The utility of motor-evoked potential monitoring during intramedullary surgery.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to J W Renaudin.
Explore the source record for details and available documents.
Because subdural empyema (SDE) is an unusual central nervous system infection, recognition is not always prompt. Consequently delays can allow a serious but curable infection to become irreparably damaging or even fatal. This condition, particularly in the early stages, is relatively easy to treat. Personal experience with six patients during the past 3 years promoted us to review the data from UCLA and its affiliated hospitals. Among the 23 cases of SDE reviewed, the predisposing factor in 16 was sinusitis, mastoiditis, or otitis media. The clinical presentation, encompassing a systemic febrile illness, headache, and neurological deficit, was monotonously uniform. The high incidence of paranasal sinus involvement in the adult, middle ear infections in infants, and seizures in 15 patients comprised further clinical clues suggesting the diagnosis. Although usually diagnosed as an intracranial inflammatory process, an initial failure to suspect a purulent collection in the subdural compartment was typical. Although the findings of definitive diagnostic studies (computed tomography or angiography) are strikingly positive in advanced cases, in the earlier stages of this disorder they may be subtly abnormal. Because the mortality and morbidity rates, in some measure, depend on the stage at which the process is arrested, the real challenge lies in making a prompt diagnosis. The most favorable results are associated with early, decisive surgical treatment.
A simple wire template is placed on the patient's head during computerized tomography scanning, and the results of the scan are later reproduced on the scalp prior to surgery. Measurements of the distance between the wires and the relationship of the mass provide the key to accurate localization of the mass on the scalp surface.
19 cases of intracranial ependymomas were reviewed to determine the incidence of seeding. 4 patients demonstrated conclusive evidence of seeding in sites remote from the operative and irradiated field, 3 of whom had high-grade ependymomas. Clinical-pathological correlation disclosed a greater tendency to seeding and a worse prognosis among patients with high-grade ependymomas. A more aggressive therapeutic approach is indicated when high-grade ependymomas are involved.