Larry K. Page

The infratentorial-supracerebellar exposure of tumors in the pineal area.

Nine pineal area lesions were operated upon by the infratentorial-supracerebellar approach. There was one operative death and one death due to disseminated germinoma recurrence 2 1/2 years postoperatively. The remaining seven patients have shown no sign of recurrence and are neurologically normal. The surgical method that has evolved through these nine cases is discussed. The infratentorial-supracebebellar exposure is an excellent one for lesions in the region of the pineal gland, posterior 3rd ventricle, and superior cerebellar vermis. Access is less hampered by the major tributaries of the vein of Galen than with the supratentorial operations. This approach is also a useful extension of the standard posterior fossa exploration when dealing with primarily subtentorial lesions that involve the dorsal midbrain or herniate upward.

Bilateral optic canal meningiomas: a case report.

In the case presented, bilateral optic canal meningiomas produced binocular visual loss. Correct diagnosis was delayed because of inadequate and misinterpreted radiological studies. Careful radiological and surgical examination of the planum sphenoidale later suggested this as the source of both canalicular masses. The pertinent aspects of this case are reviewed in relation to information from similar cases reported previously. In the future, increased clinical suspicion and more accurate neuroradiological studies should improve the detection and afford earlier surgical treatment of meningiomas of the optic canal.

Split notochord syndrome: case report.

Split notochord syndrome includes a cleft of the vertebral column associated with malformation of the central nervous system. Fourteen cases involving the lumbosacral spine have been reported in the literature. We report on a female neonate who had intact function of her lower extremities, a posterior midline lumbar defect bounded by two complete spinal canals that contained two spinal cords. A meningocele, a large bowel fistula, and a mature teratoma protruded through the cleft. The baby is doing well after repair of the anomaly and placement of a ventriculoperitoneal shunt.

Posterior fossa arachnoid cyst presenting with an isolated twelfth nerve paresis: Case report and review of the literature

An unusual case of a posterior fossa arachnoid cyst containing atypical fluid is described in a patient presenting with an isolated ipsilateral twelfth nerve paresis. Despite the chronicity of symptoms, surgical decompression resulted in a satisfactory functional recovery.

Cerebrospinal fluid and extracellular fluid: their relationship to pressure and duration of canine hydrocephalus

Fifteen greyhound dogs were made hydrocephalic by the transsphenoidal injection of silicone into the basal cisterns at the level of the tentorial incisura. Six of these animals had ventriculocisternal perfusions 4 weeks later and six at 8 weeks, half at 150 and half at 100 mm H2O. Three 12-week dogs were perfused at 150 mm H2O. Serial sections of brain from the ependyma of the left frontal horn to the overlying pia were counted for14C inulin and3H methotrexate uptake. Tissue concentrations of both markers varied indirectly with distance from ependyma and from pia, and varied directly with perfusion pressure. The data indicate that the diffusional pathway between cere-brospinal fluid (CSF) and extracellular fluid (ECF) can be modified by CSF pressure changes, i.e., CSF flows from the ventricles and subarachnoid space into the extracellular space when CSF pressures are raised. Brain uptake of inulin and methotrexate was significantly increased in the dogs made hydrocephalic 4 weeks prior to perfusion, but was less so in the 8-week hydrocephalics. Uptake of the tracers in three 12-week animals was similar to that found previously in normal dogs at elevated pressures. These findings correspond in location and time to the periventricular lucencies that are seen by computed tomography in human subacute hydrocephalus. They are apparently due to pressure-related changes in the volume of the ECF.

Primary cerebral leiomyosarcoma

A case of a rare primary cerebral leiomyosarcoma in an 8-year-old male is described. The patient presented with a new-onset seizure disorder and was found to have a rapidly expanding left parietal extra-axial lesion, documented by radiological imagings. The patient underwent surgical resection of the leiomyosarcoma, as well as adjuvant radiotherapy and chemotherapy. He is still surviving to date in stable neurological condition. The clinical presentation, surgical procedure, pathological findings and post-operative clinical course will be reported. The possible etiology of this rare extra-axial neoplasm is discussed.

Acquired Double Elevator Palsy in a Child With a Pineocytoma

Purpose/Methods We examined an 8-yearold girl who had an acquired double elevator palsy and a histopathologically confirmed benign pineocytoma. Results/Conclusions Mass lesions in the region of the pineal gland can produce monocular blepharoptosis and supranuclear upgaze paresis with the resultant clinical picture of double elevator palsy

Vertebral artery aneurysm--a unique hazard of head banging by heavy metal rockers. Case report.

A 15-year-old drummer in a neighborhood rock music band suffered a traumatic true aneurysm of the cervical vertebral artery from violent head and neck motion. He underwent excision of the aneurysm after distal and proximal ligation of the artery. He is neurologically normal 1 year after surgery. The mechanisms of injury caused by extremes of cervical motion, as well as 5 previously reported cases of extracranial vertebral artery aneurysm from closed trauma, are discussed. Excision of vertebral artery aneurysms in patients with emboli from a mural thrombus is recommended. The consequences of vertebral artery ligation and the indications for distal reconstruction are discussed.

Cushing's disease in childhood: benign intracranial hypertension after trans-sphenoidal adenomectomy. Case report.

A 7-year-old girl presented with the physical and endocrinological stigmata of Cushings disease. An adrenocorticotropic hormone (ACTH)-producing pituitary microadenoma was excised. Three weeks after trans-sphenoidal adenomectomy, the patient developed benign intracranial hypertension. Although ACTH levels had decreased to normal, the serum cortisol had fallen to subnormal levels. The child responded to exogenous steroid therapy, which was gradually tapered and discontinued after 5 months. Normal pituitary and adrenal functions persist 2 years later.

Spinal cord tumors presenting with neural tube defects

Two primary lumbosacral tumors arising at the site of neural tube defects are presented. One was a teratoma diagnosed in an infant with myelomeningocele. The other was an ependymoma that developed in an adult with meningocele. It is postulated that these cases represent a neoplastic transformation of heterotopic primordial elements that have been incorporated within the defect, supporting the view that overgrowth of neural tissue may be the result rather than the cause of neural tube deformity. Such rare occurrences may be due to interaction between intrauterine teratogenic factors and familial predisposition in affected patients.