摘要:

Summary:Nontraumatic intracranial arterial dissection was previously and is probably at present uncritically accepted as “cerebral infarction in otherwise healthy young adults.” This article challenges this conception of intracranial dissection. Data on 260 cases were collected from the literature (162 cases), unpublished cases in Japan (54 cases), and our own series (44 cases) to elucidate the natural history of nontraumatic intracranial dissections. The true incidence is not known. The incidence of symptomatic dissection is much higher in the vertebrobasilar than in the carotid system. The mean age of all the patients was 44.8 years. Patients with carotid lesions were younger (mean age, 32.2 years). The male/female ratio was 2:1. The most commonly affected artery was the vertebral, followed by the basilar and then the internal carotid arteries. Fifty-six percent of the patients were first seen with subarachnoid hemorrhage. Surgery was performed in 29% of the patients with carotid lesions and 60% of the patients with vertebrobasilar lesions. Dissection between the intima and media tends to cause arterial narrowing and occlusion, and dissection in the media or between the media and adventitia tends to cause rupture. Three fourths of the patients achieved favorable outcomes, and one fourth died. Outcome was better in the vertebrobasilar than in the carotid lesions.

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:The tethered cord syndrome (TCS) has been diagnosed with increasing frequency as our understanding of the disease has progressed. In addition, modern neuroimaging and neurosurgical techniques have advanced to the point where prompt diagnosis and treatment have become the norm. The vast majority of patients with a tethered spinal cord, if left untreated, will develop progressive neurological dysfunction characterized by bowel and bladder problems and lower extremity weakness, often associated with back and leg pain usually described as burning and dysesthetic in nature. At times progressive scoliosis is seen. Once neurological dysfunction has occurred, there is only a moderate chance of improvement with surgery. Consequently, current recommendations are that appropriate neuroimaging studies of the entire spine be done at the time of initial diagnosis to rule out second lesions. Surgical treatment should not be delayed unless the risk of resection of a complex lesion outweighs the benefit to the patient. Newborns should be operated on early in life. This approach to treatment seems to provide optimal outcome.

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:The history of chymopapain chemonucleolysis (CNL) has been peppered with controversy since CNL was first used 30 years ago for the treatment of unremitting sciatica of a herniated nucleus pulposus. Numerous studies from the United States, Europe, Canada, and Australia have shown that the procedure is a safe, effective, and practical alternative to laminectomy at an average of approximately half the cost of surgical diskectomy. Neurological complications have been shown to be due to faulty surgical technique, and anaphylaxis can be avoided in >99% of patients by using sensitivity testing. Through careful management, no deaths have occurred from anaphylaxis since 1987. Patient selection criteria for CNL are more rigorous than for laminectomy and must be carefully followed for a successful outcome. Long-term outcomes of CNL patients indicate that good to excellent results are enduring and compare favorably with those of laminectomy. A protocol for investigating chemonucleolysis in cervical disk herniation is being developed; positive results from Europe should pave the way for the expanded use of CNL in the United States. Although studies of other lytic enzymes are being conducted, chymopapain remains the standard by which they are to be judged.

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:As the elder population lives longer, symptomatic lumbar stenosis will become a more frequent clinical entity. Once surgical decompression is considered, controversy exists as to when to fuse. In this study, 206 patients with symptomatic lumbar stenosis were treated initially by decompression only. After a mean follow-up of 28 months, six patients needed a subsequent operation for a fusion. A common denominator was not determined except for a possible grade II spondylolisthesis. Fusion with decompression is not routinely recommended unless grade II spondylolisthesis is co-existent.

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:The surgical approaches to aneurysms of the vertebrobasilar arterial complex vary considerably depending on the location, projection, and size of the aneurysm. The surgeon must have a very clear understanding of the local anatomy and any possible variation in the arrangement of vessels encountered. Electrophysiologic monitoring and other adjunctive measures allow safer visualization and direct manipulation of these unusual aneurysms. Endovascular techniques may improve overall management, but they are not fully established. This article reviews our experience with aneurysms of the vertebrobasilar region and emphasizes the need for a complete armamentarium in their surgical management.

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID