Graham Martin

Spinal cord herniation into an extradural arachnoid cyst.

A herniation of the thoracic spinal cord into the mouth of an extradural arachnoid cyst is reported in a 37 year old man. This is the 20th case, but the first posterior herniation; all the others were anterior. He presented with progressive paraparesis and the magnetic resonance imaging (MRI) showed kinking of the cord into the cyst. Surgical release of the neck of the hernia was successful.

First rib resection for the thoracic outlet syndrome.

Review of a personal series of 25 first rib resections for thoracic outlet syndrome shows that operation offers a 60% chance of improvement for an acceptable morbidity. This series is the first to consist solely of patients operated on for brachial plexus compression and diagnosed by stated criteria, which were: (1) pain and paraesthesiae running down the arm into the fingers (usually ulnar, but not exclusively); (2) reproduction of distal symptoms by pulling the shoulder down and back, and/or straight down, and/or forwards; (3) pressure in the supraclavicular fossa over the brachial plexus is painful and may reproduce the distal symptoms; and (4) a normal radiculogram.

Craniotomy: the first case histories

The oldest existing case histories of craniotomy are from the false Hippocratic writings, about 330 BC, and one is reconstructed about the death of Ptolemy VI in 145 BC. Greek surgeons had rational indications for trepanning, when the difficulties of the times are understood. All compound fractures were infected, so death from an extradural abscess was likely. Trepanning was intended to drain the extra dural space. Copyright 1999 Harcourt Publishers Ltd.

Successful Drainage of an Extradural Abscess in 1667: Prince Rupert's trephination

The technique of the successful drainage of Prince Ruperts extradural abscess in 1667 has been reconstructed by putting together the details from several contemporary documents. The operation is shown to be a rational and well planned procedure in the context of the times, and not the lucky outcome of a desperate desire to try something dramatic.