摘要:

&NA;Ninety consecutive cases of brain abscess admitted to this center between 1964 and 1978 have been reviewed. The overall mortality has fallen in three consecutive 5‐year periods from 42 to 21 to 9.7%. A number of factors seem to be responsible for this. Early surgical intervention was associated with the reduction in mortality between the first and second 5‐year periods. Recognition of the significance and extent of cerebral edema. confirmed since computed tomographic (CT) scans have been available, led to a greater use of steroids during the last 5‐year period, but the number of patients thus treated was too small to permit an assessment of any effect on mortality. There is no evidence to suggest a change in the natural history of the disease, and surgical management has not altered significantly. Experience with CT scanning in this center in the diagnosis of brain abscess is limited. It is therefore not possible to assess whether any improvement in mortality may have arisen from the early and accurate diagnosis obtainable with this technique. Improvement in culture technique has been of major importance, leading to a better understanding of the bacteriology of brain abscesses. This has allowed a more rational antibiotic program to be instituted, in particular the use of agents active against obligate anaerobes. (Neurosurgery8:1‐6, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;The cerebrospinal fluid (CSF) of 33 patients with a nontraumatic subarachnoid hemorrhage was analyzed to determine whether hypoglycorrhachia occurred frequently after a subarachnoid hemorrhage. Twenty‐three patients (70%) developed an abnormally low CSF glucose concentration or a lowered CSF‐blood glucose ratio after their hemorrhage. Thus, hypoglycorrhachia seems to be a common spinal fluid finding after subarachnoid hemorrhage. (Neurosurgery8:7‐9, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Plasma norepinephrine (NE) and dopamine&bgr;‐hydroxylase (DBH) levels were measured during the first 7 days after head injury in 48 patients. Blood pressure, pulse, temperature, and Glasgow coma score (GCS) were recorded at the time of sampling for each patient, and the relationships of these to NE and DBH were examined. In patients with multiple trauma. NE levels were usually elevated, regardless of the GCS. In patients with head injury alone, however, NE was proportional to GCS. Alert patients after a brief loss of consciousness (GCS, 14) had normal NE levels. Those in coma had levels as high as 7 times normal. Blood pressure, pulse, and temperature were found to be elevated proportionally to elevations in plasma NE in patients with head injury. The finding of elevated plasma NE in patients with severe head injury raises the possibility of adverse effects of sympathetic hyperactivity in patients with severe head injury, including hypermetabolism, cardiovascular abnormalities, and direct effects of catecholamines on the damaged central nervous system. (Neurosurgery8:10‐14, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Previous assessments of the value of sequential computed tomographic (CT) scanning in brain tumor patients have suffered from the heterogeneous nature of the study populations in regard to (a) pathology, (b) treatment plan, and (c) time of scanning. This report is based on the first 21 of 30 consecutive cases of glioblastoma multiforme entered into a cumulative high dose chemotherapy study. Each patient received a maximal surgical resection, 5800 to 6300 rads of radiation therapy, and BCNU (1,3‐bis(2‐chloroethyl)‐1‐nitrosourea) chemotherapy (beginning at 100 mg/m2/day × 3 days) every 8 to 10 weeks for the life of the patient. CT scans were obtained pre‐ and postoperatively and at each admission for chemotherapy; the scan at the time of the first BCNU course served as the postradiotherapy scan. Edema was present on 94% of the initial scans, and 94% of the tumors demonstrated contrast enhancement. In 70 instances it was possible to compare clinical status and an enhanced scan at the time of an adjuvant treatment. When the scan was improved or unchanged so was the patient (46 of 46), but worsening of the scan was accompanied by worsening of the patient only 62% of the time (15 of 24). Sequential CT scanning proved useful in (a) detecting the positive effect of a treatment plan in clinically stable patients; (b) detecting non‐tumor related causes of clinical deterioration; (c) detecting early treatment failure as a prelude to reoperation and/or a change in drug protocol before clinical deterioration; and (d) detecting asymptomatic complications of the treatment plan (i.e., a 20% incidence of ventricular enlargement). (Neurosurgery8:15‐19, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Eighteen cases of multiple primary brain tumors of different histological types were found in a review of Mayo Clinic records from 1950 to 1978. The predisposing factors, clinical presentation, location, and type of tumor are discussed. The clinical significance and etiology of these multiple tumors are considered. (Neurosurgery8:20‐25, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;In a series of 1341 patients with histologically proven malignant melanoma seen at Duke University Medical Center from 1968 to 1978, 107 patients developed central nervous system (CNS) metastases. These patients were evaluated on the basis of which factors were associated with the development of CNS metastases. Male patients, patients with invasive primary lesions as measured by Clark's system, and patients with primary lesions of the head/neck or oral mucosa had higher incidences of CNS metastasis. Age and race were not significant factors. Clinically, single CNS metastases were seen in 48.8% of the patients; multiple cerebral lesions were seen in 37.2% of the patients. In 22% of the patients there was CNS metastasis alone, in 41% a second organ was involved, and in 20% three organs were involved. (Neurosurgery8:26‐30, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;Benign osteoblastic lesions are rare bone tumors and they are usually divided into osteoid osteomas and benign osteoblastomas based on their biological behavior. Both lesions are prevalent in the spine, with the lamina and pedicle being involved frequently. Long diagnostic delays are frequent. Pain, the most prominent symptom, is often nocturnal and is relieved by aspirin in 30 to 40% of patients. Radicular pain occurs in 50% of the patients. The most common physical finding is tenderness in the vicinity of the lesion. Neurological abnormalities are more frequent in patients with osteoblastomas, which frequently extend into the neural canal. Tomograms are invaluable in most patients in whom plain films are normal. The bone scan is one of the most important diagnostic studies and provides an excellent means of following patients postoperatively. Myelograms do not always demonstrate the epidural extensions. Computed tomography accurately demonstrates the location and extent of the tumor. Permanent relief of pain and neurological recovery is dependent primarily on total removal of the lesion. (Neurosurgery8:31‐38, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;A population of 28 patients underwent the percutaneous placement of a shunt in the lumbar region with a single tube, the other end of which was placed in the peritoneal cavity by laparotomy. The clinical indications for the procedure were: communicating hydrocephalus (16 patients), pseudotumor cerebri (3 patients), cranial cerebrospinal fluid fistula (4 patients), and a bulging postcraniotomy site (2 patients). An additional 3 patients were treated by lumbar subcutaneousperitoneal shunt for a cerebrospinal fluid (CSF)‐subcutaneous fistula after the removal of a leptomyelolipoma. The mean time of follow‐up was 18.8 ± 7.8 months. All patients with pseudotumor cerebri and subcutaneous lumbar CSF fistula and all but 1 of the patients with a cranial CSF fistula improved without further therapy. Twelve of the 16 patients with communicating hydrocephalus improved and did not require other shunt procedures. There was one shunt infection, one wound dehiscence that led to shunt removal, and one shunt migration into the spinal canal. Shunt obstruction that led to revision of the shunt occurred on three occasions in 2 patients. The shunt functioned in only 1 of 4 infants under 4 months of age. (Neurosurgery8:39‐42, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;The intravascular use of the rapidly polymerizing acrylic compound, isobutyl 2‐cyanoacrylate (IBC). in 10 patients with intracranial arteriovenous malformations (AVMs) is described. The monomer was introduced into each malformation at craniotomy using angiographic control and microvascular dissection technique to identify, isolate, and inject the major components of each vascular lesion while attempting to preserve normal arterial circulation. Postoperative angiography was used routinely to evaluate the results of IBC embolization. Four patients underwent the injection and immediate surgical excision of an intracranial AVM, and 6 underwent injection alone; 3 of the latter had residual malformation demonstrated on postoperative angiography, and 1 of these patients had the remnants of her malformation occluded by a second embolic procedure. There was no operative mortality nor permanent neurological morbidity. Three patients suffered transient neurological dysfunction in the immediate postoperative period. (Neurosurgery8:43‐51, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

&NA;The intravascular use of the rapidly polymerizing acrylic compound isobutyl 2‐cyanoacrylate in four patients with carotidcavernous fistulas is described. The monomer was injected into the cavernous sinus at craniotomy after the intraoperative angiographic identification of the fistula site and the origin of its venous drainage. All patients had postoperative angiographic documentation of fistula closure and confirmed carotid artery patency. There was no operative mortality or permanent neurological morbidity. Two patients (50%) suffered transient dysfunction in the immediate postoperative period of one of the cranial nerves that transit the cavernous sinus. (Neurosurgery8:52‐55, 1981)

ISSN:0148-396X    

出版商:OVID    

年代:1981

数据来源: OVID