Neurosurgery
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The authors present a patient who underwent transsphenoidal surgery for a pituitary adenoma and afterward developed late, severe rhinorrhea and tension pneumocephalus. The patient was treated conservatively.
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Six patients with intramedullary cavernous malformations of the spinal cord are presented. Four men and two women presented with acute, subacute, or episodic signs and symptoms of spinal cord dysfunction, ranging in duration from 3 days to 25 years. ⋯ Neurological function either stabilized or improved postoperatively in all patients; follow-up ranged from 4 to 84 months. The increasing awareness of the propensity for recurrent hemorrhage, clinical features, and resectability of these malformations are discussed.
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Review Case Reports
Cavernous sinus syndrome as the presentation of malignant lymphoma: case report and review of the literature.
Cavernous sinus syndrome (CSS) is an unusual presentation of malignant lymphoma. We report a patient with lymphoma that presented with CSS, and we review the literature on nine other reported cases. Sharp retroorbital pain, paraesthesia around the orbit, and complete 6th nerve palsy were dominant presenting symptoms. ⋯ The mean age of the patients was 45 years. The mean survival time after the first presenting symptom was 8.7 months. Two of the reported patients as well as our patient had disseminated disease, which became evident at autopsy.
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Comparative Study
To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients?
The treatment options for intracranial arachnoid cysts are either craniotomy and fenestration of the cyst into the cerebrospinal fluid spaces or shunting of the cyst contents extracranially. Fenestration may eliminate the need to shunt, but it is a major operative procedure and is not always successful. To determine which treatment provides the greatest benefit with the fewest complications, the records of 31 patients with 34 arachnoid cysts treated at the Children's Hospital of Los Angeles between 1976 and 1986 were reviewed. ⋯ Of the total 12 cystoperitoneal shunts, 5 have required revisions on one or more occasions. No significant difference in morbidity was noted between the two treatment options. Because we consider shunt independence to be a major goal of therapy, we suggest that patients with arachnoid cysts be divided into two categories, those presenting with associated hydrocephalus and those without hydrocephalus.(ABSTRACT TRUNCATED AT 250 WORDS)
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Atherosclerotic plaques were induced in abdominal aortas of rabbits. At 8 weeks, 5 mg of dihematoporphyrin ether (Photofrin II) per kg was injected intravenously followed by sacrifice of the animal, fluorescence microscopy, and quantitative assay of porphyrin in the plaque-containing aortas at 1, 12, 24, 48, and 72 hours. Photofrin II was taken up preferentially by the plaque, with the highest plaque to normal wall ratio occurring at 48 hours. ⋯ Animals were killed at 2, 4, and 6 weeks. The 6-week specimens showed the most dramatic reduction in plaque in comparison to controls. Photodynamic therapy may provide an alternate strategy in dealing with focal atherosclerosis.