Neurosurgery
-
Long-term evaluation of patients with aneurysms of the internal carotid artery (ICA) treated by intravascular balloon occlusion has not been reported. From 1977 to 1992, 58 patients (age 14 to 81 years) with ICA aneurysms were treated at our institution by this technique. The aneurysms included 40 intracavernous carotid, 5 petrous carotid, 3 cervical carotid, and 10 ophthalmic segment aneurysms. ⋯ Mean follow-up was 76 months (range, 6 months to 15 years). Six patients who developed transient ischemia caused by emboli responded to volume expansion and anticoagulation treatment. Two patients developed a delayed infarction, and one patient developed aneurysm enlargement that required surgical clipping and obliteration. (ABSTRACT TRUNCATED AT 250 WORDS)
-
The effect of increased intracranial pressure on the flow velocity of the basilar artery was measured with transcranial ultrasonic Doppler in New Zealand White rabbits under alpha-chloralose anesthesia and artificial respiration. Laser Doppler flowmetry served to study changes of the cortical microcirculation. The results confirm a high inverse correlation of the diastolic flow velocity, the pulsatility index, and the resistance index with the cerebral perfusion pressure (CPP). ⋯ Therefore, transcranial Doppler indices permit the detection of critical reductions of microcirculatory blood flow. The Cushing reaction occurred with a constant time lag of 5.5 +/- 0.7 seconds after the loss of CPP. The Cushing reaction did not establish systolic blood flow, which remained below the functional threshold, as concluded from the temporary loss of somatosensory evoked potentials.
-
Glossopharyngeal neuralgia is an uncommon cause of facial pain with a relative frequency of 0.2 to 1.3% when compared with trigeminal neuralgia. It is characterized by intermittent, lancinating pain involving the posterior tongue and pharynx, often with radiation to deep ear structures. Since its first description in 1910 by Weisenburg, a variety of destructive procedures have been performed to provide relief in patients whose pain was refractory to medical treatment. ⋯ Long-term follow-up (mean, 48 mo; range, 6-170 mo) reveals excellent results (complete or > 95% reduction in pain without any medication) in 76% of the patients and substantial improvement in an additional 16%. There were two deaths at surgery (5%) both occurring early in the series as the result of hemodynamic lability causing intracranial hemorrhage. Three patients (8%) suffered permanent 9th nerve palsy. (ABSTRACT TRUNCATED AT 250 WORDS)
-
Pathological and clinical data from 56 patients operated on for craniopharyngioma since 1981 were analyzed to determine the utility of dividing patients with this tumor into distinct clinical groups based on recognized pathological type and to determine the prognostic import of brain invasion. Of the tumors in the 30 adult patients, 66% were adamantinomatous, 28% were squamous papillary, and the remainder were mixed. However, of the tumors in the 26 children, 96% were adamantinomatous and none were pure squamous papillary (P < 0.01). ⋯ There were no significant differences in Karnofsky performance status score, mortality rate, or visual and endocrine outcomes when comparing patients based on histological tumor type. When controlling for age and extent of resection, we found that brain invasion had no significant effect on recurrence rate in totally resected tumors. Based on the limited number of patients in this series, we conclude as follows. 1) Contrary to previous reports, squamous papillary craniopharyngiomas, like adamantinomatous tumors, may recur when subtotally resected. 2) For both tumor variants, the most significant factor associated with craniopharyngioma recurrence is the extent of surgical resection rather than histopathological subtype. 3) Contrary to prior hypotheses, brain invasion in totally resected tumors does not predict higher recurrence. 4) GTR is associated with a significantly lower recurrence rate and can be achieved without sacrificing functional outcome.