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Biomedical subjects

A D Parent

Publications and source records attributed to A D Parent.

At least 19 recordsLinked to original sources
PubMed1995

Indications for the surgical management of central nervous system blastomycosis.

BACKGROUND: Blastomycotic infections of the central nervous system (CNS) occur infrequently. The medical literature concerning blastomycosis of the CNS contains little information regarding indications for surgery. METHODS: We report five cases of CNS blastomycosis that required surgery: four intracranial and one intraspinal. One patient had a prior diagnosis of sarcoidosis, whereas none of the others had been diagnosed with any other systemic illness. The patients were evaluated with plain x rays as well as with computed tomography or magnetic resonance imaging. RESULTS: Four of these patients had extradural abscesses that required surgical drainage as well as debridement of granulomatous tissue and infected bone. The remaining patient had an intracerebellar abscess. Postoperatively, three patients were treated with amphotericin B, one with amphotericin B and ketoconazole, and one with an experimental protocol of fluconazole alone. All of the patients recovered without sequelae of seizures, recurrence of disease, or reaction to pharmacotherapy, although one patient had transient renal insufficiency due to amphotericin B. CONCLUSIONS: Our experience with CNS blastomycosis managed surgically is reported. We propose three general surgical indications for these patients: mass lesions, diagnostic biopsy, and osteomyelitis refractory to pharmacotherapy.

Adolescent↗
PubMed1995

Neurosurgical considerations on the anatomy of the medial canthus in children.

Craniofacial surgery and anterior skull base surgical techniques require an intimate knowledge of periorbital structures. The medial orbital anatomy is especially important for midline approaches to nasion encephalocele, midline trauma, surgery for hypertelorism as well as midline approaches to anterior skull base lesions. The medial canthal tendon is of primary importance in anchoring the eyelid medially in a cosmetic and functional fashion. This review will summarize the anatomic features of the medial canthus and its surrounding structures, including vascular and muscular components. The intimate relationship of the three components of the medial canthal tendon to the nasal lacrimal apparatus is emphasized. Techniques to prevent injury as well as to repair abnormalities in this area will be discussed.

Child↗
PubMed1995

Contemporaneous shunting with repair of myelomeningocele.

The combination of overt hydrocephalus and an open myelomeningocele in a newborn has prompted some authors to advocate the repair of the myelomeningocele and the performance of a shunt procedure during the same anesthetic procedure. Advocates of this approach stress the merits of administering only one anesthetic, diminution in incidence of cerebrospinal fluid leaks from the repair, and shortened hospital stay and the resultant cost-effectiveness. This study was performed to assess the complication rate of shunts inserted at the time of myelomeningocele repair as well as of those inserted at a later date as a separate procedure. It would later appear that the insertion of a ventriculoperitoneal shunt, contemporaneous with the repair of the myelomeningocele, does not increase the risks of shunt infection or shunt malfunction within the 1st year of life.

Cerebrospinal Fluid Shunts↗
PubMed1994

Severe cervical kyphotic deformities in patients with plexiform neurofibromas: case report.

Two patients with cervical plexiform neurofibromas are presented. Each of these patients had severe cervical kyphosis and has undergone anterior decompression, anterior reconstruction, and posterior stabilization. We discuss the surgical management of cervical kyphotic deformities associated with plexiform neurofibromas and review the factors associated with bony changes in neurofibromatosis.

Adolescent↗
PubMed1992

Lateral cervical spine dislocation and vertebral artery injury.

Although anterior and posterior traumatic displacement of cervical vertebrae are commonly noted, and the devastating neurological deficits associated with these injuries have been amply defined, lateral displacement with fractures has been rarely recognized, and the clinical significance of this injury has been overlooked. This report describes five cases of cervical spine fractures with lateral dislocation. All patients had lateral and anteroposterior cervical spine radiographs as well as cervical angiography or postmortem study demonstrating either complete occlusion or significant impairment of flow of the vertebral arteries. Two cases had traumatic vertebral artery occlusion with secondary medullary and cerebellar infarction resulting in the patient's death. Vertebral artery injury apparently is not uncommon in this particular type of fracture. The diagnosis of these vascular injuries may require angiography or magnetic resonance angiography. A vertebral occlusion or dissection is a problem of considerable complexity, requiring individualized management depending on the patient's symptomatology, location and nature of the injury, and time lapsed since the injury.

Adult↗
PubMed1990

Visual recovery after blindness from pituitary apoplexy.

In a series of 11 patients with classic pituitary apoplexy, two patients had the acute onset of bilateral blindness. After transsphenoidal decompressive surgery both patients had useful recovery of vision. Although impairment of neurologic function appears irreversible when central nervous tissue has been compressed to the point of total loss of function it would appear that the optic chiasm may be an exception to this experience. Our review of the literature and our experience suggests that decompression can be worthwhile even late in the course of this disease and visual loss should not be treated expectantly.

Adult↗
PubMed1990

Pathologic findings in brains of patients with focal epileptic seizures who had a craniotomy procedure.

This report reviews the pathologic findings in brains of 12 patients with focal epileptic seizures who had a craniotomy procedure. A majority of patients (seven) had either a cerebral neoplasm or a developmental abnormality (tuberous sclerosis and hamartoma), and these were found in six of the nine patients with chronic and intractable seizures. Four patients had cortical gliosis or scarring, and one had a bacterial brain abscess. Ten patients had a visible focal structural lesion during cranial imaging procedures, and in two instances, the MRI study was more sensitive than the CT in detecting a cerebral lesion.

Adolescent↗
PubMed1989

Thoracic disc herniation and paraplegia in Stickler's syndrome.

Stickler's syndrome, an autosomal dominant connective tissue disorder, is characterized by progressive ophthalmic, orofacial, and skeletal abnormalities. Epiphyseal dysplasia is seen in this syndrome and affects the spine, causing anterior vertebral body wedging and Schmorl's node formation. These spinal abnormalities are usually asymptomatic. We report here the first case of thoracic disc herniation and paraplegia associated with Stickler's syndrome.

Adolescent↗
PubMed1987

Syringomyelia after decompressive laminectomy for cervical spondylosis.

We describe a case of cervical spondylotic myelopathy in which deterioration occurred a month after decompressive laminectomy. Syringomyelia was then in evidence as seen by myelography and delayed metrizamide computed tomography scanning. The etiology of this finding and its possible relation to the course and treatment of cervical spondylotic myelopathy are discussed.

Adult↗
PubMed1987

Supratentorial pressures. Part I: Differential intracranial pressures.

Dynamic supratentorial pressure changes may differentially alter tissue pressure and intraventricular fluid pressure. To evaluate these pressures, we used a floppy cuff intracerebral catheter and an intraventricular catheter in the cat and rhesus monkey. Baseline intraventricular pressures exceeded intracerebral pressure in both species. Intraventricular pressure was 3-4 mmHg in cats and 6-14 mmHg in monkeys, while the intracerebral pressure was in the range 0-4 mmHg in both. Saline injection into the spinal or cranial subarachnoid space resulted in a greater increase in ventricular fluid pressure, and the time for return to baseline was one and a half times longer in the intraventricular compartment. Jugular venous and abdominal compression resulted in a greater rise in the ventricular pressure than intracerebral pressure. Inflation of subdural balloons and intracerebral injection of silicone caused a differential pressure across the brain with the pressure being greatest in the ipsilateral hemisphere and lowest in the contralateral hemisphere. Rapidly evolving epidural masses produced varied results. We did not evaluate compensatory pressure changes in these animals. Those pressures that involve cerebrospinal fluid (CSF) dynamics alter intraventricular pressure more than tissue pressure. Alternatively, rapidly forming masses tend to increase tissue pressure near the mass more than intraventricular pressure.

Animals↗
PubMed1987

Supratentorial pressures. Part II: Intracerebral pulse waves.

Intracerebral pulse waves were recorded in cat and monkey while intracranial pressure (ICP) manipulations were performed. The intracerebral pulse waves appeared comparable to cerebrospinal fluid (CSF) pulsations. The wave forms were divided into multiple smaller waves, designated P1 to P4. The P1 component was primarily of arterial origin and was accentuated by increasing ICP unrelated to increased venous pressure, most commonly from a mass lesion. Bilateral carotid occlusion resulted in decreased amplitude of P1. Venous hypertension from jugular venous or sagittal sinus occlusion, on the other hand, accentuated waves P2 and P3 more than P1. This is consistent with a Starling resistor model of the cerebral venous system in which mass lesions may compress low-pressure veins and accentuate the arterial pressure-dependent P1 wave, whereas venous hypertension causes increased prominence of the later P2 and P3 waves.

Animals↗
PubMed1987

Subdural empyemas in children.

Subdural empyema is a neurosurgical emergency which is rapidly fatal if not recognized and managed promptly. Most series report a 30-40% mortality, and recommend a craniotomy along with aggressive medical therapy. Between 1978 and 1986, 8 children (2 months to 13 years) with subdural empyemas were diagnosed and treated at our institution, and form the basis for this study. Burr hole and catheter drainage was the treatment of choice in 5 children, while craniotomy was required in 1 case of sinusitis with osteomyelitis. Three infants received multiple subdural taps via the anterior fontanel. All patients responded to surgical intervention and antibiotic therapy. The average follow-up period was 29 months, and 5 children had no developmental delay, decrease in school performance, or impairment of intellectual function. There were no deaths in our series. Although the surgical management of subdural empyemas remains controversial, it appears that burr hole and catheter drainage is sufficient in most cases. With earlier diagnosis, aggressive antibiotic therapy, and timely surgical intervention, the morbidity and mortality of subdural empyemas have significantly diminished in recent years.

Adolescent↗
PubMed1985

Intracranial pressure monitoring by flaccid-cuff catheter in an animal model.

Several methods of monitoring intracranial pressure (ICP) are in current use, each with its own advantages and disadvantages. The intraventricular line has been most useful because of the ability to withdraw cerebrospinal fluid to assist in control of elevated ICP. However, masses within the brain or generalized increased ICP may compress the lateral ventricle, making insertion of the catheter difficult or impossible. The intracerebral wick records hydrostatic changes too slowly to be used clinically. Swollen cerebral tissue may occlude the subarachnoid bolt thereby dampening the recorded pressure, and epidural monitors may give falsely high recordings because of irregularities of dura or bone. The authors have developed a flaccid-cuff catheter which has proven in animals to be an effective ICP monitor. There are several advantages, such as easy insertion into the centrum semiovale, rapid response to acute pressure changes, and continued sensitivity for periods of up to 3 weeks. The flaccid catheter cuff has no tension so that the pressure across the membrane is equal to zero, simplifying calibration. This type of cuff is necessary for maximum sensitivity to interstitial, brain-tissue, and gross ICP changes. The flaccid-cuff catheter may prove to be useful in a variety of situations such as after closed head trauma or intracranial surgery to assess elevated ICP caused by edema or evolving hematoma.

Animals↗
PubMed1985

Acromegaly.

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Acromegaly↗