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Biomedical subjects

D L Barrow

Publications and source records attributed to D L Barrow.

At least 37 records · Page 2Linked to original sources
PubMed1994

The blood supply of the intracavernous cranial nerves: an anatomic study.

Cranial nerve deficits are the most common complications of cavernous sinus surgery. Often the deficit occurs despite anatomic preservation of the nerve, and ischemic injury is thought to be the cause. A better understanding of the blood supply of these nerves may help to prevent such complications. The authors performed a cadaveric microsurgical study of the intracavernous cranial nerves and their blood supply in 20 cavernous sinuses. The oculomotor nerve received branches from the inferolateral trunk or its equivalent in all specimens (100%). The proximal trochlear nerve received branches from the inferolateral trunk in 80% of the specimens and from the tentorial artery of the meningohypophyseal trunk in 20%. The distal half was supplied by the branches from the inferolateral trunk only. In the region of Dorello's canal, the proximal third of the abducens nerve received branches from the dorsal clival artery of the meningohypophyseal trunk. The middle and distal thirds received branches from the inferolateral trunk. The ophthalmic and proximal maxillary segments of the trigeminal nerve received branches from the inferolateral trunk. The distal maxillary segment was supplied by the artery of the foramen rotundum. In the majority of cases, the medial third of the Gasserian ganglion received branches from both the inferolateral trunk and the tentorial artery. The middle third of the ganglion received branches from either the inferolateral trunk or the middle meningeal artery. Our findings indicate the important role the intracavernous branches of the internal carotid artery play in the blood supply of the intracavernous cranial nerves, and stress the need to preserve these branches to prevent or minimize postoperative deficits.

Abducens Nerve↗
PubMed1994

Combined extracranial-intracranial bypass and intraoperative balloon occlusion for the treatment of intracavernous and proximal carotid artery aneurysms.

A protocol for the treatment of selected intracavernous and proximal internal carotid artery aneurysms is described. Intraoperative angiography is used together with intraoperative balloon occlusion of the internal carotid artery and electroencephalography to optimize the timing of an extracranial-intracranial bypass before occlusion of the carotid artery and to provide intraoperative documentation of graft patency. This protocol has been used successfully in seven patients with complex aneurysms that were unsuitable for other endovascular methods or a direct microsurgical approach. Six aneurysms were located in the cavernous sinus, and one was located on the supraclinoid portion of the internal carotid artery. There were no permanent complications; one patient had a brief episode of dysphasia, which resolved without sequelae.

Adult↗
PubMed1994

The microsurgical anatomy of the superior hypophyseal artery.

Interest in the anatomy of the proximal segment of the intracranial internal carotid artery has been kindled by the recognition that there are multiple potential sites of aneurysm formation in this region. These various aneurysm locations have characteristic hemodynamic and clinical features as well as surgical considerations. Recently recognized as a distinct clinical and anatomical entity are aneurysms that are hemodynamically related to the superior hypophyseal artery. Although aneurysms arising in proximity to the superior hypophyseal artery are not rare, the anatomy of this vessel arising from the medial or posteromedial aspect of the proximal internal carotid artery is poorly understood. We performed a cadaveric microsurgical anatomical study of 20 internal carotid arteries between the ophthalmic and posterior communicating arteries to develop a better understanding of the anatomical relationships of the superior hypophyseal artery. There were an average of 1.8 superior hypophyseal arteries arising from each carotid artery with an average diameter of 0.22 mm. The origin of the superior hypophyseal arteries was within 5 mm of the ophthalmic artery origin in 85% of the specimens. There were two distinct patterns of superior hypophyseal artery anatomy. In 42%, a large, dominant superior hypophyseal artery branched like a candelabra with smaller branches to the pituitary stalk, optic nerve, and chiasm. The average diameter of the larger branches was 0.3 mm. In the absence of a large dominant branch, two or three medial vessels were found. In one specimen, an incidental aneurysm was discovered at the origin of the superior hypophyseal artery on the medial aspect of the internal carotid artery at the origin of a large candelabra-like branch.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Surgical management of arteriovenous malformations in the region of the ventricular trigone.

The results in the surgical management of 26 patients with arteriovenous malformations intimately related to the trigone of the lateral ventricle are presented. Three operative approaches were used in the series, including a transtemporal route through the inferior or middle temporal gyrus (15 patients), an interhemispheric approach (8 patients), and a transcortical parieto-occipital approach (3 patients). The surgical approach was chosen on the basis of the relationship of the arteriovenous malformation to the trigone, the presence and location of associated hematoma, and preoperative neurological deficits. This report emphasizes the use of surgical adjuncts that are instrumental in the management of these challenging lesions, including magnetic resonance imaging for precise localization and operative planning, preoperative embolization to obliterate deep arterial supply, and intraoperative ultrasound and angiography to aid in localization and to document complete excision of the arteriovenous malformation before closure. The results of the management of these 26 patients are as follows: 21 had no or minor neurological deficits and were able to resume premorbid activities; 2 had a fair result, being independent but unable to resume their premorbid occupation; 2 had a poor result and were dependent as the result of an incapacitating neurological deficit; and 1 died.

Adolescent↗
PubMed1994

Intradural perimedullary arteriovenous fistulas (type IV spinal cord arteriovenous malformations).

Intradural perimedullary arteriovenous fistulas (Type IV spinal cord arteriovenous malformations (AVM's)) are rarely reported in the literature and occasionally are classified together with Type II AVM's as intradural spinal cord AVM's. The authors report eight cases of Type IV spinal cord AVM's managed over a 2-year period. Seven of these AVM's were surgically obliterated, with intraoperative angiography being used as an adjunct; one other patient was managed using endovascular therapy. One of these lesions was definitely and another possibly the result of trauma; a malformation in a newborn infant was clearly congenital. The authors believe that the pathophysiological mechanisms and anatomical features of these lesions represent a unique spinal vascular anomaly that must be recognized angiographically to plan appropriate therapy.

Adult↗
PubMed1994

Immune response in hosts with cadaveric dural grafts. Report of two cases.

The use of cadaveric human dura has been critical in the repair of dural defects since the dawn of neurosurgery. Reports in the literature of immune response to this type of graft have been extremely rare. Two patients are presented who received cadaveric dural implants with resulting meningeal signs and cerebrospinal fluid eosinophilia several weeks after surgery. Peripheral eosinophilia was present in one patient. The signs and symptoms resolved temporarily during corticosteroid therapy and permanently upon removal of the offending grafts. These cases illustrate that an immune-type reaction can occur with significant morbidity in patients receiving cadaveric dural grafts. A proposed mechanism for this response is discussed.

Adult↗
PubMed1993

Cocaine-induced aneurysmal rupture: an emergent negative factor in the natural history of intracranial aneurysms?

Recent statistics from the National Institute on Drug Abuse indicate that cocaine abuse continues to be a significant public health problem. Between 1988 and 1990 at Grady Memorial Hospital in metropolitan Atlanta, Georgia, we identified 12 patients in whom subarachnoid hemorrhage was temporally related to cocaine abuse. All 12 patients had underlying cerebral aneurysms that had ruptured. Currently, the incidence of ruptured intracranial aneurysms in patients with cocaine-induced subarachnoid hemorrhage is 84.9% (mean age, 31.1 years; overall mortality, 60.5%). Hypertension is the likely precursive factor in cocaine-induced aneurysmal rupture. Cocaine abuse appears to be a significant negative factor in the natural history of cerebral aneurysms, especially in young adults. We review the epidemiology of cocaine-induced subarachnoid hemorrhage and its effects on the cerebral circulation, and suggest guidelines for patient management.

Adult↗
PubMed1993

Natural history of intracranial aneurysms and vascular malformations.

A fundamental aspect of the practice of a medical or surgical specialty is clinical decision making. This process presumes a careful comparison of the risks of various treatment options and the risks of the natural history of the patient's disorder. A multitude of factors enter into an accurate assessment of the risks involved in any surgical or medical therapy. In the specialty of vascular neurosurgery, these risks are often of great consequence. Potential complications underscore the importance of the other side of the clinical decision-making equation, namely, the natural history of the patient's affliction. Our knowledge of the natural history of intracranial vascular anomalies is incomplete. Much, however, is known of the outlook for patients harboring intracranial vascular malformations and aneurysms. It is of paramount importance that this knowledge be reviewed periodically so that the most accurate information is used when one consults an individual patient on the most appropriate course of therapy.

Adolescent↗
PubMed1992

Intraoperative angiography in the management of neurovascular disorders.

Intraoperative angiography is useful in verifying the goals of neurovascular operations during the procedure and before the wound is closed. We report on our technique of intraoperative angiography in 115 neurovascular operations, including obliteration of intracranial aneurysms, resection of brain and spinal arteriovenous malformations, creation of extracranial-to-intracranial bypass grafts, and carotid endarterectomy. Of these 115 procedures, intraoperative angiograms provided information that altered the operative procedure on 19 occasions. There were two complications in the 115 cases that may be related to the intraoperative angiographic procedure. Overall, however, the quality of image provided by portable digital subtraction intraoperative angiography makes this technique a safe adjunct to neurovascular surgery.

Angiography, Digital Subtraction↗
PubMed1992

Infectious intracranial aneurysms.

Infectious cerebral aneurysms are uncommon, accounting for only 2.6% to 6% of all intracranial aneurysms according to autopsy studies. These aneurysms may arise from an intravascular or extravascular source of infection. The vast majority occur in the setting of bacterial endocarditis with an intravascular source of infection due to embolization of fragments of infected cardiac valve emboli. Infectious aneurysms are usually discovered after a devastating intracranial hemorrhage that carries a 60% to 90% mortality. More recently, fungal infectious aneurysms, which carry an even graver prognosis, have become more common. A high index of suspicion and early diagnosis of infectious aneurysms prior to hemorrhage is an important factor in reducing morbidity and mortality. Some lesions are effectively treated with antibiotics alone, but other require surgical intervention.

Aneurysm, Infected↗
PubMed1991

Intracranial aneurysms in sickle-cell anemia: clinical features and pathogenesis.

Intracranial aneurysms are an unusual complication of sickle-cell anemia; only 15 patients have been described in the world literature. An additional 15 patients with sickle-cell anemia and subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms are presented. There was a high incidence of multiple aneurysms (60%); some of which were in unusual locations. The clinical and pathological features of this series of patients have provided a paradigm for acquired aneurysm formation that may be applicable to other intracranial aneurysms. Thirteen patients underwent craniotomy and clip ligation; the perioperative management of these patients is discussed. Of these 13, eight had a good recovery, three were left with moderate disability, one patient died of surgical complications, and one died of complications related to sickle-cell anemia. Two of the 15 patients died of SAH. The authors propose that endothelial injury from the abnormal adherence of sickle erythrocytes to the endothelium is the initiating event in arterial wall injury. Subsequently, there is fragmentation of the internal elastic lamina and degeneration of the smooth-muscle layer. Hemodynamic stress at these loci of arterial wall damage results in aneurysm formation. This hypothesis also explains other cerebrovascular manifestations of sickle-cell anemia, namely vaso-occlusive disease and hemorrhage without aneurysm formation. Pathological material from this series and data from the literature are presented to support this hypothesis.

Adolescent↗
PubMed1991

CREST-associated multiple intracranial aneurysms and bilateral optic neuropathies.

A patient with a clinical and serological diagnosis of CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal motility abnormalities, sclerodactyly, telangiectatic lesions), a variant of PSS (progressive systemic sclerosis), was found to have multiple intracranial aneurysms. She subsequently developed bilateral optic neuropathies. Ischemic and compressive etiologies are proposed and related to the histopathology of the patient's underlying systemic disease.

Aged↗
PubMed1990

Loss of vision after transsphenoidal surgery.

Eleven patients who experienced significant loss of vision after transsphenoidal surgery are reported on. The mechanisms involved in these visual complications include direct injury or devascularization of the optic apparatus, fracture of the orbit, postoperative hematoma, cerebral vasospasm, and prolapse of the optic chiasm into an empty sella. Factors that may increase the risk of visual complications include the presence of a pituitary macroadenoma, previous visual impairment, a "bottleneck" or dumbbell-shaped tumor, previous surgery and/or radiation therapy, and, possibly, use of a lumbar subarachnoid catheter during operation. A practical approach to the management and avoidance of these complications is presented.

Adenoma↗
PubMed1990

Infectious intracranial aneurysms: comparison of groups with and without endocarditis.

A series of 12 patients with infectious intracranial aneurysms is presented, and a number of unusual features of the disorder are emphasized. A comparison of characteristics of the aneurysms and clinical course is made between patients with and without infective endocarditis. Most of the unusual characteristics of infectious aneurysms, including rare locations, causative organisms, and predisposing medical conditions, occurred in the group without endocarditis. The relationship of atypical features of infectious aneurysms to the etiology of aneurysm formation is discussed, and an approach to treatment is presented.

Adolescent↗
PubMed1989

Modification of acute focal ischemia in rabbits by poloxamer 188.

We studied the effect of a synthetic copolymer surfactant, poloxamer 188, on cerebral blood flow in a rabbit model of focal cerebral ischemia. Following retro-orbital craniectomy, the parietal branch of the middle cerebral artery was occluded with bipolar current. Cerebral blood flow was measured by the hydrogen clearance technique using platinum-iridium electrodes placed within the parietal cortex. Ten rabbits were infused with 50 mg/kg poloxamer 188 in saline beginning 30 minutes after occlusion; 12 control rabbits received an equal volume of saline. Poloxamer 188 increased blood flow significantly in areas of severe or moderate ischemia but had little effect in areas with mild or no ischemia. The improvement in blood flow could not be accounted for by hemodilution, and the copolymer did not affect blood viscosity at any shear rate from 1 to 100 sec-1. We hypothesize that poloxamer 188 increases circulation in ischemic tissue by inhibiting adhesive interactions among proteins (fibrin and fibrinogen) and cells in the microcirculation.

Animals↗
PubMed1988

Intracranial extracerebral glioneural heterotopia.

A newborn baby girl with intracranial extracerebral glioneural (brain) heterotopia in the right frontoparietal area is described. The heterotopic brain was predominantly composed of neuronal and glial elements, with partial cerebellar differentiation. It also contained well-differentiated adipose tissue. The possible mechanism for its origin and the causes of central nervous system heterotopia are discussed.

Brain Neoplasms↗