Acta neurochirurgica
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Acta neurochirurgica · Jan 1992
Case ReportsMultiple intracranial aneurysms: a high risk condition.
There is still a relative silence in the literature on what policy should be followed in treating multiple aneurysms. The main risks are: bleeding of a formerly asymptomatic aneurysm during the haemodynamic tides of the peri-operative period; aneurysm(s) can be hidden on angiograms and tend to be overlooked easier in case of an already revealed aneurysm; misjudgement of the ruptured one as a silent additional aneurysm, therefore left for second stage surgery. ⋯ But it also describes those silent aneurysms which safely could be clipped later. Hazards and disadvantages concerning the more aggressive surgery proved to be less significant than the natural history of multiple aneurysms represents.
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Acta neurochirurgica · Jan 1992
Effects of dorsal root entry zone lesions on CSF and plasma neuropeptides and catecholamines.
Effects of dorsal root entry zone lesions (DREZLs) on cerebrospinal fluid (CSF) and plasma concentrations of neuropeptides, catecholamines, and cyclic nucleotides were studied in 9 patients with intractable chronic pain. Contents of beta-endorphin-like-material in CSF decreased in all patients 12-17 days following DREZLs during which complete to good pain relief was achieved. Contents of beta-endorphin-like-material in CSF increased again about one month after DREZLs in two and remained unchanged in one of three patients tested, who complained of partial reappearance of pain. ⋯ Substance P, noradrenaline, adrenaline, and cyclic nucleotide levels in both CSF and plasma were variable among the subjects and did not change significantly following the operations. Thus, the results suggest that production of beta-endorphin-like-material in the central nervous system is decreased by DREZL, though the increase in its turn-over might not be neglected. The mechanisms of the decrease in contents of beta-endorphin-like-material in CSF after DREZLs were discussed in terms of our current knowledge of pain and pain inhibitory systems.
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A survey is given of the development and actual state of the prediction of outcome in severe head injury. Thanks to the data collection in some large databanks it has become possible, in a relatively large number of cases, to estimate reliably the chances of survival and the chance of developing an intracranial haematoma base on clinical data and CT obtained during the first 24 hours. Later during the posttraumatic course prediction is possible of the degree of remaining disability in survivors, and the chances of developing epilepsy and neuro-behavioural sequelae. Due to changing management-regimens further data collection in international databanks is necessary.
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Acta neurochirurgica · Jan 1992
Review Case ReportsCerebral salt wasting syndrome distinct from the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).
Two cases with pituitary tumour developed postoperative hyponatraemia which was not caused by inappropriate secretion of antidiuretic hormone. The one case with non-functioning macro-adenoma showed severe hyponatraemia (116 mEq/l) on day 11 after trans-sphenoidal surgery in association with diabetes insipidus (DI). The patients was treated by aqueous pitressin and saline administration to control urinary output and keep positive salt balance at the same time. ⋯ This was corrected by additional salt intake. The plasma atrial natriuretic polypeptide (ANP), antidiuretic hormone (ADH) as well as aldosterone levels were normal in the latter case. These patients were considered to manifest primary salt wasting disorder, which should be clearly differentiated from the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).
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Acta neurochirurgica · Jan 1992
Near-anatomical reduction and stabilization of burst fractures of the lower thoracic or lumbar spine.
Thirty-one consecutive symptomatic patients with burst fractures of the lower thoracic or lumbar spine (T 11-L4) were treated by early surgery in a 36-month period, with near-anatomical reduction being achieved via the postero-lateral route. Fusion and reconstruction of the vertebral body was done by using autologous or processed bovine bone. Correction of the kyphotic deformity was obtained by using distraction rods or transpedicular devices. ⋯ All but one of the 25 patients with incomplete paraplegia exhibited neurological improvement, with complete recovery occurring in 20 cases (median follow-up: 16 months) irrespective of the location of the lesion at the thoraco-lumbar junction (T 11-L1) or the lower lumbar segment (L2-L4). Out of the 6 patients with pre-operative complete paraplegia, useful motor power returned in one case with a lesion below L1. The results confirm the suitability of the postero-lateral route and are consistent with the assumption that early near-anatomical reduction and stabilization favours maximum neurological recovery in symptomatic patients.