Subtotal neonatal calvariectomy

1979 ◽  
Vol 51 (5) ◽  
pp. 691-696 ◽  
Author(s):  
Laurence W. Mabbutt ◽  
Vincent G. Kokich ◽  
Benjamin C. Moffett ◽  
John D. Loeser
Keyword(s):  
Postoperative Period ◽  
Surgical Margin ◽  
Regenerative Process ◽  
Bone Union ◽  
Histological Techniques ◽  
Content Type ◽  
Rate Of Development ◽  
Definite Pattern ◽  
Fine Print

✓ A subtotal calvariectomy was performed on rabbits between 10 and 14 days of age. The animals were allowed to grow and were then sacrificed serially so that the sutural and skeletal redevelopment could be analyzed through a combination of gross, radiographic, and histological techniques. The results indicate that calvarial regeneration is a progressive process with a definite pattern and rate of development. During the regenerative process, bone was deposited both at the surgical margin and as islands within the surgical defect. The eventual approximation of these areas of ossification produced multiple fibrous articulations. The majority of these articulations were obliterated by bone union, except for the midsagittal, coronal, and metopic sutures, which were re-established in their appropriate anatomical positions. The maintenance of dural integrity during the surgical phase and the regeneration and establishment of pericranial continuity during the postoperative period were believed to be important in the re-establishment of normal sutural and skeletal architecture.

Miniature intravascular pCO2 sensors in neurosurgery

1975 ◽  
Vol 43 (2) ◽  
pp. 172-176 ◽  
Author(s):  
Julius Neumark ◽  
Ann Bardeen ◽  
Edith Sulzer ◽  
John P. Kampine
Keyword(s):  
Postoperative Period ◽  
Recovery Room ◽  
Spontaneous Respiration ◽  
Paired Comparisons ◽  
Average Difference ◽  
Awake Patient ◽  
Content Type ◽  
On Line ◽  
Fine Print

✓ In this study the authors compared PaCO2 measurements from a newly developed miniature intravascular pCO2 sensor for continuous on-line monitoring with those from a Radiometer bench instrument. In 10 patients undergoing craniotomy procedures, 84 paired comparisons were made. At the same time it was possible to follow continuously the trend of PaCO2 during deliberate hyperventilation, during the apneic period following hyperventilation, and during spontaneous respiration in the postoperative period. The comparisons showed an average difference in pCO2 of 1.62 ± SE 0.15 torr. The apneic threshold for PaCO2 after passive hyperventilation was lower than in the awake patient. After the period of apnea no hypoxemia occurred. In the recovery room the PaCO2 increased and the PaO2 decreased. The latter decreased to subnormal levels in two patients more than an hour postoperatively.

Ventricular pressure monitoring during bilateral decompression with dural expansion

1999 ◽  
Vol 91 (6) ◽  
pp. 953-959 ◽  
Author(s):  
Do-Sung Yoo ◽  
Dal-Soo Kim ◽  
Kyung-Suck Cho ◽  
Pil-Woo Huh ◽  
Chun-Kun Park ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Initial Pressure ◽  
Ventricular Pressure ◽  
Decompressive Surgery ◽  
Brain Swelling ◽  
Content Type ◽  
Proper Patient Selection ◽  
Ventricular Puncture ◽  
The Mean ◽  
Fine Print

Object. The management of massive brain swelling remains an unsolved problem in neurosurgery. Despite newly developed medical and pharmacological therapy, the rates of mortality and morbidity caused by massive brain swelling remain high. According to many recent reports, surgical decompression with dural expansion is superior to medical management in patients with massive brain swelling. To show the quantitative effect of decompressive surgery on intracranial pressure (ICP), the authors performed a ventricular puncture and measured the ventricular ICP continuously during decompressive surgery and the postoperative period.Methods. Twenty patients with massive brain swelling who underwent bilateral decompressive craniectomy with dural expansion were included in this study. In all patients, ventricular puncture was performed at Kocher's point on the side opposite the massive brain swelling. The ventricular puncture tube was connected to the continuous monitor via a transducer device. The ventricular pressure was monitored continuously, during the bilateral decompressive procedures and postoperative period.The initial ventricular ICP was variable, ranging from 16 to 65.8 mm Hg. Immediately after the bilateral craniectomy, the mean ventricular ICP decreased to 50.2 ± 16.6% of the initial ICP (range 5–51.5 mm Hg). Additional opening of the dura decreased the mean ICP by an additional 34.5% and reduced the ventricular pressure to 15.7 ± 10.7% of the initial pressure (range 0–15 mm Hg). Ventricular pressure measured postoperatively in the neurosurgical intensive care unit was lowered to 15.1 ± 16.5% of the initial ICP. The ventricular ICP trend in the first 24 hours after decompressive surgery was an important prognostic factor; if it was greater than 35 mm Hg, the mortality rate was 100%.Conclusions. Bilateral decompression with dural expansion is an effective therapeutic modality in the control of ICP. To obtain favorable clinical outcomes in patients with massive brain swelling, early decision making and proper patient selection are very important.

Hypermetabolism in the acute stage of hemorrhagic cerebrovascular disease

1990 ◽  
Vol 72 (5) ◽  
pp. 710-714 ◽  
Author(s):  
Hajime Touho ◽  
Jun Karasawa ◽  
Hisashi Shishido ◽  
Toshitaka Morisako ◽  
Keisuke Yamada ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Respiratory Quotient ◽  
Intracranial Aneurysms ◽  
Acute Stage ◽  
Nitrogen Excretion ◽  
Content Type ◽  
Ruptured Intracranial Aneurysms ◽  
Urinary Nitrogen Excretion ◽  
Fine Print ◽  
Urinary Nitrogen

✓ Oxygen consumption carbon dioxide production , urinary nitrogen excretion, respiratory quotient, resting energy expenditure (REE), %REE, and the consumption rates of carbohydrate, fat, and protein (%CHO, %Fat, %Prot, respectively) were determined pre- and postoperatively by indirect calorimetry in 13 patients with ruptured intracranial aneurysms and 11 patients with hypertensive intracerebral hemorrhage in the acute stage. The preoperative urinary nitrogen excretion, respiratory quotient, REE, and %REE were, respectively (mean ± standard deviation): 171 ± 46 ml/min, 203 ± 56 ml/min, 10.3 ± 1.7 gm/day, 0.84 ± 0.01, 1397 ± 389 Cal/day, and 129% ± 8%. The values for REE, and %REE were all increased above normal levels. The %Prot was increased to 26.1% ± 9.1%. In the postoperative period, the urinary nitrogen excretion, REE, and %REE significantly increased to: 186 ± 44 ml/min, 229 ± 56 ml/min, 14.8 ± 2.9 gm/day, 1557 ± 384 Cal/day, and 141% ± 21%, respectively. The %Fat and %Prot also increased significantly, but the %CHO significantly decreased. Preoperatively, in the patients with ruptured intracranial aneurysms, there was a greater increase in %Prot in eight patients classified (according to Fischer) as having a Group 3 or 4 subarachnoid hemorrhage (SAH) on computerized tomography than in five patients classified as having a Group 1 or 2 SAH. In summary, increased metabolic expenditure, especially increased catabolism of protein and fat, is characteristic of accompanying hemorrhagic cerebrovascular disease, and there is an increase in consumption of fat and protein in the postoperative period. Lack of precise knowledge about the cause and consequences of these metabolic responses makes it impossible at present to judge the optimal extent of nutritional replacement. The hypermetabolic state should be taken into consideration when caring for these patients as it may cause weight loss, poor wound healing, and susceptibility to infection.

Cerebral microvascular architecture following experimental cold injury

1988 ◽  
Vol 68 (4) ◽  
pp. 608-612 ◽  
Author(s):  
Tetsuji Orita ◽  
Takafumi Nishizaki ◽  
Toshifumi Kamiryo ◽  
Kunihiko Harada ◽  
Hideo Aoki
Keyword(s):  
Regenerative Process ◽  
Cold Injury ◽  
Antibody Technique ◽  
Content Type ◽  
Brain Surface ◽  
Injured Part ◽  
Microvascular Architecture ◽  
Immunohistochemical Studies ◽  
The Brain ◽  
Fine Print

✓ The sequential changes in microvascular architecture following local cold injury in rat brains were studied post mortem by scanning electron microscopy and the vascular casting method. The findings were compared with the results of immunohistochemical studies of injured endothelial cells using the bromodeoxyuridine (BUdR) and anti-BUdR monoclonal antibody technique. Repair of the microvascular architecture had begun by the 3rd day after injury, with hematogenous cells and reactive astrocytes present in the edematous brain participating in the regenerative process. The normal microvascular architecture was reconstructed starting from the edge of the lesion nearest to the brain surface. On the other hand, in the most severely injured part of the brain surface, newly formed microvascular architecture appeared, resembling that of the developing fetal and newborn rat cortex. Seven days after injury, the entire microvascular architecture in the region of the lesion had been reconstructed.

Immediate correction of sagittal synostosis

1978 ◽  
Vol 49 (5) ◽  
pp. 705-710 ◽  
Author(s):  
John A. Jane ◽  
Milton T. Edgerton ◽  
J. William Futrell ◽  
Tae Sung Park
Keyword(s):  
Bone Union ◽  
Cosmetic Result ◽  
Sagittal Synostosis ◽  
Content Type ◽  
Fine Print

✓ A technique for correction of sagittal synostosis with achievement of an immediately pleasing cosmetic result is presented. Even with replacement of bone and no attempt to inhibit bone union, premature reclosure does not occur. Moss' theory of dural tensions is discussed to explain the effect.

RG2 glioma growth in rat cerebellum after subdural implantation

1986 ◽  
Vol 65 (2) ◽  
pp. 222-229 ◽  
Author(s):  
Stanislaw Krajewski ◽  
Jürgen C. W. Kiwit ◽  
Wolfgang Wechsler
Keyword(s):  
Light And Electron Microscopy ◽  
Tumor Model ◽  
Nerve Tissue ◽  
Blue Dye ◽  
Histological Techniques ◽  
Content Type ◽  
Rat Glioma ◽  
Glioma Growth ◽  
Microsurgical Techniques ◽  
Fine Print

✓ The nitrosourea-induced rat glioma clone RG2 was tested for its capacity to form multicellular tumor spheroids (MTS's). Resulting spheroids were investigated by light and electron microscopy with regard to their proliferation patterns and morphological features. Using microsurgical techniques and avoiding mechanical injury of the brain tissue, the authors successfully transplanted avascular MTS's under the dura of the cerebellum, above the vermis, in 43 adult syngeneic Fischer CD rats. The rate of tumor establishment was 93%, and the tumors that were solid and spheroid in shape grew exponentially. Neovascularization could be observed at 3 days after implantation, and invasion of the cerebellum occurred by 3 to 5 days. Neurological deterioration, including ataxia, impairment of walking, and apathy, could be observed after 10 days. The mean survival time was approximately 16 days. The subdural cerebellar tumors were studied by histological techniques, and two morphometric methods were applied to check the growth of implanted spheroids. All tumors were deeply stained with the Evans blue dye-albumin complex, demonstrating disturbance of the blood-brain barrier. The easy accessibility of the cerebellar vermis in rats, the microsurgical implantation of glioma spheroids under the dura avoiding nerve tissue disruption, and the high percentage of reproducible establishment of tumors favor this experimental brain-tumor model. This should be an excellent model for study of experimental therapies.

Use of folded vascularized rib graft in anterior fusion after treatment of thoracic and upper lumbar lesions

2001 ◽  
Vol 94 (2) ◽  
pp. 323-327 ◽  
Author(s):  
Hiroaki Nakamura ◽  
Yoshiki Yamano ◽  
Masahiko Seki ◽  
Sadahiko Konishi
Keyword(s):  
Anterior Approach ◽  
Spinal Metastasis ◽  
Intercostal Nerve ◽  
Bone Union ◽  
Autogenous Bone ◽  
Anterior Fusion ◽  
Content Type ◽  
Grafting Technique ◽  
Vascularized Rib ◽  
Fine Print

✓ For lesions involving the anterior and/or middle column of the spine, an anterior approach is adequate for curetting the lesion and restoring spinal stability. Materials such as autogenous bone grafts, cages with bone chips, some artificial materials, or allografts are used as strut materials. Rib material is usually removed when the anterior approach is conducted for thoracic or thoracolumbar lesions. A rib itself is not rigid enough to support the load, and a bone union is not easily obtained. The purpose of this paper is to describe a method of grafting vascularized rib in folded form to fill the defects left after removal of a spinal lesion. The rib, with the artery and vein at two levels cranial to the involved vertebral body, was isolated from surrounding tissues such as the intercostal nerve, muscles, and pleura. After curetting the lesion, the rib was folded into three or four pieces to a length adequate to fill the defect and inserted as a pedicled vascularized graft. A total of 23 cases, including 14 men and nine women, underwent surgery in which this grafting technique was used. The pathological conditions requiring anterior decompression and fusion were spinal trauma in nine cases, spinal infection in six cases, osteoporotic fracture in seven cases, and spinal metastasis in one case. In all cases a solid bone union was obtained and all infections resolved. With vascularized rib graft folded into three to four pieces, solid bone union can be obtained without use of any other grafted materials even in cases of infection and osteoporosis.

Experimental lingual-basilar arterial microanastomosis

1971 ◽  
Vol 34 (4) ◽  
pp. 500-505 ◽  
Author(s):  
O. Howard Reichman
Keyword(s):  
Basilar Artery ◽  
Postoperative Period ◽  
Cerebral Perfusion ◽  
Early Postoperative Period ◽  
Arterial Spasm ◽  
Content Type ◽  
Factors Influencing ◽  
Arterial Inflow ◽  
Healing Phase ◽  
Fine Print

✓ A lingual-basilar artery microanastomosis was performed in 33 dogs; in 24, the cerebral arterial inflow was isolated to the lingual-basilar system. This experimental model demonstrated several factors influencing the use of extracranial vessels to enhance cerebral perfusion. The new lingual-basilar system increased in size to meet flow requirements formerly served by the normal vessels. Arterial spasm was present in the early postoperative period. Arteriography was detrimental if performed at the time of anastomosis or in the healing phase.

Monitoring of blood parameters following anterior cervical fusion

2000 ◽  
Vol 92 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Steffen K. Rosahl ◽  
Alireza Gharabaghi ◽  
Peter-Michael Zink ◽  
Madjid Samii
Keyword(s):  
Cervical Spine ◽  
Cell Count ◽  
Postoperative Period ◽  
White Cell Count ◽  
Anterior Cervical Fusion ◽  
Anterior Fusion ◽  
Cervical Fusion ◽  
Content Type ◽  
Cervical Spine Surgery ◽  
Fine Print

Object. Both C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) were measured prospectively in 51 cases in which uncomplicated cervical anterior fusion was performed. The object of the authors was to quantify the differences in the responses of these parameters recorded in the immediate postoperative period and to determine factors influencing their course. Methods. Nineteen one-level, 23 two-level, and nine three-level procedures for disc herniation and degenerative disease of the cervical spine were performed in 22 female and 29 male patients (mean age 49.2 years). Blood samples were obtained 1 day before as well as on 10 consecutive days and 3 months following anterior cervical fusion. Serum CRP level was measured using a fluorescence polarization immunoassay and ESR was determined from the same samples. Operative time, the number of blood transfusions, and drugs administered in the postoperative period were recorded. In addition, hemoglobin, hematocrit, red blood cell count, platelet count, white cell count, and axillary body temperature were checked daily. Conclusions. Monitoring of CRP level is superior to that of ESR for early detection of infections after cervical spine surgery. Although CRP was not related to any of the factors that have been proposed to explain its peak value variance in previous studies, individual acute-phase protein metabolism response to tissue affection appears to be a more decisive element in this respect.

Vertebral hydatid disease

1976 ◽  
Vol 44 (1) ◽  
pp. 72-76 ◽  
Author(s):  
Werner L. Apt ◽  
Juan L. Fierro ◽  
Ciro Calderón ◽  
Carlos Pérez ◽  
Patricio Mujica
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Postoperative Period ◽  
Long Term Results ◽  
Common Procedure ◽  
Laboratory Findings ◽  
Content Type ◽  
Surgical Interventions ◽  
Fine Print

✓ The authors present 27 cases of vertebral hydatidosis with clinical and laboratory findings. The most frequent location of the lesion was the lumbar spine. Principal neurological symptoms were paraparesis, sphincter disturbances, paresthesia and paraplegia. The average number of surgical interventions per patient was 2.6; the most common procedure was laminectomy with extirpation of the cyst and surgical toilet. The results of surgical treatment were generally good in the immediate postoperative period, but long-term results were poor.

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