Predicting recovery of facial nerve function following injury from a basilar skull fracture.

Twenty-five patients with posttraumatic facial nerve palsy were studied. Partial recovery of function had occurred in 95% of these patients by 18 months after injury. At 5 months posttrauma, there was some recovery in 92.5% of those with a partial lesion compared with 10% of those with a complete lesion. This difference attains statistical significance. Complete recovery of nerve function had occurred by 10.5 months in 53.5% of the patients; in 62% of patients with a partial lesion, complete recovery had occurred by 4 months compared with 0% in those with a complete lesion. This difference also attains statistical significance. There was no statistically significant difference in recovery of function between patients with an immediate as opposed to a delayed onset of facial nerve palsy. It was determined that the degree of palsy had a statistically significant influence on recovery of facial nerve function, whereas the time of onset did not. The data presented support a conservative approach to these injuries and it is recommended that the possibility of surgical treatment should be entertained in patients with complete facial palsy persisting for 12 to 18 months after injury.

Primary intracranial chondrosarcoma: a report of two cases.

Two cases of primary intracranial chondrosarcoma are presented. The cases were similar in that they both arose from the temporal bone, contained both myxomatous tissue and material of cartilaginous consistency, and were avascular. Histological studies excluded the diagnosis of chondroid chordoma. A brief review of the subject is presented.

Massive cerebellar infarction: "conservative" management.

Eleven patients with large cerebellar infarctions were admitted recently to our service. Eight of them showed evidence of hydrocephalus on the CT scan examination. Five were treated with controlled external ventricular drainage and six were managed conservatively. One death, most likely due to progressive brainstem infarction, occurred. The outcome was favorable in the other patients. It is suggested that prompt treatment of the acute obstructive hydrocephalus may obviate the need for posterior fossa decompression in patients with massive cerebellar infarction.

Supratentorial capillary hemangioblastoma presenting with fatal spontaneous intracerebral hemorrhage.

Spontaneous intracerebral hemorrhage from a supratentorial capillary hemangioblastoma resulting in the death of a 26-year-old woman is reported. We suggest that the presence of glial fibrillary acidic protein containing stromal cells in the tumor tissue may serve as a point distinguishing hemangioblastoma from angioblastic meningioma.

The recurrence of intracranial meningiomas after surgical treatment.

A study of 114 surgically treated patients with intracranial meningiomas was carried out to evaluate factors influencing recurrence. The data of the initial surgery extended over a 24-year period from January, 1956, to December, 1979. The patients ranged in age from 1 1/2 years to 82 years. Seventy-one (62.3%) were females and 43 (37.7%) were males. The surgical procedure was graded according to Simpson's classification from 1 to 5 (Grade 1 = complete excision, Grade 5 = simple decompression). In this series, 33 procedures (28.9%) were Grade 1, 55 (48.2%) were Grade 2, seven (6.1%) were Grade 3, 18 (15.8%) were Grade 4, and one (0.9%) was Grade 5. There were eight (7%) postoperative deaths. Approximately 60% of the tumors were located in the sphenoid wing (23.7%), convexity (21.1%), and parasagittally (14.9%). Histological diagnosis in 96% of the patients was transitional (42.1%), syncytial (34.2%), and fibroblastic (20.2%) meningiomas. Eight (7%) patients received postoperative radiotherapy. There was evidence of recurrence in 22 patients (19.3%). Twenty-one underwent a second surgical procedure. Using survival analysis, it was determined that 80% of the patients were free of recurrence 5 years after the initial surgery, and approximately 50% showed no recurrence 20 years after the initial surgery. Only the grade of the initial surgery had a statistically significant influence on recurrence. Sex of patients, site and histology of the tumor, and postoperative radiotherapy had no statistically significant influence on recurrence. Angioblastic and malignant meningiomas were rare (only four cases), and recurred relatively quickly.

Role of protein content in CSF ascites following ventriculoperitoneal shunting. Case report.

The case is reported of an 11-year-old girl with a recurrent craniopharyngioma who developed massive ascites following a ventriculoperitoneal (VP) shunt procedure for hydrocephalus, associated with an elevated cerebrospinal fluid (CSF) protein level. The ascites resolved after removal of the shunt. The CSF protein returned to normal levels following excision of the recurrent craniopharyngioma, and ascites did not recur after a second VP shunt was inserted for recurrent hydrocephalus. In this case, elevated CSF protein is believed to have been responsible for ascites developing after VP shunting. There was no recurrence of ascites after the peritoneal cavity was again used for shunting, at which time the protein had returned to normal values. Twelve previous cases of ascites complicating VP shunting are reviewed and the etiology of the condition is discussed.