Neurosurgery
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We report a case of the complete resection of a parasagittal meningioma, including an 8-cm length of the superior sagittal sinus and adjacent dura. Flow through the sagittal sinus was reestablished through an interposed saphenous vein graft. ⋯ Follow-up magnetic resonance angiography 9 months after surgery demonstrated continued patency of the graft. Sagittal sinus replacement with a vein graft can be safely performed during Simpson Grade I resection of parasagittal meningiomas.
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Symptomatic pineal cysts are rare and typically managed with an open surgical approach. We report the successful treatment of a symptomatic pineal cyst using a stereotactic endoscopic technique.
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INTRAOPERATIVE MONITORING OF motor evoked potentials (MEPs) may become a valuable test of spinal cord function during surgery. Unfortunately, MEP responses are affected by most common anesthetics. We studied the effect of intravenous propofol on transcranial magnetic MEPs (tcMMEPs) in the rat. ⋯ Infusion tcMMEPs displayed increased onset latencies but demonstrated a significant change in amplitudes only after the largest infusion dose. The MEPs approached baseline levels after discontinuation of the propofol. This study demonstrates that tcMMEPs can be successfully recorded from the rat during propofol anesthesia.
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Case Reports
Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding.
The major causes of mortality and morbidity in patients surviving the rupture of a saccular aneurysm are subsequent bleeding and vasospasm. The purpose of this study was to evaluate the influence of early treatment of ruptured aneurysms with Guglielmi detachable coils on the incidence of subsequent bleeding. Thirteen patients were treated within 72 hours of initial aneurysm rupture with Guglielmi detachable coils. ⋯ In addition to reducing the risk of subsequent bleeding, early treatment facilitated the institution of an aggressive approach for management of both vasospasm and increased intracranial pressure. Patient outcome, as measured by the Glasgow Outcome Scale, was good in 9 of 13 (69%), poor in 1 of 13 (8%), and death in 3 of 13 (23%) patients. The results of this study suggest that early Guglielmi detachable coil treatment of ruptured aneurysms may be effective in reducing the incidence of subsequent bleeding and can be performed with a low incidence of complications.(ABSTRACT TRUNCATED AT 250 WORDS)