Journal of neurosurgery
-
Journal of neurosurgery · Apr 1996
Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension.
Spinal cerebrospinal fluid (CSF) leaks are often implicated as the cause of the syndrome of spontaneous intracranial hypotension, but they have rarely been demonstrated radiographically or surgically. The authors reviewed their experience with documented cases of spinal CSF leaks of spontaneous onset in 11 patients including their surgical observations in four of the patients. The mean age of the six women and five men included in the study was 38 years (range 22-51 years). ⋯ The radiographic study of choice is CT myelography. The disease is usually self-limiting, but in selected cases our experience with surgical ligation of leaking meningeal diverticula has been satisfactory. An underlying connective tissue disorder may be present in some patients with a spontaneous spinal CSF leak.
-
Journal of neurosurgery · Apr 1996
Case ReportsLongitudinal atlantoaxial dislocation with type III odontoid fracture. Case report and review of the literature.
Odontoid fractures are a common traumatic upper cervical spine injury. Treatment of Type III odontoid fractures includes skeletal traction for realignment and halo vest immobilization. ⋯ Radiographic findings were identified that were suggestive of extensive ligamentous disruption. Recommendations for individualized patient management are given in the context of related literature.
-
Journal of neurosurgery · Mar 1996
Incidence of seizures after surgery for supratentorial meningiomas: a modern analysis.
The authors have assessed the incidence of postoperative seizures in 158 patients with supratentorial meningiomas diagnosed by computerized tomography (CT) and/or magnetic resonance (MR) imaging, which theoretically should lead to early diagnosis and treatment and the potential for improved seizure outcome. Univariate chi-square and logistic regression analyses were performed 24 independent variables against the outcome variable of occurrence of a postoperative seizure. The median duration of preoperative seizures was 1 month, considerably shorter than that found in studies conducted prior to the advent of CT and MR imaging. ⋯ These variables were incorporated into a diagnostic model designed to predict the risk of a postoperative seizure following meningioma surgery. On the basis of their findings, the authors conclude that earlier detection and treatment of supratentorial meningiomas improve seizure outcome in patients with preoperative epilepsy. Furthermore an assessment of the risk of postoperative seizures may help guide decisions concerning weaning patients from anticonvulsant medications postoperatively.
-
Journal of neurosurgery · Mar 1996
Case Reports Clinical TrialMultiple burr-hole operation for adult moyamoya disease.
Excellent results from multiple burr-hole operations for adult moyamoya disease are reported in this study. Ten patients had between one and four burr holes (mean 2.1) drilled in each hemisphere. In four patients new burr holes were added on the opposite side after depression of cerebral blood flow (CBF) was detected by follow-up single-photon emission computerized tomography imaging of the brain with N-isopropyl-p-[123I]iodoamphetamine. ⋯ Transient ischemic attacks disappeared in all six patients presenting with this symptom, and preoperative symptoms improved in both of the patients who presented with cerebral infarction and in both patients with intraventricular hemorrhage. There was no mortality or morbidity, and no new neurological deficits or rebleeding developed during the follow-up period. The authors strongly recommend the multiple burr- hole operation as the surgical treatment of choice for adult moyamoya disease because of its safety and effectiveness.
-
Journal of neurosurgery · Mar 1996
Clinical TrialMeningiomas of the tentorial notch: surgical anatomy and management.
Twenty-five meningiomas located at the tentorial notch were surgically treated between 1978 and 1993 at the Neurosurgical Department of Nordstadt Hospital in Hannover, Germany. Nineteen meningiomas were classified as originating from the lateral tentorial incisura (Group I) and six were from the posteromedial tentorial incisura (Group II). Clinically, the most common symptom was trigeminal neuralgia, followed by headache. ⋯ Follow up revealed that 80% of patients were able to return to their premorbid activity. Surgical approaches to the tentorial notch included the suboccipital retrosigmoidal or the combined subtemporal-presigmoidal approach for Group I tentorial notch meningiomas; and the supracerebellar-infratentorial or the suboccipital-transtentorial approaches for Group II meningiomas. Because the best surgical approach to the tentorial incisura is still a matter of debate, the anatomy of the tentorial incisura, the clinical presentation of the patients, diagnostic indications, surgical findings, and follow up are discussed, with reference to the literature.