Neurochirurgia最新文献

In a prospective randomized study the effect of low-molecular-weight heparin (one injection of 1500 a PPT-Units/d Mono-Embolex NM) was compared with the effect of unfractionated heparin (5000 IU t.i.d.) in 200 patients undergoing micro-neurosurgical lumbar disc operations. Criteria of evaluation were lethal pulmonary embolisms, clinical signs of pulmonary embolisms, confirmed by radioisotopic lung scans, and major bleeding complications. The present investigation demonstrates, that a single daily subcutaneous injection of Mono-Embolex NM is an effective and well tolerated measure against thrombo-embolic complications, at least equal to the established low dose heparin prophylaxis with 5000 IU t.i.d.

Six cases with arteriovenous malformations (AVM) and intracerebral hematomas causing coma and tentorial herniation are presented. All patients were operated on acutely: The hematoma and malformation were removed. All patients survived. The acute operation on AVM with hematomas even in comatose patients with tentorial herniation is useful and possibly contributes to reduction of the total mortality.

A case of bifrontal oligodendroglioma with bilateral posterior communicating artery aneurysms, one symptomatic and the other incidental, is presented. This is the first instance of such a combination. Clipping of the aneurysm, along with partial tumour excision, was performed at the same sitting, successfully. Literature on this association is reviewed and the pathogenesis is discussed.

The records of 57 patients who were operated on at the Beilinson Medical Center from 1970 through 1982 for supratentorial low-grade astrocytomas were reviewed. The management of these patients was correlated with survival. Our study demonstrates that a younger age at onset and a negative radionuclide uptake on isotope scan, were the most important factors associated with a better survival rate. Extensive tumor resection combined with radiation therapy also exercised a beneficial effect in prolonging survival.

Intraosseous neurilemmoma is a rare benign tumour of the bone with characteristic radiological and histological features. The most common places of this tumor are mandible, sacrum and vertebral bodies. A case of a not previously reported location of this tumor in the vault of the skull is presented.

Intracranial hypertension which does not respond to customary hyperosmotic agents may successfully be treated with hypertonic saline. The absence of diuresis and the maintainance of intravascular volume are supposed to be the main advantages of hypertonic sodium chloride. Volume overload and toxic hyperosmolality from frequent application of such solutions are possible disadvantages. The presented experiments checked the time course of intravascular volume shifts after a 100 ml 1-molar saline bolus in 14 patients during neurosurgery using plasma protein concentration changes. An initial intravascular volume expansion of about 270 ml remained quite unchanged for the first 8 minutes, followed by a nearly linear decrease. Extrapolation of the curves demonstrated that the preinfusion state would have been reached after about 20 minutes. Osmolality remained increased by about 4 mosmol/kg 15 min after the bolus. Thus it appears that repetitive infusion of these amounts of hypertonic saline will cause no serious volume overload if 30 minutes intervals are kept, but osmolality should be checked before each bolus.

Meningiomas should be considered as a possible diagnosis when dealing with tumors of the head and neck, even though these lesions may be located outside the cranial cavity. We report three patients who harbored primary ectopic epidural meningioma arising in the right occipital, parietal and left frontal region protruding extracranially through destructed calvarium and also developing intracranially without dural involvement. The diagnostic value of CT scan is emphasized and the relevant literature on ectopic meningioma is reviewed.

The case of a 12-year-old patient with a wooden foreign body which had penetrated the superior orbital fissure is presented. Using a transethmoidal approach, only some splinters lying in the periorbital soft tissue were removed. The patient became febrile, indicating an infectious complication due to a retained foreign body. This was confirmed by CT scan and MRI demonstrating a main splinter in the superior orbital fissure. Total removal of the wood was achieved via a pterional extradural approach. The difficulties of identifying wooden foreign bodies as well as the topographical problems involved with the approach to the superior orbital fissure are discussed.