ISSN:0268-8697    

DOI:10.3109/02688698709034337

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

The discouraging history associated with management of aneurysmal subarachnoid haemorrhage (SAH) is reviewed along with improvements in outlook attributable to progress made within the past decade. Among the new developments is the introduction of microsurgical techniques that allow elective surgery in the acute stage thereby preventing repeat haemorrhages. Early operation also offers the possibility of a more aggressive pharmacological anti-ischaemic treatment. Notwithstanding the improved results of acute elective surgery and the fact that delayed ischaemic deterioration (symptomatic cerebral vasospasm) now may be almost eliminated, the overall outcome remains gloomy. Despite recent advances not more than one out of three individuals, who are struck by the rupture of an intracranial aneurysm, may be expected to make a good neurologicalandfunctional recovery. Hope for further improvements may depend on the development of techniques that can identify intracranial aneurysms before they rupture and increased knowledge of the aetiology of such arterial wall lesions.

ISSN:0268-8697    

DOI:10.3109/02688698709034338

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

In a well-defined area, The Kingdom of Denmark, 1076 patients with ruptured intracranial aneurysms were admitted to the six Danish neurosurgical departments in a prospective consecutive study in the 5-year period 1978–1983. Follow-up examinations were accomplished 3 months and 2 years after the admission. A total of 674 women and 402 men with a median age of 49 years were included in the study. The localisation of the ruptured aneurysms were: internal carotid artery 285, anterior communicating artery and horizontal part of anterior cerebral artery 383, middle cerebral artery 291, basilar and vertebral arteries 83 and peripheral or other localisation 34. A significantly better outcome was seen in cases with internal carotid aneurysms compared to other localisations. 670 patients underwent operation. A highly significantly better outcome was found in operated versus non-operated patients in comparable clinical conditions. The advantage of microneurosurgery was well documented. Patients with vasospasm had a significantly worse outcome. Within the first 2 weeks a daily rebleeding rate from 0.2% to 2.1% was observed, and patients who rebled had a significantly worse outcome compared to patients, who did not rebleed. The overall outcome at 2-year follow-up was: normal 27.5%, mild dementia 15.8%, severe dementia 9.9%, vegetative 1.3% and mortality 45.5%.

ISSN:0268-8697    

DOI:10.3109/02688698709034339

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

During a 5-year period (1978–1983) the clinical features and operative morbidity/mortality were registered prospectively for all patients in Denmark with an unruptured symptomatic (27 patients) or incidental (21 patients) intracranial saccular aneurysm. A follow-up examination was performed 2 years after diagnosis of the aneurysm. Thirty symptomatic aneurysms in 27 patients most frequently involved the visual pathways or ocular motility (66%). The median diagnostic delay for patients with impaired visual acuity was 7 months but only 14 days for patients with impaired ocular motility. The localisation of the 30 symptomatic and 23 incidental aneurysms were: internal carotid artery (73%±35%), anterior communicating artery (3%±26%) and middle cerebral artery (7%±35%). The diameters of 73% of the symptomatic aneurysms were greater than 10 mm, while the diameter of 74% of the incidental aneurysms were below 10 mm. The total operative morbidity and mortality were 15% and 4%, respectively. The mortality rate in the follow-up period was 10–11% mainly due to fatal bleeding from unoccluded aneurysms. In 21 survivors, a normal mental status was found in 43% and mild dementia was found in another 43%. The impaired visual acuity was unchanged in 67% of patients, while the ocular motility had normalised in 75%. A normal daily functional capacity was enjoyed by 57% while 43% had a moderate reduction, mostly due to visual disturbances.

ISSN:0268-8697    

DOI:10.3109/02688698709034340

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

ISSN:0268-8697    

DOI:10.3109/02688698709034341

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

The clinical course of 21 patients who underwent syringopleural shunting for syringomyelia is summarised. All the patients were continuing to deteriorate at the time of the operation. Objective improvement was seen in nine patients following the procedure but three subsequently deteriorated. Contralateral syrinx symptoms have appeared in two patients. No change was seen in six patients who did not deteriorate later. Three were worse following the procedure.In syringomyelia with marked hydrocephalus, ventricular drainage by a valved shunt may be the preferred first procedure. Craniovertebral decompression is recommended for syringomyelia with hindbrain herniation without dense arachnoiditis. In appropriate cases syringopleural shunting may be performed in combination with craniovertebral decompression, and may be the procedure of choice in cases with marked hindbrain arachnoiditis. In cases with a sizeable syrinx who have subsequently deteriorated following craniovertebral decompression, syringopleural shunting may be considered the preferred second procedure. Syringopleural shunting is suggested in amenable cases of syringomyelia associated with spinal tumour, trauma or arachnoiditis.

ISSN:0268-8697    

DOI:10.3109/02688698709034342

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

The records of the first 18 patients with intractable facial pain treated with nucleus caudalis dorsal root entry zone lesions were reviewed. The pain etiology varied but the largest group was that of post-herpetic neuralgia. Within the immediate postoperative period 90% of patients had satisfactory pain relief in comparison to 58% on subsequent follow-up. Seventy-one percent of those with post-herpetic neuralgia had satisfactory relief on subsequent follow-up. Favorable results tended to correlate with a lesser preoperative sensory deficit, pain restricted to trigeminal distributions and pain of a burning or lancinating/penetrating quality.

ISSN:0268-8697    

DOI:10.3109/02688698709034343

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

It is important to distinguish cord compression due to cervical disc prolapse, which has a very favourable prognosis following surgery, from that due to cervical spondylosis. In the elderly the occurrence of cervical disc prolapse as a cause of spinal compression may be under-recognised because symptoms are too readily attributed to long standing degenerative changes on plain cervical X-rays. The difficulty of making an accurate diagnosis is complicated further in the elderly by the prevalence of other diseases which may mask the symptoms of cord compression.We report our experience with 19 patients over 60 who underwent anterior cervical discectomy for myelopathy due to intervertebral disc prolapse. There was generally a short history of walking difficulty, but the presence of‘numb clumsy hands’, perhaps due to selective posterior column impairment, was often a more disabling complaint. Neck pain and disturbances of micturition were unusual. The prognosis after disc excision can be excellent. In this series all the severely disabled patients returned to an independent existence. Overall 16/19 patients made an excellent or good recovery.

ISSN:0268-8697    

DOI:10.3109/02688698709034344

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

The Children's Tumour Registry in Manchester records details of children in the North West Region of England with gliomas of the anterior optic pathways. In the 30 years to 1983, the diagnosis of optic nerve glioma was confirmed in only 22 children out of a population of 1 million under the age of 15 years. This paper examines the presentation, investigation and management of these children in relation to the site of their tumour. The place of radiotherapy is considered, and with the widespread availability of new imaging techniques, fresh protocols are offered for the investigation and treatment of this rare tumour.

ISSN:0268-8697    

DOI:10.3109/02688698709034345

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

A selected series of 14 patients with lumbar disc prolapse causing sciatica have been operated successfully with outpatient (daycase) surgery. Postoperative pain has been much less than expected. This form of surgery has proved very acceptable to patients and to their family doctors.

ISSN:0268-8697    

DOI:10.3109/02688698709034346

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor