Lyal G. Leibrock

Chitosan: A New Topical Hemostatic Agent for Diffuse Capillary Bleeding in Brain Tissue

The effectiveness of chitosan as an intraoperative topical hemostatic agent for brain tissue was tested. Cerebral cortical lesions were made in 10 cats. Chitosan was used to obtain hemostasis. The elapsed time from the application of the hemostatic agent to hemostasis was determined. The animals were killed and the lesions were examined grossly and microscopically to evaluate the biocompatibility of chitosan. Chitosan was easy to apply and required minimal subsequent manipulation. Histopathological examination revealed that chitosan is biocompatible with cerebral cortex.

The long-term clinical outcome of patients undergoing anterior cervical discectomy with and without intervertebral bone graft placement

OBJECTIVE This retrospective study provides data on the long-term clinical outcomes of patients with either anterior cervical discectomy alone (ACD) or anterior cervical discectomy with intervertebral bone graft placement (ACDF). METHODS A questionnaire was mailed to 525 patients who had undergone ACD (290 patients) or ACDF (235 patients) at least 2 years previously. All procedures were performed by University of Nebraska Medical Center faculty in the Section of Neurosurgery. The follow-up period averaged 8.1 years, with a range of 2 to 14 years. RESULTS Two hundred sixty-two (49.9%) patients responded to the questionnaire. There was no demographic difference between respondents and nonrespondents (P > 0.05). Respondents who underwent ACDF reported fewer problems with pain than did those who underwent ACD (P < 0.05). A higher percentage of respondents with ACDF reported that they had normal function than did those who underwent ACD (P < 0.05). When limited to respondents who underwent first-time, single-level operations (191 patients), similar results were obtained for the pain parameter (P < 0.05) but not for the level of function (P = 0.25). Patients with longer follow-up periods had fewer problems with pain and better levels of function (P < 0.05). CONCLUSION Patients who underwent ACD or ACDF did well and benefited from their operations. Those who underwent ACDF did better than those who underwent ACD. Length of follow-up was also an important predictor of current levels of function and pain.

Radiation‐induced neoplasms of the brain

The histopathology of two patients with radiation‐induced neoplasms of the brain following therapeutic irradiation for intracranial malignancies is described. The second neoplasms were an atypical meningioma and a polymorphous cell sarcoma, respectively. They occurred 12 and 23 years after irradiation (4000 rad), within the original field of irradiation. In both cases, the radiation‐induced tumors were histologically distinct from the initial medulloblastomas. Both patients were retreated with local irradiation using permanent implantation of radioactive iodine‐125 seeds.

Patient outcome after resection of lumbar juxtafacet cysts

Study Design. Retrospective review of patients who underwent lumbar juxtafacet cyst resection with questionnaire follow-up. Objectives. Determine the long-term outcome after resection of lumbar juxtafacet cysts. Summary of Background Data. Juxtafacet cysts are uncommon causes of radicular pain and are often associated with significant spinal degenerative disease. Previous studies have not focused on the outcome of patients who have undergone resection. Methods. Charts of 29 patients who underwent lumbar juxtafacet resection were reviewed and an outcomes questionnaire was sent to each. Results. Thirty-three lumbar juxtafacet cysts were resected from 29 patients. Cysts, 31 (94%) from facets and 2 (6%) from the ligamentum flavum, most commonly arose at the L4–L5 level (51%). Twelve patients (41%) were found to have some degree of spondylolisthesis before surgery, while 26 patients (90%) had facet arthropathy. Two patients (7%) underwent concurrent resection and fusion. Recurrence occurred in 3%. Three patients (9%) had subsequent lumbar spine operations, including 2 fusions (6%). Incidental durotomy was the most common surgical complication occurring in 3 cases (9%). Twenty-four patients (83%) responded to follow-up questionnaire or phone interview. Mean length of follow-up was 24 months (4–64 months). Twenty patients (83%) reported improvement in pain, and 16 (67%) reported an improved level of function. All respondents reported some degree of improvement in their condition after surgery. Conclusions. Juxtafacet cysts are an uncommon cause of radiculopathy. Surgical resection is the treatment of choice with low rates of complications, recurrences, and residual complaints.

The MR appearance of hypothalamic hamartoma

SummaryHypothalamic hamartoma is the most common detectable cerebral lesion causing precocious puberty. Two histologically confirmed cases were studied by computerized tomography (CT) and magnetic resonance (MR) imaging. T2 weighted, sagittal MR images were superior to CT in delineating the tumor from surrounding grey matter. The lesion was isointense to grey matter on T1 weighted images allowing exclusion of other hypothalamic tumors. MR will undoubtedly become the imaging modality of choice in the detection of hypothalamic hamartoma.

Dysphagia and dysphonia secondary to anterior cervical osteophytes.

A 77-year-old man presented with a 4-year history of progressive dysphagia to the point that he could no longer swallow solid foods. During the past several months, he had developed dysphonia. Cervical spine x-ray films demonstrated massive anterior degenerative osteophytic spurs between C-3 and C-7. Evaluation with barium swallow and cervical computed tomography demonstrated esophageal and laryngeal compression. Resection of the anterior osteophytes resolved the dysphagia and dysphonia.

High activity iodine 125 endocurietherapy for recurrent skull base tumors

Experience with endocurietherapy of skull base tumors is reviewed. We present our cases of recurrent pituitary hemangiopericytoma, radiation‐induced recurrent meningioma, recurrent clival chordoma, recurrent nasopharyngeal cancer involving the cavernous sinus, and recurrent parotid carcinoma of the skull base which were all successfully retreated with high‐activity 125iodine (I‐125) permanent implantation.

Cerebellopontine angle lipoma: a review

Lipomas located in the cerebellopontine angle (CPA) have rarely been reported. With the advent of computed tomographic scanning and more sophisticated physiological diagnostic techniques, CPA lipomas are being reported more frequently. This paper reviews the worlds literature on this lesion and summarizes the symptoms and signs, diagnostic studies, pathology, and surgical results. Recommendations regarding the therapy of this lesion are presented.

The importance of MRI findings for the diagnosis of nontraumatic lumbar subacute subdural haematomas

SummarySpinal subdural haematoma (SSH) is a rare cause of spinal cord or cauda equina compression which occurs mainly in patients with a bleeding diathesis. This report presents a case of subacute lumbar subdural haematoma demonstrated by magnetic resonance imaging. MRI appears to be more sensitive than myelography and CT.

Local Control of Recurrent Clival and Sacral Chordoma after Interstitial Irradiation with Iodine-125: New Techniques for Treatment of Recurrent or Unresectable Chordomas

Using new 125I brachytherapy techniques, we were able to deliver safely a tumor volume dose of 16,000 rads to a previous irradiated, large, recurrent sacral chordoma by means of the intraoperative interstitial implantation of 229 low activity 125I seeds and 40,000 rads to a previously irradiated, small, recurrent clival chordoma by means of the transnasal needle implantation of two high activity 125I seeds. Iodine-125 brachytherapy was followed by regression of tumor, lessening of symptoms, and bony recalcification in both cases.