Arthur E. Rosenbaum

Microsurgical Removal of a Primary Intraorbital Meningioma

A 48-year-old woman with a primary intraorbital meningioma associated with the optic nerve sheath underwent a microsurgical removal of the tumor through a lateral orbitotomy. Visual recovery was essentially complete.

Cervical spondylosis and dyskinesias

THE ROLE OF TRAUMA, occupational and sporadic, in the production of cervical spondylosis has been alluded to in past studies of this disease entity.l-3 While in the older age groups the importance of this factor may b e disputed, in patients below 50 it seems to have definite significance. By involving the cervical spine in repetitive abnormal movements, the dyskinesias-choreoathetosis, dystonia, and spasmodic torticollis-should give rise to an earlier and higher incidence of spondylosis. This has not been extensively studied. We became interested in this problem through one of our patients, a 38-year-old man with choreoathetosis. In addition, he had severe cervical spondylosis, with progressive neurological disability. Root and cord encroachment had caused bilateral flaccid weakness of the upper extremities with spastic lower extremities. Subsequently, w e reviewed X-rays of the cervical spine in twenty cases of dyskinesia. These suggested a causal relationship between the movement disorder and the development of cervical spondylosis.

Diagnostic approaches to pituitary adenomas

The utility of diagnostic tests for pituitary adenoma was compared in 12 patients. Endocrine and radiologic studies were always abnormal, even when neuro-ophthalmologic tests were normal. In most cases, both tomography of the sella turcica and CT scan revealed a mass in the region of the sella turcica. For more precise definition of suprasellar extension of the mass, metrizamide CT cisternography or tomographic pneumoencephalography with metrizamide provided similar details, although CT cisternography was much more easily done. Angiography provides a means to exclude an aneurysm or vascular malformation, a vascular tumor, or an aberrant course of the internal carotid artery.

Metrizamide Computed Tomographic Cisternography for the Diagnosis of Occult Lesions of the Hypothalamic-Hypophyseal Axis in Children

In children, hypothalamic-hypophyseal syndromes such as diabetes insipidus, precocious puberty, growth retardation, and panhypopituitarism can be due either to structural lesions or to functional disorders of the cerebral endocrine complex. When clinical and endocrinological parameters fail to distinguish between these etiologies, neuroradiographical diagnosis becomes extremely important. Although conventional intravenously enhanced computed tomography (IVCT) is satisfactory for the diagnosis of lesions larger than 1 cm, metrizamide CT cisternography (MCTC) greatly improves the diagnostic yield for smaller juxtapituitary masses in the suprasellar cistern, clearly defines their sizes and relationships with contiguous structures, and definitively confirms the diagnosis of empty sella syndrome. Six patients with endocrinopathies and normal or ambiguous IVCT findings are presented to illustrate how MCTC can influence their management and outcome without the patient discomfort and technical complexity associated with pneumoencephalography.

Dynamics of Cerebrospinal Fluid System as Defined by Cranial Computed Tomography

With the development of cranial computed tomography (CT), the neuroradiological evaluation of the cerebrospinal fluid (CSF) system has been markedly altered. A definitive representation of the ventricles and subarachnoid spaces (SASs) is now non-invasively obtained within a matter of minutes. Associated pathological processes are also readily demonstrated.

A new method for uncoiling knots in angiographic tubing

SummaryTechniques for uncoiling knots formed in catheters during angiography have been the subject of several previous reports. A new technique for catheter unknotting is presented, based on the use of graded flexibility guidewires. The application of this graded taper method appears particularly pertinent to uncoiling softer, narrow-caliber, adversely looped catheters. Moreover, the mechanisms of knot uncoiling in the previous reports are reassessed and their imprecisions corrected.

Electroencephalographic Changes in Pediatric Patients following Metrizamide Cisternography

Serial electroencephalograms were obtained over a 24-hour period in 15 children from 3 months to 17 years following metrizamide CT cisternography. Persistent EEG abnormalities were noted in 8 children, 5 of whom were older than 2 years. Bifrontal slowing was a frequent change in the children older than 2 years.

Reduced morbidity in gas myelography.

Gas myelography is a useful technique in the evaluation of the spinal canal and its contents. Although it has been greatly simplified and the high-resolution imaging greatly improved, morbidity remains a problem. Removal of the gas at the end of the examination through the lumbar route significantly decreases morbidity. This can be achieved through the same needle if the examination is performed via a lumbar puncture. Insertion of a second needle in the lumbar region may be necessary if the cervical or cisternal puncture is employed for gas introduction.