Donald F. Dohn

Spinal Neurofibromas: A Report of 66 Cases and a Comparison with Meningiomas

A series of 66 spinal cord neurofibromas was analyzed for history, signs, surgical approach, and outcome. The tumors presented primarily with sensory symptoms. Plain films were abnormal in 1/2 of cases and 1/2 had a complete block. They were primarily intradural, and primarily thoracic. A conservative exam system was used for follow-up and 85% with pain had complete relief; 50% with motor loss had normal motor function, and 88% had normal sensation who had prior sensory loss. In comparison to meningiomas, the principal differences were that neurofibromas had an even sex distribution, a lower incidence of cord signs and symptoms, more frequent findings on plain x-rays, and higher cerebrospinal fluid protein. Surgical outcome was similar. Sacrifice of the involved root during removal usually did not produce a deficit. The series is compared with a similar series of meningiomas from the same institution over the same time period.

Long Term Results in the Management of Craniopharyngiomas

The results of surgical treatment, with and without radiotherapy, in 50 patients with craniopharyngioma treated over a 26-year period at the Cleveland Clinic are presented. Thirty-five patients were operated upon before the introduction of the operating microscope, and 30 of these survived operation. In this group of 30 patients, long term survival (5 to 24 years) occurred in 8 of 10 (80%) nonradiated patients who were considered to have had total excision. Nine of 11 patients (82%) who had aggressive subtotal excision and radiation therapy have survived from 3 to 17 years. Seven of nine patients (78%) died 1 to 14 years after subtotal excision without radiation therapy. Since the introduction of the operating microscope in 1972, 15 patients have had surgical treatment, and 12 of these have survived.

Paget's disease of the spine with cord or nerve-root compression.

We review the literature and present six case histories in which a neural deficit was caused by the bone proliferation associated with Pagets disease of the vertebrae. There were three cases of compression of the spinal cord and three of compression of nerve root or the cauda equina. The orthopaedic surgeon must be aware of this manifestation of Pagets disease if he is to make the diagnosis promptly and institute effective treatment.

Arterial occlusion following anastomosis of the superficial temporal artery to middle cerebral artery.

Symptoms of cerebral ischemia following superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis are uncommon and are usually related to impaired flow through the anastomosis or occlusion of the cortical receptor artery. In this report, 3 patients are described who developed symptoms of cerebral ischemia after surgery despite a widely patent anastomosis. In each patient, postoperative angiograpby revealed occlusion of a previously demonstrated high-grade stenosis of the intracranial internal carotid artery (ICA) or MCA. Occlusion of the stenotic artery was probably related to decreased velocity of blood flow through the narrowed vessel resulting from alterations in flow patterns following anastomosis.

Intrasacral Cyst: Report Of A Case And Review Of The Literature

A case of a patient with symptomatic intrasacral cyst mimicking a primary lesion of the sacrum is presented. The etiology, clinical features, roentgenographic and myelographic appearance, differential diagnosis, and surgical treatment of intrasacral cysts are reviewed.

Central Cord Syndrome as a Delayed Postoperative Complication of Decompressive Laminectomy

We report five cases of a central cord syndrome that appeared as a delayed surgical complication several days after decompressive laminectomy with the patient in the sitting position. Some episode of abnormal positioning of the neck or hypotension seems to have triggered the central cord syndrome. The patients improved slowly, but did not return to their immediate postoperative status. This complication probably can be avoided with careful mobilization after operation, with the avoidance of hypotension, and with the use of a firm collar during the first few postoperative days.

Arteriovenous malformation of the vein of Galen as a cause of heart failure and, hydrocephalus in infants

ARTERIOVENOUS MALFORMATIONS affecting the vein of Galen and causing cardiac failure and hydrocephalus are becoming a well-established entity in the field of pediatrics and pediatric neurosurgery. Large communications between the cerebral arteries and the vein of Galen or internal cerebral veins affect the systemic circulation by lowering the peripheral resistance and causing increased cardiac output. Attempts to maintain homeostasis produce a state of hypervolemia which cannot be maintained for an indefinite period without producing myocardial insufficiency and congestive heart fai1ure.l-3 Compression of the aqueduct of Sylvius by a dilated vein of Galen would appear to be the mechanism for the development of hydrocephalus. Three clinical syndromes related to the stage of growth of the patient have been described: 1,4 [ 11 the neonatal period, in which signs of severe congestive heart failure are the most prominent and carry an extremely poor prognosis for survival; [2] infancy in which the presence of hydrocephalus and convulsions is the usual manifestation of the anomaly, hydrocephalus sometimes being of acute onset5 (as in our Case 1); and [3] childhood and adolescence, in which the disease may have an onset with headaches, mental retardation, subarachnoid hemorrhage, or other focal neurologic signs such as loss of vision, hemiparesis, ataxia, and symptoms that are due to anoxic changes in the cortex or direct pressure

Recurrence of lumbar canal stenosis a decade after decompressive laminectomy

Lumbar canal stenosis is treated by decompressive laminectomy with a high rate of success, but patients may experience late recurrence of pain. We report on 3 patients with return of symptoms years after their original decompression. CT scanning showed reformation by bone; their symptoms were relieved by decompression. While scarring is probably a more common cause of the return of pain, this reformation of bone can be more easily treated than scar formation and its presence should be sought by CT scanning.

Transsphenoidal Yttrium 90 Hypophysectomy in the Treatment of Breast Cancer

Transsphenoidal yttrium 90 hypophysectomy has proved to be a simple and effective method of pituitary destruction. Objective remission was obtained in 30 per cent of 69 patients with breast cancer. Stainless steel screws loaded with yttrium 90 are implanted through the sella turcica.