Postoperative mutism in neurosurgery

1994 ◽  
Vol 81 (1) ◽  
pp. 115-121 ◽  
Author(s):  
J. Stuart Crutchfield ◽  
Raymond Sawaya ◽  
Christina A. Meyers ◽  
Bartlett D. Moore
Keyword(s):  
Motor Cortex ◽  
Thalamic Nucleus ◽  
Transient Condition ◽  
Brain Surgery ◽  
Content Type ◽  
First Case ◽  
Ventrolateral Nucleus ◽  
Supplementary Motor Cortex ◽  
Parasagittal Meningioma ◽  
Fine Print

✓ Mutism is defined as a state in which a patient is conscious but unwilling or unable to speak. It has been reported to occur in association with a multitude of conditions, including trauma, epilepsy, tumors, stroke, psychoses, and brain surgery. The cases of two patients who became mute in the immediate postoperative period are presented. The first patient developed mutism following removal of a parasagittal meningioma, and the second following removal of a posterior fossa medulloblastoma. It is believed that transient injury may have occurred to the supplementary motor cortex in the first case and to the dentate nuclei in the second case. It is interesting that these two areas are connected via pathways involving the ventrolateral nucleus of the thalamus, and that lesions of this thalamic nucleus can also lead to mutism. It therefore appears plausible that interruption of these pathways may be involved in the pathogenesis of mutism. Although mutism is an infrequent complication of brain surgery, neurosurgeons should be aware that it may occur following removal of lesions in these areas and that it is generally a transient condition.

The use of intraarterial papaverine in the management of vasospasm complicating arteriovenous malformation resection

1995 ◽  
Vol 82 (2) ◽  
pp. 296-299 ◽  
Author(s):  
Michael K. Morgan ◽  
Maurice J. Day ◽  
Nicholas Little ◽  
Verity Grinnell ◽  
William Sorby
Keyword(s):  
Arteriovenous Malformation ◽  
Perfusion Pressure ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Venous Occlusion ◽  
Neurological Deterioration ◽  
Unusual Complication ◽  
Content Type ◽  
First Case ◽  
Normal Perfusion Pressure Breakthrough ◽  
Fine Print

✓ The authors report two cases of treatment by intraarterial papaverine of cerebral vasospasm complicating the resection of an arteriovenous malformation (AVM). Both cases had successful reversal of vasospasm documented on angiography. In the first case sustained neurological improvement occurred, resulting in a normal outcome by the time of discharge. In the second case, neurological deterioration occurred with the development of cerebral edema. This complication was thought to be due to normal perfusion pressure breakthrough, on the basis of angiographic arterial vasodilation and increased cerebral blood flow. These two cases illustrate an unusual complication of surgery for AVMs and demonstrate that vasospasm (along with intracranial hemorrhage, venous occlusion, and normal perfusion pressure breakthrough) should be considered in the differential diagnosis of delayed neurological deterioration following resection of these lesions. Although intraarterial papaverine may be successful in dilating spastic arteries, it may also result in pathologically high flows following AVM resection. However, this complication has not been seen in our experience of treating aneurysmal subarachnoid hemorrhage by this technique.

Transcranial electrical stimulation through screw electrodes for intraoperative monitoring of motor evoked potentials

2004 ◽  
Vol 100 (1) ◽  
pp. 155-160 ◽  
Author(s):  
Katsushige Watanabe ◽  
Takashi Watanabe ◽  
Akio Takahashi ◽  
Nobuhito Saito ◽  
Masafumi Hirato ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Motor Cortex ◽  
Evoked Potentials ◽  
Intraoperative Monitoring ◽  
Primary Motor Cortex ◽  
Motor Evoked Potentials ◽  
Transcranial Electrical Stimulation ◽  
Content Type ◽  
Motor Pathways ◽  
Fine Print

✓ The feasibility of high-frequency transcranial electrical stimulation (TES) through screw electrodes placed in the skull was investigated for use in intraoperative monitoring of the motor pathways in patients who are in a state of general anesthesia during cerebral and spinal operations. Motor evoked potentials (MEPs) were elicited by TES with a train of five square-wave pulses (duration 400 µsec, intensity ≤ 200 mA, frequency 500 Hz) delivered through metal screw electrodes placed in the outer table of the skull over the primary motor cortex in 42 patients. Myogenic MEPs to anodal stimulation were recorded from the abductor pollicis brevis (APB) and tibialis anterior (TA) muscles. The mean threshold stimulation intensity was 48 ± 17 mA for the APB muscles, and 112 ± 35 mA for the TA muscles. The electrodes were firmly fixed at the site and were not dislodged by surgical manipulation throughout the operation. No adverse reactions attributable to the TES were observed. Passing current through the screw electrodes stimulates the motor cortex more effectively than conventional methods of TES. The method is safe and inexpensive, and it is convenient for intraoperative monitoring of motor pathways.

Spontaneous spinal subdural hematoma associated with low-molecular-weight heparin

2005 ◽  
Vol 2 (5) ◽  
pp. 612-613 ◽  
Author(s):  
Yoon-Hee Cha ◽  
John H. Chi ◽  
Nicholas M. Barbaro
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Spinal Instrumentation ◽  
Cord Compression ◽  
Low Molecular Weight ◽  
Content Type ◽  
First Case ◽  
Spinal Subdural Hematoma ◽  
History Of ◽  
Fine Print

✓ Spinal subdural hematomas (SDHs) are a rare cause of cord compression and typically occur in the setting of spinal instrumentation or coagulopathy. The authors report the first case of a spontaneous spinal SDH occurring in conjunction with low-molecular-weight heparin use in a patient with a history of spinal radiotherapy.

Functional neuronavigation with magnetoencephalography: outcome in 50 patients with lesions around the motor cortex

1999 ◽  
Vol 91 (1) ◽  
pp. 73-79 ◽  
Author(s):  
Oliver Ganslandt ◽  
Rudolf Fahlbusch ◽  
Christopher Nimsky ◽  
Helmut Kober ◽  
Martin Möller ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Three Dimensional ◽  
Image Data ◽  
Data Set ◽  
Content Type ◽  
Promising Tool ◽  
Neuronavigation System ◽  
Functional Neuronavigation ◽  
Intraoperative Recording ◽  
Fine Print

Object. The authors conducted a study to evaluate the clinical outcome in 50 patients with lesions around the motor cortex who underwent surgery in which functional neuronavigation was performed.Methods. The sensorimotor cortex was identified in all patients with the use of magnetoencephalography (MEG). The MEG-source localizations were superimposed onto a three-dimensional magnetic resonance image and the image data set was implemented into a neuronavigation system. Based on this setup, the surgeon chose the best surgical strategy. During surgery, the pre- and postcentral gyri were identified by neuronavigation and, in addition, the central sulcus was localized using intraoperative recording of somatosensory evoked potentials. In all cases MEG localizations of the sensory or motor cortex were correct. In 30% of the patients preoperative paresis improved, in 66% no additional deficits occurred, and in only 4% (two patients) deterioration of neurological function occurred. In one of these patients the deterioration was not related to the procedure.Conclusions. The method of incorporating functional data into neuronavigation systems is a promising tool that can be used in more radical surgery to lessen morbidity around eloquent brain areas.

Intracerebral hemorrhage complicating cervical “hourglass” schwannoma removal

2001 ◽  
Vol 94 (1) ◽  
pp. 150-153 ◽  
Author(s):  
Xavier Morandi ◽  
Laurent Riffaud ◽  
Beatrice Carsin-Nicol ◽  
Yvon Guegan
Keyword(s):  
Intracerebral Hemorrhage ◽  
Surgical Procedure ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Neurosurgical Procedure ◽  
Content Type ◽  
Postoperative Course ◽  
First Case ◽  
Fine Print

✓ The authors report a case of infra- and supratentorial intracerebral hemorrhage complicating the postoperative course of a patient who had undergone surgical removal of a cervical schwannoma with an hourglass configuration. To their knowledge, this is the first case in which this neurosurgical procedure was followed by such a complication. Possible mechanisms are discussed; however, pathological events leading to this complication are unclear. The development of new neurological deficits not attributable to the surgical procedure should suggest this possibility.

Cavernous hemangioma of Meckel's cave

1988 ◽  
Vol 68 (4) ◽  
pp. 645-647 ◽  
Author(s):  
Michael G. Fehlings ◽  
William S. Tucker
Keyword(s):  
Cavernous Hemangioma ◽  
Vascular Malformation ◽  
Facial Pain ◽  
Gasserian Ganglion ◽  
Middle Fossa ◽  
Meckel’S Cave ◽  
Content Type ◽  
First Case ◽  
Meckel's Cave ◽  
Fine Print

✓ A case of a cavernous hemangioma located within Meckel's cave and involving the gasserian ganglion is described in a patient presenting with facial pain and a trigeminal nerve deficit. Although these lesions have been reported to occur in the middle fossa, this is believed to be the first case of such a vascular malformation arising solely from within Meckel's cave.

Abscess formation within a parasagittal meningioma

1998 ◽  
Vol 88 (5) ◽  
pp. 895-897 ◽  
Author(s):  
Mark B. Eisenberg ◽  
Rolando Lopez ◽  
Albert E. Stanek
Keyword(s):  
Lower Extremity ◽  
Proteus Mirabilis ◽  
Focal Seizure ◽  
Abscess Formation ◽  
Content Type ◽  
Immunocompetent Individual ◽  
Parasagittal Meningioma ◽  
Fine Print

✓ The authors present the case of a 78-year-old woman who developed right lower-extremity paralysis after a focal seizure. Neuroradiological studies revealed a small parasagittal meningioma, which at the time of resection was found to contain a bacterial intratumoral abscess secondary to Proteus mirabilis. This is only the second reported case of intratumoral abscess formation in a meningioma and the first such occurrence to be reported in an otherwise healthy, immunocompetent individual.

Traumatically induced lymphangioma of the ulnar nerve

2000 ◽  
Vol 93 (6) ◽  
pp. 1069-1071 ◽  
Author(s):  
John C. L. Sun ◽  
John Maguire ◽  
Thomas J. Zwimpfer
Keyword(s):  
Peripheral Nerve ◽  
Ulnar Nerve ◽  
Venous System ◽  
Lymphatic Tissue ◽  
Content Type ◽  
First Case ◽  
Fine Print

✓ Lymphangiomas, benign hamartomatous lesions involving lymphatic tissue, result from a failure of lymphatic channels to communicate with the venous system or normal lymphatic channels. The authors describe a case in which a lymphangioma arising within the ulnar nerve developed after trauma to the same area. This is the second reported case of a lymphangioma that originated from a peripheral nerve and the first case in which the lesion was associated with trauma. The authors propose that a lymphangioma involving the peripheral nerve may be the result of trauma.

Reversal of thalamic hand syndrome by long-term motor cortex stimulation

2000 ◽  
Vol 93 (5) ◽  
pp. 873-875 ◽  
Author(s):  
Angelo Franzini ◽  
Paolo Ferroli ◽  
Domenico Servello ◽  
Giovanni Broggi
Keyword(s):  
Motor Cortex ◽  
Complete Recovery ◽  
Common Mechanism ◽  
Central Pain ◽  
Motor Cortex Stimulation ◽  
Content Type ◽  
Hand Dystonia ◽  
Fine Print

✓ The authors describe a case of complete recovery from the so-called “thalamic hand” syndrome following chronic motor cortex stimulation in a 64-year-old man suffering from poststroke thalamic central pain. As of the 2-year follow-up examination, the patient's dystonia and pain are still controlled by electrical stimulation.It is speculated that a common mechanism in which the thalamocortical circuit loops are rendered out of balance may sustain hand dystonia and central pain in this case of thalamic syndrome. To the authors' knowledge this is the first reported case of its kind.

Management of carotid-cavernous fistulas by surgery combined with interventional radiology

1983 ◽  
Vol 59 (6) ◽  
pp. 1076-1081 ◽  
Author(s):  
Brian M. Tress ◽  
Kenneth R. Thomson ◽  
Geoffrey L. Klug ◽  
Roger R. B. Mee ◽  
Bruce Crawford
Keyword(s):  
Interventional Radiology ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Balloon Catheter ◽  
Superior Ophthalmic Vein ◽  
Detachable Balloon ◽  
Content Type ◽  
First Case ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ Two cases of carotid-cavernous fistulas were successfully treated by standard interventional radiology techniques after otherwise inaccessible vessels were surgically exposed. In the first case, an internal carotid artery (ICA), which had previously been ligated as part of an attempted surgical “entrapment” procedure, was recanalized to permit passage of a detachable balloon catheter to the fistula, resulting in its obliteration. In the second case, an enlarged superior ophthalmic vein was exposed and isolated to facilitate retrograde catheterization of the cavernous sinus and obliteration of a dural fistula between the ICA and the cavernous sinus by steel Gianturco coils. The methods and complications of both procedures are discussed.

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