摘要:

OBJECTIVE:The goal was to report the treatment results after a second gamma knife treatment and to compare them with the results obtained after a first gamma knife treatment, as well as to investigate whether the models to predict the results after a first treatment are also applicable after gamma knife treatment of previously irradiated arteriovenous malformations.METHODS:The number of complications and the posttreatment hemorrhage rate were recorded for 112 patients in the study, and the number of obliterations was recorded for the 101 patients for whom conclusive angiograms were obtained. The results were compared with the expected results after a first gamma knife treatment.RESULTS:The observed number of obliterations was 62, which is not significantly different from the predicted number of 65. There were 14 observed and 5 predicted complications. When the risk from the preceding radiation treatment was added, the observed number of complications was similar to the predicted number. Six hemorrhages were observed after the second treatment. Of the 5 patients with unchanged arteriovenous malformation size after both the first and second treatments, 2 experienced hemorrhages after the second treatment, compared with none among the 81 patients for whom the malformation was obliterated or significantly decreased in size after the second treatment.CONCLUSIONS:The obliteration rate after gamma knife surgery for previously irradiated arteriovenous malformations is similar to that after primary gamma knife treatment. The complication rate increases with the amount of radiation previously given. The incidence of posttreatment hemorrhages is lower in the latency period if the malformation is affected by the radiation.

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

OBJECTIVE:This is a retrospective study of a series of 28 Rathke's cleft cysts operated on transsphenoidally that was undertaken for the following reasons: 1) to study the presentation, with particular reference to hormonal and visual disturbances; 2) to study postoperative improvements in endocrine function and vision; 3) to record postoperative complications; and 4) to assess the efficacy of a minor modification of the standard transsphenoidal surgical technique, whereby the cyst is allowed to drain directly into the sphenoid air sinus without fossa floor repair when there is no intraoperative cerebrospinal fluid leak.METHODS:A retrospective study was made of case notes, radiological findings, and operative notes in the series.RESULTS:There were 16 female and 12 male patients, with a mean age of 45 years. Endocrine disturbance was the most common presentation (50%), followed by headaches (32.1%) and visual impairment (14.3%). Neuro-ophthalmological assessment showed central visual acuity and field deficits in 32.1 and 44.6% of eyes, respectively. Biochemically, 85.7% of patients showed hormonal disturbances. Magnetic resonance imaging was used for 84.7% of cases, and 60.7% of cases showed suprasellar extension. Four magnetic resonance imaging patterns were noted. All cases were operated on transsphenoidally. Postoperative complications included cerebrospinal fluid rhinorrhea (7.1%), diabetes insipidus (3.6%), and meningitis (3.6%). Recovery of visual acuity and field was seen in 66.6 and 68% of eyes, respectively. Postoperative prolactin levels declined to normal or nearly normal values in 62.5% of cases, 20% of cases with low preoperative gonadotrophin levels achieved normal levels, and 15.4% of cases with preoperative pan-hypopituitarism achieved normal serum cortisol levels postoperatively. Within the study period there were no recurrences; although a relatively short time interval is presented for this series, a patient with a similar lesion operated on by the same method 7 years previously remains well, without radiological evidence of recurrence.CONCLUSION:Although comparatively rare and benign lesions, Rathke's cleft cysts are an important cause of hormonal and visual disturbances. Transsphenoidal surgery is safe and efficacious and leads to excellent improvement of function in the majority of cases. The surgical modification described seems safe and satisfactory and is extremely easy to perform.

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

OBJECTIVE:Low-grade brain tumors may remain asymptomatic in contrast to malignant gliomas. The mechanisms underlying the preservation of cerebral function in such gliomas are not well understood.METHODS:We used positron emission tomography and transcranial magnetic stimulation for presurgical monitoring of motor hand function in six patients with gliomas of the precentral gyrus. All patients were able to perform finger movements of the contralesional hand.RESULTS:Movement-related increases of the regional cerebral blood flow occurred only outside the tumor in surrounding brain tissue. Compared with the contralateral side, these activations were shifted by 20 ± 13 mm(standard deviation) within the dorsoventral dimension of the precentral gyrus. This shift of cortical hand representation could not be explained by the deformation of the central sulcus as determined from the spatially aligned magnetic resonance images but was closely related to the location of the maximal tumor growth. Dorsal tumor growth resulted in ventral displacement of motor hand representation, leaving the motor cortical output system unaffected, whereas ventral tumor growth leading to dorsal displacement of motor hand representation compromised the motor cortical output, as evident from transcranial magnetic stimulation. In two patients, additional activation of the supplementary motor area was present.CONCLUSION:Our data provide evidence for the reorganization of the human motor cortex to allow for preserved hand function in Grade II astrocytomas.

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

OBJECTIVE:Craniotomy and brain mapping performed with the patient under local anesthesia and monitored sedation is an important technique to allow optimal resection of brain tumors or other lesions in close apposition to eloquent cortex. The subjective experience of patients undergoing this procedure has not been addressed in the literature.METHODS:This study formally, intensively, and prospectively assessed the subjective experience of 21 consecutive patients undergoing this procedure. Assessment involved structured interviews at 2 to 3 days postoperatively by a member of the surgical team and at 1 month postoperatively by a psychiatrist, supplemented by pre- and postoperative assessments of the patients' moods using the brief Profile of Mood States questionnaire.RESULTS:At the 1-month interview, all patients were entirely comfortable with the experience and there were no indications of adverse psychological sequelae of the event. In the early postoperative interview, approximately one-half of the patients reported that the experience was entirely satisfactory, without any intraoperative discomfort or pain. One-third of the patients recalled minor difficulties at some stage of the experience, and one-fifth recalled moderate difficulties. An operating room score was devised to quantify the data. Minor technical changes are suggested to improve the patients' subjective experience.CONCLUSIONS:This series confirmed that this technique is a very useful and safe technique for resection of lesions involving eloquent cortex that might otherwise be considered inoperable. This procedure involves a level of stress that remains within the tolerance level of the average adult.

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

OBJECTIVE:In vivo proton magnetic resonance spectroscopy was performed for 24 patients with pyogenic brain abscesses, to examine the consistency of the spectral patterns and to observe the changes in metabolites with treatment.METHODS:Localized proton spectra were obtained from 4- to 8-ml volumes in the abscesses, using stimulated echo acquisition mode and spin echo sequences. Twenty-two patients were treated with combined surgical and medical therapy, and two patients were treated conservatively. High-resolution magnetic resonance spectroscopy was performed for 15 samples of abscesses obtained from these patients, to confirm the assignments of resonances seen in vivo. Postaspiration studies were performed for 12 patients treated with combined medical and surgical therapy and 2 patients treated medically.RESULTS:Lactate and amino acids were seen in spectra for all patients, irrespective of the time of spectroscopy after the onset of combined medical and surgical therapy. Acetate and pyruvate disappeared after 1 week of combined treatment.CONCLUSION:It was concluded that spectral patterns for brain abscesses are consistent and specific and can assist in the noninvasive diagnosis of abscesses. Responses to combined treatment could be monitored by showing the changes in metabolite patterns in serial spectroscopic studies.

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

OBJECTIVE:This retrospective study was designed to investigate whether chronic lumbar intrathecal administration of morphine leads to the development of opioid tolerance in patients suffering from intractable cancer pain.METHODS:Between 1978 and 1995, 159 patients with refractory cancer pain were treated with intrathecal morphine in our Multidisciplinary Pain Center. The treatment consisted of preservative-free morphine administered through an access port as a single bolus. In this series of patients (n = 159), the daily doses of intrathecal morphine were determined as a function of duration of follow-up.RESULTS:The mean follow-up period was 95 days (range, 5-909 d), the mean starting daily dose of intrathecal morphine was 2.69 mg (range, 1-7.5 mg), and the mean terminal dose was 7.82 mg (range, 1-80 mg). The results demonstrated that only a moderate increase in daily dose of intrathecal morphine was required during the course of treatment (a two- to threefold increase for a 3-mo period). Furthermore, the dose increment was similar for patients followed up for more or less than 60 days. This increase did not result in any central opioid-related side effects, and the pain was managed satisfactorily.CONCLUSION:The requirement for a moderate increase in intrathecal opioid doses reflects the development of tolerance but did not limit the patients' ability to obtain adequate analgesia during the course of their painful disease.

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

OBJECTIVE:Posttraumatic acute subdural hematoma carries a high postoperative mortality rate. Preservation of subarachnoid spaces in preoperative computed tomographic (CT) scans may be interpreted as a favorable prognostic factor.METHODS:Thirty-one cases of posttraumatic acute subdural hematoma operated on consecutively, with an interval from trauma to surgery of less than 4 hours and a Glasgow Coma Scale score of less than 8, were reviewed. The immediate and long-term results were evaluated with reference to preoperative CT images, distinguishing cases with preserved subarachnoid spaces from the others.RESULTS:In 5 of the 31 cases, preoperative CT scans showed intact subarachnoid spaces and the absence of blood in the cerebrospinal fluid. These cases presented a much better postoperative course than did the others.CONCLUSION:The presence of intact subarachnoid spaces in CT scans for patients with acute subdural hematomas may be interpreted as an extremely favorable prognostic factor; this may be attributed to the protective effect of the integral visceral membrane of the hematoma, which prevents the diffusion of neurotoxic and vasoactive substances into the subarachnoid spaces. This group of hematomas was classified as "intradural," with reference to the concept of the "subdural compartment" described in studies conducted using an electron microscope.

ISSN:0148-396X    

出版商:OVID    

年代:1998

数据来源: OVID