摘要:

Summary:First described in the 1920s, hemispherectomies (HS) had an extraordinary impact on the practice of neurosurgery as well as on the understanding of the developing nervous system. Few people would have predicted that a patient would survive such an extensive resection. That patients survived, and that the effects were not much worse than a severe stroke, dramatically challenged the fledgling neuroscience community. Here was a clinical result that called for an entire reexamination of the theories of localization, plasticity, handedness, and development. However, the operation failed its initial goal. HS could not cure brain cancer, and it offered no long-term survival benefit. The procedure would have disappeared except that another pioneer, McKenzie in Canada, saw that Dandy's “last resort” operation for brain tumors could be applied to infantile hemiplegia and intractable epilepsy. Krynauw's description of 12 cases subsequently became the basis for the use of HS in children. Initial results were remarkable and gratifying. Seizures stopped. Children became free of medications and could reestablish happy lives. This picture of enthusiasm gradually changed to concern, then outright pessimism, after long-term studies indicated that the initial period of wellness could be followed in 6–8 years by a progressive neurological decline and death. Autopsies showed brain stem shifts and slow intracranial bleeding leading to hydrocephalus and hemosiderosis. The literature today contains numerous warnings about the sequelae of HS. The third generation of HS began in the 1970s. Qualified observers considered that the long-term side effects could be surgically managed. Moreover, the operation remained the viable option for the relief of intractable seizures. Several third-generation case series recently have been published. It is important to compare results, for there are notable differences in the surgical approach at various centers. Even within a given series, surgical methods, including anesthetic techniques, may change as reports appear and personal contacts share information.

ISSN:1050-6438    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:The region of the jugular foramen represents one of the most complex areas of the skull base. Advances in radiology, microsurgery, interdisciplinary management, and postoperative intensive care have brought great changes in treatment of the tumors affecting this region. Surgical treatment has been considered the current preferred management in the majority of the cases. Tumors involving the jugular foramen are divided into two major groups: those arising within the foramen, such as the schwannomas of cranial nerves IX, X, and XI, and the glomus jugulare tumors; and those arising from structures surrounding the foramen, such as meningiomas, chondrosarcomas, metastases, etc. The choice of surgical approach depends on the nature and extension of the lesion. Benign well-encapsulated tumors are resected totally, with potential preservation of surrounding nerves. Inversely, infiltrative growing or malignant tumors are partially resected in order to decompress the surrounding structures. Two major approaches are performed: a primary intradural suboccipital approach and a combined intradural-extradural procedure through a transmastoid-cervical approach. Radiotherapy is reserved for single cases in which surgery is not indicated. Preoperative embolization has been shown to be very useful in management of glomus jugulare tumors. CSF leakage, meningitis, and swallowing problems are the major potential complications in jugular foramen surgery. Both prevention and treatment of the complications have considerably improved the postoperative outcome in these patients.

ISSN:1050-6438    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Spasticity accompanying neurologic conditions such as spinal cord injury, multiple sclerosis, stroke, cerebral palsy, and head trauma may produce significant functional incapacitation and discomfort over and above the underlying disease process. In patients whose symptoms of hypertonia and spasm are intractable to medical therapy, a variety of neurosurgical procedures are presently available that merit consideration. This article reviews the surgical alternatives of neurotomy, myelotomy, dorsal root entry zone lesioning (DREZ-otomy), thermal rhizotomy, selective dorsal rhizotomy, spinal baclofen, and spinal cord stimulation. Recommendations are made regarding the use of these operations in specific clinical settings.

ISSN:1050-6438    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:The physiologic aspects and differential diagnosis of syndromes causing acute myelopathy are reviewed. Emphasis is placed on the noncompressive types.

ISSN:1050-6438    

出版商:OVID    

年代:1996

数据来源: OVID