摘要:

Endovascular neurosurgery is a relatively new field that is evolving at a rapid pace. The specialty is driven by new technologies that allow us to approach increasingly difficult problems. In recent years, the Guglielmi detachable coil system has moved to the forefront of endovascular approaches to the treatment of intracranial aneurysms and has practically replaced several previous endovascular approaches to most of these lesions. Open craniotomy with clipping is still the treatment of choice when the neurosurgeon feels the risks are acceptable and the patient is an appropriate candidate. However, the indications for the endovascular approach are expanding as long-term outcome data accumulate. We are now beginning to define specific subsets of patients in whom endovascular treatment may be a more attractive option than open surgical clipping. More recently, new ideas about aneurysm architecture have been described that may contribute to predicting long-term outcomes with endovascular treatment.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Spinal cord stimulation (SCS) is a useful surgical technique tor the treatment of chronic pain, including vasculopathic pain. In this clinical study. SCS was used to treat a selected group of patients with intractable angina pectoris. Clinical criteria for inclusion were diagnosis of stable class 3-f angina pectoris, with at least 3 months of nonresponse to maximum tolerable pharmacologic treatment, and no indication for other surgical procedures. Our 23 patients suffered angina pectoris secondary to arteriosclerotic coronary artery disease. A percutaneous technique was used for electrode implantation and the upper cervical spinal cord was stimulated within the parameters of 120 Hz frequency, pulse width of 0.1 ms. and the maximum intensity to cause not-unpleasant paresthesias to the patient. Initial pattern of stimulation was 4 hours in the morning and 4 hours in the afternoon. Our results demonstrate the efficacy of high cervical SCS in the treatment of severe angina pain with no major complications. Neurostimulation does not change the natural history of the coronary disease, but all patients experienced improved quality of life. In addition, SCS does not mask pain secondary to myocardial infarction. Several mechanisms of action have been invoked to explain these clinical results of SCS. The main mechanism would be analgesia by means of activation of descending inhibitory systems; a secondary nism would be the blocking of some segmentary autonomic responses developed in response to myocardial ischemia.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The reason tor the recent resurgence of spinal infections is threefold: the segment of the population that is aged or immunosuppressed is growing, the number and complexity of spinal procedures being performed are rising, and the number of resistant microbes is increasing. The treatment of spinal osteomyelitis, discitis. and intramedullary or epidural abscess requires a multidisciplinary team approach including an infectious disease consultant, a neuroradiologist, and a spinal surgeon. The advent of sophisticated imaging modalities has greatly facilitated the diagnosis, local ization, and characterization of these lesions. The diagnosis is made by clinical history. imaging, blood cultures, and, frequently, closed or open biopsies of the involved area. The cornerstone of treatment for spinal infection remains medical, consisting of appropriate antimicrobial therapy. Surgical intervention is indicated to obtain cultures, to secure a diagnosis, to relieve or prevent intractable pain, to maintain or restore spinal stability, and to prevent or reverse neurologic deterioration.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Baltic cranial surgery pioneer Ernst von Bergmann (1X36–1907) showed a lifelong interest in identifying the cause of postoperative infectious complications and in searching for remedies. Above all. he insisted on long and meticulous scrubbing of the surgeon's hands. Baltic-Estonian surgeon Werner Zoege von Manteuffel (1857–1926) strongly advocated the use of boiled rubber gloves in surgical practice. Zoege, a pivotal figure in advancing the development of the ‘“boiled rubber-gloved hand” in surgery, described in 1897 the use of boiled rubber gloves with the specific aim of offering protection from the surgeon's bare hands. In 1890, American surgeon William Halsted began using rubber gloves to protect his scrub nurse's hands from a dermatitis. He later admitted that he was surprised it took such a long a time for anyone, including himself, to realize the importance of rubber gloves to offer protection against secondary contamination.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Advances in various fields of neuroscience have led to a more aggressive surgical attitude toward skull base lesions. Consequently, cranial nerves are more frequently damaged, causing significant morbidity. This article discusses the theoretical and practical aspects of intracranial nerve repair, including histologic aspects of cranial nerve repair, types of coaptation technique, and recovery of function. Results of various studies show that intracranial nerve repair is worthwhile and that at least some functional recovery occurs, mainly dependent on the preoperative function and the complexity of the cranial nerve involved.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Paranasal sinus cancer usually presents at an advanced stage to the neurosurgeon, with ethmoid sinus involvement and incipient or actual invasion of the anterior cranial fossa floor; in the past this has usually been associated with a poor prognosis. Our experience with 67 patients using craniofacial resection at the Royal Melbourne Hospital, Australia, between June 1983 and June 1995 has produced a 5-year survival of 80% with no deaths and a low rate of serious complications. This appears to represent a significant improvement in the long-term results compared to conventional surgery and radiotherapy. We believe that a major improvement in tumor control can be achieved using careful surgical techniques, and we place special emphasis on the use of a vascularized pericranial flap in the reconstruction of the floor of the anterior cranial fossa. An overview of paranasal sinus cancer is presented, with particular emphasis on our experience with craniofacial resection for these tumors.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID