ISSN:0268-8697    

DOI:10.3109/02688698809000998

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Between 1979 and 1986 the number of psychosurgical operations carried out in Britain fell from 70 to 15 procedures annually. There are a number of possible reasons for this change of which increased experience with new regimes of psychotropic medication is perhaps the most important. The new Mental Health Act (1983) which brought psychosurgery under the direct jurisdiction of the law was followed by a sudden reduction in the number of patients treated but referals are now increasing. In current psychiatric practice, classification relies largely on description of syndromes, each characterised by a set of core symptoms. Schizophrenia and affective psychoses (endogenous depression, mania and obsessional illness of late onset) are characterised by disturbances of mood, thinking and perception often so profound as to impair the patient's contact with reality. In contrast, neuroses produce symptoms which are quantitatively, rather than qualitatively different from normal experience and psychosurgery has no place in their treatment. Following the introduction of phenothiazines in the early 1950's schizophrenia ceased to be an indication for psychosurgery. For a small group of severely disabled and distressed people suffering from endogenous depressive and obsessional illnesses, when other treatments have failed or ceased to be effective, psychosurgery remains an appropriate treatment. Just over half the patients treated at the Geoffrey Knight Unit are relieved to the extent that they are either free of symptoms or such symptoms that remain do not significantly impair social function. Following operation recovery is slow and progressive and a programme of rehabilitation is usually necessary. Personality which is often severely damaged by the effects of long illness returns towards normal. Neuropsychiatric evaluation has consistently failed to demonstrate adverse cognitive effects. Evaluation and selection of patients for operation should be done by a psychiatrist and neurosurgeon working in partnership. Stereotactic techniques have made it possible to produce precisely located lesions of consistent size, virtually eliminating side effects and reducing the epileptic risk to between two and three percent. The Mental Health Act, contrary to early expectations, has allowed that psychosurgery retains a place in the treatment of a small highly selected group of patients.

ISSN:0268-8697    

DOI:10.3109/02688698809000999

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

With an incidence of approximately 1 in 2,000 per head of population, most neurosurgeons are presented at times with the problem of Craniosynostosis. This paper summarises the different clinical effects of different skull deformities, and describes the present state of the art with regard to surgical management.

ISSN:0268-8697    

DOI:10.3109/02688698809001000

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Nine patients (four females and five males) with chronic rheumatoid arthritis (RA) and atlanto-axial (AA) instability subjected to occipito-cervical fusion were evaluated clinically and radiologically. All of them had soft tissue formation (pannus) around the odontoid peg. The age ranged from 50 to 79 years (mean: 66). The duration of the RA disease was 3–48 years (mean: 18.5). All patients were seropositive. Both conventional radiography and magnetic resonance imaging (MR) were performed pre-and postoperatively. All fusions except one were stable. One patient was re-fused after 2 months because of wire break. With regard to pain all patients had improved and eight were pain free. Six patients who experienced signs of myelopathy prior to the fusion had improved at follow up. MR revealedreduction of pannus in all nine cases.This was obvious in one patient within 6 weeks postoperatively. The MR findings of a reduction or even disappearance of pannus following posterior fusion should decrease the need for transoral surgery.

ISSN:0268-8697    

DOI:10.3109/02688698809001001

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

The role of neurosurgical intervention in penetrating spinal injury has not been clearly established. Functional outcome has not been shown to be influenced by operation. In fact, neurosurgical intervention has been shown to potentially increase the risk of serious complications. This paper examines a unique subset of patients with penetrating spinal injury—those secondary to shotguns. An analysis of five such cases and a review of the limited literature on the subject suggests that neurosurgical intervention is of limited value in such injuries and that initial management should focus primarily upon non-neurological injuries.

ISSN:0268-8697    

DOI:10.3109/02688698809001002

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

A retrospective survey has been carried out on 56 children with shunted hydrocephalus either with a primary idiopathic cause or as a result of a low spina bifida complex. In all 56 children, a separate reservoir has been inserted at some stage in the management of their hydrocephalus.There was no mortality. Morbidity was not increased from CSF infection or shunt blockage. There was less chance of the initial shunt blocking and there was a lesser incidence of visual and schooling handicap. Double cortical puncture did not result in an increased incidence of hemiplegia or epilepsy.We conclude that a separate reservoir greatly eases the managment of these children and does not cause significant increased morbidity.

ISSN:0268-8697    

DOI:10.3109/02688698809001003

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Creatine kinase (CK) and creatine kinase BB isoenzyme (CK-BB) activities were measured in ventricular CSF obtained by lateral ventricle cannulation in patients suspected of normal pressure hydrocephalus. Lateral ventricle cannulation resulted in highly and variably elevated CK and CK-BB levels. The results emphasise the interference of these CK and CK-BB elevations in studies on the prognostic value of CSF CK and CK-BB levels in head trauma patients with respect to outcome.

ISSN:0268-8697    

DOI:10.3109/02688698809001004

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Ten patients are described in whom intraventricular bleeding occurred after blunt head injury. A mechanism is proposed to explain this phenomenon by drawing analogies with neonatal intraventricular haemorrhage and the pathological findings in strangulation. The outcome in the patients described seems more favourable than in those hitherto reported.

ISSN:0268-8697    

DOI:10.3109/02688698809001005

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Twenty-two patients with subdural haematomas associated with long term oral anticoagulation have been reviewed. Clinical presentation was similar to other subdural haematomas, but patients were generally older and the clinical course was more rapid. The incidence of over-anticoagulation was 23% and there was no correlation between anticoagulant status and the extent of bleeding or prognosis. Mortality was 27%, a residual neurological deficit was present in 14% and 59% made a complete recovery. The results suggest that morbidity and mortality could be reduced by early diagnosis and treatment and any patient on oral anticoagulant therapy who develops a headache or confusion should have urgent neurological investigation, including a CT scan. The indications for long term anticoagulation, particularly in the elderly, should be critically reassessed.

ISSN:0268-8697    

DOI:10.3109/02688698809001006

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Interhemispheric subdural haematoma (ISH) is a rare complication of head injury with only 19 cases reported since 1940, but it may also occur spontaneously (three cases). In both circumstances, clotting disorders are frequent (six cases). We have recorded seven cases (five traumatic, two spontaneous).Classically ISH is due to tearing of bridging veins or cortical contusions. In one of our cases, it was due to arterial bleeding from a pericallosal branch. CT scan shows that ISH may extend above the tentorium and on the hemispheric convexity. Mortality is high (35%). The best operative procedure is parasagittal craniotomy. Chronic interhemispheric subdural haematomas also occur.

ISSN:0268-8697    

DOI:10.3109/02688698809001007

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor