A tentorial sling in microvascular decompression for trigeminal neuralgia. Technical note.

The key to the successful microvascular decompression of the trigeminal nerve is the maintenance of the separation between the trigeminal nerve and the offending vessel. The authors describe a technique whereby a dural sling is fashioned from the tentorium cerebelli (the anatomy of which is briefly reviewed), which is used to suspend the vessel away from the nerve and is secured by a single hemoclip.

The intertransverse approach to extraforaminal disc protrusion in the lumbar spine.

STUDY DESIGN: This retrospective study describes the typical clinical presentation of the extraforaminal disc herniation in the authors' experience, and the surgical management of this via the intertransverse approach. OBJECTIVES: To establish an accurate preoperative diagnosis that enables the surgeon to plan an operative approach for preserving the apophysial joint. SUMMARY OF BACKGROUND DATA: In the past, failure to recognize the extraforaminal disc herniation (clinically and via investigations) resulted in inadequate management, oftne with destructive surgical approaches to the pathology. This need not be so. METHODS: The records of 40 patients who underwent surgery for extraforaminal disc herniation were analyzed and long-term follow-up was conducted by telephone. Also, the extraforaminal areas of the lumbar spine in cadavers were dissected and examined. RESULTS: Examination of the cadaver specimens confirmed the presence of a fibrous band (always seen at surgery) lateral to the nerve root. The results of surgical decompression of the nerve root via the intertransverse approach were at least comparable with other approaches. There was complete resolution of presenting leg pain in 85% of the patients, 7.5% were left with minimal residual discomfort, and 7.5% derived little or no benefit from surgery. CONCLUSIONS: The extraforaminal disc herniation is a distinct clinical entity that, with a high index of suspicion and the aid of magnetic resonance imaging, can be identified preoperatively. This provides the basis for a planned surgical approach in which destruction of the apophysial joint can be avoided.

Chronic pain problems. Experience in a pain clinic.

Our experiences during a year of activity in a pain clinic are presented. Most of the patients treated had pain due to malignant disease. The assessment and management of these patients are described together with the treatment given and the result.

Anastomosis of the superficial temporal to the middle cerebral artery in the management of an intracranial aneurysm. A case report.

A patient with a subarachnoid haemorrhage due to a large right-sided internal carotid artery aneurysm presented unusual problems in management. Direct obliteration of the aneurysm was not possible, while ligation of the internal carotid artery as an alternative form of treatment necessitated the provision of an alternative collateral blood supply to the right cerebral hemisphere, the anterior circle of Willis being deficient. This case illustrates a new surgical technique which has a place in the management of selected cases of cerebral ischaemic disease.

Peripheral cerebral arterial aneurysms caused by stabbing.

Aneurysms of peripheral cerebral arteries caused by stabs of the vault are described in 2 patient. The importance of early recognition of this potentially fatal complication of an apparently benign injury of the head is emphasized.

The pitfalls in early diagnosis of childhood spinal compression.

Thirty-one children under the age of 13 years with spinal cord and cauda equina compression are presented. Some of these cases are used to illustrate the problems encountered in the early recognition of compressive lesions involving the spinal cord and cauda equina in the paediatric age group.