Gordon B. Thompson

Third ventricular colloid cysts presenting with acute neurological deterioration.

Colloid cysts may be found in any part of the third ventricle. The authors report that four out of 12 patients with colloid cysts of the third ventricle suffered acute neurological deterioration, and unilateral ventriculostomy resulted in dramatic recovery in two patients. Unilateral ventriculostomy followed by clinical assessment and computed tomographic scanning is an acceptable approach in emergency situations; computed tomographic scanning allows early detection of third ventricular colloid cysts. Ventriculoperitoneal shunting provides a laternative measure to surgical removal of the cyst. Definitive management soon after diagnosis and before acute neurological deterioration is recommended. The cases presenting with sudden death in the literature are reviewed.

Symptomatic Anterior Spinal Arachnoid Diverticulum

The authors report a case of symptomatic arachnoid diverticulum, which was located anterior to the spinal cord and covered the entire length of the spinal canal. The patient underwent cervical laminectomy and cystoperitoneal shunting with subsequent neurological improvement. The causes, clinical manifestations, diagnosis, and management of spinal arachnoid diverticulum are discussed.

Serum Cortisol Abnormalities after Craniocerebral Trauma

Serial estimations of serum cortisol were performed in 49 patients with craniocerebral trauma. Abnormalities of serum cortisol, including alterations in diurnal rhythm and elevations of serum cortisol level, occurred in 21 patients. The frequency and severity of the abnormalities correlated with the severity of the head injury, and there was a trend suggesting that middle fossa basal skull fractures predisposed to cortisol abnormalities. A further 6 patients were studied to assess the effects of exogenous dexamethasone, and in all patients there was suppression of elevated serum cortisol levels by the dexamethasone. The findings suggest that hypercortisolemia after head injury is related to an alteration rather than an abolition of the normal feedback mechanism. (Neurosurgery, 5: 559--565, 1979).

Ischemic necrosis of the scalp after preoperative embolization of meningeal tumors.

The authors report two patients who suffered ischemic necrosis of their scalps after preoperative therapeutic embolic occlusion of the external carotid artery and its terminal branches for highly vascular meningeal tumors. Local anesthesia, selective catheterization of the external carotid artery, and radiopaque polyvinyl alcohol and Gelfoam as embolic agents were used. The various complications of external carotid artery embolization are reviewed. The importance of preserving normal branches of the external carotid artery (especially the superficial temporal artery) during embolization and of careful design of the scalp flap to avoid ischemic necrosis is emphasized.

Primary choroid plexus papilloma of the cerebellopontine angle.

A case of choroid plexus papilloma of the cerebellopontine angle, extending from the upper cervical region to the level of the tentorial notch, in a 50-year-old woman is presented. The differential diagnosis of tumors in the cerebellopontine angle and the role of surgical treatment vs. radiation therapy are discussed.