✓ Therapy of cervical spine fractures is reviewed from the time of the Egyptians (4000 B.C.) to the present day. Immobilization has been practiced for slightly more than a century; devices for exerting traction upon the skull have been in use for 37 years. The Renaissance surgeon, Fabricus Hildanus, designed a tool for exerting traction upon the cervical vertebrae, but this method did not become popular. Until the 20th century, few physicians considered the therapy of this common injury.
John D. Loeser
✓ A retrospective study of 45 patients who had dorsal rhizotomies for relief of chronic pain is reported. The overall long-term success rate was 28% although initial results were much more favorable. The long-term results were correlated with a variety of preoperative and operative factors. Sex, age, history of narcotic use, compensation, number of roots cut, duration of pain, level of roots cut, effect of nerve blocks, or prior surgery for pain did not seem to influence the long-term results. The presence of arachnoiditis or pain subsequent to disc disease was associated with poorer results. Pain secondary to a malignancy responded better to this operation. The potential causes of operative failure are discussed.
Kenneth R. Peirce and John D. Loeser
✓ The authors report a case in which the cut end of a Raimondi peritoneal catheter apparently caused intestinal perforation and contamination of the shunt system. The authors advise that if this type of catheter is to be divided the cut should be distal to the end of the sharp wire contained in it, which otherwise will protrude.
Eldon L. Foltz and John D. Loeser
✓ The authors review the embryopathology and clinical manifestations of craniosynostosis and analyze a series of 27 children. The operative procedure of linear craniectomy and immediate cranioplasty is described and evaluated. Since few children with craniosynostosis have neurological deficits that can be ascribed to the skull anomalies, surgery to prevent neurological complications is only rarely justified. However, it is often possible to ameliorate the cosmetic deformity in many of these patients if operative intervention is undertaken in early infancy.
Robert C. Leaver and John D. Loeser
✓ High velocity wounds of the brain have been associated with the development of Lhermitte's phenomenon in 26 of 56 consecutive cases from Vietnam studied from 1 month to 1 year after injury. No antecedent factors could be identified. Civilian trauma and elective neurosurgical procedures have not, to our knowledge, been reported to cause this sign. Subarachnoid or subdural adhesions are suggested as the cause of Lhermitte's phenomenon in these patients.
John D. Loeser and Richard J. Lewin
Randall W. Smith and John D. Loeser
✓ A variant of lumbar arachnoiditis is described in patients undergoing rhizotomy for intractable radicular pain following multiple lumbar epidural operative procedures. The peculiar adhesions of the arachnoid, nerve roots, and dura are described and pictured. The slight myelographic abnormality seen in the presence of this kind of arachnoiditis, namely, lack of root sleeve visualization, is correlated with the gross operative findings and contrasted with the commonly recognized myelographic picture of lumbar arachnoiditis. Diagnostic and therapeutic implications are discussed.
Case report and review of the literature
Gavin W. Britz, D. Kyle Kim and John D. Loeser
✓ Diffuse villous hyperplasia of the choroid plexus, which is distinct from bilateral choroid plexus papillomas, is extremely rare and is often associated with hydrocephalus due to the overproduction of cerebrospinal fluid (CSF). The authors describe an infant with hydrocephalus, diagnosed by computerized tomography scanning, who developed ascites following placement of a ventriculoperitoneal shunt and, subsequently, demonstrated excessive CSF production when the shunt was externalized. The patient was later successfully treated by placement of a ventriculoatrial shunt. Magnetic resonance imaging demonstrated diffuse villous hyperplasia of the choroid plexus as the cause of the patient's hydrocephalus. The literature on diffuse villous hyperplasia of the choroid plexus is reviewed.
Kim J. Burchiel, Hadley Clarke, Michael Haglund and John D. Loeser
✓ Forty patients were followed for an average period of 8½ years after 44 consecutive suboccipital craniotomies for trigeminal neuralgia. Among these patients, 36 had microvascular decompression (MVD) of the nerve, four had repeat trigeminal rhizotomy after MVD was not successful in controlling their pain, and four had primary trigeminal rhizotomies. Of the 36 patients undergoing MVD, 17 (47%) experienced recurrent postoperative neuralgic pain: in 11 (31%) pain recurrence was major, and in six (17%) it was minor. Among the eight patients undergoing rhizotomy, four (50%) had major pain recurrences and one (13%) had a minor recurrence, for a 63% total recurrence rate. There was a strong statistical relationship between an operative finding of arterial cross-compression of the nerve and long-term complete pain relief. Patients with other compressive pathology (related to veins or bone structures) did not on the average fare as well. Despite this, there appeared to be no point in time in the postoperative interval when the patient could be considered “cured.” Major recurrences averaged 3.5% annually, and minor recurrences averaged 1.5% annually. The implications of these findings for the treatment of trigeminal neuralgia and the current understanding of the mechanism of MVD for this disorder are discussed.
John D. Loeser, H. Lee Kilburn and Tim Jolley
✓ The authors describe three cases of neonatal depressed skull fracture subsequent to difficult delivery, treated without surgical elevation. None of the patients developed neurological deficits, cosmetic deformity or electroencephalographic signs of epileptiform activity. Neonatal depressed skull fractures not associated with focal neurological signs may not require surgical therapy; we are not certain what the absolute criteria for operation should be.