ISSN:0268-8697    

DOI:10.3109/02688699409002387

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

We describe our experience of 600 patients with progressive post-traumatic myelopathy, predominantly of the cystic type. The aetiology, clinical and radiological features and treatment are described and discussed.

ISSN:0268-8697    

DOI:10.3109/02688699409002388

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

To address the question of managing subarachnoid haemorrhage (SAH) in the older patient, the management and outcome of 199 consecutive patients aged≥60 years with a confirmed diagnosis of subarachnoid haemorrhage (n= 186) or an unruptured intracranial aneurysm (n= 13) were reviewed. In seven patients, the cause of the SAH was an arterio-venous malformation and these were excluded from further analysis. Angiogra-phy was performed in 141 patients with a complication rate of 2.1%. Angiography was not performed in 51 patients and, in this cohort, the in-patient mortality rate was 68.6% and only 27.5% had a favourable outcome at discharge. Operation was not performed in 21 patients with demonstrated aneurysms for a variety of reasons. In this group, the in-patient mortality rate was 47.6% and 38.1% had a favourable outcome at discharge. Eighty-one patients in good neurological grade underwent surgery for a ruptured aneurysm and six patients underwent surgery for a symptomatic unruptured aneurysm. The surgical mortality was 1.1% and a favourable outcome at discharge was achieved in 83.9% of patients. Thirty-three patients were angiographic negative and there was a favourable outcome in 97% of this group. The management mortality in these selected patients admitted to the Department of Clinical Neurosciences was 24.4% and a favourable outcome was recorded in 66.2% of patients. Long-term follow-up (median 40 months, range 3–120 months) was obtained in 97% of discharged patients. The probability of survival at 60 months for patients in good condition at discharge was 0.826 (95% confidence interval 0.722–0.894). We conclude that angiography and surgical treatment of an intracranial aneurysm are advisable in patients aged 60 years or more in good neurological grade (WFNS≤2) following SAH. The witholding of angiography and surgery from older patients with SAH solely on the grounds of advanced age is not justified.

ISSN:0268-8697    

DOI:10.3109/02688699409002389

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Fungal infections including those due to aspergillus are rare in neurosurgical practice despite their possible inclusion in many differential diagnoses. Recently, these diseases have been diagnosed with increasing frequency, principally as opportunistic infections in patients undergoing treatment for diseases resulting in immune compromise. The epidemiology is poorly understood as mycoses are not notifiable diseases. We have recently been involved in the care of seven patients with aspergillosis between 1988 and 1991. Its presentation, with abscess formation, granulomas, the rhinocerebral form, meningitis, hydrocephalus and vascular involvement, is varied. The majority of cases were seen in immunocompromised patients following haematogenous dissemination from a pulmonary or gastro-intestinal focus. Direct spread from sinus infection has also been seen. The prognosis is poor despite modern antifungal treatment, which in part reflects the primary underlying condition.

ISSN:0268-8697    

DOI:10.3109/02688699409002390

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Failure of an intact ventriculoperitoneal shunt, in the absence of an overt infection, is often due to its occlusion by cellular debris and/or an abdominal pseudocyst. This failure is thought to be caused by an infection by an organism which is difficult to culture or by some poorly defined allergic response to the shunt materials. Little attention has been directed to the treatment that the shunts receive prior to implantation: specifically, their exposure to ethylene oxide as a means of sterilization. We have found ethylene oxide metabolites in the spinal fluid of children with shunt malfunction months after their systems were implanted. Many of these patients had coincident CSF eosinophilia. In addition, two of the children had detectable serum IgE antibody directed against an albumin-ethylene oxide conjugated protein. Both of these children had several shunt malfunctions within a short period, yet neither child could be shown to have a shunt infection despite multiple cultures. We therefore suggest that in some patients proteins altered by ethylene oxide incite an IgE mediated response which may lead to shunt malfunction.

ISSN:0268-8697    

DOI:10.3109/02688699409002391

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Microdiscectomy for lumbar disc prolapse on a day-patient basis was introduced by our department in 1985 and first reported in 1987, but has not been generally adopted in the United Kingdom. We now report our experience of the first 100 patients with lumbar disc prolapse treated by day-case microdiscectomy. Post-operative assessment was in the out-patient clinic and by subsequent postal questionnaire (average follow-up 37 months, range 3–64 months). Complications were few and are described. Only three patients developed a recurrent disc prolapse. Patient feedback was favourable and the majority (85%) said that, if necessary, they would be prepared to have the operation again on a day-case basis. For selected patients, lumbar microdiscectomy is a suitable procedure for day-case surgery.

ISSN:0268-8697    

DOI:10.3109/02688699409002392

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Four giant prolactin-secreting tumours invading the skull base are described. All of them occurred in men. The presenting features were sufficiently diverse to be clinically misleading. We advocate the estimation of prolactin levels before embarking on complicated skull base surgery in men where doubt remains regarding the diagnosis after clinical and radiological study.

ISSN:0268-8697    

DOI:10.3109/02688699409002393

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

The neurosurgical manifestations in three patients with sphenoid sinus mucoceles and two others with fronto-eth-moidal mucoceles are presented. In two patients, sphenoid sinus mucoceles produced visual loss while in the other severe headache was the only symptom. Both patients with fronto-ethmoidal mucoceles presented with proptosis. All patients had surgical treatment. While other symptoms were relieved following treatment, visual loss remained unchanged in both patients in whom it was present. We recommend a high level of suspicion for mucoceles as a cause of sudden or progressive visual loss. Prompt surgical therapy is needed to achieve good visual outcome.

ISSN:0268-8697    

DOI:10.3109/02688699409002394

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

An experimental study was undertaken to evaluate the accuracy with which the intercommissural line (IL) length and anterior-posterior commissural (AC-PC) plane could be selected using unreformatted axial CT8800 imaging. Using these reference points, the Schaltenbrandt and Bailey stereotactic atlas and the Brown-Roberts-Wells (BRW) stereotactic system 1.82 mm ball bearings were deposited at selected diencephalic and pallidal targets in cadaver brains. There were errors in both IL length (median 1.5 mm) and AC-PC plane (median forward angulation of 9°) estimation. Ball bearing deposition into large nuclei such as the pulvinar and globus pallidus and those in proximity to the mid IL such as the nuclei ventro oralis anterior (Voa), ventro oralis posterior (Vop) and ventro intermedius (Vim) was generally good; however, localization of the relatively small intralaminar nucleus was poor. This study suggests that when the AC and PC are not well imaged on sagittal reformations of axial diencephalic CT scans estimation of the AC-PC plane and IL from axial CT scans may be accurate enough for anatomical localization of certain functional stereotactic targets. The implications of this experimental study to operative functional stereotaxy are discussed.

ISSN:0268-8697    

DOI:10.3109/02688699409002395

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

In the prospective consecutive Danish Aneurysm Study 192 patients (19%) had a ruptured intracranial aneurysm (RA) with a maximum diameter<5 mm (small). In 524 (51%) and 306 patients (30%) the size was 5–10 mm (medium) and 11–24 mm (large), respectively. More patients with large RA (35%) were unconscious more than 1 h after the bleeding and had more CT-visualized haematomas (49%) compared with the patients with small RA (28 and 34%) and medium RA (27 and 37%). After 2 years, more patients with small RA and medium RA had resumed their previous occupation (49 and 49%), regained a normal daily functional capacity (55%, 55%) and normal mental outcome (29 and 32%) compared with the patients with large RA (34, 44 and 23%). The mortality was 47, 39 and 51% for patients with small, medium and large RA, respectively. With also a very serious prognosis after rupture of aneurysms of 10 mm or less and even less than 5 mm we also recommend surgical treatment of unruptured aneurysms of these sizes.

ISSN:0268-8697    

DOI:10.3109/02688699409002396

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor