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The Use of Products Prepared from Human Fibrinogen and Human Thrombin in Neurosurgery

Fibrin Foams as Hemostatic Agents; Fibrin Films in Repair of Dural Defects and in Prevention of Meningocerebral Adhesions

Franc D. Ingraham and Orville T. Bailey

not amenable to treatment by application of muscle. For example, one such instance was in dealing with a blood vessel malformation exposed in the course of an operation for focal epilepsy. The foam proved to be strikingly effective even when such large venous channels had been opened. The same result has been achieved in dealing with openings in dural sinuses. TABLE I Tumor, intracranial or intraspinal 42 Lead encephalopathy 3 Congenital anomaly (Arnold-Chiari, etc.) 21 Depressed fracture 2 Jacksonian epilepsy 7

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Abraham Kaplan

T raumatic pneumocephalus, though still rare, is now being recognized with increasing frequency. In 1884 Chiari 8 was the first to demonstrate at post mortem that air had entered the frontal lobe and ventricular system through a rent communicating with the ethmoidal cells. It was not until 1913 that Luckett 15 first reported X-Ray evidence of air in the ventricles of the brain following a skull fracture. Since then similar reports have been more frequent and in 1926 Dandy 11 collected 25 cases and added 3 of his own. Nevertheless further discussion of this

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Henry T. Wycis

approximately one inch with greater displacement on the right side than on the left. There was a suggestive Chiari deformity due to a kinking of the posterior part of the medulla against the upper cervical cord. It appeared as if the entire cervical cord and medulla were foreshortened because of the deformity. The second cervical roots were swung in a hammock fashion about the lower poles of the tonsils. The second cervical roots were crushed on both sides. The dura was allowed to remain open and the muscle layers were closed with interrupted steel wire. Skin was closed with

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Paul C. Bucy and Ben W. Lichtenstein

T he term “Arnold-Chiari Deformity” is generally used to designate a specific modification in the configuration and location of the hind-brain. 3, 4 With this deformity this portion of the nervous system is narrowed laterally and elongated in its axial diameter so that the lowermost portions of the medulla oblongata and the cerebellum extend through the foramen magnum into the vertebral canal. This deformity is frequently associated with a relative stenosis of the aqueduct of Sylvius and with abnormal stretching of the lowermost cranial and the upper cervical

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, Comparison of Contrast Media, and Spinal Fluid Reaction Captain William G. Peacher Major Robert C. L. Robertson May 1945 2 3 220 231 10.3171/jns.1945.2.3.0220 Subependymoma: A Newly Recognized Tumor of Subependymal Derivation I. Mark Scheinker May 1945 2 3 232 240 10.3171/jns.1945.2.3.0232 A Method for Control of Carotid Cerebral Circulation During Operation Wallace B. Hamby May 1945 2 3 241 244 10.3171/jns.1945.2.3.0241 Arnold-Chiari Deformity in an Adult Without Obvious Cause Paul C. Bucy Ben W. Lichtenstein May

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A Contribution Related to Treatment

Olan R. Hyndman

subarachnoid spaces of the sulci (Su.) and was prominent in perivascular spaces (P.S.). MANAGEMENT OF CONGENITAL HYDROCEPHALUS Given an infant with advancing hydrocephalus obvious at birth or shortly thereafter, the chances are so great that the hydrocephalus is not due to a surgical lesion, such as tumor, one may reasonably disregard such a diagnosis. The usual cause will be atresia or absence of the aqueduct of Sylvius, Arnold Chiari malformation or adhesive arachnitis. * One may determine whether the hydrocephalus is communicating or non-communicating by

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1948 5 5 493 495 10.3171/jns.1948.5.5.0493 On the Syndrome of Arnold-Chiari Jerzy Chorobski Lucjan Stȩpien September 1948 5 5 495 500 10.3171/jns.1948.5.5.0495 Unilateral Exophthalmos Due to Cerebellar Tumor and Orbital Defect W. James Gardner September 1948 5 5 500 502 10.3171/jns.1948.5.5.0500 A New Needle for Cerebral Angiography Hans Simonsen September 1948 5 5 502 504 10.3171/jns.1948.5.5.0502 A Versatile Retractor for Laminectomy and Posterior Fossa Exposures C. M. Ramírez Corría September 1948 5 5 504 505

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Jerzy Chorobski and Lucjan Stȩpien

A malformation of the metencephalon, associated with herniation of the spinal cord and of its meninges through a large lumbosacral spina bifida, was first described by Arnold 3 in 1894. Two years later, Chiari 6 published a description of a still more serious developmental anomaly consisting of transposition not only of the abnormal cerebellum, but also of the medulla oblongata into the cervical portion of the vertebral canal. Schwalbe and Gredig (1907) 17 added 4 similar cases and pointed out that, as a rule, both types of malformation, i.e. of the

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Ernest Sachs Jr. and Gilbert Horrax

, Steinke 43 mentions 2, and Elsberg (1941) mentions 4 of his own, none of which is included here, since no details are given and it cannot be determined which of these has been previously reported. TABLE 1. Intraspinal dermoids and epidermoids Author Year Sex Age Type Location Operative Result Remarks 1. * Eppinger 1875 ? ? Chol. Mult. cord & brain ? Not accepted by Craig 11 2. Chiari 1883 M 33 Chol. T4-6 — Intramed. Called “dermoid” by Bostroem 3. * Muscatello 1893

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Homer S. Swanson and Edgar F. Fincher

S ince the early and original contributions of Arnold 3 and Chiari 5 on the malformation that now bears their names, numerous articles have appeared pertaining to the mechanism, diagnosis and treatment of this anomaly. The occurrence of this-deformity has usually been found in infants to be associated with extreme degrees of spina bifida and cranium bifidum. When encountered in adults this pathologic entity has generally been seen in conjunction with some type of bony anomaly of the cranio-vertebral junction, such as basilar impression (platybasia) or the