摘要:

Hippocrates, Galen, Avicenna, and Jurjani first reported on human affliction by hydatidosis. The complete life cycle ofEchinococcusincludes several carnivores, but humans are infected incidentally and usually in childhood by ingestion of the ova. When an embryo ofEchinococcus granulosuslodges in the brain, a solitary cyst develops. Hydatid cyst is a slow-growing lesion that does not invade the brain; it produces symptoms when the increasing size of the cyst exerts local pressure. The late appearance of focal neurologic deficits follows a long history of epileptic attacks, and symptoms compatible with increased intracranial pressure are the common clinical presentation. Serobiologic tests are not confirmatory for preoperative diagnosis, but radiologic examinations have a high degree of accuracy. In both computed tomography and magnetic resonance imaging, a spherical but occasionally ovoid cyst with clearly defined borders is visible. The cyst content is of the same density as cerebrospinal fluid on computed tomography and on T1 and T2 relaxations in magnetic resonance imaging. Usually, there is no identifiable rim in either computed tomography or magnetic resonance imaging, even after contrast injection. Surgical removal of the intact and unruptured cyst is advised in all cases. If the cyst ruptures during removal, local irrigation with 1% formalin, 0.5% silver nitrate, or hypertonic saline solutions can prevent local recurrence of the cysts. Long-term administration of oral parasiticidal agents such as mebendazole or albendazole may be effective in controlling recurrences in case of rupture of the cyst. In these two articles, the authors present their large and long-term experience in the diagnosis and management of hydatidosis of the central nervous system and orbit.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Hydatidosis may affect any place in the central nervous system (CNS) with or without brain involvement, such as the skull, orbit, vertebral column, and spinal cord. The authors review briefly the characteristics and management of such cases of hydatidosis.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

This article is a review of endoscopic carpal tunnel release compared with open carpal tunnel release. In the first section, a brief account of anatomical and pathophysiologic aspects relevant for carpal tunnel surgery is given. It is followed by an overview of the different techniques presently available for endoscopic carpal tunnel release, comprising both monoportal and biportal approaches. Contraindications for endoscopic carpal tunnel release are discussed in detail. Results and complications of the endoscopic techniques are then compared with those of open carpal tunnel release. The article concludes that the development of new techniques, as well as increased knowledge of the contraindications, has made endoscopic carpal tunnel release as safe and effective as open carpal tunnel release.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Soon after it was first described, normal-pressure hydrocephalus became a notable and, it was thought, successful topic for neurologic research. Its mechanism of formation was soon explained and its diagnosis and treatment were prescribed. However, after a series of contradictory reports, confusion replaced certainty. Research has continued, concentrating on predicting the outcome of shunt insertion. The author reviews our evolving understanding of the pathophysiology, diagnosis, and treatment of this entity and offers a strategy to assist in deciding which patients might benefit from shunting.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Cerebrospinal fluid diversion is the only established treatment for hydrocephalus. Despite significant advances in the shunt technology and development of diverse type of proximal catheters and valves, there has been only a marginal impact on the rate of malfunction and shunt-related complications. Although individual cases may benefit from use of devices used to decrease overdrainage from the shunt, studies conducted to evaluate these devices have not shown significant long-term or short-term benefit from their use. Endoscopic surgery has provided alternative strategies in patients with isolated ventricles or obstructive hydrocephalus. However, there is limited data in literature to suggest that long-term survival of third ventriculostomy is superior to that of a shunt. This article reviews the available literature and controversies in management of hydrocephalus using the above strategies.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Neuropathic pain is a very difficult problem, which the neurosurgeon must frequently deal with when all medical therapies known to be active in chronic pain caused by neurogenic mechanisms have failed (anticonvulsants, tricyclic antidepressants). Functional neurosurgery may be indicated in well selected cases. The neurosurgical methods to be considered are (1) modulative, i.e., the use of neurostimulation or implanted drug delivery systems, and (2) ablative, i.e., the creation of selective therapeutic lesions in well-defined targets demonstrated to sustain pain mechanisms. Consideration of the mechanism(s) of the pain and of the topographic level of the causal lesion is the most important prerequisite for choosing the most appropriate and effective procedure. Transcutaneous electrical nerve stimulation can be effective, especially if the peripheral nerve to be stimulated is close to the skin and the lesion is distally situated. To be effective, spinal cord stimulation requires that the dorsal column fibers be functional up to the brainstem nuclei; otherwise, the target must be thalamic (ventroposterolateral nucleus) or cortical (precentral). Intrathecal morphine therapy is rarely indicated for neuropathic pain as it is for cancer pain. Ablative techniques are usually used for cancer pain (with long survival time), with the exception of dorsal root entry zone surgery, which can be indicated for neuropathic pain caused by root avulsions, segmental pain after spinal cord lesions, and, more rarely, pain after peripheral nerve lesions when a paroxysmal and/or an allodynic component is predominant.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Left-sided vagus nerve stimulation (VNS) is a relatively new and efficacious neurophysiological treatment for patients with refractory epilepsy who were rejected for resective epilepsy surgery or who have had insufficient benefit from such a treatment. Animal experiments have shown that electrical stimulation of the vagus nerve can reduce the occurrence and duration of electrically and chemically induced seizures. The precise mechanism of action remains unclear. In 1988 the first vagus nerve stimulator was implanted in humans. Currently more than 7500 patients have been implanted world-wide. Randomized controlled clinical studies have shown a more than 50% reduction in seizure frequency in one third of the patients. Results on long-term treatment indicate that VNS remains effective over time and a trend towards improved seizure control with longer use of VNS was observed. VNS seems equally efficient in children. Hoarseness or voice change during stimulation are the most common side effects. VNS requires a substantial financial investment. Cost-efficacy studies have shown that these costs can easily be payed back by savings in epilepsy related direct medical costs in patients treated with VNS.

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1050-6438    

出版商:OVID    

年代:2001

数据来源: OVID