Prevalence of psychologic disorders after surgical treatment of seizures.

To investigate whether surgical treatment of refractory epilepsy is associated with increased risk for serious psychopathology, 25 treated patients were compared with 25 current candidates for surgery matched on demographic and neuroepileptic characteristics. Diagnoses were made by the National Institute of Mental Health Diagnostic Interview Schedule. No differences between groups in lifetime or point prevalence rates were significant. The rate of psychosis in the postoperative group (8%) approximated the lower estimates in previous studies. Thus, surgical treatment of seizures did not increase the risk for psychopathology. However, patients with temporal lobe electroencephalogram foci or tumor as the epileptogenic lesion were more likely to have serious disorders than other patients. Also, anxiety disorders were more prevalent in our patient groups than in the general population.

[Experimental validation of the use of an ultrasonic surgical instrument in neurophysiology]. / Eksperimental'noe obosnovanie primeneniia ul'trazvukovogo khirurgicheskogo instrumenta v neirofiziologii.

The effect of ultrasonic and surgical instruments on nervous tissue in chronic experiments on the cats were investigated with electrophysiological and morphological methods. The authors compared the results of removal of the neocortex zones using ultrasonic and surgical instruments or routine methods. Electrophysiological and morphological studies have shown small injury effects made by ultrasonic and surgical instruments on the surrounding brain tissue.

Incidence and cardiac effects of systemic venous air embolism. Echocardiographic evidence of arterial embolization via noncardiac shunt.

Central nervous system dysfunction in venous air embolism may result from air entering the arterial circulation. Using two-dimensional and pulsed-wave Doppler echocardiography, this study not only documented the frequent presence of air in the right heart chambers of patients undergoing upright neurosurgery or pacemaker insertion, but also documented the presence of air in the left atrium and left ventricle of one patient via noncardiac shunt. Studies in dogs confirmed paradoxical air embolism in the absence of anatomic communications between right and left heart chambers. Systemic venous air also produced a dose-dependent increase in pulmonary artery pressure and diastolic flattening of the ventricular septum with increase in left ventricular filling pressure despite preserved systolic function.

[Treatment of post-neurosurgical diabetes insipidus with desmopressin by intramuscular route]. / Traitement du diabète insipide post-neurochirurgical par la desmopressine par voie intramusculaire.

Desmopressin (DDAVP) is used intramuscularly in the treatment of post operative diabetes insipidus as soon as the condition is diagnosed to ensure continuous replacement of antidiuretic hormone secretion during the first 5 days of therapy. Two successive studies, each involving 15 patients, were conducted. The first study was designed to test the effectiveness and detect the possible side effects of intramuscular DDAVP, while the purpose of the second study was to evaluate the clinical application of the drug. With seven 2 mcg doses of DDAVP, administered 12-hourly by intramuscular injection to patients weighing more than 30 kg, continuous antidiuresis during 96 hours was achieved. This method is simple and effective, but it should not be prolonged beyond that period of time. Moreover, to prevent plasma hypo-osmolality, fluid intake must be strictly controlled and kept at the same level as or below diuresis.

Stabilization procedures for thoracic and lumbar fractures.

New concepts regarding the biomechanics of spinal instability, new technology for spinal and neurodiagnostic imaging, further evolution of the role of neurological decompression, and the development of improved systems and techniques for achieving anatomical reconstruction and fixation of the spine continue to improve the care of patients suffering injuries of the thoracic and lumbar spine. This field of medicine is in rapid evolution, and newer improved methods will be forthcoming in the near future. An understanding of all of these developments as well as their limitations and potential complications is requisite if we are to optimize the functional capability of patients suffering these catastrophic injuries.

[Treatment of post-traumatic and post-neurosurgical bacterial meningitis with ceftriaxone alone or in combination with fosfomycin]. / Traitement des méningites bactériennes post-traumatiques et post-neurochirurgicales par la ceftriaxone seule ou en association avec la fosfomycine.

From 1984 to 1986, 13 patients (10 adults, 3 children) with bacterial meningitis following neurosurgery or traumatism were given ceftriaxone alone 6 times at a dose of 40 mg/kg one IV injection per day, or in association 7 times with fosfomycin at a dose of 200 mg/kg/day, 3 IV perfusions every 4 h. The bacteriological diagnosis was confirmed in 9 cases (3 Staphylococcus aureus, 4 Streptococcus pneumoniae, 1 Klebsiella, 1 Peptococcus). In vitro neither synergy nor antagonism were observed between the two antimicrobial agents. The acute infections episode resolved in all patients except on who died with a negative CSF culture. One superinfection meningitis with Achromobacter was seen. CSF concentrations of ceftriaxone were assayed and found to be comparable with those reported by most authors. Tolerance was excellent for all our patients.

Repercusiones hemodinamicas y pulmonares de la embolia aerea en posición sentado / Haemodynamic and respiratory repercussions of venous air embolization in the sitting position

La embolia aérea puede ocurrir cada vez que exista una gradiente entre la altura de cavidades cardiacas derechas y el lugar donde se realiza la intervención. Este último debe estar a mayor altura. La entrada de aire al sistema venoso es un riesgo significativo de la posición sentado empleada en procedimiento neuroquirúrgicos. El propósito de este trabajo es estudiar nuestra incidencia de embolia aérea y sus repercusiones cardiopulmonares. Fueron estudiados 50 pacientes operados en posición sentada en forma consecutiva. El diagnóstico de embolia aérea se formuló sólo cuando se aspiró aire através del catéter central. Nueve enfermos (18%) presentaron una embolia aérea. La monitorización de estos pacientes con Doppler, presión venosa central, presión arterial directa, electrocardiografía continua, gases arteriales pre y postembolia permitió evidenciar que en el 55% de las embolias hay hipotensión arterial significativa con presiones arteriales medias bajo 50 mmHg. Tres de los pacientes con embolia aérea presentaron extrasistolia ventricular frecuente y dos de ellos tuvieron un alza mayor de un 50% en la presión venosa central. 44% de los pacientes que tuvieron una embolia aérea presentaron un alza en la PaCO2 y 33% una caída en la PaO2 inmediatamente después del episodio embólico. Ningún paciente presentó problemas pulmonares clínicamente significativos en el postoperatorio. En esta serie no hubo mortalidad. La embolia aérea es un cuadro grave. El Doppler se mostró como el monitor de mayor sensibilidad para el diagnóstico y nos parece indispensable contar con un catéter central para un tratamiento adecuado. La posición sentado por los riesgos que conlleva debe reservarse exclusivamente para cirugía que no pueda realizarse en otra posición

Acute brain swelling during evacuation of subdural hematoma caused by delayed contralateral extradural hematoma: report of two cases.

Two patients experienced severe brain swelling during the evacuation of acute subdural hematomas. Postoperative computed tomographic (CT) scans revealed delayed extradural hematomas on the sides opposite the subdural hematomas. Extradural bleeding occurred in the area of the fractured skull. One patient improved neurologically after evacuation of the extradural hematoma, and the other was not operated because he was moribund. Drilling exploratory burr holes in the fractured area may have been a better strategy than awaiting a postoperative CT scan. The reduction of intracranial pressure after the removal of subdural hematoma was postulated to be the most important factor contributing to the formation of the extradural hematoma.

Bilateral hearing loss after unilateral removal of an acoustic neuroma by the suboccipital approach: case report.

Contralateral hearing loss is a very rare complication of acoustic neuroma surgery. A case of immediate postoperative contralateral hearing loss is reported. Possible causes and the pertinent literature are reviewed.

Bacterial infections of the central nervous system in neurosurgery.

CNS infections following clean neurosurgery are uncommon but occur with increased frequency following neurotrauma and placement of CSF shunts and ventriculostomies. When faced with the possibility of meningitis or brain abscess in these settings, the clinician must aggressively seek definitive diagnostic information by means of CT scanning and cell counts, Gram stain, and culture of the CSF. Appropriate empiric therapy should then be administered promptly to achieve cidal activity in the CSF against the most likely infecting pathogens. Prophylaxis for clean neurosurgery and for placement of CSF shunts has been advocated by several investigators. However, regimens are many, and data are few and conflicting. When given, prophylaxis should be administered only during the intraoperative period. There is, at best, a weak scientific basis for what remains a widespread practice.

Comparison of surgical and anesthetic complications in neurosurgical patients experiencing venous air embolism in the sitting position.

Because venous air embolism (VAE) has been considered to be a major deterrent to use of the sitting position, records of 255 patients undergoing neurosurgery in the sitting position from 1975 to 1982 were reviewed to determine the nature of morbidity and mortality in relation to the surgical procedure as well as to the occurrence of VAE. Complications were classified as surgical or anesthetic during joint review by a neurosurgeon and two neuroanesthesiologists. Outcome was classified on the basis of postoperative hospital course and discharge examination. The incidence of VAE was 30%. Although there was a variety of perioperative complications in patients with and without VAE, most of the complications were related to the operative procedure, not the sitting position or VAE. The episodes of VAE did not seem to be significant factors in the perioperative morbidity and mortality in our series of patients operated upon in the sitting position. Two case reports are discussed in detail.

Traumatic bilateral epidural hematomas presenting at different times in a patient with large ventricles.

In a patient with large ventricles, a huge epidural hematoma of venous origin developed after removal of a contralateral traumatic epidural clot which was produced by the tearing of the middle meningeal artery. The possible pathophysiologic characteristics of such hematomas are discussed.