Surgical correction of proximal femoral nerve entrapment.

BACKGROUND: Femoral nerve palsy is usually a result of trauma. Isolated femoral nerve palsy without external trauma is restricted to occasional case reports in various circumstances. CASE DESCRIPTION: Three cases of nontraumatic femoral nerve palsy are reported who presented with pain and weakness. Symptoms were relieved by transection of the iliopectineal arch. This is believed to be a newly described syndrome. An additional case of femoral nerve entrapment following vaginal hysterectomy is described. This case presented only as a pain syndrome. CONCLUSIONS: There is a syndrome of femoral nerve entrapment at the iliopectineal arch that can be easily relieved by sectioning of this arch, analogous to carpal tunnel syndrome. Several cases of femoral nerve palsy previously reported may be examples of this syndrome.

Delayed CSF seeding of benign oligodendroglioma.

We report the case of a man who at 42 years of age had right frontal lobectomy for removal of a benign oligodendroglioma. Seventeen years later, at age 60, he had resection of a fourth ventricular vermian lesion, which was found to be histologically identical to the original lesion. A further lesion in the left occipital lobe was not biopsied but was treated with radiation therapy. We suggest that these subsequent two neoplasms represent CSF spread of the original tumor. This case emphasizes the need for indefinite longitudinal surveillance for these patients.

The injudicious laminectomy.

This report is an attempt to point out a hazard of what would be otherwise competent treatment of acquired spinal stenosis, namely laminectomy and facetectomy, in a small group of patients who are osteoporotic and who also have a "minor" compression fracture in the area in which the surgery is contemplated. Three patients who had such laminectomies, with disastrous results, are presented, along with one patient who, instead, had internal fixation and fusion at the time of laminectomy with an excellent result. The latter approach is recommended in such cases.

Treatment of cerebrospinal fluid leaks and gram-negative bacillary meningitis with large doses of intrathecal amikacin and systemic antibiotics.

Six patients with cerebrospinal fluid (CSF) leaks and gram-negative bacillary meningitis (GNBM) were treated with large doses of intrathecal amikacin (20 to 40 mg daily) and systemic antibiotics. Bactericidal activity was measured in the CSF of each patient, and the dose of intrathecal amikacin was increased if bactericidal activity was absent. Five of six patients had no bactericidal activity with systemic antibiotics alone and/or low dose intrathecal amikacin. All six patients were cured, and three of four patients with vertebral lesions had cessation of CSF leaks within 72 hours of the start of intrathecal amikacin. Intrathecal treatment for 7 to 10 days was adequate for five patients; the CSF of all patients was sterile within 72 hours, and all had a 90% reduction of pleocytosis in the CSF within 96 hours. One patient had radicular back pain after each intrathecal injection, but other side effects were not observed. These findings indicate that CSF leaks associated with GNBM can be effectively treated with large doses of intrathecal amikacin plus systemic antibiotics.

EEG operant conditioning in intractable epileptics.

Eight epileptic patients with mixed seizures refractory to medical control participated in a double-blind crossover study to determine the effectiveness of operant conditioning of the EEG as an anticonvulsant procedure. Baseline levels of seizures were recorded for four months prior to the beginning of treatment. Participants then received false (noncontingent) feedback for two months followed by an ABA-patterned training program lasting a total of ten months. Subjects were assigned to three treatment groups based on different schedules of EEG feedback. They were first trained (A1 phase) either to suppress slow activity (3 to 8 Hz), to enhance 12- to 15-Hz activity, or to simultaneously suppress 3- to 8-Hz and enhance 11- to 19-Hz activity. This was followed by a B phase, in which patients were trained to enhance slow activity (3 to 8 Hz). In the final phase (A2), the initial training contingencies were reinstated. Neuropsychological tests were performed before and after training, and changes in EEG activity as determined by Fast Fourier spectral analyses were analyzed. Five of eight patients experienced a decrease in their mean monthly seizure rate at the completion of feedback training as compared with their initial baseline level.

Early third ventriculostomy in meningomyelocele infants - shunt independence?

Percutaneous anterior and posterior third ventriculostomy utilizing a McKinney leukotome has been performed with fluoroscopic control in 9 newborn infants with meningomyelocele and hydrocephalus immediately following their shunt. The procedure was instituted in 1975, and there have been no shunt revisions in such patients since that time. Wider application of this or a similar technique in newborn meningomyelocele infants seems warranted.

Caudal block: cost effective primary treatment for back pain.

Therapeutic caudal block was applied as primary treatment to 81 consecutive patients. The 26 who were completely relieved of symptoms were older, were predominantly women, and usually had had no previous surgery. Multiple blocks were required in some, but there were no complications. Because considerable financial benefit accrued to the patients whose pain was relieved, therapeutic caudal block is suggested as primary treatment for back or back and leg pain, particularly in older patients not previously operated on.

Percutaneous restoration of a kinked shunt. Case report.

A thin-walled atrial catheter used in shunting for hydrocephalus may become curled or kinked in the neck after it has been in normal position and functioning for years. The usual cause is a bout of severe coughing. Such a case is described together with a percutaneous method of restoration of the shunt by transfemoral catheterization utilizing a wire loop.

Afibrinogenemia with intracerebral hematoma. Report of a successfully treated case.

A patient with congenital afibrinogenemia underwent removal of an intracerebral hematoma following specific therapy with fibrinogen-containing concentrates. We believe the successful neurosurgical intervention in a life-threatening complication of this unusual coagulation disorder to be unique.

Experiences with the technique and complications of meglumine iothalamate (Conray) ventriculography.

The development of contrast ventriculography is outlined and an experience with 40 meglumine iothalamate ventriculograms in 37 patients is described. The details of the procedure, hazards, value, and indications are discussed.