ISSN:0148-396X    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

&NA;In 13,700 patients who received one or more lumbar disc injections of chymopapain, 401 complications, adverse reactions, and delayed untoward events were recorded, including eight deaths. The deaths were secondary to anaphylaxis, pulmonary embolism, discitis with subacute bacterial endocarditis, ruptured abdominal aortic aneurysms (two patients), encephalitis (of unknown etiology), and myocardial infarction. Of these, the deaths secondary to anaphylaxis and discitis with subacute bacterial endocarditis can be attributed directly to the procedure of chemonucleolysis.

ISSN:0148-396X    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

&NA;Tumors and vascular malformations in the posterior parts of the dominant hemisphere are frequently associated with preoperative alexias, and surgical maneuvers in these areas may cause the appearance of this neurobehavioral deficit as an operative complication. Lesions of the dominant (left) angular gyrus are associated with the syndromes of alexiawithagraphia. Alexiawithoutagraphia results from lesions of the pathways which conduct visual information from the calcarine areas to the left angular gyrus (splenium of the corpus callosum, left lingual and fusiform gyri, left transverse and vertical occipital fasciculi). A brief bedside examination (outlined in the text) provides useful pre‐and postoperative localizing information. Fresh cadaver studies of the brainin situhave shown that the approximate center of the left angular gyrus area is found by first locating a point 9 cm forward along the midline from the inion and then moving 4¼ cm laterally. These measurements define a point which is a few centimeters medial and posterior to the center of the parietal eminence.

ISSN:0148-396X    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

&NA;In a 36‐month period, 103 consecutive patients have been treated for classical trigeminal neuralgia with either percutaneous radiofrequency trigeminal neurolysis (PTN) (48 patients) or microvascular decompression (MVD) via a suboccipital craniectomy (55 patients). The results of these two procedures are tabulated, emphasizing especially the complications that have occurred with each. Successful initial relief of pain was achieved in 88% of the patients with PTN and 96% of the patients with MVD. Two significant complications occurred in the former group. Severe recurrences have occurred to date in 13% of the patients with PTN and in 5% of those with MVD. It is concluded that both procedures are effective, but that microvascular decompression offers the advantage of avoiding sensory loss and associated dysesthetic sensations. Follow‐up is too short to conclude that MVD is a curative procedure, but the early results are very encouraging.

ISSN:0148-396X    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

&NA;The authors report the operative and follow‐up results (3 months to 9 years) of 86 consecutive extra‐intracranial bypass operations on 84 patients with cerebral ischemia, emphasizing both the prophylactic role of the operation in preventing further catastrophic cerebral ischemia, and the low morbidity and mortality of the operation.

ISSN:0148-396X    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

&NA;The authors have developed a technique of occluding intracranial aneurysms by the direct injection of a tissue adhesive. Previous work in our laboratory had revealed the unusual intravascular characteristics and physiological properties of isobutyl‐2‐cyanoacrylate (IBC). These findings had indicated the feasibility of utilizing IBC in the treatment of intracranial aneurysms by its direct injection. We have now treated twenty patients by this method. Eighteen aneurysms were injected during open craniotomy and two were treated by closed stereotactic injection utilizing electronic radiography. Follow‐up data, ranging from 1 to 6 years after operation, are available on these patients. Sixteen patients (80% of the series) have had good to excellent results. Our experience and the application of this technique as a potential tool in the treatment of intracranial aneurysms are discussed.

ISSN:0148-396X    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

&NA;After the study of over 300 angiograms of supratentorial cerebral arteriovenous malformations (AVM's), the authors have formulated an anatomical grading scheme of I to IV to correspond to the degrees of surgical difficulty for total obliteration. The grading is based upon the number of directly participating arteries for which there is a standardized nomenclature. Occasionally, allowance for clinical grading, in addition to this anatomical grading, must be made. Also, for the anticipation of morbidity, but not mortality, the location of the lesion is important. The authors present the postoperative results in a series of 49 patients to demonstrate the clinical usefulness of the grading scheme.

ISSN:0148-396X    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

&NA;Nine pineal area lesions were operated upon by the infratentorial‐supracerebellar approach. There was one operative death and one death due to disseminated germinoma recurrence 2½ years postoperatively. The remaining seven patients have shown no sign of recurrence and are neurologically normal. The surgical method that has evolved through these nine cases is discussed. The infratentorial‐supracerebellar exposure is an excellent one for lesions in the region of the pineal gland, posterior 3rd ventricle, and superior cerebellar vermis. Access is less hampered by the major tributaries of the vein of Galen than with the supratentorial operations. This approach is also a useful extension of the standard posterior fossa exploration when dealing with primarily subtentorial lesions that involve the dorsal midbrain or herniate upward.

ISSN:0148-396X    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

&NA;Experimental hydromyelia and syringomyelia, induced by kaolin in dogs, has been investigated by scanning electron microscopy. This study demonstrated that communication between the 4th ventricle and the spinal central canal is normally occluded by a plug of acellular material lying within the central canal. This plug is broken down following the onset of hydrocephalus and communication is rapidly established between the ventricles and the central canal. The canal distends and ruptures dorsally into the spinal gray matter with the development of extensive intramedullary cavities, lined by glial and neuronal elements. The morphological changes demonstrated are consistent with a physical destructive process of the cord resulting from CSF dissection.

ISSN:0148-396X    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

&NA;Open‐ended ventriculocisternal perfusion techniques for determining cerebrospinal fluid production and absorption rates are severely restricted by the absolute requirement that steady state conditions be present. A new closed recirculatory spinal perfusion technique is described. Because steady state equilibrium is not necessary, numerous determinations at multiple intracranial pressures or under varied experimental conditions are possible within relatively brief perfusion periods. Cerebrospinal fluid (CSF) and nondiffusible albumin tracer are rapidly recirculated through the spinal subarachnoid space in a cephalad direction. The concentration of fluorescein‐tagged albumin is continuously monitored as the CSF is circulated through a fluorometric flow cell. Measured continuously, intracranial pressure (ICP) is regulated by changing the volume of the external perfusion circuit with a syringe pump connected in series to the recirculatory spinal perfusion. CSF formation and absorption rates are calculated from measurements of albumin concentration, concentration changes with time, ICP, syringe pump infusion rate, and the external perfusion circuit volume. In dogs, data can be collected after only 45 minutes for mixing; perfusions at four or five intracranial pressures in addition to normal resting pressure can be completed within 2 to 3 hours. The data from 15 perfusions in 14 dogs are presented. The method provides normal resting pressure values of CSF production and absorption consistent with those values in the literature determined by traditional ventriculocisternal perfusion techniques. Determinations at multiple intracranial pressures suggest a proportional relationship between absorption and ICP. No consistent acute change in CSF formation with pressures to 50 mm Hg can be inferred from these data.

ISSN:0148-396X    

出版商:OVID    

年代:1977

数据来源: OVID