Synovial cyst of the cervical spine.

A case of acute posttraumatic myelopathy resulting from hemorrhage into synovial cysts bilaterally at the C-6, C-7 facet joints is presented. The pathogenesis of synovial cysts remains unclear, although reports in the literature have implicated trauma leading to cyst enlargement. Hemorrhage into the cavity of the synovial cysts resulted in epidural compression of the spinal cord in this patient. Because spinal synovial cysts cannot be unequivocally diagnosed preoperatively, other more common conditions must be considered in the differential diagnosis. Radiographic analysis including plain films, computed axial tomography, and metrizamide myelography are of value in establishing a neurological diagnosis. Surgical decompression and excision of the lesion may result in significant neurological improvement.

A new technique for making cortical incisions with minimal damage to cerebral tissue.

A new technique is described that minimizes the damage to neural tissues caused by the cortical incisions that must be made when operating on intracerebral or intraventricular lesions. Symmetric cortical incisions were made bilaterally in the same region of the middle suprasylvian gyrus in six dogs. Blunt dissection was performed on the right side. A new technique, which utilizes a balloon catheter, was employed on the left side. A greater hemiparesis was observed on the left side in all dogs. There was a mild but definite hemiparesis on the right side in four dogs, which improved within 2-3 days postoperatively. The dogs were killed on the sixth postoperative day. The Fink-Heimer technique for selective staining of degenerating axons and their terminal boutons was used to determine the extent of neuronal damage. Histologic studies support clinical observations in the experimental animal that the neural damage resulting from cortical incision is significantly decreased when the balloon catheter technique is applied.

Intratemporal schwannoma of the facial nerve.

Two patients with schwannomas that originated from the region of the geniculate ganglion of the facial nerve are reported. They presented with progressive facial nerve paralysis and variable disturbance of hearing. Computed tomograms demonstrated a mass lesion eroding the temporal bone (petrous portion) and extending into the middle fossa. The treatment consisted of complete excision of the tumor, and a hypoglossal-facial nerve anastomosis. Computed tomography should be performed on all patients with facial palsy of a progressive nature. Early diagnosis and surgical treatment of facial schwannoma should permit preservation of function of the facial and the acoustic nerves.

Modification of intracranial aneurysm clip. Technical note.

A modification of the Mayfield aneurysm clip is described which is thought to decrease the chance of slippage of the clip, mainly in the case of large-necked and atherosclerotic aneurysms.

Modified suction tip. Techical note.

A modification of the standard suction tip is described that decreases risk to delicate tissues.