Critical reviews in neurosurgery : CR最新文献

Being the most prevalent group of brain tumors in all age groups, low-grade gliomas still leave the question of the optimal treatment open. Despite the indolent, non-aggressive behavior of these tumors, there has been no dramatic improvement in treatment results. Surgery and radiotherapy have certain limitations in the treatment of patients with low-grade gliomas. The purpose of this review is to display a role of chemotherapy in overcoming these therapeutic obstacles. The recent reports of groups studying treatment for low-grade gliomas are analyzed.

It is well established that hypothermia will protect cerebral and cord tissue against necrosis from prolonged ischemia. The optimum depth of hypothermia and safe total time has not yet been established. There is considerable evidence that hypothermia may be useful as a treatment adjunct after trauma or ischemias, but the same caveats apply. There are agreed risks, the exact nature of which are unknown, and there are suspicions that hypothermia after the insult may be only delaying the natural recovery processes.

This paper reviews the literature concerning symptomatic epidural lipomatosis. The different diagnostic procedures (conventional myelography, computed tomography, and magnetic resonance imaging) and therapeutic approaches (including medical treatment, surgery, and dietary influence) are discussed.

Computer-aided design (CAD) and computer-aided manufacturing (CAM) by stereolithography are already being widely used in industry for the design and manufacture of new parts and have already shown accuracy in reproducing the desired model. The only shortcoming of this technique is that it can only make one model at a time, a "prototype." It cannot be used for mass production. It is precisely this property, namely making a prototype, that makes it so attractive in reconstructive surgery and implantation of prostheses, where each "part" has to be adapted to the unique anatomy of the patient. It was not until the early nineties that reports of the application of stereolithography to reconstructive surgery appeared in the literature, and even now they are scarce. However, it is a very promising technique, and we think that it is important for physicians to familiarize themselves with this concept.

This article reviews four reports that have addressed the efficacy of spinal instrumentation to enhance spinal fusion in patients with degenerative spondylolisthesis. These papers serve to highlight some of the common problems with interpreting and applying the clinical findings of such studies: small, nonuniform patient selection; variable instrumentation techniques; relatively brief follow-up periods (usually less than 5 years); lack of a uniform scale for clinical assessment of patients; and lack of consensus on the definition and clinical documentation of motion segment instability.

In the past decade there has been a resurgence of interest in neurosurgical interventions for the treatment of medically intractable Parkinson's disease. The reasons for this development include improved surgical techniques, a better understanding of the pathophysiology of Parkinson's disease providing the scientific rationale for such interventions, and the clinical problems of long-term levodopa treatment. Among the modern stereotactic procedures that are now available for the treatment of patients with advanced Parkinson's disease and levodopa-induced side effects, the effects of pallidotomy are best studied. More recently, chronic high-frequency stimulation of the internal pallidum and subthalamic nucleus have been proposed as surgical alternatives. This article reviews the most recent reports concerning the indication and results of stereotactic surgery for the treatment of advanced Parkinson's disease.

The clinical symptoms of intracranial dural arteriovenous fistulas (AVFs) depend mainly on the site and venous drainage pattern of the lesion. The goal of treatment of the lesion is the permanent and complete elimination of the arteriovenous shunt. Transarterial embolization or stereotactic radiation may affect feeding arteries or nidus. The involved sinus can be obliterated by percutaneous or surgical transvenous embolization, or resected by surgery. In cases of patients with pure leptomeningeal drainage, surgical interruption of leptomeningeal drainage may be effective. Based on the experiences reported in the literature, transarterial embolization of accessible feeding arteries is the initial treatment to decrease arterial blood flow. Transvenous embolization may be effective depending on the venous drainage pattern. For the AVFs remaining after transarterial embolization, stereotactic radiosurgery is recommended if feasible. Transvenous embolization may be applied cautiously considering the risk of venous hypertension and intracranial hemorrhage. Direct microsurgery is indicated if stereotactic radiosurgery is not performed safely. For cases without dural sinus drainage, surgical interruption of leptomeningeal drainage may be applied safely. The decision to intervene in dural AVFs is based on the following factors: age and general condition of the patient, severity of the presenting symptoms, natural history of the lesion if left untreated, angiographic features on the location of dural AVFs and the venous drainage pattern, and morbidity and mortality of the procedure being considered.

The review describes and discusses the status of the major approaches to functional neuromuscular stimulation (FNS) for the purpose of ambulation by traumatic complete thoracic-level paraplegics, namely, hybrid body bracing with FNS, percutaneous FNS, fully implanted FNS, and transcutaneous FNS. For each approach, the review discusses the system for which the most published user data are available and, where relevant, where the largest user population exists. The review covers methodologies and system descriptions. The Analysis sections of the review discuss ambulation performance, patient-training aspects, and, when available, multi-user medical, physiological, and psychological evaluation data. A comparative tabulation is given in the Synthesis section of the review.