Journal of neurosurgery
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Journal of neurosurgery · Jan 1997
Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging.
Surgical management and prognosis of traction injuries of the brachial plexus depend on the accurate diagnosis of root avulsion from the spinal cord. Myelography, computerized tomography (CT) myelography, and recently magnetic resonance (MR) imaging have become the main radiological methods for preoperative diagnosis of cervical root avulsions. Most of the previous studies on the accuracy of CT myelography and MR imaging studies have correlated the radiological findings with the extraspinal surgical findings at brachial plexus surgery. ⋯ The most common reasons for false-positive or false-negative findings were: 1) partial rootlet avulsion; 2) intradural fibrosis; and 3) dural cystic lesions. Computerized tomography myelography scans using 1- to 3-mm axial slices prove to be the most reliable method to evaluate preoperatively the presence of complete or partial root avulsion in traumatic brachial plexus injuries. Because extradural judgment of cervical root avulsion can be unreliable, accurate assessment of intraspinal root avulsion enormously simplifies the decision concerning the choice of donor nerves for transplantation and/or neurotization during brachial plexus surgery.
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Journal of neurosurgery · Jan 1997
Outcome analysis for adults with spondylolisthesis treated with posterolateral fusion and transpedicular screw fixation.
The outcomes of 52 adult patients with symptomatic low-grade spondylolisthesis treated with autologous posterolateral arthrodesis and pedicle screw fixation were retrospectively reviewed. Although a 90% rate of successful fusion was obtained using this technique, only 60% of patients were considered to have good outcomes. Treatment failures consisted mostly of back pain and were not predicted by preoperative symptoms. ⋯ The authors conclude that autologous posterolateral arthrodesis combined with pedicle screw fixation resulted in a high fusion rate, and contributed to successful outcomes in the treatment of certain subgroups of adults with spondylolisthesis. In the absence of other risk factors, patients may obtain significant benefit from surgery despite older age and a single failed operation. Careful patient selection appears critical in predicting the maximum benefit from this technique.
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Journal of neurosurgery · Jan 1997
Modified open-door cervical expansive laminoplasty for spondylotic myelopathy: operative technique, outcome, and predictors for gait improvement.
Twenty-five patients underwent an expansive cervical laminoplasty for nontraumatic cervical spondylosis with myelopathy during the period from June 1990 to November 1994, and all had a minimum of 18 months of follow-up review. The open-door laminoplasty procedure presently reported consisted of the same approach evaluated by Hirabayashi in 1977, except that the authors of this report used three rib allografts to anchor the "open door," rather than spinous process sutures or autologous bone grafts. Posterior foraminotomies and decompression were performed in patients with clinical radiculopathy and radiographic evidence of foraminal stenosis. ⋯ Various predictors of surgical outcome based on gait improvement were evaluated. Age greater than 60 years at the time of presentation, duration of symptoms more than 18 months prior to surgery, preoperative bowel or bladder dysfunction, and lower-extremity dysfunction were found to be associated with poorer surgical outcome. Even when these conditions were present, gait improvement was noted in at least 70% of the patients.
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Journal of neurosurgery · Dec 1996
Subtemporal transparahippocampal amygdalohippocampectomy for surgical treatment of mesial temporal lobe epilepsy. Technical note.
Amygdalohippocampectomy (AH) is an accepted surgical option for treatment of medically refractory mesial temporal lobe epilepsy. Operative approaches to the amygdala and hippocampus that previously have been reported include: the sylvian fissure, the superior temporal sulcus, the middle temporal gyrus, and the fusiform gyrus. ⋯ Because transparahippocampal AH avoids injury to the fusiform gyrus and the lateral temporal lobe, it can be performed without intracarotid sodium amobarbital testing of language dominance and language mapping. Thus the operation would be particularly suitable for pediatric patients in whom intraoperative language mapping before resection is difficult.
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Journal of neurosurgery · Dec 1996
Warning leak and management outcome in aneurysmal subarachnoid hemorrhage.
The impact of warning leaks on management results in patients with aneurysmal subarachnoid hemorrhage (SAH) was evaluated in this prospective study. In a consecutive series of 422 patients with aneurysmal SAH, 84 patients (19.9%) had an episode suggesting a warning leak; 34 (40.5%) of these patients were seen by a physician without the condition being recognized. The warning leak occurred less than 2 weeks before a major SAH in 75% of the patients. ⋯ The difference in outcome also reflects the potential improvement in outcome that can be achieved by a correct diagnosis of the warning leak. If the correct diagnosis is made in patients seeking medical attention due to a warning leak, favorable outcomes in the overall management of aneurysmal SAH are estimated to increase by 2.8%. An active diagnostic attitude toward patients experiencing a sudden and severe headache is warranted as it offers a means of improving overall outcome in patients with SAH.