Long-term prognosis in surgically treated intracranial aneurysms

1981 ◽  
Vol 54 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Lydia Artiola i Fortuny ◽  
Luis Prieto-Valiente
Keyword(s):  
Outcome Measure ◽  
Systemic Blood Pressure ◽  
Neurological Status ◽  
Long Term Results ◽  
Control Group ◽  
Aneurysm Surgery ◽  
Systemic Blood ◽  
Content Type ◽  
Long Term Prognosis

✓ An evaluation of long-term results following aneurysm surgery is presented. Five different outcome measures are used in a population of 204 survivors followed for a minimum of 18 months and a maximum of 5½ years. The findings show that 1) results vary depending on the outcome measure used, and 2) outcome can be predicted with a considerable degree of accuracy using preoperative and early postoperative variables. The most important predictive factors were postoperative vasospasm, age, systemic blood pressure on admission, and preoperative neurological status. The results are compared with a control group.

Method for measuring brain tissue pressure

1975 ◽  
Vol 43 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Robert M. Clark ◽  
Norman F. Capra ◽  
James H. Halsey
Keyword(s):  
Blood Pressure ◽  
Brain Tissue ◽  
Systemic Blood Pressure ◽  
Systemic Blood ◽  
Tissue Pressure ◽  
Content Type ◽  
Pressure Changes ◽  
Local Brain

✓ The authors report a method for measuring total local brain tissue pressure (BTP) using a miniature catheter transducer stereotaxically introduced into the white matter of the cat's cerebrum. Quantitative rapid phasic pressure changes were satisfactorily demonstrated. Due to some drift of baseline of the transducers and inability to perform in vivo calibration, reliable long-term quantitative pressure measurements sometimes could not be studied. The BTP from each cerebral hemisphere and the cisternal pressure (CP) were monitored during alterations of pCO2 and systemic blood pressure, and distilled H2O injection prior to and after right middle cerebral artery (MCA) ligation. The catheter transducers functioned well on chronic implantation for up to 6 weeks. Compared to the chronically implanted catheters, acutely implanted catheters responded identically except for drift. The response of intracranial pressure and CP to MCA occlusion, alterations in pCO2, and systemic blood pressure were similar. No BTP gradients appeared in response to MCA ligation, hypercapnia, hypertension, or progressive swelling of the resulting infarction.

Long-term outcome of anterior decompression and spinal fixation after placement of the Wellesley Wedge for thoracic and lumbar spinal metastasis

2002 ◽  
Vol 96 (1) ◽  
pp. 6-9 ◽  
Author(s):  
David Yen ◽  
Vikas Kuriachan ◽  
Jeff Yach ◽  
Andrew Howard
Keyword(s):  
Selection Process ◽  
Spinal Metastasis ◽  
Neurological Status ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Lumbar Spinal ◽  
Fine Print

Object. The authors assessed the long-term results of anterior decompressive and vertebral body reconstructive surgery in which the Wellesley Wedge was applied in patients with metastatic spinal lesions over the life span of these individuals. Methods. The authors performed a retrospective review of the outcome of 27 consecutively treated patients who underwent surgery for thoracic or lumbar spine metastases. Decompressive surgery was performed via an anterior thoracotomy and/or retroperitoneal approach depending on the level of the lesion. The spine was reconstructed using a U-shaped plate with an interposed methylmethacrylate strut known as the Wellesley Wedge. Results. Thirty percent of patients suffered medical complications whereas 22% experienced postoperative improvement, as reflected by an improved Frankel grade. Used in patients with a variety of primary tumor types, a spectrum of ages and neurological status, and extensive preoperative osseous spinal involvement and deformity, the Wellesley Wedge resulted in spinal stability for the duration of patients' lives in 92%. Conclusions. In this series the patient selection process for surgery was a challenge yet to be solved; however, considering the durability of the Wellesley Wedge itself, the authors will continue to use it in selected patients.

Long-term neurological residua in patients surviving brain abscess with surgery

1971 ◽  
Vol 34 (5) ◽  
pp. 652-656 ◽  
Author(s):  
Michael E. Carey ◽  
Shelley N. Chou ◽  
Lyle A. French
Keyword(s):  
Brain Abscess ◽  
Adult Survivors ◽  
Neurological Status ◽  
Long Term Results ◽  
Neurological Sequelae ◽  
Content Type ◽  
Brain Abscesses ◽  
Treatment Comparisons ◽  
Fine Print

✓ Long-term neurological sequelae were analyzed in 40 patients (24 adults and 16 children) who survived a brain abscess with surgery. Median follow-up was 6 years. The brain abscesses were secondary to hematogenous spread, sinus and mastoid infections, and trauma. Hemiparesis, seizures, visual defects, and learning problems (in children) were the most common sequelae observed. Abscess location played a significant role in determining sequelae. Only two of 16 patients with frontal polar and temporal lobe abscesses had unsatisfactory long-term results, while eight of 16 individuals with abscesses near the sensorimotor strip were left with permanent unsatisfactory neurological sequelae. Nineteen of 24 adults (80%) had a satisfactory long-term neurological status, but only 10 of 16 children (63%) had a similar outcome. In adult survivors, hemiparesis and seizures were mild, and emotional changes rare. Children were often severely paretic, had poorly controlled seizures, suffered from personality impairment, and were occasionally totally disabled. If the postoperative neurological condition is used to evaluate various types of surgical therapy for the treatment of brain abscess, then the therapies under study must be matched for patient age and abscess location before treatment comparisons can be made.

scholarly journals HIGH SYSTEMIC BLOOD PRESSURE IN PRETERM INFANTS WITH BRONCHOPULMONARY DYSPLASIA AND LONG-TERM OUTCOMES

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e20-e20
Author(s):  
Florence Cayouette ◽  
Sarah Spénard ◽  
Anie Lapointe ◽  
Véronique Dorval ◽  
Julie Sommer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Neurodevelopmental Outcome ◽  
Systemic Blood Pressure ◽  
Control Group ◽  
Neurodevelopmental Outcomes ◽  
Systemic Blood ◽  
Neurodevelopmental Impairment

Abstract BACKGROUND Bronchopulmonary dysplasia (BPD) is a known risk factor for neurodevelopmental impairment in preterm infants. BPD is also associated with an increased incidence of high systemic blood pressure (HBP). However, it is not known if a diagnosis of HBP in BPD patients relates to later neurodevelopmental outcomes. OBJECTIVES We aimed to determine the incidence of neonatal HBP diagnosis in a cohort of preterm infants born <29 weeks of gestational age (GA) with BPD. The secondary objective was to assess if a concomitant diagnosis of BPD and HBP influences neurodevelopmental outcomes at 18 months. DESIGN/METHODS We performed a single center retrospective study using data from medical charts. All infants born <29 weeks GA admitted to our level-IV neonatal intensive care unit between January 2010 and December 2012 diagnosed with BPD at 36 weeks of corrected GA were included. Patients transferred before 36 weeks of corrected GA, that died before 18 months or had congenital anomalies were excluded. Patients were classified in the HBP group if HBP was a documented diagnosis in the chart. The control group was the remaining patients with BPD at 36 weeks corrected GA but without HBP. Severe neurodevelopmental impairment at 18 months was defined as either any Bailey-III score <70, cerebral palsy or severe hearing or visual impairment. Descriptive statistics for prenatal and postnatal patients’ characteristics were analyzed. Logistic regression was performed for factors associated with long-term disability. Level of significance was determined as a p value <0.05. RESULTS During the study period, 337 preterm infants <29 weeks of GA were identified and after exclusions, 98 newborns met the criteria of BPD at 36 weeks corrected GA. Mean GA and mean birth weight were 26.7 ± 1.7 weeks and 882 ± 199 g respectively. The majority were males (57%) and received antenatal steroids (87.8%). We identified twenty-five newborns (25.5%) with a diagnosis of HBP. Demographic data was similar between the 2 groups. 56% of the HBP group received a post-natal course of steroids, compared to 36% for the control group (p 0.07). The neurodevelopmental outcome at 18 months was similar between the two groups (p 0.54) and was not influenced by the presence of a HBP diagnosis after regression analysis (p 0.8). CONCLUSION The diagnosis of HBP was frequent in our cohort of preterm infants born <29 weeks GA with BPD but did not seem to be related to long-term neurodevelopmental outcomes.

Primary hypertension—induced cerebellar encephalopathy causing obstructive hydrocephalus

2003 ◽  
Vol 98 (6) ◽  
pp. 1307-1311 ◽  
Author(s):  
Meg Verrees ◽  
Jose Americo Fernandes Filho ◽  
Jose I. Suarez ◽  
Robert A. Ratcheson
Keyword(s):  
Blood Pressure ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Hypertensive Crisis ◽  
Systemic Blood Pressure ◽  
Neurological Status ◽  
Systemic Blood ◽  
Content Type ◽  
Fine Print

✓ Hypertension-induced encephalopathy is a recognized pathological process commonly focused in the parietal and occipital lobes of the cerebral hemispheres. The parenchyma of the posterior fossa is infrequently involved. The authors report on two cases of isolated edema of the cerebellar hemispheres, which occurred in the setting of hypertensive crisis and led to complete obstruction of or significant impingement on the fourth ventricle and potentially lethal hydrocephalus. To the best of the authors' knowledge, these are the first reported cases of hypertensive encephalopathy centered in the posterior fossa. Two patients presented with profound decreases in neurological status subsequent to development of malignant hypertension. Imaging studies revealed diffusely edematous cerebellar hemispheres with effacement of the fourth ventricle, causing dilation of the lateral and third ventricles. Following emergency placement of external ventricular drains, control of systemic blood pressure was accomplished, and neurological functioning returned to baseline. Although neurological deterioration resolved swiftly following placement of ventricular catheters and administration of diuretic agents, systemic blood pressure did not fluctuate with the release of cerebrospinal fluid and resolution of increased intracranial pressure. Decrease in systemic blood pressure lagged well behind improvement in neurological status; the patients remained morbidly hypertensive until systemic blood pressure was controlled with multiple parenteral medications. The authors hypothesize that the development of hypertension beyond the limits of cerebral autoregulation led to breakdown of the blood—brain barrier in the cerebellum and development of posterior fossa edema secondary to the focal transudation of protein and fluid. Correction of the elevated blood pressure led to amelioration of cerebellar edema. In the appropriate clinical setting, hypertension as the inciting cause of cerebellar encephalopathy should be considered.

Long-term follow-up review of suspension laminotomy for cervical compression myelopathy

1996 ◽  
Vol 85 (5) ◽  
pp. 817-823 ◽  
Author(s):  
Hidenori Inoue ◽  
Kazuo Ohmori ◽  
Yoshihiro Ishida ◽  
Kazuhiro Suzuki ◽  
Tetsuro Takatsu
Keyword(s):  
Posterior Longitudinal Ligament ◽  
Neurological Status ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Long Term Follow Up ◽  
Fine Print

This study compared the long-term outcome of cervical spondylotic myelopathy (CSM) with that of the ossification of the posterior longitudinal ligament of the cervical spine (OPLL) after suspension laminotomy, which was developed in the authors' clinic. Seventy-six patients who received follow-up care for more than 5 years were available for analysis. The duration of the follow-up period averaged 97.8 months (range 61–160 months). Radiological and neurological analyses were performed in these 76 patients (50 with CSM and 26 with OPLL). There were no differences in sex, age, follow-up period, and preoperative neurological status between the two groups. In the quantitative study of the dural configuration, 43 patients (86%) with CSM and 17 patients (65.4%) with OPLL attained complete decompression 1 month after surgery. At long-term follow-up review, complete decompression was maintained in 42 patients (84%) with CSM but in only seven patients (26.9%) with OPLL. The neurological evaluation improved markedly at early follow up in both groups but declined insignificantly at the last follow-up review, particularly in the OPLL group. Of 12 patients (24%) with CSM and 10 patients (38.5%) with OPLL whose neurological recovery grades later deteriorated, four (8%) with CSM and nine (34.6%) with OPLL demonstrated reconstriction causing spinal cord compression at long-term follow-up review. For the remaining eight patients (16%) with CSM, who were older than 70 years on average at last follow-up review, no radiological explanation was found. These long-term results indicate that OPLL does not resolve as well as CSM after suspension laminotomy; they both may have late deterioration due to reconstriction that occurs occasionally in CSM and frequently in OPLL.

scholarly journals Role and effectiveness of complex and supervised rehabilitation on overall and hand function in systemic sclerosis patients—one-year follow-up study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Michał Waszczykowski ◽  
Bożena Dziankowska-Bartkowiak ◽  
Michał Podgórski ◽  
Jarosław Fabiś ◽  
Arleta Waszczykowska
Keyword(s):  
Systemic Sclerosis ◽  
Hand Function ◽  
Exercise Program ◽  
Rehabilitation Program ◽  
Long Term Results ◽  
Home Exercise ◽  
Control Group ◽  
Study Group

AbstractThe aim of this study was to estimate the long-term results of complex and supervised rehabilitation of the hands in systemic sclerosis (SSc) patients. Fifty-one patients were enrolled in this study: 27 patients (study group) were treated with a 4-week complex, supervised rehabilitation protocol. The control group of 24 patients was prescribed a home exercise program alone. Both groups were evaluated at baseline and after 1-, 3-, 6-, and 12-months of follow-up with the Disability of the Arm, Shoulder and Hand Questionnaire (DAHS) as the primary outcome, pain (VAS—visual analog scale), Cochin Hand Function Scale (CHFS), Health Assessment Questionnaire Disability Index (HAQ-DI), Scleroderma-HAQ (SHAQ), range of motion (d-FTP—delta finger to palm, Kapandji finger opposition test) and hand grip and pinch as the secondary outcomes. Only the study group showed significant improvements in the DASH, VAS, CHFS and SHAQ after 1, 3 and 6 months of follow-up (P = 0.0001). Additionally, moderate correlations between the DASH, CHFS and SHAQ (R = 0.7203; R = 0.6788; P = 0.0001) were found. Complex, supervised rehabilitation improves hand and overall function in SSc patients up to 6 months after the treatment but not in the long term. The regular repetition of this rehabilitation program should be recommended every 3–6 months to maintain better hand and overall function.

The histopathology of experimental spinal cord trauma

1978 ◽  
Vol 48 (6) ◽  
pp. 1002-1007 ◽  
Author(s):  
Stephen E. Rawe ◽  
William A. Lee ◽  
Phanor L. Perot
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Systemic Blood Pressure ◽  
Post Injury ◽  
Systemic Blood ◽  
Edema Formation ◽  
Thoracic Spinal Cord ◽  
Content Type ◽  
Thoracic Spinal ◽  
Marked Enhancement

✓ The early sequential histopathological alterations following a concussive paraplegic injury to the posterior thoracic spinal cord in cats were studied. The lack of significant progression of hemorrhages over a 4-hour period after injury indicates that most hemorrhages probably occur within the first hour. The marked enhancement or retardation of hemorrhages in the post-injury period, when the blood pressure was increased or decreased, respectively, demonstrates the loss of autoregulation of spinal cord vasculature at the trauma site after a concussive paraplegic injury. Progressive edema formation was evident over a 4-hour period following injury, and it could be enhanced or retarded by elevation or reduction of the systemic blood pressure.

Dynamic cranioplasty for brachycephaly in Apert syndrome: long-term follow-up study

2001 ◽  
Vol 94 (5) ◽  
pp. 757-764 ◽  
Author(s):  
José Guimarães-Ferreira ◽  
Fredrik Gewalli ◽  
Pelle Sahlin ◽  
Hans Friede ◽  
Py Owman-Moll ◽  
...  
Keyword(s):  
Cell Mass ◽  
Apert Syndrome ◽  
Long Term Results ◽  
Safe Procedure ◽  
Content Type ◽  
Skull Shape ◽  
The Mean ◽  
Fine Print

Object. Brachycephaly is a characteristic feature of Apert syndrome. Traditional techniques of cranioplasty often fail to produce an acceptable morphological outcome in patients with this condition. In 1996 a new surgical procedure called “dynamic cranioplasty for brachycephaly” (DCB) was reported. The purpose of the present study was to analyze perioperative data and morphological long-term results in patients with the cranial vault deformity of Apert syndrome who were treated with DCB. Methods. Twelve patients have undergone surgery performed using this technique since its introduction in 1991 (mean duration of follow-up review 60.2 months). Eleven patients had bicoronal synostosis and one had a combined bicoronal—bilambdoid synostosis. Perioperative data and long-term evolution of skull shape visualized on serial cephalometric radiographs were analyzed and compared with normative data. Changes in mean skull proportions were evaluated using a two-tailed paired-samples t-test, with differences being considered significant for probability values less than 0.01. The mean operative blood transfusion was 136% of estimated red cell mass (ERCM) and the mean postoperative transfusion was 48% of ERCM. The mean operative time was 218 minutes. The duration of stay in the intensive care unit averaged 1.7 days and the mean hospital stay was 11.8 days. There were no incidences of mortality and few complications. An improvement in skull shape was achieved in all cases, with a change in the mean cephalic index from a preoperative value of 90 to a postoperative value of 78 (p = 0.000254). Conclusions. Dynamic cranioplasty for brachycephaly is a safe procedure, yielding high-quality morphological results in the treatment of brachycephaly in patients with Apert syndrome.

Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET

1995 ◽  
Vol 83 (5) ◽  
pp. 778-782 ◽  
Author(s):  
Andrew P. Gasecki ◽  
Michael Eliasziw ◽  
Gary G. Ferguson ◽  
Vladimir Hachinski ◽  
Henry J. M. Barnett ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Hazard Ratio ◽  
Content Type ◽  
Perioperative Morbidity ◽  
Artery Disease ◽  
Long Term Prognosis ◽  
Moderate Hazard ◽  
Fine Print

✓ The purpose of this study was to examine how the prognosis of patients who presented with a recent ischemic event referable to a 70% to 99% stenosis of one carotid artery (ipsilateral) was altered by stenosis and occlusion of the contralateral carotid artery. The benefit of performing carotid endarterectomy on the recently symptomatic artery, in the presence of contralateral artery disease, was also examined. A total of 659 patients were grouped into one of three categories according to the extent of stenosis in the contralateral carotid artery: less than 70% (559 patients), 70% to 99% (57 patients), and occlusion (43 patients). Strokes that occurred during the follow-up period were designated as ipsilateral if they arose from the same carotid artery as the symptom for which the patient had been entered into the study. Medically treated patients with an occluded contralateral artery were more than twice as likely to have had an ipsilateral stroke at 2 years than patients with either severe (hazard ratio: 2.36; 95% confidence interval (CI): 1.00–5.62) or mild-to-moderate (hazard ratio: 2.65; 95% CI: 1.43–4.90) contralateral artery stenosis. The perioperative risk of stroke and death was higher in patients with an occluded contralateral artery (4.0% risk) or mild-to-moderate (5.1% risk) contralateral stenosis. Regression analyses indicated that the results were not affected by other risk factors. An occluded contralateral carotid artery significantly increased the risk of stroke associated with a severely stenosed ipsilateral carotid artery. Despite higher perioperative morbidity in the presence of an occluded contralateral artery, the longer-term outlook for patients who had endarterectomy performed on the recently symptomatic, severely stenosed ipsilateral carotid artery was considerably better than for medically treated patients.

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