Biomedical subjects
Publications and source records attributed to B M Stein.
Ossification of the posterior longitudinal ligament, despite its rare occurrence in Caucasians, is one further cause of cervical myelopathy and radiculopathy that should be included in the differential diagnosis. A recent case is reported.
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Eleven cases of microsurgical removal of intramedullary spinal cord tumors are reported. Difficulties previously recorded with removal of astrocytomas were not encountered in five such tumors of this series. None of these patients was significantly worse and seven out of the eleven patients were improved following surgery. The effects of prior surgery and radiotherapy on the tumor and normal spinal cord are discussed in detail.
Twenty-eight cases of cerebral arteriovenous malformations in which the treatment consisted of embolization and/or surgical excision are reviewed. Embolization was considered an adjuvant procedure; carried out to reduce the size of the malformation or eliminate the deep arterial supply to it prior to excision. In sixteen of the cases the combined treatment was carried out with one death and one significant postoperative deficit. In the other twelve cases surgical operation or embolization alone was carried out. The anatomy of the lesion determined the applicability of embolization. Although embolization has a high degree of safety, certain pitfalls must be avoided. Changing patterns in the cerebral circulation following embolization and operation as well as the role of collateral circulation to cerebral arteriovenous malformations are discussed.
Thirteen cases of subarachnoid, extracavernous giant aneurysms are reported. The various types of presentation and treatment are discussed. Of interest is the fact that the paraclinoid carotid artery is the most common location for giant aneurysms. Thirty-one percent have another vascular abnormality associated with them, and 70% presented initially with a subarachnoid hemorrhage.
A patient who developed an embolic occlusion of the right middle cerebral artery while undergoing a cerebral arteriogram was successfully operated on by removal of the embolus under the surgical microscope. Early postoperative cerebrovascular spasm was a factor in the transient deterioration of the patient's neurological condition. When the patient was last seen 2 1/2 months after surgery she was almost intact neurologically with only a mild right parietal dysfunction but with total resolution of the left hemiplegia. The literature is reviewed.
A large traumatic arteriovenous malformation of the scalp was embolized with Pantopaque-saturated Gelfoam pledgets, which made fluoroscopic monitoring of the radiopaque emboli possible. Postembolization angiography demonstrated complete occlusion of the malformation. There is still no clinical or physical evidence of recurrence after an 8-month follow-up period.
When halo-pelvic traction is applied at a rapid rate it may induce cranial nerve palsies. The sixth, ninth, and tenth cranial nerves appear to be the most vulnerable. A proposed etiology is the stretching of these nerves resulting in a compromised blood supply with a consequent temporary paralysis which usually improves within 8 to 10 weeks.
Three cases of spinal arteriovenous malformation are reported which illustrate that localization of intra- and extramedullary components are not always adequately assessed by spinal angiography alone. One large malformation, primarily dorsal to the spinal cord, was not seen on angiography. A second lesion thought to be intramedullary and unresectable as judged by angiography was found at surgery to be primarily dorsolateral and was resected. The third malformation was thought to be extramedullary on angiography, yet had a major intramedullary component at surgery and was not resected. We conclude that surgical exploration of all spinal arteriovenous malformations should be performed despite the angiographic appearance.
Eleven cases of large arteriovenous malformations (AVMs) were treated from February 1974 to March 1975 by embolization via the internal carotid artery with beads, and 8 of them had subsequent surgery. There was one post-operative death. A second embolization was performed in 3 patients with further diminution of vascularity. Embolization improved the perfusion of the adjacent normal brain and was an important preoperative procedure which facilitated the operation and made it surgically feasible to operate on some cases which might otherwise have been considered to be inoperable.
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Experience with 25 cases of tumour of the third ventricle in children is reviewed. The majority of the lesions were infiltrating astrocytomas of the anterior and mid-portions of the third ventricle. These tumours were generally inoperable. However, other tumours within the third ventricle were benign, encapsulated, and resectable. Surgical exposure was carried out through one of three routes: posterior fossa, transcallosal, or subfrontal. The radiological criteria by which the operative approach is determined are discussed.
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