摘要:

Fusion of the occiput to the cervical spine is an infrequent but important procedure, as it provides the only permanent means of stabilization of the occipitocervical region. Occipitocervical fusion is commonly accompanied by an adjunctive procedure such as a decompression for stenotic disorders or a resection of pathologic material such as neoplasm, infection, or inflammatory pannus. Many techniques on obtaining an occipitocervical fusion, both with and without rigid internal fixation, have been described in the orthopaedic and neurosurgical literature and have evolved over time. These include simple onlay bone graft techniques, wire fixation with and without cement augmentation, malleable rod/wire constructs, and plate and screw fixation. A discussion of all described methods of occipitocervical fusion could fill an entire text. Therefore this article will focus on three primary methods: (1) occipitocervical wiring; (2) sublaminar and interspinous wire fixation about a contoured rod; and (3) plate and lateral mass screw fixation.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Neural transplantation has been a major field of research during the past 20 years. This concept is challenging because the central nervous system has a limited ability for self-repair. Fetal grafts have clearly shown that they can survive in the adult host brain and can restore some lost functions in neurologic disorders such as Parkinson's and Huntington's diseases, where a specific and limited population of neurons degenerate. However, major problems remain in the availability of donors and in the optimal survival of the grafted tissue. Therefore, a better understanding of the mechanisms of graft survival and alternatives to reduce the amount of donors is needed before considering transplantation as an effective clinical therapy.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

During the past decade, it has been repeatedly shown that mild to moderate hypothermia (32–34°C) reduces neurologic injury in animal models of focal or global ischemia, and of traumatic injury. This has led to renewed interest in the application of hypothermia for managing head injury, stroke, and cardiac arrest and for undertaking aneurysm surgery. This article reviews the relevant literature and presents the authors' experience with intracerebral hemorrhage treated under hypothermia.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Spinal infections continue to be an important source of death and complications in the developing countries. With recent advances in imaging techniques and the advent of a new generation of antimicrobials, there has been a considerable decrease in the incidence. However, there are still many pitfalls in the management of spinal infections. Early diagnosis and use of appropriate antibiotics and surgical instrumentation remain the mainstay of management. Bacterial infections (i.e., pyogenic osteomyelitis, tuberculous spondylitis, and spinal brucellosis) are the most common types seen in the Middle East. Other varieties of vertebral osteomyelitis from viral, fungal, or parasitic organisms are also seen. In this paper the authors review the standard management of spinal infections and briefly overview their experience in dealing with these infections.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Chordomas are rare tumors originating from the remnants of the primitive notochord. Their deep location and patterns of extension and the proximity of structures such as the brain stem, upper cervical spine, hypophysis, and cranial nerves make their treatment a challenge. Even if gross total removal has been achieved, the malignant histologic patterns, the presence of isolated islands of tumor into normal bone, the extension of the lesion through the skull base, and the deep and central location preclude an en bloc oncologic resection. During the past decade, several new surgical approaches and new modalities of radiation therapy have been developed for treating these lesions. In this review, the diagnosis and management of skull base chordomas are discussed, with emphasis on radical surgery treatment with radiation therapy with heavy particles. Despite the absence of malignant pathologic findings, the uncertain behavior of some lesions makes the management of skull base chordomas a “no-man's land.” A review of the current literature allows the conclusion that radical surgical removal associated with adjuvant radiation therapy with heavy particles is, up to now, the best way to treat chordomas of the skull base.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Although moyamoya disease was first described in 1957, its pathogenesis remains unknown and its prognosis poor. Because of its grave natural history, with neurologic deterioration resulting from repeated ischemic and hemorrhagic strokes, several regimens of both direct and indirect revascularization have been devised to prevent its progression. The objective of this article is to review the advances in both the surgical technique and contemporary general management. In particular, the cause and pathogenesis of this disease, the effects of a direct or indirect bypass procedure, surgical complications, and indications for direct and indirect bypass procedure are reviewed.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The craniocervical junction is a unique biomechanical interface that acts as a transition zone between the cranial base and the upper cervical spine. A clear understanding of the embryologic derivation and anatomic orientation of the osseus, ligamentous, and neural structures making up the craniocervical junction is imperative before embarking on the diagnosis and management of pathologic lesions affecting this region.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID