Richard L. Rapport II and J. Kiffin Penry
✓ This survey reports the current use of pharmacological prophylaxis for posttraumatic epilepsy by 1064 board-certified neurosurgeons. Sixty per cent use anticonvulsants preventively, but under a variety of conditions. The indications for therapy were usually either severe head trauma with penetration of the dura or profound evidence of cortical contusion. Few patients were treated for minimal blunt injuries. Thirty-four per cent of respondents were uncertain of the indications for prophylatic treatment. The drug regimens were based on individual experience in 90.7% of responses and were aimed principally at pretreatment of clinical phenomena rather than true prophylaxis of the epileptogenic process. Diphenylhydantoin, 300 mg/day, was the preventive treatment recommended by more than 50% of those reporting, but the duration of therapy varied widely.
Richard L. Rapport, David Hillier, Tim Scearce and Camari Ferguson
✓ Spontaneous intracranial hypotension (SIH) may result from occult leaks anywhere along the neuraxis. Although this syndrome has been recognized over the past 10 years in the neurology and radiology literature, the typical magnetic resonance (MR) imaging picture and clinical course are less well known to neurosurgeons. The authors describe the case of a patient with positional headache and MR imaging findings typical of SIH that resulted from an intradural disc herniation.
Richard L. Rapport II, Robert C. Dunn Jr. and Fareeda Alhady
✓ Eighteen cases of anterior encephalocele treated at the University of Malaya Hospital between 1970 and 1980 are discussed, and the literature concerning this defect is reviewed. A detailed analysis of the microscopic abnormalities present in the surgical specimens is included, along with the relevant radiographic and demographic data. Anterior encephalocele is more common in Southeast Asia than elsewhere. The possible ethnographic and geographic implications are presented, as well as a discussion of the relevant embryology, in attempting to define possible etiologies for this malformation. The authors' surgical approach to the repair of this defect and reasons for preferring a transcranial, intradural approach are described. Potential complications are enumerated.
Robert C. Dunn Jr., Carol A. Archer, Richard L. Rapport II and L. M. Looi
✓ A posterior fossa epidermoid cyst with high computerized tomographic attenuation is reported. The pathological and radiological features of this unusual case are presented.