Surg Neurol
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Convulsive seizures within 48 hours after intracranial operations using a craniotomy were reviewed. Incidence was 8.9% (44 of 493 operations): 13.5% of brain tumor operations and 3.8% of aneurysmal operations. We demonstrated that preoperative seizures, sites of lesion, sub-therapeutic anticonvulsant levels, and postoperative local organic lesions were important factors causing the immediate postoperative seizures. Among them, a survey of postoperative computed tomography scans disclosed nine intracerebral hemorrhages, eight cases of cerebral edema, and four cerebral infarctions in the 44 patients; such major complications had a significant correlation with postoperative seizures (p less than 0.005).
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Case Reports
Acute carotid-cavernous fistula with retained knife blade after transorbital stab wound.
A patient who sustained an acute carotid-cavernous fistula due to a stab wound is presented. The management problems related to acute intracranial-penetrating injuries are discussed, with particular reference to vascular injury.
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Extracorporeal circulation with circulatory arrest and deep hypothermia in surgery on certain giant intracranial arterial aneurysms or on aneurysms difficult to access is described. The series includes a giant left carotid aneurysm, an aneurysm of the basilar artery bifurcation, a patient with two aneurysms, one on the right middle cerebral artery and the other at the end of the basilar artery, and a fourth patient with two aneurysms, one on the right middle cerebral and the other on the right carotid. Closed-thorax extracorporeal circulation with femoral cannulation was performed on all the patients. ⋯ Results are encouraging. The authors suggest that the technique be used during surgical treatment of certain intracranial aneurysms that are in awkward positions or are very large in size. They emphasize that the procedure should be confined to exceptional cases.
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A modification of the Torkildsen ventriculocisternal shunting procedure, used successfully in a patient with bilateral obstruction of the foramina of Monro, is described. Through bilateral occipital burr holes, a "U-tube" system interconnected the two lateral ventricles. Spinal fluid was then drained with a separate Spetzler catheter passed from one lateral ventricle into the cisterna magna. A posterior percutaneous insertion technique (standard puncture of the cisterna magna) was used to place the catheter into this subarachnoid space.
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Somatosensory evoked potentials were determined in three patients with hysterical neurologic deficits after minor trauma. In each case the patient denied any sensation of the stimulus in the affected extremity; however, normal evoked potentials were recorded. Objective evidence of the hysterical nature of the neurologic deficit was, therefore, provided.