John C. Liu, Joseph D. Ciacci and Timothy M. George
✓ Treatment of the Dandy—Walker syndrome has included placement of a ventriculoperitoneal shunt alone or in combination with a posterior fossa cystoperitoneal shunt. Complications in shunting are common and are usually related to malfunction or infection. The authors present a case in which the patient developed headaches and focal cranial nerve deficits following infection caused by a cystoperitoneal shunt. Magnetic resonance imaging showed tethering of the brainstem. A posterior fossa craniotomy with microsurgical untethering and cyst fenestration achieved two goals: improvement of the focal cranial nerve deficits and elimination of the cystoperitoneal shunt.
Joseph H. Piatt Jr.
Report of four cases
Joseph L. Koen, Roger E. McLendon and Timothy M. George
✓ Intradural spinal teratoma is a rare tumor that can be associated with dysraphic defects. Although the origin of these tumors is traditionally thought to be secondary to primordial germ cells misplaced early in embryogenesis, the pathogenesis of intraspinal teratoma remains unclear. The authors present a series of patients in whom an intradural teratoma arose at the same site as a developmental spinal cord abnormality, including a split cord malformation, myelomeningocele, and lipomyelomeningocele. It is postulated that these lesions were the result of a dysembryogenic mechanism and were not neoplastic.
Shokei Yamada, George T. Mandybur and Joseph R. Thompson
✓ There have been sporadic reports on tail proboscis, a vestigial appendage, as part of sacrococcygeal dysraphism. The case the authors present, different from the tail proboscis, is the first report linking a proboscis containing a hemilipomyelomeningocele with tethered cord syndrome, associated with diastematomyelia. Tethering was caused by the diastematomyelia that anchored the split spinal cord. The authors emphasize the importance of prompt diagnostic and therapeutic measures for treatment of this condition.
Ajax E. George, Joseph P. Lin and Robert A. Morantz
✓ The angiographic demonstration of a rare case of persistent trigeminal artery aneurysm is reported. The incidence of persistent trigeminal artery in the authors' series is 0.6%. Approximately 14% of patients with a persistent trigeminal artery also have an intracranial aneurysm. The embryology involved and related cases are reviewed.
An Autopsy Report
Richard A. Olafson, Joseph G. Rushton and George P. Sayre
George T. Tindall, Annabelle Craddock and Joseph C. Greenfield Jr.
Roland N. Auer, George P. A. Rice, George G. Hinton, A. Loren Amacher and Joseph J. Gilbert
✓ Juvenile cerebellar astrocytoma characteristically has a very benign course and good prognosis. A case is reported of juvenile cerebellar astrocytoma with massive craniospinal leptomeningeal spread prior to surgical intervention. The patient died 8 months after the onset of symptoms and only 5 weeks after presentation to the hospital. At postmortem examination, it was found that tumor encased the brain and spinal cord. The histology was benign. The literature on cerebellar astrocytoma is reviewed.
Joseph H. Goodman, W. George Bingham Jr. and William E. Hunt
✓ Endothelial changes leading to edema formation are examined in the primate spinal cord (Macaca mulatta) following a lesion created by a 20-gm weight falling 15 cm onto the exposed dura. Intravascular perfusion of a paraformaldehyde-glutaraldehyde solution followed by carbon black provides adequate fixation of vascular structures and glial elements. Myelin is poorly preserved. Ultrastructural alterations of the blood-brain barrier consist of loss of integrity of the endothelial tight junctions. Edema caused by vascular disruption and parenchymatous extravasation of intravascular contents is observed along with glial swelling. Interglial gap junctions persist in areas of marked cellular separation and do not impede the migration of edema fluid.