Journal of neurosurgery
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Journal of neurosurgery · Nov 1982
Case ReportsSurgical treatment of post-lumbar puncture dural CSF leak causing chronic headache. Case report.
A 58-year-old woman experienced incapacitating headache and occipital paresthesiae for 5 years after lumbar myelography. Conservative methods of treatment failed. ⋯ Repair of the dural defect with dorsolumbar fascia resulted in almost complete alleviation of symptoms. This case is unusual because of the radiographic technique used, the duration of symptoms, and the rarity of reports of successful surgical treatment for this serious complication of lumbar puncture.
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Journal of neurosurgery · Oct 1982
Surgical control of chronic migrainous neuralgia by trigeminal ganglio-rhizolysis.
Chronic migrainous neuralgia is not diagnosed as often as the periodic or "cluster" form of Horton's syndrome. The distinguishing features of chronic migrainous neuralgia, compared with the periodic variety, are the frequency and persistence of the attacks of hemicraniofacial pain and the intractability to medical management. Eight male patients ranging in age from 22 to 45 years received prompt, although transient, pain relief by blockade of the Gasserian ganglion on the side of their hemifacial pain with a local anesthetic. ⋯ There were no significant complications from this procedure. Review of the literature indicated that other ablative neurosurgical procedures, such as alcohol injection of the Gasserian ganglion and trigeminal rhizotomy by the subtemporal craniectomy approach, have relieved migrainous neuralgia, but with a greater risk and incidence of complications. The characteristic clinical features of migrainous neuralgia and the medical and surgical approaches to therapy are discussed.
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Using a CO2 laser, discrete thoracic spinal cord lesions were made in cats anesthetized with ketamine and xylazine (Rompun). Differences in cortical somatosensory evoked potentials (SEP's) produced with high-intensity stimulation (20 times the motor threshold) of each posterior tibial nerve determined for nine different combinations of unilateral spinal cord lesions. The results of these studies show that nerve fibers in the ipsilateral dorsal column, the ipsilateral dorsal spinocerebellar tract, and the contralateral ventrolateral tracts with respect to the side of leg stimulation, contribute to cortical SEP's. ⋯ The effects of various combinations of lesions on the cortical SEP's were not additive, which indicates significant interaction between afferent pathways. These findings suggest that high-intensity peripheral nerve stimulation, which activates both C and A fibers, could be used intraoperatively to assess spinal cord function with more accuracy than the current practice of using a stimulus strength of twice the motor threshold. The importance of using anesthetic agents that do not depress cortical activity (which may affect the later components of the SEP) is also emphasized.
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Journal of neurosurgery · Oct 1982
Incidence of spinal column deformity after multilevel laminectomy in children and adults.
Fifty-eight patients, all less than 25 years of age, underwent multilevel laminectomy for conditions that in themselves do not usually cause spinal deformity. Spinal deformity developed in 46% (12 of 26) of the patients who were less than 15 years of age, but in only 6% (two of 32) of the patients aged 15 to 24 years. Spinal deformity developed in all (100%) patients who had cervical laminectomy, in 36% of those who had thoracic laminectomy, and in none (0%) of those who had lumbar laminectomy. There was no correlation between the occurrence of deformity and sex, number of laminae removed, neurological conditions after laminectomy, or length of time after surgery.