Acta neurochirurgica
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Acta neurochirurgica · Jan 1994
Bovine bone grafting in occipito-cervical fusion for atlanto-axial instability in rheumatoid arthritis.
Bovine bone chips (Surgibone) were used in occipito-cervical fusion in nine patients with atlanto-axial instability due to rheumatoid arthritis. The patients were examined with CT 12-15 months after surgery. Graft resorbtion was observed in one patient. ⋯ One patient was revised, and at the grafted site a bony bridge was found. In conclusion, the use of bovine chips in posterior occipito-cervical fusion will not lead to predictable bone union. However, there seem to be exceptions to that rule.
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Acta neurochirurgica · Jan 1994
Duration of symptoms as a predictor of outcome after lumbar disc surgery.
Retrospectively 93 consecutive patients operated on for lumbar disc herniation were studied in order to evaluate the prognostic value of symptoms (lumbar pain and sciatica) and sick-leave. Surgical results were evaluated 1-3 years postoperatively by a questionaire. The duration of the present attack of sciatica and sick-leave prior to surgery was significantly longer in the group with unsatisfactory outcome compared to the group with satisfactory outcome. ⋯ Patients who returned to the same type of work had a preoperatively statistically significant shorter duration of present sick-leave, compared to the patients who had changed the type of work and the patients who did not return to work. The patients with duration of their present sick-leave of less than 6 months had a significantly higher percentage of returning to the same type of work compared to patients with duration of their present sick-leave of 6-12 months and more than 12 months. We conclude that the duration of sciatica and sick-leave before the operation has value as predictive factors concerning the over-all result after surgery for lumbar disc herniation.
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Acta neurochirurgica · Jan 1994
Penetrating craniocerebral shrapnel injuries during "Operation Desert Storm": early results of a conservative surgical treatment.
A follow-up study is presented of the initial neurosurgical treatment of 20 patients who sustained penetrating craniocerebral injuries during "Operation Desert Storm". Fifteen of these patients had received intracranial debridement through a craniectomy and five patients had received care of scalp wounds only. Following treatment and stabilisation in a frontline hospital, these patients were transferred to the Riyadh Armed Forces Hospital for further evaluation and management. ⋯ No patient died or developed a seizure disorder. These results suggest that re-operation for removal of retained fragments is unnecessary. It is concluded that the initial treatment of shrapnel wounds of the brain should be to preserve maximal cerebral tissue and function either by limiting the wound debridement performed through a craniectomy or by care of scalp wounds only.
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Acta neurochirurgica · Jan 1994
Intracranial meningiomas: analysis of recurrence after surgical treatment.
Recurrence of intracranial meningiomas after surgery has long been recognized, but there is still no consensus about factors responsible for recurrence. To better understand such factors, we analysed data on 276 patients with meningiomas who were treated at our institution from 1976 to 1990 (mean follow-up = 5.1 years). Effects of sex, tumour histology, tumour site, and radiotherapy on recurrence were closely studied. ⋯ We found that radiotherapy did not decrease "recurrence" or "regrowth" regardless of when administered, either at first resection or on recurrence. This was true for benign as well as malignant meningiomas. However, due to the small number in our series, we cannot conclude that radiotherapy has no beneficial role in the treatment of meningiomas.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acta neurochirurgica · Jan 1994
Comparative StudyParameters in electrode positioning in thoracic percutaneous facet denervation: an anatomical study.
The purpose of the present study was to verify if needle placement in thoracic percutaneous facet denervation (PFD), based on bony landmarks, and under fluoroscopic guidance, would lead to constant anatomical positioning; and hence to an adequate placement at the assumed target, i.e., the medial branch of the dorsal ramus of the spinal nerve; and furthermore to determine if interpretation of the needle position by CT is more reliable than by fluoroscopy. The procedures were carried out bilaterally at all 12 levels on two cadavers, simulating the clinical setting as much as possible. In 44 cases the position of the needles was determined on hard copies of fluoroscopic images, 1.5 mm interval CT-images, surface-photographs, and on counterstained 25 microns sections obtained by a multirange heavy duty cryomicrotome. ⋯ The correlation between fluoroscopic images and sections was poor. The correlation between CT and sections was better, except for the mediolateral direction. The results of the present study suggest that "pure" anatomical positioning based on bony landmarks analogous to those used in the lumbar region is not reliable enough for thoracic PFD, and that corrections after electrostimulation substantially contribute to obtaining an adequate position of the needle.