Journal of neurosurgery
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Journal of neurosurgery · Sep 1982
Case ReportsCombined epidural and peripheral nerve stimulation for relief of pain. Description of technique and preliminary results.
A technique is described that combines percutaneous epidural with peripheral nerve stimulation to provide limited paresthesia to a lower extremity. The peripheral electrode is placed percutaneously and positioned along the course of the anterior division fo the spinal nerve anterolateral to the vertebral bodies. This is accomplished by a modified epidural tap. ⋯ The procedure proved simple; there were no perioperative and only few minor late complications. Results were similar to those from conventional epidural stimulator implantation. It is concluded that combined epidural-peripheral nerve stimulation constitutes a valid therapeutic alternative for patients with unilateral lower extremity pain.
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Journal of neurosurgery · Sep 1982
Case ReportsBenefit from and tolerance to continuous intrathecal infusion of morphine for intractable cancer pain.
A patient with painful bilateral metastatic lumbosacral plexopathy from cervical cancer was treated with levorphanol tartrate (Levo-Dromoran), 4 mg orally every 4 hours, with poor pain relief. A lumbar subarachnoid catheter was then placed percutaneously. A bolus of 1 mg of morphine gave complete pain relief for 17 hours. ⋯ Oral Levo-Dromoran intake averaged 3.4 mg/day. Levo-Dromoran intake was less during the 1st week of each 2-week cycle than the last week (mean 15.0 versus 38.0 mg/wk, p less than 0.05). No sedation or respiratory depression was seen.
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Journal of neurosurgery · Jun 1982
Results and complications of surgical management of 809 intracranial aneurysms in 722 cases. Related and unrelated to grade of patient, type of aneurysm, and timing of surgery.
Data from 722 consecutive causes with intracranial aneurysms were stored in a computer and later retrieved for analysis. Results and complications (including preoperative death and morbidity) of the surgical management of these patients were correlated with the Botterell grade of the patient in individuals with a recent subarachnoid hemorrhage (SAH), with the type of aneurysm, and with the timing of the surgical procedure. Patients with no SAH within 30 days prior to hospital admission were classified as "no SAH." Approximately 30% of all patients had sustained more than one hemorrhage. ⋯ Intraoperative complications were related both to the size of the aneurysm and to its location. Repair of multiple aneurysms did not adversely affect the result. The surgical approach, the importance of using a self-retaining brain retractor, and the technical complications in these cases are discussed.
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Journal of neurosurgery · Jun 1982
Case ReportsResolution of occlusion in spontaneously dissected carotid arteries. Report of two cases.
Two cases of internal carotid artery occlusion secondary to spontaneous dissection are reported. Both patients presented with transient ischemic attacks. both had antiplatelet aggregation therapy, followed by spontaneous resolution of the occlusion. ⋯ In both cases, restoration of flow was angiographically documented 14 days and 10 weeks after the initial arteriogram. Strategies for treatment of such patients are discussed.
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Journal of neurosurgery · May 1982
Randomized Controlled Trial Comparative Study Clinical TrialOsmotic and osmotic-loop diuresis in brain surgery. Effects on plasma and CSF electrolytes and ion excretion.
In 22 patients to be operated on for brain tumors or cerebral aneurysms, the effect of osmotic diuresis was compared with that of osmotic-loop diuresis on plasma and cerebrospinal fluid (CSF) electrolytes, and water and ion excretion. Mannitol or mannitol plus furosemide were used to reduce brain bulk. After treatment with thiopental and hyperventilation, patients received randomly a rapid infusion of mannitol (1.4 gm/kg), or mannitol (1.4 gm/kg) plus furosemide (0.3 mg/kg). ⋯ At peak diuresis after mannitol, Na+ and Cl- excretion average 0.57 and 0.62 mEq/min, respectively. This compares with mean values of 3.7 and 4.12 mEq/min for Na+ and Cl-, respectively, after mannitol plus furosemide. Although optimum brain shrinkage is achieved with osmotic-loop diuresis, the rapid electrolyte depletion (Na+ and Cl-) must be corrected to avoid altered sensorium during the patients' postoperative course.