Neurosurgery
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The effect of a 2 g/kg intravenous bolus of mannitol on intracranial pressure (ICP) and white matter water content was determined by following the time course of ICP and spatial white matter water content after administration of mannitol in a hemispheric cold lesion model of vasogenic edema in the cat. After mannitol infusion, maximal ICP reduction occurred at approximately 20 minutes and began to return to baseline after 26 minutes. ⋯ White matter water content in the lesioned hemisphere was not changed significantly after mannitol infusion. We conclude that the rapid reduction of ICP after intravenous administration of mannitol is not solely due to the dehydration of white matter.
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The author has designed a simple and inexpensive cylindrical stereotactic retractor that is compatible with the Leksell stereotactic system. The device allows the stereotactic localization and open resection of appropriate intracranial lesions through a 3-cm craniotomy, using standard microsurgical techniques and a completely sterile field. The device and its use are described.
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We evaluated the treatment outcome of 17 patients with anaplastic oligodendroglioma and 17 patients with anaplastic mixed oligodendroglioma-astrocytoma. In the anaplastic oligodendroglioma group, eight patients were treated at the time of the initial admission with radiotherapy and adjuvant chemotherapy, and nine patients were treated at the time of recurrence with salvage chemotherapy. Three patients for whom adjuvant chemotherapy was not successful were also treated with chemotherapy at the time of recurrence. ⋯ The initial treatment resulted in two complete responses, three partial responses, and seven stable disease (response and stable disease, 100%), with most responses lasting longer than 12 months. The treatment of the patients with recurrent disease resulted in one partial response and five stable disease (response and stable disease, 100%), with a median time to progression of 6 months. These results suggest that aggressive treatment is beneficial for recurrent anaplastic oligodendrogliomas and mixed gliomas as well as initial mixed gliomas but may offer only minimal advantage over conventional radiotherapy for the initial treatment of anaplastic oligodendrogliomas.