Considerations on the origin of subarachnoid hemorrhages.

The Authors emphasize the importance of C.T. in the study of subarachnoid hemorrhages. By means of this new radiological investigation they are able to exclude a vascular or tumoral etiology in those patients who had no aneurysms detectable by cerebral angiography, and suggest the problem of the so-called spontaneous subarachnoid hemorrhages. They discuss the degenerative nature of the endocranial aneurysms. Several interesting case-reports stress the importance of the primitive lesions of the arterial wall vessel in the degenerative origin of endocranial aneurysms.

Hemifacial spasm: report of nine cases treated by posterior fossa microsurgical decompression.

Nine cases of hemifacial spasm have been treated, in our department until 1979, by posterior fossa microsurgical decompression, as described by Jannetta, without mortality or significant postoperative complications. A blood vessel was found crossing or looping the facial nerve in 8 cases. The relief of hemifacial spasm was immediate and complete in 7 cases, and partial in 1 case. This technique seems to be an effective and safe treatment, in this particular disease.

On the neurological complications of internal and external shunt in patients with non-neoplastic stenosis of the aqueduct.

In our Department 35 patients have been operated for non-neoplastic stenosis of the aqueduct. In the first years, ventriculocisternal shunt according to Torkildsen was performed, obtaining 6 recoveries and 1 death. Later, ventriculosternostomy acc. to Stookey and Scarf, was carried out in 3 cases, obtaining 2 recoveries and 1 death; by using right ventriculo-atrial shunt we had 4 successes and 1 failure. More recently, since 1973, ventriculoperitoneal shunt has been carried out without deaths out of 21 operated patients. With this technique we have had many complications requiring repeated drainage system revisions in 9 cases, and evacuation of a chronic subdural haematoma in 3 cases. 2 patients, operated by drainage system revision and 1 for evacuation of subdural haematoma, had a dramatic postoperative course, characterised by apallic syndrome. Considering the results of the various techniques, we could conclude that the elective operation must be internal shunt (posterior or anterior ventriculocisternostomy) if, of course, the patency and the functionality of the cisterns have been ascertained.

Cyclic AMP excretion in urines of patients with subarachnoid hemorrhages.

Urinary excretion of cAMP was closely monitored for several days in 74 patients with subarachnoid hemorrhages. A rise in urinary cAMP up to 45 microM/24h was observed (normal values being 1 to 5 microM/24h). Patients with associated metabolic disorders were excluded from this study. We have found a correlation between the severity of the clinical conditions, recovery from acute disorder and cAMP excretion, thus suggesting that an increase of urinary cAMP level is related to the extent and the evolution of the acute cerebral damage.

[Indications and results of surgical treatment of spontaneous intracerebral hematomas]. / Indicazioni e risultati del trattamento chirurgico degli ematomi intracerebrali spontanei.

A series of 96 cases of spontaneous intracerebral haematoma, 82 of them operated on, is reported. The results are discussed in relation to the site of the haemorrhage, the aetiology, the patient's age, general and neurological conditions, and the time gap between haemorrhage and operation.

Ruptured intracranial aneurysms: the preoperative management and the timing of surgery.

The authors review 179 consecutive cases of ruptured intracranial aneurysms: 80 out of the first 101 patients underwent aneurysm surgery in a period ranging from 7 days to 2 weeks following subarachnoid haemorrhage (SAH) and patients with all grades of the Hunt and Hess classification were included without discrimination. The total case mortality rate was 23%. The postoperative mortality rate was 16%. Of the 78 patients in the 2nd group, 44 cases were operated upon. All patients with grades I, II and III and five cases with IV and V underwent aneurysm surgery. The timing of surgery was established on the basis of the various clinical and biochemical data, especially the improvement of meningeal signs, and decreased sensitivity of cerebral vessels to vasoconstriction. In this group the angiographic vasospasm and focal neurological deficits, without further clinical damage, were not considered a risk for surgery. The surgical mortality rate was 7%. The evidence presented indicates that both a more selective method of assessing the preoperative neurological function and also an appropriate timing of surgery have improved the surgical morbidity and mortality.