摘要:

Summary:Brain metastases are common in patients with systemic cancer, and their incidence is increasing. Most brain metastases become overtly symptomatic and if left untreated lead to an inexorable neurologic deterioration and death. The most common symptoms are headache, limb paresis, behavioral and cognitive changes, and seizures. Most early symptoms are due to peritumoral edema and as such can be ameliorated with glucocorticosteroids. Timely diagnosis and vigorous treatment of cerebral metastases, although rarely curative, may lead to a remission of symptoms, enhance quality of life, and prolong survival. The treatment of choice for the single or multiple solitary brain metastases in the absence of active systemic cancer is surgical resection. Patients with unresectable multiple cerebral metastases or those with progressive systemic disease are best treated with whole-brain radiotherapy. Radiosurgery is emanating as a promising modality for the treatment of a single lesion or for up to four cerebral lesions, or for lesions at relapse, with a tumor control rate of >90%. At recurrence, treatment options are generally limited. Those patients with a single recurrent lesion and systemic disease under check can derive significant benefit from reoperation to result in a median survival similar to that after surgery for the original metastasis. Treatment with a radiation boost with stereotactic radiation is gaining momentum in this setting. The overall prognosis for patients with cerebral metastases is dismal, and the treatment is primarily palliative. The best subgroup of patients, those who are candidates for surgical resection, have an expected median survival of 9 months, with 1-, 2-, 3-, and 5-year survival rates of 40%, 16%, 11%, and 6%, respectively.

ISSN:1050-6438    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Summary:Endoscopic neurosurgery has been practiced for >80 years but with equipment designed for other specialties. It is only recently that specific neuroendoscopes and their ancillary equipment have become available. This communication reviews the current state of the art. Rigid or flexible endoscopes may be used, separately or together, to visualize the cerebral ventricles, brain parenchyma, cysts, cranial or spinal epidural and subarachnoid spaces, subdural hematomas, thoracic and peritoneal cavities together with the inside of cerebral arteries, spinal cord (syrinx), intervertebral disk, and carpal tunnel. In these situations it is possible to perform inspection, biopsy, aspiration, resection, vaporization, coagulation, fenestration, intubation, removal of foreign bodies, and microvascular decompression. Well-documented therapeutic success rates exist for communicating hydrocephalus (by choroid plexus coagulation) of 52–80%. for late onset noncommunicating hydrocephalus (by third ventriculostomy) of 82–94%, for thoracic sympathectomy of 95%, and for lumbar diskectomy of 95%. Success in smaller series has been claimed in cases of arachnoid cyst, colloid cyst of the third ventricle, intracerebral tumor, intracerebral and multilocular subdural and epidural hematoma, cerebrospinal fluid (CSF) fistula, multiseptate syringomyelia, and carpal tunnel syndrome. In addition, the first recorded cases of endoscopic hypophysectomy and endoscopic revision of encysted peritoneal shunt catheter are described.

ISSN:1050-6438    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Summary:Cysticercosis is the most frequent parasitosis of the central nervous system. Because anticysticercal drugs do not prevent complications such as hydrocephalus, many patients with cysticercosis require surgical intervention. A review of the pathophysiology and surgical treatment of this disease is presented. Free spinal cysts may need surgical removal, generally with transient good results. Cysts compressing cranial nerves or the brainstem may be removed, generally with good results. Frequently patients with cysticercosis need surgery to control increased intracranial pressure. Based on the pathophysiological mechanisms of intracranial hypertension, different surgical approaches may be indicated. Giant cysts are removed with good results. Patients with the pseudotumoral form of cyst whose clinical treatment has failed generally have poor outcomes when subjected to decompressive craniectomies. Removal of cysts and/or ventriculoperitoneal shunting are performed in patients with hydrocephalus. Removal of free ventricular cysts generally produces a good outcome. Patients with adherent cysts need ventriculoperitoneal shunting posteriorly. Patients with inflammatory hydrocephalus require ventriculoperitoneal shunting. Despite many complications, ventriculoperitoneal shunting is effective to control increased intracranial pressure. Generally, patients with intraparenchymal forms of cysticercosis (normal size or giant cysts) have a better prognosis than do patients with the extraparenchymal form (cisternal, ventricular, and spinal), except for cases of free intraventricular cysts. We present our recent policy for management of patients with this disease.

ISSN:1050-6438    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Summary:The use of intraoperative neurophysiologic monitoring of cranial nerves is reviewed. Over the past 15 years, intraoperative monitoring has been used increasingly during various operations that may involve surgical injuries to cranial nerves. Such monitoring relies on the assumption that some neuroelectric potentials change as a result of injury to a specific cranial nerve and that the risk of permanent injury can be reduced by reversing the surgical manipulation that caused the change in the recorded potentials. It is shown that such monitoring can be performed using methods similar to those used in routine clinical testing and in the physiological laboratory for many years. Although it has been difficult to prove the efficacy of such intraoperative monitoring, except for that of a few cases, such monitoring is generally regarded to be beneficial in helping to decrease the risk of permanent postoperative deficits. In specific operations these electrophysiological methods can aid the surgeon in the operation in various ways, and in many situations it provides a feeling of security for the surgeon. Communication between the monitoring team and the surgeon as well as the anesthesiologist is essential for the success of intraoperative neurophysiological monitoring.

ISSN:1050-6438    

出版商:OVID    

年代:1995

数据来源: OVID