[Venous cerebral circulation under normal conditions and during increased intracranial pressure].
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Biomedical subjects
Publications and source records attributed to S Kamiński.
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The authors analyzed the signs and clinical data from the preoperative period in 39 patients with tumours of the conus terminalis and cauda equina. Most patients had been treated for a long time for lumbar discopathy with sciatic pains. Most symptoms and neurological signs were in many cases suggestive rather of lumbar disc prolapse than spinal tumour. Radiological examinations of the spine failed in a overwhelming majority of cases to provide clues for correct diagnosis, only the type of tendon jerks loss, results of Queckenstedt's test and protein level in the cerebrospinal fluid suggested spinal tumor as a cause of the disease. Contract radiological examination of the vertebral canal gave definite answer in all cases.
The authors present a group of 38 patients with middle cerebral artery aneurysms in whom 48 aneurysms were excluded from the cerebral circulation by microsurgical techniques. In 11 cases multiple aneurysms were found. In 2 cases the wall of the aneurysm was strengthened. In the light of this material and a survey of the pertinent literature the authors analyse the relationship between the results of surgical treatment and various factors. A significant increase in postoperative mortality was found with more severe condition of the patients by the Botterell scale. The factors worsening the prognosis were also: presence of intracerebral haematoma and aneurysm location in the bifurcation of an artery. Arteriospasm increased the incidence of neurological deficits.
The author analyses the clinical data and pathological manifestations in 29 cases of intraspinal tumours in which the results of preoperative lumbar tap were equivocal or excluded presence of vertebral canal obliteration. On the other hand, myelography showed presence of complete or incomplete contrast stop at the level of the tumour, despite misleading information of the diagnostic lumbar tap.
Thirteen patients treated surgically for multiple intracranial aneurysms are described. They accounted for 12% of all patients with intracranial aneurysms diagnosed by arteriography. The incidence of multiple intracranial aneurysms, their location, surgical tactics and results of surgical intervention are discussed in the light of an analysis of own results and a survey of the pertinent literature.
Therapeutic results are reported in 115 patients operated upon for intracranial aneurysms using the microsurgical technique from Yasargil's approach. Elimination of the aneurysm from the circulation by clipping its pedicle was done in 94 cases (82%), trapping of the afferent artery (12%), in 7 cases (6%) only the wall of the aneurysmatic sac was strengthened by wrapping. A good therapeutic result was obtained in 68 patients (59.1%), satisfactory in 6 (5.2%), poor in 13 (11.3%). The overall mortality was 24.4% (28 cases) but after taking into account 4 patients dying due to extracerebral causes, the mortality caused by complications related to exclusion of the aneurysm from cerebral circulation was 20%. The factors influencing the results of surgical treatment of cerebral aneurysms are discussed in the light of the own material.