Cranial Operation Research Articles

A combined procedure to deliver autologous mesenchymal stromal cells to patients with traumatic brain injury

There is increasing evidence of therapeutic benefits from bone marrow (BM)-derived mesenchymal stromal cells (MSC) in various animal models with neurologic disorders. It is of great interest to apply the approach to clinical patients, i.e. to take the investigations from laboratory bench to the patient's bedside. This clinical trial was performed to assess the safety and feasibility of a combined procedure to deliver autologous MSC to patients with traumatic brain injury. MSC were isolated by BM aspiration and expanded in culture. Seven patients received autologous cell transplantation. A primary administration of 10(7)-10(9) cells was applied directly to the injured area during the cranial operation; a second dose of 10(8)-10(10) cells was infused intravenously. All patients were followed up regularly for 6 months. There was no immediate or delayed toxicity related to the cell administration within the 6-month follow-up period. Neurologic function was significantly improved at 6 months after cell therapy. The procedure used is safe and feasible at ordinary medical facilities without additional invasive procedures for the patient. The combined cell delivery procedure is expected to enhance the engraftment efficacy of transplanted cells at injured brain tissue, thereby promoting neurologic recover.

Infratemporal and intraorbital metastasis of the glioblastoma multiforme: A case report

Primary brain tumors rarely metastasize outside of the central nervous system. A case of 37-year-old woman with a temporal lobe glial tumor which shows infratemporal and orbital invasion is presented. She had undergone a cranial operation because of temporal lobe epilepsy 8 years ago. Defects on the dura and bone flap were thought to be the mechanisms of the infratemporal fossa invasion. The case illustrates extra-axial metastasis of glioblastoma multiforme, an exceptional finding.

Social attitudes toward shaving for cranial neurosurgery

Unshaved cranial neurological surgery has been successfully performed at Songklanagarind Hospital. However, within the Buddhist community, shaving is one of the traditional procedures for cleanliness and purification, and the unshaved method may have a cultural effect on social beliefs. Knowledge of social attitudes toward shaving or not shaving for cranial neurological surgery has implications for informed consent process prior to cranial operation. The attitudes of shaving were surveyed in the communities of Songkhla Province where Songklanagarind Hospital is situated. Of 1128 respondents, the female to male ratio was 3:2, their age was mostly under 40 years old and 91% were Buddhist. Sixty per cent of the respondents were in favour of shaving. After knowing the equivalent result of surgery either by shaved or unshaved method, the group favouring unshaved cranial surgery increased from 12 to 37%. Statistical analysis, through ordinal and multinomial logit, identified the young age, female and more educated who needed to socialize, and frequently meet many people were the groups who preferred or were ready to change their choice to the unshaved method. The neurosurgeon should give an advice to the patient not only the indications and results of surgery, but also a choice of shaved or unshaved cranial neurological surgery.

Factors Influencing Posttraumatic Seizures in Children

The ideal treatment of children with head trauma would include prevention of posttraumatic seizures. Ninety-two of 937 children with head injuries (9.8%) experienced posttraumatic seizures. In 94.5% of these patients (87 of 92), seizures developed within the first 24 hours after injury. Three children convulsed between 24 hours and 7 days, but only 2 children developed seizures after the 1st week. Factors found to influence the likelihood of seizures included severe head injury (GCS, 3 to 8), diffuse cerebral edema, and acute subdural hematoma (P less than 0.001). Seizures occurred in 35% of severely head-injured children compared to 5.1% with minor head injury (P less than 0.001). A less significant correlation (P less than 0.1) was noted between seizures and open, depressed skull fractures. We found no significant correlation between seizure occurrence and numerous other factors including age, sex, fracture location and type (other than open, depressed fractures), parenchymal injuries, fixed neurological deficits, and cranial operation. Based on our observations, we recommend the prophylactic use of anticonvulsants in children at higher risk for posttraumatic seizures: those with diffuse cerebral edema, acute subdural hematoma, open, depressed skull fracture with parenchymal damage, or severe head injury (GCS less than or equal to 8).

Current Techniques in Operative Neurosurgery

This book, the proceedings of a 1976 symposium, contains 33 chapters treating diverse subjects of operative neurosurgery. Included in most of the chapters is information about patient selection, diagnostic criteria, perioperative care, and tabulations of results as well as descriptions of surgical procedures. The broad range of subjects includes a number of procedures that are innovative or interesting. Among the topics dealt with are transbasal approach to the base of the skull, carotid-cavernous fistulas, tumors of the orbit, hypophysectomy, surgery of the vertebral column, and various topics in the surgery of brain tumors. This work is not a comprehensive treatment of operative neurosurgery. For example, the only cranial nerve operation presented is a percutaneous rhizotomy, and there is little material about arteriovenous malformations. No space is devoted to hydrocephalus or to the craniofacial dysostoses. Some procedures are described in great detail while others are not. The illustrations and photographs vary

Cerebrospinal fluid rhinorrhea and the empty sella.

C EREBROSPINAL fluid rhinorrhea is associated infrequently with abnormalties of the pituary fossa or sphenoid sinus. It has almost always been described in reference to tumor, cyst, infection, head injury, nasal or cranial operation, yttrium or x-ray therapy. The occurrence of cerebrospinal fluid rhinorrhea in the absence of the above and in the presence of an empty had not been reported in the English literature prior to June, 1968. At that time Ommaya, et al., reviewed 18 cases of nontraumatic rhinorrhea including two patients with empty sellas. ''16 One was a 57-year-old man with seizures and mild hypopituitarism, in whom pneumoencephalography and surgery showed that the anterior portion of the sella was empty. A second patient, mentioned only briefly, had an arachnoidal hernia through a hole in the floor of the sella. Both patients were operated on successfully for arrest of the rhinorrhea. The empty syndrome 3,9 usually refers to a rare late complication of radiotherapy for pituitary adenomas. Years after receiving radiation, these patients characteristically develop vision impairment, probably due either to involvement of the optic nerve and chiasm by dense scar tissue or radiation degeneration, without evidence of tumor recurrence. In our four new patients cerebrospinal fluid rhinorrhea was associated with leakage through an empty as verified at operation. None had received radiotherapy and in none was there any evidence of tumor.

The influence of posture of the neck on progression of the fowl (Gallus domesticus).

In the course of our investigation of the body righting reflexes in the fowl, a detailed report of which will appear shortly, we had one animal which as a result of a cranial operation assumed a peculiar posture at certain times. It would keep its head down and tail up, so that the long axis of the body was at an angle about 60° to the horizontal. When in such a condition, the animal invariably walked backward and continued to do so till it would hit the wall of the room. But when it kept its head in a normal position it could and did walk forward.In order to find out the mechanism of this phenomenon we studied a number of normal Leghorn and Sebright Bantam fowls in which the lower portion of the neck was kept flexed upon the trunk by means of a gauze bandage. We found that these animals, without exception, in attempting to move walked backward. After the bandage was removed they immediately returned to the normal method of progression. Such test could be performed repeatedly on the same animal with simil...

Thrombosis of the Cavernous Sinus ; Report of Four Cases, with One Cranial Operation

Thrombosis of the Cavernous Sinus ; Report of Four Cases, with One Cranial Operation

Thrombosis of the Cavernous Sinus; With Report of Four Cases, Including One Cranial Operation

Thrombosis of the Cavernous Sinus; With Report of Four Cases, Including One Cranial Operation