Neurosurgery
-
the occurrence of spontaneous arterial subdural hematomas is very rare. We report five patients who presented with sudden severe headache and who developed progressive neurological deficits, two becoming comatose. None had a history of trauma. ⋯ The source of bleeding was identified as a cortical artery located near the sylvian region in four of our five patients and in most of the reported cases. There are several possible anatomical situations that may predispose a cortical artery to "spontaneous" rupture: (a) spontaneous rupture of a cortical artery at the point of origin of a fragile arterial twig, especially a right-angled branch, a point of potential weakness; (b) rupture of a small artery traversing the subdural space and connecting a cortical artery to the dura mater (a "bridging" artery); (c) adhesions between a cortical artery and arachnoid or dura mater; (d) a knuckle of cortical artery protruding through the arachnoid and adherent to the dura mater. In each situation, the artery is probably torn by a sudden movement of the brain during a vigorous head movement, not severe enough to be considered trauma.
-
Historical Article
Perspectives in international neurosurgery: neurosurgery in Spain.
-
Håkanson's method of treatment of trigeminal neuralgia by injecting glycerol into the trigeminal cistern is being used in a few clinical centers with encouraging results. We undertook this experimental study utilizing a rat sciatic nerve model to elucidate the mode of action of glycerol. Fifty-six rats were divided into three groups. ⋯ The animals were killed at the end of either 1 or 3 1/2 weeks after the application of glycerol, and the sciatic nerves were examined with light and electron microscopy. Our results show that myelin disintegration and axonolysis occur with glycerol application. Myelinated and unmyelinated fibers are affected at random, although the most striking histological changes were seen in the myelinated fibers.
-
Comparative Study
Role of radiation therapy in the treatment of cerebral oligodendroglioma: an analysis of 57 cases and a literature review.
Fifty-seven cases of histologically confirmed cerebral oligodendroglioma treated at the Cleveland Clinic between 1950 and 1980 were reviewed. No difference in the 5-year survival rate was seen in patients treated with postoperative radiation therapy vs. operation alone. These data are compared to previously published series with special emphasis on the role of radiation therapy.
-
Between 1963 and 1980, one or more posterior-lateral foraminotomies were performed for simple cervical radiculopathy as the sole operative procedure for 736 patients. One hundred three patients (14%) required a second posterior procedure, but only 24 (3%) cases represented true recurrent radiculopathy. There were 13 minor complications (1.5%) and no deaths or detectable incidence of air embolism. ⋯ The mean length of time to return to work or other "normal" activities was 9.4 weeks. The mean length of follow-up time was 146 weeks (2.8 years). There was an associated incidence of significant lumbar disc and/or foraminal disease requiring operation of 33.4%.