Malleable microsurgical suction device. Technical note.
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Humans↗
Biomedical subjects
R F Spetzler
Publications and source records attributed to R F Spetzler.
Barbiturate-induced coma therapy for focal cerebral ischemia. Effect after temporary and permanent MCA occlusion.
The authors have studied the therapeutic effect of barbiturate coma following middle cerebral artery (MCA) occlusion in primates. The relationship of the efficacy of barbiturate protection to the presence or absence of recirculation was examined. Barbiturate therapy was begun 30 minutes after MCA occlusion. The findings were as follows: 1) barbiturate-induced coma, with its attendant monitoring, was safely tolerated by primates for 96 hours; 2) 6 hours of MCA occlusion followed by recirculation resulted in a neurological deficit that was worse than the neurological deficit produced by permanent MCA occlusion; 3) barbiturate-induced coma for 96 hours, initiated 30 minutes after the onset of MCA occlusion, in the absence of reperfusion, was in fact detrimental; 4) barbiturate-induced coma for 96 hours, initiated 30 minutes after MCA occlusion, with the establishment of reperfusion at 6 hours, provided nearly complete protection from ischemic damage.
Animals↗
Clinical and pathological study of dysplastic gangliocytoma. Case report.
A case of dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease) is reported. Computerized tomography revealed a nonenhancing mass lesion surrounded by areas of calcification. Surgical excision resulted in complete resolution of the patient's symptoms. The histological findings support the concept that this tumor represents a congenital abnormality in granule-cell migration and is not a true neoplasm.
Adult↗
Improved neurologic function after cerebrovascular accident with extracranial-intracranial arterial bypass.
This study, by use of direct measurement, sought to investigate the role of diminished cerebral blood flow on neurologic function after cerebrovascular accident (CVA). Twenty-seven patients had mean middle cerebral artery pressure (MCAP) measured intraoperatively prior to a superficial temporal artery to middle cerebral artery bypass. The ratio of MCAP to mean systemic blood pressure (BP) was less than 0.500 in 11 patients. Six of these 11 had preoperative neurologic deficit and four of these six had improved neurologic function after revascularization. In 16 patients the MCAP/BP was greater than 0.500, and none of the seven patients with neurologic deficit improved postoperatively. In general, the MCAP/BP correlated well with the angiographic severity of cerebrovascular disease. In 16 patients, unsuitable for conventional bypass, autogenous saphenous vein was used as a bypass from the subclavian or other extracranial artery to a cortical branch of the middle cerebral artery. One cerebral death and one CVA occurred postoperatively early in the series, but there have been no untoward events since deep barbituate anesthesia has been used. Diminished cerebral blood flow after CVA may leave a pool of viable but nonfunctional neurons. Extracranial-intracranial bypass may improve neurologic function in such patients.
Blood Pressure↗
The role of EC-IC in the treatment of giant intracranial aneurysms.
Extracranial to intracranial bypass surgery was used in 27 cases of intracranial giant aneurysm to prevent ischemic complications. In 19 of 21 patients the aneurysm was considered unfit for a direct clipping or ligation, and an EC-IC bypass was done in conjunction with staged clipping of the internal carotid artery or occlusion of the middle cerebral artery. All bypass grafts have remained patent postoperatively. None of the patients have developed ischemic complications in the 6--14 month period of follow-up.
Adult↗
Subdural pneumocephalus resulting from drainage of cerebrospinal fluid during craniotomy.
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Adolescent↗
Percutaneous lumboperitoneal shunt: review of 130 cases.
One hundred thirty consecutive cases of percutaneous lumboperitoneal shunting are reviewed. The efficacy of this procedure in the management of cerebrospinal fluid fistulas and bulging craniotomies is documented. The place of lumboperitoneal shunts in the management of communicating hydrocephalus, with particular emphasis on "normal pressure" hydrocephalus, is discussed.
Adolescent↗
Chronic reversible cerebral ischemia: evaluation of a new baboon model.
The authors describe their experience with a baboon model of reversible cerebral ischemia. Middle cerebral artery occlusion was achieved by external compression with an implantable, inflatable balloon cuff in awake, unanesthetized baboons. Selective cerebral angiography confirmed consistent, reliable occlusion. Computed tomography demonstrated early density changes after ischemia, which were reversible with reperfusion. Neurological evaluation demonstrated a "recruitment response" of increasingly persistent deficit with repeated occlusion. Permanent deficits were noted after extensive angiography during periods of occlusion. This was accompanied by the dropout of small vessels in the middle cerebral artery distribution. The results of pathological examinations were consistent with the clinical examinations. No gross or microscopic changes were noted after repeated occlusions that caused deficits like those of transient ischemic attacks. Consistent infarctions were noted in animals with permanent deficits after permanent occlusion or after repeated occlusion and extensive angiography.
Animals↗
Alternative superficial temporal artery to middle cerebral artery revascularization procedure.
The intact superficial temporal artery was sutured to the cortical arachnoid in a patient in whom no adequate cortical recipient vessel could be found. Subsequent arteriography demonstrated good revascularization of the middle cerebral distribution fed through the superficial temporal artery. The patient was relieved of this symptoms and remained neurologically intact postoperatively. In the rare instance where an adequate recipient middle cerebral artery is not available, this method may be an alternative means of providing cortical revascularization.
Adult↗
Holographic interferometry applied to the study of the human skull.
A laboratory technique that allows strain measurements of the skull is described. Holographic interferometry allows the entire surface displacement of the skull to be mapped within 1/10 of the wavelength of light. Holographic interferometric pictures are presented following various stress applications to the skull. The method, besides being exquisitely sensitive, allows strain measurements simultaneously in any desired direction over the entire skull. No physical contact with the skull is required, and the experimental set-up is simple.
Holography↗
Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery.
Thirteen patients with giant aneurysms of the internal carotid artery (ICA) were treated with ICA ligation and an extracranial-intracranial arterial bypass. A method for establishing a proper superficial temporal artery to middle cerebral artery pressure gradient while maintaining partial flow through the ICA is presented. This procedure allows the anastomosis to become established before full occlusion of the cervical ICA. None of these patients suffered any immediate or delayed ischemic or rebleed complications over an average follow-up period of 18 months.
Adult↗
Subclavian to middle cerebral artery saphenous vein bypass graft.
A variation of an extracranial-intracranial arterial bypass is presented. The subclavian artery is used as the donor vessel and the saphenous vein as the graft; thus, a bypass to a cortical branch of the middle cerebral artery can be accomplished. The advantage of this modification is that the saphenous vein, when tunneled subcutaneously behind the ear, is positioned in a straight line from the donor to the recipient vessel. Since the vein lies in the axis of head rotation, turning of the head causes little displacement of the graft, as opposed to a graft from the common carotid artery to the middle cerebral artery. An additional advantage over the superficial temporal artery to middle cerebral artery bypass is the large flow obtained immediately after anastomosis.
Aged↗
The "bonnet bypass". Case report.
A saphenous vein bypass graft from the contralateral superficial temporal artery to the ipsilateral middle cerebral artery was performed in a patient who required occlusion of his left common carotid artery. This procedure was used because of the unavailability of an ipsilateral donor artery. The bypass is working well 8 months postoperatively.
Aneurysm↗
Spontaneous opening of large occipital-vertebral artery anastomosis during embolization. Case report.
A patient undergoing external carotid artery therapeutic embolization for obliteration of a dural arteriovenous malformation suddenly developed a large occipital artery to vertebral artery shunt. A devastating stroke was averted because the appearance of the shunt was observed by fluoroscopy, the embolization was stopped, and the shunt verified on a subsequent angiogram. The risk of external carotid artery embolization without constant fluoroscopic control is emphasized.
Cerebral Arteries↗
Therapeutics for focal cerebral ischemia.
A review of the therapeutic modalities available for the treatment of focal cerebral ischemia is presented. The theoretical aspects and present practical applications of each treatment are discussed. The possibilities for future research and for the implementation of new modalities are indicated.
Animals↗
New design for an implantable vessel occluder.
A new implantable balloon cuff for experimental cerebral artery occlusion is described. The device consists of a small silastic balloon connected to a pressure sensitive valve and reservoir by a spring reinforced catheter. The unique features of this occluder and its insertion and function are discussed.
Animals↗
Microsurgery in stroke management.
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Aspirin↗