摘要:

&NA;The management of low‐grade gliomas represents a challenge to the physician as a significant proportion may undergo malignant degeneration to a high‐grade tumor. We present the positron emission tomography (PET) scans, using [18F] fluorodeoxyglucose (FDG), of 12 patients who have histological and/or clinical evidence of malignant degeneration of a low‐grade glioma. Each scan displays a focal area of hypermetabolism similar to that of malignant gliomas which arisede novo.Three patients also underwent PET scanning prior to malignant degeneration. When the initial scan is compared with the postmalignant degeneration study, a difference in tumoral glucose uptake can be recognized. A region previously shown to be hypometabolic develops focal hypermetabolism as malignant changes evolve. This study displays the utility of FDG‐PET in the evaluation of malignant degeneration of low‐grade gliomas. The knowledge that a neoplasm has altered its biological behavior may influence subsequent therapeutic options. If these findings can be confirmed in larger series and by other investigators, it is possible that FDG‐PET may be adopted as one of the diagnostic tools for guiding the management of low‐grade gliomas. (Neurosurgery24:1‐5, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;If a sufficient concentration of the stable isotope10B is introduced into a neoplasm, radiation therapy can be effected by short‐range heavy charged particles from the disintegration of10B by slow neutrons. Brain tumors were irradiated postoperatively by Hatanaka and co‐workers in Japan using a 1 to 2 hour intraarterial infusion of10B‐enriched Na2B12H11SH (Na210B12H11SH) before exposure of the tumor‐bearing area of the brain to slow neutrons from a 100 kilowatt nuclear reactor. The clinical outcome of such boron neutron capture therapy has been favorably impressive in some patients, but its efficacy in brain tumors needs improvement. In our study, a terminally ill patient with malignant astrocytoma was infused intravenously with Na210B12H11SH for 25 hours. The postmortem distribution of10B in unfixed, frozen, tumor‐bearing brain and spinal cord tissues was studied by comparing representative cryostat sections of these specimens with neutron‐induced heavy charged particle radiographs of the same sections. Preferential accumulation of10B was observed in the tumor, with relatively little accumulation of10B in the parenchyma of the central nervous system. (Neurosurgery24:6‐11, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Twenty‐four patients with petroclival meningiomas were operated upon at the neurosurgical clinic of the City Hospital of Hannover between 1978 and 1987. Seventeen were women and seven men; the mean age was 45 years. Symptoms were usually present for more than 2 years before the diagnosis was made. The most common symptom was disturbance of gait; the most common preoperative sign was cranial nerve deficit, mainly of the 7th and 8th nerves. Preoperative neuroradiological evaluation included computed tomography and four‐vessel cerebral angiography. Fifteen patients (62%) had a tumor larger than 2.5 cm in its major diameter. The surgical approaches used were the retromastoid, pterional, subtemporal, and combined retromastoid‐subtemporal. We developed a modification of the retromastoid‐subtemporal approach with preservation of the transverse sinus and used this in the last 2 patients. There was no postoperative death; 11 patients (46%) suffered postoperative complications, mainly in the form of cranial nerve deficits, often reversible. “Total” tumor removal was achieved in 17 patients (71%). Twenty patients (83%) were independent at the time of discharge from the hospital. With accurate neuroradiological evaluation, careful choice of the surgical approach, and sound application of microsurgical techniques, petroclival meningiomas may be “totally” and safely resected in a significant number of patients. (Neurosurgery24:12‐17, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Forty‐two patients with neoplasms involving the cavernous sinus had operations between 1983 and 1987. The lesions included 25 benign tumors (e.g., meningioma, neurilemoma) and 17 malignant tumors (e.g., chondrosarcoma, adenoid cystic carcinoma). The cavernous sinus was entered by inferior, anterolateral, or medial extradural approaches or by superior or lateral intradural approaches. The intracavernous internal carotid artery was managed by dissecting tumor away from it or by occlusion and excision with or without direct vein graft reconstruction, based on the results of a preoperative balloon occlusion test. Cranial nerves III, IV, V, and VI usually were dissected from tumor, but in 3 cases of tumor invasion, the excised nerve segment was reconstructed by direct suture or with a sural nerve interposition graft. Twenty‐one of the benign tumors and 8 of the malignant tumors were excised totally and the remainder subtotally. On follow‐up ranging from 3 to 48 months, one subtotally excised meningioma recurred and was treated with reexcision and adjuvant radiation therapy. Two “totally” excised malignant tumors recurred outside the cavernous sinus at the margins of excision. There was no operative mortality or permanent cerebral morbidity. Postoperatively, the ocular and neurological function of most patients was similar to the preoperative status; in some, it was significantly improved. Thirteen additional patients with intracavernous neoplasms also were evaluated during the same period and followed without operation. The early follow‐up information regarding these patients is provided. (Neurosurgery24:18‐30, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Data were obtained prospectively for 7,912 head‐injured patients admitted from 1980 to 1981 to 41 hospitals in 3 U.S. metropolitan areas. Highly significant independent predictors of mortality were motor score, number of reactive eyes, systolic blood pressure, abdominal injury, chest injury, age, and hospital unit (hospital or group of hospitals). The difference between the number of deaths observed and the number expected, by hospital unit, ranged from 43% below expectation to 52% above expectation. The 2 hospital units with the lowest mortality had only 1 death, where 9.4 would be expected, in patients whose risk of death was estimated to be less than 10%. In the single hospital with clearly excess mortality, however, the standardized mortality ratios were 208, 135, and 144% for the risk groups whose probabilities of death were 0 to 50, 50 to 80, and 80 to 100%, respectively. The lack of deaths in those hospitals with the best mortality experience and the excess mortality in the hospital with the worst mortality experience appear to be explained largely by differences in patients who, by clinical criteria, seem to be at low risk for death, and not by severely injured patients. (Neurosurgery24:31‐36, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;An experience with 19 cases of transoral exposure of the lower clivus and ventral aspect of the upper cervical spine is presented. The spectrum of pathological entities in this series includes malformative, neoplastic, and spondylotic conditions. The report is designed to focus upon some points of overall surgical management of patients treated by the transoral approach, with emphasis on management of postoperative instability, and to underline the discrepancy in the prognosis of congenital and acquired disorders, in terms of mortality, morbidity, and long‐term results. (Neurosurgery24:37‐42, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Norepinephrine (NE) changes during hydrocephalus, and the effects of surgical decompression on these changes, were studied using a new model of neonatal hydrocephalus. Kittens 4 to 10 days old received intracisternal injections of a sterile solution of 25% kaolin. Control kittens were injected similarly with sterile injectable saline. Ultrasonography was used to follow the progression of ventriculomegaly and the initial effects of the shunts. A subgroup of hydrocephalic animals was shunted using a cerebrospinal fluid lumbar‐peritoneal catheter. Hydrocephalic animals were killed at approximately 25 days of age (16‐21 days after kaolin injection). Surgical decompression was performed at 12, 16, and 17 days after kaolin injection; these animals were killed 30 days after the shunts were inserted. Control animals were killed at 29 and 53 days of age, to correlate with the ages of the hydrocephalic and shunted animals, respectively. Cortical samples equivalent to Brodmann's areas 4, 22, and 17 were measured for NE using high‐performance liquid chromatography. Hydrocephalus caused NE levels to decrease significantly in all cortical areas. These alterations followed a rostrocaudal gradient in severity, with mean reductions of 65.8, 83.9, and 95.8% in areas 4, 22, and 17, respectively. Partial recovery occurred in animals that received shunts 16 and 17 days after kaolin injection, such that NE reductions of 75.7, 56.2, and 81.6% were noted in areas 4, 22, and 17, respectively. Shunting at 12 days after kaolin injection produced complete recovery in areas 4 and 22, with only a 67.7% decrease in area 17. These results suggest that the projection fibers from the locus ceruleus are damaged by the direct effects of hydrocephalus. Axotomy or neuropraxia of these fibers could result in decreases in NE throughout the cerebral cortex. In addition, there appears to be a period of time during which surgical decompression will allow neuropraxic fibers to recover with partial restoration of NE levels. Earlier insertion of a shunt appears to allow for more recovery than later decompression. (Neurosurgery24:43‐52, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Patients with craniopharyngiomas who demonstrate cyst enlargement after surgery and radiation are often presumed to be treatment failures. Therapeutic approaches in various centers include repetitive cyst aspirations, surgical reexcision, and instillation of cytotoxic agents such as methotrexate,32P, or198Au. Each intervention has associated severe or even lethal side effects. Not all patients with craniopharyngioma who have cystic enlargement after primary therapy require an intervention, as demonstrated by 4 patients recently managed in the University of Rochester Medical Center. Since 1978, when computed tomography was routinely in use, we have managed 11 patients with craniopharyngiomas who were treated with surgery followed by radiation therapy. Three of these patients demonstrated post‐irradiation enlargement of the residual cystic component followed by a decrease in size without surgical intervention. An additional patient showed cystic growth followed by stabilization of size. It is noteworthy that the cyst enlarged within the first 5 months after radiation therapy in the 3 patients who subsequently demonstrated a diminution in the size of their cysts. This suggests that the mechanism for cyst formation remained intact and subsequently abated because of a radiation‐induced lesion. We conclude that after treatment with surgery and radiation therapy, the cystic component of craniopharyngiomas may increase and, without intervention, subsequently decrease in size. Thus, in the asymptomatic patient who demonstrates cystic growth soon after primary therapy, close observation alone may be warranted. (Neurosurgery24:53‐59, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The influence of nitrous oxide on motor evoked potential (MEP) elicited in rats by cortical and midcervical electrical stimulation was studied and compared with early components of somatosensory evoked potential (SEP) following stimulation of the posterior tibial nerve in 6 rats. We found that nitrous oxide gradually suppresses MEP, depending on the concentration of this inhalation agent. At a concentration of 66 vol% of nitrous oxide, the MEP was completely abolished, whereas the initial component N1‐P1 of the SEP was only slightly reduced. We conclude that the descending impulse elicited by electrical stimulation of the corticospinal tract is mainly inhibited at the level of the spinal neuronal or interneuronal system, since (1) neuromuscular transmission is not blocked by nitrous oxide, and (2) MEP suppression is the same following cortical and midcervical stimulation. (Neurosurgery24:60‐62, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Eleven patients with chronic pain due to severe vasospastic disorders in the upper limbs were treated with cervical spinal cord stimulation. In 8 patients the pain was due to reflex sympathetic dystrophy in the late stage of the disease, and 3 patients had severe idiopathic Raynaud's disease. The mean follow‐up for both groups was 27 months. A total of 10 patients (90.9%) had good or excellent results. Thermographic and plethysmographic changes were observed in both groups. There seems to be a very close relationship between the increase of blood flow and the amount of pain relief achieved. In an attempt to quantify the intensity of pain, the visual analog scale and McGill Pain Questionnaire were used, Stimulation proved to be harmless, with no mortality and very low morbidity. The latter centered around local infection and displacement of the electrodes. No objective changes occurred in trophic alterations such as bone decalcification and ankylosis, but there were improvements in the alterations in the nails and skin. In the reflex sympathetic dystrophy group, the amount of pain relief achieved enabled most patients to undergo subsequent physiotherapy and rehabilitation. In severe cases of reflex sympathetic dystrophy and idiopathic Raynaud's disease, spinal cord stimulation is an alternative treatment that can be used as primary therapy or as secondary therapy after unsuccessful sympathectomy or sympathetic blocks. (Neurosurgery24:63‐67, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID