Journal of neurosurgery
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Journal of neurosurgery · Jan 1995
Case ReportsTreatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation. Case report.
The author presents the case of a patient with a ruptured vertebral artery dissecting aneurysm in which the posterior inferior cerebellar artery (PICA) arose from the wall of the aneurysm. The aneurysm was treated by trapping and the PICA was anastomosed to the vertebral artery proximal to the dissection. This technique allows intraoperative obliteration of the aneurysm while maintaining normal blood flow to the PICA.
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Journal of neurosurgery · Jan 1995
Case ReportsDorsal root entry zone lesions for intractable pain after trauma to the conus medullaris and cauda equina.
This review was undertaken to determine the efficacy of using dorsal root entry zone (DREZ) lesions to treat intractable pain caused by trauma to the conus medullaris and cauda equina. Traumatic lesions of this area are unique in that both the spinal cord and the peripheral nerve roots are injured. Although DREZ lesions have been shown to relieve pain of spinal cord origin in many patients, they have been shown not to relieve pain of peripheral nerve origin. ⋯ Operative complications included weakness (four patients), bladder or sexual dysfunction (three), cerebrospinal fluid leak (two), and wound infection (two), but overall, 79.5% of patients (31 of 39) were without serious complications. Complications were limited to patients with prior tissue damage at the surgical exploration site and were most prevalent in patients who underwent bilateral DREZ lesions. In conclusion, this preliminary report suggests that DREZ lesions may be useful in combating intractable pain from traumatic injuries to the conus medullaris and cauda equina, with some risk to neurological function that may be acceptable in this group of patients.
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Journal of neurosurgery · Jan 1995
Microvascular anatomy of the anterior surface of the medulla oblongata and olive.
The arterial supply and the microanatomy of the anterior surface of the medulla oblongata and olive were studied in 11 cadaveric specimens, with investigation of the size, course, and length of the arteries. Two distinct anatomical entities divide the vascular supply in this region: 1) the pyramid, which is the anterior surface of the medulla; and 2) the olive, which is adjacent to the lateral aspect of the pyramid. Primary vascularization of the pyramid was via small branches of the anterior spinal artery, a branch of the vertebral artery. ⋯ The authors observed a wide anastomotic net connecting the small arteries in this area. These patterns of microvascular supply of the pyramid and olive may deepen the understanding of clinical and pathological conditions resulting from arterial occlusion. The existence of an anastomotic net may account for the rare incidence of medullary infarction in the olive region.
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Journal of neurosurgery · Dec 1994
Effect of stable xenon inhalation on intracranial pressure during measurement of cerebral blood flow in head injury.
Xenon-enhanced computerized tomography (CT) is well suited for measurements of cerebral blood flow (CBF) in head-injured patients. Previous studies indicated divergent results on whether inhalation of xenon may cause a clinically relevant increase in intracranial pressure (ICP). The authors employed Xe-enhanced CT/CBF measurements to study the effect of 20 minutes of inhalation of 33% xenon in oxygen on ICP, cerebral perfusion pressure (CPP), and arteriovenous oxygen difference (AVDO2) in 13 patients 3 days (mean 1 to 5 days) after severe head injury (Glasgow Coma Scale score < or = 7). ⋯ Individual variations were observed indicating possible individual tolerance, possible influence of type and extent of the cerebral injury, disturbances in cerebrovascular reactivity, and possible influence of medication. These effects of xenon suggest that hyperventilation should be ensured in patients with evidence of reduced compliance or high ICP. On the other hand, inhalation of stable xenon is not believed to pose a risk because no signs of cerebral oligemia or ischemia were indicated in the AVDO2 values.
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Journal of neurosurgery · Dec 1994
Biography Historical ArticleArchival correspondence regarding the origin of the Harvey Cushing Society: the American Association of Neurological Surgeons.
Behind the scenes in the origin of the Harvey Cushing Society, now known as the American Association of Neurological Surgeons, there were many interesting political factors occurring, which appeared in correspondence and were preserved and later forwarded by William P. Van Wagenen to the Harvey Cushing Section of the Yale Medical Library. This correspondence, circa 1931, provides an interesting account of the aspirations of young neurosurgeons who wished to gain societal status, without offending the giants of the Society of Neurological Surgeons.