Marshall B. Allen

Late Results of Cervical Discectomy and Interbody Fusion: Some Factors Influencing the Results

The symptoms, physical findings, and roentgenograms of sixty patients who underwent cervical discectomy and interbody fusion by the Robinson-Smith technique were reviewed and compared with the patients condition two to nine years after surgery. On the basis of such a long-term evaluation, these patients were categorized and the findings were utilized to determine the factors that influence the results of surgery. These findings were as follows: 1. Patients with radicular symptoms had a higher rate of improvement than those whose symptoms were non-radicular. A positive correlation was found between satisfactory results and either motor or sensory deficits. This correlation was still greater when both motor and sensory findings were present. 2. Men tended to have much better results from discectomy than did women. 3. Occipital headaches and non-radicular symptoms as the predominant complaints tended to reduce the likelihood of a desirable result although some patients with such complaints were greatly improved. 4. A slight but definite correlation was obtained between the findings on roentgenograms of the cervical spine and the results of surgery. Patients with apparently normal cervical spines tended to have less desirable results than those with osteophyte formation or narrowing of the interspace or both. 5. The value of discography and myelography was not clearly defined by this evaluation. These methods are of secondary importance to the clinical evaluation. 6. Patients with correlating symptoms and signs of root compression had better results from surgery than did those whose treatment resulted in bone fusion, suggesting that the selection of patients for cervical discectomy may be more important than the obtaining of a bone fusion.

Cranial arteritis associated with herpes zoster. Case report with angiographic findings.

Abstract Angiographic findings of unilateral angiitis in a case of herpes zoster ophthalmicus with contralateral hemiplegia are described. Herpes zoster is often associated with major CNS involvement and a vascular etiology was previously postulated. Recent pathological reports suggest that cerebral angiitis secondary to herpes virus infection may be more common than heretofore realized. Our findings suggest a means by which suspected cases can be more fully evaluated.

Potentiation of Luteinizing Hormone Release by Estradiol at the Level of the Pituitary

The objective of this study was to determine the influence of estradiol-17beta and/or progesterone on gonadotropon secretion at the level of the pituitary. Female rats in which the hypothalamo-hypophyseal connections had been permanently interrupted after castration served as the experimental model in which the effect of estradiol and/or progesterone on LH-RH-induced gonadotropin release was examined. In out experimental animals, LH secretion was readily activated by LH-RH administration. LH release was greatly augmented by the prior administration of estradiol benzoate (1 mug/kg b.w./day). Progesterone (5 mg/day) in the absence of estradiol did not modify the 10-min responese to LH-RH but reduced the enhancement of LH secretion caused by estradiol pretreatment. Our findings suggest that estradiol potentiated the releasing effect of LH-RH at the level of the gonadotroph, whereas progesterone interfered with the potentiation effect. Plasma levels of FSH were not significantly elevated above the basal value by the administration of LH-RH alone, or in combination with estradiol and/or progesterone.

Ganglioglioma, a malignant tumor? Correlation with flow deoxyribonucleic acid cytometric analysis.

This study describes the flow cytometric deoxyribonucleic acid (DNA) analysis of a resected ganglioglioma. The initial histopathological analysis revealed a benign tumor characterized by a predominance of mature ganglion cells. The flow cytometric DNA analysis of the necrotic areas, however, demonstrated an aneuploid population of cells. Further examination by histological analysis of the tumor revealed both benign and atypical foci. The retrospective DNA analysis performed from paraffin sections of tissue with benign-histological findings demonstrated euploid populations of cells consistent with a benign, slow-growing lesion. In contrast, DNA analysis performed from tissue with atypical histological findings revealed aneuploid populations of cells consistent with a malignant phenotype. Our analysis provides additional data supporting the existence of tumor progression in some gangliogliomas. Results support the concept of tumor cell heterogeneity and the importance of adequate tumor sampling. The finding of aneuploid populations with unfavorable histology further supports the use of flow cytometry as an adjunct method in assessing tumor biology.

The value and limitations of brain scanning a review of 401 consecutive cases

The authors present their experience with scanning 401 patients over a 5 year period, using RISA Hg 203 and Hg 197. With 65 proven tumors, 72% of scans were positive, 7% suspicious and 21% negative. Lesions limited to the cerebral hemispheres were positive in 83% with an additional 5% suspicious. Scan findings were correlated with the findings of other neurological investigations. Scanning is useful for investigating non-neoplastic lesions. Chronic subdural hematomas were identified in 5 of 6 patients and suspected in the sixth. Scans on intracerebral hematomas were less revealing and uncomplicated subarachnoid hemorrhages were not identified. Completed strokes were positive in 19 of 37 patients (51%). Intermittent vascular insufficiency was suspected in 5, negative in 14 and positive in one. Three proven abscesses were positive. Scanning may aid in demonstrating and following localized cerebritis; in all 11 patients the scan was positive or strongly suspicious. The aetiology of the positive brain scan is discussed. Limitations are presented and possible means of enhancement are suggested.

Further consideration of sellar changes associated with increased intracranial pressure

Abstract The size and shape of the sella turcica can be significantly influenced by prolonged elevation in the cerebrospinal fluid pressure. Mechanisms whereby such alterations of the sellar architecture may be produced have been postulated in recent years (du Boulay and El Gammal, 1966). Thirteen patients with intracranial pathology and intrasellar extension of the subarachnoid recess are reported. Eleven of these patients had alteration in the architecture of the sella turcica. These cases suggest that the intrasellar extension of the subarachnoid recess may play an important role in the production of certain types of sellar changes (Categories I, III and IV). They also support the hypothesis previously advanced, explaining mechanisms by which some sellar changes occur in association with increased intracranial pressure (du Boulay and El Gammal, 1966).

Effect of pressure on cerebrospinal fluid absorption in cats, baboons, and humans: comparison of the linear and logarithmic models.

: To circumvent time constraints inherent in indicator clearance measurements of cerebrospinal fluid absorption, investigators have used the relationship between CSF pressure at steady state and the rate of infusion of mock CSF, in both patients and experimental animals, to evaluate the bulk absorption rate of CSF. This latter approach required mathematical model of the effect of CSF pressure on CSF bulk flow. Two such models--a fixed resistance and a variable resistance model of CSF flow through arachnoid villi--have been used in both clinical and laboratory settings. In this study, the relationship between steady state CSF pressure and mock CSF infusion rate was assessed using both mathematical models. We studied two patients, three cats, and seven baboons. Values of CSF outflow resistance calculated according to both models as well as other parameters of CSF bulk flow estimated on the basis of both models were all in the range expected from other studies. The data from these experiments do not provide justification for preferring one model over the other. Depending on the experimental or clinical situation, some of the assumptions behind both models may not be valid. Multiple direct measurements of the rates of CSF absorption and formation over a wide range of CSF pressures in individual subjects will be necessary to validate either the variable or the fixed resistance model or to suggest a more appropriate model. Until such information is available, it is probably reasonable to use both approaches for the analysis of mock CSF infusion data. CSF bulk flow parameters calculated on the basis of either the variable or the fixed resistance model should never be taken as absolute, but should be evaluated critically in the context of the clinical or experimental situation.

Effect of Pressure on Cerebrospinal Fluid Absorption in Cats, Baboons, and Humans

To circumvent time constraints inherent in indicator clearance measurements of cerebrospinal fluid absorption, investigators have used the relationship between CSF pressure at steady state and the rate of infusion of mock CSF, in both patients and experimental animals, to evaluate the bulk absorption rate of CSF. This latter approach required mathematical model of the effect of CSF pressure on CSF bulk flow. Two such models--a fixed resistance and a variable resistance model of CSF flow through arachnoid villi--have been used in both clinical and laboratory settings. In this study, the relationship between steady state CSF pressure and mock CSF infusion rate was assessed using both mathematical models. We studied two patients, three cats, and seven baboons. Values of CSF outflow resistance calculated according to both models as well as other parameters of CSF bulk flow estimated on the basis of both models were all in the range expected from other studies. The data from these experiments do not provide justification for preferring one model over the other. Depending on the experimental or clinical situation, some of the assumptions behind both models may not be valid. Multiple direct measurements of the rates of CSF absorption and formation over a wide range of CSF pressures in individual subjects will be necessary to validate either the variable or the fixed resistance model or to suggest a more appropriate model. Until such information is available, it is probably reasonable to use both approaches for the analysis of mock CSF infusion data. CSF bulk flow parameters calculated on the basis of either the variable or the fixed resistance model should never be taken as absolute, but should be evaluated critically in the context of the clinical or experimental situation.

Neurosurgery at medical college of georgia, georgia regents university in augusta (1956-2013)

: The neurosurgery service at the Medical College of Georgia, Georgia Regents University at Augusta has a rich history spanning almost 6 decades. Here, we review the development of neurological surgery as a specialty in Augusta and the history of the Department of Neurosurgery at Georgia Regents University. This article describes some of the early neurosurgeons in the city and those who have contributed to the field and helped to shape the department. Our functional and stereotactic program is emphasized. Our surgical epilepsy program dates back more than a half-century and remains a highly experienced program. We also describe our affiliation with the medical illustration graduate program, which was the first to be accredited and remains 1 of 4 such programs in the world. Finally, we list our alumni, former faculty, and current faculty, as well as the major accomplishments in our first decade as a full department.