Biomedical subjects
Publications and source records attributed to E Arbit.
This paper reports a case of the extracranial extension of meningioma from the anterior cranial fossa to the nasal cavity which presented clinically with epistaxis. On rare occasions, the initial manifestation of olfactory groove meningioma is through ENT symptoms. Both the surgical approach and the relevant literature are reviewed.
We examined the effects of electrical stimulation of a restricted area of the dorsal medullary reticular formation (DMRF) on regional cerebral blood flow (CBF) in anesthetized (by chloralose), paralyzed (by curare) rats. CBF was measured in tissue samples by the Kety principle, with 14C-iodoantipyrine as indicator. Stimulation of DMRF elicited a widespread, significant increase in CBF in 12 of 13 areas. The increase in flow was greatest in cerebral cortex, up to 240% of control. However, it was also substantially increased in selected regions of telencephalon, diencephalon, mesencephalon, and lower brainstem, but not cerebellum. In contrast, electrical stimulation of the midline (interstitial nucleus of the medial longitudinal fasciculus) 1 mm medial to the DMRF did not change CBF. The increase in CBF evoked by DMRF stimulation persisted after transection of the spinal cord at C1 or cervical sympathetic trunk. We conclude that excitation of neurons originating in or passing through the DMRF can elicit a potent and virtually global increase of CBF. The effect appears to be mediated by intrinsic pathways of the central nervous system.
A newly designed cottonoid is fixed to the tip of the suction device by the negative pressure. It is especially useful during microsurgical procedures in areas crowded with neurovascular elements. The advantage of pressure-mounted cottonoids lies in the protection provided to the brain and neurovascular elements during suction, even in the face of high aspiration pressure, and in the simplicity of their use.
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A 15-year-old right-handed woman had selective impairment of speech--aphemia--after drainage of a left frontal hematoma caused by an arteriovenous malformation. There was no buccofacial or pharyngeal muscle dysfunction. Computerized tomography demonstrated residual injury extending from the Broca area to the inferior left precentral gyrus. Aphemia may have resulted from disruption of the connection between Broca's area and the portion of the motor cortex that controls oral and pharyngeal muscles.
A surgical approach to the clivus and anterior spine from C-1 to the upper part of C-5 is described. It is a direct approach that provides a wider and longer exposure than does the transoral approach. Despite the seemingly radical incision, the cosmetic deformity and functional loss are minimal. This approach is useful for the surgical treatment of a variety of processes that are situated ventral to the upper cervical spinal cord and the cervicomedullary junction.
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The results of surgical excision of solitary intracerebral metastases followed by whole-brain radiation therapy between 1972 and 1978 in a series of 78 patients were analyzed. The overall median survival of the series was 6 months with a 1-year survival rate of 29%. Statistical analyses of the data revealed that patients who presented with a cerebral metastasis 1 year or more after diagnosis of the primary cancer had a significantly longer survival than those in whom the metastasis was detected within 1 year (P less than .04). Patients with mild or no neurological deficits at time of craniotomy had a longer median survival and a 1-year survival of 44% (P less than .01). The presence of metastases at one or two other sites did not significantly affect overall survival except in those patients in whom the brain metastasis was detected more than 1 year after diagnosis of the primary tumor. Factors found to affect survival in this study may be useful in predicting survival of future patients similarly treated.
A patient with intracranial extension of an ethmoidal carcinoma is reported. Since the tumor progressed in size despite conventional radiation and chemotherapy, the patient was treated with Cis-dichlorodiamine platinum). Significant regression in the intracranial component was noted, thus allowing complete excision of the tumor through a craniofacial approach. Preoperative chemotherapy with this agent may have a role in the management of patients with paranasal sinus carcinoma if intracranial extension is present.
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Three cases of thoracic disc herniation presenting with signs of spinal cord compression are reported. The patients were operated on by an approach through a midline incision in which a pedicle is removed. Two patients were cured and one has improved.