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Biomedical subjects

D B Moreland

Publications and source records attributed to D B Moreland.

8 recordsLinked to original sources
PubMed2000

Endoscopic endonasal hemisphenoidotomy for resection of pituitary lesions confined to the sella: report of 3 cases and technical note.

The authors report use of a minimally invasive endoscopic procedure, unilateral endonasal hemisphenoidotomy, for removal of lesions contained in the sella. The entire procedure was performed through a single nostril with the use of an endoscope. A unilateral endonasal hemisphenoidotomy (1.5 cm x 1.5 cm) was performed and was sufficient to expose the sellar floor for successful removal of adenomas confined to the sella in three patients. Neither outfracturing the midline septum nor exposure of the opposite sphenoid ostium was necessary for adequate visualization, tumor exposure, or instrument maneuverability. There was, however, a learning curve required in order to become facile and efficient with the equipment. All lesions were completely resected. When compared to a bilateral endoscopic endonasal sphenoidotomy as practiced by us, the operative time was reduced and the length of stay was 1-2 days. There was less operative trauma, patients appeared to experience less pain immediately postoperatively, and their satisfaction was very high. In conclusion, for resection of this group of intrasellar tumors, the hemisphenoidotomy procedure proved to be less invasive and traumatic, more simple, and faster than the standard bilateral endoscopic sphenoidotomy.

Adult↗
PubMed1998

Endoscopic resection of pituitary lesions through the nostril.

The endoscope has been used in paranasal sinus surgery for many years. More recently, cooperation between neurosurgeons and ear, nose, and throat (ENT) surgeons has resulted in an extension of use of the endoscope to resection of lesions in the sella turcica region. The procedure described herein involves insertion of the endoscope and surgical instruments through one nostril to provide improved visualization of the pituitary gland and an economy of perioperative trauma. As compared with the traditional sublabial, transseptal approach, endonasal pituitary tumor resection is more direct, less traumatic, and allows excellent exposure of the tumor. These improvements result in reduced morbidity, shorter length of stay, and greater patient satisfaction.

Craniopharyngioma↗
PubMed1990

Cotrel-Dubousset instrumentation for the treatment of thoracolumbar fractures.

Cotrel-Dubousset instrumentation (CDI) was introduced in 1984 primarily for the treatment of scoliosis. The applications of this unique and versatile system have expanded to other diseases of the spine. Thoracolumbar fractures are a common management problem for which the device seems to be well suited. We review our results of 15 patients with unstable thoracolumbar fractures treated with CDI at an average of 24 months' follow-up. The results are promising and compare favorably with other forms of surgical and medical management. Postoperatively, there was a loss of 2 degrees in the angle of deformity and 0.9 mm of vertebral body displacement. Incomplete neurological injuries improved one or more Frankel grades in 75% of our patients. There were three complications (20%). CDI offers theoretical advantages over Harrington instrumentation and conservative (nonoperative) management. The use of CDI in the treatment of unstable thoracolumbar fractures is endorsed by these results.

Adolescent↗
PubMed1989

Leukotrienes in experimental spinal cord injury.

Leukotrienes are a group of noncyclized fatty acid eicosanoids which are formed from the breakdown of arachidonic acid. They are potent mediators of inflammation and may contribute to secondary injury in the central nervous system. All mammalian tissue including cerebral cortex is capable of synthesizing these; however, clear documentation of leukotriene formation in the spinal cord is lacking. We subjected 55 rabbits to weight drops of 200, 300, and 400 gm/cm, respectively, on an exposed spinal cord. The traumatized spinal cord was removed after periods of 15, 30, and 45 minutes and 1, 2, 4, 8, and 24 hours. Radioimmunoassay for leukotriene B-4 was then performed on the specimens. Significant (p less than 0.05) elevation was noted in the 200 and 300 gm/cm groups with peak levels occurring in the first 4 hours. The 400 gm/cm group showed significant depression of values below control levels from 2 to 24 hours. We conclude that in sublethal central nervous system injury leukotrienes are produced in significant amounts and may contribute to secondary spinal cord injury.

Animals↗
PubMed1988

Focal cortical dysplasia. Case report.

A histologically confirmed case of focal dysplasia of the cerebral cortex is presented. The computerized tomographic, electroencephalographic, pathological, and angiographic findings are discussed with respect to this rare developmental disorder. A review of the literature is presented with a possible etiology for this condition.

Adult↗
PubMedDate not supplied

Vertebroplasty: techniques to avoid complications.

BACKGROUND CONTEXT: The use of vertebroplasty for treatment of spinal fractures and spinal hemangiomas is increasing at a rapid pace. Although this is a minimally invasive procedure, complications have been reported. The most important of these is the unintentional migration of polymethylmethacrylate (PMMA). PURPOSE: The authors present methods, equipment, and principles that minimize occurrence of PMMA migration and other complications. STUDY DESIGN/SETTING: Patients in a private/university neurosurgery practice were studied retrospectively by chart review. PATIENT SAMPLE: During a 3-year period, 53 levels of vertebroplasty were performed on 35 patients presenting with indications of intractable pain resulting from vertebral body compression fractures. OUTCOME MEASURES: Pain assessment and outcome determination were made by the treating physician based on dialog with the patient, examination, and the patient's use of narcotics. The medical records of patients were reviewed for these factors as well as for signs of cerebrospinal fluid leak, PMMA migration, new radiculopathy, myelopathy, new fracture, pulmonary emboli, infection, or bleeding. METHODS: Criteria for inclusion consisted of disabling back pain corresponding to a recent fracture, pharmacotherapy, and medically stable for anesthesia. Vertebroplasty patients were followed up at 2 to 3 weeks and at 3 months after their procedure. RESULTS: Success rate for relief of pain was 89%. The overall complication rate was 6% per treated vertebral level. There were no deaths or delayed complications. Factors that reduce complications were identified and include the following: accurate needle placement, adequate barium radio-opacification of PMMA, viscous low pressure delivery of PMMA, and PMMA delivery under direct fluoroscopic visualization. CONCLUSION: Although vertebroplasty is considered a minimally invasive procedure, it can result in serious complications even without technical misadventures.

Adult↗