British journal of neurosurgery
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Stereotactic techniques are commonly used to place intracerebral depth electrodes. We placed 15 depth electrodes (9R, 6L) freehand, orthogonally into temporal lobes in 12 patients undergoing monitoring with subdural strip electrodes in the evaluation of their intractable epilepsy. Coronal MRI was performed with the electrodes in place. ⋯ Ictal onset was mesial temporal in 11 patients and frontal in one. Temporal onset was detectable in the depth electrode in each case, usually simultaneously with the onset in the subdural electrode although often the discharge was better developed in the depth electrode. We conclude that freehand placement of depth electrodes orthogonally into the temporal lobe can achieve a degree of accuracy sufficient to localize seizure onset in the mesial temporal lobe.
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Biography Historical Article
Wylie McKissock--reminiscences of a commanding figure in British neurosurgery.
Wylie McKissock founded the neurosurgical unit at Atkinson Morley's Hospital which has grown to become the largest neurosurgical unit serving London. He trained a large number of British and overseas neurosurgeons, six of whom achieved presidency of the Society of British Neurological Surgeons. McKissock made a great contribution to the development of British neurosurgery, and reminiscences from some of his trainees and colleagues are collected together in this article.
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A prospective study was undertaken to establish the normal spectrum of early gadolinium-enhanced magnetic resonance (MR) imaging findings in patients who had resolution of symptoms after lumbar discectomy. Thirty-four patients underwent MR examinations 6 weeks and 6 months after lumbar discectomy on a 1.5 T superconducting unit, including sagittal and axial spin-echo (SE) T1-weighted images before and after intravenous administration of gadolinium-DTPA, as well as sagittal turbo (or fast-) SE T2-weighted images. All patients showed soft tissue enhancement along the surgical track in the subcutaneous soft tissue lateral to the spinous process and in the epidural space. ⋯ Enhancement of the intervertebral space was seen in 67% of patients 6 weeks after surgery and in 86% of patients after 6 months. It may be concluded that, despite the use of gadolinium-DTPA, MR studies obtained in the initial postoperative period are difficult to interpret, because of the normal sequence of changes. Consequently, the clinical picture still remains the major indicator for recurrent surgery.
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Comparative Study
The Apache II scoring system in neurosurgical patients: a comparison with simple Glasgow coma scoring.
In order to compare the predictive value of the Apache II, the Glasgow Coma Scale and Revised Trauma Scoring systems in relation to outcome in a neurosurgical department high dependency unit (HDU), all 109 patients entering the unit under the care of one consultant were studied. All patients in the HDU were self-ventilating, so that motor responses were not suppressed by muscle relaxants or sedation. Initial Minimum and Maximum Glasgow Coma Scale Scores, Revised Trauma Score, Apache II and the Apache minus neurological weighting (Apache-NW) scores, were compared as predictors of outcome (as assessed by the Glasgow Outcome Score at 6 months). ⋯ For this group, Apache II had an outcome predictive value of 97% compared with 93% for initial and 95% for minimum GCS. Removing the neurological weighting from Apache II weakened its predictive ability in all patients, emphasizing that it is the neurological status of the patient which best predicts overall functional outcome. Apache II data are also much more time-consuming to collect than GCS data.(ABSTRACT TRUNCATED AT 250 WORDS)
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We have reviewed the records of 53 patients with visual impairment secondary to pituitary macroadenomas and studied the visual outcome after surgery. After transsphenoidal procedures visual field defects improved in 89% of the patients and visual acuity improved in 82%. There were 13 cases of acute symptomatic intratumoural haemorrhage (pituitary apoplexy) in this series. After surgery, visual defects improved in all these cases even when the delay between the onset of symptoms and surgery was long.