Journal of neurosurgery
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Journal of neurosurgery · Aug 1981
Case ReportsHydrocephalus and infratentorial tumors. Incidence, clinical picture, and treatment.
One may consider that the child with hydrocephalus complicating a primary brain tumor has two distinctly different diseases: 1) a neoplasm, and 2) hydrocephalus. The hydrocephalus may be obstructive, communicating, or (in the case of choroid plexus papilloma) hypersecretory. This paper presents the incidence, symptomatology, and management of hydrocephalus associated with infratentorial brain tumors in 156 children and with pineal tumors in 21 children, all treated by the first author during the period 1967 to 1979. ⋯ Eighteen of these children required shunt revisions after craniotomy; 36 of 80 patients followed for 6 months or more had their shunts permanently removed, but it was necessary to reinsert the shunt from 5 days to 13 months later in 30% of these patients. Only 25 patients remained permanently shunt-free. It is considered that the placement of shunts before craniotomy is justified by the extraordinarily high incidence of papilledema and visual impairment associated with hydrocephalus. "Upward herniation" and dissemination of neoplastic cells through the shunting system are theoretical contraindications to precraniotomy shunt insertion, although the former is rare (3%), and there is no statistical evidence to support the latter.
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Journal of neurosurgery · Jun 1981
Case ReportsPharmacokinetics of epsilon-aminocaproic acid during peritoneal dialysis.
Two patients requiring peritoneal dialysis were treated with epsilon-aminocaproic acid (EACA), an antifibrinolytic agent. Samples of serum and dialysate were assayed for EACA concentrations. ⋯ Our results suggest that patients undergoing peritoneal dialysis should receive 25% of the usual recommended dose of EACA. Dialysis clearance accounted for only 58% of total body clearance, suggesting an alternative route of elimination of EACA.
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Journal of neurosurgery · Apr 1981
Biography Historical ArticleCushing's legacy to transsphenoidal surgery.
Cushing's experience with the surgical treatment of pituitary adenomas and other lesions producing the chiasmal syndrome is reviewed. The conclusion is that his ultimate rejection of the transsphenoidal route was not due to his dissatisfaction with this procedure, but rather came about because of the transfrontal route provided him with access to the pituitary and, at the same time, enabled him to verify all suprasellar tumors if the preoperative diagnosis was uncertain. Until he gave it up in 1929, Cushing used the transsphenoidal route preferentially when the sella was large. Some of his assistants in the clinic, notably Norman Dott, came away with a high and lasting regard for the operation, and Dott's subsequent influence on Gérard Guiot is a crucial link in the return of transsphenoidal surgery to its current preeminent position.
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Journal of neurosurgery · Mar 1981
Case ReportsIntratumoral hemorrhage in posterior fossa tumors after ventricular drainage. Report of two cases.
Severe intratumoral hemorrhage in posterior fossa tumors is reported in two children, one with a Grade I astrocytoma, and the other with a medulloblastoma. Fatal bleeding occurred a few hours after insertion of ventricular drainage for preoperative management of obstructive hydrocephalus.