Journal of neurosurgery
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Journal of neurosurgery · Apr 1984
ReviewSome inquiries in neuroanesthesia and neurological supportive care.
Complications of performing neurosurgery in the sitting position have been well defined, and include cardiac and respiratory effects, air embolism, and pneumocephalus. Prophylactic measures and early diagnosis allow prompt therapy with minimal residual sequelae. ⋯ Patients with cerebrovascular disorders frequently have multisystem disease, and careful preanesthetic assessment and preparation ensure a more stable intraoperative and postoperative course. Many chemical and mechanical reactions follow an ischemic hypoxic insult, but appropriate therapeutic intervention and early establishment of cardiorespiratory support measures have shown promise in improving the neurological outcome in these patients.
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The spinal canals of 11 patients with various pathological conditions, both benign and malignant, were examined intraoperatively using real-time ultrasonography. The spinal cords in eight of these patients with lesions causing cord compression were seen to oscillate rhythmically over each mass with a frequency corresponding to the patient's arterial pulsations. ⋯ Spinal cord motion, as described, has important implications for neurosurgery, since it contradicts the previously held belief that oscillations of the spinal cord or dura mater imply a "free" or noncompressed spinal cord. Furthermore, spinal cord motion may play a role in the degradation of computerized tomography images of the cord, since these movements are maximized at the areas with the most severe pathology.
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The microsurgical anatomy of the tentorial incisura was evaluated in 25 adult cadavers using X 3 to X 40 magnification. The area surrounding the incisura is divided into the anterior, middle, and posterior incisural spaces. ⋯ The arterial relationships in the anterior incisural space and the venous relationships in the posterior incisural space are extremely complex, since the anterior incisural space contains all the components of the circle of Willis and the bifurcation of the internal carotid and basilar arteries, and the posterior incisural space contains the convergence of the internal cerebral and basal veins and many of their tributaries on the vein of Galen. The discussion reviews tentorial herniation and operative approaches to the incisura.
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Journal of neurosurgery · Feb 1984
Significance of contrast enhancement in cranial computerized tomography after subarachnoid hemorrhage.
Eighty patients with subarachnoid hemorrhage underwent computerized tomography (CT) scanning before and after administration of Conray contrast medium. Abnormal enhancement was seen in visual evaluation of the CT scans in 26 cases, in the regions bordering the subarachnoid spaces. ⋯ Measurements of absorption values in the thalamus revealed significant increases in density after contrast enhancement in those patients whose scans showed abnormal enhancement in the regions bordering the subarachnoid spaces on visual evaluation. The authors suggest that the abnormal enhancement is parenchymal, in the gyri, and is not "subarachnoid." They suggest that it is due to gyral hyperemia or extravasation of contrast material into the cortex resulting from breakdown of the blood-brain barrier, or a combination of both factors.