Neurosurgery
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Ependymomas are the most common intramedullary tumor of the spinal cord. They are most common at the region of the cauda equina, accounting for up to 90% of primary tumors in that area. Extraspinal ependymomas are rare. We describe a case of an ependymoma arising in a spinal peripheral nerve root.
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Comparative Study
Changes in human intracerebral temperature in response to different methods of brain cooling.
The rectal, epidural, and intraventricular temperatures were continuously monitored in 10 seriously injured and unconscious patients admitted for neurosurgical intensive care. Different attempts were made to lower their brain temperatures. Isolated head cooling, whether with frozen liquid (Hypotherm Gel Kap; Flexoversal, Hilden, Germany) or a cooling helmet, had very limited effect. ⋯ During barbiturate coma, a considerable increase in brain temperature was observed. The administration of paracetamol was the single most effective method by which to lower brain temperature, at times by 2 degrees C and usually with a concomitant decrease in the temperature gradient between the rectum and the brain. However, in order to achieve a lasting reduction of brain temperature to 35 degrees C, we had to use a combination of head cooling and intensive whole-body cooling.
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We report five patients with intracranial vertebrobasilar dissecting aneurysms, all of whom had ischemic symptoms. Angiographically, four of the five cases revealed distention and elongation of the vertebrobasilar artery like dolichoectasia and one irregular stenosis, the so-called "string sign". ⋯ We also present a successful demonstration of slow flow in the false lumen by gradient refocused magnetic resonance imaging scan with partial flip angle by the cardiac gating method. It is suggested that many of the classical "dolichoectasia" may include dissecting lesions.
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Comparative Study
Dose changes in long- and medium-term intrathecal morphine therapy of cancer pain.
Intrathecal morphine analgesia for the treatment of cancer pain was administered using implanted ports and drug delivery systems (DDS) in 79 patients. Effective control of the pain was achieved in nearly all patients; in only two patients was the use of the DDS discarded because of relative ineffectiveness. Fifty-three manual drug release systems (41 lumbar, 12 ventricular) and 26 lumbar ports were used. ⋯ Three patients with less than 2 months' survival time had a rather continuous increase. All long-time survivors (i.e., with more than 2 months' survival time) reached a plateau and remained there until a preterminal if any increase occurred. These findings suggest the morphine dosage to be indicative of the progress of the disease rather than of a drug tolerance.(ABSTRACT TRUNCATED AT 250 WORDS)
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This investigation tested the hypothesis that the degree of impairment to memory function caused by an anterior temporal lobectomy (ATL) is inversely related to the pathological status of the resected hippocampus. Specifically, the greatest risk to postoperative memory function should be to patients with no or minimal hippocampal sclerosis, i.e., those with a functional hippocampus. Forty patients who underwent a partial resection of the left (n = 21) or right (n = 19) anterior temporal lobe were administered tests of immediate and delayed verbal and figural memory, both preoperatively and 6 months postoperatively. ⋯ No statistically significant relationship was noted for patients who underwent a right ATL, but the findings were in the same direction for five of six memory measures. It may be possible to predict and avoid surgically induced impairment of memory function among patients who undergo left ATL through the use of preoperative hippocampal volumetric magnetic resonance imaging. Better clinical tests of right hippocampal function are needed to predict the outcome for patients who undergo a right ATL.