False-positive abrupt decrease in EtCO2 during craniotomy in the sitting position.
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A 64-year-old woman had the syndrome of inappropriate ADH secretion (SIADH) after surgical repair of a ruptured aneurysm of the anterior communicating artery. SIADH began while the intracranial pressure was elevated, and resolved when the pressure returned to normal. Whether this syndrome was caused by direct hypothalamic lesions, local pressure on the hypothalamus secondary to enlargement of the third ventricle, or some other mechanism cannot be ascertained. The occurrence of intracranial pressure changes with SIADH is described.
BACKGROUND: Techniques used to repair craniofacial skeletal defects parallel the accepted surgical therapies for bone loss elsewhere in the skeleton and include the use of autogenous bone and alloplastic materials. Transplantation of a bone marrow stromal cell population that contains osteogenic progenitor cells may be an additional modality for the generation of new bone. METHODS: Full thickness osseous defects (5 mm) were prepared in the cranium of immunocompromised mice and were treated with gelatin sponges containing murine alloplastic bone marrow stromal cells derived from transgenic mice carrying a type I collagen-chloramphenicol acetyltransferase reporter gene to follow the fate of the transplanted cells. Control surgical sites were treated with spleen stromal cells or gelatin sponges alone, or were left untreated. The surgical defects were analyzed histologically for percent closure of the defect at 2, 3, 4, 6, and 12 weeks. RESULTS: Cultured bone marrow stromal cells transplanted within gelatin sponges resulted in osteogenesis that repaired greater than 99.0+/-2.20% of the original surgical defect within 2 weeks. In contrast, cranial defects treated with splenic fibroblasts, vehicle alone, or sham-operated controls resulted in minimal repair that was limited to the surgical margins. Bone marrow stromal cells carrying the collagen transgene were immunodetected only in the newly formed bone and thus confirmed the donor origin of the transplanted cells. CONCLUSIONS: These studies demonstrate that mitotically expanded bone marrow cells can serve as an abundant source of osteoprogenitor cells that are capable of repairing craniofacial skeletal defects in mice without the addition of growth or morphogenetic factors.
Glioblastoma multiforme is a highly malignant glioma with a well-known tendency for intracranial spread but rarely for extracranial spread. We report a case of an adult woman who presented with symptoms of leptomeningeal metastasis from an intracranial glioblastoma multiforme located adjacent to the lateral ventricle. There have been very few cases of glioblastoma multiforme presenting with leptomeningeal metastasis in the absence of previous therapeutic intervention.
The nurse, as primary and continuous accessor of the patient, must have a thorough knowledge of complications related to posterior fossa surgery. Continuous evaluation of neuro status will alert her to any changes. These changes can occur quickly and require immediate intervention to prevent life-threatening situations. Attentive nursing care, both physiological and psychological, with utilization of other health care team members (social service, mental health counselors, physical and occupational therapy) can ensure a more secure recuperative period.
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Among 344 patients with posterior fossa tumours treated from 1979 to 1986 a ventriculoperitoneal, or, less commonly, a ventriculatrial shunt was inserted in 164 cases pre-operatively. Haematoma following the insertion of a shunt was found to be an important cause of deterioration. While the occurrence of cerebrospinal fluid leak (p less than 0.3) and pseudomeningocele (p less than 0.01) was more frequent in the non-shunted cases, seizures (p less than 0.01) were found to occur more frequently in the shunted cases.
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Three patients with intracranial atypical teratomas presented with symptoms of endocrine dysfunction (diabetes insipidus, hyperprolactinemia, and anterior hypopituitarism) suggestive of a hypothalamic disorder. Computer-assisted tomography done in two of the three cases enabled us to document the presence of a mass and institute radiotherapy, without prior neurosurgical exploration. Computer-assisted tomography also provided a safe and effective method of assessing the effects of radiotherapy.
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Large cranial defects do not always heal spontaneously, especially in humans; often they have to be obturated with metallic or acrylic fillers. Bilateral cranial trephine defects, measuring 14-20 mm in diameter, were created in three Rhesus monkeys, providing a typical primate model system for investigations in comparative physiology of bone regeneration. Each skull had one control and one experimental trephine defect. Control defects were implanted with bovine serum albumin (BSA). Experimental defects were implanted with 100-200 mg of a partially purified fraction of bovine bone morphogenetic protein (bBMP) in two monkeys. In one monkey, the BMP was incorporated in a 1:1 poly(lactic) poly(glycollic) acid copolymer, high-viscosity formula. The animals were killed at eight weeks, ten weeks, and 16 weeks after implantation. The tissue responses were analyzed by computed histomorphometry and routine histologic examination. At each time interval, the BMP implanted defects produced more complete regeneration than the control implants. The morphogenetic response occurred in the following sequences: mesenchymal cell proliferation, chondrogenesis, and increased bone formation. BMP-induced osteogenesis may initiate the regenerative process. The copolymer releases BMP but may constitute a barrier to the end stages of replacement by new bone, and would be more useful in a low-viscosity rapidly biodegradable form.
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