Biomedical subjects
Publications and source records attributed to E I Kandel.
A wide ranging review of the Soviet literature on epilepsy is provided, detailing historical aspects, pathophysiology, investigations, medical treatment, and the long term results of surgical treatment, including stereotaxic intervention. The features of Kojevnikoff epilepsy are presented.
Erythromelalgia is a very rare vascular disease affecting children and is accompanied by severe burning pain in the extremities. The disease is practically incurable. There are no recommendations in the literature concerning the possibility of managing the disease by stereotactic surgery. We operated on 3 children with severe pain due to erythromelalgia. The stereotactic destruction of VPL and CM was performed (in 2 cases on one side and bilaterally in 1). An excellent result with the disappearance of not only pain but all signs of the disease was noted in all cases (follow-up 8, 4.5 years and 6 months).
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The authors have developed a new technique for the stereotactic clipping of the feeding vessels of deep-seated arteriovenous malformations (AVM), for use when direct attack may be very dangerous or impossible. A special clipping device and the technique for its application are described. The instrument is introduced through a burr hole using the stereotactic apparatus designed by the authors. The clipping is monitored by intraoperative angiography. The method was used in 32 patients with supratentorial AVMs. It is concluded that in selected cases the method is effective, is less traumatic and gives successful results.
If the main feeder of an arteriovenous malformation (AVM) is a branch of the middle cerebral artery, one segment of which lies on the brain surface, it is advisable to clip it through a burr hole placed at an angiographically preselected point. The technical details of the procedure are described. This simple maneuver performed directly prior to radical surgery decreases the risk of possible rupture of an AVM during craniotomy and facilitates radical AVM excision.
The authors describe a new device for removal of intracerebral hematomas, based on the principle of stereotaxic evacuation of these lesions proposed in 1978 by Backlund and von Holst. The optimum parameters of stereotaxic aspiration, including speed of screw rotation and amount of suction, have been determined experimentally. Computerized tomography scanning was used to locate the hematoma site, to assess its volume, and to determine stereotaxic coordinates. A new method of preventing rebleeding is also described. This procedure was used to aspirate hematomas in 32 patients with spontaneous intracerebral hemorrhage, including one case caused by aneurysmal rupture and one secondary to rupture of an arteriovenous malformation. All patients were operated on in a severely comatose or semicomatose state. In all but four cases, the hematomas were almost totally removed. Three patients were operated on twice because of recurrent bleeding. The mortality rate for the series was 22%. A preliminary conclusion is made that this new method is safer and less traumatic than open surgery in most cases of severe intracerebral hematoma.
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The case of a patient who had spontaneous cure of an intracranial saccular aneurysm, documented by angiography, is reported. This occurred in a 41-year-old patient, admitted four months after recurrent subarachnoid hemorrhage due to an angiographically verified supraclinoid internal carotid artery aneurysm. The relevant literature is reviewed, and the possible mechanism of spontaneous aneurysmal thrombosis is briefly discussed. It is concluded that repeating angiography is not without merit in patients with already documented cerebral aneurysms who are referred for surgical treatment some time after a subarachnoid hemorrhage.
A new method of stereotaxic clipping of arterial and AV aneurysms has been developed. The surgical technique and the special clipping device are briefly described. Successful results have been obtained in 30 clipping operations performed on 27 patients with arterial or AV aneurysms at different locations with follow-up ranging from 6 months to 6 years. There was one fatal outcome not directly related to the clipping operation.
Total removal of an arteriovenous malformation of the cervical spinal cord is uncommon. Two cases of complete excision of such a malformation confirmed by angiography are reported.
Combined Conray-Myodil ventriculography is described. An emulsified mixture of the two drugs is prepared immediately before injection into the lateral ventricle. The method gives excellent visualization of the entire ventricular system. There were no complications in 208 neurosurgical cases.
In carefully selected cases of arterial aneurysms and deep-seated arteriovenous malformations (AVM), when direct attack may be dangerous or impossible, the authors advocate stereotaxic clipping. A special device and technique for its application are described. The instrument is introduced through a trephine opening and clipping is monitored by angiography. Successful results have been obtained in 10 operations performed on eight patients, three of whom had arterial aneurysms (two internal carotid and one anterior cerebral-anterior communicating) and five with AVM's.
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