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Howard M. Eisenberg and Gregory Bergey

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Lumboperitoneal shunts

Review of 34 cases

Howard M. Eisenberg, Robin I. Davidson and John Shillito Jr.

✓ A series of 34 lumboperitoneal shunts performed at Children's Hospital Medical Center, Boston, for communicating hydrocephalus is reviewed. The ease of placement and revision of this shunt, the relatively benign complications that occurred, and the fact that 21 of these 34 patients are still using lumboperitoneal shunts with good control of the hydrocephalus have justified continuing use of this method as the initial bypass procedure in the treatment of communicating hydrocephalus.

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Howard M. Eisenberg, J. Gordon McComb and Antonio V. Lorenzo

✓ With the use of a ventricular perfusion technique, a cerebrospinal fluid formation rate of 1.4 ml/min was determined in a 5-month-old child with a choroid plexus papilloma and hydrocephalus. This rate was slightly greater than four times the rate observed in normal children. The clinical course, as well as a measured absorption rate, indicated that the patient's capacity for absorption was normal.

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Howard M. Eisenberg, James E. McLennan and Keasley Welch

✓ Cats were made hydrocephalic by cisternal instillation of kaolin. Three to 8 weeks later it was found by perfusion between the ventricular system and the spinal subarachnoid space that communication had been reestablished through a demonstrably dilated central canal of the spinal cord. Absorption of fluid from the ventricular system, measured both by ventriculospinal perfusion and, after ligation of the spinal cord, by perfusion between the lateral ventricles, was found to be indistinguishable from zero over a wide range of ventricular pressure.

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Howard M. Eisenberg, Charles Y. Liu and Oren Sagher

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Freddie L. Contreras, Massako Kadekaro and Howard M. Eisenberg

✓ Local cerebral glucose utilization was measured with the autoradiographic 2-deoxyglucose technique in rats injured by a focal parietal cortical freeze lesion then treated with hyperbaric oxygen (HBO). The cold lesion depressed glucose utilization in the contralateral as well as in the ipsilateral hemisphere. The largest decreases were observed in ipsilateral cortical areas. Treatment of lesioned animals with HBO at 2 atm for 90 minutes on each of 4 consecutive days tended to increase the overall cerebral glucose utilization measured 5 days after injury when compared to animals exposed to normobaric air. This improvement reached statistical significance in five of the 21 structures studied: the auditory cortex, medial geniculate body, superior olivary nucleus, and lateral geniculate body ipsilateral to the lesion, and the mammillary body. The data indicate that changes in lesioned rats exposed to HBO are not restricted to the period of time that the animals are in the hyperbaric chamber but are persistent.

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Howard M. Eisenberg, Mohammed Sarwar and Sydney Schochet Jr.

✓ A case of a symptomatic Rathke's cleft cyst in a 10-year-old boy is described. The importance of the intraoperative differentiation between this rare tumor and a craniopharyngioma is discussed.

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Patrick J. Kelly, Ralph J. Gorten, Robert G. Grossman and Howard M. Eisenberg

✓ In a retrospective study of 44 patients with verified ruptured intracranial aneurysms, the results of radionuclide cerebral perfusion scintigraphy (dynamic brain scanning) and the presence or absence of arteriographic spasm were correlated with the clinical outcome. The data indicated that patients with normal dynamic scans had a better outcome as a group and following intracranial surgery than those in whom perfusion was reduced. Patients with normal perfusion had a higher incidence of preoperative rebleeding from their aneurysms, while patients with reduced perfusion had a higher incidence of infarction, especially after intracranial surgery. There was no correlation between the presence or absence of arteriographic spasm and the results of the dynamic scans, and no correlation between the presence or absence of spasm and the outcome of the group as a whole. However, in some individual cases with severe spasm, reduced perfusion on the dynamic scan and a poor outcome were noted. It was concluded that the results of the dynamic scan correlated better with eventual patient outcome than the presence or absence of arteriographic spasm. It is therefore suggested that patients in Grades I and II with normal dynamic scans be operated on promptly to prevent rebleeding, and that surgery in patients in Grades I and II with abnormal dynamic scans be delayed until the dynamic scan returns to normal.