Journal of neurosurgery
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Journal of neurosurgery · Apr 1995
Treatment of occipital neuralgia by partial posterior rhizotomy at C1-3.
To minimize the sensory loss associated with intradural posterior rhizotomy for medically refractory occipital neuralgia, partial sectioning of the upper cervical posterior rootlets was performed in 11 patients. The ventrolateral aspect of each posterior rootlet from C-1 to the upper portion of C-3 was divided at the root entry zone. In three patients with bilateral neuralgia, the procedure was performed on both sides, for a total of 14 partial rhizotomy procedures in the 11 patients. ⋯ The other four procedures alleviated pain in the territory of the greater occipital nerve, but the results were marred by persistent periorbital or temporal pain. Two patients subsequently underwent complete C1-3 posterior rhizotomy without further improvement. Although partial posterior rhizotomy at C1-3 did not always relieve pain in the periorbital and temporal regions, this procedure did provide consistent long-term relief of severe occipital pain with minimal risk of postoperative vertigo, scalp anesthesia, or deafferentation syndrome.
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Journal of neurosurgery · Mar 1995
Comparative StudyEffectiveness of controlled release of a cyclophosphamide derivative with polymers against rat gliomas.
Most malignant gliomas grow despite treatment by standard chemotherapeutic agents. The authors explored the use of an innovative drug, 4-hydroperoxycyclophosphamide (4HC), delivered via a controlled-release biodegradable polymer to determine whether local delivery would enhance efficacy. This drug is an alkylator-type chemotherapeutic agent derived from cyclophosphamide. ⋯ Long-term survival for more than 80 days was 40% in the 4HC-treated rats versus 30% in the BCNU-treated rats. The polymer carrier used in this study was a copolyanhydride of dimer erucic acid and sebacic acid 1:1, which was able to maintain the hydrolytically unstable 4HC in a stable state for local delivery. Thus, it is concluded that 4HC-impregnated polymers provide an effective and safe local treatment for rat glioma.
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Journal of neurosurgery · Feb 1995
Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulas.
To establish if interruption of the intradural draining spinal vein or surgical excision are curative treatments for spinal dural arteriovenous fistulas (AVFs), the medical records and radiographic studies of 19 patients with spinal dural AVFs and progressive myelopathy were reviewed. Spinal arteriograms were obtained before and within 2 weeks after surgery in 19 patients, and after a delay of 4 months or more in 11 patients. The mean clinical and arteriographic follow up was at 37 and 35 months, respectively. ⋯ In patients in whom a common vessel supplies the spinal cord and the dural AVF, simple surgical interruption of the vein draining the AVF is the treatment of choice, as it provides lasting obliteration of the fistula and it is the only treatment that does not risk arterial occlusion and cord infarction. Simple interruption of the venous drainage of a spinal dural AVF provides lasting occlusion of the fistula, as it does for cranial dural AVFs, if all pathways of venous drainage are interrupted. This result provides further evidence that the venous approach to the treatment of dural AVFs can be used successfully.
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Journal of neurosurgery · Jan 1995
Coagulopathy with the use of hetastarch in the treatment of vasospasm.
The use of colloid agents to achieve hypervolemia in the prevention and treatment of postsubarachnoid hemorrhage (post-SAH) vasospasm is included in the standard of care at many institutions. Risk profiles are necessary to ensure appropriate use of these agents. In a series of 85 patients with recent aneurysmal SAH, 26 developed clinical symptoms of vasospasm. ⋯ Hetastarch increased partial thromboplastin time from a mean of 23.9 seconds to a mean of 33.1 seconds (p < 0.001) in all patients who received infusions of this agent, while no effect was noted in the 12 patients who received PPF infusions. No other coagulation parameters were altered. This study shows an increase in coagulopathy with the use of hetastarch as compared with the use of PPF for the treatment of postaneurysmal vasospasm.
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Twenty-five patients suffering from intractable pain due to a chronic spinal cord lesion underwent a percutaneous test of spinal cord stimulation. At the end of the test period, 40.9% of the patients reported a mean of 65% pain relief and these patients were selected for ongoing stimulation. ⋯ Pain relief rates were analyzed in relation to quality of pain, neurological status, level and extent of the lesion, and electrode level to identify prognostic factors that could improve the clinical usefulness of spinal cord stimulation. Patients experiencing painful spasms or a constrictive type of pain and with incomplete thoracic lesions were found to be the best candidates for spinal cord stimulation.