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Neurosurgery: a historical prologue to the future

2000 Presidential address

Martin H. Weiss

✓ The author provides a brief history of the genesis of organized neurosurgery and, in particular, the formation and evolution of the American Association of Neurological Surgeons. The legacy of neurosurgery is noted and the author discusses the present and future practice of neurosurgery.

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Nocardia Asteroides Brain Abscess Successfully Treated by Enucleation

Case Report

Martin H. Weiss and John A. Jane

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Radioactive tissue changes induced to control experimental hydrocephalus

Martin H. Weiss and Uros Roessmann

✓ Hydrocephalic animals were given an intraventricular infusion of radioactive colloidal gold and then sacrificed up to 7 weeks after infusion. Histological evaluation revealed progression from a marked hemorrhagic necrosis of choroid plexus vessels and stroma to eventual replacement by fibrous connective tissue, sclerosis, and fibrinous degeneration of stromal vessels. Particulate colloid was found engulfed in perivascular spaces in the subependymal periventricular tissues, but there was no evidence of vascular damage, gliosis, or demyelination. These findings may play a role in decreasing cerebrospinal fluid production.

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The Effect of Glucocorticoids on CSF Flow in Dogs

Martin H. Weiss and Frank E. Nulsen

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Editorial

Pituitary surgery

Martin H. Weiss

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Defining Postoperative Values for Successful Resection of Prolactinomas

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Cerebrospinal fluid rhinorrhea from an empty sella: transsphenoidal obliteration of the fistula

Technical note

Martin H. Weiss, Benjamin Kaufman, and David E. Richards

✓ A case of cerebrospinal fluid rhinorrhea developing in a progressively enlarging empty sella is described in which the fistula was successfully obliterated via a transsphenoidal approach. A modification of the standard closure for transsphenoidal hypophysectomy enabled reconstruction of the dural floor of the sella.

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Antibiotic neurotoxicity

Laboratory and clinical study

Martin H. Weiss, Theodore Kurze, and Frank E. Nulsen

✓ By ventriculocisternal perfusion, a series of newer antibiotics were circulated through the central nervous system to ascertain the potential toxicity of these drugs to the nervous parenchyma. Ampicillin, carbenicillin, gentamycin sulfate, and polymyxin B sulfate appear to be well tolerated whereas cephalexin monohydrate and penicillin G caused a repeated pattern of significant CSF pleocytosis, histological evidence of periventricular perivascular infiltrates, and evidence of clinical toxicity. A regime for treatment of central nervous system infections is presented, derived from the data presented above. Preliminary experience in a clinical series appears to support this program.

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Sixth nerve schwannomas

Report of two cases

Howard Tung, Thomas Chen, and Martin H. Weiss

✓ Two cases of sixth cranial nerve schwannoma are presented with a review of four other cases from the literature. The clinical spectrum, neuroradiological findings, and surgical outcome of the six cases are discussed. There are two distinct clinical presentations for sixth cranial nerve schwannomas. Type I sixth nerve schwannomas present with sixth nerve palsy and diplopia and arise from the cavernous sinus. In contrast, type II sixth nerve schwannomas have a more severe presentation with obstructive hydrocephalus, raised intracranial pressure, sixth nerve palsy, and diplopia. This type arises along the course of the sixth cranial nerve in the prepontine area. Cavernous sinus involvement in either type may preclude total surgical excision and indicate an increased possibility for recurrence.

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Selective radionecrosis of the choroid plexus for control of experimental hydrocephalus

Martin H. Weiss, Frank E. Nulsen, and Benjamin Kaufman

✓ Hydrocephalic dogs treated with intraventricular radioactive colloidal gold showed a sustained decrease in cerebrospinal fluid flow and intraventricular pressure associated with a reversal of progressive hydrocephalus. Gamma scanning and isotopic sampling, however, indicated a more diffuse distribution of the isotope than previously thought, although pathological changes up to 7 weeks post-instillation of the radioactive colloid appeared confined to the choroid plexus.