Faculty Bibliography

CT was used to examine six patients with clinically evident atlantoaxial rotary fixation, two patients with torticollis, and six normal subjects who had turned their heads to the side as far as voluntarily possible. The CT appearances of the atlantoaxial complex were identical in all three groups. To differentiate these groups, we propose a functional scan through C1-C2 in which patients are scanned initially as they present, with their heads fixed in lateral rotation. Subsequent scans are obtained with their heads turned to the maximum contralateral rotation. CT scans in patients with atlantoaxial rotary fixation demonstrate no motion at C1-C2 during this maneuver, while those in patients with transient torticollis show a reduction or reversal of the rotation of C1 on C2

From 1977 to 1986, 50 children aged 15 months to 18 years were treated for supratentorial malignant gliomas at the Memorial Sloan-Kettering Cancer Center and the New York University Medical Center. Thirteen patients had glioblastoma multiforme, 29 had anaplastic astrocytomas, and 8 had malignant gliomas. In 10 patients the tumor evolved from a low-grade lesion. Seven patients, including 2 patients with neurofibromatosis, developed multiple primary malignant neoplasms. The median time to tumor progression after surgery was 31 weeks, with local recurrence representing the mode of treatment failure in nearly all patients. Notable clinical features included symptomatic leptomeningeal metastasis (13 patients) and intratumoral hemorrhage (9 patients). The estimated median survival time for all 50 patients was 98 weeks, with a 3-year survival rate of 32%. A trend toward longer survival was seen in patients 12 years of age or younger at diagnosis. There was no apparent correlation between survival and tumor histology or tumor location. Recommendations for management are presented

Fifty-eight patients with previously irradiated intramedullary spinal cord astrocytomas underwent laminectomy for radical excision of their tumors. A high incidence of postoperative cutaneous cerebrospinal fluid fistulas and large pseudomeningoceles following routine closure prompted the development of an alternative method of wound closure using mobilized musculofascial flaps. The authors describe the surgical techniques and pitfalls to be avoided during the closure of complicated laminectomy wounds

Between July 1975 and July 1985, 20 patients with 24 congenital distal anterior cerebral artery (DACA) aneurysms were admitted to our institution and underwent microsurgical clipping of their aneurysms. This group composes 4% of the 588 aneurysms managed surgically during this period. The clinical presentations included subarachnoid hemorrhage, transient ischemic attacks, headaches, and seizures. Fourteen patients had additional vascular anomalies documented by angiography: multiple aneurysms, bilateral DACA aneurysms, arteriovenous malformation distal to incidental DACA aneurysms, and azygous DACA. Computed tomography was performed in 19 patients and was valuable in preoperative planning and prognosis: intracerebral hematoma and intraventricular hemorrhage were associated with poor preoperative grade and the development of vasospasm. Operative management, case morbidity/mortality, and the high incidence of multiple aneurysms and other vascular anomalies associated with DACA aneurysms are discussed. Because of the devastating effects of subarachnoid hemorrhage from these aneurysms, they should be carefully searched for and treated before hemorrhage occurs

A 34-year-old woman with Factor XI deficiency presented with rapidly progressive quadriplegia following a 1-week prodrome of cervical pain. At operation, a spontaneous hematomyelia was evacuated from the C4-6 vertebral level. The pathophysiology of spontaneous hematomyelia is discussed