Between 1983 and 1994, posterior cervical foraminotomy as described by Frykholm was performed on 89 patients with exclusively radicular symptoms caused by cervical osteophytes. The main presenting feature was arm pain. Objective neurological signs were present in 50% of the patients. At mean postoperative follow-up of 8.6 months, 95.5% of patients reported excellent or good results, while 4.5% were not improved. No patient was rendered worse following the procedure. There were no deaths and the complication rate was 2.2%. Further surgery for recurrent root symptoms was required by 6.7% of patients. Our findings are in keeping with the good results and low complication rate of this procedure as described in other studies. Informal inquiries suggest that this procedure is not widely used, at any rate in the United Kingdom, and we present this series in order to emphasize the efficacy and safety of this procedure.
SUMMARY Three cases of a form of focal hydrocephalus are described which the authors term "entrapment of the temporal horn". Obstruction of one lateral ventricle in the region of the trigone isolates the temporal horn. Continued secretion of cerebrospinal fluid within the temporal horn causes it to behave as a mass lesion. In the cases described the causes of the condition were recurrent glioma, previous tuberculous meningitis and surgical excision of an arteriovenous malformation which extended into the trigone. Shunting of the trapped temporal horn provides satisfactory treatment.We describe three cases of a syndrome in which obstruction of the trigone of the lateral ventricle seals off the temporal horn from the rest of the ventricular system. Continued secretion of cerebro-spinal fluid by the choroid plexus within the temporal horn leads it to expand into a cyst which behaves as a mass lesion. This entity which we have termed "entrapment of the temporal horn" is a form of focal hydrocephalus, which has previously attracted little notice. It is distinct from two other rare but well recognised forms of partial hydrocephalus: unilateral hydrocephalus caused by obstruction of one foramen of Monro and septation of the ventricular system after infantile meningitis. Case reportsCase 1This 23-year-old woman had undergone resection of a right temporal malignant glioma 2 l/2 years previously followed by a course of radiotherapy. Eighteen months later a local recurrence of her tumour had been treated by further surgical resection and chemotherapy. At neither operation had the ventricular system been entered and she had been left with no neurological defect. One year later she developed severe progressive headache and drowsiness over a period of three days. On admission she was found to be confused and irri- horn which contained 60 ml of clear colourless fluid resembling cerebro-spinal fluid. The communication of the temporal horn and the trigone was severely narrowed by fibrous tissue. This stenosis was opened up so that the temporal horn communicated freely with the trigone. After operation she made a rapid recovery although she was left with a left lower facial weakness and a homonymous lower quadrantinopia. She remained well until six months later when she died from a recurrence of her tumour.
Objectives: To evaluate the results of treatment of patients with a ruptured intracranial aneurysm treated by a single experienced vascular neurosurgeon in the period prior to the introduction of endovascular coiling. Methods: Over a mean (SD) period of 9 (2) years, between January 1990 and June 1999, 245 consecutive patients with ruptured intracranial aneurysms were treated. Patients' details were obtained from a database that had been constructed prospectively. The patients consisted of all those patients treated by the senior author (Mr Maurice-Williams) over this period-that is, every third day on call at his unit. During this period, all patients under the age of 75 years with a diagnosis of subarachnoid haemorrhage were admitted to the neurosurgical unit as soon as was practicable regardless of clinical grade. Results: Of 245 patients, 190 (77.6%) underwent treatment by open surgery using standard microsurgical techniques. At 1 year, the mortality of the operated patients was 2.6%, while 89.5% of the patients had a Glasgow Outcome Score (GOS) of 4 and 5. The overall management outcome (all patients treated, including operated and non-operated cases) at 1 year was: 17.1 % dead while 74.3% had GOS 4 and 5. Of the 190 patients who underwent surgery, 38 (20%) required additional operations, totalling 72 operations in all. Of these, 32 were for hydrocephalus and 17 for the evacuation of intracranial haematomas/collections. Complications of surgery occurred in 56 patients (29.5%). Conclusion: Open surgery, despite good eventual results, is associated with a significant rate of reoperations and complications that would probably be largely avoided with endovascular treatment. Nevertheless, although endovascular coiling has these immediate advantages over surgery it is still not certain that the long term results will be superior to surgery which leads to permanent obliteration of the aneurysm. There may still be a need for open surgery in the future.
We describe two patients with Wegener's granulomatosis involving the pituitary. The diagnosis of Wegener's granulomatosis was inferred from the histological appearance of biopsy tissue and the presence of anti-neutrophil cytoplasmic antibodies with cytoplasmic distribution in the first case, in which disease remained confined to the pituitary, causing anterior and posterior pituitary dysfunction. In the second case the diagnosis was made by the progressive involvement of other organ systems, compatible histology and the presence of anti-neutrophil cytoplasmic antibodies with cytoplasmic distribution. In neither patient did posterior pituitary dysfunction respond to immunosuppressive therapy, despite remission of other features of systemic vasculitis. Panhypopituitarism in association with isolated pituitary Wegener's granulomatosis has not previously been described.
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