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A Contribution Related to Treatment

Olan R. Hyndman

T he following paper was read before the American Neurological Association in 1942 and appears in abstract form in the transactions of that year. I decided not to publish the original paper, however, until further clinical tests could be made. In pursuing the problem of congenital hydrocephalus I have arrived at conclusions that no doubt many others have deduced. It is only in the occasional and well selected infant having an otherwise reasonably normal brain that one can hope to have any gratifying success regardless of the method used. Successes in the

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Olan R. Hyndman and William F. Gerber

. It is because of this development that the construction of fistulas between the ventricles or subarachnoid spaces and soft tissues are not practical or of permanent value in the treatment of congenital hydrocephalus. It is probably the rule that closures made in the dura are not immediately water-tight, and if a drain is left in the soft tissue wound for a day or two, considerable spinal fluid will escape from the wound. The flow will usually cease in 3 to 5 days, indicating that the dural wound has healed sufficiently to become water-tight. If the wound is not

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Franc D. Ingraham, Eben Alexander and Donald D. Matson

experimental tool has been put to little use in the laboratory investigation of the therapy of hydrocephalus. Congenital hydrocephalus has been reported in animals by Houck 21 and numerous others, but its occurrence is very rare and such cases would not be available in sufficient numbers for investigative purposes. A reliable method for experimental production of hydrocephalus is the first requisite to laboratory investigation of this condition. A review of the literature pertinent to this subject will be presented, followed by data on a technic for the production of

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Ira Cohen

When obstructive hydrocephalus in adults is due to a lesion that is not removable, one of two palliative procedures may be employed. The obstruction may be by-passed by a tube leading from the lateral ventricle into the cisterna magna, as described by Torkildsen. 5 Or the accumulation of excess fluid in the ventricle may be prevented by opening a communication between the 3rd ventricle and the basal cisternae. This procedure, first described by Dandy 1 in 1922, was devised for congenital hydrocephalus in older age groups. Among others its use has been

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Nonobstructive Hydrocephalus

Treatment by Endoscopic Cauterization of the Choroid Plexus. Long Term Results

John E. Scarff

more will permit an average intellectual development. Two adults with congenital hydrocephalus arrested in childhood and many years later studied at the Neurological Institute lend support to this opinion. One of these, a girl 26 years of age, had completed high school, was regularly employed, and appeared to be normal in all respects. Following an acute infectious disease signs of increased intracranial pressure developed and she was admitted to the Neurological Institute for diagnosis and treatment. A ventriculogram revealed a relative aqueduct insufficiency with

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J. M. Meredith and George R. Gish Jr.

—such patients being notoriously prone to subdural hematomas. It is not unusual to find greatly thinned calvaria, simulating congenital hydrocephalus, in young infants with chronic subdural hematoma. One may even see a very asymmetric skull protruding locally over a subdural clot, as in a 24-month-old white male child operated upon by our colleague Dr. C. E. Troland (March 1952). This patient had a very prominent asymmetrically protruding left parietal calvarium, beneath which was an enormous chronic subdural hematoma, following the removal of which complete and early

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Eben Alexander Jr.

-standing obstruction, such as is often seen in congenital hydrocephalus in younger infants. SUMMARY 1. The case of an infant with progressive hydrocephalus caused by a benign cyst below the tentorium has been reported. 2. This is the second reported case of such a cyst located at this point causing obstructive hydrocephalus. The cyst in this case was lined with arachnoid, whereas that in the case of Hamby and Gardner showed a definite ependymal lining. 3. No previously reported arachnoid cyst has been found in the supracollicular space. 4

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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

W hile in recent years subarachnoid-peritoneal anastomoses have been performed, the majority of patients with congenital hydrocephalus have been treated in this clinic by choroid plexectomy. Our technique for the operation has been reported in detail elsewhere. 2 In order to maintain the integrity of the cranial vault when cerebrospina1 fluid is withdrawn from the ventricle, a plaster cast is applied preoperatively in the form of a ring encompassing the forehead and occiput. Following excision or coagulation of the plexus, Ringer's solution is instilled into

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Griffith R. Harsh III

congenital hydrocephalus. Two patients had hydrocephalus associated with myelomeningocele. In 1 infant hydrocephalus developed after meningitis. The patients in this series were between 3 months and 3 years of age at the time of operation. The longest postoperative interval is 12 months; the shortest, 8 weeks ( Table 1 ). The postmeningitic patient has been followed for 6 months without evidence of failure of the shunt or of recurrence of meningitis. TABLE 1 Case Age (mos.) Type Operation Remarks Result E.S. 3

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An Anatomicoclinical picture

J. A. Picaza, G. Cardelle and R. Martin Jimenez

constant findings were deformity of the head and psychomotor arrest. These symptoms were present to some degree in all patients. The increase in size of the head was similar to that seen in hydrocephalus and measurements varied from 41 cm. in circumference at 1 month to 56 cm. at 4 months. The fontanels bulged slightly and the shape of the head was not unlike that seen in congenital hydrocephalus ( Fig. 1 ). There was one example of turricephaly which was probably the result of a certain amount of premature synostosis of the parietotemporal and lambdoid sutures. One