Faculty Bibliography

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

Intramedullary spinal cord astrocytoma is a relatively uncommon neoplasm accounting for only 4% of central nervous system tumors in childhood (1-5). Over the past four years the authors have operated on 100 young patients with very extensive astrocytomas, many of which involve the entire length of spinal cord. This unusual series has provided us with a unique opportunity to study the biology of the tumor, the response to conventional surgical and radiation therapy, and to develop a surgical technique that permits gross total resection of the neoplasms

The authors describe their experience with an unusual postoperative syndrome of pseudobulbar palsy occurring a few days after the extirpation of large midline vermian/4th ventricular tumors in children. The patients had a delayed onset of supranuclear cranial nerve palsies associated with emotional incontinence and lability that resolved over several weeks to months. It is postulated that retraction pressure on the medial cerebellum and split vermis is the operative insult responsible for edema that subsequently tracked along fiber pathways in the middle and superior cerebellar peduncles into the upper pons and midbrain. Modifications of operative technique to eliminate the need for retraction are presented