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Biomedical subjects

H Troupp

Publications and source records attributed to H Troupp.

At least 19 recordsLinked to original sources
PubMed1990

Functional results of facial nerve suture after removal of acoustic neurinoma: analysis of 25 cases.

The facial nerve is sometimes severed during the removal of acoustic neurinomas, either intentionally to ensure complete removal, or unintentionally because of difficulties in identification. In such cases we have, if possible, sutured the nerve stumps microsurgically, either end to end or by use of an intervening nerve graft. We analyzed the outcome of 25 instances of facial nerve suturing in a series of 219 patients operated on for acoustic neurinoma from 1979 to 1987. The first signs of recovery appeared at an average of 12 months, and there was continued improvement for several years. Recovery was graded from 1 to 6. The anastomosis was successful in 24 of the 25 sutured nerves, in that at least some facial movement and tone were restored (Grade 5 or higher). In 11 of the 25 cases, facial appearance at rest and with movement was moderately good (Grade 2 or 3). A Grade 1 result, with no perceivable facial dysfunction, was never achieved. Typically, oral muscles showed the most improvement and frontal muscles the least. Facial appearance was better at rest than with movement, which was always complicated by some degree of synkinesis. Closure of the eye was so good in 13 of the 25 cases that neither tarsorrhaphy nor an eyelid spring was necessary. When the facial nerve is severed, intraoperative suture is recommended, because it provides a chance for moderately good restoration of facial appearance.

Evaluation Studies as Topic↗
PubMed1990

The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment.

The authors have updated a series of 166 prospectively followed unoperated symptomatic patients with arteriovenous malformations (AVM's) of the brain. Follow-up data were obtained for 160 (96%) of the original population, with a mean follow-up period of 23.7 years. The rate of major rebleeding was 4.0% per year, and the mortality rate was 1.0% per year. At follow-up review, 23% of the series were dead from AVM hemorrhage. The combined rate of major morbidity and mortality was 2.7% per year. These annual rates remained essentially constant over the entire period of the study. There was no difference in the incidence of rebleeding or death regardless of presentation with or without evidence of hemorrhage. The mean interval between initial presentation and subsequent hemorrhage was 7.7 years.

Adolescent↗
PubMed1989

The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment.

In a prospective study, 52 patients with a spontaneous supratentorial intracerebral hematoma (ICH) were randomly assigned to receive emergency surgery or conservative treatment within 48 hours after the bleed. Patients with a decreased level of consciousness and/or a severe neurological deficit were admitted to the study. The overall mortality rate at 6 months was 42%: 10 (38%) of the 26 patients in the conservative group and 12 (46%) of the 26 in the surgical group. Six (20%) of the 30 survivors at 6 months were able to conduct their activities of daily living independently: five (31%) of the 16 patients in the conservative group and one (7%) of the 14 in the operative group. These differences are not statistically significant. The mortality rate of semicomatose or stuporous patients (Glasgow Coma Scale score 7 to 10) was statistically significantly lower in the surgical group (none of the four patients) than in the conservative group (four of five patients) (p less than 0.05); however, all surviving patients in this subgroup were severely disabled. The study suggests that surgical treatment of this category of patients with ICH does not offer any definite advantage over conservative treatment. In semicomatose or stuporous patients, surgery may improve the length of survival, but the quality of life remains poor.

Adolescent↗
PubMed1988

Correlations between meatocisternography and audiological tests in suspected eight nerve tumors.

92 cases of suspected eight nerve tumors are analysed. Correlations between the findings in audiological and vestibular tests, patient histories and findings in conventional x-ray examinations and on the other hand those obtained in meatocisternography with air contrast in computerized tomography are drawn in order to see whether specific features of audiological tests can predict the meatocisternographic finding. The cases with positive findings are verified at surgery.

Audiometry↗
PubMed1986

Volume growth rate of acoustic neurinomas.

Of 79 acoustic neurinomas seen between June 1980 and June 1984, at least two CT scans were available for each of 23 tumors (21 patients); the scans were performed at intervals of at least 6 months. The volume growth rate of the tumours was either moderate, with a volume doubling time ranging from 205 to 545 days, or slow, with a doubling time ranging from 1090 days to no observable growth. No single clinical, radiological or histological feature correlated with any type of growth rate. However, some conclusions were drawn. If a primary CT scan is negative, at least 1 year should elapse before it is worthwhile taking another scan, even though audiological findings suggest growth; after an apparently radical removal, at least 3 years should elapse before a check CT scan is worthwhile; and if a small acoustic neurinoma is diagnosed, but for some reason not operated upon, a second CT scan should be carried out 1 year later in order to reassess the case.

Adolescent↗
PubMed1986

Hormone treatment of meningiomas: lack of response to medroxyprogesterone acetate (MPA). A pilot study of five cases.

Medroxyprogesterone acetate (MPA) has been used in high doses as hormone treatment for metastatic breast cancer. We treated five intracranial meningiomas with MPA expecting that MPA would reduce the volume or decrease the growth rate. All five patients were postmenopausal women, aged 47 to 73 years. Before treatment, the growth rate of each tumour was assessed by two consecutive CT scans (CT 1 and CT 2). Tumours 1 to 4, histologically benign meningiomas, grew slowly as the tumour volumes were not found to increase in 21 to 45 months between CT 1 and CT 2. Tumour 5 was an anaplastic meningioma the rapid growth of which was evident in 8 weeks between CT 1 and CT 2. After CT 2, MPA was given 1,000 mg intramusculary once weekly for 17 to 29 weeks until CT 3 which showed the response. Tumours 1 to 4 had neither reduced in volume nor developed necroses, and tumour 5 continued its fast growth at the same rate as before.

Aged↗
PubMed1986

Suboccipital removal of vestibular neurinoma with preservation of the labyrinth.

Hearing preservation in surgery for vestibular neurinoma depends on several factors, the first of which is, of course, early diagnosis. If a small enough tumor is found in a patient with reasonable hearing, there is a fair chance that it can be removed in toto with preservation of some hearing. We report data from 40 operated patients; the question was whether the identification of the transverse crest and the removal of tumor from the lateral part of the internal auditory meatus could be achieved without opening of perilymph spaces. In most of these ears the angle from the medial edge of a suboccipital craniectomy allowed the surgeon a direct view of the lateral part of the internal auditory meatus with good exposure of the transverse crest without his having to open the labyrinth. So far we believe that loss of hearing caused during these operations is mainly due to the unfavorable location of the cochlear blood supply through the meatus.

Ear, Inner↗
PubMed1981

Changes in the requirements for blood transfusion in brain surgery.

The amount of blood used in transfusions during certain neurosurgical operations was less in 1978-79 than in 1971-72 and in 1965-66. The operations investigated were for gliomas and meningiomas of the brain, pituitary adenomas, acoustic neurinomas, arteriovenous malformations, and arterial aneurysms. The major change in anaesthetic techniques between 1965-66 and 1971-72 was the introduction of hypocapnia by controlled artificial hyperventilation. We suggest that this was the main factor responsible for the reduction in the need for blood transfusions. The avoidance of halothane, the use of induced hypotension, and microsurgical technique may have been responsible for the smaller drop between 1971-72 and 1978-79. Good neurosurgical anaesthesia demands anaesthetic expertise, reliable apparatus, and instant laboratory service, but may also reduce costs by reducing the need for blood transfusions.

Anesthesia↗
PubMed1980

A retrospective study on the effects of low and high doses of betamethasone on severe closed head injury.

A retrospective analysis of 113 patients with severe head injuries (unconscious for six hours or more) showed no difference in the outcome for 59 patients treated with low doses of betamethasone compared to the outcome for 54 patients treated with high doses of betamethasone. There was no difference in the number of useful recoveries (low dose, 21/59; high dose, 20/54) and the mortality rates were about the same (low dose 29/59; high dose, 31/54). There were three deaths from infectious complications in the patients treated with high doses of betamethasone.

Adolescent↗
PubMed1979

Recent expericience in the surgery of acoustic neurinomas.

A translabyrinthine method was used in 49 and a suboccipital approach in 55 cases, for the removal of an acoustic neuroma. The translabyrinthine procedure is well suited in cases with no pontine compression, whereas in large tumours the wide opening in the suboccipital method gives added safety to the procedure. The mortality rate was 3% and the facial nerve function after translabyrinthie surgery showed permanent paralysis in 4 patients. A team approach using the suboccipital route has been started in an attempt to save hearing in small- and medium-sized tumours.

Ear, Inner↗
PubMed1978

Subarachnoid haemorrhage: long-term follow-up results of late surgical versus conservative treatment.

During 1964-9, 178 patients with subarachnoid haemorrhage from a single intracranial arterial aneurysm were allocated at random to receive operative or conservative treatment at an average of seven weeks after bleeding. During the follow-up fatal rebleeding episodes occurred in six of the 86 patients treated surgically and 16 of the 92 treated conservatively. This difference was significant. Fatal rebleeding occurred on average 40 months after the first episode. Deaths from all causes occurred in 17 of the 86 patients treated surgically and 22 of the 92 treated conservatively. Life-table analysis of the chances of surviving 1, 5, and 11 years gave probabilities of 95 and 91%, 87 and 86%, and 76 and 75% in the two treatment groups respectively. Of the 139 patients alive after a mean follow-up of nine years, 130 (94%) were fully independent in their daily lives, and only 43 (31%) were unable to work. The method of treatment did not affect the quality of survival.The results show that fatal rebleeding may occur even many years after the first episode. Nevertheless, if the patient is in good condition seven weeks after a haemorrhage from a single intracranial arterial aneurysm the outcome is good irrespective of whether operation is performed at this late stage.

Adult↗
PubMed1975

Brain creatine kinase in blood after acute brain injury.

Severe cold injury of the brain increased significantly both total creatine kinase and the corresponding brain isoenzyme (CKBB) activity in confluens sinuum samples. CKBB could be detected also in peripheral blood a few hours after severe brain injury in eight of 12 patients. Finding of CKBB in human plasma may prove a useful indicator of severe brain injury.

Animals↗
PubMed1975

Intracranial pressure in hydrocephalus after subarachnoid haemorrhage.

10 patients with hydrocephalus after subarachnoid haemorrhage underwent a continuous ventricular fluid pressure recording for at least 22 hours, 21-67 days after the first subarachnoid haemorrhage. 3 patients had normal pressures; 4 patients had pressures somewhat above normal, between 10 and 20 mmHg; three patients had rather a high pressure, with a mean above 20 mmHg and peaks to 45 mmHg. 5 patients had a shunt operation, which seemed to improve the patient's condition in 3 instances; a sixth patient improved during ventricular drainage, but suffered a fatal haemorrhage before a shunt could be inserted. Of those 3 patients who improved after a shunt, 2 had a ventricular fluid pressure somewhat above normal (see Fig. 2) and one a high pressure. Of the 2 patients that did not improve in spite of a well-functioning shunt, one had a pressure somewhat above normal (Fig. I) and one high pressure (Fig. 3). 4 patients did not have a shunt operation; in 3 of these the pressure appeared to be within normal limits, and one patient, though the pressure was somewhat above normal, was in such a good conditon that no operation was thought necessary. One of the patients with normal pressure has spent 12 months in a mental hospital; the others recovered reasonably well, though only one has returned to work. From this small series it seems that a pressure recording cannot predict how the patient is going to become with a shunt; but the recording may help to sortout those with normal pressure, who are not likely to require a shunt, particularly as many complications are on record for shunts. In 2 instances, an aneurysmo re-bled after a high ventricular fluid pressure had been reduced, 40 and 38 days after the first subarachnoid haemorrhage; the risks inherent in changing the pressure conditions within the skull should be remembered.

Cerebrospinal Fluid Shunts↗