摘要:

Cranial gunshot wounds frequently produce devastating injuries to central nervous system (CNS) structures. Surgical therapy and primary and secondary debridement, including repair of dural defects and removal of retained intracranial bone and metal fragments, were applied to 374 cranial gunshot wound victims at Gulhane Military Medical School in Turkey from 1992 to 1999. Dural defects were closed primarily or with temporalis fascia, pericranium, and cadaver grafts. Central nervous system infections were mostly observed in cases with cerebrospinal fluid (CSF) fistulas. All patients underwent computed tomography (CT) scans periodically. In 119 of 374 (32%) patients, bone and metal fragments were determined on control CT scans. We also performed angiography in some patients to reveal traumatic vascular pathologic findings. Most of the deaths in this group of patients were attributed to the direct effects of brain injury and occurred within the first month after injury. Fragments retained after the first debridement were followed periodically by CT scan. Surgery was not performed until infection developed. Retained fragments did not increase the infection risk, but high rates of infection did occur in cases with CSF fistulas. The presence of diffuse brain damage, brainstem injury, CNS infection, or ventricular injury was associated with a poor outcome.

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Facial palsy is a functional disability and a cosmetic distress for patients who undergo vestibular schwannoma surgery. The aim of modern schwannoma surgery is not only complete tumor removal but preservation of the seventh and eighth nerve complex. With microsurgical techniques and intraoperative cranial nerve monitoring, preservation can be achieved in most cases. Nevertheless, preservation of the anatomic integrity of the facial nerve does not always predict the outcome of postoperative facial function. In addition to structural preservation of the nerve itself, other factors influencing facial function need to be considered. Delayed facial palsy disappoints the surgeon as well as the patient when it occurs hours or days after surgery. The etiology is complicated and poorly understood; thus, the treatment strategies vary. Many hypotheses have been postulated, including intraoperative manipulation, vascular compromise, an edematous process, external compression, and viral reactivation in the facial nerve. Without histologic or electrophysiologic confirmation, the cause of delayed facial palsy remains speculative. We suggest that postoperative vasospasm in combination with edema of the nerve may explain this unpleasant phenomenon and review the literature to discuss the other possible etiologies of this disease entity. Some strategies are also proposed to treat and prevent its occurrence.

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The risk of developing an intracranial complication after head injury is greater in those who have sustained a skull fracture. Fractures of the basis cranii are usually the result of extension of a vault fracture. The most important complications of these fractures are cerebrospinal fluid (CSF) fistula, related infection and pneumocephalus with fistula, and cranial nerve and intracranial major vessel injury. Although CSF fistulas and posttraumatic meningitis have been discussed extensively in the literature, neurovascular complications of basilar skull fractures have not been so well described. Posttraumatic evaluation and management of basal skull fractures have not yet been standardized. Here, we have classified basal skull fractures according to site and evaluated the posttraumatic complications. Anterior and middle cranial base fractures generally cause upper cranial nerve injuries (I, II, III, IV, V, and VI) and vascular injuries to the carotid artery and middle cerebral artery. Posterior cranial base fractures are associated with injury to the lower cranial nerves (IX, X, XI, and XII) and major venous sinuses. Laterobasal fractures, including those of the petrous bone, are usually associated with deficits of facial and vestibulocochlear nerves (VII and VIII). Controversies in the management of skull base fractures and related complications have gained little attention in medical practice. Many authors have discussed prophylactic antibiotic therapy for CSF fistulas caused by basal skull fractures, but there has not been a standardized protocol for CSF leak management. Early evaluation of skull base fractures and related complications has been discussed in many articles, but the timing of surgical interventions for basal skull fractures and related complications has not been standardized.

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

In this article, the description, classification, incidence, clinical findings, and diagnosis of skull base fractures are outlined. Complications of skull base fractures such as intracranial vascular injuries, nerve injuries, leptomeningeal cyst formation, cerebrospinal fluid fistulas, craniocervical instability, hematomas, and iatrogenic cerebral parenchymal injury are described, and the literature is reviewed.

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Disabling hypertonia—spasticity, dystonia, or a combination—is a major clinical problem in children and is most commonly seen in cerebral palsy. This article reviews current definitions of various types of hypertonia and the management of hypertonia in these children. The multidisciplinary nature of the management is stressed, and the various modalities of treatment are discussed, with an emphasis on the neurosurgical aspects of management. The two major neurosurgical treatments, namely, selective dorsal rhizotomy and intrathecal baclofen, are reviewed in detail, with the current knowledge about outcomes with these treatments presented according to a paradigm developed by the National Council for Medical Rehabilitation Research. Guidelines are provided for the selection of the most appropriate treatment modalities in any given situation.

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Brain metastasis is a common complication of systemic cancer. The management of this complex problem has been controversial over the years. High-dose steroids and whole-brain radiation therapy (WBRT) have been the main treatments in the past. Surgery was established as the gold standard treatment of cerebral metastases in the early 1990s. More recently, radiosurgery has been considered as a possible replacement therapy for metastases less than 3 cm in diameter. Several authors advocate the use of adjuvant WBRT after surgery/radiosurgery, whereas others advise against its routine administration. The aim of this article is to review the current recommendations published in the literature and report on the management strategy followed at The University of Texas M. D. Anderson Cancer Center for treating patients with brain metastases.

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1050-6438    

出版商:OVID    

年代:2002

数据来源: OVID