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Subdural tension pneumocephalos

Report of two cases

L. Dade Lunsford, Joseph C. Maroon, Peter E. Sheptak, and Maurice S. Albin

✓ Two patients developed subdural tension pneumocephalus after undergoing posterior fossa surgery performed in the sitting position. The mechanism for entry of air into the intracranial compartment is analogous to the entry of air into an inverted soda-pop bottle. As the fluid pours out, air bubbles to the top of the container. We have thus referred to this as the “inverted pop-bottle syndrome.” Computerized tomography provided prompt diagnosis and confirmed brain displacement. Twist-drill aspiration of the air resulted in improvement in both patients, although one patient subsequently died from an intracerebellar hemorrhage. Tension pneumocephalus appears to be another potential complication of posterior fossa surgery in the sitting position. This condition is easily diagnosed and treated, and should be considered whenever a patient fails to recover as expected following posterior fossa surgery.

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Javier Verdura, Robert J. White, and Maurice S. Albin

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Etiology and definitive microsurgical treatment of hemifacial spasm

Operative techniques and results in 47 patients

Peter J. Jannetta, Munir Abbasy, Joseph C. Maroon, Francisco M. Ramos, and Maurice S. Albin

✓ The clinical and operative findings are reviewed in 47 patients with intractable hemifacial spasm. The syndrome was classical in its features in 45 patients and atypical in two. Mechanical compression distortion of the root exit zone of the facial nerve was noted in all 47 patients. In 46 the abnormality was vascular cross-compression, usually by an arterial loop. In one patient, a small cholesteatoma was discovered and removed. Morbidity and postoperative results are discussed.

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Robert J. White, Maurice S. Albin, Javier Verdura, and George E. Locke

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Maurice S. Albin, Robert J. White, Gaston Acosta-Rua, and David Yashon

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Robert J. White, J. George Dakters, David Yashon, and Maurice S. Albin

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Maurice S. Albin, Anthony N. D'Agostino, Robert J. White, and John H. Grindlay

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Julian S. Chestnut, Maurice S. Albin, Evelyn Gonzalez-Abola, Philippa Newfield, and Joseph C. Maroon

✓ Moment-to-moment control of blood pressure is important in the management of the neurosurgical patient. The ideal agent to control blood pressure or induce hypotension should be non-toxic, maintain cerebrovascular autoregulation, and not alter cardiac output or change intracranial pressure. Intravenous nitroglycerin has been used to control blood pressure in 54 neurosurgical cases. This agent produces a rapid, controllable, but not precipitous fall in blood pressure without rebound, is non-toxic, may not alter cerebrovascular autoregulation, and does not raise intracranial pressure. Our clinical experience with intravenous nitroglycerin indicates that it has an important role as a hypotensive agent for the neurosurgical patient.