Facial nerve preservation during surgery for removal of acoustic nerve tumors.

A series of 33 patients with 35 acoustic nerve tumors is reviewed. Tumor size was estimated from computerized tomography (CT) scans, and its influence on anatomical and functional preservation of the facial nerve was assessed. Six tumors (one invading the petrous bone, three medium and two large tumors) were not detected on CT scans. The translabyrinthine approach was used in seven instances (one small and six medium tumors) and the suboccipital transmeatal approach for 28 tumors (seven medium and 21 large tumors). Anatomical preservation of the facial nerve was achieved in 83% of operations for tumor removal, two of which were subtotal. A further two patients underwent subtotal removal, but the facial nerve was destroyed. Large tumors carried an increased risk of damage to the facial nerve, but even in this group the nerve was preserved anatomically intact in 70% of cases. Damage to the facial nerve occurred more frequently in patients with preoperative evidence of facial weakness; however, this factor did not appear to influence functional recovery of the facial nerve, provided that the nerve was intact at the end of the operation. A simple grading system for facial nerve function is described. Ony 76% of anatomically intact facial nerves showed any evidence of function 1 month after surgery. Postoperatively, facial function improved with time. At the latest review, 45% of these patients had normal facial function or mild facial weakness (Grades I and II).

Sustained tumour opacification in infants during cerebral angiography.

Total body opacification in infants following the intravenous injection of a large dose of water soluble contrast medium has long been recognised, but no example of increased radiodensity of abdominal or intracranial tumours has been reported using this technique. This paper reports the sustained opacification of intracranial tumours in three infants during cerebral angiography. Two of the tumours were papillomas of the choroid plexus of the lateral ventricle and the third a medulloblastoma of the fourth ventricle. Three possible explanations of this phenomenon are briefly considered: 1. That the amount of contrast medium was sufficient to cause total body opacification and the visibility of the tumours was due to a combination of their vascularity and the iodine concentration in the circulation blood. 2. That the observed phenomenon is peculiar to these tumours. 3. That the sustained opacity of these these tumours is due to the same cause or causes as the density enhancement of some intracranial tumours demonstrated by computerised tomography after intravenous injection of contrast medium.

Computerized transverse axial tomography in the newborn.

7 babies, aged 6 days--8 wk, who presented with abnormal neurological signs during the first days of life were investigated by computerized transverse axial tomography. 3 babies had suffered perinatal asphyxia. Only 1 baby required a general anaesthetic to facilitate the investigation. Structural intracranial lesions were seen in 6 babies and comprised hydranencephaly, cerebral agenesis with grossly dilated lateral ventricles, unilateral cerebral oedema, subarachnoid cyst of localized cerebral atrophy.

Gowers' syringal haemorrhage.

The second case of Gowers' syringal haemorrhage, successfully treated by surgery, and the first such case in a child, is described. It is suggested that the very slow development of haematomyelia within an existing hydrosyringomyelia may originate from a torn intraspinal vein, deprived of its normal neural and glial support.