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  • By Author: Spetzler, Robert F. x
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Neil A. Martin, Wesley A. King, Charles B. Wilson, Stephen Nutik, L. Phillip Carter and Robert F. Spetzler

✓ Eight patients with dural arteriovenous malformations (AVM's) of the anterior cranial fossa are presented, and the pertinent literature is reviewed. Unlike cases of dural AVM's in other locations, sudden massive intracerebral hemorrhage was the most frequent reason for presentation. Other symptoms included tinnitus, retro-orbital headache, and a generalized seizure. The malformations were supplied consistently by the anterior ethmoidal artery, usually in combination with other less prominent feeding vessels. The lesion's venous drainage was through the superior sagittal sinus via a cortical vein; in addition, in two cases a subfrontal vein drained the AVM. A venous aneurysm was encountered near the site of anastomosis with the dural feeder in most cases, and was found in all patients who presented with hemorrhage. The AVM was obliterated surgically in six patients, with favorable results achieved in five. One patient died postoperatively from a pulmonary complication. Because of their anatomy and proclivity for hemorrhage, these vascular malformations represent a unique group of dural AVM's. Surgical management of anterior fossa dural AVM's carries low morbidity, and is indicated when the lesions have caused hemorrhage or when there is an associated venous aneurysm.

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Robert F. Spetzler and Charles B. Wilson

✓ The authors review 39 patients with cerebrospinal fluid (CSF) leaks originating from the middle or posterior fossa. They evaluate the usefulness of preoperative investigative procedures, including cisternal radionuclide scanning and the deliberate increase of intracranial pressure. The results in this series emphasize the important role that abnormal CSF dynamics play in the recurrence of problematic cases of rhinorrhea or otorrhea. The following guidelines are recommended by the authors on the basis of their recent experience: 1) if hydrocephalus is present, if the cisternogram is abnormal, or if the CSF leak is intermittent and slight, the initial treatment should be insertion of a lumboperitoneal shunt; 2) if the leak is localized in the sellar or parasellar area, a transsphenoidal approach to obliterate the leak is advised; 3) if the CSF leak originates through a dural opening into the middle ear, an intracranial repair is indicated.

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Robert F. Spetzler, Philip R. Weinstein, Norman Chater and Charles B. Wilson

✓ The authors describe a shunt inserted by a percutaneous route to the cisterna magna for the treatment of various cerebrospinal fluid disorders.

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Robert F. Spetzler and Charles B. Wilson

✓ The authors present a case in which an enlarging arteriovenous malformation was documented angiographically. Enlargement of the malformation concurrent with the appearance of basilar artery insufficiency was ascribed to a sump effect (steal) by the arteriovenous shunt.

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Robert F. Spetzler, Charles B. Wilson and John M. Grollmus

✓ The authors describe a new catheter for use in percutaneous lumboperitoneal shunting, designed to overcome the problem of kinking. They present their experience with the catheter in 14 patients.