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  • By Author: Sonntag, Volker K. H. x
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correlation it is difficult to substantiate the presence of an arteritis. The authors are to be commended for their awareness of potential hazards of EACA therapy. The clinical effectiveness of EACA for subarachnoid hemorrhage secondary to ruptured aneurysm is certainly still controversial. However, it does not seem justifiable to implicate EACA in these cases on the basis of the circumstantial evidence presented in this article. Neurosurgical Forum: Letters to the Editor Response Volker K. H. Sonntag , M.D. Bennet M

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Volker K. H. Sonntag and Bennett M. Stein

arteriogram 7 days after the start of EACA therapy revealed the aneurysms, spasm, and alternate dilatation and narrowing of the cerebral arteries ( Fig. 3 upper right ). During the next 2 days the patient deteriorated further, and consequently a shunt was installed for hydrocephalus and the EACA stopped. The patient's status slowly improved so that 4 weeks after her first subarachnoid hemorrhage and 1½ weeks after the EACA had been stopped she was fully oriented without neurological deficit. Repeat arteriography demonstrated the aneurysms but no other vascular changes

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Mark N. Hadley, Curtis A. Dickman, Carol M. Browner and Volker K. H. Sonntag

T reatment of C-2 vertebral (axis) fractures has evolved over the last 10 years. 2, 4, 9, 11–13, 17, 23, 25, 29 New fracture types have been identified, and nonodontoid, nonhangman's C-2 fractures have been classified. 14, 15, 17, 28, 29 Treatment of the most common type of axis fractures, odontoid Type II fractures, remains controversial. Investigators have attempted to identify specific patient or fracture features that might guide appropriate therapy. 4, 9, 11–13, 17 The degree of dens dislocation has been cited as the single most important factor that

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Conrad T. E. Pappas, Peter C. Johnson and Volker K. H. Sonntag

-microglioma group of brain tumours: a consideration of their clinical features and therapy. Brain 95 : 199 – 212 , 1972 Schaumburg HH, Plank CR, Adams RD: The reticulum cell sarcoma-microglioma group of brain tumours: a consideration of their clinical features and therapy. Brain 95: 199–212, 1972 18. Silberman S , Fresco R , Steinecker PH : Signet ring cell lymphoma. A report of a case and review of the literature. Am J Clin Pathol 81 : 358 – 363 , 1984 Silberman S, Fresco R, Steinecker PH: Signet ring cell

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Stephen M. Papadopoulos, Curtis A. Dickman and Volker K. H. Sonntag

without myelopathic deficits is still controversial. Patients with severe rheumatoid arthritis often have complex multisystem medical problems associated with the disease process, in addition to complicating side effects related to drug therapies. The operative mortality rate associated with cervical spine stabilization procedures ranges from approximately 5% to 15% 3, 4, 11, 24, 25, 31 The failure rate for atlantoaxial (C1–2) fusion may reach as high as 50%. 12 Nonetheless, many authors believe that “prophylactic” C1–2 fusion should be performed in select patients

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Paul W. Detwiler, Frederick F. Marciano, Randall W. Porter and Volker K. H. Sonntag

Although the efficacy of posterior decompression for symptomatic lumbar stenosis that is recalcitrant to conservative therapy is well proven, uniform agreement on the need for simultaneous arthrodesis is lacking. The variability in the rate of lumbar fusion with and without instrumentation has been attributed to a number of factors: advances in surgical technique; rapid development of instrumentation; radiographic advances in the diagnosis of disease entities of the lumbar spine; evolution in our understanding of bone healing; improved pre- and postoperative care; aggressive rehabilitation; patient compensation; hospital and surgeon reimbursement; better education of residents, fellows, and practicing neurosurgeons; and, most important, the lack of clear indications based on defined diagnostic categories. Based on review of the literature and their experience at the Barrow Neurological Institute, the authors have attempted to define indications for lumbar fusion with or without instrumentation based on defined diagnostic categories. Clear indications for fusion include trauma, tumor, or infection with two- or three-column injury, iatrogenic instability, and isthmic spondylolisthesis. Relative indications for fusion include degenerative spondylolisthesis, radiographically proven dynamic instability with pain or neurological findings, adult scoliosis, and mechanical back pain. Fusion is rarely indicated with discectomy, abnormal radiographs without appropriate findings (such as degenerative disc disease), facet joint syndrome, failed back surgery, or stable spinal stenosis.

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Curtis A. Dickman, Mark N. Hadley, Carol Browner and Volker K. H. Sonntag

three patients (12%) had 7 mm or greater displacement of the lateral masses. Fig. 3. Open-mouth radiograph (left) and computerized tomography scan (right) showing undisplaced fractures of the lateral masses of C-1 and C-2 (arrow) . The treatment of patients with combination C1–2 fractures, in general, was determined by the type of C-2 fracture present. The treatment modalities employed in the 25 patients in this series are presented in Table 3 . Nonoperative therapy was the initial treatment in 84% of patients. This consisted of halo vest

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Dean Chou, Roger Hartl and Volker K. H. Sonntag

10° of kyphosis. Treatment and Follow Up. Despite the patient’s bowel and bladder abnormalities, he wished to pursue conservative therapy. Thus, a thoracolumbar orthosis was applied and he was discharged home. His bowel and bladder dysfunction persisted for 4 months after his initial injury and then returned to normal. At all times, his sexual function was normal. At his 6-month follow-up examination, the patient had normal bowel and bladder function, and his lower-extremity strength and sensation were intact. Discussion Classically, a pure conus

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beam irradiation is even more limited and its role as an adjunctive or alternative form of therapy is unclear, although it has been employed with some success in cases of inaccessible intracerebral cavernous angiomas. 1, 2 It is possible that the widespread use of magnetic resonance imaging will help broaden our clinical experience with this rare condition and allow us to make more informed therapeutic decisions. References 1. Padovani R , Tognetti F , Proietti D , et al : Extrathecal cavernous hemangioma. Surg Neurol 18

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Suprascapular nerve entrapment

A summary of seven cases

Mark N. Hadley, Volker K. H. Sonntag and Hal W. Pittman

and symptoms. Considering the length of the nerve and its propensity to sustain injury from trauma to the shoulder, it is surprising that this syndrome manifests itself so infrequently. Increased awareness by the physician of its clinical presentation, diagnostic characteristics, and treatment may lead to more frequent correct diagnoses, earlier therapy, and reduced patient morbidity. The most common cause of suprascapular nerve entrapment is trauma to the shoulder, usually direct trauma with injury to the nerve and/or damage to the transverse scapular ligament or