Proficiency in neurosurgery.

This evaluation of proficiency is a comparison of other high performance occupations with neurosurgeons, an attempt to understand the minimal number of cases required for proficiency during both residency training and after, and the effect of human factors.

Facial reanimation after facial nerve injury.

Patients with facial paralysis are often seen in neurosurgical practice. Obtaining full facial symmetry and function after facial nerve damage presents the neurosurgeon with a difficult challenge. Various surgical techniques have been developed to deal with this problem.

Syringomyelia as a postoperative sequela of the resection of a chordoma of the clivus: case report.

Syringomyelia has been described frequently in association with various abnormalities of the skull base but rarely with tumors of the skull base. Syringomyelia as a postoperative sequela of surgery of the skull base has not been reported. The authors describe a case of cervical syringomyelia developing after the partial resection of a chordoma and combined conventional and proton beam irradiation.

Intracranial pressure monitoring in the posterior fossa: a preliminary report.

Direct therapeutic drainage and intracranial pressure monitoring from the posterior fossa has never been accepted in neurosurgical practice. Potential complications including cerebrospinal fluid leak, cranial nerve palsies, and brain-stem irritation have been a major deterrent. The authors placed a catheter for pressure monitoring in the posterior fossa of 20 patients in the course of posterior fossa surgery: 14 patients with acoustic schwannomas, four with posterior fossa meningiomas, one with cerebellar hemangioblastoma, and one with a solitary cerebellar metastatic lesion.

Experimental peripheral nerve repair: environmental control directed at the cellular level.

This study recognizes recent advances in the understanding of the anatomy and physiology of peripheral nerves at the cellular level. It has reproduced study conditions originally advocated by de Medinaceli and coworkers, with modifications. Eighty-four rats were divided into three groups.

The effect of intravenous lidoflazine on whole blood-induced basilar artery contraction. An in vivo study.

Lidoflazine, a piperazine derivative of known selectivity for vascular smooth muscle, was evaluated as a possible agent for prophylaxis of cerebral vascular contraction induced by subarachnoid perfusion with whole blood. Previous studies from this laboratory have indicated its efficacy in preventing basilar artery contraction induced by serotonin. The animals treated with a subarachnoid perfusion of whole blood had a mean 30% reduction in vessel diameter over the control value.

Transcallosal parafornicial approach for third ventricle tumors: neuropsychological consequences.

Five adult patients with 3rd ventricle tumors underwent a transcallosal intraventricular parafornicial approach. Pre- and postoperative cognitive reviews were conducted on all patients. Each review consisted of: a standardized neuropsychological battery, mental status reviews, specific tests for disconnection, and a personality variable, where possible.

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.

The effect of intravenous lidoflazine on serotonin-induced cerebral vascular contraction--an in vivo study.

Lidoflazine, a piperazine derivative with known selectivity for vascular smooth muscle, was evaluated as a possible agent for prophylaxis of cerebral vascular contraction induced by subarachnoid perfusion with serotonin. The animals treated with serotonin (5 X 10(-6) M), had a 60% reduction in the diameter of basilar artery but when pretreated with Lidoflazine (1 mg/kg) intravenously, only had a 20% reduction in diameter (p less than 0.01).

Multiple intracranial arteriovenous malformations: case report.

The authors describe a case of multiple supratentorial intracranial arteriovenous malformations in a patient with a family history of cerebrovascular disease. There was no sign of any other vascular dysplasia. A brief review of this rare entity is given.

Magnetic resonance imaging of acoustic neuromas.

Ten patients with neurosensory hearing loss and computed tomographic (CT) evidence of acoustic neuromas were evaluated with magnetic resonance imaging (MRI). Tumors ranged in size from 0.8 to 3.

Vertebral osteochondroma causing spinal cord compression: case report.

A case of spinal cord compression secondary to an osteochondroma of the vertebral body of T-4 is reported. Computed tomography aided in the display of the lesion and the planning of its resection.

Compound frontobasal skull fractures: surgical management of the acute phase.

The management of frontobasal skull fractures must be dealt with in a multidisciplinary manner. The advent of computed tomography has simplified the emergency radiologic investigation and expedited immediate surgical intervention. The major problem to be dealt with is closure of the frontobasal dura, which we accomplish by using an autogenous fascial graft packed under the frontal lobes and secured basally with autogenous adipose implants.

Detection of retained surgical sponges.

The accuracy of radiographic detection of neurosurgical sponges was measured experimentally. Commercially available sponges were inserted into a cadaver in several paravertebral locations and radiographed. A total of 72 radiographs (90 sponges) were assessed, as well as an equal number of radiographs without sponges.

Control of hypertension and prophylaxis against vasospasm in cases of subarachnoid hemorrhage: a preliminary report.

Thirty hypertensive patients with subarachnoid hemorrhage were divided randomly into two groups. The treated group was begun on preliminary volume expansion, and control of hypertension was carried out using vasodilators and centrally acting drugs. The control group was treated in the classical manner for hypertension, with a diuretic as the foundation for therapy.