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Paul H. Crandall, Richard D. Walter and Robert W. Rand

lesions, were achieved by the en bloc resections developed by Falconer et al . 4 in 1955. It has been amply documented in all reported series that best results of surgical treatment are obtained in cases of clearly unilateral seizures. In the first large group of surgically treated cases Jasper et al. 13 found 34 per cent of temporal epilepsy to be unilateral. Of 26 patients considered for surgical treatment at the University of California Medical Center in Los Angeles since 1956, after many scalp and basal electroencephalograms, only 4 with unilateral temporal

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Collin S. MacCarty, John M. Waugh, Mark B. Coventry and W. Frank Cope Jr.

in which some appraisal is justified. Three of these 10 had coccygeal teratomas and underwent successful en bloc resection. Results should be good. Four others had ganglioneuroma, neurofibroma, neurofibrosarcoma and giant osteoid osteoma with follow-up at last report of 33, 39, 66, and 45 months, respectively, with no evidence of recurrence. In most instances these are not recent follow-ups, however, and the current status of the patients is necessarily indefinite. The remaining 3 cases include a patient with sacral chondrosarcoma who has survived 137 months and

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J. M. Van Buren, A. K. Ommaya and A. S. Ketcham

course. This incidence is approximately the same as that of Ashley and Schwartz 1 who noted at autopsy that only 25% of maxillary carcinomas spread beyond the local area. Metastases usually appeared in the retropharyngeal and superior cervical lymph nodes if the primary tumor was in the superior and medial portion of the antrum. Tumors involving the floor and lateral wall were more prone to show metastases in the submandibular lymph nodes. Taken together, these features encourage surgical attack upon the local lesion. Unfortunately, hopes of an en bloc resection

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B. L. Rish and W. F. Meacham

has not yet been described. The surgeon should, when encountering tissue of the sort described here, carry out an en bloc resection of the area, using every precaution to avoid contamination of the subarachnoid space, and determine the pathological diagnosis as soon as possible in order to begin appropriate therapy. Amphotericin-B is currently the agent of choice in the treatment of Cryptococcus neoformans infections. 2, 3 Summary We have reported a patient with a cerebral toruloma containing a large solitary cyst. The lesion was removed by total

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Shokei Yamada, Frederic D. Schuh, J. Shand Harvin and Phanor L. Perot Jr.

early as 1899 Heyer 8 described piecemeal removal of the temporal bone for carcinoma. In general, the results of surgery for these tumors were so discouraging that radiotherapy was adopted as a preferable mode of treatment. Campbell and associates 1 in 1951 suggested, however, that the principle of en bloc resection might be applied. It was in 1954 that the first en bloc resection was reported by Parsons and Lewis. 11 Using this technique, Coleman 2 performed en bloc resection in seven cases and summarized his long-term results in 1966, showing a 42

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J. Hartley Bowen, Peter C. Burger, Guy L. Odom, Philip J. Dubois and James M. Blue

✓ Two adults presented with frontal lobe masses. As visualized by computerized tomography, both lesions were large cysts with contrast-enhancing mural nodules and enhancing circumferential rims. En bloc resections of the mural nodules and cyst walls were performed. Pathological evaluation of each nodule disclosed a meningioma, and neoplastic cells were found in the distant cyst walls. Although the walls of large cysts associated with some meningiomas have been composed of reactive glia or collagen, the neoplastic character of the cysts in the present cases underscores the need for resection and careful pathological evaluation of the large cysts associated with meningiomas.

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Narayan Sundaresan, Gerald Rosen, Joseph G. Fortner, Joseph M. Lane and Basil S. Hilaris

, through February, 1981), marked regression in size of the tumor mass was noted ( Fig. 1 right ). Fig. 1. Preoperative computerized tomography scans in Case 1. Left: Admission scan demonstrating a large paraspinal tumor with involvement of the spine at the costotransverse junction. Right: Scan after chemotherapy demonstrating regression of the tumor. Operation . In March, 1981, an en bloc resection of the paraspinal tumor and associated muscles was carried out. A thoracic laminectomy at the T-6 to T-8 levels, including resection of the posterior ends

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David G. Kline and Donald J. Judice

bloc resection of benign tumors of the plexus; one required graft repair for a medial and lateral cord to median nerve deficit of several inches, with surprisingly good results, and the other had a 3-in. graft repair for posterior cord to radial nerve deficit, also with good results. One unfortunate patient had a delay of several months in the diagnosis of an axillary artery aneurysm secondary to axillary angiography. 15 Despite resection of the aneurysm and neurolysis of the plexus, he has made an incomplete and poor recovery. In those patients sustaining

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Michael E. Carey, Roger H. Tutton, Richard L. Strub, F. William Black and Emily A. Tobey

inferiorly from the main track (B and C), indicating additional damage. In C, close dots indicate surface involvement, and sparse dots deeper involvement. Case 3 This 21-year-old right-handed helicopter crewman received a grazing right parieto-occipital vertex bullet wound on May 31, 1969. Preoperatively, he was drowsy with a left lower monoplegia. A right parieto-occipital craniectomy with an en bloc resection of the right posterior parietal lobe was performed. Resection extended from the right side of the falx medially down to the trigone of the right

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Fredric B. Meyer, Thoralf M. Sundt Jr. and Bruce W. Pearson

that carotid body tumors can usually be resected while maintaining the integrity of the carotid artery complex. Intraoperative electroencephalography and CBF monitoring are important adjuncts to protect the cerebral hemisphere during dissection when temporary arterial occlusion may be required. This is preferable to injudicious shunting, in our judgment. Division of these tumors into Groups I, II, and III according to Shamblin, et al. , 48 was not of predictive values in terms of shunting or en bloc resection of the tumor-carotid complex. With precise