Neurosurgery
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Considerable evidence indicates that brain temperature during ischemia affects the extent and distribution of ischemic injury. However, only limited data have been presented concerning the influence of temperature on ischemic damage after reversible focal cerebral ischemia. Because focal ischemic events of this type resemble conditions observed in the clinic, studies were undertaken to examine the effects of mild and moderate hypothermia on the extent of cerebral infarction after focal neocortical ischemia. ⋯ The following groups with different intraischemic temporal muscle temperatures were analyzed: 1) control, 35.8 to 36.2 degrees C; 2) mild hypothermia, 33.0 to 33.5 degrees C; and 3) moderate hypothermia, 27.5 to 29.2 degrees C. The volumes of infarction were 214.5 +/- 17.9, 166.5 +/- 6.8, and 108.2 +/- 5.9 mm3 (mean +/- SEM) for the control, mild hypothermia, and moderate hypothermia groups, respectively. These findings demonstrate that both mild and moderate hypothermia reduce the impact of temporary focal ischemia in Sprague-Dawley rats.
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Thirty-one patients with moyamoya disease, who had been treated for encephaloduroarteriosynangiosis (EDAS), encephalomyosynangiosis (EMS) or EMS with encephaloarteriosynangiosis (EAS) in other hospitals, were admitted to Osaka Neurological Institute from January 1985 to September 1991. Twenty-seven of 57 sides treated by indirect anastomosis showed good filling of the middle cerebral artery (MCA) territory via the anastomosis, whereas 16 and 14 showed fair and poor collaterals via the anastomosis, respectively. ⋯ Clinical improvement after superficial temporal artery-MCA anastomosis with or without EMS was noted in all patients, except on one side, where a completed stroke had resulted in fixed neurological deficits. We do not know the reasons for the uncertainty of the development of collaterals via the indirect anastomosis, but there are many patients who still need direct reconstruction of the indirect anastomosis.
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Magerl's technique of combining C1-C2 posterior screw fixation with a supplemental bone-wire fusion has been advocated for the management of atlanto-axial instability. Between October 1990 and August 1992, a modification of this technique was used in the treatment of 22 patients with this disorder. In the absence of spinal deformity or neoplastic disease, screw fixation and bony fusion were used alone without associated wiring, thus avoiding the risk of neural injury resulting from the sublaminar passage of wire and the retrodisplacement of ventral structures. ⋯ The one intraoperative complication was an inability to achieve secure screw purchase on one side that required unilateral screw placement with a Gallie fusion-using cable. Postoperative complications included one patient with a superficial wound infection that resolved after local debridement and antibiotics and suboccipital numbness in two patients. Progression of spinal deformity, screw pullout or breakage, and neurological or vascular complications did not occur.(ABSTRACT TRUNCATED AT 250 WORDS)