Carole A. Miller

Pediatric Neck Injuries

This review of pediatric neck injuries includes patients admitted to Childrens Hospital of Columbus, Ohio, during the period 1969 to 1979. The 122 patients with neck injuries constituted 1.4% of the total neurosurgical admissions during this time. Forty-eight patients had cervical strains; 74 had involvement of the spinal column; and 27 had neurological deficits. The injuries reached their peak incidence during the summer months, with motor-vehicle accidents accounting for 31%, diving injuries and falls from a height 20% each, football injuries 8%, other sports 11%, and miscellaneous 10%. There is a clear division of patients into a group aged 8 years or less with exclusively upper cervical injuries, and an older group with pancervical injuries. In the younger children, the injuries involved soft tissue (subluxation was seen more frequently than fracture), and tended to occur through subchondral growth plates, with a more reliable union than similar bone injuries. In the older children, the pattern and etiology of injury are the same as in adults. The entire cervical axis is at risk, and there is a tendency to fracture bone rather than cartilaginous structures.

Surgical treatment of the spontaneous spinal epidural abscess

Seven cases of spontaneous epidural abscess are reviewed. Three patients had posterior abscesses and no evidence of vertebral body osteomyelitis. These patients had excellent outcomes with laminectomies and antibiotics. Because of significant vertebral destruction, two patients with vertebral osteomyelitis required posterior fixation after laminectomy. Two other patients with vertebral osteomyelitis had complete destruction of the vertebral body and required anterior decompression and fusion in addition to posterior fixation. In the four patients with vertebral osteomyelitis, morbidity was high, reflecting their age and significant medical problems. This review supports the contention that medically stable patients with posterior epidural abscesses can be treated with laminectomy and antibiotics with little risk of progressive instability. The proper surgical treatment of anterior epidural abscesses secondary to osteomyelitis requires knowledge about the amount of destruction of the supporting columns, the amount of neural compression secondary to the purulence, and the patients general medical condition.

Magnetic resonance imaging of trauma to the thoracic and lumbar spine. The importance of the posterior longitudinal ligament

Magnetic resonance imaging was used to evaluate 24 patients with injuries to the thoracic, thoracolumbar (T12-L1), or lumbar spine. Correlation of the magnetic resonance imaging findings to surgical therapy and outcome was evaluated, with particular attention to the longitudinal ligaments. The ability of the magnetic resonance imaging to detect the extent of trauma to the spinal cord parenchyma and to the anterior and posterior longitudinal ligaments was found to be important in guiding the surgical approach to these spine fractures.

Steroid-induced remission in primary-malignant lymphoma of the central nervous system

A case of primary malignant lymphoma of the central nervous system is described in which lesions seen on computed tomography scans disappeared, and clinical remissions occurred with the administration of corticosteroids. The tumor affected the region of the fourth ventricle and parietal and frontal lobes. In our patient, three remissions occurred over a span of 24 months, each in conjunction with corticosteroid administration. This supports other observations that steroids alter the natural history of primary malignant lymphoma of the central nervous system, leading to both radiologic and clinical remissions.

Midbrain deafness following head injury.

A patient is described who became deaf following a head injury. Postmortem examination revealed bilateral lesions of the lateral lemnisci and inferior colliculi. The clinical pattern of midbrain deafness is examined and compared with syndromes of cortical and peripheral auditory impairment.

Cerebral and spinal fluid anaerobism during circulatory arrest

RESTRICTION of canine cerebral circulation leads to an accumulation of tissue lactate proportional to time up to about ten minutes of total substrate deprivation.1 Following severe cerebral stress of almost any etiological category with or without obvious cerebral nutrient and oxygen deficiency, cerebrospinal fluid (CSF) lactate levels have been noted to be elevated., Following restoration of circulation after vascular interruption, CSF lactate levels are also increased.3 Both the rapidity of lactate egress from brain tissue to CSF and the absolute amount of lactate in CSF during acute ischemia are unknown. Since CSF lactate concentration may be a measure of “brain death,” knowledge of CSF lactate concentration with known cerebral tissue lactate (CTL) accumulation may be valuable during an extended and known period of circulatory deprivation. Also, such comparison may afford information regarding the mechanism and rapidity of the transfer of this important metabolite across the brain-CSF barrier. CSF has been considered representative of brain extracellular space for many constituent elements, and CSF lactate levels have been utilized to indicate cerebral metabolic pe r fo r rnan~e .~ ,~ This investigation casts doubt upon the validity of the CSF lactate content, during extended circulatory arrest, as being entirely representative of conditions existing within brain tissue. Also, relative rates of lactate accumulation in brain, CSF, and blood have been substantiated.