Journal of neurosurgery
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The complications associated with 92 dorsal column stimulator implants are reported. They were of two types, technical and functional. ⋯ Late failure in stimulation was observed in 32 implants that had given excellent pain control for periods ranging from months to years. Improvements in the results of this procedure may be achieved by future technical developments and by clarification of physiological mechanisms.
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Journal of neurosurgery · Dec 1977
Case ReportsInfantile chronic subdural hematoma of the posterior fossa diagnosed by computerized tomography. Case report.
A 9-week-old infant manifested continuous vomiting for 1 week accompanied by a tense fontanel, "sun setting" of the eyes, frequent opisthotonos, and hypertonicity. The head circumference was at the 50th percentile. Computerized tomography (CT) revealed acute hydrocephalus and a posterior fossa subdural hematoma. ⋯ A shunt followed by occipital craniectomy resolved both the hydrocephalus and subdural hematoma. Repeat CT scan 15 days postoperatively disclosed continuing higher density of the cerebellum and brain stem (60 Hounsfield units) relative to cerebral white matter. Increased density of the infantile cerebellum has been noted previously but not to the same extent as in this patient.
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Journal of neurosurgery · Nov 1977
Case ReportsThe management of ruptured intracranial aneurysm in sickle cell anemia. Case report.
The problems of sickle cell disease and its complications is discussed. Subarachnoid hemorrhage is not a common complication of sickle cell disease and should be evaluated in the same way as if it were not associated with the disease. Patients with sickle cell trait have an added risk during angiography and hypotensive anesthesia. Guidlines are given for angiography and craniotomy with hypotensive anesthesia and reduction of brain volume in these patients.
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Journal of neurosurgery · Nov 1977
Neurosurgery 1977: problems and attainments. The 1977 AANS presidential address.
The President of the American Association of Neurological Surgeons (AANS) discusses the many elements that appear to restrict the professional activities of neurosurgeons and other physicians. He stresses the importance of the active role required of the AANS, the American Medical Association, and the American College of Surgeons in finding solutions to problems related to neurosurgery.
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Measurements of intracranial pressure (ICP) were begun within hours of injury in 160 patients with severe brain trauma, and continued in the intensive care unit. Some degree of increased ICP (greater than 10 mm Hg) was present on admission in most cases (82%), and in all but two of the 62 patients with intracranial mass lesions requiring surgical decompression; ICP was over 20 mm Hg on admission in 44% of cases, and over 40 mm Hg in 10%. In patients with mass lesions only very high ICP (greater than 40 mm Hg) on admission was significantly associated with a poor neurological picture and outcome from injury, while in patients with diffuse brain injury any increase in ICP above 10 mm Hg was associated with a poorer neurological status and a worse outcome. ⋯ Even in patients without mass lesions, ICP rose above 20 mm Hg in a third of the cases, despite artificial ventilation and steroid therapy. Of the 48 patients who died, severe intracranial hypertension was the primary cause of death in nearly half and even moderately increased ICP (greater than 20 mm Hg) was associated with higher morbidity in patients with mass lesions and those with diffuse brain injury. Measurement of ICP should be included in management of patients with severe head injury.