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Biomedical subjects

R F Spetzler

Publications and source records attributed to R F Spetzler.

At least 235 records · Page 13Linked to original sources
PubMed1986

Microsurgical endarterectomy under barbiturate protection: a prospective study.

Carotid endarterectomy has the potential to improve on the natural history of untreated carotid artery disease with respect to subsequent infarction in symptomatic patients with causative angiographic lesions. This benefit of a reduced risk of stroke can be realized only if the perioperative morbidity and mortality rates are kept low. An approach to symptomatic carotid artery bifurcation disease is outlined, with a defined protocol of microsurgical endarterectomy utilizing barbiturate protection during the period of potential focal temporary cerebral ischemia. This protocol includes preoperative antiplatelet therapy, barbiturate anesthesia, the avoidance of an internal shunt, the use of the operating microscope, and strict control of postoperative hypertension. A series of 200 consecutive endarterectomies performed within this protocol in 180 patients and the resultant combined permanent morbidity and mortality rate of 1.5% are reported.

Adult↗
PubMed1986

A proposed grading system for arteriovenous malformations.

An important factor in making a recommendation for treatment of a patient with arteriovenous malformation (AVM) is to estimate the risk of surgery for that patient. A simple, broadly applicable grading system that is designed to predict the risk of morbidity and mortality attending the operative treatment of specific AVM's is proposed. The lesion is graded on the basis of size, pattern of venous drainage, and neurological eloquence of adjacent brain. All AVM's fall into one of six grades. Grade I malformations are small, superficial, and located in non-eloquent cortex; Grade V lesions are large, deep, and situated in neurologically critical areas; and Grade VI lesions are essentially inoperable AVM's. Retrospective application of this grading scheme to a series of surgically excised AVM's has demonstrated its correlation with the incidence of postoperative neurological complications. The application of a standardized grading scheme will enable a comparison of results between various clinical series and between different treatment techniques, and will assist in the process of management decision-making.

Cerebral Angiography↗
PubMed1985

Synovial cyst of a cervical facet joint: case report.

Intraspinal synovial cysts are rare. Those reported have occurred in the lumbar region. We report a case of an extradural true synovial cyst of the cervical spine causing spastic paraparesis. The cyst occurred after a cervical spine fracture and, hence, was probably related to trauma. Surgical therapy resulted in a satisfactory recovery.

Adult↗
PubMed1985

Otolaryngologic manifestations of posterior fossa arachnoid cysts.

Posterior fossa arachnoid cysts are more common than previously reported. While they may present with symptoms of hearing loss, vertigo, and tinnitus, often they are associated with vague, nonspecific complaints such as headache, dizziness, or generalized unsteadiness. We present five cases of posterior fossa arachnoid cysts discovered in adult patients. Four of the five patients had nonlocalizing symptoms (three of those sought medical evaluations for persistent dizziness and/or headache). Two patients had prolonged symptoms despite medical evaluation and normal audiometric testing before the correct diagnosis was made. We describe the case of our senior author (C.P.D.) in detail and include computerized tomographic and nuclear magnetic resonance studies outlining his pathology. A review of the management of these lesions is included. Dizzy patients and those patients with nonspecific complaints referable to the inner ear or posterior fossa who have normal audiometric testing, and in whom the index of suspicion is high, should have high resolution computerized tomography of the posterior fossa.

Adult↗
PubMed1985

Transcallosal approach to the contralateral ventricle. Technical note.

Recent experience with an intraventricular arteriovenous malformation (AVM) demonstrated the usefulness of a transcallosal approach to the contralateral ventricle. Although this technique provides excellent exposure, its application has not been stressed in the literature. A brief description of the technique and its value is presented.

Adolescent↗
PubMed1985

Multiple intracranial aneurysms: determining the site of rupture.

A retrospective hospital chart and radiograph review was performed of all patients with multiple intracranial aneurysms seen over a 52-month period. Sixty-nine patients with a total of 205 aneurysms were studied. Among the patients with aneurysms, the incidence of multiple aneurysms was 33.5%. Multiple aneurysms were much more common in women, with a female to male ratio of 5:1 for all patients and 11:1 for patients with three or more aneurysms. Common locations for multiple aneurysms were the posterior communicating artery (22%), middle cerebral artery (21.5%), anterior communicating artery (12%), and ophthalmic artery (11%). However, locations with the highest probability of rupture were the anterior communicating artery (62%), posterior inferior cerebellar artery (50%), and basilar artery summit (50%). The middle cerebral artery was the least likely site for rupture. In contrast to previous studies, in this series irregularity of contour was more important than size in identifying the site of rupture. Using a simple algorithm outlined in the text, it was possible to identify the site of aneurysm rupture in 97.5% of cases.

Aged↗
PubMed1985

Occipital artery to extradural vertebral artery bypass procedure. Case report.

A 17-year-old boy suffered blunt trauma to the posterior cervical spine and later developed vertebrobasilar transient ischemic attacks refractory to medical management. At angiography, a pseudoaneurysm of the distal left vertebral artery was found. By means of a posterior midline approach, an extradural occipital artery to vertebral artery anastomosis was performed and the affected vertebral artery was clipped distal to the pseudoaneurysm. The indications for this procedure, the operative approach, and the clinical outcome are described.

Adolescent↗
PubMed1985

Revascularization and aneurysm surgery: current status.

Unclippable intracranial aneurysms are most effectively treated by hunterian ligation; however, the attendant risk of cerebral ischemia is significant. Many techniques have been used in an attempt to predict the safety of proximal vessel occlusion. Unfortunately, there is none that is risk-free and highly successful. A combination of stump pressure and cerebral blood flow measurements has been shown to be the most accurate in the acute assessment. In addition, recent studies have demonstrated that the long term risk of carotid ligation is significant. Extracranial-intracranial bypass grafting (EC-IC) has been shown to improve the safety of parent vessel ligation and is a low risk procedure. Whenever hunterian ligation is planned for the treatment of an intracranial aneurysm, EC-IC should be strongly considered.

Brain Ischemia↗
PubMed1985

Magnetic resonance imaging: comparative study of radiofrequency pulse techniques in the evaluation of focal cerebral ischemia.

The recently developed technique of magnetic resonance (MR) imaging utilizes radiofrequency (RF) radiation in the presence of a strong magnetic field to provide cross sectional displays of body anatomy similar to computed tomography. When utilizing MR, the operator alters tissue contrast electronically by changing RF pulse sequences. The three most frequently used RF pulse sequences are partial-saturation (PS), inversion-recovery (IR), and spin-echo (SE). We evaluated the sensitivity of these RF sequences to detect ischemic changes in our primate model. Serial MR scans were carried out using all three pulse formats 5 to 60 hours after middle cerebral artery occlusion (MCAO) in four animals. SE- and IR-sequenced proton MR images readily identified areas of evolving infarct 5 to 60 hours after MCAO, whereas PS scans that were performed during this acute period appeared normal. From 24 to 60 hours after MCAO, PS-sequenced scans showed focal areas of progressively decreasing signal intensity. However, SE and IR scans performed at the same intervals always demonstrated more extensive tissue changes. The basis of MR imaging, the effects of altering RF pulse sequences, and the resulting interpretation of changes observed in MR sections are presented.

Animals↗
PubMed1985

Clinical role of magnetic resonance imaging in the neurosurgical patient.

The results of magnetic resonance (MR) evaluation in 18 patients with common neurosurgical problems, including cerebrovascular lesions, intracranial tumors, and craniovertebral junction pathological conditions, are presented. The results are compared with those of routine diagnostic studies. Overall, MR imaging was equivalent or superior to computed tomography in 16 of 18 cases. In 2 cases, MR demonstrated pathological changes when standard diagnostic imaging procedures failed to demonstrate the lesion responsible for the patient's deterioration. MR is a versatile, noninvasive imaging technique that is capable of demonstrating a wide range of disease processes, without exposure to ionizing radiation or contrast agents.

Adult↗