Search PubMed⌕ Search

Biomedical subjects

O Heiskanen

Publications and source records attributed to O Heiskanen.

At least 37 records · Page 2Linked to original sources
PubMed1989

Cognitive deficits related to computed tomographic findings after surgery for a ruptured intracranial aneurysm.

A consecutive series of 118 patients operated on for ruptured intracranial arterial aneurysms was studied. Ninety-six of them could be adequately examined with a battery of psychological tests and computed tomographic scans 1 year after a subarachnoid hemorrhage. Seventeen orthopedic control patients with no history of brain damage were also tested. The pattern of cognitive deficits was strongly related to the findings on the computed tomographic scans. Patients with left lateral infarctions had deficits on performances requiring verbal efficiency, including memory and classification tasks, whereas patients who had right lateral infarctions were poor on a visuoconstructional task (the copying of Rey's Figure). These deficits were pronounced when lateral infarction was associated with diffuse brain damage. Patients with frontal medial infarctions had low scores on memory tests; the inefficiency in verbal fluency, categorical reasoning, and memory was related to diffuse brain damage. The patients who had no infarctions did not differ significantly from the control group. Cognitive impairments after left lateral and frontal medial infarctions, as well as diffuse brain damage, correlated with the Glasgow Outcome Scale.

Brain↗
PubMed1989

Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study.

A total of 216 patients with a ruptured aneurysm of the anterior part of the circle of Willis were enrolled into this prospective randomized study of timing of the operation after aneurysmal subarachnoid hemorrhage (SAH). Only patients in clinical Grades I to III (according to the classification of Hunt and Hess) who were admitted and randomly assigned to a treatment group within 72 hours after the SAH were included in the trial. The patients were randomly assigned to one of three operation groups: acute surgery (AS: 0 to 3 days after the SAH; day of SAH = Day 0), intermediate surgery (IS: 4 to 7 days after the SAH), or late surgery (LS: 8 days to an indefinite time after the SAH). Three patients (4.3%) in the IS group and six patients (8.6%) in the LS group died before surgery was undertaken. At 3 months post-SAH, 65 patients (91.5%) from the AS group were classified as independent compared to 55 (78.6%) from the IS group and 56 (80.0%) from the LS group. The management mortality rate in the AS group was 5.6% compared to 12.9% in the LS group. Of the 216 patients enrolled in the timing study, 159 were randomly assigned to an independent double-blind placebo-controlled trial of nimodipine in Grade I to III patients. A total of 79 patients received nimodipine and 80 placebo. When the nimodipine group and the no-nimodipine group (the 80 placebo-treated patients plus the 52 patients who were not entered into the nimodipine trial) were analyzed separately, a significant difference was seen in the outcome of the no-nimodipine group (dependent AS vs. dependent IS, p = 0.01). Nimodipine treatment was associated with a significant reduction of delayed ischemic deterioration (all operation group combined, nimodipine vs. no nimodipine p = 0.01; LS with nimodipine vs. LS with no nimodipine, p = 0.03).

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

Craniopharyngioma surgery in children: endocrine and visual outcome.

Twenty-two children with craniopharyngioma were operated on in our Department of Neurosurgery from 1970 to 1981. Removal was total in 11 patients. There was one surgical death, but no recurrences in this group. Only partial removal could be performed in 10 children, followed by stereotactic radiotherapy in one. Recurrences have occurred in 4 of these children and 2 of them have died. In 1 child a biopsy was performed, followed by insertion of a shunt and stereotactic radiotherapy. Nine years after treatment there have still been no recurrences. Visual acuity was unchanged after the procedure in 17/21 survivors, improved in 1, and deteriorated in 3. The visual fields remained unchanged in 11, improved in 3, and deteriorated in 7. The visual fields and visual acuity were normal postoperatively in 5 patients. Hypopituitarism was more extensive after the procedure. We recommended an attempt at total removal whenever possible.

Child↗
PubMed1988

Acute surgery for intracerebral haematomas caused by rupture of an intracranial arterial aneurysm. A prospective randomized study.

In a randomized prospective study, 15 patients with an intracerebral haematoma caused by an intracranial aneurysm were treated concervatively and 15 operated on as an emergency. Mortality was 12/15 (80%) in the conservative group and 4/15 (27%) in the surgical group. The difference is statistically significant. The deaths in the conservative group were caused by both the primary haematoma and rebleeding. The results suggest that intracerebral haematomas caused by rupture of an intracranial aneurysm should be evacuated immediately, and that the aneurysm should be clipped at the same operation.

Adolescent↗
PubMed1988

Postoperative computed tomographic control of 38 patients with craniopharyngioma.

Computed tomography scanning was performed on 38 patients 1-12 years after surgery for craniopharyngioma. Recurrence of the tumor had appeared in nine patients. Thirteen patients had a residual tumor, and 16 were tumor-free after primary surgery. In addition, one patient became tumor-free after total removal of the recurrent tumor. After partial removal, the rate of recurrence was high and the quality of life was impaired.

Adolescent↗
PubMed1988

Effect of nimodipine on the outcome of patients after aneurysmal subarachnoid hemorrhage and surgery.

The effect of intravenous nimodipine on the incidence of mortality and delayed ischemic neurological deficits of patients after aneurysmal subarachnoid hemorrhage (SAH) and surgery was studied in a prospective double-blind placebo-controlled trial. Upon admission, all of the patients were in Grades I to III according to the classification of Hunt and Hess. Of the 213 patients enrolled in the study, 58 underwent early surgery (within 72 hours after the bleed: Days 0 to 3), 69 were operated on subacutely (between Days 4 and 7), and 74 had late surgery (on Day 8 or later). Eleven patients died before surgery was undertaken and one was not scheduled for operation. Administration of the drug was started immediately after the radiological diagnosis of a ruptured aneurysm had been made. The dose of nimodipine or matching placebo was 0.5 micrograms/kg/min via continuous intravenous infusion for 7 to 10 days after the SAH and, if the patient was operated on late, for 2 to 3 days after the operation as well. After intravenous treatment, oral administration of nimodipine or placebo was continued for up to 21 days after SAH in a dose of 60 mg every 4 hours. Nimodipine treatment was associated with a significant decrease in mortality rate (p = 0.03) in the early and subacute surgery groups. In the total series the number of deaths due to delayed ischemic deterioration was significantly lower in the nimodipine group than in the placebo group (p = 0.01).

Adolescent↗
PubMed1987

Craniopharyngioma in children and adults. Correlations between radiological and clinical manifestations.

We studied the radiological and clinical manifestations of craniopharyngioma in 22 children and 29 adults. The tumours tended to be smaller in adults than in children, and non-calcified, more often solid than cystic and suprasellar than suprasellar-intrasellar. Small tumours were associated with symptoms which had long been overlooked. The size of the tumour did not influence the results of surgery in children, but in adults total removal was more often successful for small tumours. In the children total removal was achieved least often with calcified and suprasellar-intrasellar tumours. Pre-operative skull radiography was abnormal in all except one of the children but in only half of the adults. Sclerosis of the sella floor and erosion of the dorsum sellae are early signs which are easily overlooked.

Adult↗
PubMed1987

Surgery of incidental intracranial aneurysms.

A series of nine patients with an unruptured asymptomatic aneurysm not associated with a ruptured aneurysm is discussed. Three had giant aneurysms. Two patients had bilateral aneurysms of the middle cerebral artery. Five had solitary aneurysms of the middle cerebral artery. One had an aneurysm of the anterior communicating artery. One had an ophthalmic aneurysm. All aneurysms were clipped. Two operations were necessary in the two patients with bilateral aneurysms. There was no mortality and no significant morbidity. Clipping of the aneurysm is recommended for those patients who have no other serious illness that significantly increases the surgical risk. If a combination of pituitary tumor and aneurysm is found, a subfrontal instead of transsphenoidal approach should be considered so as to treat both the tumor and aneurysm at the same operation.

Cerebral Angiography↗
PubMed1987

Craniopharyngioma in adults.

Twenty-nine adults operated on for craniopharyngioma between 1970 and 1981 are described. Headache and/or endocrine symptoms often preceded the diagnosis by several years. There were 3 surgical deaths. One patient died accidentally 4 years after surgery. The 5-year survival was 5/5 after total removal, 10/11 after partial removal, 0/3 after palliative surgery; 1/1 after total removal and radiotherapy, 0/2 after partial removal and radiotherapy and 3/3 after palliative surgery and radiotherapy. Visual acuity improved in 9 of 23 patients and deteriorated in 1 patient. Visual fields improved in 8 of 21 patients and deteriorated in 7. Surgery increased the degree of hypopituitarism. Relative body weight increased greater than or equal to 10% by 3 months after surgery in 8 of 15 patients. The prognosis would probably be improved by earlier diagnosis.

Adult↗
PubMed1986

Craniopharyngioma in Finland. A study of 123 cases.

We report on 123 patients with craniopharyngioma diagnosed in Finland from 1951 to 1982. 45 patients were under 16 years of age at the time of diagnosis and 78 over 16 years. The age-distribution had peaks at 11-20 years and at 41-50 years. 115 patients were operated on; operation was radical in 67 cases (58%). Surgical mortality was 13%. The number of radical operations increased and surgical mortality decreased after 1970. Recurrence developed in 26 patients (21%), 11 after a radical and 15 after a non-radical operation. Recurrence-free survival, 10-year survival and life expectancy were best after radical operation. We consider that radical operation is the best treatment. For patients with a non-radical operation or with recurrence modern radiotherapy gives long-lasting relief.

Adolescent↗
PubMed1986

Risks of surgery for unruptured intracranial aneurysms.

A series is presented of 43 patients with multiple aneurysms and subarachnoid hemorrhage in whom a second operation was necessary in order to clip all the aneurysms. There was one surgical death due to coronary thrombosis and infarction which occurred 3 weeks after surgery, for a surgical mortality rate of 2.3%. One patient developed a permanent neurological deficit (hemiparesis and dysphasia). Thus, the surgical risks are smaller than the natural risk of bleeding and death from hemorrhage. Patients with any other serious illness increasing the surgical risk should not be subjected to an operation for an unruptured aneurysm; a second operation is indicated in all low-risk patients with multiple aneurysms or with incidentally identified aneurysms.

Adult↗
PubMed1985

Surgery of cerebellar astrocytomas, ependymomas and medulloblastomas in children.

A report is given on 118 children operated on for cerebellar astrocytoma, ependymoma or medulloblastoma in 1968-1982. During the first period (1968-1975) when the diagnosis was based on ventriculography and the operation performed later on the same day, the surgical mortality was 5%, 22%, and 16% respectively in these tumours. In the period since 1976, during which the diagnosis was based on CT and preoperative shunting was routine with the posterior fossa operation performed a week later and an operation microscope was available, no surgical mortality occurred. In patients with ependymoma or medulloblastoma the shunt was left in permanently; in patients with astrocytoma the shunt was removed if the patient tolerated its closure. The prognosis for astrocytoma was excellent. The 10-year survival rate was 97%. The five-year survival rate for medulloblastoma was 27% and the 10-year survival rate 13% which are less than the rates generally reported. For ependymoma patients the prognosis was poor whatever the therapy.

Astrocytoma↗
PubMed1981

Intracranial arterial aneurysms in children and adolescents.

This is a report on 32 patients with subarachnoid haemorrhage caused by rupture of an intracranial arterial aneurysm in the 0-19 age group. Sixteen of the aneurysms were situated in the bifurcation of the internal carotid artery, 8 in the anterior communicating artery, 4 in the posterior communicating artery, two in PICA, one in the middle cerebral artery, and one in the pericallosal artery. Direct intracranial clipping of the neck of the aneurysm was carried out in 26 cases, proximal clipping in three, wrapping in two, and common carotid ligation in one case. There was one death from surgery. The surgical mortality was thus 3.1%. In 80% of cases the result was good, i.e., the patient had no neurological deficit and was able to work or continue at normal school. The psychological tests indicated some cognitive deficits in aneurysm patients as compared to the control patients. The common feature of these deficits seemed to be an impairment of active retrieval and searching of memory, while common cognitive skills were usually preserved. Four of the five patients who were disabled had obvious deficits in their performances. In the other patients these deficits did not affect their capacity for work or studies, and they were usually unaware of them. Children seem to tolerate surgery better than adults. Comatose or drowsy patients should not be operated on. The operative method of choice is direct intracranial clipping of the neck of the aneurysm.

Adolescent↗
PubMed1981

Risk of bleeding from unruptured aneurysm in cases with multiple intracranial aneurysms.

The author presents a follow-up review of 61 patients with subarachnoid hemorrhage (SAH) and at least two intracranial artery aneurysms in whom only the ruptured aneurysm had been clipped. During a 10-year follow-up period, seven patients bled from a previously unruptured aneurysm; four of the hemorrhages were fatal. Three additional patients suffered fatal bleeding more than 10 years after the first SAH. The surgical mortality rate when operating on a ruptured aneurysm at this clinic was 4.2% in 1979. Considering that the mortality rate after rebleeding during an average follow-up period of 16 years was 11.5%, operation for unruptured aneurysms seems to have a slight edge over conservative treatment.

Adolescent↗
PubMed1979

Granulocytic sarcoma (chloroma) of the cerebellum and meninges a case report.

A 7-year-old boy, having had headache and vomiting for one month, was operated for a tumour in the left side of the posterior fossa. The tumour, weighing 52 g, infiltrated the dura mater, leptomeninges, and also, superficially, the left cerebellar hemisphere. The patient died five weeks after operation. Light and electron microscopical examination revealed a granulocytic sarcoma (chloroma). Pre- and postoperative blood examinations, together with postoperative and autopsy bone marrow examinations, showed no sign of acute myelogenous leukaemia. This is the second reported case of primary intracranial chloroma with no preceding sign of acute myelogenous leukemia, and the first case with cerebellar infiltration.

Cerebellar Neoplasms↗
PubMed1979

Chronic bilateral subdural haematoma in adults.

Twenty-nine patients with chronic bilateral subdural haematomas were surgically treated during 1966 to 1977. Twenty-four of them (83%) had a history of head injury, which caused unconsciousness in eight cases. The mean interval from trauma to operation was eleven weeks. The mean age of the patients was 60 years. The prevalence of the most commonly encountered symptoms and signs was: headache 72%, mental symptoms 48%, papilloedema 41%, vertigo 31%, nausea 28%, reduced consciousness 28%, walking difficulties 24%, hemiparesis 24%, and paraparesis 14%. The aggregate thickness of haematomas was 34 mm, 36 mm, and 40 mm in age groups of 20--39, 40--59, and over 60 years, respectively. All patients were operated on, four of them only unilaterally. Three patients in the whole series died. Two of them had been operated upon only on one side in the first session, the haematoma of the other side being evacuated 8 1/2 hours and four days later, respectively. Unilateral operation is likely to cause severe distortion of the midline structures and the brain stem and thus aggravates the cerebral situation. Therefore the necessity of simultaneous evacuation of the haematomas on both sides is stressed. The reason for the death of the third patient was delay in diagnosis. All three patients who died belonged to the group of eight patients with a reduced level of consciousness before surgery. Twenty-three of the survivors were fully independent in their daily lives, and three needed some help after operative treatment.

Adult↗