Arterial blood supply of the normal human pituitary gland. An anatomical study.

A technique for the removal of sphenoid blocks from cadavers and for selective injection of the hypophyseal arteries of these specimens is described. Results of such injections are presented, with emphasis on the role of the inferior hypophyseal artery (IHA). The IHA was found to be the most important artery supplying the pituitary gland, and in particular, the structures involved in production, transportation, and storage of the antidiuretic hormone. The literature pertinent to the arterial blood supply of the normal pituitary gland is reviewed.

Fatal subdural bleeding following superficial temporal-middle cerebral artery anastomosis. Case report.

This report describes a sudden death during convalescence from superficial temporal artery-middle cerebral artery bypass surgery. Artificial arterial anastomosis introduces the danger of a high-pressure subdural hemorrhage in an unnatural location.

Cylindromas of the base of the skull. Report of four cases.

Cylindromas are rarely encountered in the neurosurgical field. Four cases of this rare tumor are presented. Conventional and computerized tomography scanning were most useful in establishing the diagnosis; angiography did not provide any further information. Because these tumors are well demarcated from surrounding structures, even in cases of recurrence, surgery is the treatment of choice. Radiation therapy is useful in the postoperative management. Long survival times with multiple recurrences are the rule.

Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid space. Report of four cases.

Four patients with tentorial arteriovenous malformations (AVM's) were treated surgically. The operative findings in the first case suggested that clipping of the draining vein close to the AVM may result in complete cure. The three subsequent cases were treated with this technique. The clinical and radiological implications are discussed.

Retromastoid microsurgical approach to vascular compression of the eighth cranial nerve.

In our series of 10 patients, the age ranged between 31 and 69 years. Seven patients were followed for from 1-2 1/2 years. Complaints consisted of tinnitus, vertigo, or both. Vegatative symptoms consisting of nausea or vomiting were minimal or absent. Audiometry revealed a varying neurosensory loss. Vestibular hypoexcitability was a common finding. Good discrimination appeared to indicate a vascular loop rather than hydrops. The neuroradiological work-up was unremarkable. Treatment consisted of neurovascular decompression of the VIIth nerve by microdissection. The approach used was a retromastoid incision with a bony removal limited to 20 mm. Cerebrospinal fluid withdrawal and lateral decubitus positioning permitted visualization of the VIIIth nerve without retraction of the cerebellum. Lack of bleeding, rapidity of procedure and benign postoperative course are emphasized. The results on tinnitus and vertigo were satisfactory. No additional deficit was created by surgery. If the symptoms are significantly disabling, microsurgical exploration is indicated.

Lumbar disc excision in the second decade.

Of a series of 1200 consecutive cases of lumbar disc excisions from a general neurosurgical service, 1% of the patients were between the ages of 13 and 18 and 3.7% between 13 and 21. Differences in the clinical picture between adolescents and adults are emphasized. They include a higher ratio of males, a high frequency of radicular pain, a frequent history of trauma, and a lack of neurologic deficit, the latter being particularly striking among the younger patients. There was often a delay between the onset of pain and surgical treatment. This is attributed to a reluctance to consider this diagnosis in young people and to the frequent lack of neurologic deficit. Since the results are often excellent in this age group, early surgical treatment. is advocated.

Microsurgical management of tuberculum sellae meningiomas. Results in 28 consecutive cases.

A series of 28 cases of meningioma of the tuberculum sellae is reviewed. This tumor was most frequent in the fifth decade, with a clear predominance in women. Neurological and endocrine deficits were minimal, whereas ophthalmologic signs were always present. Visual deficits were bilateral in cases with more than a 1-year history. Osteoma of the tuberculum sellae was rare and had no correlation with tumor size. Angiography of the internal carotid artery was found useful in demonstrating vascular displacements and tumor blush. Computed tomography was the most reliable diagnostic tool. All patients underwent a unilateral pterional craniotomy using the operating Outside of patients with total blindness, improvement of visual acuity was the rule, even in cases of long-term duration. Best results were obtained in patients operated upon within 1 year of the onset of visual symptoms.

Posterior lumbar interbody fusion using the Ray threaded fusion cage.

Though recommended some years ago by Cloward, PLIF (posterior lumbar interbody fusion) was not widely used for many years. Recently many authors have recognised PLIF as a preferred technique for lumbar stabilisation. Preservation or re-establishment of disc height is associated with an improved patency of the intervertebral foramen. The use of the threaded fusion cage (TFC) provides immediate stabilisation, preservation of disc height due to highly resistant material, and long term fusion with autogenous bone. The instrumentation, designed in association with the cage, provides a safe environment for the neural structures during the procedure. It also makes the procedure more reproducible and less dependent on the operator. The learning curve for doing the operation is rapid. Using the Prolo scale, on the economic and functional scales, 83% of cases were rated good to excellent. The fusion rate was 94% at one year.

Percutaneous lumbar disc excision: experience with sixty cases and review of the literature.

A series of 60 cases of percutaneous disc excisions is presented. There were 43 males and 17 females with an average age of 36 years. All cases were failures of conservative treatment and were disabled for their usual occupation. Results were excellent or good in 44 cases, satisfactory in four and failures in eight. There was no postoperative complication. The importance of a complete radiologic workup is emphasized. The cost/benefit and risk/benefit ratios of this operation compare favorably with conventional open laminectomy. The procedure is best indicated in younger patients with good distal water content and contained herniated lumbar disc. It is contraindicated in patients with a free fragment and in patients with previous surgery at the same level.

[Lumbar interbody fusion with threaded titanium cages. Results on 222 cases]. / La fusion intersomatique lombaire à l'aide de cages vissées en titane. Résultats à propos de 222 cas.

Retrospective analysis of 222 cases of degenerative disc disease treated by threaded cage fusion. The objective was to determine the safety and efficiency of lumbar interbody fusions using screwed titanium cages and autogenous bone. Two hundred twenty-two patients had lumbar fusion at 243 levels between L2 and S1, at one or two disc spaces. Main indication was discogenic back pain with radicular leg radiation in degenerative discopathy complicated by disc protusion, segmental canal stenosis with chronic instability or spondylolysthesis of the first degree. Previous failed surgery after discectomy, nonunion or biologically cured discitis were other indications in selected cases. Results were classified as good to excellent in 80%, 15% improved but remained disabled, 5% had minimal or no improvement. Fusion rate was 91% at one year and 96% at 2 years. Peroperative dural tears occurred in 10 patients and transient neurological deficits in 9. A superficial infection occurred in one patient. Reoperation in the first three months included a cage revision in one patient and a foraminotomy in another. Two osteoporotic women needed an additional posterior fixation for kyphotic deformity. In conclusion, lumbar interbody fusion with threaded titanium cages appears to be efficacious with an acceptable rate of complications. Experience up to 7 years confirms that impression. Long term observation is needed before recommending this new method.

[Epidural stimulation for pain control (author's transl)]. / La stimulation épidurale dans le traitement des douleurs chroniques.

Twenty consecutive cases of internalized epidural stimulators are reviewed. All patients presented with the "failed disc syndrome" following multiple laminectomies. Transcutaneous insertion technique is discussed and results as well as complications are reviewed. Good results on pain, together with regaining normal physical activity occurred in 50% of the cases in the past two years. While patients with a lateralized pain syndrome fared well, a bilateral distribution of pain results in many failures. One post-operative infection required removal of the stimulator. In six cases, electrode movements were considered as the cause of failure. Epidural stimulation is indicated in the treatment of chronic pain. Better patient selection and decrease in electrode movements should improve the results in the future.

Rationale for interbody fusion with threaded titanium cages at cervical and lumbar levels. Results on 357 cases.

STUDY DESIGN: Retrospective analysis of 357 cases of degenerative disc disease treated by interbody fusion with threaded titanium cages. OBJECTIVE: To determine the safety and efficiency of cervical and lumbar interbody fusions using threaded titanium cages and autogenous bone. SUMMARY OF BACKGROUND DATA: Stabilizing the anterior column by interbody fusion, though reported over 50 years ago, is less commonly done than posterior fusions. The recent development of rigid cages housing autogenous bone simplifies the technique of interbody fusion. This report shows our combined results using this technique. MATERIALS AND METHODS: One hundred thirty-five patients had cervical fusions at 175 levels between C3 and C7. Two hundred twenty-two patients had lumbar fusion at 243 levels between L2 and S1. All surgeries involved one or two disc spaces except for one three level cervical fusion. We implanted all disc spaces with threaded cages containing autogenous bone. RESULTS: In the cervical area, 95% of the radiculopathic patients had a good to excellent result, but only 50% of the myelopathic patients did so. At lumbar level, 80% of the patients were classified as good to excellent, 15% improved but remained disabled, 5% had minimal or no improvement. The cervical fusion rate was 90% at 6 months and 100% at one year. Lumbar fusion rate was 91% at one year and 96% at 2 years. No late breakage or cage displacement occurred. CONCLUSIONS: Cervical and lumbar interbody fusions with threaded titanium cages appear to be efficacious with few complications. Long term follow-up (4 years cervical, 7 years lumbar) confirms that impression.

[Transsphenoidal hypophysectomy in metastasizing breast cancers. Experience from 160 cases]. / Hypophysectomie transsphénoïdale dans les cancers du sein métastatiques. Expérience de 160 cas

160 patients suffering from advanced metastatic cancer of the breast had transsphenoidal open surgical hypophysectomy. Mortality (1,8 p.cent) and morbidity were extremely low in view of the general conditions of the patients. Immediate relief of pain due to bone metastasis was obtained in 92 p.cent of cases. Such results emphasized the important point of achieving total hypophysectomy.