Neurochirurgie
-
Cerebral protection combines techniques aimed 1) to avoid death of neurones which sustained primary ischemic of traumatic insults and 2) to prevent secondary insults to the brain. The chemical brain retractor concept includes the use of a total intravenous anesthesia technique, mild hypocapnia and mannitol with strict monitoring and maintenance of the global cerebral homeostasis. ⋯ Neuronal protection is based on a better understanding of the biological basis of secondary brain damage; therapeutic or prophylactic techniques include the use of specific pharmacological agents, hypothermia, hemodilution and maintenance of an elevated cerebral perfusion pressure. In short, although the favourable effects of such techniques are nor easy to demonstrate in man, their use in today's clinical practice, in association with the concept of the chemical brain retractor, is an effective way to prevent ischemic cerebral insults during neurosurgical procedures.
-
Review Case Reports
[An unusual cervical tumor: meningioma. Apropos of a case of petrous origin. Review of the literature of meningioma presenting as cervical mass].
Primary ectopic meningiomas are uncommon. The authors report a case of a 12-year-old boy with a meningioma presenting as a neck mass. The conclusion of the initial biopsy was chemodectoma, but on surgical resection, the tumour was found to have invaded the petrous bone. ⋯ In a few cases the neck mass is a metastasis. These findings suggest that a complete neuroradiological work-up is required. Prognosis depends on the completeness of the surgical resection and the histologic aggressiveness frequently encountered.
-
Two consecutive series of patients operated for insertion or revision of a shunt for hydrocephalus have been followed for at least 18 months. The series are comparable. The first series (84 cases) did not receive antibiotic prophylaxis, whereas the second series (59 cases) received a unique dose of intravenous Vancomycin immediately before the operation. ⋯ Bacteriological samples were taken during these operations. The positive cultures, mostly for sta. epidermidis, were as frequent among the cases of the first series than among those of the second series. The antibiotics are considered effective in protecting the shunting device against contamination during the surgical procedure by germs from the skin of the patient.