Quantitative analysis of the cervical spinal canal by computed tomography.

Computed tomography measurements of the AP diameter, width, and cross-sectional area of the bony cervical canal were derived from cervical spine examinations of fifty-two normal adults. These quantitative parameters were then used to evaluate 80 patients with various cervical abnormalities to determine the clinical usefulness of the measurements. With the exception of spinal stenosis, quantitative cervical canal analysis was found to be of limited usefulness since normal measurements frequently occurred in the presence of significant cervical pathology.

Transarterial carotid occlusion. Case report and review of the literature.

Postoperative carotid artery rupture occurs in 3% to 4.5% of head and neck resections involving a mucosal primary and radical neck dissection. Other indications for carotid sacrifice-ligation include en bloc removal of the artery with tumor, inadvertent injury during surgery, and hemorrhage from vessel erosion by unresectable tumor. The mortality and morbidity of unilateral carotid occlusion are significantly decreased when performed electively in a hydrated and normotensive patient with a normal serum hemoglobin level. Sequelae approximate 5% when adequate collateral cerebral blood flow is present. A transarterial catheter approach to the measurement of carotid artery back pressure and permanent obstruction of flow in an awake patient is presented.

Benign osteoblastoma of the maxillary sinus.

Benign osteoblastoma is an uncommon fibro-osseous neoplasm with a predilection for the vertebrae and long bones, and a 2-to-1 male-to-female ratio of occurrence. Peak incidence occurs in the second decade, with 80% of all patients being under 30 years of age. The clinical, radiographic, and histologic presentation of a large maxillary sinus osteoblastoma is reviewed. Preoperative embolization of this vascular neoplasm is advocated.

Dural plasmacytoma.

Dural plasmacytoma is an unusual form of myeloma. We describe a woman with plasmacytoma of the tentorium cerebelli that was managed successfully with surgical decompression and radiotherapy. Computed tomography, not previously reported in cases of dural plasmacytoma, was useful in her management. Another unique feature was the restoration of a normal immunoglobulin G content in the blood and cerebrospinal fluid after local treatment of the neoplasm. Two previously reported cases showed similar normalization of cerebrospinal fluid immunoglobulin G after local radiotherapy. Dural plasmacytoma presents a characteristic clinical syndrome. The typical patient is a woman (92% of the reported cases) in the 5th decade of life. Clinical findings reflect intracranial hypertension, often with focal neurological signs, consistent with the usual dural or tentorial origin of the tumor. Immunoglobulin abnormalities may be found in serum or cerebrospinal fluid. The prognosis is good after surgical decompression and local radiotherapy.

Congenital kyphosis and subluxation of the thoraco-lumbar spine due to vertebral aplasia.

Vertebral body aplasia or hypoplasia leads to rapidly progressive spinal deformity and neurologic defects when unrecognized in infancy. Four patients with this unusual defect are described.

The computed tomographic appearance of colloid cysts.

Three cases of colloid cysts are described, each having a different density. The relative frequency of occurrence of low-density colloid cysts is discussed. The correlation between the CT appearance and the composition of the cyst contents is discussed.

Treatment of nontraumatic atlantoaxial dislocation and fibrous fusion. Case report.

The authors describe a case of nontraumatic atlantoaxial dislocation secondary to acute rheumatic fever, in which there appeared to be fibrous fusion between the axis and the atlas in the subluxed position. The dislocation was reduced by means of combined traction and steroid therapy. Fibrous fusion occurred in the realigned position after immobilization.

Calcified pituitary prolactinoma.

A case of calcification in a pituitary prolactinoma is presented. Calcification was radiologically evident for 10 years and was histologically confirmed after surgery. Immunochemical staining showed prolactin only, and the calcified mass was surrounded by granulated lactotrophs without a boundary zone of tissue necrosis.

Cerebral arterial aneurysm in a neonate.

The diagnosis and successful treatment of a cerebral aneurysm in a 1-month-old child are described. A review of the few aneurysms previously recorded in children up to three months of age reveals that such aneurysms tend to be large, but show no predilection for any particular site, although a relatively large number of them arise from the vertebrobasilar circulation. They occur more commonly in females and are usually congenital. Surgery has been undertaken successfully in about one-third of the cases.

Neurogenic pulmonary edema and missile emboli.

A case of missile emboli to a major intracranial vessel resulting in fulminant pulmonary edema is reported. A discussion of the etiology of neurogenic pulmonary edema (NPE) is presented. The cause is thought to be a marked increase in pulmonary artery pressure, due to a massive catechol release in the CNS, and possibly secondary to post-capillary sphincteric constriction. Missile emboli to the cerebral arteries should be removed in order to avoid distal embolization and infarction. The case reported appears to represent the first documented case of missile emboli causing NPE.