摘要:

The operative morbidity for small intracranial aneurysms is approximately 2% for experienced aneurysm surgeons. The operative morbidity for giant intracranial aneurysms, however, continues to be unacceptably high. Despite some problems, improved surgical results with these lesions over the last two decades suggest that most giant aneurysms can be surgically treated. Interventional neuroradiologic techniques may prove efficacious for sizeable cavernous and large vertebral aneurysms, but for most giant aneurysms surgery remains superior. Careful microsurgical dissections and clip placement can lead to satisfactory results in most cases of anterior circulation and vertebrobasilar giant aneurysms. Advances in temporary clipping and hypothermic circulatory arrest are useful when combined with current surgical techniques.

ISSN:1050-6438    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Secondary ischemic brain damage continues to be an important contributor to mortality and morbidity after head injury. A robust, reliable clinical classification of head injury that takes account of the risk factors for development of intracranial hematoma is important so that head injury management should be preemptive rather than responsive. Surgical decompression for extracerebral hematomas causing midline shift should be immediate. The use and timing of surgical decompression for intracerebral lesions must be clearly defined. Systemic and intracranial insults are common after head injury and are associated with impaired outcome. Raised intracranial pressure, reduced cerebral perfusion pressure, and episodes of arterial hypotension, often iatrogenic, are a particular problem. In treating elevated intracranial pressure, the therapy used should take account of the mechanism of intracranial hypertension, whether this is predominantly vascular or nonvascular.

ISSN:1050-6438    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Spontaneous subarachnoid hemorrhage (SAH) is the leakage of arterial or venous blood into the subarachnoid space. Primary SAH may be caused by trauma, arteriovenous malformation, venous angioma, cavernous angioma, or bleeding from an intracranial tumor. Lesser causes of primary SAH include blood dyscrasias and CNS infections. Secondary SAH implies tracking of blood into the subarachnoid space from a primary intraparenchymal hemorrhage. Diagnosis of SAH is customarily made by CT and/or lumbar puncture. It is important to determine the etiology of the hemorrhage, and CT scanning, MRI imaging, and formal angiography are the mainstays of diagnosis in such cases. Treatment of SAH involves elimination of the offending lesion and differs depending on the etiology. Surgical intervention will almost always be proposed for cases of intracranial aneurysm and intracranial tumor, and in many cases of arteriovenous malformation hemorrhage. For SAH arising from trauma or from blood dyscrasias and infections, supportive management and medical treatment are most often the mainstays of therapy. Complications of SAH are greatest with aneurysmal subarachnoid hemorrhage and include vasospasm, rebleeding, and hydrocephalus. These problems are almost nonexistent with other etiologies of SAH. The treatment of vasospasm is with calcium channel blocking agents, hypertensive/hypervolemic therapy, and careful attention to surgical timing. Rebleeding may be prevented by use of antifibrin-olytic agents or early surgery. Hydrocephalus is treated by classical methods of ventricular drainage and shunting. The long-term outcome from primary SAH depends in large measure on the responsible lesion. Careful attention to surgical detail and optimal recognition and management of potential complications will clearly do much to improve the outcome for these unfortunate patients.

ISSN:1050-6438    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Refinements in instrumentation for the cervical spine have led to an increase in experience with these devices during the past decade. The need for postoperative immobilization, required to stabilize the patient while the fusion mass heals, is decreased or negated by internal fixation. Internal fixation may provide added security to the nervous system before bony fusion occurs, may lessen the number of levels requiring fusion, may increase the probability of successful fusion, and is conducive to early patient mobilization. Bony fixation is now most frequently accomplished with screw/plate systems designed for use in the cervical spine. The cervical spine has been successfully stabilized with both anterior and posterior instrumentation from C2 to C7. This article reviews the indications, biomechanics, surgical technique, results, and complications for anterior and posterior cervical instrumentation.

ISSN:1050-6438    

出版商:OVID    

年代:1992

数据来源: OVID