Have neurosurgeons lost their chance to operate on spine problems?
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Humans↗
Biomedical subjects
G H Koenig
Publications and source records attributed to G H Koenig.
Failure of intracisternal tissue plasminogen activator to prevent vasospasm in certain patients with aneurysmal subarachnoid hemorrhage.
Recent experimental and clinical reports suggest that the intracisternal administration of recombinant tissue plasminogen activator (tPA) within 72 hours of subarachnoid hemorrhage decreases the incidence of severe angiographic and clinical vasospasm. In this report, we present four of eight patients with aneurysmal subarachnoid hemorrhage who developed angiographic and clinical vasospasm with delayed neurological deterioration, despite the use of intracisternal tPA after early aneurysm clipping. One patient did not clear her massive subarachnoid hemorrhage with tPA; one patient had extremely poor collateral flow with occlusion of one cervical internal carotid artery and 80% stenosis of the other cervical internal carotid artery; the other two patients had a subarachnoid hemorrhage 7 to 12 days after their sentinel hemorrhage. Three patients ultimately made excellent or good recoveries, and one was left with hemiparesis. The four other patients treated by this protocol did not develop vasospasm. We conclude that intracisternal tPA may not prevent vasospasm in certain patients. This may relate to inadequate clearing of the subarachnoid clot, pre-existing poor collateral supply, or the occurrence of prior subarachnoid hemorrhage.
Adult↗
Aneurysm surgery in a community setting.
A 15-year surgical experience of 34 aneurysms in private practice is reported. There was 1 death secondary to postoperative arterial spasm, and 3 patients sustained neurological injury. The remaining patients were normal or neurologically stable or improved. Although intracranial aneurysm surgery in a community setting differs from such surgery in a university setting, it seems that similar results can be obtained despite the more limited number of cases encountered.
Adult↗
Conservative treatment of benign traumatic intracerebellar hematoma.
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Cerebellar Diseases↗
Symptomatic Rathke's cleft cysts. Report of two cases.
Two unusual cases of symptomatic Rathke's cleft cysts are described. The first patient was a 47-year-old man who presented with recurrent aseptic meningitis in addition to visual symptoms, panhypopituitarism, and hydrocephalus. The second patient was a 41-year-old man presenting with increasing headache, and a large, nonenhancing sellar cyst showing suprasellar extension on computerized tomography. The similarities between Rathke's cleft cysts and craniopharyngiomas are discussed.
Bone Neoplasms↗
Rupture of intracranial aneurysms during cerebral angiography: report of ten cases and review of the literautre.
Ten new cases of intracranial aneurysms that ruptured during cerebral angiography, obtained from four local hospitals and the practices of eight angiographers, are detailed. A review of the literature reveals 28 other well-documented cases. An analysis of this clinical material shows that internal carotid injections are not necessarily more dangerous than common carotid injections. Although critically ill patients are at higher risk and must be treated with caution, there is not enough evidence to warrant a delay in angiography to avoid rupture. The recent trend toward early angiography in cases of subarachnoid hemorrhage is reflected in the statistical analysis. A plea for meticulous angiographic technique is advanced.
Adult↗
Subdural spread of medulloblastoma: case report.
A case of widespread intracranial subdural invasion by medulloblastoma is presented. The origin of the metastases would seem to be a large subfrontal tumour mass, with dissemination through the subdural space. This appears to be the first report of intracranial spread of tumour by this route.
Brain↗