1/5. Posterior fossa surgery in the sitting position in a pregnant patient with cerebellopontine angle meningioma.Primary brain tumours and pregnancy rarely occur together; meningioma and pregnancy is rarer still. We describe a 30-yr-old woman in the 25th week of pregnancy who underwent surgery in the sitting position for a large cerebellopontine angle meningioma that was compressing and displacing the pons and medulla. The surgical procedure and postoperative period were uneventful. This case demonstrates that when absolutely necessary, anaesthesia and neurosurgery for posterior fossa lesions can be successful during the second trimester of pregnancy. Furthermore, if indicated and if the operating team is experienced, the operation can be performed safely with the patient in the classical sitting position. It is emphasized that continuous and attentive monitoring of the mother and fetus are essential.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/5. isoflurane in the management of status epilepticus after surgery for lesion around the motor area.When conventional treatment for status epilepticus fails, general anaesthesia is recommended. We present our experience with isoflurane, an inhalational anaesthetic, in the management of four patients with status epilepticus which occurred soon after surgery for motor area lesion. The seizures were controlled with relatively small concentrations of isoflurane. hypotension, the only adverse effect of isoflurane, was managed easily with the use of dopamine in physiological saline. Although status epilepticus occurring soon after surgery is transient, it carries a risk of persistent brain damage if active treatment is not instituted promptly. isoflurane general anaesthesia may be recommended to control it in the intensive neurosurgical care.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/5. Extracranial surgery--intracerebral tumour.A case is described in which localising neurological signs developed on the first day following general anaesthesia for insertion of a silastic implant over a frontal fracture. Despite prompt appropriate investigation seven weeks elapsed before the correct diagnosis was made. Aspects of the management of patients who develop a neurological deficit soon after general anaesthesia are discussed.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
4/5. Inverse activity of masticatory muscles with and without trismus: a brainstem syndrome.Clinical and EMG findings in 10 cases of intrinsic brainstem lesions are reported with paradoxical activity of jaw closing muscles during jaw opening, with and without trismus. In five cases with trigeminal anaesthesia, the inverse activity of jaw closers is interpreted as a manifestation of disturbance in the central programming of mastication in the motor trigeminal area of the brainstem. Stretch reflex mechanisms and disinhibition of the trigeminal motor neurones play no part in the origin of inverse activity. The distinct brainstem syndrome can only be detected by EMG and the special clinical features.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/5. Clinical presentation of "silent" meningiomas after general anaesthesia.We present two patients who became unrousable within 48h after general anaesthesia for non-neurosurgical operations; both were found to have frontal meningiomas. Analysis of these and previous reports suggest that several anaesthetic and perioperative factors probably combine to contribute to the accelerated presentation of these previously "silent" tumours, and we recommend that dexamethasone should be administered early in the course of unexplained neurological deterioration after operation.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |