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Biomedical subjects

Z H Rappaport

Publications and source records attributed to Z H Rappaport.

At least 37 records · Page 2Linked to original sources
PubMed1996

The choice of therapy in medically intractable trigeminal neuralgia.

Trigeminal neuralgia stands out as one of the few severe neuropathic pain states for which successful treatment options are available. Up to one-half of patients become refractory to medical therapy over time. At this point, the question of which intervention is appropriate becomes an important issue. A personal series of 150 patients treated between 1988 and 1995 is reviewed. Patients under 65 years and in good general health underwent surgery for microvascular decompression of the trigeminal root; in the remaining 120 patients glycerol was injected percutaneously into the trigeminal cistern. The results in these two patient groups is presented and the rationale of choosing an operative versus a percutaneous procedure is discussed in light of the outcome in this series and in the literature.

Follow-Up Studies↗
PubMed1994

Meningiomas of the anterior cranial fossa floor. Review of 67 cases.

The authors report 67 cases of meningioma of the anterior cranial fossa floor treated surgically between 1978 and 1992. The olfactory groove and tuberculum sellae were the most frequent locations. Mean duration of the clinical history was 30 months. Seventy-three percent of the tumors were large (> 4 cm). All patients were examined with computed tomography and 18 with magnetic resonance imaging as well. Complete removal was performed in 56 cases (84%); in the remaining 11 (16%), partial removal was performed because of encasement of the carotid artery, cavernous sinus, or optic nerves by the tumour. Mortality was 9%. Results at follow-up of the 61 survivors were good in 56 (84%), fair in four (6%), and poor in one (1%). The clinical results were correlated to tumor location and dimension. After review of the literature, the management of these difficult tumours and the preferred surgical technique are discussed. The authors stress the importance of early diagnosis for improving the surgical results.

Adolescent↗
PubMed1993

Suprasellar arachnoid cysts: options in operative management.

Suprasellar arachnoid cysts are uncommon lesions the optimal management of which is still subject for debate. Various authors have presented differing treatment preferences which include: 1) Subfrontal fenestration of the cyst to the basal cisterns; 2) Transcallosal fenestration of the cyst into the lateral ventricles with optional shunting; 3) Cystoperitoneal shunt; 4) Percutaneous ventriculocystostomy. There is a significant incidence of re-operation whatever the initial approach. Based on recent experience with 5 operative cases of suprasellar arachnoid cyst and a selective review of 6 major operative series covering 42 cases, the available surgical options are critically analyzed. Percutaneous ventriculostomy may offer the best chance for a definitive treatment. However the technique is demanding and is not readily available. Cystoperitoneal shunting entails shunt dependency and has a significant incidence of failure, as does cyst marsupialization to the subarachnoid cisterns. The establishment of a single CSF space by surgically communicating the cyst with the ventricular system appears to offer the best chance of success in the treatment of suprasellar arachnoid cysts, though a concomittant shunt may still be required in the occasional hydrocephalic patient.

Adult↗
PubMed1993

Epilepsy in chronic subdural haematoma.

We studied retrospectively 143 adult patients treated in our department from 1979 to 1991 for chronic subdural haematoma (SDH) in order to identify the incidence of seizures and the necessity for prophylactic anticonvulsant treatment. Furthermore, after review of the literature, we selected an additional 879 cases for comparison. Results indicated a low incidence of epilepsy. Before surgery 5.6% of patients in our series and 4.3% in the literature had epilepsy, whereas after surgery, the frequencies were 3% and 1.8%, respectively. According to our data, antiepileptic drugs need not be administered prophylactically in patients with chronic SDH. But the situation is different for alcoholic patients, because they have a major risk of epilepsy.

Adolescent↗
PubMed1992

Orbital porencephalic cyst following penetrating orbitocranial trauma.

In a 10-year-old boy an orbitocranial penetrating wound produced by an umbrella tip caused an orbital roof bone fragment to penetrate up to the anterior part of the third ventricle behind the left foramen of Monro. Hemorrhages and encephalomalacia developed along the trajectory of the fragment and subsequently a porencephalic cyst was formed at this site. Six months after the trauma, increased pressure developed in the left ventricular system due to obstructive hydrocephalus and consequently the porencephalic cyst herniated into the orbit through the orbital roof fracture, producing intermittent diplopia, left exophthalmos, and palpebral swelling. A ventriculo-peritoneal shunt led to shrinkage of the orbital cyst content and resolution of the symptoms.

Child↗
PubMed1992

Myelomeningocele repair by a combined fasciocutaneous flap closure. Technical note.

The principles of myelomeningocele repair have been clearly described in the literature and generally delineate a technique that calls for the dissection and closure of five separate layers: arachnoid, dura, fascia a subcutaneous layer, and skin. We should like to describe our technique of repairing the myelomeningocele defect following dural separation and closure by shifting complete fasciocutaneous tissue blocks from either side of the defect to the midline following dural closure. A full thickness primary closure can be obtained even in large defects.

Follow-Up Studies↗
PubMed1992

Patient positioning for the operative approach to midline intracerebral lesions: technical note.

Patients undergoing craniotomies for intracerebral lesions are generally positioned in such a way that the lesion is highest in the field. For midline lesions alongside the falx, patients are commonly positioned on their backs for an anatomically symmetrical approach. We propose positioning the patient in the lateral decubitus position ipsilateral to the lesion to take advantage of gravity by allowing the brain to fall away from the midline, thus obviating the need for retraction. We have used this position in 15 cases of falcine and parafalcine tumors to great advantage, without encountering untoward operative or anesthetic complications.

Craniotomy↗
PubMed1992

Psychosurgery in the modern era: therapeutic and ethical aspects.

Brain operations for psychiatric illness were in the past the centre of public controversy. Fear of untoward side-effects and an exaggerated use of the procedure including treatment of societal aspects of the disease process caused a virtual cessation of psychosurgical operations. With the introduction of techniques that could accurately lesion specific areas in the brain, especially in the limbic system, psychosurgical procedures were revived. Psychiatric syndromes, such as obsessive-compulsive affective disorders, were shown to have benefited from such intervention, without giving rise to untoward side-effects. Given societal supervision it is appropriate to reconsider the use of psychosurgery in well-defined clinical entities of mental disease that do not respond to alternative therapy.

Behavior Control↗
PubMed1991

[CT-stereotactic determination of targets for thalamotomy for movement disorders].

The methodology of determining an invisible target by CT-stereotaxy, such as the ventrolateral nucleus of the thalamus, is described. This approach obviates the need for traditional ventriculographic determination of the third ventricle commissures and allows accurate measurement of third ventricular width. Morbidity and length of hospitalization are thereby reduced.

Adolescent↗
PubMed1991

Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumors.

A retrospective study was designed to evaluate clinical thromboembolic phenomena (TEP) in patients operated upon for brain tumours. Among 492 patients treated surgically in the supratentorial area, the overall incidence of clinical TEP was 7%. There were 5% with deep vein thrombosis (DVT) and 4% with clinical pulmonary embolism (PE). Seven patients (1%) died from massive PE. Among 141 patients treated surgically in the infratentorial area there were no episodes of TEP. Significant risk factors for TEP development were operations in the supratentorial area, malignant gliomas (compared to meningiomas) and para- or hemiparesis. Age, sex and the specific location in the supratentorial area were not found to be statistically significant risk factors. Among 12 patients who presented initially with DVT two developed PE despite full heparinization. 7/19 patients with PE died within minutes to hours of the clinical episode despite full conservative measures. In 2/26 patients who were treated with full heparinization complications occurred. There was one case of diffuse subcutaneous bleeding and one case of tumour bed haematoma. The identification of risk factors for the development of TEP will allow the implementation of prophylactic measures in appropriate patients undergoing elective brain tumour surgery.

Adult↗
PubMed1990

[Transsphenoidal approach to pituitary tumors].

Over the past 2 years 44 patients with pituitary tumors underwent transsphenoidal resection. A specialized team performed the procedure so as to optimize the results. 20 patients had nonsecreting macroadenomas and 24 suffered from hormone-secreting adenomas. All who presented with visual deterioration had improved vision after operation. Only 3 developed new endocrine deficits following surgery, while in 4 with invasive prolactinoma vision improved following surgery but hyperprolactinemia persisted. 8 of 11 patients with acromegaly were cured, while in the other 3, who had invasive tumors, growth hormone decreased significantly. 8 of 9 patients with Cushing's disease were cured. In only 1 case did a permanent complication, diabetes insipidus, occur; there was no mortality. These results demonstrate the efficacy of the procedure and the advantages of a dedicated team.

Adenoma↗
PubMed1990

[Interstitial radiotherapy for brain tumors].

Interstitial radiotherapy (brachytherapy) for brain tumors has radiobiological advantages over conventional teletherapy. With this method the tumor area can be exposed to effective, high dose irradiation with minimal damage to surrounding tissues.

Brachytherapy↗
PubMed1990

Effect of pulsed electromagnetic fields on calcium tissue changes in focal ischaemia.

The effect of a pulsed electromagnetic field (PEMF) (parameters: 27.1 MHz, 585 W peak power, and 65 microseconds pulses, 400 times per second) on rats undergoing middle cerebral artery occlusion (MCAo) was investigated. Four groups of eight rats each underwent microsurgical MCAo. Two groups were treated with a PEMF generator for 2 h following the onset of ischemia and were sacrificed at 4 and 24 h following the MCAo respectively. The other two groups were also sacrificed at the same time intervals. Regional brain sodium, potassium, and calcium tissue contents were determined by atomic spectrophotometry. As distinct from results found in spinal cord contusion, no significant difference between the PEMF-treated groups and the non-treatment groups was found. PEMF treatment did not alter the 300% rise in calcium tissue dry weight content observed at 24 h following MCAo in the infarcted tissue. Regional brain water content was determined by the dry weight method. A regionally inconsistent reduction in brain water content was noted in the PEMF-treated rats.

Animals↗