Acta neurochirurgica
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Acta neurochirurgica · Jan 1995
Case ReportsAtlanto-axial instability of a hypoplastic upper cervical spine. Case report.
The authors report on the development of myelopathy in a case of hypoplastic upper cervical spine with atlanto-axial instability. Its surgical treatment with transarticular screw fixation and interlaminar fusion is outlined.
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Thoracic percutaneous facet denervation has been employed for the treatment of thoracic zygapophysial joint pain. But the surgical anatomy of this procedure has been assumed to be the same as for lumbar medial branch neurotomy. To establish the anatomical basis for thoracic medial branch neurotomy, an anatomical study was undertaken. ⋯ Although the curved course remained essentially the same, the inflection occurred at a point superior to the superolateral corner of the transverse process. At no time during the dissection were nerves encountered crossing the junctions between the superior articular processes and transverse processes which have been the target points advocated for thoracic facet denervation. Rather, the results of this study indicate that the superolateral corners of the transverse processes are more accurate target points.
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An encapsulated fluid epidural haematoma in a 9-year-old boy was successfully evacuated by a simple burr hole procedure 5 months after a minor head injury. Clinicopathological findings suggested that chronic expansion of an initially unsuspected epidural haematoma occurred as a result of repeated haemorrhages from the haematoma membrane, resulting in an unusually long delayed appearance of clinical evidence. This case demonstrates that a chronic expanding process similar to that seen in chronic subdural haematoma needs to be considered as a possible complication of epidural haematoma and indicates an important role for the haematoma membrane in the chronic expansion of epidural haematoma.
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Acta neurochirurgica · Jan 1995
Significance of ST segment elevation in electrocardiograms in patients with ruptured cerebral aneurysms.
Twenty-three patients with aneurysmal subarachnoid haemorrhage (SAH), who showed an ST segment elevation in their electrocardiograms (ECG), were examined. There were 12 males and 11 females, with a mean age of 61 years. The clinical condition on admission was Hunt and Kosnik grade II in four, III in seven, IV in one, and V in 11 patients. ⋯ These results suggest that ST segment elevation in the acute stage of SAH reflects transient cardiac dysfunction rather than myocardial injury. In some patients, however, the elevated serum levels of myocardial enzymes or T wave inversion suggested the presence of myocardial injury. Close follow-up seems to be necessary in such cases.
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Acta neurochirurgica · Jan 1995
Case ReportsTension pneumocephalus after transsphenoidal surgery: two case reports.
In this paper, a brief information on factors taking role in intracranial air formation and tension pneumocephalus because of two cases epidural air formation and tension pneumocephalus following transsphenoidal operation is presented. Two cases were treated conservatively.