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The Torkildsen Procedure

A Report of 19 Cases

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

reviewed 6 cases of neoplastic aqueductal stenosis and added 2 examples. All of these patients had been operated upon; 7 did not survive 2 weeks after operation, and the 8th was alive 7 months after operation and exhibited progressive symptoms. Howard Brown 2 in 1947 reported a lengthy tolerance of a rubber catheter. This patient had an intraventricular tumor removal on December 17, 1941 —“the thin membrane was removed as widely as possible but appeared to merge into the ventricular wall inferiorly.” One year later an insertion of a Torkildsen tube was necessary and

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Eldridge Campbell

that by 1943 he recorded 564 operations; there was but one death. It is hard to see how this record will ever be surpassed! INTRAVENTRICULAR TUMORS In 1933 and 1934 Dandy published his classic monographs on tumors of the third and of the lateral ventricles. The clinical pictures were drawn upon the basis of his singularly large personal experience. The ventriculographic findings were clearly demonstrated and served in good measure to explain the development of signs and symptoms. The high recovery rate reflected not only the precision of his diagnostic

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Gilbert Horrax and William Q. Wu

the later stages of the disease. Of the 19 patients with intrahemispheric tumors reported by Shenkin et al. , 17 12 (63.1 per cent) had epileptic seizures prior to operation. Since none of their 6 patients in the intraventricular group had preoperative seizures it would mean that 48 per cent of their whole group had such attacks, a percentage similar to ours. Our 2 patients with intraventricular tumors were also free from seizures prior to operation. Bailey and Cushing 2 called attention to the fact that when people of middle life begin to have epileptiform

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Colloid Cysts of the Third Ventricle

Report of Seven Cases

James L. Poppen, Victor Reyes and Gilbert Horrax

O f the true intraventricular tumors, colloid cysts of the 3rd ventricle form an interesting and favorable group. Previous to the advent of cerebral pneumography, reported cases were mere pathologic curiosities. Their clinical diagnosis and surgical removal were made possible by the pioneering work of Dandy 6 who, in 1933, reported 5 cases with successful results in 4. A number of reviews have since appeared in the literature 16, 26, 29, 33 McLean 16 in 1936 and Zeitlin and Lichtenstein 31 in 1937 particularly discussed the pathogenesis. In a later

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Donald D. Matson

cerebrospinal fluid or of xanthochromia in the absence of red blood cells should suggest the possibility of intraventricular tumor. In this clinic it is standard procedure to carry out bilateral subdural taps, combined ventricular and lumbar puncture and ventricular air studies on every infant with hydrocephalus who does not already exhibit gross evidence of irreversible neurological damage, no matter what the age. Routine studies of this character, supplemented by additional diagnostic and surgical pursuit of unusual clinical situations, should prevent any possibility of

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Yun Shang Huang and Chisato Araki

tumors in his series were pure fibromata) could be diagnosed with sufficient accuracy. Later in 1938, Gardner and Turner 9 likewise expressed their view that the recognition of primary benign intraventricular tumors by clinical means was practically impossible. Cushing and Eisenhardt 2 grouped the symptoms of lateral tumors of the velum under five headings, but symptoms of a tumor of the lateral ventricle do not necessarily correspond therewith. A review of their cases and those reported by Lynn-Thomas, 11 Tschernyscheff, 18 Petit-Dutaillis and Bertrand, 14

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Kenneth J. Strully

conformation found in the adult. CONCLUSIONS 1. A case of successful removal of a massive aneurysm of the left choroidal artery is presented. The clinical picture was that of an intraventricular tumor and the nature of the lesion was not suspected until it had been removed. 2. A review of the literature establishes the rarity of such an anomaly. 3. The anatomy and embryology of the choroidal arteries is presented and the general clinical significance is discussed. REFERENCES 1. Bassett , R. C. Intracranial

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Ralph A. Munslow and Alfred H. Hill

in Fig. 1 . Case 3 . A.L., a 46-year-old paternally related nephew of Cases 1 and 2, entered a hospital in Phoenix, Arizona in October, 1950, under the care of Dr. John Green. He presented a 3-month history of personality change, headaches and left-sided paresthesias. Examination . The patient was right-handed, with definite evidence of increased intracranial pressure, left astereognosis and dysesthesias. Spinal fluid pressure and protein were elevated. Ventriculography suggested a right intraventricular tumor. Operation . At craniotomy a right

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Janusz Subczyński and Janusz Gradzki

A case of intraventricular tumor in a 3-year-old boy was described by Guerard 5 in 1883. The tumor was like a thyroid gland in appearance, consisted mainly of vessels, and originated in the choroid plexus. This was the earliest report found of a papilloma of the choroid plexus. In the following years there were many case reports and also larger monographic treatments of the clinical and pathological anatomy of these tumors. Papillomas of the choroid plexus are rare tumors. In Cushing's 2 series they represented only 0.6 per cent of all his intracranial

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Jacques P. Schaerer and Robert D. Woolsey

seem entirely academic. There is no characteristic clinical picture associated with these tumors. As long as they are small they may not cause any symptoms whatsoever. When of sufficient size they will impair circulation of the spinal fluid, causing internal hydrocephalus. In addition there will be effects of pressure on surrounding structures clinically imitating effects of lesions originating in these same areas, such as gliomas of the brain stem or the cerebellum. Identical pictures, of course, may be produced by intraventricular tumors of different histogenesis