Biomedical subjects

J A Persing

Publications and source records attributed to J A Persing.

At least 19 recordsLinked to original sources

PubMed1992

Neurological deterioration after lumbar cerebrospinal fluid drainage.

Large-bore lumbar spinal fluid drainage is used frequently as part of the preoperative and intraoperative management of patients undergoing cranial base tumor resection. Such drainage allows displacement of the brain with minimal force, thereby potentially decreasing retraction damage to it. We document 2 patients in whom serious complications resulted from lumbar drainage systems. These patients deteriorated into a coma state following cerebrospinal fluid (CSF) drainage. Reinfusion of synthetic CSF solutions caused a brisk return to normal neurological status. These plus other potential complications associated with lumbar drainage, such as persistent CSF leaks into the back and soft-tissue nerve root injury, warranted abandoning the lumbar cistern drainage route of CSF drainage in favor of drainage directly from the intracranial compartment. Depending on the particular operation performed, drainage of CSF near the cribriform plate, the suprachiasmatic cistern, or from the sylvian fissure may be effective sites for CSF drainage. Unlike lumbar drainage, intracranial CSF drainage does not have the added risk of promoting cerebral herniation.

Carcinoma, Squamous Cell↗

PubMed1992

The serratus anterior free tissue transfer for craniofacial reconstruction.

The serratus anterior muscle was used as a free tissue transfer to reconstruct complex craniofacial defects in 5 patients. Serratus anterior muscle alone and serratus anterior muscle with rib were the transfers made. All flaps survived and scapular winging did not occur. The serratus anterior muscle has several advantages for the reconstruction of medium-sized craniofacial defects. Because of its position, a two-team approach is possible. It has a consistent pedicle anatomy and low donor site morbidity. It has a large caliber vessel and a long pedicle. When compared with the commonly employed rectus abdominis flap for moderate-sized defects, the serratus muscle offers greater versatility in design and has the option of incorporating bone and innervated muscle without increasing significant donor site morbidity.

Adolescent↗

PubMed1992

Surgeon's foot: a report of sural nerve palsy.

Although compression neuropathies are encountered frequently in neurosurgical practice, involvement of the sural nerve is described rarely. We report a case of bilateral compression neuropathy of the sural nerve with an unusual mechanism of injury. The case is discussed, and the pertinent literature is reviewed.

Follow-Up Studies↗

PubMed1991

Electrophysiological findings in localized hypertrophic mononeuropathy.

Localized hypertrophic mononeuropathy (LHM) is a rare foccal neuropathy associated with perineurial cell proliferation due to an undefined stimulus. We report a case of LHM involving the proximal ulnar nerve in a 13-year-old boy. Serial clinical and electrophysiological observations were done, including intraoperative recordings directly from the nerve on two occasions. The evolution of abnormalities, as documented by electrophysiological and immunohistochemical studies, is compatible with a process of progressive thinning of myelin sheaths, culminating in axonal degeneration in later stages. Intraoperative recording of nerve action potentials was used to guide surgical management of the lesion. Ultimately, there was a good clinical and electrophysiological response to resection of the lesion and sural nerve fascicular grafting.

Action Potentials↗

PubMed1991

Duraplasty in cranial base resection.

Complications of cerebrospinal fluid leakage following cranial base surgery are a predominant source of morbidity and mortality. The physical properties of the dura in this region, advanced patient age, previous irradiation, and the extent of tumor resection often limit or complicate the reconstructive options available to cranial base surgeons. We describe a technique that delivers vascularized tissue to the dural wound by transposing a dural flap based on the axial pedicle blood supply from the middle meningeal artery. This "duraplasty" can allow primary closure of defects at the cranial base. The donor site, which is less gravitationally dependent, more accessible, and often not affected by radiation therapy, can be closed using traditional methods. Advantages, disadvantages, and indications for this technique are discussed.

Cerebrospinal Fluid↗

PubMed1991

Skull base expansion: craniofacial effects.

In order to determine what effect the anterior cranial base has on the developing craniofacial skeleton, mechanical expansion of the growth of one segment of the anterior cranial base was performed. New Zealand white rabbits were used for this study. A sham-treated group (n = 16) underwent implantation of dental amalgam markers to either side of the frontonasal, coronal, and lambdoid sutures at 9 days of age to serve as markers of vault growth. The experimental group (n = 7) underwent the same marker placement at 9 days of age, but, in addition, at 30 days of age these animals underwent placement of a mechanical spring, unilaterally, at the frontosphenoid suture. A second control group (n = 8) underwent the same exposure of the frontosphenoid suture, but the spring was laid only on the surface of the bone. All animals were followed by radiographic cephalometry at 9, 30, 60, and 90 days of age. The experimental group demonstrated statistically significant expansion of the cranial base and ipsilateral coronal suture. The midface skeletal dimensions were unchanged by spring distraction of the cranial base. These findings indicate that cranial base sutural growth can be manipulated mechanically and that growth changes can be attained secondarily in the cranial vault skeleton.

Animals↗

PubMed1991

Cranial deformation in craniosynostosis. A new explanation.

Skull growth after premature fusion of a single suture was described by Virchow in 1851. He observed that growth was restricted in a plane perpendicular to a fused suture. However, he failed to predict the compensatory growth patterns that produce many of the deformities recognized as features of individual craniosynostosis syndromes. The deformities resulting from premature closure of a coronal, sagittal, metopic, or lambdoid suture can be predicted by the following observations: (1) cranial vault bones that are prematurely fused act as a single bone plate with decreased growth potential; (2) asymmetrical bone deposition occurs mainly at perimeter sutures, with increased bone deposition directed away from the bone plate; (3) sutures adjacent to the stenotic suture compensate in growth more than those sutures not contiguous with the closed suture; and (4) enhanced bone deposition occurs along both sides of a nonperimeter suture that is a continuation of the prematurely closed suture. These four rules were derived by critically examining the clinical deformities observed with each form of craniosynostosis. These rules assume that cranial sutures have the capacity to compensate by depositing bone asymmetrically along their edges. Unequal growth patterns have been demonstrated in the frontonasal suture of rabbits by Selman and Sarnat. In addition, unequal bone deposition has also been demonstrated along the parieto-interparietal suture in albino rats by Baer. Human studies to determine if asymmetrical bone deposition actively occurs along cranial vault sutures in response to a stenotic suture have not been performed, however. It is also unclear whether these four guidelines apply to cranial base abnormalities observed with craniosynostosis. As new radiologic techniques develop to define the configuration of the skull in intricate detail, a skull pattern of growth explaining the pathogenesis of all deformities created by premature fusion of a cranial vault suture may become apparent.

Animals↗

PubMed1991

Surgical treatment of metopic synostosis.

Metopic synostosis can present with various skull abnormalities for which early surgical treatment can provide significant benefit to the patient. Correction of skull deformities associated with metopic synostosis requires accurate assessment of the full range of craniofacial defects within context of the patient's age. Alteration in the characteristics of cranial bone as the child grows older necessitates modifications in techniques used for bony remodeling. Changes in the rate of brain and cranial vault growth also must be considered for adjustments in fixation methods. Thus, both the patient's age and the severity of aesthetic deformity dictate the surgical techniques used in the correction of metopic synostosis.

Child, Preschool↗

PubMed1991

Treatment of syndromic and nonsyndromic bilateral coronal synostosis in infancy and childhood.

The treatment of nonsyndromic and syndromic bilateral coronal synostosis has been outlined. Essential features of this individualized approach include technique modification in bone remodeling and fixation according to the age of the patient as well as additional emphasis on elongating the anterior cranial base or periorbital segment in patients with syndrome-associated bilateral coronal synostosis. Common to the treatment of all patients with turribrachycephaly related to bilateral coronal synostosis is an emphasis on holistic reshaping of the skull afforded by the positioning of the patient in the modified prone position, which gives simultaneous access to the anterior and posterior skull for optimal reshaping of hypoplastic and compensatory abnormalities.

Age Factors↗

PubMed1991

Craniofacial suture stenosis: morphologic effects.

Craniofacial anomalies, such as Apert's and Crouzon's syndromes, are presumed to be related to premature growth arrest of cranial base growth sites. However, premature growth arrest at cranial vault sutures in animals appears to play a causative role in the development of cranial deformities characteristic of single-suture, or simple, craniosynostosis in humans. To study the possible causative role of cranial vault and other (interface) suture stenoses on the development of craniofacial deformity, a vault suture and an interface suture between the cranial vault and facial skeleton were simultaneously immobilized. Thirty-one New Zealand White rabbits at 9 days of age underwent implantation of dental amalgam growth markers adjacent to cranial vault and facial sutures. In the experimental group (n = 15), methylcyanoacrylate adhesive was applied over the coronal (vault) and frontonasal (interface suture between vault and facial skeleton) sutures to immobilize them. The remaining 16 animals served as sham-treated controls. All animals underwent serial radiographic cephalometry to document growth effects in the cranial vault, cranial base, and facial skeleton. Application of adhesive resulted in statistically significant (p less than 0.05) reduction in growth at the coronal and frontonasal sutures. This was accompanied by an overall significant reduction in neurocranial vault length during the first 30 days of development.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

Vascular lesions involving the cranial base: combined surgical and interventional radiologic approach.

Advantages and possible complications of combined surgical and interventional radiologic approach to vascular lesions involving the cranial base are presented in three case examples. The methodology and technology of endovascular embolization and occlusion techniques, selection of embolic materials, functional testing to prevent neurologic injury and surgical implications of these treatment modalities are discussed. Emphasis is placed on individualization of each combined approach relative to the aforementioned factors.

Catheterization↗

PubMed1990

Remodeling techniques for immature and mature cranial vault bone: technical note.

Remodeling cranial vault bone requires age-dependent technique modifications. Cranial vault bone, in children less than 1 year of age, remodels, readily using radially oriented osteotomies. In children older than 1, however, the bone is relatively brittle, yet it, too, may be remodeled by sectioning it first into 1.5 to 2.0 cm wide strips, then placing resistance-weakening kerfs on the bone's endocranial surface. The kerfs weaken the bone regionally so that controlled bending may occur.

Age Factors↗

PubMed1990

Total cranial vault reconstruction for parietal encephalocele.

A 3-year-old boy underwent skull reconstruction in order to reduce a parietal encephalocele. The reduction of the encephalocele was accomplished fully and safely while simultaneously correcting a concomitant turriscaphocephaly skull-shape irregularity. A combination of the modified prone position and cranial reconstruction using barrel stave expansion of the basal vault was employed.

Child, Preschool↗

PubMed1990

Floating C-shaped orbital osteotomy for orbital rim advancement in craniosynostosis: preliminary report.

A method of lateral orbital rim advancement is described for periorbital deformities associated with coronal and metopic synostosis in infants. The technique offers the advantages of a smooth lateral rim contour and improvement in accompanying malar recession. In 13 patients with follow-up periods of up to 2 years following surgery, improved orbital contour has been appreciated. Further observation is warranted to determine whether this improvement will last into adulthood.

Child, Preschool↗

PubMed1990

Treatment of bilateral coronal synostosis in infancy: a holistic approach.

Bilateral coronal synostosis often results in a turribrachycephalic skull shape. Reduction of skull height and elongation of the anteroposterior axis of the skull while preserving normal cerebral function are the major therapeutic goals. A surgical technique is described which can successfully accomplish these goals in a single operative procedure.

Craniosynostoses↗

PubMed1990

The versatile frontal sinus approach to the floor of the anterior cranial fossa. Technical note.

A technique to expose the anterior cranial base is described with entry through the anterior and posterior walls of the frontal sinus. Burr holes are avoided in the visible portion of the forehead. Expansion of the operative field may be accomplished, if necessary, by supplemental superior frontal or supraorbital rim osteotomy. The technique is rapid, safe, and provides excellent operative exposure and superior cosmetic results.

Facial Neoplasms↗

PubMed1990

Craniofacial trauma: an assessment of risk related to timing of surgery.

Following the retrospective analysis of approximately 4000 head-injury patients, 49 were identified with a combination of displaced facial fractures and significant cerebral trauma. The purpose of this study was to define clinical and radiographic features in these patients that are associated with a poor prognosis, which in turn might influence the timing of facial fracture repair. The presence of an upper-level facial fracture, low Glasgow coma score, intracranial hemorrhage, displacement of normally midline cerebral structures, and multisystem trauma was associated with a statistically significant poorer prognosis. Additionally, in demographically similar groups of patients (age, sex, concomitant injury) preselected for intracranial pressures of less than 15 mmHg at the time of surgery, no significant difference in survival was appreciated in patients who underwent early (0 to 3 days), middle (4 to 7 days), or late (greater than 7 days) surgical repair. Early surgical repair of facial fractures in these circumstances does not appear to have a negative impact on recovery.

Adolescent↗

PubMed1989

Craniosynostosis.

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Craniosynostoses↗