Search Results

You are looking at 1 - 9 of 9 items for

  • Author or Editor: David W. Rowed x
Clear All Modify Search
Restricted access

David W. Rowed

✓ Twenty-one patients with universal syndesmophytosis due to ankylosing spondylitis were identified in a consecutive series of 1578 patients with acute spine and spinal cord injuries. They were predominantly male, older than spinal cord-injured patients in general, and most were injured by falls. Approximately one-half were managed by halo-vest immobilization alone with good clinical and radiological outcomes. The remainder required surgery either for recurrent dislocation or for spinal cord compression associated with neurological deterioration. Extradural hematoma, a recognized cause of spinal cord compression in ankylosing spondylitis patients with spinal fractures, was encountered in two patients. Herniated intervertebral disc as a cause of spinal cord compression in ankylosing spondylitis does not appear to have been previously reported and was recognized three times in the present series, once in association with extradural hematoma. The pathology of ankylosing spondylitis is such that the nucleus pulposus tends to be spared, allowing disc herniation to occur in the heavily ossified spine. In virtually all patients, satisfactory correction of the flexion deformity could be safely accomplished following spinal fracture.

It is concluded that fracture/dislocations of the cervical spine should be managed initially by halo-vest immobilization, without prior traction and with careful incremental correction of flexion deformity. Decompression is performed as required for extradural hematoma or intervertebral disc herniation, and internal fixation is carried out for recurrent dislocation.

Restricted access

Charles H. Tator and David W. Rowed

✓ The authors describe a fluoroscopic method of guiding percutaneous needle penetration of the foramen ovale. The advantages are simplicity, speed, accuracy, and comfortable patient positioning. Radiation exposure is minimized.

Restricted access

David W. Rowed and Julian M. Nedzelski

✓ In a series of 514 consecutive operations for complete excision of acoustic neuromas, 94 procedures were performed via a retrosigmoid approach to preserve the patient's hearing. Twenty-six of these procedures (5.1%) were performed in cases of intracanalicular tumor and 68 (13.2%) were for larger lesions in which most of the tumor was located medial to the porus acusticus within the cerebellopontine angle. Preservation of useful hearing was achieved in 13 (50%) of 26 patients with intracanalicular tumors and in 20 (29%) of 68 with larger tumors. A trend toward higher success rates in intracanalicular tumors appears to be present, although the difference is not statistically significant (p = 0.09). Normal or nearnormal facial function (House and Brackmann Grades I and II) was present postoperatively in 25 (96%) of 26 patients. Indications for treatment of intracanalicular acoustic neuromas are considered and treatment alternatives are reviewed. Results from other series reporting removal of intracanalicular acoustic neuromas are considered with respect to hearing conservation and postoperative facial nerve function. Surgical excision of intracanalicular acoustic neuromas in otherwise healthy patients appears to be warranted if preservation of useful binaural hearing is considered a worthwhile objective and if perioperative morbidity can be maintained at an acceptably low level. The retrosigmoid approach is familiar to all neurosurgeons and offers a comparable success rate for hearing conservation and probably a superior outcome in terms of facial nerve function when compared with the middle fossa approach.

Restricted access

Chen Li, David A. Houlden and David W. Rowed

✓ An analysis of Motor Index score, pinprick sensory score, joint position sense score, somatosensory evoked potential (SSEP) grade in the ulnar (SSEPu) and posterior tibial (SSEPt) regions, and overall SSEP grade (mean SSEPu+t) was conducted in 36 patients with cervical spinal cord injuries to determine the relationship of these scores, both individually and in combination, to functional outcome (as determined using the Barthel Index) at 6 months after injury. The clinical and electrophysiological data were obtained on the same day within 2 weeks after injury. Nineteen patients underwent two SSEP tests 1 week apart within the first 3 weeks following injury in an attempt to identify mean SSEPu+t improvement. Somatosensory evoked potential grading was based on the presence or absence of the cortical evoked potential, the amplitude of the early cortically generated waveform (P22 or P37), and the interpeak latency across the lesion site.

Mean SSEPu+t had the strongest individual relationship with outcome (R-square 0.75, p < 0.0001) and mean SSEPu+t improvement over a 1-week interval during the first 3 weeks after injury was associated with Motor Index score improvement over a 6 month period. Joint position sense score was the best clinical predictor of outcome (R-square 0.64, p < 0.0001). Mean SSEPu+t correlated with outcome more closely than the combination of Motor Index score and pinprick sensory score. Mean SSEPu+t in combination with all three clinical indicators produced the strongest correlation with outcome (R-square 0.87, p < 0.0001).

This study confirms the prognostic value of quantitative SSEP analysis for patients with acute spinal cord injuries.

Restricted access

David A. Carter, David W. Rowed and Anthony J. Lewis

✓ A case of extensive circumferential meningioma of the spinal subdural space is reported. A potential mechanism for this growth pattern is proposed, and preoperative diagnosis by computerized tomography is discussed. This case reinforces the necessity for intradural exploration when an expected extradural neoplasm is not encountered at operation.

Restricted access

David W. Rowed, Edward E. Kassel and Anthony J. Lewis

✓ Painful ophthalmoplegia due to lesions in the region of the anterior cavernous sinus and superior orbital fissure may elude early diagnosis. Principal disease categories to be considered in patients with this complaint are neoplasm, vascular lesion, and inflammation. Although high-resolution computerized tomography (CT) may be helpful, definitive diagnosis frequently requires histological examination of tissue. In suitable patients this may be obtained by transsphenoidal or orbital biopsy. The orbital fine-needle aspiration technique has been recommended, but experience with this method is limited, and a definitive diagnosis cannot always be reached. The authors have established that, in suitable patients, the fine-needle aspiration technique with CT guidance may also be employed safely and effectively for lesions of the anterior cavernous sinus.

Restricted access

Charles H. Tator, Kotoo Meguro and David W. Rowed

✓ From 1969 to 1979, 20 patients with syringomyelia were treated with a syringosubarachnoid shunt. The principal indications for this procedure were: significant progressive neurological deterioration and absent or minimal tonsillar ectopia. There were 15 patients with idiopathic syringomyelia, four with posttraumatic syringomyelia, and one with syringomyelia secondary to spinal arachnoiditis. The operations were performed with an operating microscope, and attention was directed to preserving the arachnoid membrane to ensure proper placement of the distal end of the shunt in an intact subarachnoid space. In all cases, a silicone rubber ventricular catheter was inserted into the syrinx through a posterior midline myelotomy.

The average follow-up period was 5 years. A favorable result was obtained in 15 of the 20 patients (75%), including an excellent result with improvement of neurological deficit in 11 patients and a good result with cessation of progression in four patients. In the remaining five patients the result was poor with further progression of neurological deficit. A short duration of preoperative symptoms was usually a favorable prognostic feature. Four patients with a history of less than 6 months all had excellent results. Thirteen patients had a syringosubarachnoid shunt only, and all had good or excellent results. Seven patients had other surgical procedures, before, accompanying, or after shunt placement, and two had favorable results. Thus, the syringosubarachnoid shunt is an effective therapeutic modality for many patients with syringomyelia, particularly if there is little or no tonsillar herniation.

Restricted access

Jeffrey W. Brennan, David W. Rowed, Julian M. Nedzelski and Joseph M. Chen

Object. The aims of this study were to review the incidence of cerebrospinal fluid (CSF) leakage complicating the removal of acoustic neuroma and to identify factors that influence its occurrence and treatment.

Methods. Prospective information on consecutive patients who underwent operation for acoustic neuroma was supplemented by a retrospective review of the medical records in which patients with CSF leaks complicating tumor removal were identified. This paper represents a continuation of a previously published series and thus compiles the authors' continuous experience over the last 24 years of practice.

In 624 cases of acoustic neuroma the authors observed an overall incidence of 10.7% for CSF leak. The rate of leakage was significantly lower in the last 9 years compared with the first 15, most likely because of the abandonment of the combined translabyrinthine (TL)—middle fossa exposure. There was no difference in the leakage rate between TL and retrosigmoid (RS) approaches, although there were differences in the site of the leak (wound leaks occurred more frequently after a TL and otorrhea after an RS approach, respectively). Tumor size (maximum extracanalicular diameter) had a significant effect on the leakage rate overall and for RS but not for TL procedures. The majority of leaks ceased with nonsurgical treatments (18% with expectant management and 49% with lumbar CSF drainage). However, TL leaks (especially rhinorrhea) required surgical repair significantly more often than RS leaks. This has not been reported previously.

Conclusions. The rate of CSF leakage after TL and RS procedures has remained stable. Factors influencing its occurrence include tumor size but not surgical approach. The TL-related leaks had a significantly higher surgical repair rate than RS-related leaks, an additional factor to consider when choosing an approach. The problem of CSF leakage becomes increasingly important as nonsurgical treatments for acoustic neuroma are developed.