No shinkei geka. Neurological surgery
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Case Reports
[Cranioplasty following decompressive craniectomy--analysis of 300 cases (author's transl)].
Three hundred cases of cranioplasty, following large decompressive craniectomy for various diseases, were analyzed. 1. Neurological status was evaluated before and after cranioplasty in 52 patients with remaining neurological deficit. There observed no changes in 13 patients with skin flap of full or bulging type. ⋯ In one case, there occurred 3 episodes of fracture. 4. Infected cranioplasty, in all as epidural empyema, was seen in 10 (3%) of 300 cases. One of the most important factors related to infection, was the time interval after the primary surgery; all infected cases were operated on within 3 months.
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The neural mechanism of the modulating effects of spinal cord stimulation upon intractable pain was studied in cats under local anaesthesia. The electrical activity at the centre median nucleus of the thalamus (CEM), which responded to noxious stimuli and was inhibited by nitrous oxide inhalation, was recorded as an indicator of the degree of pain sensation. The suppressed effect upon the evoked potential responding to sciatic stimulation (1 Hz) was recorded during and after train stimulation of various parts of the spinal cord by means of silver ball bipolar electrode. ⋯ This effect corresponds to the inhibitory effect by 75% N2O gas inhalation. Upon dorsal column stimulation, the intraspinal electrical activity is found in the central gray matter the antero-lateral quandrants of the spinal cord as well as the dorsal column. 2) Following lateral or anterior column stimulation as well as dorsal column stimulation, the CEM evoked potential responding to sciatic stimulation is inhibited by about 50% of its amplitude. 3) Following bilateral dorsal tractotomy cranial, caudal or both to the stimulating point, the CEM evoked potentials responding to sciatic stimulation are inhibited by dorsal column stimulation. According to the experimental results, it may be concluded that the inhibitory modulating mechanism by dorsal column stimulation for pain relief is not only mediated through the dorsal column, but also through other ascending spinal pathways.