Neurosurgery
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Review Case Reports
Ruptured occult arteriovenous malformation associated with an unruptured intracranial aneurysm: report of three cases.
Three patients who were admitted for intracranial hemorrhage are reported. Cerebral angiography demonstrated an aneurysm arising from the middle cerebral artery bifurcation. No other malformation was visible either on the computed tomographic scan or on angiography. ⋯ Evacuation of the hematoma and thorough exploration of the cavity led to the discovery and resection of a small vascular anomaly typical of an arteriovenous malformation responsible for the hemorrhage. Occult vascular malformations and the association of aneurysm with arteriovenous malformations are discussed. In these 3 patients, the coexistence of these two malformations could be related to a common congenital abnormality.
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Spinal cord astrocytomas are rare lesions, usually of low grade, with a long natural history. Because of this, it is difficult to define the optimum approach to therapy based on available data. To provide more data, a retrospective review was performed. ⋯ Of the 15 irradiated patients, 7 experienced recurrence of the tumor, which occurred within the irradiated portion of the spinal cord in all 7. Gross total resections were rarely achieved and, also, the extent of resection did not influence the risk for recurrence. In summary, we observed a long natural history for this disease, and although additional local therapy appears needed, it is unclear that either higher doses of radiation or more extensive surgery will decrease the risk of recurrence.
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Review Case Reports
Meningeal hemangiopericytoma of the posterior fossa and thoracic spinal epidural space: case report.
The rare combination of spinal and intracranial meningeal hemangiopericytomas in the same patient is reported. The coexistence of cerebral and spinal meningiomas of all histological subtypes is distinctly uncommon with only nine cases found in the literature.
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Randomized Controlled Trial Clinical Trial
Therapeutic trial of cerebral vasospasm with the serine protease inhibitor, FUT-175, administered in the acute stage after subarachnoid hemorrhage.
The therapeutic effect of the synthetic serine protease inhibitor, FUT-175, on cerebral vasospasm after subarachnoid hemorrhage (SAH) was investigated. Twenty-three patients with severe SAH who were admitted between February and July 1990 and who underwent surgery within 48 hours of the initial aneurysmal rupture were treated with an intravenous administration of FUT-175 soon after the operation. The patients were divided randomly into three groups, each receiving a different dose of FUT-175 (Group A, 20 mg every 12 hours for 4 days; Group B, 20 mg every 6 hours for 4 days, Group C, 40 mg every 6 hours for 4 days). ⋯ The incidence of a delayed ischemic neurological deficit significantly decreased from 55% in the control group to 13% in all patients treated with FUT-175 and to 7% in the patients treated with higher doses (P less than 0.05). The incidence of cerebral infarction resulting from vasospasm significantly decreased from 43% in the control group to 9% in patients treated with FUT-175. In the patients treated with higher doses of FUT-175 (Groups B and C), none developed cerebral infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
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Between January 1, 1970, and December 31, 1988, 179 children (birth to age 16) were treated for spinal cord and/or vertebral column injury by the Neurosurgical Service at the University of Iowa Hospitals and Clinics. Pediatric injuries accounted for 9% of all spinal trauma seen during this period. The mean age was 10.2 years. ⋯ Most injuries can be successfully managed with nonoperative therapy. Prognosis is primarily correlated with the severity of the initial neurological insult. Finally, children with severe spinal cord injury must have close, long-term follow-up to monitor the development of posttraumatic spinal deformity.