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Felix Umansky, Thalia Kaspi and Mordechai N. Shalit

✓ Subarachnoid hemorrhage (SAH) was induced in 13 adult mongrel cats by a slow injection of fresh autogenous blood into the cisterna magna. Serial determinations of regional cerebral blood flow (rCBF) in the cortex and deep-seated areas (internal capsule, thalamus, and caudate nucleus) were made during the following 2 hours, while intracranial pressure (ICP) was maintained at normal values. A decrease in rCBF was observed in all the areas examined. This reduction followed a characteristic triphasic pattern with an initial steep decline immediately after the SAH. The clinical implications of these findings are discussed.

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Avigdor Zelikovski, Gidon Zucker, Avinoam Eliashiv, Raphael Reiss and Mordechai Shalit

✓ A new sequential pneumatic instrument for the prevention of deep vein thrombosis (DVT), the Lympha Press, was investigated in neurosurgical patients. In the control group, 50% of patients developed DVT and in the treated group only 4.3% were affected. These results demonstrate the highly beneficial effect of this method of preventing DVT during and after surgery, especially when the use of other preventive methods is precluded.

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Intracranial pressure monitoring after elective intracranial surgery

A retrospective study of 514 consecutive patients

Shlomi Constantini, Shamay Cotev, Z. Harry Rappaport, Shlomo Pomeranz and Mordechai N. Shalit

✓ A retrospective study of 514 consecutive patients whose intracranial pressure (ICP) was monitored after elective supratentorial or infratentorial surgery is reported. Of the 412 patients operated on in the supratentorial region, 76 (18.4%) had a postoperative sustained ICP elevation exceeding 20 torr. Abnormally high ICP occurred after 13 (12.7%) of the 102 infratentorial operations. Risk factors for postoperative ICP elevation were: resection of glioblastoma in 27.2% of cases, repeat surgery in 42.9% of cases, and protracted surgery (> 6 hours) in 41.7% of cases. Of the 89 patients with elevated ICP, 47 (52.8%) had an associated clinical deterioration. In 19 of these, the rise in ICP occurred before this deterioration was noticed, leading as a rule to quick diagnostic and management response. In eight patients clinical deterioration was noticed before the rise in ICP, and in 20 it happened simultaneously. The higher the level of ICP elevation, the greater were the chances of associated deterioration.

The most common findings on computerized tomography scanning in 35 of the 89 patients with elevated ICP were brain edema (19 cases) and bleeding in the tumor bed (15 cases). Mannitol, thiopental, additional hyperventilation, and reintubation (in patients who were previously extubated) were used to reduce ICP, in addition to surgical decompression whenever indicated. Thirteen patients with raised ICP and clinical deterioration underwent reoperation.

The postoperative infection rate was 1.2% (six cases). In only one patient could infection be attributed to ICP monitoring. It was concluded that ICP monitoring is advantageous in the immediate postoperative management after elective intracranial surgery and is almost risk-free. It should therefore be used liberally, especially when risk factors for ICP elevation can be identified prior to the end of surgery.

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Uriel Wald, Pavel J. Levy, Zvi H. Rappaport, Shalom D. Michowitz, Lucia Schuger and Mordechai N. Shalit

✓ Gangliogliomas are rare tumors, primarily seen in patients under the age of 30 years. They occur least commonly in the spinal cord. This report presents a 2½-year-old boy who harbored an intramedullary conus tumor with the light microscopic appearance of a ganglioglioma. The neurobiological behavior of this tumor is yet to be determined.

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Abraham B. Rubinstein, Mordechai N. Shalit, Mathias L. Cohen, Uri Zandbank and Eli Reichenthal

✓ The authors retrospectively analyzed the clinical and histopathological findings in 201 patients with intracranial meningiomas operated on in the period 1978 to 1982. Forty-three of the patients (21.4%) had at some previous time received radiation treatment to their scalp, the majority for tinea capitis. The findings in these 43 irradiated patients were compared with those in the 158 non-irradiated patients. Several distinctive clinical and histological features were identified in the irradiated group, which suggest that radiation-induced meningiomas can be defined as a separate nosological subgroup.

The use of irradiation in large numbers of children with tinea capitis in the era prior to the availability of griseofulvin may be responsible for a significantly increased incidence of intracranial meningiomas.

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Eli Reichenthal, Mathias L. Cohen, Elias Schujman, Nachman Eynan and Mordechai Shalit

✓ A case of tuberculous brain abscess in a 52-year-old woman is presented. The computerized tomographic (CT) scan demonstrated a multilocular space-occupying lesion in the right parietal area, surrounded by a thick hyperdense enhancing rim. It is suggested that a relatively long clinical history together with the appearance of a thick-walled abscess-like lesion on the CT scan may indicate the diagnosis of a tuberculous brain abscess.

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Eli Reichenthal, Mathias L. Cohen, Riri Manor, Gideon Marshak, Shoshana Matz and Mordechai N. Shalit

✓ A case of primary osteogenic sarcoma of the sellar and parasellar region is described. A biopsy performed through the transnasal transsphenoidal approach appears to be the best method of establishing the diagnosis in lesions in this location. A previous case, documented in the German literature, is discussed together with the case presented here.