Biomedical subjects
W A Shucart
Publications and source records attributed to W A Shucart.
Endoscopic sphenoidotomy approach to the sella.
OBJECTIVE: Advances in optics, miniaturization, and endoscopic instrumentation have revolutionized surgery in the past decade. We report our experience with the endoscope in nine patients with sellar lesions who underwent an endoscopic sphenoidotomy approach to the sella. METHODS: An endoscopic transnasal cavity sphenoidotomy approach without a septal dissection was used in the resection of pituitary adenomas and other sellar lesions. RESULTS: This approach provided excellent exposure of the sella and adequate working space. The technique produces less postoperative pain and, in some cases, shortens hospital stay. The sphenoidotomy approach eliminates the problems of lip numbness, septal perforations, and oronasal fistulas. CONCLUSION: The endoscopic sphenoidotomy approach has become our preferred approach to sellar lesions.
A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment.
A classification is proposed that unifies and organizes spinal and cranial dural arteriovenous fistulous malformations (AVFMs) into three types based upon their anatomical similarities. Type I dural AVFMs drain directly into dural venous sinuses or meningeal veins. Type II malformations drain into dural sinuses or meningeal veins but also have retrograde drainage into subarachnoid veins. Type III malformations drain into subarachnoid veins and do not have dural sinus or meningeal venous drainage. The arterial supply in each of these three types is derived from meningeal arteries. The anatomical basis of the proposed classification is presented with several cases that illustrate the three types of dural AVFMs. A rationale for the treatment of spinal and cranial dural AVFMs according to their anatomical characteristics is discussed.
Correction: dural arteriovenous fistulous malformations.
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De novo development of an aneurysm: case report.
A case of the de novo formation of an aneurysm in a young woman is presented. At age 13 years, she had a spontaneous subarachnoid hemorrhage. Cerebral angiography showed an aneurysm of the bifurcation of the left internal carotid artery and a small aneurysm of the left anterior choroidal artery. At surgery, the aneurysm of the internal carotid artery was clipped, and the aneurysm of the left anterior choroidal artery was wrapped with muslin. Thirteen years later, the patient had another subarachnoid hemorrhage. Cerebral arteriography showed four aneurysms that had developed at previously angiographically normal sites. This case suggests that young patients with aneurysms might benefit from follow-up angiography in search of late aneurysm formation.
Enlargement of basilar artery aneurysms following balloon occlusion--"water-hammer effect". Report of two cases.
Two patients with distal basilar aneurysms were treated with intra-aneurysmal balloon occlusion. After apparently successful therapy, follow-up angiograms demonstrated aneurysm enlargement with balloon migration distally in the sac. Geometric mismatch between the base of the balloons and the aneurysm neck together with transmitted pulsation through the 2-hydroxyl-ethylmethacrylate (HEMA)-filled balloon directly contributed to aneurysm enlargement. In this report, the authors discuss the problems of progressive aneurysm enlargement due to a "water-hammer effect" and the possibility of hemorrhage following subtotal occlusion.
Temporary balloon occlusion of a proximal vessel as an aid to clipping aneurysms of the basilar and paraclinoid internal carotid arteries: technical note.
One aneurysm of the basilar artery and three large, paraclinoid aneurysms of the internal carotid artery (ICA) were treated with the aid of intraoperative temporary balloon occlusion of the vessel. Optimal clip placement was confirmed using intraoperative angiography. This technique provided excellent proximal vascular control and for the large aneurysms of the paraclinoid ICA obviated the need for surgical exposure of the ICA in the neck. We think this is a useful adjunct in the surgical management of aneurysms of both the basilar artery and proximal ICA.
Tinnitus and neurosurgical disease.
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Preoperative arteriographic spasm and outcome from aneurysm operation.
The timing of intracranial operation for the treatment of ruptured cerebral aneurysm remains controversial. To find objective parameters to guide us, we performed angiography 24 to 72 hours before contemplated operation in 35 Grade I patients in whom subarachnoid hemorrhage had occurred at least 1 week earlier. Operation in the presence of angiographic vasospasm in Grade I patients over 1 week after SAH was associated with increased morbidity and mortality rates. Only 1 of 28 patients in whom spasm was absent or mild at the time of operation had an unsatisfactory outcome from operation (P less than 0.003). There was no correlation between clinical grade and significant spasm; 17 patients who were clinically Grade I over 1 week after SAH had moderate or severe angiographic spasm. These data suggest that all patients should undergo angiography just before contemplated operation and that operation should be postponed if vasospasm is present.
Implications of very high serum prolactin levels associated with pituitary tumors.
Five patients with pituitary tumors associated with unusually high serum prolactin levels are presented. Tumor size and the presence of suprasellar extension were variable, but the finding common to all five cases was invasion of the cavernous sinus. It is proposed that very high serum prolactin levels suggest an invasive tumor, perhaphs, specifically, invasion into a cavernous sinus. The surgical significance of this proposition is discussed.
Epsilon-aminocaproic acid and recurrent subarachnoid hemorrhage: a clinical trial.
A clinical trial of epsilon-aminocaproic acid (EACA) in preventing recurrent hemorrhage from intracranial arterial aneurysms is reported. Previous reports were reviewed, and their results concerning antifibrinolytic agents were inconclusive in establishing their efficacy. One hundred patients with documented ruptured intracranial aneurysms were admitted to this study within 48 hours of the initial hemorrhage: 45 patients received 36 gm of EACA/day, with 11 documented rebleeds and one suspected rebleed. No benefit was seen from the use of EACA.
Lateral approach to the upper cervical spine.
A procedure for access to the ventral portion of the spinal canal from the foramen magnum to the superior portion of C-3 is described. This is useful for lesions that are primarily ventral or ventrolateral to the spinal cord, such as meningiomas or neurofibromas. The exposure involves no more bone removal than does a posterior laminectomy, but the angle of approach reduces markedly the amount of spinal cord manipulation necessary to deal with ventrally situated lesions.
Treatment of Cushing's disease with o,p'-DDD.
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Listeria monocytogenes: brain abscess or meningoencephalitis?
A brain abscess caused by Listeria monocytogenes developed in an immunosuppressed renal transplant patient. Meningitis and meningoencephalitis from this organism were encountered in three other renal transplant recipients at this medical center during the past 4 years. Focal neurologic deficits occurred in patients with either Listeria abscess or meningoencephalitis. Computerized tomography was a rapid aid to the diagnosis of abscess. Immunosuppression has increased the incidence of central nervous system Listeria infections, but ampicillin still provides effective treatment, even when immunosuppressive therapy is continued. Limited experience with Listeria brain abscess suggests that surgical intervention improves the prognosis.
Noninvasive test of cerebrospinal shunt function.
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Management of diabetes insipidus in neurosurgical patients.
The authors present a brief review of the problem of diabetes insipidus in neurosurgical patients, with particular emphasis on the differential diagnosis of postoperative and posttraumatic polyuria and the management of diabetes insipidus in these periods. A listing of drugs currently used in its treatment is given.
Reopening some occluded carotid arteries. Report of four cases.
Four cases are presented in which intermittent ischemic symptomatology was referable to a cerebral hemisphere. Arteriography in each case showed complete occlusion of the ipsilateral internal carotid artery in the neck with collateral filling of the ipsilateral intracranial carotid artery into the cavernous portion. Endarterectomy was performed successfully in each case from 1 to 5 weeks after the demonstrated complete occlusion. The collateral circulation to the intracranial portion of the internal carotid artery and the probable reasons for the technical success of these operations are discussed.
Experimental negative intraventricular pressures.
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