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Subdural tension pneumocephalos

Report of two cases

L. Dade Lunsford, Joseph C. Maroon, Peter E. Sheptak and Maurice S. Albin

pneumocephalus. Neurological improvement followed prompt twist-drill aspiration of air from the subdural space. Case Reports Case 1 This 69-year-old right-handed woman was admitted for treatment of debilitating glossopharyngeal neuralgia. Past history disclosed evidence of chronic obstructive lung disease and healed peptic ulcer disease. She had previously undergone cholecystectomy and excision of a lymphoid cyst at the base of the left epiglottis. Blood pressure and general physical examination were normal. The neurological examination revealed a rapid, fine tremor

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Anterior surgery for cervical disc disease

Part 1: Treatment of lateral cervical disc herniation in 253 cases

L. Dade Lunsford, David J. Bissonette, Peter J. Jannetta, Peter E. Sheptak and David S. Zorub

syndromes to anatomical etiologies. To determine the value of anterior cervical disc surgery, five questions must be considered: 1) Are the results of surgery related to the type of disc extrusion, that is, acute soft disc or chronic hard herniation? 2) Are the results of surgery different when discectomy and fusion or discectomy alone is performed? 3) Among patients with spinal fusion, are results different between cases treated with interbody dowel grafts (Cloward technique), or wedge grafts (Smith-Robinson technique)? 4) Are results related to the number of cervical

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Ian F. Pollack, L. Dade Lunsford, Thomas L. Slamovits, Lewis W. Gumerman, Geoffrey Levine and Alan G. Robinson

appparatus from chronic compression. In contrast to the dramatic decreases in cyst volume on serial radiographic studies and the generally favorable impact of treatment on visual function, changes in endocrine status were modest. This again may relate to irremediable damage to the hypothalamopituitary axis since radiographic evidence of mass effect was alleviated in all nine cases. Before treatment, five patients had absent anterior pituitary function; four showed no significant changes in replacement hormone requirements after surgery. One patient with absent anterior

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L. Dade Lunsford, Douglas Kondziolka, John C. Flickinger, David J. Bissonette, Charles A. Jungreis, Ann H. Maitz, Joseph A. Horton and Robert J. Coffey

basilar artery aneurysm. Multiple embolizations and treatment of three isocenters with radiosurgery using the 18-mm collimator (16 Gy at the 45% isodose) failed to prevent repeat hemorrhage. Chronic headaches were present in 104 patients before treatment. This symptom was adequately re-evaluated in 73 patients during follow-up examination: 56 patients (75%) had improvement, 14 had no change, and three were worse. Improvement in headache usually accompanied decreased flow identified on serial MR studies. Forty-three of the 70 patients with seizures before radiosurgery

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Douglas Kondziolka, Thomas Lemley, John R. W. Kestle, L. Dade Lunsford, Gerhard H. Fromm and Peter J. Jannetta

2. Hassenbusch SJ , Kunkel RS , Kosmorsky GS , et al : Trigeminal cisternal injection of glycerol for treatment of chronic intractable cluster headaches. Neurosurgery 29 : 504 – 508 , 1991 Hassenbusch SJ, Kunkel RS, Kosmorsky GS, et al: Trigeminal cisternal injection of glycerol for treatment of chronic intractable cluster headaches. Neurosurgery 29: 504–508, 1991 3. Jannetta PJ : Trigeminal neuralgia: treatment by microvascular decompression , in Wilkins RH , Rengachary SS (eds

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Douglas Kondziolka, L. Dade Lunsford and John R. W. Kestle

from a cavernous malformation was relatively low, hemorrhage prevention should not be an absolute indication for surgical resection. They also acknowledged that the risk of rebleeding after an initial hemorrhage was unknown. 1 Tung, et al. , 12 reported 13 patients with recurrent hemorrhages from cavernous malformations located in all brain regions. The median interval from first to second hemorrhage was 12 months. They noted that all surgical specimens showed histological evidence of chronic and recent hemorrhage. In many patients multiple microscopic

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Satoshi Maesawa, Douglas Kondziolka, C. Edward Dixon, Jeffrey Balzer, Wendy Fellows and L. Dade Lunsford

, et al : Kainic acid induced hippocampal seizures in rats: comparisons of acute and chronic seizures using intrahippocampal versus systemic injections. Ital J Neurol Sci 16 : 39 – 44 , 1995 Babb TL, Pereira-Leite J, Mathern GW, et al: Kainic acid induced hippocampal seizures in rats: comparisons of acute and chronic seizures using intrahippocampal versus systemic injections. Ital J Neurol Sci 16: 39–44, 1995 2. Barcia-Salorio JL , Barcia JA , Hernández G , et al : Radiosurgery of epilepsy. Long-term results. Acta Neurochir Suppl 62 : 111 – 113

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Melvin Field, Timothy F. Witham, John C. Flickinger, Douglas Kondziolka and L. Dade Lunsford

of hemorrhage (p = 0.9484). Effect of Hypertension In our series, 105 patients (21%) exhibited either intraoperative hypertension (systolic blood pressure > 150 mm Hg) or a history of chronic hypertension at the time of biopsy. Perioperatively, all patients were treated for systolic blood pressure that was greater than 150 mm Hg with oral or intravenous antihypertension medications. Postbiopsy CT scanning revealed acute hemorrhages in nine (8.57%) of the patients with hypertension, but only one of these patients had a hemorrhage larger than 10 mm in

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Jason P. Sheehan, Douglas Kondziolka, John Flickinger and L. Dade Lunsford

documented tumor regression, the other patient whose vision deteriorated 18 months after CT-based GKS had a new defect in the temporal field of his right eye 7 months posttreatment. This patient underwent repeated resection to decompress the optic apparatus. Although headaches were not the sole reason for GKS treatment, nine patients experienced headaches that were thought to be associated with their pituitary adenoma at the time of GKS, and three of the nine experienced subsequent improvement of headache. Following GKS, one patient had a worsening of her chronic

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L. Dade Lunsford, Ajay Niranjan, John C. Flickinger, Ann Maitz and Douglas Kondziolka

have no data to substantiate this allegation based on our experience in more than 800 patients. In our experience tinnitus is usually unchanged after GKS. In fact, tinnitus almost certainly represents a deafferentation phenomenon similar to chronic pain. We have noted a number of patients who are deaf after microsurgery who have residual tinnitus. There are very few cases of exacerbation of tinnitus in our patients, including those who have long-term preservation of hearing. No doubt a properly case-matched study in which the outcomes of microsurgery and