✓ With the announcement that Harvey Cushing is to be honored by a United States postage stamp in the Great American stamp series, the qualities that this remarkable man possessed are reviewed — artist, author, bibliophile, scientist, soldier, physician, and teacher. The events that led to Cushing becoming a neurosurgeon are summarized. The recognition by the United States Postal Service of physicians and others who have appeared on stamps that had some relationship to Cushing's activities is discussed. Based on the tradition of Harvey Cushing, eight guidelines are presented.
Robert G. Ojemann
Robert G. Ojemann
Christopher S. Ogilvy and Robert G. Ojemann
✓ A safe technique is described for performing a lateral posterior fossa craniotomy to gain access to the cerebellopontine angle. The method makes use of currently available high-speed air drills. Thus, it is possible to replace the removed bone at the conclusion of the procedure and to re-establish normal tissue planes while providing rigid protection to the posterior fossa.
A pathological case report
C. Miller Fisher and Robert G. Ojemann
✓ In a case of subarachnoid hemorrhage, the arteries of the circle of Willis were left undisturbed and undissected at postmortem examination. A block of frontal lobe tissue with the attached vessels was serially sectioned disclosing in its entirety a saccular aneurysm that had ruptured at the base rather than the dome. The histology of the hemostatic process was clearly depicted.
Robert G. Ojemann, Saul Aronow and William H. Sweet
Report of a Case with Recovery
Robert G. Ojemann and Paul F. J. New
Report of three cases
Eric L. Zager, Robert G. Ojemann and Charles E. Poletti
✓ Three unusual cases are reported in which communicating syringomyelia presented acutely. The first patient presented with paraplegia, the second with acute respiratory distress secondary to bilateral vocal cord paralysis, and the third with symptoms of acute brain-stem ischemia. Each patient had a communicating spinal cord syrinx associated with a posterior fossa and foramen magnum region anomaly (a huge posterior fossa arachnoid cyst in one and Chiari malformations in two). The mechanisms of craniospinal pressure dissociation and hindbrain herniation are discussed, along with other reported emergency presentations of syringomyelia.
Robert G. Ojemann, Robert A. Levine, William M. Montgomery and Patricia McGaffigan
✓ Twenty-two patients with unilateral acoustic neuromas and preoperative speech discrimination scores of 35% or more had intraoperative monitoring of the electrocochleogram (ECoG) using a transtympanic electrode, and of the brain-stem auditory evoked potentials (BAEP's) using scalp electrodes. Rapid feedback was provided about the status of the cochlear microphonics from the hair cells of the inner ear (CM of the ECoG), the compound action potential of the auditory nerve (N-1 of the ECoG or Wave I of the BAEP's) and the potentials from the lower brain stem (Wave V of the BAEP's). All patients had total removal of the tumor. In 21, the cochlear nerve was anatomically preserved, and 20 had good postoperative facial nerve function. Correlation of tumor size with postoperative hearing was as follows: discrimination scores of more than 35% in three of four patients with 1-cm tumors, two of eight with 1.5-cm tumors, two of six with 2- to 2.5-cm tumors, and one of four with tumors of 3 cm or more. Two other patients with 1.5-cm tumors had discrimination scores of less than 35%, and one patient with a 2-cm tumor had only sound perception. In two patients, the discrimination scores improved. At the end of the operation, all patients with hearing had a detectable N-1, and, when recorded, CM. All but one patient with no hearing had lost N-1, and CM was absent or reduced. Unless Wave V was unchanged, it was a poor predictor of postoperative hearing, and its absence did not preclude preservation of good hearing.
The electrophysiological changes during each stage of the operation were analyzed and correlated with events during surgery. Areas in which there was an increased risk of loss of the potentials were determined. In some patients monitoring was unnecessary, because either there were no significant changes or the changes were abrupt and no recovery occurred. However, in other patients, monitoring alerted the surgeon to a possible problem and the method of dissection was altered. Possible mechanisms of hearing loss were suggested from the changes in the recordings.