Kissing spines: fact or fancy?

In the Neurosurgical Clinic in Groningen 64 patients underwent surgery between 1975 and 1985 for a clinical and radiological syndrome described by Baastrup in 1933 and called in the Anglo-saxon literature: "kissing spines". Because the results of the surgical treatment were disappointing we submitted these results to further analysis.

The recurrence of supratentorial meningiomas after surgery.

A series of 113 consecutive patients underwent surgical treatment for a supratentorial meningioma between January 1955 and January 1975. There were 73 women and 40 men. There were 10 postoperative deaths (8.8%). The surgical procedure was graded according to Simpson's classification. 18 patients had a recurrence (17.5%). Women had a preponderance for recurrence. In our series the recurrence rate was 13 for women (17.8%) and 5 for men (12.5%). There was no correlation with the age of the patient or site of the tumour. The grade of initial surgery and the histology of the tumour were shown to be important.

Anatomical relations in the carpal tunnel: a computed tomographic study.

Computed tomography of the carpal tunnel was performed in the hands of both patients and controls in a neutral position, in flexion and in extension. The median nerve was not compressed between the long flexors and the flexor retinaculum in either flexion or extension of the wrist. In flexion, the nerve usually moved dorsally, away from the flexor retinaculum. No difference could be found between the cross-sectional area of the carpal tunnel between patients and controls.

Tumours of the thalamic region. A retrospective study of 27 cases.

Twenty seven patients with thalamic tumours were evaluated retrospectively in the Neurosurgical Clinic of the University Hospital in Groningen between 1969 and 1983. The diagnosis was based on neuroradiological studies. The authors recommend stereotactic biopsy of thalamic tumours followed by irradiation in selected cases.

Cerebrospinal fluid shunting for hydrocephalus: a retrospective analysis.

A series of 383 extracranial CSF shunts performed between Jan. 1980 and Jan. 1985 for hydrocephalus in children and adults is reviewed. Ventriculoatrial (VA) and ventriculoperitoneal (VP) shunts were compared with a special attention to infections. The difference between VA and VP shunts concerning indication of revision, operative mortality and infection related morbidity and mortality was not significant.

Sympathetic dysfunction in patients with persistent pain after prolapsed disc surgery. A thermographic study.

Vasomotor function in the lower limbs was tested by means of thermography in 48 patients with and without residual complaints after surgery for a prolapsed intervertebral disc. There is a definite correlation between the severity of the complaints and the thermographic responses which corresponds well with the evidence for a sympathetic reflex dystrophy of the legs (causalgia).

Barbiturates for cerebral aneurysm surgery. A review of preliminary results.

Ninety-two cerebral aneurysm cases treated by clipping under moderate hypothermia are reviewed. Twenty-three of these cases received pentobarbitone during surgery in doses sufficient to render the EEG flat. The overall combined mortality and morbidity (complication rate) among 69 non-barbiturate cases was 21.7%. There were significant differences in results between aneurysms in different anatomical locations. The complication rate among eight middle cerebral artery aneurysm cases was 62.5% and among ten internal carotid artery bifurcation cases 40%, while that among nineteen internal carotid artery cases was 16% and among 27 anterior communicating complex cases 7.4%. The overall complication rate among 23 pentobarbitone cases was 17%. There were no complications among eight middle cerebral artery cases; one of two internal carotid bifurcation cases became hemiplegic following occlusion of the middle cerebral artery at is origin. The complication rate among nine internal carotid cases was 22%. No difficulties were experienced regarding haemodynamic stability or cardiac rhythm while using pentobarbitone at normothermia or at 28 degrees C. It is suggested that cerebral aneurysms involving the middle cerebral artery which appear to be most at risk may have the most to gain by the prophylactic use of pentobarbitone during surgery.

The cause of failure in high cervical percutaneous cordotomy: an analysis.

Factors that might have contributed to failure of high cervical percutaneous cordotomy in 23 patients with intractable pain were investigated. Cordotomy failed in 3 patients, 20 had initially good pain relief (87%). True recurrence occurred in 5 patients, 3 of them developed pain elsewhere. Analysis of these three types of failure showed a purely technical cause in 2 cases; other failures or recurrences were due to the underlying disease being not strictly unilateral, or possibly to the existence of other ascending pathways carrying nociceptive impulses apart from the spinothalamic tract. There was no influence of age, sex, type of cancer or previous medication on the result of percutaneous cordotomy. Patients with plexus involvement did better than those with bone metastasis.

Transfrontal pituitary surgery: clinical results, intraoperative management, and postoperative monitoring.

Sixty-nine cases of pituitary tumours with suprasellar extensions are reviewed. Twenty cases were recurrent. All were removed via a frontal craniotomy and surgery was performed under moderate hypothermia in all except seven cases. In 59 cases, lumbar cerebrospinal fluid (CSF) drainage was performed in order to improve operating conditions. Amongst 42 primary cases, 29 (69%) were uncomplicated, 5 (12%) developed severe transient complications and one (2.4%) had a persistent deficit postoperatively; there were no deaths. Amongst 17 recurrent cases, 6 (35%) were uncomplicated; there were five deaths (29%) in the immediate postoperative period and one patient had a persistent deficit (6%). Acute hypertension and/or bradycardia were seen in 32 cases (54%) at the time of lumbar CSF drainage. These included all those who subsequently died and 10 of the 12 cases who developed severe complications. In 7 cases where ventricular CSF drainage was performed intraoperatively, one showed acute hypertension accompanying brain retraction but there were no postoperative complications. Two of these cases were recurrent. Postoperative intracranial pressure, measured epidurally, varied widely in both complicated and uncomplicated cases and was frequently low (less than 10-15 mm Hg) in the presence of severe complications. It is concluded that lumbar CSF drainage should not be performed in the presence of a suprasellar extension and that postoperative monitoring of the epidural pressure is of little value in these cases for the early detection of postoperative complications pertaining to the operative field.

Relation of false localizing signs and remote hyperaemia in patients with intracranial mass lesions.

Seventeen patients with intracranial mass lesions underwent rCBF measurements with the xenon-133 carotid injection technique. In 11 patients remote areas of hyperaemia were found. There was a relation between location of the remote hyperaemia and the site of the mass lesion. In 10 of 11 patients with remote hyperaemia autoregulation was focally lost, and in 5 of 7 patients there was focal impairment of arterial pCO2-reactivity. In 8 of 11 patients with remote hyperaemia false localizing signs were found, related to the hyperaemic areas. It is suggested that the remote hyperaemic areas may be the result of brain bulk shifting due to the mass lesion and represent the initial stage of brain herniation.

Some considerations on the central regulation of respiration and its disturbances.

The effect of increased intracranial pressure on the respiration pattern was studied in cats. It appeared that the different patterns described by Plum and Brown blend into each other under certain conditions.

Some principles of postoperative epidural pressure monitoring.

A retrospective analysis is presented of 115 cerebral tumour cases where continuous epidural pressure (EDP) monitoring was carried out postoperatively using an implantable transducer constructed on a coplanar principle. Correct implantation of the transducer is crucial to reliable measurement. The influence of transducer location on EDP is highly significant and can be accounted for at least partly by hydrostatic forces. The effect of postural changes similarly has a hydrostatic component. Clinically complicated cases were usually easily distinguishable from uncomplicated cases with a similar transducer location. EDP is usually low in the absence of complications during the first 6 to 12 hours postoperatively. For postoperative monitoring, an EDP transducer should be placed as near to the site of surgery as possible for maximum sensitivity to local pressure changes and the earliest detection of complications.