The clinical features, perioperative course, and postoperative outcomes of 144 patients who underwent microsurgical resection of craniopharyngioma were reviewed. Overall, 90% of the tumors were completely resected and 7% recurred. Evaluation of those patients who underwent primary resection revealed much better results. The operative techniques and approaches are reviewed in detail. The results of this series suggest that primary total removal of craniopharyngiomas yields the best long-term outcome for the patient. Experience has shown that the larger the tumor the greater will be the damage, both preoperatively and intraoperatively, to vital intracranial structures. Consequently, early diagnosis, at a stage when the tumor is still small, improves the chances of accomplishing complete removal and of achieving good operative results. The early diagnosis of craniopharyngioma, before it can produce devastating neurological defects, continues to be the principal goal of our medical and pediatric colleagues.
SUMMARY Twenty eight patients with severe, intractable spasticity have been treated by chronic intrathecal administration of baclofen. An implantable programmable drug-administration-device (DAD) was used with a permanent intrathecal catheter. Infusion of 50 to 800 ug//day of baclofen completely abolished spasticity. Follow-up was up to two years. Therapeutic effect was documented by clinical assessment of tone, spasms and reflexes and by electrophysiological recordings of monoand polysynaptic reflex activity. Complications and untoward side-effects of the procedure were few. This procedure is recommended for spasticity of spinal origin refractory to physiotherapy and oral medication. It is a preferable alternative to ablative surgical intervention.After an upper motoneuron lesion in man, a spastic syndrome often develops with a delay of weeks or months. This is characterised by hyperactive monoand polysynaptic reflexes and a velocity dependent increase in muscle tone. Depending on the site of the lesion, the features of the motor disorder can vary considerably. In spinal cord transection the powerful inhibitory action of the vestibulo-spinal pathway (projecting from the lateral vestibular nucleus) on the tonic innervation offlexors is eliminated, leading to an increase in flexor muscle tone of the legs. Lesions of the reticulo-spinal pathways cause loss of inhibition of the flexion reflex, resulting in spontaneous and sometimes painful flexor spasms. On the other hand, extensor spasms can also occur. All these patients suffer frequently from severe disability having their legs in a fixed, usually flexed, position causing nursing problems and severe handicap in daily life.Flexor spasticity is often resistant to drugs in tolerable doses. Microsurgical procedures like selective peripheral neurotomy, posterior rhizotomy' and longitudinal myelotomy have been used. These interventions are designed to interrupt the spinal reflex arc or to reduce the afferent input to the dorsal horn.
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