Eben Alexander Jr., S. M. Wigser and Courtland H. Davis
Harold P. Smith, Venkata R. Challa and Eben Alexander Jr.
✓ Cervical spine involvement by rheumatoid arthritis is common; brain-stem compression secondary to vertical subluxation of the odontoid in patients with rheumatoid arthritis is rare. Vertical subluxation results from 1) destruction of the transverse atlantal, apical, and alar ligaments of the atlas and odontoid, and 2) bone resorption in the occipital condyles, lateral masses of the atlas, and basilar processes of the skull. Neurological symptoms result from direct compression of the brain stem or from ischemia secondary to compression of vertebral arteries, anterior spinal arteries, or small perforating arteries of the brain stem and spinal cord. A case is reported in which a slowly progressive neurological deficit developed in a woman with rheumatoid arthritis following a fall from a stretcher. Neurological symptoms represented direct compression of the medulla by the dens, a mechanism confirmed at operation and autopsy.
Recognition of progressive neurological deficit is often difficult in patients with rheumatoid arthritis because of their inactivity and their atrophic and immobile joints, but is essential if appropriate decompressive or stabilizing procedures are to be done. In patients with vertical subluxation of the dens, the transoral approach with removal of the odontoid is recommended. Decompression should be extensive, including the fibrous capsule around the odontoid and overlying synovial tissue as well as the odontoid itself.
James B. Campbell and Eben Alexander Jr.
Keasley Welch, Frank Turnbull and Eben Alexander Jr.
✓ Three authors, who were all individual contributors to the first volume of the Journal of Neurosurgery, share some thoughts and remembrances of their original published articles. They also speak to the history of the Journal and its relationship to the growth of neurosurgery.
The Value of Early Fusion of C1, C2, and C3
Eben Alexander Jr., H. F. Forsyth, C. H. Davis Jr. and Blaine S. Nashold Jr.
David L. Kelly Jr., Eben Alexander Jr., Courtland H. Davis Jr. and Jack M. Smith
✓ An operative technique using methyl methacrylate (acrylic) and wiring for the treatment of atlanto-axial dislocations is described. Long-term evaluation of a series of patients indicates that this is a safe and effective method of obtaining cervical fixation.
Modern diagnosis and treatment
Jack Kushner, Eben Alexander Jr., Courtland H. Davis Jr., David L. Kelly Jr. and Annetta Horwitz Kushner
✓ This article discusses the nature and treatment of Crouzon's disease and reproduces a translation of part of Crouzon's original description. Six typical patients with this disease are presented, and the reasons for surgical treatment emphasized.
Christopher W. Norwood, Eben Alexander Jr., Courtland H. Davis Jr. and David L. Kelly Jr.
✓ Six cases of craniosynostosis are reported in which recurrent and multiple closure of cranial sutures occurred after craniectomy and insertion of polyethylene film. In all patients there was closure of a second and sometimes a third suture as well as reclosure of the treated suture. In four children the second operations were done before the age of 18 months; none had increased intracranial pressure preoperatively and three who are living have normal intelligence. In two children, the second operations were not done until after the age of 3 years; both had increased intracranial pressure preoperatively, and both are now mentally retarded.
Kenneth R. L. Lassiter, Eben Alexander Jr., Courtland H. Davis Jr. and David L. Kelly Jr.
✓ A long-term study has been made of a consecutive series of 37 patients with brain stem gliomas, 22 of whom were children and 15 adults. Surgical exploration was carried out in 34 of the 37 cases and only very rarely was a diagnosis made on clinical grounds or air study alone. In 10 cases a histological diagnosis was made at operation. In five patients a significantly large neoplastic cyst was found and evacuated, and four of these have had long-term useful survivals. There were nine postoperative deaths, most of them in the pre-Decadron era; 17 cases died during follow-up, with a mean survival of 33 months; and eight patients are living, with a mean survival of 3 months to 9 years. A plea is made for surgical exploration of these lesions in the hope of finding a surgically approachable cyst, and for the use of radiation therapy at a later time.