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PubMed1990

[Closure of defects of the dura mater using flaps of autologous periosteum].

The author has used for closure of the defects of dura mater the periosteal flaps on a pedicle. Such a flap is mobilized in the operative wound, its careful sewing to the dura mater provides hermetization of the subdural space, its size is not limited, it can stretch, providing in necessity brain decompression. The tender adhesions are forming between the periosteal flap and underlying brain. The method was successfully used in 49 patients. No complications were noted. A shortcoming of the method consists in the fact that it can be used only in resective cranial trepanation.

Dura Mater↗
PubMed1989

[Clinical use of magnetic resonance tomography in the assessment of vital organs in malignant arterial hypertension].

Magnetic resonance tomography was performed to examine the kidneys, brain, adrenals, vessels, and heart in 110 patients with malignant arterial hypertension (MAH). The findings were compared with those of the examination of healthy subjects and patients with benign hypertensive disease (BHD). As compared to the controls, all the MAH patients had changes in the target organs, however, their nature and magnitude varied with under underlying MAH disease. Renal alterations were most profound in chronic glomerulonephritis. All the patients displayed signs of concentrated cardiac hypertrophy: its maximum degree being noted in renovascular hypertension, the least, in MAH of adrenal genesis. Examination of the central nervous system in MAH patients revealed that the ventricular system and subdural space were dilated. It was shown that it was feasible to diagnose hypertrophic encephalopathy in the prehospital period by employing magnetic resonance tomography.

Adolescent↗
PubMedDate not supplied

[Pneumoencephalos: etiology, pathologic significance and diagnosis. Apropos of 13 observations].

Thirteen cases of pneumoencephalos attended at our hospital in a four-year period are reported. All the cases were men; mean age was 47.2 years. The most frequent cause was injury (seven cases) followed by surgical procedures (five cases); in one case, pneumoencephalos was secondary to barotrauma. In the initial period, the most frequent clinical features were impairment of level of consciousness and psychomotor agitation (84%), whereas in the established period, deep coma (Glasgow scale less than or equal to 7) predominated in 69% of patients. Only 16% of patients complained of headache. The most frequent localization of gas was in subdural space (54% of cases) followed by subarachnoid space (23% of cases). Twenty-three percent of patients presented tension pneumoencephalos. With respect to distribution of gas, 53% of patients presented pneumatocele, 38% of patients had pneumoencephalos, and 15% presented a laminar distribution of the gas. Pneumoencephalos is usually associated to a high mortality rate; 53% of our patients died. In the postsurgical group, mortality rate was 60% and in the posttraumatic group, mortality rate was 43%.

Adult↗
PubMed1986

[Diagnosis and differential diagnosis of back pain from the neurological point of view].

Affections of the vertebral body, the intervertebral disc, the epidural and subdural space, the nerve root, and the spinal cord may have back pain as the main symptom. Initially a topical diagnosis is established in the light of the neurologic symptoms and signs (segmental "beltlike" pain, radicular motor and sensory signs, central mono-, para-, and tetraparesis, as well as sensory signs and bladder dysfunction). Degenerative changes and herniated discs are the most frequent causes of cervical and lumbar spinal disease with neurologic signs, followed by extramedullary tumors. In the extradural space metastases, plasmocytoma, lymphomas and primary bone tumors are the most common, and neurinomas and meningiomas in the intradural space. In the spinal cord ependymomas and astrocytomas are found, as well as benign cavities (syringomyelia). Conditions which are rare, but very important because treatable at an early stage, are spinal epidural hematomas with anticoagulation and spinal epidural abscesses. Vertebral osteomyelitis must also be considered in differential diagnosis. Inflammatory nerve root lesions seldom cause pain, except for subacute demyelinating polyneuropathy responding to corticosteroid treatment, and radiculitis caused by borrelia and herpes zoster.

Adult↗
PubMed1988

[Experience using intracranial endoscopy in neurologic traumatology].

The endoscopic anatomy of the subdural space structure and endoscopic semiotics of intracranial lesions are presented. The direct vision of the lesion substrate outside projection of a small trepanation opening raised the reliability of diagnosis, provides a wide and atraumatic access for the removal of spreaded hematomas and other foci, allows surgery to be fulfilled even in critical patients. The application of intracranial endoscopy in neurotraumatology is considered as a technical principle.

Adolescent↗
PubMed1987

[Evaluation of regional cortical blood flow by thermal diffusion using a Peltier stack].

The possibility of quantitative evaluation of cerebral blood flow (CBF) by thermal diffusion has been reported, when the thermal gradient was created by a Peltier stack. We already described the linear relationship between the CBF and the inverse of thermal gradient elsewhere when the CBF measured by hydrogen clearance (Hydrogen CBF) was compared to the values estimated by thermal diffusion. In this paper, the correlation of linear relationship between the thermal CBF and hydrogen CBF in each animal was first investigated. Secondary, the possibility of in vitro calibration for quantitative evaluation was discussed. Two kinds of probes were manufactured. One was treated not to leak the heat from the Peltier stack except the sensors for the experimental or intraoperative use, and the other was not treated to minimize the size of probe for the long-term use by implantation into the subdural space. When the thermal CBF was compared to hydrogen CBF in each of 3 cats, a linear relationship was obtained in each and the values showing gradient and constant of the regression line were similar in each cat. Moreover, a good linear relationship was also observed when all measurements in 3 cats were included. These results suggested that there is no difference between each animal in the relationship of thermal and hydrogen CBF when the same probe is employed. In addition, the probe can be characterized with two values, and these are gradient and constant of the linear relationship. The fact that the blood flow is proportional to the heat conductivity indicates that the heat conductivity of some material is equivalent to some CBF value in the brain tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

[Effect of brain death on hemodynamics and cardiac function: an experimental study].

An experimental model was designed to study hemodynamic and left ventricular functional changes in the course of and after brain death in 13 mongrel dogs. Brain death was induced by creating intracranial hypertension by inflating a balloon inserted into the subdural space. Hemodynamic parameters and left ventricular systolic function as assessed by echocardiography were measured before and during intracranial hypertension and 30 min and 1, 2, 3, 5 and 8 hrs after brain death. During intracranial hypertension, heart rate, systemic and pulmonary blood pressures, cardiac output and systemic vascular resistance raised significantly. After brain death, all parameters decreased rapidly and significantly, and then stabilized. On comparison with values obtained before intracranial hypertension, systemic blood pressure decreased markedly following brain death, while no marked change was noted in cardiac output. This result is attributable to a marked reduction in peripheral vascular resistance following the induction of intracranial hypertension. The left ventricular end-diastolic and end-systolic diameters did not change; consequently, fractional shortening did not change, either. The Weissler's index improved after brain death, reflecting a marked reduction in systemic vascular resistance. This indicates limited usefulness of afterload-dependent cardiac indices. At the agonal period of brain death, three of 13 dogs died because of ventricular fibrillation or a marked decline in systemic blood pressure. Within five to eight hours after brain death, seven dogs died because of intractable acidosis. These results represent the specific hemodynamic features occurring after brain death. It is thought that recognition of these features is useful in managing cases of brain death and in selecting donors for heart transplants.

Animals↗
PubMed1987

[Intracranial pneumocephalus under pressure. A possible cause of postoperative deterioration in neurosurgery. 10 cases].

10 patients in whom an early post operative alteration of the level of consciousness or of the neurological status could be related to a tension pneumocephalus are reviewed. Four underwent a surgical procedure in the sitting position. Among these, 2 had been previously shunted for hydrocephalus. A 5th patient underwent a IIId ventriculocisternostomy for tumorous occlusion of the aqueduct. The other five patients were involved with supra-tentorial conditions (hemispheric glioma: 1 case, meningioma: 1 case, chronic subdural hematoma: 3 cases). The post-operative deterioration clinically suggested a post operative hematoma. CT showed a very low density effusion either located in the operative area or in the subdural space or both, with significant mass effect. 9 patients steadily improved after conservative therapy. In 1 case, reoperation was required. Pathogenesis of symptomatic pneumocephalus remains controversial. The role of the sitting position and of CSF drainage seem likely. Spontaneous or nitrous oxide induced expansion of post-operative residual intra cranial air plays a debatable role. It is postulated that tension pneumocephalus may result from a discrepancy between spontaneous reexpansion of the cerebral mass and a residual air collection. Such complications are regarded as serious enough to justify several preventive measures.

Adult↗
PubMed1986

A technique for repeated sampling of pure cerebrospinal fluid from the conscious rabbit.

For the study of drug pharmacokinetics' a reliable method for repeated sampling of uncontaminated cerebrospinal fluid (CSF) from a conscious rabbit was established. The subdural space was punctured between a spinous processes of the lumbar vertebrae. A catheter was inserted through a cannula and pushed up to the region of the cisterna magna. After removing the cannula, the distal end of the catheter was sealed and placed subcutaneously until the onset of the experiments. Ten days after the insertion, samples of clear and colorless CSF up to 1 ml could be withdrawn.

Animals↗
PubMed1986

[Two cases of intracerebral hemorrhage in full-term neonatal infants].

Intracranial hemorrhage in neonatal infants is mostly noted in the subependymal or subdural space. The former is characteristically noted in premature infants and is attributed to hemorrhage from the subependymal germinal matrix layer. The latter is prevalently noted in full-term neonatal infants and is thought to be associated with injury in the vicinity of the falx cerebri or tentorium cerebelli. We report two cases of intracerebral hemorrhage, which is relatively rare in full-term neonatal infants. In both of them hematoma was located in the left frontal area adjacent to the coronal suture. Angiogram did not reveal any causative abnormality. From CT scan and intraoperative findings it is speculated that the hemorrhage was caused by moulding at the coronal suture. In other words, moulding made the frontal bone slipped in beneath the parietal bone at the coronal suture causing pressure over the brain. The hemorrhage is thought to be caused by contusion of fragile vasculature of neonatal infants.

Cerebral Angiography↗
PubMed1986

[The prevention of spinal cord ischemia during the operation on the thoracic aorta utilizing the evoked spinal cord potential (ESP)].

The evoked spinal cord potential was used for the moniter of the spinal cord ischemia during the operation on the thoracic aorta. At first, experiments were performed on 23 dogs. Following laminectomy and 1t. thoracotomy, evoked spinal cord potential to the stimulation from bipoler electrodes in the midline dorsal subdural space at the level of near L1 were recorded from needle electrode in the intervertebral disk at the level of Th4-5. After baseline measurements, the thoracic aorta was occluded in all dogs by aortic cross-clamping (AXC) distral to the origin of the left subclavian artery. Then 3 types of changes were detected. TYPE-I (n = 8) showed loss of the ESPs during AXC and return after reperfusion. TYPE-II (n = 10) showed no changes during and after AXC. TYPE-III (n = 5) showed return of ESPs after transient loss of them even during AXC. Five of 7 dogs (71%) in TYPE-I and 1 of 5 dogs (20%) in TYPE-III developed paraplegia, but all of them in TYPE-II avoided paraplegia. Secondly, ESP was used for the moniter of spinal cord ischemia during operation on 13 patients. Ten patients showed no changes of ESPs, but 3 showed loss of ESPs during AXC and return after reperfusion of them. No paraplegia appeared. We have concluded that intraoperative ESP monitering is a more reliable indicator of the spinal cord ischemia than other methods previously reported.

Adult↗
PubMed1985

[Endogenous foreign body meningitis due to a spinal epidermoid].

We present a two year old child with recurrent aseptic meningitis due to a spinal epidermoid in the subdural space. A dermal sinus had been operated earlier in this child. The connection between dermal sinus and spinal epidermoid is demonstrated. Computed tomography (CT) examination should be used as a screening in all patients with congenital dermal sinus with special reference to visualizing anatomical details.

Child, Preschool↗
PubMed1986

Parelaphostrongylus tenuis in captive reindeer and sable antelope.

Parelaphostrongylus tenuis caused neurologic disease in 6 reindeer (Rangifer tarandus tarandus) and 2 sable antelope (Hippotragus niger) that were housed at the National Zoological Park Conservation and Research Center in Front Royal, Va. Progressive hindlimb ataxia and weakness were seen in all affected animals. The parasite was recovered from the subdural space of one reindeer and was seen histologically within the neuropil of another reindeer and a sable antelope. In the other reindeer and sable antelope, diagnoses of parelaphostrongylosis were based on clinicoepidemiologic findings and microscopic lesions. Because parelaphostrongylosis is a density-dependent disease and because the number of white-tailed deer probably will increase, the incidence of P tenuis infections in domestic and nondomestic animals probably will increase as well. Zoos and wildlife parks especially should be cautious when introducing exotic hoofstock to areas with Parelaphostrongylus tenuis-infected white-tailed deer.

Animals↗
PubMed1985

[Some practical problems and several methodological trials in continuous intracranial pressure monitoring].

The continuous intracranial pressure monitoring has been widely applied in intensive or critical care, but there are various kinds of methods for its monitoring at present. One hundred and forty-one cases mostly with severe head injury were subject to the intracranial pressure recordings in the critical care ward in Department of Emergency Medicine, University of Tokyo Hospital, from October, 1980 through May, 1983, and in Neurosurgical Unit, Showa General Hospital, in April and May, 1984. The authors made several methodological trials for the monitorings in them and compared with one another from the aspect of clinical practice. The subarachnoid catheter was inserted into the subarachnoid or sometimes into the subdural spaces by way of the burr hole in 112 cases and proved not to demonstrate in some cases the intracranial pressure waves clearly due to so called damping phenomenon but to indicate the reliable values, or trustworthy mean pressures in all the cases except for impending brain dead patients with swollen hemispheres and least cerebrospinal fluid remained in intracranial subarachnoid spaces. The ventricular fluid pressure was monitored in nine cases and was most dependable as well as the subarachnoid pressure. The ventricular cannulation and its maintenance were, however, difficult when the ventricles were compressed or deviated, which were often experienced in acute severe head injury and also in impending brain death just because of the same above mentioned reasons. These demerits were attempted to be conqured with epidural pressure monitorings such as the fiberoptic sensor (Ladd) in 17 cases, the intracranial catheter tip pressure transducer (Gaeltec) in nine cases and the sensor of bioimplantable polymer (Plastimed) in three cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Xenoplasty of the dura mater by means of formalinized grafts].

The possibility of using as plastic material animal (neat cattle, pig) dura mater stored in 0.5% formaldehyde solution was studied. The structure of the dura mater tissue is maintained for a 3-year storage period, and it therefore can be used during this period. The results of experiments (on 30 dogs) and clinical observations (63 patients) show that dura mater grafts used to repair a defect ensure airtightness of the subdural space and separate the brain from the overlying tissues, thus preventing the development of an adhesive-cicatricial process. On resorption, the graft is replaced by an organ-typical regenerated material performing the function of the lost dura mater.

Animals↗