En bloc removal of large bilateral olfactory groove meningioma.

With careful pre-operative angiographic evaluation, reversible intra-operative external carotid occlusion, controlled hypotension, steroids, osmotic diuretics, and early control of nutrient arteries, the en bloc removal of a large bilateral olfactory groove meningioma is feasible in some instances. Dissection around the tumor is facilitated by shrinkage of the tumor, as its nutrient vessels are occluded. Ligation and division of the venous drainage is left until the end. This technique may be particularly valuable in poor risk patients, as it may considerably reduce blood loss and operating time, without sacrifice of brain.

Neurogenic intermittent claudication and stenosis of the lumbar spinal canal.

Neurogenic intermittent claudication is briefly reviewed and correlated with twenty consecutive cases of lumbar spinal canal stenosis. Irreversible damage may occur if surgical decompression is unduly delayed. A unilateral decompression may be sufficient in carefully selected cases.