摘要:

&NA;In 47 cases of verified ruptured saccular aneurysm, we investigated the relationship of the amount and distribution of subarachnoid blood detected by computerized tomography to the later development of cerebral vasospasm. When the subarachnoid blood was not detected or was distributed diffusely, severe vasospasm was almost never encountered (1 of 18 cases). In the presence of subarachnoid blood clots larger than 5 × 3 mm (measured on the reproduced images) or layers of blood 1 mm or more thick in fissures and vertical cisterns, severe spasm followed almost invariably (23 of 24 cases). There was an almost exact correspondence between the site of the major subarachnoid blood clots and the location of severe vasospasm. Every patient with severe vasospasm manifested delayed symptoms and signs. Excellent correlation existed between the particular artery in vasospasm and the delayed clinical syndrome. Severe vasospasm involved the anterior cerebral artery in 20 cases and the middle cerebral artery in only 14. As the grading system used is partly subjective, the findings should be regarded as preliminary. The results, if confirmed, indicate that blood localized in the subarachnoid space in sufficient amount at specific sites is the only important etiological factor in vasospasm. It should be possible to identify patients in jeopardy from vasospasm and institute early preventive measures. (Neurosurgery,6: 1‐9, 1980)

ISSN:0148-396X    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

&NA;Fifty cerebellar hemispheres from 25 adult cadavers were examined. The superior cerebellar artery (SCA) was present in each of the 50 hemispheres. Forty‐three SCAs arose as a single trunk, and 7 arose as duplicate trunks. One solitary trunk and the rostral trunk of one duplicate vessel arose from the posterior cerebral artery. The remainder arose from the basilar artery. The SCA was divided into four segments: the anterior pontomesencephalic segment lay below the oculomotor nerve; the lateral pontomesencephalic segment coursed below the trochlear and above the trigeminal nerve; the cerebel‐lomesencephalic segment coursed in the groove between the cerebellum and the upper brain stem; and the cortical segment was distributed to the cerebellar surface. The SCAs arising as a single trunk bifurcated into a rostral and a caudal trunk, corresponding to the trunks formed by a duplicate origin. The rostral trunk supplied the medial and the caudal trunk supplied the lateral parts of the cerebellar cortex. The SCA gave off perforating, precerebellar, and cortical arteries. The perforating arteries penetrated the interpeduncular fossa, the cerebral peduncles, the junctions of the superior and middle cerebellar peduncles, and the colliculi. The precerebellar branches arose within the cerebellomesencephalic groove and supplied the adjoining parts of the cerebellum and brain stem. The cortical branches were divided into vermian, hemispheric, and marginal arteries. The 50 SCAs had points of contact with 32 oculomotor, 46 trochlear, and 26 trigeminal nerves. (Neurosurgery,6: 10‐28, 1980)

ISSN:0148-396X    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

&NA;Six cases of giant cell tumor of the spine are reported. Based on cases reported in the literature and on their personal experience, the authors stress the difficulty of making a proper differential diagnosis between giant cell tumor and other giant cell variants (i.e., aneurysmal bone cyst and benign osteoblastoma) on the basis of the clinicoradiological findings alone. It is pointed out that the disappointing recurrence rate of about 50% for giant cell tumors in ordinary locations (such as the long bones) and in the sacrum is remarkably decreased when these tumors involve the movable part of the vertebral column; giant cell tumors above the level of the sacrum have a better prognosis. (Neurosurgery,6:29‐34, 1980)

ISSN:0148-396X    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

&NA;To define better the syndromes of hydranencephaly and maximal hydrocephalus, we followed 10 neonates demonstrating (by computerized tomography) virtual absence of the cerebral substance with serial computerized tomographic (CT) scans, electroencephalograms (EEGs), and developmental evaluations. The follow‐up period ranged from 4 to 23 months. Two well‐defined syndromes emerged. Five patients showed absence of cortical activity on EEG and a CT picture of minimal occipital brain parenchyma connected by a thin bridge of tissue to intact basal ganglia. These patients were shunted and showed no improvement with time, either neurologically or radiologically. Five patients showed minimal frontal cerebral mantle on CT and the presence of electrical activity on EEG. These patients required bilateral shunts to control head size and showed remarkable progress with time. Serial CT scans demonstrated the appearance of considerable brain substance, and neurological development was either normal or slightly delayed. We believe that the former pattern of only minimal occipital brain and absent EEG activity defines true hydranencephaly, whereas the presence of small amounts of frontal brain tissue associated with EEG activity seems to represent maximal hydrocephalus. The differences in CT pattern, EEG, and clinical progress all suggest a different pathophysiology for these two conditions. (Neurosurgery,6:35‐38, 1980)

ISSN:0148-396X    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

&NA;Intrauterine constraint is responsible for a number of structural defects of the craniofacial and peripheral skeleton including plagiocephaly, micrognathia, congenital hip dislocation, and talipes equinovarus. This report describes five infants with serious craniofacial alterations, all attributable to intrauterine constraint. All five children had clinical and laboratory evidence strongly suggestive of craniosynostosis. In three of the five, sutural fusion was documented either at operation or at necropsy. In the other two the clinical course indicated that true synostosis was not present. In all cases the sutural involvement corresponded to the dimension in which head growth had been restricted. This determination was based upon an assessment of the other craniofacial alterations that were present. The etiology of the intrauterine constraint was different in each case. Factors involved included breech presentation, primagravidity, uterine malformations, amniotic bands, and defects in fetal neuromuscular development, all of which are known to produce fetal deformations. As further evidence of severe constraint, fetal activity was greatly reduced during four of the five pregnancies. There was no history of craniosynostosis in other family members. We propose that in utero compression may lead to a spectrum of craniofacial defects that includes craniosynostosis when the constraint is particularly prolonged. The data suggest that mechanical forces may play a role in the etiology of some cases of craniosynostosis. The fact that head shape spontaneously remolded in one of the five cases suggests further that surgical correction may not be required in all cases in which constraint is the suspected etiology of the deformation. (Neurosurgery,6:39‐44, 1980)

ISSN:0148-396X    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

&NA;Zenker's solution is a tissue fixative containing mercuric chloride, potassium bichromate, sodium sulfate, and glacial acetic acid. In 1956, Anderson and Johnson reported its use in clinical neurosurgery. They applied the solution to the exposed dura after craniectomy. Delayed bone formation was thought to be due to the suppression of the osteoblastic activity of the outer layer of the dura. The fixative has since become a well‐accepted adjuvant to the treatment of craniosynostosis. In 1972, Pawl and Sugar reported postoperative seizures in 6 of 34 patients treated with this solution. They assumed that the fixative penetrated the dura and irritated or damaged the cortex. To clarify the effect of Zenker's solution on the underlying brain, we performed bilateral parasagittal craniectomies in a group of kittens and adult cats. Zenker's solution was applied to one side and the other side served as a control. The animals were killed after periods varying from 24 hours to 2 months. We then examined the cortex under the craniectomies. There was immediate breakdown of the blood‐brain barrier, as evidenced by the penetration of intravenous Evans blue. In the postoperative period investigated, an inflammatory response in the underlying brain with thickening of the arachnoid occurred. The results and implications of these experiments are presented. (Neurosurgery,6: 45‐48, 1980)

ISSN:0148-396X    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

&NA;Enhanced computerized tomography (CT) is a noninvasive means of monitoring blood‐brain barrier (BBB) disruption. In the present study this technique was used to monitor the degree, distribution, extent, and reversibility of osmotic BBB disruption. With a canine model, the timing of administration of iodinated contrast agent was shown to be crucial to optimize enhancement by CT of the disrupted BBB. Meglumine iothalamate given intravenously resulted in excellent enhancement on CT scan. Intracarotid infusion of this contrast agent was less satisfactory. Under similar conditions, enhancement due to metrizamide was less marked and more transient than that observed with meglumine iothalamate. Systemically administered methotrexate after osmotic BBB disruption resulted in increased brain levels in areas that closely correlated with CT scan enhancement. These results suggest that the CT scan provides an excellent noninvasive monitor of both BBB disruption and the delivery of chemotherapeutic agents to the brain. (Neurosurgery,6:49‐56, 1980)

ISSN:0148-396X    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

&NA;We evaluated the treatment regime of dopamine‐induced hypertension in association with volume expansion and ventilatory support in an experimental subarachnoid hemorrhage (SAH) model using the cynomolgus monkey. Regional cerebral blood flow, vessel caliber, intracranial pressure, and other pertinent physiological parameters were monitored throughout each study. We report the results for nine animals receiving treatment after an induced SAH and compare them with results obtained in a group of five animals not treated after SAH. Improvements in cerebral blood flow, vessel caliber, and morbidity and mortality rates were seen with this treatment. Seven of nine animals were alive at 20 hours after SAH in the treatment group, whereas all five animals in the untreated group died before this time. The mechanisms of action of this treatment are discussed. (Neurosurgery,6:57‐62, 1980)

ISSN:0148-396X    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

&NA;We present our clinical experience with the repair of spinal cerebrospinal fluid fistula in three patients with the use of butyl cyanoacrylate, a tissue adhesive that polymerizes on contact with water. All three patients presented serious problems to conventional repair. With the use of butyl cyanoacrylate we eliminated the fistulas successfully. We conclude that this method is safe and effective and should be considered to be an acceptable method of treatment for this difficult problem. (Neurosurgery,6: 63‐65, 1980)

ISSN:0148-396X    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

&NA;Epileptogenic lesions affecting the supplementary motor area usually create partial seizures of the postural type, and these seizures may be associated with sensory, inhibitory, or autonomic phenomena; vocalization or speech interference; and a variety of ictal sensory experiences. Contributions leading to the present understanding of the supplementary motor area in humans and the history, findings, and care of a patient who was treated successfully by means of surgical excision of this area in her dominant hemisphere are the bases of this presentation. (Neurosurgery,6: 66‐75, 1980)

ISSN:0148-396X    

出版商:OVID    

年代:1980

数据来源: OVID