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W. H. Sweet and H. S. Bennett

arterial contraction or to permit a clot to fill the aneurysm and a cure to occur. Reid 20 cites 4 cases (numbers 45, 47, 53, and 55) in which only proximal occlusion of common, internal or external carotid arteries for massive aneurysms in the neck was followed by conversion of the pulsating mass to a solid pulseless swelling which then gradually disappeared. This would probably be an even more likely event in the smaller intracranial berry aneurysms. Similarly, Locke, 14 in a complete summary of all reported cases of carotid cavernous fistula up to 1924, found that

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Oscar Sugar

which is shown in Fig. 7 . This area may also be the weak spot which predisposes to traumatic or “spontaneous” rupture of the carotid artery in the formation of a carotid-cavernous fistula. Some such explanation is necessary to understand why the normally thick-walled strong carotid artery should break just here, surrounded by a much thinner-walled sinus containing venous blood. Figs. 8 and 9 show lateral and anteroposterior views of arteriograms in patients with such fistulae. The latter film demonstrates reflux into the fistula from injection of the

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Eldridge Campbell

which were disclosed at operation. In one patient the ligation of the arterial trunk was followed by collapse of the mass of veins and subsequent improvement; an attempted resection of a second resulted in fatal hemorrhage; all of the remainder survived. Although twenty years later Pilcher and Olivecrona were able to record a number of successful excisions, Dandy's bold pioneering, for the most part sans electrocautery, sans continuous suction, sans blood bank, and sans peur, commands one's admiration. Dandy first isolated a carotid-cavernous fistula in 1934

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Miguel Ramos and Lester A. Mount

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. Cloward March 1953 10 2 154 168 10.3171/jns.1953.10.2.0154 Sensitization of the Spinal Cord of the Cat to Pain-Inducing Stimuli Margaret A. Kennard March 1953 10 2 169 177 10.3171/jns.1953.10.2.0169 Carotid Cavernous Fistula with Signs on Contralateral Side Miguel Ramos Lester A. Mount March 1953 10 2 178 182 10.3171/jns.1953.10.2.0178 Left Frontoparietal Meningioma with Quadriplegia James L. Poppen Eugene W. Skwarok March 1953 10 2 182 184 10.3171/jns.1953.10.2.0182 Eosinophilic Granuloma of Bone Garrett Swain

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Persistent Carotid-Basilar Anastomosis

Three Arteriographically Demonstrated cases with one Anatomical Specimen

Clinton R. Harrison and Charles Luttrell

obliterated carotid-basilar anastomosis accounts for the predilection of the carotid to rupture within the cavernous sinus with resulting arteriovenous fistula. Dandy and Follis 4 demonstrated congenital weakness in the wall of the internal carotid artery with loss of the elastic coat at the location of the fistula in a case which was precipitated by trauma. In a spontaneous case of carotid-cavernous fistula they found two openings in the wall of an aneurysm within the sinus. SUMMARY The embryologic origin of the persistent carotid-basilar anastomosis is described

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Captain T. H. Mason, Captain G. M. Swain and Colonel H. R. Osheroff

The carotid-cavernous fistula presents an intriguing clinical and pathological picture. The specific surgical treatment has been recognized since 1809, when Travers 13 cured a patient with pulsating exophthalmos by ipsilateral common carotid ligation. A cirsoid aneurysm of the orbit was thought to have been the etiological factor. In 1823 Guthrie 4 recorded the autopsy of a patient with pulsating exophthalmos, who was found to have an aneurysm of the ophthalmic artery. Aneurysmal rupture within the cavernous sinus was described by Baron 1 in 1835. It was not

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Paragonimiasis R. S. Hooper May 1954 11 3 318 323 10.3171/jns.1954.11.3.0318 Bilateral Carotid-Cavernous Fistula Captain T. H. Mason Captain G. M. Swain Colonel H. R. Osheroff May 1954 11 3 323 326 10.3171/jns.1954.11.3.0323 Herniation of Thoracic Intervertebral Discs with Spinal Cord Compression in Kyphosis Dorsalis Juvenilis (Scheuermann's Disease) John H. Van Landingham May 1954 11 3 327 329 10.3171/jns.1954.11.3.0327 Howard Renninger Erb 1914–1953 Dwight Parkinson May 1954 11 3 330 331 10.3171/jns.1954

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Phillip Harris and George B. Udvarhelyi

the location of the 326 intracranial aneurysms in our series. The aneurysms under discussion (90 cases) make up 27 per cent of the total. An attempt will be made to study the angiographic appearances and clinical features of this group, and to evaluate the different methods of treatment. TABLE 1 Location of 326 intracranial aneurysms Internal carotid artery Intracavernous 7 Carotid cavernous fistula 12 Ophthalmic artery 14 Anterior choroidal artery 4 Posterior communicating artery 90 Bifurcation

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Dean H. Echols and John D. Jackson

A lthough there are several operations for correction of carotid-cavernous fistulas, both the medical literature and personal experience indicate that no method can be relied upon to bring about a cure. Moreover, there seems to be no way to determine which patient may be in the group of approximately 10 per cent in which spontaneous obliteration of the fistula will be obtained. Although we are pessimistic regarding the possibility of obtaining complete cure when confronted by a patient with pulsating exophthalmos, it seems worth while to record our experience