Neurosurgery
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Although the prognoses of children with medulloblastoma have improved dramatically over the last several decades, the reported survival for very young children with this tumor remains poor. We undertook a retrospective review of patients less than 36 months of age at the time of the diagnosis of a medulloblastoma who were treated at our institution during a 36-year period. ⋯ The presence of a metastatic tumor at the time of diagnosis was identified as a significant indicator of a poor prognosis, and all completely staged patients without metastasis are surviving without a recurrence of disease. This report suggests that the survival of very young children with a medulloblastoma may not be as poor as has been previously reported, particularly if a disseminated tumor is not present at the time of diagnosis.
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Injuries to the cervical spine among athletes present inherent difficulties, especially in advising for return to contact sports. Experience with the acute care of 63 patients who sustained cervical spine injuries while participating in organized sporting events is analyzed. Forty-five patients had permanent injury to the vertebral column and/or spinal cord, while 18 suffered only transient spinal cord symptoms. ⋯ A classification was developed to assist in the management of these patients: Type 1 athletic injuries to the cervical spine are those that cause neurological injury; patients with Type 1 injuries are not allowed to participate in contact, competitive sporting events. Type 2 injuries consist of transient neurological deficits without radiological evidence of abnormalities; these injuries usually do not prohibit further participation in contact sports unless they become repetitive. Type 3 injuries are those that cause radiological abnormality alone; these represent a heterogeneous group.(ABSTRACT TRUNCATED AT 250 WORDS)
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We present the results of intraoperative monitoring of motor evoked potentials from 34 patients undergoing spinal surgery under total anesthesia with intravenously administered propofol. Intraoperative recording was performed with transcranial electrical stimulation. Two groups of patients were studied: 1) a control population of 26 patients undergoing lumbar discectomy for prolapsed intervertebral disc, all of whom had normal preoperative motor conduction; and 2) a population of 8 patients undergoing neurosurgical procedures for spinal tumor (5 patients) and spinal arteriovenous malformation (3 patients), all of whom had abnormal preoperative neurological signs and abnormal preoperative motor conduction. ⋯ Intraoperative monitoring was successful in 87% of the patients in the pathological group. We observed significant changes in both amplitude (greater than 50%) and/or onset latency (greater than 3 ms) from the intraoperative baseline that indicated either improvement (3 patients) or deterioration (2 patients) in motor conduction within minutes of surgical maneuvers anticipated to alter spinal cord function. Only permanent complete loss of intraoperative motor conduction (1 patient) correlated with a significant change in the postoperative neurological state.(ABSTRACT TRUNCATED AT 250 WORDS)
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In this study, we compared the suitability and accuracy of imprints, smears, and frozen sections of suspected brain and spinal cord tumors of 150 patients. Eighty-six percent of the imprints, 91% of the smears, and 99% of the frozen sections were suitable for interpretation. ⋯ Although frozen sections were clearly more accurate than imprints and smears, the latter two provided diagnoses in patients with acquired immunodeficiency syndrome where frozen sections were not done to avoid contaminating our cryostat and in a patient with an epidermoid cyst of the middle fossa that could not be adequately frozen sectioned. Our study shows that imprints and smears complement frozen sections in the intraoperative diagnosis of tumors of the central nervous system.
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The neurology and neurosurgery clinical clerkship experience (excluding lectures and conferences) of the students in U. S. allopathic medical schools during one of the academic years 1986 to 1987 or 1987 to 1988 was surveyed. Almost all schools have at least some students taking these clerkships. ⋯ Furthermore, first clerkships offered in the fourth year, whether they were required, selective, or elective, tended to be longer than the corresponding third-year first clerkships at other schools. Whereas the average length of a first clinical clerkship in neurology is almost as long for schools requiring it (3.4 wk) as for those that offer it as an elective or selective (4.0 wk), required neurosurgical clerkships are much shorter (1.5 wk) than elective or selective rotations (3.1 wk). Schools with residency training programs more frequently required students to a clerkship and, consequently, had greater numbers of students taking a clerkship in the corresponding specialty.(ABSTRACT TRUNCATED AT 250 WORDS)