Neurochirurgia最新文献

Intracranial hydatid cysts, although rare, are still prevalent in agricultural and sheep-raising communities. The authors discuss some of the peculiarities in 120 consecutive cases of intracranial hydatid cysts and review the literature in this report.

We report on a case of fibrous dysplasia of the cervical spine accompanied by atlanto-axial dislocation, a rare condition first reported by Stirrat. A 37-year-old man who had shown cervical myelopathy for about 6 months was diagnosed as having cervical fibrous dysplasia on the basis of plain x-ray and CT film findings. In addition, atlanto-axial dislocation, which was the apparent main cause of his symptoms, was also detected. We performed a successful two-stage operation from first the posterior and then the anterior approach. The possibility that grafted cancellous bone for anterior fusion may be replaced by dysraphic tissue in the presence of fibrous dysplasia was a complicating factor in this case.

Gadolinium-DTPA enhanced MRI was examined before and after surgery in 14 patients with particular attention to the enhancement of falx cerebri, tentorium cerebelli and dura mater. A marked enhancement was observed in 2 falx and 2 tentorium before surgery, whereas it was observed in 7 falx, 9 tentorium and 11 dura after surgery. Among 6 falx, 7 tentorium and 12 dura showing increased enhancement after surgery, 2 falx, 3 tentorium and 8 dura showed marked enhancement which was not observed before surgery. A small amount of subdural haemorrhage during surgery is known to heal as subdural neomembrane with capillaries. An increased enhancement of dural structures conceivably derives from the extravasation of Gd-DTPA through capillaries involved in the subdural neomembrane. In the postoperative MRI, the enhancement of dural structures should be taken into consideration.

A 25-year-old male was wounded accidentally in the neck by a metallic fragment, which penetrated his right carotid artery and migrated within the ipsilateral middle cerebral artery. Clinical and laboratory findings over a 16-month-period are reported. Problems arising from the presence of metallic emboli to the cerebral circulation are discussed on the basis of the pertinent literature.

A case of facial neurinoma is reported. There was a progredient facial palsy persisting for one year. While X-ray examination as well as CT and MR did not show a pathological finding, classical topodiagnosis resulted in mastoidectomy, during which a neurinoma of 0.5 x 0.8 cm could be removed. The defect was reconstructed by an auricular nerve graft, with satisfactory functional results.

We have examined the effects of a single injection of naloxone (5 mg/kg, i.v.) in cats with cerebral ischemia produced by transorbital occlusion of the middle cerebral artery (MCA). Cerebral blood flow (CBF) was measured and the cerebral metabolic rate of oxygen consumption (CMRO2) was estimated based on measurements of arteriovenous (A-V) oxygen difference. Six cats were treated with naloxone 30 minutes after occlusion and 8 were treated 2 hours after occlusion. In 6 control animals, naloxone produced a 10-15% increase in mean arterial blood pressure (MABP), CBF and CMRO2 lasting 30 minutes. MCA occlusion reduced CBF by 70-75% in the ipsilateral MCA territory and by 15% in the contralateral hemisphere. Naloxone increased CBF by 3.5-6% in the ischemic region and 10-22% in the contralateral hemisphere in both treatment groups to the same extent as seen in control animals. There was no significant change in A-V oxygen difference and the estimated increase in CMRO2 of non-ischemic regions of both treatment groups was similar to that of control animals. These effects were transient and lasted 15-60 minutes. We have concluded that naloxone caused a transient increase in cerebral metabolism which equals or exceeds the corresponding increase in CBF. Therefore, naloxone would not be beneficial, and may be detrimental in the treatment of cerebral ischemia.

Thermal lumbar sympathectomy has been the method of choice since the 'eighties in the treatment of reflex dystrophy. We are using this method since January 1990. First results are presented and critically analysed. 15 patients who underwent thermal lumbar sympathectomy were examined and interviewed 1 year after treatment. 7 patients reported persisting pain relief, while the remaining 8 did not.

Many clinicians currently use antifibrinolytic therapy (AFT) routinely in the management of subarachnoid haemorrhage (SAH). Many others do not, either because they remain unconvinced that AFT reduces the risk of rebleeding, or that the medication itself causes serious complications and in particular cerebral ischaemia. Nineteen randomly selected patients were studied, 9 receiving tranexamic acid (9 g a day) and the remaining 10 placebo, with SAH confirmed by CT scanning and by lumbar puncture. There was no difference between the active and placebo group regarding the age, sex, clinical grade, CT scan and angiographic appearance. The intravenous Xe133 technique was used for serial determinations of hemispheral cerebral blood flow. The cerebral blood flow remained stable during the first week following subarachnoid haemorrhage, and then fell progressively, reaching its bottom level by the end of the second week. The cerebral blood flow levelled out during the third week at the end of which a sharp elevation, well above the first week's post-subarachnoid haemorrhage level, was noted. This rebound rise of cerebral blood flow was observed for both cerebral hemispheres. Cerebral flow was greatest in the contralateral (to side of ruptured aneurysm) brain hemisphere save for the peak observed during the first week post-subarachnoid haemorrhage. The difference between the ipsi- and contralateral hemispheres was most pronounced in patients receiving active treatment. Analysis of variance showed that cerebral blood flow was reduced by the active treatment and especially more so on the ipsilateral side with the ruptured aneurysm. The usefulness of AFT should therefore be reconsidered.(ABSTRACT TRUNCATED AT 250 WORDS)

Operations on lumbar disc prolapses are the most frequent operations in German neurosurgery divisions. After such operations, spondylodiscitis is a dreaded complication which is sometimes difficult to diagnose. Treatment of spondylodiscitis is always protracted and a burden for doctors and patients. Hence, it appears worthwhile to present a further report on discitis and spondylodiscitis, infections of the intervertebral space and the surrounding tissues after disk operations. Various clinical pictures are described: septic progress forms with neurological disorders and the necessity of open wound treatment as well as clinical pictures without septic signs with good recovery after immobilisation and antibiotic treatment. In two cases, CT-guided puncture of purulent suppuration with identification of the causative organisms and specific antibiotic treatment was possible. All patients had a relatively good result: pareses and/or bladder/rectal disorders disappeared completely in every case. The causes of discitis are discussed. The condition arises when nosocomial microorganisms, or very frequently even harmless skin bacteria, enter the wound. A large number of operations are carried out under pressure of time and under hectic conditions, as well as in a confined space in operation theatres which are too warm; these factors increase the susceptibility to infection. However, the resistance of the patient to infection is also weakened after longterm prior antiinflammatory treatment and a stay in hospital before the operation. Besides appropria to treatment of the infection (immobilisation, wound treatment, antibiotic therapy), psychological management of the patient is an important component of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)