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Biomedical subjects

W A Hall

Publications and source records attributed to W A Hall.

107 records · Page 6Linked to original sources
PubMed1988

Diagnosis of tethered cords by magnetic resonance imaging.

Thirty children presented with signs and/or symptoms of tethered spinal cord, 13 in association with spina bifida occulta and 17 after myelomeningocele repair. Preoperative magnetic resonance imaging (MRI) of 27 children showed tethering (27), intradural fat (17), distal syrinxes (8), and thickened filum terminale (2). There was an excellent correlation between MRI and the surgical findings. Postoperative MRI was obtained within 1 year after operation in 14 children; spinal cord ascent was seen on only four studies and retethering was suspected on five studies. We consider MRI the procedure of choice to diagnose a tethered cord because this technique accurately defines anatomical relationships without risk to the patient. In addition, we conclude that cord ascent is seen less often than expected and that retethering may occur, especially to cadaveric dura mater.

Adolescent↗
PubMed1988

Touch preparations in the rapid intraoperative diagnosis of central nervous system lesions. A comparison with frozen sections and paraffin-embedded sections.

Cytologic preparations provide a rapid, simple method for intraoperative diagnosis of central nervous system (CNS) lesions. Details of cellular morphology are defined sharply, avoiding artifacts often introduced by the frozen section technique. In 100 neurosurgical biopsies performed between 1984 and 1986, touch preparations and cryostat (frozen) sections were made at the time of surgery for preliminary intraoperative diagnosis. To assess the accuracy of each of the diagnostic methods used independently, slides obtained with each of the two techniques were later reviewed retrospectively with appropriate clinical and radiological data, but without knowledge of the final neuropathological diagnoses. When compared with the final diagnoses, intraoperative diagnoses were confirmed in 95 cases. The diagnoses based on cytologic and frozen section techniques were compared with the final diagnoses based on paraffin sections. Touch preparation diagnosis was confirmed by paraffin sections in 76 cases; in 18 additional cases a clinically useful, but nonspecific diagnosis (benign versus malignant, glial versus nonglial) was established by touch preparation. In five cases with firm or rubbery tumors, insufficient cells were imprinted for reliable evaluation, and no definitive diagnoses could be made. Specific cryostat diagnoses were confirmed by paraffin sections in 88 cases; nonspecific diagnoses were made in 11 cases. A single incorrect diagnosis was obtained with each technique. When the two techniques were used together, a specific and accurate diagnosis was achieved in 95 cases. Touch preparations were superior to frozen sections for evaluating soft or highly cellular tumors and for preliminary diagnosis from a minute surgical specimen (i.e., stereotactic biopsy).(ABSTRACT TRUNCATED AT 250 WORDS)

Central Nervous System Diseases↗
PubMed1987

Nocardial brain abscess: diagnostic and therapeutic use of stereotactic aspiration.

Three cases of nocardial brain abscess are presented. All three patients were receiving immunosuppressive therapy at the time of diagnosis. Two patients had cardiac transplantation and the third had periarteritis nodosa. The patients presented with generalized seizures or focal weakness. Accurate localization of the intracerebral mass lesion was obtained from computed tomography (CT) scans, but CT-guided stereotactic aspiration was required for diagnosis and treatment in every case. After Nocardia asteroides was seen on Gram's stain and subsequently identified by culture, appropriate antibiotic therapy was initiated. Both heart transplant patients survived in good neurological condition. We believe that stereotactic aspiration followed by prolonged antibiotic therapy may significantly improve the outcome of patients with nocardial brain abscess.

Adult↗
PubMed1987

Changing concepts in the treatment of colloid cysts. An 11-year experience in the CT era.

Since computerized tomography (CT) scanning became available at the University Health Center of Pittsburgh in July, 1975, 17 patients have undergone removal of colloid cysts of the third ventricle by transfrontal, transcallosal, or stereotaxic surgery. All patients presented with symptoms and signs of increased intracranial pressure; CT scanning proved to be the best neurodiagnostic test to define the colloid cysts. Since the development of CT-guided stereotaxic surgery, the authors have preferentially performed stereotaxic aspiration in seven patients; three of these subsequently required craniotomies to remove residual cysts producing persistent symptoms. The viscosity of the intracystic colloid material and/or displacement of the cyst away from the aspiration needle were reasons for unsuccessful aspiration; the CT appearance did not correlate with the ability to aspirate the lesion by the sterotaxic technique. Postoperative patency of the ventricular system was documented by intraoperative CT ventriculography performed during stereotaxic surgery. Removal of the cyst wall was not necessary. Because of the low associated morbidity rate, percutaneous stereotaxic aspiration is recommended as the initial treatment of choice for colloid cysts of the third ventricle. If stereotaxic aspiration fails and symptoms persist, craniotomy should be performed.

Adult↗
PubMed1986

Anaplastic ganglioglioma in an infant: case report and review of the literature.

A 6-month-old girl had a gradually increasing head circumference. A preoperative computed tomographic (CT) scan of the head revealed an enhancing calcified partially cystic right frontal mass that was removed through a right frontotemporal craniotomy. On microscopic examination, the tumor was composed of sheets of neurons in a glial background alternating with highly cellular anaplastic areas. The diagnosis of anaplastic ganglioglioma was made. The child has done well for the 20 months since the operation without any evidence of tumor recurrence on subsequent CT scans. Because of the immaturity of the child's developing central nervous system, we have elected not to initiate radiotherapy at this time. The pertinent literature regarding gangliogliomas is reviewed.

Brain Neoplasms↗
PubMed1979

Simple screening technic to estimate postoperative narcotic use.

The General Health Questionnaire, a 30-item, self-response inventory, identified individuals who required significantly more pain medication after elective cholecystectomy. The questionnaire is well tolerated by surgical patients and is easy to score. It can identify those individuals prone to request excessive narcotic medication postoperatively.

Adult↗
PubMedDate not supplied

MR-guided and MR-monitored neurosurgical procedures at 1.5 T.

A combined MR suite and operating room (MR-OR) has been developed and extensively assessed for its use in a wide spectrum of therapeutic applications. Equipped with a 1.5 T short bore clinical MR scanner and standard neurosurgical OR equipment, in this MR surgical suite, surgeons can obtain intraoperative planar and volumetric MR images with superior soft tissue contrast and spatial resolution for surgical planning, guidance, and monitoring. Besides MR morphologic imaging capability, blood oxygen level-dependent functional MRI and proton MR spectroscopic imaging have been demonstrated intraoperatively in the same MR-OR to aid in surgical planning and guide tumor resections. A perspective surgical navigation device and remotely operated instrument have been developed and successfully used to assist surgeons in aligning and introducing biopsy needles under fluoroscopic MRI in brain biopsy procedures. Furthermore, surgical complications can be assessed immediately before the closure. There are numerous advantages offered by this unprecedented MR-guided surgical approach, most of which are demonstrated and presented herein. Since 1997, >270 neurosurgical cases (42% brain biopsies, 25% tumor resections, 11% functional neurosurgeries, 10% cyst drainages and shunt placements, and 12% others) have been performed in the MR-OR with a <1% overall complication rate. The tumor recurrence rate for the MR-guided surgical approach is significantly less than that of the conventional one. Exemplary neurosurgical cases that have been performed in the MR-OR suite within the last 24 months are included. Overall, this high magnetic field approach to the MR-guided minimally invasive surgical procedures has been shown to be practical and acceptable to neurosurgeons as well as to neuroradiologists for a wide range of neurosurgical and neuroradiologic applications.

Biopsy, Needle↗