Abstract:
OBJECT:A classification is proposed to organize anterior cranial base fractures systematically according to their location and size. The goal of this study was to determine whether these two variables, irrespective of cerebrospinal fluid (CSF) rhinorrhea, are related to the long-term risk of posttraumatic meningitis and, hence, to standardize decision making concerning surgical repair of associated CSF fistulas. METHODS:With the aid of high-resolution thin-section coronal computerized tomography (CT) scanning, anterior cranial base fractures were classified into the following four major types: I, cribriform; II, frontoethmoidal; III, lateral frontal; and IV, complex (any combination of the other three types). Fractures with a maximum bone displacement that extended farther than 1 cm in any plane were classified as "large" and those less than 1 cm as "small." The authors used this classification in a study of 48 patients who were treated by conservative (20 patients) or surgical (28 patients) means. The results showed a gradation of risk: the fracture most likely to develop infection was a large cribriform (Type I) and the least likely was a small lateral frontal (Type II). Statistical analysis showed that the trend for an increased infection rate was related to the cumulative effect of three variables in the following order: 1) prolonged duration of rhinorrhea (analysis of variance [ANOVA], p = 0.017); 2) large size of fracture displacement (ANOVA, p = 0.079); and 3) fracture's proximity to the midline (ANOVA, p = 0.015). CONCLUSIONS:In this series, microsurgical repair was accompanied by a minimum complication rate. Hence, the authors recommend that patients with fractures that combine the aforementioned variables should be considered to have a high long-term risk of infection and their injury should be surgically repaired as soon as the posttraumatic edema has subsided. This applies to the following fractures: large cribriform (Type I) with transient rhinorrhea lasting 5 to 8 days and large frontoethmoidal (Type II) with prolonged rhinorrhea lasting longer than 8 days. Furthermore, the authors conclude that this classification can improve the management of posttraumatic CSF fistulas of the anterior cranial base and may provide insights into the mechanisms underlying their spontaneous repair and susceptibility to meningitis.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Sakas DE,Beale DJ,Ameen AA,Whitwell HL,Whittaker KW,Krebs AJ,Abbasi KH,Dias PSdoi
10.3171/jns.1998.88.3.0471subject
Has Abstractpub_date
1998-03-01 00:00:00pages
471-7issue
3eissn
0022-3085issn
1933-0693journal_volume
88pub_type
杂志文章abstract::The magnetic resonance longitudinal relaxation time (T1) and transverse relaxation time (T2) of the water proton of the periventricular white and cortical gray matter were measured for 17 control patients and 21 patients with suspected normal-pressure hydrocephalus (NPH). Of the latter group, 14 showed good response t...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1990.73.6.0864
更新日期:1990-12-01 00:00:00
abstract:OBJECT:Radiosurgery and radiation therapy represent important but unique treatment paradigms for patients with certain neoplasms, vascular lesions, or functional disorders. The authors discuss their differences. METHODS:Reviewing the authors' experiences shows how the roles of these approaches vary just as their techn...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.2004.101.4.0585
更新日期:2004-10-01 00:00:00
abstract::The treatment of cervical fixed flexion deformity in ankylosing spondylitis presents a challenging problem that is traditionally managed by a corrective cervicothoracic osteotomy. The authors report a new approach to this problem that involves performing a two-level osteotomy at the level of maximum spinal curvature, ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2000.93.2.0283
更新日期:2000-10-01 00:00:00
abstract:OBJECT:The purpose of this study was to assess the long-term outcome achieved after repeat Gamma Knife surgery (GKS) for trigeminal neuralgia (TN) using a uniform treatment plan. METHODS:Between 1985 and 2010, 53 patients underwent repeat GKS for refractory TN. In the initial GKS, which involved targeting the root ent...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2010.8.GKS101075
更新日期:2010-12-01 00:00:00
abstract::The health care needs of children with hydrocephalus continue beyond childhood and adolescence; however, pediatric hospitals and pediatric neurosurgeons are often unable to provide them care after they become adults. Each year in the US, an estimated 5000-6000 adolescents and young adults (collectively, youth) with hy...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2018.6.JNS188
更新日期:2018-11-01 00:00:00
abstract::The authors report a case of multiple meningiomas in a 37-year-old woman with Rubinstein-Taybi syndrome. The patient harbored a bifrontal ossifying meningioma and multiple intracranial meningiomas. She underwent surgery for the frontal ossifying meningioma and a right frontoparietal meningioma. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2005.102.1.0167
更新日期:2005-01-01 00:00:00
abstract:OBJECT:Mitoxantrone is a drug with potent in vitro activity against malignant brain tumor cell lines; however, its effectiveness as a systemic agent has been hampered by poor central nervous system penetration and dose-limiting myelosuppression. To avoid these problems, we incorporated mitoxantrone into biodegradable p...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2002.97.5.1173
更新日期:2002-11-01 00:00:00
abstract:OBJECT:The purpose of this study was to evaluate the safety and efficacy of gamma knife surgery (GKS) for the treatment of arteriovenous malformations (AVMs) involving the corpus callosum. METHODS:Thirty-two patients aged from 7 to 65 years (median 25 years) with AVMs of the corpus callosum underwent GKS between 1990 ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2005.102.s_supplement.0049
更新日期:2005-01-01 00:00:00
abstract:OBJECT:Expression of matrix metalloproteinases (MMPs) has been postulated to play a central role in brain tumor invasion; however, its underlying mechanism is not yet fully understood. In the present study, by assessing the effect of a specific p38 mitogen-activated protein kinase (MAPK) inhibitor, SB203580, on the sec...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2002.97.1.0112
更新日期:2002-07-01 00:00:00
abstract::A patient is reported in whom a meningioma of the lateral one-third of the sphenoid ridge was completely removed and long-term prophylaxis for seizures with diphenylhydantoin was prescribed. One and a half years later, a powerful inhibitor developed that specifically neutralized Factor VIII, the antihemophilic factor,...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.53.5.0600
更新日期:1980-11-01 00:00:00
abstract::A new method was developed for the clinical assessment of motor function in rats after experimental spinal cord injury. The method consists of placing the animal on an inclined plane which can be adjusted to provide a slope of varying grade, and then assessing the maximum angle of the plane at which the animal can mai...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1977.47.4.0577
更新日期:1977-10-01 00:00:00
abstract:OBJECT:Gamma knife surgery (GKS) has been a safe and effective treatment for vestibular schwannomas in both the short and long term, although less is known about long-term outcomes in the past 10 years. The aim of this study was to clarify long-term outcomes in patients with vestibular schwannomas treated using GKS bas...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2005.102.1.0010
更新日期:2005-01-01 00:00:00
abstract:OBJECTIVE:Although intravenous indocyanine green (ICG) videoangiography has been reported to be useful when applied to cerebral arteriovenous malformation (AVM) surgery, the ICG that remains after the procedure makes it difficult to understand the anatomy, to evaluate nidus blood flow changes, and to repeat ICG videoan...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2020.3.JNS20319
更新日期:2020-05-22 00:00:00
abstract:OBJECT:The aim of this paper was to validate the diffusion tensor imaging (DTI) model for delineation of the corticospinal tract using cortical and subcortical white matter electrical stimulation for the location of functional motor pathways. METHODS:The authors compare probabilistic versus deterministic DTI fiber tra...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.4.JNS131160
更新日期:2014-08-01 00:00:00
abstract::In patients with vein of Galen malformations, high-flow shunting decreases cerebral perfusion. By reducing or eliminating these shunts, transarterial embolization can improve cerebral perfusion and clinical outcomes. Quantifying pre- and postembolization shunt blood flow may help determine the optimal timing and effic...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2006.104.1.41
更新日期:2006-01-01 00:00:00
abstract:OBJECT:Brain metastases from gastrointestinal cancers are rare. However, the incidence is increasing because patients with gastrointestinal carcinoma tend to live longer due to earlier diagnosis and more effective treatment of systemic disease. The purpose of this study was to evaluate the efficacy of Gamma Knife surge...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2008.9.JNS08281
更新日期:2009-09-01 00:00:00
abstract::A unique case is reported of Chiari malformation and compression of the medulla oblongata by both vertebral arteries. A 39-year-old woman complained of unsteady giant and motor weakness of the legs, and magnetic resonance imaging revealed the malformation and compression. Vascular decompression of the vertebral arteri...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1992.77.2.0307
更新日期:1992-08-01 00:00:00
abstract::Some intracranial aneurysms that might be considered inoperable by open craniotomy are readily treatable by stereotaxic thrombosis. This is possible because the stereotaxic technique requires only that some point on the fundus of the aneurysm can be punctured with a needle. Illustrative cases are given describing the ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1977.47.6.0833
更新日期:1977-12-01 00:00:00
abstract:OBJECT:The goal of this study was to determine the tensile strength of cranial pia mater. METHODS:Samples of isolated bovine cranial pia mater were subjected to quasistatic traction to evaluate its tensile strength. The experimental curves of physiological deformation that were obtained can be subdivided into three pa...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2004.100.1.0111
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVE:Removal of jugular foramen (JF) tumors usually requires extensive skull base approaches and is frequently associated with postoperative morbidities such as lower cranial nerve injury. The endoscope-assisted retrosigmoid infralabyrinthine approach is a relatively new approach to tumors extending into the bony ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.3.JNS142904
更新日期:2016-04-01 00:00:00
abstract::Vertebral artery dissection may be spontaneous or related to some traumatic event. Diagnosis has usually been made by angiography, an invasive procedure with certain well-known risks. The authors describe the magnetic resonance (MR) appearance (both on conventional spin-echo and on gradient refocused "flow" sequences)...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1990.72.6.0964
更新日期:1990-06-01 00:00:00
abstract::OBJECTIVE The comparative effectiveness of the 2 treatment options-surgical clipping and endovascular coiling-for unruptured cerebral aneurysms remains an issue of debate and has not been studied in clinical trials. The authors investigated the association between treatment method for unruptured cerebral aneurysms and...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.1.JNS152028
更新日期:2017-03-01 00:00:00
abstract::In this paper, the authors describe the history of neurosurgery at St. Michael's Hospital, University of Toronto. St. Michael's has long been regarded as one of the top teaching and research hospitals in Canada. A detailed literature review of published and unpublished works was performed to formulate a succinct but i...
journal_title:Journal of neurosurgery
pub_type: 历史文章,杂志文章
doi:10.3171/2016.9.JNS161119
更新日期:2017-12-01 00:00:00
abstract::A series of 14 patients with intracerebral hemorrhage after carotid endarterectomy is reviewed. This complication occurred in 0.6% of 2362 consecutive carotid endarterectomies performed at the Mayo Clinic from 1972 through 1986. All hemorrhages occurred within the first 2 weeks after operation and were ipsilateral to ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1988.68.4.0532
更新日期:1988-04-01 00:00:00
abstract:OBJECT:Ascites and abdominal pseudocysts are two complications that can occur following placement of a ventriculoperitoneal (VP) shunt. Although various factors have been implicated, the exact pathogenesis of the two conditions remains elusive. To the authors' knowledge, there are no studies in which these two obviousl...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2007.106.5.350
更新日期:2007-05-01 00:00:00
abstract::Thalamic, pallidal, and hypothalamic targets were determined in 16 patients by a stereotactic computerized tomography (CT) study using a noninvasive technique with Laitinen's Stereoadapter. At surgery, the Stereoadapter was remounted to the head and the stereotactic CT coordinates were transferred to the Stereoguide w...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1990.73.4.0565
更新日期:1990-10-01 00:00:00
abstract:OBJECT:This study was conducted to determine if there is a change in intracranial arterial diameters after papaverine infusion for vasospasm and to determine whether the change occurs in proximal, intermediate, and distal arteries. METHODS:The authors measured arterial diameters retrospectively in all patients who rec...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1998.88.1.0038
更新日期:1998-01-01 00:00:00
abstract::To investigate overcrowding in the posterior cranial fossa as the pathogenesis of adult-type Chiari malformation, the authors studied the morphology of the brainstem and cerebellum within the posterior cranial fossa (neural structures consisting of the midbrain, pons, cerebellum, and medulla oblongata) as well as the ...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/jns.1997.86.1.0040
更新日期:1997-01-01 00:00:00
abstract::The complete avulsion of the brachial plexus is a severe injury usually caused by high-energy trauma. Even with the advent of modern microsurgical techniques, many patients have been rendered severely handicapped following this injury. The authors present a new reconstructive procedure that uses a microsurgical reinne...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1996.85.1.0174
更新日期:1996-07-01 00:00:00
abstract:OBJECT:Traumatic parenchymal mass lesions are common sequelae of traumatic brain injuries (TBIs). They occur in up to 8.2% of all TBI cases and 13%-35% of severe TBI cases, and they account for up to 20% of surgical intracranial lesions. Controversy exists concerning the association between radiological and clinical ev...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,多中心研究
doi:10.3171/2013.12.JNS131090
更新日期:2014-04-01 00:00:00