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The Torkildsen Procedure

A Report of 19 Cases

Edgar F. Fincher, Gordon J. Strewler and Homer S. Swanson

. Non-neoplastic aqueductal stenosis has been attributed to ependymal or subependymal proliferation on a developmental or inflammatory basis. 16, 21 Neoplastic stenosis, in addition to the fairly diffuse spongioblastic stem glioma, finds its pathology in small, local, tumorous proliferation of pineal, subependymal, and hemangioblastic tissues, a plausible pathogenic basis having been found in heterotopic, extrinsic, and phylogenic factors. 10, 11 Pennybacker 18 in 1940 reviewed Cairns' 18 cases of non-neoplastic aqueductal stenosis treated prior to the

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Arne Torkildsen

aqueductal stenosis resulted in a failure, the treatment by means of an artificial aqueduct (ventriculocisternostomy) seems to have been a success. Since the operation the development of the patient has been normal. He has lost the hydrocephalic appearance, he has become relieved of the signs and symptoms of intracranial hypertension, his head has grown at a normal rate, and he has shown normal intellectual development ( Fig. 8 ). Fig. 8 Case 4. Left: Appearance of patient before ventriculocisternostomy. Right: Two years after the operation. Case 5

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Homer S. Swanson and Edgar F. Fincher

. The Arnold-Chiari malformation is apparently a congenital deformity and may be associated with a wide variety of other anomalies in addition to the bony deformity. The incomplete development of the cerebellar vermis has repeatedly been encountered, as in the case reported here. In Case V of McConnell and Parker, there was a congenital absence of the foramina of Magendie and Luschka. Lichtenstein 6 reported an associated aqueductal stenosis. The etiology of the malformation in the presence of spina bifida has apparently been well established as due to the traction

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Lennart Herlin

have been operated upon by Torkildsen's method during the years 1939 to 1948. Nine of them had undergone other operations earlier, or shortly before or after the Torkildsen procedure, and in these cases it is difficult to decide the significance of the Torkildsen procedure with regard to improvements obtained and the risk of operation. They have therefore been excluded, and the present report comprises 22 cases. The hydrocephalus was due to Sylvian aqueductal obstruction in 4 cases, and to tumours in 18. In 2 of the cases of aqueductal stenosis an unsuccessful

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G. M. Tice and N. W. Irving

there was a midline obstruction in the aqueduct. Operation . On June 9, 1949 posterior fossa exploration was done. A block was found in the aqueduct from the 3rd to the 4th ventricle. The nature of the block was not revealed. Exploration was not deemed advisable. Course . Following operation x-ray therapy was instituted. A dose of 5,000 r to the midline was delivered. This patient rapidly became free of his symptoms. At present he is a student in a medical school. We think this is undoubtedly a case of aqueduct stenosis; in fact, stenosis was found in operation

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Joseph Ransohoff

. Fig. 2 shows a fairly large occipital defect covered with screen which was held in place by suturing the periosteum over its edges. The defect was produced during the process of splitting the tentorium prior to the insertion of a Torkildsen tube in a hydrocephalic infant with an aqueduct stenosis and a subarachnoid block at the tentorial ring. REFERENCE 1. Mount , L. A. Tantalum discs for covering trephine defects and tantalum clips for ligation of internal carotid artery intracranially. J. Neurosurg. , 1948 , 5 : 208 – 210

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John E. Scarff

by puncture of the lamina terminalis and floor of the third ventricle Case Sex Age Pathology Postoperative Result Original series reported in 1936. 3 1. M 40 yrs. ? Tumor, posterior to 3rd vent. Good . Pressure relieved. Still asymptomatic 3 yrs. postop. Relief of headache, unsteady gait, visual hallucinations & weakness both legs. 2. F 14 yrs. Aqueduct stenosis Good . Pressure relieved. Still well 14 mos. postop. No complaints of visual or gait disturbances. Attending school. 3. M 14

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Subdural Hematoma Occurring in Surgically Treated Hydrocephalic Children

With a Note on a Method of Handling Persistent Accumulations

Leo M. Davidoff and Emanuel H. Feiring

encountered at a 2nd-stage operation 6 weeks after choroid plexectomy on the opposite side. In arriving at a diagnosis various etiologic possibilities were considered. The background of hydrocephalus invariably raised the question of reactivation of the original process. Such conditions as the Arnold-Chiari malformation and aqueduct stenosis were given consideration in the differential diagnosis. The evidence that in all 3 instances suggested the possibility of a subdural hematoma was the EEG pattern. A diminution in amplitude of electrical activity over the involved

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Griffith R. Harsh III

Communicating Salpingothecal (2) First tube slipped out of theca; replaced. Functioning shunt, 12 mos. follow-up. R.B. 5½ Mixed Torkildsen Salpingothecal Aqueductal stenosis and obliterated lateral cisterns. Functioning, 10 mos. after salpingothecal. R.G. 11 Communicating Salpingothecal Shunt above associated myelomeningocele. Functioning, 9 mos. after shunt. B.J. 3 Communicating Salpingothecal Cardiac arrest at operation, temporary response to cardiac massage. Died, 24 hrs. M.R. 6 Communicating Salpingothecal

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Joseph Ransohoff

pressure signs for 7 months until death from tumor growth . A 16-year-old girl was admitted complaining of headache, tinnitus and episodes of numbness in the right arm. Examination showed a mild right hemiplegia and papilledema. On July 26, 1952 ventriculography was considered to demonstrate aqueduct stenosis. After a negative posterior fossa exploration, ventriculocisternostomy was performed. Her signs of pressure continued. On Aug. 23, 1952 a lamina terminalis and third ventriculostomy were performed. These procedures also failed to relieve the increased pressure