Neurosurgery
-
The clinical and computed tomographic (CT) findings in a series of 161 consecutive patients operated upon for postraumatic extradural hematoma are analyzed. Thirteen (8%) patients had delayed epidural hematoma formation. The overall mortality for the series was 12%, significantly lower than that observed during the prior "angiographic" period at the same unit (30%). ⋯ There were no significant differences between these groups in age, sex, mechanism of injury, preoperative course of consciousness (lucid interval or not), or epidural hematoma location and shape. In contrast, significant differences were seen between the two subgroups in trauma-to-operation interval, hematoma volume, CT hematoma density (mixed low-high CT density vs. homogeneous hyperdensity), midline displacement, severity of associated intracranial lesions, and postoperative intracranial pressure (ICP). Patients comatose at operation usually evidenced a more rapid clinical deterioration (a shorter trauma-to-operation interval) and tended to have a large hematoma volume, a higher incidence of mixed CT density clot (hyperacute bleeding), more marked shift of midline structures, more severe associated lesions, and higher postoperative ICP levels.
-
Case Reports
Pyriformis syndrome in a 10-year-old boy as a complication of operation with the patient in the sitting position.
We present a case of sciatic neuropathy due to the pyriformis syndrome after operation in the sitting position. Neither sciatic nerve injury nor the pyriformis syndrome has been reported after operation in the sitting position, although a low incidence of common peroneal nerve injury has been reported as a complication of operation on patients who are in the sitting position. ⋯ The syndrome may occur because of extreme flexion of the hips and prolonged pressure while in the sitting position, leading to pyriformis muscle trauma, resultant spasm, and sciatic compression. The prognosis is for complete recovery after symptomatic treatment with nonsteroidal antiinflammatory medication and physical therapy.
-
Malignant hyperthermia is a seemingly rare genetic myopathy. Hypermetabolic crisis accompanied by a rise in body temperature to as high as 44 degrees C is its hallmark. Malignant hyperthermia is usually triggered by potent inhaled anesthetics or depolarizing muscle relaxants. ⋯ The contracture study was positive in all patients. No anesthetic or surgical complication was encountered. This study demonstrates that neurosurgical procedures can be performed safely in patients at risk of developing malignant hyperthermia while they undergo appropriately selected general anesthesia.
-
Biography Historical Article
The American centennial of brain tumor surgery.
Early in 1887 the first well-documented total removal of an unequivocal brain tumor in America was carried out in New York City by Robert F. Weir. The patient died during the immediate postoperative period. ⋯ In 1886, a Dr. Morse in California had probably performed a partial removal of a glioma from a patient who died shortly after the operation. To celebrate the centennial of Keen's triumph, it is worthwhile as well to contemplate the efforts of his contemporaries.
-
Multiple thoracic disc herniation is rare, and one of the main problems in its treatment has been the lack of accuracy in diagnostic tests. Now, with the advent of computed tomographic scanning with metrizamide in the subarachnoid space, the accuracy has been greatly improved. ⋯ Computed tomographic metrizamide myelography clearly showed anterior compression of the spinal cord due to disc herniation at T5-T6, T6-T7, T7-T8, T8-T9, and T9-T10. Removal of the herniated discs was followed by interbody fusion using autogenous bone grafts, and excellent results were obtained.