The likelihood of rupture of unruptured intracranial aneurysms that were less than 10 mm in diameter was exceedingly low among patients in group 1 and was substantially higher among those in group 2. The risk of morbidity and mortality related to surgery greatly exceeded the 7.5-year risk of rupture among patients in group 1 with unruptured intracranial aneurysms smaller than 10 mm in diameter.

Spontaneous spinal epidural hematoma should be considered in the differential diagnosis of sudden onset of spinal cord compression in association with back pain. Patients initially presenting with severe neurologic dysfunction are potential candidates for conservative management if they demonstrate rapid and progressive improvement in neurologic function. Patients treated in this manner can have nearly complete restoration of function.

Object. The authors conducted a study to assess health-related quality of life (HRQOL) and the appropriateness of surgery in patients who have undergone elective lumbar discectomy. Methods. The study involved a prospective cohort of 82 surgically treated patients with lumbar disc herniation causing lower-extremity radiculopathy. An independent study coordinator recorded demographic data and administered the North American Spine Society (NASS) lumbar spine instrument and the Short Form—36 (SF-36) before treatment, and at 6 months and 1 year after surgery. The HRQOL results were also compared with normative data for the NASS and SF-36. The influence of baseline variables on HRQOL was determined using regression modeling. The InterQual Indicators for Surgery and Procedures (ISP) were used to compare surgeon practice patterns with standardized indications for surgery. The NASS neurogenic symptom (NSS) and pain/disability scores (PDSs) showed very significant improvement at 6 months and little change between 6 months and 1 year. The SF-36 physical function and bodily pain scale scores were associated with the greatest improvement. Interestingly, the 1-year NASS (NSS and PDS) and SF-36 (only PCS) scores remained lower than those of age-matched normative data. Other than preoperative HRQOL scores, the only other variable that inversely influenced HRQOL was the duration of time between symptom onset and surgery. Ninety-five percent of ISP forms were completed, and 97% of the indications recorded by the surgeon matched the criteria. Conclusions. The reporting of standardized outcomes in association with indications for surgery is feasible and may help elucidate the ideal rate for discectomy.

The pathology of spinal cord injury has been studied in 34 rabbits and 5 dogs with attention focused on the condition of the microvasculature during the evolution of neuronal and axonal degeneration and necrosis. The animals were killed and perfused arterially with colloidal barium from 10 min to 14 days after a controlled spinal injury. Microradiographs of the injured tissues were obtained and compared with corresponding histological sections. Microangiography at 7 to 14 days defines two zones in the injured spinal cord. Zone 1 is located in the posterocentral part of the cord. Capillaries in this region progressively lose their ability to conduct blood and perfusate over the first 4 hours. Degenerative changes in neurons are visible by 1 hour after injury. Necrosis of all elements including capillaries ensues. Zone 2 surrounds Zone 1. Microvascular patterns are normal in Zone 2 although neuronal and axonal degeneration is severe. Pericapillary hemorrhages which occur as early as 10 min after injury in Zone 1 and become progressively larger over the first 4 hours seldom are seen in Zone 2. The evidence indicates that at all times in the pathogenesis of spinal cord injury the microvasculature in Zone 2 is capable of perfusion. Degeneration of neural structures either precedes microvascular breakdown (Zone 1) or occurs in the absence of microvascular disruption (Zone 2). Recovery of damaged neurons and axons depends upon a preserved microcirculation.

Giant intraspinal pseudomeningoceles are a rare complication of brachial plexus root injuries or avulsion, capable of causing significant morbidity. Early intervention can improve symptoms related to long tract involvement and prevent further deterioration of lower motor neuron disease. The pathophysiology of neurological dysfunction caused by these giant collections is unclear; however, vascular and mechanical factors thought to be important in the pathogenesis of cervical myelopathy also may have a role.