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John F. Alksne

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John F. Alksne and Randall W. Smith

✓ The authors review 22 consecutive cases of anterior communicating artery aneurysms treated by stereotaxic iron-acrylic occlusion. There was no mortality and no rebleeding in this series. The morbidity was low, and 16 of the 22 patients have returned to work. The patients whose aneurysms could be treated transsphenoidally enjoyed the best outcome.

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John F. Alksne and Randall W. Smith

✓ A new iron-acrylic compound has been developed for stereotaxic thrombosis of intracranial aneurysms. The compound polymerizes rapidly, does not fragment, and is nontoxic. It has been used in a series of experimental animals and in initial clinical cases with good results. The use of this material simplifies and increases the safety of stereotaxic aneurysm treatment.

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Randall W. Smith and John F. Alksne

✓ Some intracranial aneurysms that might be considered inoperable by open craniotomy are readily treatable by stereotaxic thrombosis. This is possible because the stereotaxic technique requires only that some point on the fundus of the aneurysm can be punctured with a needle. Illustrative cases are given describing the successful treatment of aneurysms arising at the origin of the ophthalmic artery, within the cavernous sinus, within the sella turcica, and from the vertebrobasilar and the posterior inferior cerebellar arteries ventral to the brain stem. The aneurysms within the sella or cavernous sinus can be approached through the sphenoid sinus, and the aneurysms ventral to the brain stem can be approached through the clivus without opening the dura.

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John F. Alksne and Jerry H. Greenhoot

✓ The authors report a new experimental model for the study of delayed intracranial arterial spasm in monkeys. The injection of norepinephrine into the prepontine cistern produces an intense immediate vasospasm that disappears in minutes and is followed by a second stage of vasospasm that persists for 8 to 10 days. Electronmicroscopic examinations of the basilar artery removed during the second stage of this spasm reveal myonecrosis of the media, with fragmentation of myofibrils, dissolution of the sarcolemma, and interstitial edema.

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John F. Alksne and Ethel T. Lovings

✓ The electron microscope examination of arachnoid villi from dogs after the subarachnoid injection of blood reveals that erythrocytes accumulate and degenerate in the villi. A continuous layer of endothelium separates the villus from the lumen of the sagittal sinus. No evidence for pores through the endothelium or for the passage of intact erythrocytes from CSF to blood through arachnoid villi has been found.

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David Barba and John F. Alksne

✓ Clinical records and patient interviews in 37 cases of trigeminal neuralgia treated by microvascular decompression by a single surgeon were studied retrospectively. Outcomes were determined with an average follow-up period of 43 months. Abnormalities in the region of the trigeminal nerve were identified in each case. Patients undergoing microvascular decompression as a primary procedure were cured (total pain relief without further therapy) at a rate of 91%, versus 43% in patients treated with destructive procedures (rhizotomies) prior to microvascular decompression (p < 0.005). Analysis also suggests that trigeminal neuralgia of greater than 9 years' duration was cured at a rate of only 42%, versus 88% in cases of less lengthy duration (p < 0.005). Sex and age at time of surgery were not significant predictors of outcome. There were no deaths in this group of patients aged from 32 to 90 years. A horizontal surgical approach is described.

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Charles J. Wrobel and John F. Alksne

✓ A method is described that simplifies placement of an Ommaya reservoir for chronic access to the basilar cisterns. This technique is useful in treating coccidioidomycosis and other fungal meningitides.

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Randall W. Smith and John F. Alksne

✓ The use of external ventriculostomy at our institution has been retrospectively analyzed to determine the incidence of cerebrospinal fluid sepsis. Placement of 65 ventriculostomies over a 2-year period resulted in three cases of complicating meningitis and ventriculitis (4.5%). Duration of ventriculostomy placement did not seem related to the rate of infection but the method of placement, the prophylactic antibiotics used, and the monitoring and collecting system employed may be important.