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The two-stage excision of huge acoustic neurinomas

Peter E. Sheptak and Peter J. Jannetta

✓ Total removal of huge acoustic neurinomas was carried out in 23 patients by means of a two-stage suboccipital transmeatal approach with microsurgical technique. There was no operative mortality. Good results were obtained in 18 (78%) of the patients who have returned to normal activities or full-time employment. Five patients (22%) have residual preoperative neurological deficits causing a reduced level of activity. All of these, except one, are able to care for themselves. None of the patients has had any further significant neurological deficit caused by the operative procedures. Anatomical integrity of the facial nerve was maintained in 17 patients (74%). Surgical technique, operative morbidity, and results are thoroughly discussed. The potential advantages of this technique are stressed.

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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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Anterior surgery for cervical disc disease

Part 1: Treatment of lateral cervical disc herniation in 253 cases

L. Dade Lunsford, David J. Bissonette, Peter J. Jannetta, Peter E. Sheptak, and David S. Zorub

✓ Between 1971 and 1977, 334 patients at the Presbyterian-University Hospital underwent anterior surgery for treatment of hard or soft cervical disc herniation. Of these patients, 295 had radicular symptoms only. This retrospective study details the results of anterior cervical surgery for treatment of lateral disc herniation in 253 patients who survived 1 to 7 years postoperatively. Sixty-seven percent had excellent or good results. Although 77% initially noted complete relief of symptoms after surgery, 38% subsequently developed one or more recurrent symptoms at some time during the follow-up period. The overall results of surgery for soft disc cases were no different from the results for hard discs, although significantly more hard disc cases required postoperative conservative treatment. The results of surgery after anterior fusion were no different than the results after anterior discectomy alone. However, overall postoperative complications were more frequent and hospitalizations were longer in the patients who underwent fusion. Patients with multiple-level surgery had statistically similar results to those with single-level surgery. None of the nine preoperative clinical features reported by others to influence the results of anterior cervical surgery were found to consistently affect outcome in the present series.