients suggest that total surgical removal is both practicable and relatively safe even in the case of those lesions situated within the branstem.

ISSN:0268-8697    

DOI:10.3109/02688699109002860

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

The study describes the microsurgical neurovascular relationships of the root entry zone of lower cranial nerves in 23 cadavers. The vessel type, frequency of contact and site of contact on the root entry zone were analysed. Three types of vascular patterns (Types I—III) were found. Facial nerve: frequency of contact 31.8%; arterial contact 92.9%, Type I (lying across) 78.9%; anterior inferior cerebellar artery in 84.6%. Glossopharyngeal nerve: frequency of contact 23.9%; arteries 54.5%, veins 45.5%; posterior inferior cerebellar artery in 83.3% and Type II (loop) 50.1%. Vagus nerve: frequency of contact 26.1%, arteries 58.3%. Types II and III (passing through) formed 42.9% each. Hypoglossal nerve: frequency of contact 78.2%; vertebral artery 88.9%. No‘grooving’on any nerve was seen. Hence,‘contact’by a vessel at the root entry zone may not be significant in the etiology of lower cranial rhizopathies.

ISSN:0268-8697    

DOI:10.3109/02688699109002861

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

A prospective, randomized study of continuous Polydioxanone with subcuticular vicryl closure is compared to interrupted Neurilon in a general neurosurgical practice. Ninety-nine patients were studied with 49 closed with Polydioxanone and 50 by Neurilon. The two groups were comparable with respect to risk factors and general composition. There was no significant difference in the rate of infection, wound dehiscence, CSF leak or suture protrusion, but Neurilon had a significantly higher incidence of palpable knots. Wound closure time was compared with no overall difference being found. We conclude that continuous Polydioxanone closure with subcuticular vicryl is an acceptable form of closure for neurosurgical wounds.

ISSN:0268-8697    

DOI:10.3109/02688699109002862

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

In the National Neurosurgical Centre in the Sultanate of Oman, four patients with cranio-facial actinomycosis were seen over a 5-year period. All patients had osteomyelitis and intracranial granulomata and the diagnosis was confirmed with histopathology. In two cases the organisms were cultured. In three patients the cranial spread was by contiguity from the scalp and face while one case had the extradural granuloma following a dental extraction. With medication there was gross reduction of proptosis and intracranial lesion in one patient and in two there was marked reduction in the size of the intracranial lesion as seen on serial computerized tomographic scanning of the head (CT head). Three patients are now asymptomatic and are being followed up while one expired with subarachnoid haemorrhage. Although eradication of the disease is difficult, with adequate medication and appropriate surgical intervention, three of these patients continue to remain relatively symptom-free for long periods of time.

ISSN:0268-8697    

DOI:10.3109/02688699109002863

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Neurocytoma has only recently been recognized as a distinct pathological entity. Previously a rare tumor, it is now being recognized with increasing frequency. It typically presents in an intraventricular location in young adults. Many neurocytomas were originally diagnosed by light microscopy as oligodendrogliomas. More recently they have been shown to have ultrastructural and immunohistochemical features of neuronal differentiation. This paper presents two cases of intraventricular neurocytomas and reviews the recent literature.

ISSN:0268-8697    

DOI:10.3109/02688699109002864

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Complications of epidural pressure (EDP) monitoring are much less severe than those of ventricular fluid pressure (VFP) monitoring. Hence, an insight into the relationship between the epidural and the ventricular pressures is of clinical importance. The pressure volume response as obtained during infusion tests performed on dogs can be categorized into two phases: (i) the latent phase and (ii) the monotonic rise phase. During the latent phase the VFP first rises to a maximum and then falls to a minimum, but these changes in VFP are not reflected in EDP. The latent phase is followed by the monotonic rise phase during which both VFP and EDP rise simultaneously and monotonically. Although the changes in VFP and EDP are similar the epidural pressure remains consistently less than the ventricular fluid pressure. Hence, changes in VFP can be estimated by monitoring EDP during the monotonic rise phase but not during the latent phase.

ISSN:0268-8697    

DOI:10.3109/02688699109002865

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Ligation of the carotid artery remains an accepted treatment for unclippable giant carotid artery aneurysms. Postoperative evaluation is commonly made subsequently by CT scan and angiography, the latter involving an invasive procedure. This paper describes the magnetic resonance (MR) appearance of a traumatic giant terminal carotid artery aneurysm treated by common carotid ligation. MR appears to be the imaging technique of choice for follow-up of giant aneurysms of the terminal carotid artery treated by carotid ligation, the accuracy of delineation of the aneurysm and its content surpassing that of the CT scan.

ISSN:0268-8697    

DOI:10.3109/02688699109002866

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

The author reports an unusual case with recurrent episodes of subarachnoid haemorrhage. Complete angiographic examination was negative on three occasions. An unexpected distal posterior inferior cerebellar artery aneurysm was found at autopsy. The case illustrates the occasional failure of angiography in the detection of aneurysms and the need to have a high index of suspicion of an aneurysm in cases with recurrent subarachnoid haemorrhage with negative angiography. The role of magnetic resonance imaging is discussed.

ISSN:0268-8697    

DOI:10.3109/02688699109002867

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

A case is presented of a large infratentorial arachnoid cyst with third ventricular extension treated by stereotactic CT-guided aspiration and insertion of Ommaya reservoir.

ISSN:0268-8697    

DOI:10.3109/02688699109002868

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor