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Biomedical subjects

J P Sheehy

Publications and source records attributed to J P Sheehy.

10 recordsLinked to original sources
PubMed1998

The cerebellopontine angle: does the translabyrinthine approach give adequate access?

A long-standing but unfounded criticism of the translabyrinthine approach is the misperception that this approach does not give adequate access to the cerebellopontine angle. Because of what is perceived as limited visualization and operating space within the cerebellopontine angle, some surgeons still believe that the translabyrinthine approach is inappropriate for large acoustic tumors. In this study, the surgical access to the cerebellopontine angle by virtue of the translabyrinthine approach is measured and analyzed. The parameters are compared with those measured for the retrosigmoid approach. This series objectively confirms that the translabyrinthine approach offers the neurotologic surgeon a shorter operative depth to the tumor, via a similar-sized craniotomy. This permits superior visualization by virtue of a wider angle of surgical access. Such access is achieved with the merit of minimal cerebellar retraction.

Cerebellopontine Angle↗
PubMed1996

Evolution of the management of hydrocephalus associated with acoustic neuroma.

The management of hydrocephalus in association with a cerebellopontine angle tumor is controversial. There is a widely held belief that initial therapy should always be directed toward treatment of hydrocephalus before definitive surgery. The potential problems of cerebrospinal fluid (CSF) shunting and drainage have to led to an evolution in the management of hydrocephalus at St. Vincent's Hospital. There is growing evidence that complete removal of cerebellopontine angle tumors will result in resolution of hydrocephalus without requiring other methods of CSF decompression. The authors present their experience of 14 patients with hydrocephalus found in a recent series of 104 consecutive cases of acoustic neuroma. This study has detected a significant correlation between hydrocephalus and increasing tumor size (P = .0234). The mean tumor size in this series was 3.8 cm. The series has also demonstrated that successful. safe, and complete tumor removal can be achieved without CSF drainage before surgery.

Adult↗
PubMed1994

Paraganglioma of the cauda equina with associated syringomyelia: case report.

We present an association not previously described in which the rare entity of paraganglioma of the cauda equina was found in association with syringomyelia of the cervico-thoracic cord. The patient, a 50-year-old woman presented with a long history of lower back pain with recent onset of sciatic pain and altered sensation in the right leg. Surgical resection of the tumor with intraoperative syringostomy of the syrinx has led to eradication of all symptoms and at 5 months shows no evidence of residual pathology.

Cauda Equina↗
PubMed1992

Surgical treatment of tumours of the skull base.

OBJECTIVE: To describe the special features of surgical removal of tumours of the skull base and to review a series of patients treated for skull base tumours. DESIGN: A retrospective review of patients followed up for between six months and six years. SETTING: A unit specialising in surgery of the skull base at a tertiary referral centre. PATIENTS: Sixty-six patients with skull base tumours were referred to the unit between February 1984 and December 1989. INTERVENTIONS: Fifty-six of the patients underwent complete or partial surgical removal of the tumour. Radiotherapy was used as primary treatment in 10 patients, for tumour recurrence in four patients and as adjuvant postoperative treatment in 10 patients. RESULTS: In the majority of patients the tumours were benign and have been controlled or are considered cured. Of the seven patients with malignant tumours five have died and two are long-term survivors (one has multiple metastases). Three patients with histologically "benign" tumours died of multiple metastases. There have been a total of 10 deaths in the series but only one occurred in the perioperative period. Cranial nerve palsy was the major postoperative complication. CONCLUSION: Modern microsurgical techniques and modern anaesthesia and intensive care skills lead to a cure in many patients with skull base tumours previously considered inoperable.

Follow-Up Studies↗
PubMed1992

Evaluation of TRISS as a means of selecting trauma deaths for clinical peer review.

This study was carried out to evaluate the predictive power of a mathematical model called TRISS in identifying avoidable trauma deaths when compared with peer review (PR). The subjects studied comprised the 24 deaths that occurred among 81 severely injured patients (Injury Severity Score greater than or equal to 16) admitted to a trauma unit over a 1 year period. Sixteen patients who had a greater than 50% probability of survival (Ps) calculated by TRISS died. Peer review concluded that five of those were potentially avoidable deaths. Eight deaths occurred in patients with a Ps less than 50%. Peer review regarded those eight as inevitable deaths. The data, when analysed, showed TRISS to have a 100% sensitivity, 42% specificity, 31% positive predictive value and a negative predictive value of 100% when compared with peer review. It is concluded that TRISS tends to over-estimate potentially avoidable death, especially in patients with severe head injury. However it is a good audit filter as it reliably excludes inevitable death.

Age Factors↗
PubMed1991

Meningioma of the posterior skull base.

Combined intratemporal and cerebellopontine angle meningiomas are rejatively rare. There are unsolved problems with the stability of the skull and spine and the lower cranial nerves and there is a marked tendency for the tumor to involve the spinal cord. This article reports on five cases of combined intratemporal and cerebellopontine angle meningiomas.

Journal Article↗
PubMed1983

Dorsal root entry zone lesions (Nashold's procedure) for pain relief following brachial plexus avulsion.

Brachial plexus avulsion is an important cause of severe intractable pain, particularly in young motor cyclists. The pain usually develops soon after the injury. In a minority of cases severe pain persists and is refractory to management. Nineteen patients are reviewed in whom dorsal root entry zone lesions have been produced for pain relief. The operative technique is described. Early post-operative motor or sensory disturbance in the ipsilateral leg have been temporary side effects, with mild persisting deficits in a minority. Sixteen cases have had significant persisting pain relief. The maximum follow-up period is 2 1/2 years.

Accidents, Traffic↗
PubMed1983

Multiple meningiomas: a long-term review.

Ten cases of multiple meningiomas seen over a 34-year period have been reviewed. The total case load from which these cases were selected was 566. The incidence of multiple meningiomas found prior to the introduction of computerized tomography (CT) in this series was 1.1%. The incidence since the introduction of CT was 8%. In eight cases all the tumors were found at the initial presentation and surgery; in the other two cases new tumors were discovered 1 and 4 years later. In only one case was von Recklinghausen's disease known to be present, and this patient developed new tumors. Six cases have been followed for 5 or more years, two for 16 years. Tumor recurrence has not been seen. All the patients were females. There was a higher proportion than usual of the whorling psammomatous type of tumor; papillary, angioblastic or malignant forms were not noted. The possibility of multiple meningiomas being a forme fruste of von Recklinghausen's disease is considered.

Adult↗