✓ The problem of sickle cell disease and its complications is discussed. Subarachnoid hemorrhage is not a common complication of sickle cell disease and should be evaluated in the same way as if it were not associated with the disease. Patients with sickle cell trait have an added risk during angiography and hypotensive anesthesia. Guidelines are given for angiography and craniotomy with hypotensive anesthesia and reduction of brain volume in these patients.
Richard A. Close and William A. Buchheit
Tariq S. Siddiqi and William A. Buchheit
✓ A case is described in which a patient suffered severe radicular leg pain following myelography. At surgery, a nerve root was found to be herniated through the dural puncture site. The leg pain was relieved after the dura was opened and the nerve root repositioned. The possible mechanism of such an injury is discussed.
Seung H. Lee, Morris A. Osborn and William A. Buchheit
✓ A case is presented of a jugular foramen syndrome caused by an ectopic glioma. Treatment was by intracapsular removal through a suboccipital craniectomy.
Marc A. Flitter, William A. Buchheit, Frederick Murtagh and Marc S. Lapayowker
✓ A technique employing a Doppler ultrasound flowmeter in determining cerebrospinal fluid shunt patency is described. The technique has proven to be a valuable aid in the evaluation of the patient in whom shunt function is in question.
Robert H. Rosenwasser, Laurence I. Kleiner, Joseph P. Krzeminski and William A. Buchheit
✓ Direct therapeutic drainage and intracranial pressure monitoring from the posterior fossa has never been accepted in neurosurgical practice. Potential complications including cerebrospinal fluid leak, cranial nerve palsies, and brain-stem irritation have been a major deterrent. The authors placed a catheter for pressure monitoring in the posterior fossa of 20 patients in the course of posterior fossa surgery: 14 patients with acoustic schwannomas, four with posterior fossa meningiomas, one with cerebellar hemangioblastoma, and one with a solitary cerebellar metastatic lesion. A Richmond bolt was also placed in the frontal area.
Continuous monitoring of the supratentorial and infratentorial compartments was performed for 48 hours. During the first 12 hours the posterior fossa pressure was 50% greater than that of the supratentorial space in all patients (p < 0.01). Over the next 12 hours the supratentorial pressure was 10% to 15% higher than the posterior fossa pressures in all patients, and by 48 hours of monitoring the pressures had equilibrated. There was no mortality or morbidity referable to insertion of the posterior fossa catheter.
The conclusions drawn from this study are that: 1) direct monitoring and drainage of the posterior fossa is safe and effective; and 2) within the early postoperative period, the supratentorial pressures failed to reflect what is taking place within the posterior fossa. The implications and advantages of direct posterior fossa monitoring in the postoperative patient are discussed.