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The Lucite Calvarium

A Case Report

Gale Clark

phenobarbital. Chemotherapy for infection consisted of intrathecal penicillin, intravenous sodium sulfadiazine, and intramuscular penicillin and streptomycin. On the 5th postoperative day the patient began to talk coherently but a CSF leak at the margin of the dural transplant became definite, and it was necessary to resuture the fascia lata flap. On the 8th postoperative day a second CSF leak developed as another corner of the dural transplant broke down, necessitating a second repair. The fascial transplant appeared to be steadily shrinking and drying out and it

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Rhinorrhea and Pneumocephalus

Surgical Treatment

Hugo V. Rizzoli, George J. Hayes and Harry F. Steelman

Auto accident 5 yrs. before. Aseptic meningitis 1 wk. after 1st op. No CSF leak after 2nd op. * Time elapsed when seen by us. † Duration of rhinorrhea to time of surgery. At surgery, an opening communicating with the ethmoid sinus was found in 10 cases, and in 3 the opening communicated with the frontal sinus. In Case 12, there was a communication with both the right frontal and left ethmoid sinuses. The second fistula was not discovered until the second operation. Cases 5 and 13 required three surgical attacks before closure of the

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J. Lawrence Pool

auditory canal with small rongeur or chisel preparatory to total removal of tumor after its intracranial portion has been excised. B. Diagram showing intact facial nerve (VII) and adjacent cranial nerves after total removal. A dissecting microscope has proved helpful in dissecting the facial nerve. If the facial nerve has been divided, its ends can sometimes be sutured or a nerve graft used (see Facial Nerve Function). Great care should be taken to seal off any openings in the bone with bone wax lest a CSF leak occur; this occurred in one early case of this type

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B. Watson Brawley and William A. Kelly

leak, some cases will not be treated which will later develop meningitis. Of 128 cases of paranasal sinus fracture, Calvert 3 noted six cases of meningitis in patients who had no history of rhinorrhea or otorrhea. It seemed worthwhile to review our own case material to determine the risk of infection in basal skull fractures with and without CSF leak to see if the cases of recurrent meningitis could not be predicted during the acute illness. Case Material All cases of basal skull fracture at King County Hospital for the 5-year period from 1953 to 1958 were

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Charles G. Drake

the limited field of action, total hearing loss is produced prior to the identification of a tumor unless the middle fossa approach is used. There is no opportunity to reconstruct the facial nerve if involved by tumor and there is an increased risk of a CSF leak. If partial removal is indicated, there is no need for the extensive translabyrinthine procedure to spare facial action. The operation would be more radical and safe through the posterior fossa. Analysis of Cases An analysis of House's cases 14 ( Table 1 ) reinforces these contentions. The size of

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James G. Wepsic

irrigation or by wiping with moist cottonoid. Fig. 1. The fiber-optic illuminated suction instrument. This instrument has been used to show the walls of intracerebral hematomas, to identify bleeding points beneath the bone flaps in subdural hematomas, to demonstrate the Gasserian ganglion, to illuminate aneurysms of the anterior communicating artery for clipping, to help locate dural defects in CSF leaks, to illuminate the lateral and third ventricles for removal of a colloid cyst, and in other procedures where external lighting could not be ideally

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P. Yarnell, G. Charlton, C. R. Merril, F. Ghiardi and A. K. Ommaya

; cathode-platinum was 0.001 inch diameter. The cisterna magna was punctured percutaneously with a No. 14 spinal needle. The stylette was withdrawn and replaced by the oxygen electrode with its tip projecting slightly from the needle opening ( Fig. 1 insert ). The fit between electrode and needle was such that only a minimal amount of CSF leaked away. Several criteria were used for judging acceptable position of the needle and electrode in the cisternal space: a) the CSF had to exhibit respiratory pulsations; b) the electrode had to yield a reading greater than zero; c

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Giovanni Di Chiro, Ayub K. Ommaya, William L. Ashburn and William H. Briner

rhinorrhea. Diagnostic procedures for CSF rhinorrhea include the use of dyes, fluorescent substances, radiography, and radioactive tracers ( Table 1 ). Dyes and fluorescein usually are not very informative for the localization of the fistula and, in addition, may be dangerous. 26, 34, 44 Plain x-rays and even detailed tomographic studies are frequently disappointing. In our opinion no convincing evidence has yet been offered for the value of Pantopaque as a localizing agent for the CSF leaks, and this x-ray opaque medium is not always innocuous. 18, 28 Radioactive

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Postoperative Lumbar Meningocele

Report of Two Cases

Italo Rinaldi and William F. Peach Jr.

, and at a repeat operation, while scar tissue was being removed, a dural tear occurred, with escape of CSF. No recurrence of disc herniation was found at that time. A small amount of oxycel was used to control the CSF leakage. Following the operation, the CSF leak persisted, and several days later the old incision was reopened and “a false meningocele” was found. No mention is made as to whether any definite arachnoidal lining was present at that time. The dural opening could not be closed, and tissues adjacent to the sac were used to close the defect by imbrication

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Burton L. Wise, Jacob L. Mathis and Ernest Jawetz

of Meningitis Treatment Outcome Comment 1 2½ F Compound skull fracture, burr holes Scalp wound infection Intrathecal Polymyxin B; 1 week—relapse 3 weeks—cure Cure Reported in ref. 8 2 3 F Cerebellar astrocytoma incomplete resection Wound dehiscence with CSF leak Intramuscular penicillin & terramycin Intrathecal Polymyxin B, 3 doses Death Meningitis present about 3 weeks before therapy begun 3 10 F Cerebellar astrocytoma, incomplete resection Indwelling lumbar intrathecal catheter Intramuscular penicillin