摘要:

We have attempted to highlight aspects of transoral procedures that we have acquired by experience in 235 cases and review the necessary applied surgical anatomy as well as some aspects of surgical pathology that are either not available or appropriately emphasised in the standard texts. Some previously unpublished conclusions drawn from our work have been made, but technical details of procedures available in published work have been excluded. We consider such surgery the route of choice in all midline extradural, clival, craniocervical junction, and upper cervical spine pathology, and it may also be used for some intradural pathology. All of this requires teamwork and experience; it is not an area for the occasional operator. Having said that, however, we believe that there is still a great deal of pathology not yet referred that would benefit by this type of surgery.

ISSN:1050-6438    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

It is now possible to evaluate regional cerebral hemodynamics in patients with atherosclerotic occlusive cerebrovascular disease using noninvasive techniques to study the cerebral circulation and metabolism. The degree of carotid stenosis and the presence of carotid occlusion correlates poorly with the hemodynamic status of the ipsilateral cerebral circulation due to the variation of the collateral cerebral circulation in individual patients. Atherosclerotic occlusive cerebrovascular disease is a complex multifactorial disease, and the role of cerebral hemodynamics in the pathophysiology of patients with ischemic cerebrovascular disease is not entirely clear. Further studies of cerebral hemodynamics and metabolism are needed to determine whether or not this is an important factor in the therapy and prognosis of patients with atherosclerotic occlusive cerebrovascular disease.

ISSN:1050-6438    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Optimal clinical management of pineal region tumors can vary greatly, depending upon which of a variety of histological subtypes is present. An open surgical procedure is the preferred method for obtaining sufficient tumor specimen, since it minimizes errors in histological diagnosis and can be safely accomplished through one of several surgical approaches. Stereotactic biopsy is a reasonable alternative to open surgery in patients with metastatic tumors or extensive underlying medical disease. Cranial radiation is given for malignant pineal tumors, with chemotherapy added for nongerminomatous ma lignant germ cell tumors. The use of prophylactic spinal radiation is controversial, but is generally not given except when spinal metastases are demonstrated radiographically. Nearly one-third of pineal tumors are benign and have a cure rate approaching 100% with surgery alone. Aggressive treatment of most malignant pineal tumors with a combination of surgery and adjuvant therapy has greatly improved their long-term prognosis. Current studies involving radiosurgery and new forms of chemotherapy for germinomas and pineal cell tumors are likely to improve present management strategies.

ISSN:1050-6438    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Intracranial aneurysms have been known for centuries. In the 19th century many excellent contributions were made toward the awareness and increased understanding of the nature of these treacherous lesions. It was not until the 1950s that a few pioneers started direct attacks with attempts to occlude ruptured intracranial aneurysms. From early surgery the pendulum swung to delaying surgery because of the many disastrous events associated with attempts to approach the circle of Willis in the face of a red, swollen, and angry brain. Such delayed surgery unfortunately had only a moderately beneficial effect on the overall outcome. With the introduction of the counterbalanced operating microscope, the wide range of microsurgical instruments, improved neuroanesthesia, and major advancements in diagnostic neuroradiology, the pendulum has swung back to early surgery (preferably within 48 h) for anterior as well as posterior circulation aneurysms in specially geared referral centers with accumulated experience and organization to handle such extremely demanding emergency procedures. Nevertheless, even today, <60% of all individuals who are struck down by the rupture of an intracranial rysm and are alive on admission to a neurosurgical center with a liberal policy of immediate admission irrespective of grade can be expected to show a favorable outcome. The evolution of intracranial aneurysm surgery and the historical landmarks leading to our present knowledge of this readed disease are depicted chronologically.

ISSN:1050-6438    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1050-6438    

出版商:OVID    

年代:1993

数据来源: OVID