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Biomedical subjects

L P Lassman

Publications and source records attributed to L P Lassman.

At least 19 recordsLinked to original sources

Scope of surgery for intracranial aneurysm in the elderly: a preliminary report.

Thirty-two elderly patients were reviewed six months to six years after intracranial surgery for subarachnoid haemorrhage. Out of 24 patients whose surgical outcome had been satisfactory, one had died from an unrelated illness and the remainder were well and leading normal lives. Eight patients had a poor outcome, which in some cases was due to factors other than age. In only three could a poor outcome be attributed to early surgery and advanced age. The results confirm that in at least three-quarters of patients aged 60-65 the risk of further haemorrhage can be removed by surgery without causing a major neurological deficit.

Age Factors

Meningocoele manqué.

Meningocoele manqué is a congenital anomaly relating to the spinal cord, cauda equina and the filum terminale commonly found on exploration of the spinal cord in cases of spina bifida occulta. The anomalies consist of fibrous bands, aberrant nerve roots and adhesions within the theca which may tether or press on the neural structures so interfering with nerve conduction and causing increasing neurological deficit. Treatment is to free the neural structures from these bands and adhesions surgically. An account is given of 45 cases with a discussion of their similarity to cases of meningocoele, thus justifying the naming of a previously undescribed clinical entity. Meningocoele manqué demonstrates the relation of spina bifida occulta to spina bifida cystica as having a similar origin differing only in degree of severity. All the cases discussed are drawn from a personal series of 200 cases of spina bifida occulta which have had surgical exploration of the spinal cord.

Diastema

Diagnosis and management of skeletal metastases from cerebellar medulloblastoma.

Four cases of cerebellar medulloblastoma with skeletal metastases have been described. Extracranial metastases from this tumour are extremely rare but the skeleton is the site most commonly involved. The metastases did not occur after ventriculo-atrial shunting, but in one of the cases, the diagnosis was made from the check X-ray taken on the day a shunt was introduced. The influence of vincristine sulphate and cyclophosphamide on the radiological appearances and management of the cases has been described. After the diagnosis of skeletal involvement was made three of the children survived over a year with cytotoxic drug treatment; the other case did not respond satisfactory and died from widely disseminated metastases of the central nervous system, 4 months after starting treatment.

Adolescent

Congenital midline scalp and skull defect.

A family with multiple congenital scalp defects, over two generations and probably genetically determined, is described. Although alarming in appearance, surgical intervention is not indicated at least for small lesions. The risk of haemorrhage and meningitis is emphasized.

Adult

Treatment of internal carotid bifurcation aneurysms by direct surgery.

Carotid bifurcation aneurysms have, as a group, certain characteristics. They account for about 7% of all intracranial aneurysms. They appear to be mostly leftsided and there does not seem to be any particular sex predominance. When associated with other aneurysms, the carotid bifurcation aneurysm was the symptomatic lesion. Demonstration of small aneurysms may be difficult and accurate definition of the neck may not be possible at angiography. They appear to associate themselves with one or the other division of the internal carotid artery. With careful exposure and appropriate positioning of the head it is possible to occlude these aneurysms with a clip, but we feel that the inexperienced surgeon should not tackle these cases. Carotid artery ligation may not prevent rebleeding in this group of aneurysms.

Adult