摘要:

Attempts at radical excision of craniopharyngioma have been made increasingly possible by progress in neuroradiological imaging and the use of microscopic technique. Between 1977 and 1990, 50 patients of The National Hospital for Neurology and Neurosurgery, London, have undergone radical surgical excision of craniopharyngioma by the temporal route, with a small anterior temporal resection. Surgical mortality was 4%. Thirty-eight (76%) patients remain well at average follow-up of 30 months; 15% had major complications (hypothalamic damage, subdural haematoma, scalp collections requiring shunt drainage). There were three recurrences in those patients where the initial operations were considered as complete microscopic excision. It is concluded that maximal control of tumour recurrence by removal of all tumour accessible and visible to the surgical microscope is best achieved by a radical excision at the first operation.

ISSN:0268-8697    

DOI:10.3109/02688699109002877

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Premature vascular aneurysms and fragility of cerebral arteries are commonly associated with type III collagen mutations and physical signs suggesting a generalized abnormality of connective tissue. Sometimes these traits are clearly genetically transmitted. Here we present seven examples of early cerebrovascular aneurysms or fragility including five examples of carotid cavernous sinus aneurysms. With one exception in which we suspect the mutation is too small to be detected, all of them had easily visible abnormalities of their type III collagen proteins. Further work in progress will eventually allow the characterization of their mutations at gene sequence level and will be followed by the ability to prevent transmission of the mutant genes in these families.

ISSN:0268-8697    

DOI:10.3109/02688699109002878

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Intracranial saccular aneurysms in childhood are rare neurosurgical lesions, occurring in 1–3% of large epidemiological aneurysm series. Analysis of previous reports indicates several distinct characteristics of this entity. First, there is a predominant male:female ratio approaching 2:1. Second, a disproportionately high number of these aneurysms arise at peripheral locations on the arterial tree. Third, approximately half of them are large or even giant aneurysms. These identifiable characteristics suggest that aneurysms in the younger age group may be a distinct pathophysiological entity from aneurysm in the adult population. In adults, epidemiological evidence indicates that‘acquired’factors such as hypertension, cigarette smoking, alcohol consumption, and oral contraceptive use together with‘intrinsic’or‘vascular’factors are causally related to the formation and rupture of cerebral aneurysms. Inherently, some of the‘acquired’factors must be of minor importance in aneurysm formation and rupture in childhood, whereas the‘intrinsic’factors may have a greater importance.

ISSN:0268-8697    

DOI:10.3109/02688699109002879

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Infection and extrusion of the peritoneal catheter can complicate shunt surgery. We present a modification in the technique of peritoneal catheter placement which can help reduce the incidence of these complications, as it places the peritoneal catheter away from the abdominal wound. The subcutaneous passer is first introduced into the peritoneal cavity through the abdominal incision. It is then thrust superficially and manipulated into the subcutaneous plane, from where the procedure follows the conventional steps. We have followed this technique for 6 years without any additional hazard attributed to this procedure.

ISSN:0268-8697    

DOI:10.3109/02688699109002880

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Central nervous system involvement with AIDS is not uncommon. The indications and timing of brain biopsy remains controversial. Stereotactic CT-guided biopsy offers a safe and effective means of establishing a diagnosis in any patient with a cerebral mass lesion and has less morbidity and mortality than freehand biopsy or exploratory craniotomy. Eleven patients with AIDS have undergone CT-directed stereotactic biopsy between May 1987 and November 1990 with one death from intracerebral haemorrhage. Histological diagnosis of the biopsy specimens showed multifocal leucoencephalo-pathy, toxoplasmosis, lymphoma and non-specific changes. Biopsy is recommended for patients with an atypical presentation, negative serology, progressive clinical deterioration and differential response of lesions to empirical therapy.

ISSN:0268-8697    

DOI:10.3109/02688699109002881

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Two-hundred and ninety-five patients with angiographically demonstrated intracranial aneurysms presented to the Institute of Neurological Sciences, Glasgow over a 3-year period (1986–88). We have reviewed this group to assess the effect of changing patterns of management upon outcome. The overall mortality rate was 9.4%, and the surgical mortality rate was 4% in this selected series. Factors significantly associated with a poor outcome were: WFNS grades III-V on admission, presence of a haematoma on the first CT scan, delayed ischaemic deficit, and development of a post-operative haematoma. Seventy-six per cent of the patients who developed a delayed ischaemic deficit (nearly a third of those with recent subarachnoid haemorrhage) made a good recovery, in contrast to previous studies, and over two-thirds of those accepted in grades IV and V (28 patients) made a good recovery after surgery. Active management of patients in grades IV and V, and those with delayed ischaemia, together with prophylactic Nimodipine therapy and selective early surgery, offers the best prospect for further improvement in outcome after aneurysmal subarachnoid haemorrhage.

ISSN:0268-8697    

DOI:10.3109/02688699109002882

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

One-hundred and eighty-five patients sustaining an aneurysmal subarachnoid bleed were detected in a well-defined urban region in Stockholm, during a 3-year period. Of all detected patients, 21% died before coming to neurosurgical attention. In this prospective series 54 of the admitted patients had more than one bleed. In 29 of them rebleed was subsequently verified. There were 25 patients with a clinical history of a minor bleed or a warning leak preceding the major bleed. Of all rebleeds—minor bleeds included—35% occurred in the first 24 h, 5% between days 1 and 3,19% between days 4 and 7 and 41% after the first week. Although the greatest distance to the hospital was 65 km, not more than 53% of the patients were admitted within the first 12 h post bleed. This delayed admission was attributed almost equally to a patient delay or a referral delay by doctors. The outcome of the patients was more gloomy if referral delay was apparent. A substantial number of rebleeds could have been avoided had the patient not disregarded the first bleed or the first doctor on line had not misunderstood the symptoms. Thus, 35 of the 54 rebleeds were regarded as avoidable, if admitted in time. Hypothetically a better outcome was expected in 20 of these 35 avoidable rebleeds. Substantiated by this study, aiming at early admission and treatment in the first 72 h post bleed, almost 65% of the late (after 72 h) rebleeds could be avoided.

ISSN:0268-8697    

DOI:10.3109/02688699109002883

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Dural spinal arteriovenous malformations are increasingly recognized as a rare but treatable cause of progressive paraplegia, but the clinical picture, especially in early cases, is not easy to recognize and operation may therefore be delayed until considerable loss of function has occurred. We present a series of seven cases which illustrate the characteristics and diagnostic difficulties of this condition.

ISSN:0268-8697    

DOI:10.3109/02688699109002884

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

We prospectively studied 653 consecutive head-injured children (<14 years old) treated over a 54-month period (1984–88) at the Department of Neurosurgery of the Rambam Medical Center (Haifa, Israel). Demographic and clinical data were collected, the patients were divided into five age groups (birth to 2 years, 169; 3–5 years, 194; 6–9 years, 164; 10–12 years, 77; and 13–14 years, 49), and the information relative to each was then compared. All patients (except three who died on the operating table) underwent computed tomography (CT) scans; 225 (34.6%) had intracranial pathology, e.g. focal mass lesions, diffuse axonal injury, and subarachnoid haemorrhage. The rate of detected pathology increased with age. Skull fracture was documented in 468 (72%) patients. Craniotomies were done on 114 (17.5%) patients. After 3 months, the patients were classified as having good recovery (84.8%), moderate disability (5.5%), or severe disability (2.3%); 0.9% were in a vegetative state. The mortality was 6.6% (43 patients); of these, 39 (90.7%) had admission Glasgow Coma Scale scores below 8. In our area the annual incidence of neurosurgical hospitalization due to head injury in the pediatric group was 37.6 per 100,000 inhabitants per year. This study substantiates the findings of other series on the effects on prognosis of factors such as associated trauma, admission Glasgow Coma Score, mass lesions with persistent intracranial pressure elevation, or diffuse axonal injury. This study also indicates that age has a bearing on severity of injury and outcome, even within the pediatric patient population, and that the presence of a skull fracture is not a reliable indicator of intracranial pathology. The obvious benefit of easy access to CT is illustrated.

ISSN:0268-8697    

DOI:10.3109/02688699109002885

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

A large pituitary fossa cavernous haemangioma in a 48-year-old male is presented. The rarity of this lesion is stressed. The relevant literature is reviewed.

ISSN:0268-8697    

DOI:10.3109/02688699109002886

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor