ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;This study evaluated the ability of two‐dimensional echocardiography (2D echo) to detect and localize the distal end of ventriculoatrial shunt catheters in the cardiac chambers of hydrocephalic patients. Twenty‐eight patients were studied, and the performances of 2D echo and standard chest x‐ray filming were compared. Although standard chest x‐ray filming allowed accurate determination of the catheter position in only half of the patients, 2D echo afforded clear visualization and accurate localization of the catheter in all instances. By its precise definition of intracardiac anatomical landmarks and its excellent time determination, 2D echo can provide valuable information on the movements of the catheter's distal end during the cardiac cycle, during head flexion or rotation, and during deep breathing movements. Some interesting observations were made with 2D echo. A to‐and‐fro motion of the catheter tip through the tricuspid orifice during the cardiac cycle was visualized in two instances. The combination of head movements and deep respiratory movements induced a variation in the position of the catheter tip. The magnitude of this displacement was 6 cm at the most. Two patients underwent reoperation for lengthening or shortening of the catheter. The operative findings confirmed the ultrasonic localization in both cases where the chest x‐ray film had failed to identify or adequately locate the catheter tip. It is concluded that 2D echo is a safe, innocuous, and accurate method with which to locate the distal end of a ventriculoatrial shunt. It is the only available technique that provides visualization of intracardiac structures and cardiac cycle reference. In our neurosurgical unit, 2D echo is now considered the standard reference procedure to localize postoperatively the distal end of ventriculoatrial shunts and to follow patients in an attempt to appreciate the ideal timing for prophylactic lengthening of the shunt. (Neurosurgery14:2‐7, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;This is a prospective analysis of 107 consecutive cases of extradural hematoma treated during the last 3 years at the Department of Neurosurgery of the University Hospital of Verona (Italy). The overall mortality was 5%; 89% of the patients made a good recovery or had only moderate residual disability. We regard this as meaningful progress compared to recent reports from other sources showing mortality rates of approximately 20%. The majority of our patients (57%) underwent operation within 6 hours of injury; 60% went into surgery with a Glasgow coma scale (GCS) score between 8 and 15. No deaths occurred among patients reaching surgery with a GCS score of 8 or better; all patients with scores of 8 to 15 made a good recovery (63 cases). Seventeen patients went into surgery while still free of neurological signs, and 8 had only one dilated pupil; all 25 made good recoveries. A flexion posture at admission cuts the chances of a good outcome by one‐half; an extension posture cuts the chances to one‐fourth. Ninety‐five per cent of the patients had fractures of the skull; only 21% had the classical lucid interval. The cause of all 5 deaths was identified as stemming from avoidable errors in management in outlying hospitals (2 cases) or in our own department (3 cases). The results of this study indicate that zero mortality from extradural hematoma is a realistic goal for a modern, well‐run care system for head‐injured patients that includes prompt referral by community doctors and suitable hospital facilities for constant access to emergency neurosurgery. (Neurosurgery14:8‐12, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;The occurrence of spontaneous arterial subdural hematomas is very rare. We report five patients who presented with sudden severe headache and who developed progressive neurological deficits, two becoming comatose. None had a history of trauma. A diagnosis of subarachnoid hemorrhage was suspected in all patients, but all proved to have subdural hematomas caused by “spontaneous” rupture of a cortical artery. Nineteen similar cases have been reported in the English literature. The source of bleeding was identified as a cortical artery located near the sylvian region in four of our five patients and in most of the reported cases. There are several possible anatomical situations that may predispose a cortical artery to “spontaneous” rupture: (a) spontaneous rupture of a cortical artery at the point of origin of a fragile arterial twig, especially a right‐angled branch, a point of potential weakness; (b) rupture of a small artery traversing the subdural space and connecting a cortical artery to the dura mater (a “bridging” artery); (c) adhesions between a cortical artery and arachnoid or dura mater; (d) a knuckle of cortical artery protruding through the arachnoid and adherent to the dura mater. In each situation, the artery is probably torn by a sudden movement of the brain during a vigorous head movement, not severe enough to be considered trauma. (Neurosurgery14:13‐18, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Lumbar myelography was performed in 38 patients; 19 received iohexol (an investigational aqueous contrast agent) and 19 received metrizamide. Iohexol is stable in solution, which is not the case with metrizamide. There was no other significant difference in diagnostic utility or quality between the two media. However, there was considerable postmyelography morbidity in the metrizamide group, but no postmyelography morbidity in the iohexol group. Preliminary clinical evidence suggests that iohexol is significantly superior to metrizamide as a contrast agent for lumbar myelography. (Neurosurgery14:19‐21, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Fifteen cases of delayed traumatic intracerebral hematoma (DTICH) operatively treated are reported. Patients who are awake or only drowsy on admission (Coma Grades 1 and 2, Grady scale) often undergo dramatic sudden neurological deterioration 48 to 72 hours after admission. Emergency computed tomographic scanning and prompt craniotomy for hematoma evacuation yield excellent clinical results in the majority of cases. Patients presenting in deeper grades of coma (Grades 3 to 5. Grady scale) who develop DTICH do quite poorly, often because the diagnosis is difficult to make and consequently is delayed. The development of DTICH is in our experience highly unpredictable, and often no clear secondary cause (hypercapnia, hypoxia, bleeding diathesis) can be demonstrated. (Neurosurgery14:22‐25, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Since 1978, the authors have treated 11 patients with lesions of the ventral thoracic spine via a transpleural anterolateral approach. Each of the patients presented with pain and paraparesis, 8 had sensory dysfunction, and 6 had demonstrated sphincteric disturbances. All 11 had radiographic confirmation of anterior cord compromise, and each underwent an anterior decompression, with 8 requiring graft stabilization. There were no surgical mortalities, and the postoperative complications were limited. In follow‐up, 10 of the 11 patients had complete resolution of their preoperative pain and were able to ambulate independently, Remission of sensory disturbances was noted in 6 patients, and 5 regained sphincteric control. The authors have found that this approach is both safe and effective, with several advantages over conventional laminectomy and posterolateral techniques. (Neurosurgery14:26‐30, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;One hundred infants with intracranial tumors symptomatic during the 1st year of life were studied. They differed from older children in having a higher percentage of supratentorial tumors and in the fact that 90% of the tumors were of neuroectodermal origin. Vomiting, alteration of psychomotor development, and macrocrania were the most common presenting features. The “diencephalic syndrome” was seen in 5 infants, and subarachnoid hemorrhage due to tumor was diagnosed in 4. Computed tomography as the primary investigation is increasing the number of neoplasms diagnosed in this age group, although review of the skull roentgenograms in the series disclosed an abnormality in 92%. Eighty of the tumors were verified, 68 by a cranial operation and the rest at autopsy, Of the verified neoplasms, 20% were medulloblastomas, 12.5% were choroid plexus papillomas, and 10% were cerebellar astrocytomas. The cumulative average survival was 27 months but, for those who underwent a tumor operation, the average survival was 37 months. The operative mortality was 30%. Thirty‐nine patients were irradiated, and this subset had a 5‐year survival rate of 43%. The morbidity was high irrespective of radiotherapy; 60% of those who survived 1 year were moderately or severely disabled. Those infants receiving more than 5000 rads of whole brain radiation tended to have greater deficits in the long term. When analyzed separately, patients treated after 1970 had greatly improved mortality and morbidity rates. (Neurosurgery14:31‐41, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;The use of the CO2laser in the extirpation of selected intracranial and spinal tumors has been shown to be of great benefit. The role of the CO2laser as applied to other neurosurgical procedures has not been adequately explored or defined. The authors have compared the radiological and histological effects of performing anterior cervical discectomy with the CO2laser to those of performing it by standard operative technique. Groups of laboratory dogs underwent anterior cervical discectomy performed in both operative fashions. The animals were killed and the operated disc spaces were examined radiographically and microscopically. Observations were made 1, 3, 5, 8, and 10 weeks postoperatively. Based upon these radiographic and microscopic evaluations, the authors were able to draw certain conclusions with respect to the use of the CO2laser in performing anterior cervical discectomy. (Neurosurgery14:42‐47, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Real time intraoperative sonography is a valuable tool for visualizing subcortical mass lesions. Although most solid lesions are hyperechogenic, little is known about the ultrasound characteristics of intracerebral hemorrhage and subsequent hematoma formation. We sought to determine the sonographic characteristics of an acute intracerebral hematoma, to study its evolution, and to explore factors responsible for its echogenicity. Acute intracerebral hematomas were created in adult mongrel dogs using heparinized or unheparinized autologous whole blood injected under sonographic visualization into the centrum semiovale of 10 cerebral hemispheres. Different components of blood were also imaged in polyurethane test tubes (n = 56) immersed in a degassed. room temperature water bath. All studies were performed with continuous ultrasound recording using the ATL real time Neurosector scanner with the variable 3‐, 5‐, and 7.5‐MHz transducer. Intracerebral hematomas were initially hypoechogenic, becoming hyperechogenic between 16 and 23 seconds after injection (average, 22 seconds). Full echogenicity was obtained between 40 and 213 seconds after injection (average. 91 seconds). There was no difference between the sonographic appearances of hematomas formed with whole blood and those formed with heparinized whole blood. In addition, we demonstrated the superior sensitivity of the 7.5‐MHz frequency in visualizing intracerebral hematomas in vivo, as opposed to the 3‐ and 5‐MHz frequencies. Whole blood, heparinized whole blood, and citrated whole blood were found to be highly echogenic in vitro. Phosphate‐buffered saline, plasma, serum, and packed red blood cells (PRBCs) were hypoechogenic. Resuspended PRCBs in phosphate‐buffered saline, plasma, or serum were echogenic. Our data suggest that hyperechogenicity is independent of the clotting mechanism and is related to blood stasis. The primary factor in stasis accounting for blood echogenicity seems to be red cell aggregation. We conclude that: (a) acute intracerebral hematomas are initially hypoechogenic, becoming hyperechogenic by 22 seconds after their formation: (b) all acute hematomas are hyperechogenic within 4 to 5 minutes; (c) echogenicity seems to be secondary to red cell aggregation and independent of the clotting mechanism; (d) good image resolution of acute hematoma nessesitates relatively high frequency sonographic imaging because of the small size of the echo‐producing red cell aggregates. (Neurosurgery14:48‐51, 1984)

ISSN:0148-396X    

出版商:OVID    

年代:1984

数据来源: OVID