Computerized tomography of peripheral nerve lesions

1983 ◽  
Vol 59 (1) ◽  
pp. 131-136 ◽  
Author(s):  
Stephen K. Powers ◽  
David Norman ◽  
Michael S. B. Edwards

✓ Nine patients with a peripheral nerve lesion (six intrinsic and three extrinsic) were evaluated with computerized tomography (CT). In all but one instance, the CT scans gave useful information regarding the anatomical location, size, and relationship of the lesion to surrounding structures. These cases illustrate the usefulness of CT as a diagnostic tool in the evaluation of peripheral nerve lesions.

1980 ◽  
Vol 52 (5) ◽  
pp. 733-735 ◽  
Author(s):  
John I. Moseley ◽  
Steven L. Giannotta ◽  
Justin W. Renaudin

✓ A simple wire template is placed on the patient's head during computerized tomography scanning, and the results of the scan are later reproduced on the scalp prior to surgery. Measurements of the distance between the wires and the relationship of the mass provide the key to accurate localization of the mass on the scalp surface.


1986 ◽  
Vol 65 (6) ◽  
pp. 871-873 ◽  
Author(s):  
Chung P. Yue ◽  
Kirpal S. Mann ◽  
Fu L. Chan

✓ A case of mucocele of the posterior ethmoid sinus presenting as unilateral blindness without pain, proptosis, or diplopia is reported. Computerized tomography (CT) demonstrated the precise anatomical relationship of the mucocele to the optic nerve inside the optic canal. It is proposed to use the term “optic canal syndrome” for patients with such clinical and CT presentation. Combined transcranial excision and transnasal drainage resulted in dramatic recovery of vision.


1998 ◽  
Vol 89 (4) ◽  
pp. 610-615 ◽  
Author(s):  
Russell R. Lonser ◽  
Robert J. Weil ◽  
Paul F. Morrison ◽  
Lance S. Governale ◽  
Edward H. Oldfield

Object. Although many macromolecules have treatment potential for peripheral nerve disease, clinical use of these agents has been restricted because of limitations of delivery including systemic toxicity, heterogeneous dispersion, and inadequate distribution. In an effort to overcome these obstacles, the authors examined the use of convection to deliver and distribute macromolecules into peripheral nerves. Methods. For convective delivery, the authors used a gas-tight, noncompliant system that provided continuous flow through a small silica cannula (inner diameter 100 µm, outer diameter 170 µm) inserted into a peripheral nerve. Increases in the volume of infusion (Vi) (10, 20, 30, 40, and 80 µl) of 14C-labeled (nine nerves) or gadolinium-labeled (two nerves) albumin were infused unilaterally or bilaterally into the tibial nerves of six primates (Macaca mulatta) at 0.5 µl/minute. The volume of distribution (Vd), percentage recovery, and delivery homogeneity were determined using quantitative autoradiography, an imaging program developed by the National Institutes of Health, magnetic resonance (MR) imaging, scintillation counting, and kurtosis (K) analysis. One animal that was infused bilaterally with gadolinium-bound albumin (40 µl to each nerve) underwent MR imaging and was observed for 16 weeks after infusion. The Vd increased with the Vi in a logarithmic fashion. The mean Vd/Vi ratio over all Vi was 3.7 ± 0.8 (mean ± standard deviation). The concentration across the perfused region was homogeneous (K = −1.07). The infusate, which was limited circumferentially by the epineurium, followed the parallel arrangement of axonal fibers and filled long segments of nerve (up to 6.8 cm). Recovery of radioactivity was 75.8 ± 9%. No neurological deficits arose from infusion. Conclusions. Convective delivery of macromolecules to peripheral nerves is safe and reliable. It overcomes obstacles associated with current delivery methods and allows selective regional delivery of putative therapeutic agents to long sections of nerve. This technique should permit the development of new treatments for numerous types of peripheral nerve lesions.


2004 ◽  
Vol 100 (6) ◽  
pp. 989-996 ◽  
Author(s):  
Daniel H. Kim ◽  
Judith A. Murovic ◽  
Robert L. Tiel ◽  
David G. Kline

Object. The authors present a retrospective analysis of 119 surgically treated femoral nerve lesions at intrapelvic and thigh levels seen at the Louisiana State University Health Sciences Center. Methods. Femoral nerve lesions treated between 1967 and 2000, (89 traumatic injuries and 30 tumors and cystic lesions) were evaluated for injury mechanisms, resulting lesions, surgical management, and postoperative functional outcomes by using retrospective chart reviews. The most common injury mechanism was iatrogenic (52 cases), which occurred after hernia and hip operations (10 each), followed by arterial bypass and gynecological procedures (eight each), angiography (seven), abdominal surgery (five), appendectomy (two), a laparoscopy, and a lumbar sympathectomy. Other injury mechanisms included hip or pelvic fractures (19), gunshot wounds (10), and lacerations (eight). The 30 femoral nerve tumors and cystic lesions consisted of neurofibromas (16), schwannomas (nine), ganglionic cysts (two), neurogenic sarcomas (two), and a leiomyosarcoma. Forty-four patients underwent neurolysis. Some had recordable nerve action potentials (NAPs) across their lesions in continuity, despite severe distal loss. Others with recordable NAPs had mild loss, but also experienced a pain problem, which was helped in some by neurolysis. In 36 patients, in whom repairs were performed using long sural grafts for mostly proximal pelvic-level injuries, recovery of useful function occurred. Eight of nine thigh-level suture repairs led to improvement to good functional levels. Most of the tumors and cystic lesions were resected, with preservation of preoperative function. Conclusions. The majority of femoral nerve injuries resulted in lesions in continuity, and intraoperative NAP recordings were essential in evaluating axonal regeneration across these lesions. Despite severe and frequently proximal injury levels requiring repairs with long grafts, femoral nerve lesion repairs resulted in good functional recovery.


1999 ◽  
Vol 61 (5) ◽  
pp. 557-560 ◽  
Author(s):  
Hidefumi Furuoka ◽  
Mituru Hasegawa ◽  
Yoshiyasu Kobayashi ◽  
Takane Matsui

1986 ◽  
Vol 65 (5) ◽  
pp. 706-709 ◽  
Author(s):  
Yoko Nakasu ◽  
Jyoji Handa ◽  
Kazuyoshi Watanabe

✓ Two patients with benign intracerebral cysts are reported and a brief review of the literature is given. Although computerized tomography (CT) scanning is useful in detecting a variety of intracerebral cysts, the CT findings are not specific for any lesion. An exploratory operation with establishment of an adequate route of drainage and a histological examination of the cyst wall are mandatory in the management of patients with a progressive but benign lesion.


1976 ◽  
Vol 44 (1) ◽  
pp. 109-115 ◽  
Author(s):  
Beth J. L. MacGregor ◽  
Jeffrey Gawler ◽  
John R. South

✓ The authors report two cases with large unilocular intracerebral epithelial cysts. Diagnosis was facilitated in both patients by computerized tomography (EMI scanner). The clinical and diagnostic aspects of previously reported cases are reviewed, and the etiology and pathogenesis of these cysts discussed.


1990 ◽  
Vol 110 (3) ◽  
pp. 248-257 ◽  
Author(s):  
Marion Murray ◽  
Shwun-De Wang ◽  
Michael E. Goldberger ◽  
Pat Levitt

1983 ◽  
Vol 59 (2) ◽  
pp. 217-222 ◽  
Author(s):  
M. Peter Heilbrun ◽  
Theodore S. Roberts ◽  
Michael L. J. Apuzzo ◽  
Trent H. Wells ◽  
James K. Sabshin

✓ The production model of the Brown-Roberts-Wells (BRW) computerized tomography (CT) stereotaxic guidance system is described. Hardware and software modifications to the original prototype now allow the system to be used independently of the CT scanner after an initial scan with the localizing components fixed to the skull. The system is simple and efficient, can be used universally with all CT scanners, and includes a phantom simulator system for target verification. Preliminary experience with 74 patients at two institutions is described. It is concluded that CT stereotaxic guidance systems will become important tools in the neurosurgical armamentarium, as they allow accurate approach to any target identifiable on the CT scan.


1982 ◽  
Vol 57 (2) ◽  
pp. 254-257 ◽  
Author(s):  
Henry A. Shenkin

✓ In a consecutive series of 39 cases of acute subdural hematoma (SDH), encountered since computerized tomography diagnosis became available, 61.5% were found to be the result of bleeding from a small cortical artery, 25.6% were of venous origin, 7.7% resulted from cerebral contusions, and 5% were acute bleeds into chronic subdural hematomas. Craniotomy was performed promptly on admission, but there was no difference in survival (overall 51.3%) between patients with arterial and venous bleeds. The only apparent factor affecting survival in this series was the preoperative neurological status: 67% of patients who were decerebrate and had fixed pupils prior to operation died. Of patients with less severe neurological dysfunction, only 20% failed to survive.


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