Recovery of the sutured facial nerve after removal of acoustic neuroma in patients with neurofibromatosis-2.

The authors compared the long-term recovery of sutured facial nerves after the removal of 8 neurofibromatosis-2 (NF2)-associated and 22 non-NF2 acoustic neuromas. The patients were from a series of 270 patients operated on for an acoustic neuroma between 1979 and 1989. The assessment was done with a modified House and Brackmann scale from video recordings.

Interface between the facial nerve and large acoustic neurinomas. Immunohistochemical study of the cleavage plane in NF2 and non-NF2 cases.

In acoustic neurinoma surgery, the surgeon is required to find a cleavage plane between the facial nerve and the tumor, and with the aid of the operating microscope this is usually achieved by fine dissection. A histological specimen of the nerve-tumor interface is available only if the facial nerve was hopelessly adherent to the tumor (usually a large or giant neoplasm) and the surgeon decided to sever the nerve to obtain a complete removal. The authors have examined immunohistochemically the nerve-tumor interface of 20 such facial nerves (six cases of neurofibromatosis 2 (NF2) and 14 of non-NF2) in a series of 351 acoustic neurinomas.

The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment.

The authors have updated a series of 166 prospectively followed unoperated symptomatic patients with arteriovenous malformations (AVM's) of the brain. Follow-up data were obtained for 160 (96%) of the original population, with a mean follow-up period of 23.7 years.

Functional results of facial nerve suture after removal of acoustic neurinoma: analysis of 25 cases.

The facial nerve is sometimes severed during the removal of acoustic neurinomas, either intentionally to ensure complete removal, or unintentionally because of difficulties in identification. In such cases we have, if possible, sutured the nerve stumps microsurgically, either end to end or by use of an intervening nerve graft. We analyzed the outcome of 25 instances of facial nerve suturing in a series of 219 patients operated on for acoustic neurinoma from 1979 to 1987.

The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment.

In a prospective study, 52 patients with a spontaneous supratentorial intracerebral hematoma (ICH) were randomly assigned to receive emergency surgery or conservative treatment within 48 hours after the bleed. Patients with a decreased level of consciousness and/or a severe neurological deficit were admitted to the study. The overall mortality rate at 6 months was 42%: 10 (38%) of the 26 patients in the conservative group and 12 (46%) of the 26 in the surgical group.

Correlations between meatocisternography and audiological tests in suspected eight nerve tumors.

92 cases of suspected eight nerve tumors are analysed. Correlations between the findings in audiological and vestibular tests, patient histories and findings in conventional x-ray examinations and on the other hand those obtained in meatocisternography with air contrast in computerized tomography are drawn in order to see whether specific features of audiological tests can predict the meatocisternographic finding. The cases with positive findings are verified at surgery.

Suboccipital removal of vestibular neurinoma with preservation of the labyrinth.

Hearing preservation in surgery for vestibular neurinoma depends on several factors, the first of which is, of course, early diagnosis. If a small enough tumor is found in a patient with reasonable hearing, there is a fair chance that it can be removed in toto with preservation of some hearing. We report data from 40 operated patients; the question was whether the identification of the transverse crest and the removal of tumor from the lateral part of the internal auditory meatus could be achieved without opening of perilymph spaces.

Volume growth rate of acoustic neurinomas.

Of 79 acoustic neurinomas seen between June 1980 and June 1984, at least two CT scans were available for each of 23 tumors (21 patients); the scans were performed at intervals of at least 6 months. The volume growth rate of the tumours was either moderate, with a volume doubling time ranging from 205 to 545 days, or slow, with a doubling time ranging from 1090 days to no observable growth. No single clinical, radiological or histological feature correlated with any type of growth rate.

Hormone treatment of meningiomas: lack of response to medroxyprogesterone acetate (MPA). A pilot study of five cases.

Medroxyprogesterone acetate (MPA) has been used in high doses as hormone treatment for metastatic breast cancer. We treated five intracranial meningiomas with MPA expecting that MPA would reduce the volume or decrease the growth rate. All five patients were postmenopausal women, aged 47 to 73 years.

Hearing preservation in acoustic neurinoma surgery.

In a series of 120 patients with acoustic neurinoma, hearing preservation at removal of the tumour via the suboccipital approach was attempted in 30 ears. Hearing was preserved in 13 ears (43%), but in two, hearing was lost entirely in 3 to 4 years; thus the success rate was 36%. In 9 of the remaining 11 ears useful speech discrimination was present.

Changes in the requirements for blood transfusion in brain surgery.

The amount of blood used in transfusions during certain neurosurgical operations was less in 1978-79 than in 1971-72 and in 1965-66. The operations investigated were for gliomas and meningiomas of the brain, pituitary adenomas, acoustic neurinomas, arteriovenous malformations, and arterial aneurysms. The major change in anaesthetic techniques between 1965-66 and 1971-72 was the introduction of hypocapnia by controlled artificial hyperventilation.

A retrospective study on the effects of low and high doses of betamethasone on severe closed head injury.

A retrospective analysis of 113 patients with severe head injuries (unconscious for six hours or more) showed no difference in the outcome for 59 patients treated with low doses of betamethasone compared to the outcome for 54 patients treated with high doses of betamethasone. There was no difference in the number of useful recoveries (low dose, 21/59; high dose, 20/54) and the mortality rates were about the same (low dose 29/59; high dose, 31/54). There were three deaths from infectious complications in the patients treated with high doses of betamethasone.

Recent expericience in the surgery of acoustic neurinomas.

A translabyrinthine method was used in 49 and a suboccipital approach in 55 cases, for the removal of an acoustic neuroma. The translabyrinthine procedure is well suited in cases with no pontine compression, whereas in large tumours the wide opening in the suboccipital method gives added safety to the procedure. The mortality rate was 3% and the facial nerve function after translabyrinthie surgery showed permanent paralysis in 4 patients.

Subarachnoid haemorrhage: long-term follow-up results of late surgical versus conservative treatment.

During 1964-9, 178 patients with subarachnoid haemorrhage from a single intracranial arterial aneurysm were allocated at random to receive operative or conservative treatment at an average of seven weeks after bleeding. During the follow-up fatal rebleeding episodes occurred in six of the 86 patients treated surgically and 16 of the 92 treated conservatively. This difference was significant.

Brain creatine kinase in blood after acute brain injury.

Severe cold injury of the brain increased significantly both total creatine kinase and the corresponding brain isoenzyme (CKBB) activity in confluens sinuum samples. CKBB could be detected also in peripheral blood a few hours after severe brain injury in eight of 12 patients. Finding of CKBB in human plasma may prove a useful indicator of severe brain injury.

Intracranial pressure in hydrocephalus after subarachnoid haemorrhage.

10 patients with hydrocephalus after subarachnoid haemorrhage underwent a continuous ventricular fluid pressure recording for at least 22 hours, 21-67 days after the first subarachnoid haemorrhage. 3 patients had normal pressures; 4 patients had pressures somewhat above normal, between 10 and 20 mmHg; three patients had rather a high pressure, with a mean above 20 mmHg and peaks to 45 mmHg. 5 patients had a shunt operation, which seemed to improve the patient's condition in 3 instances; a sixth patient improved during ventricular drainage, but suffered a fatal haemorrhage before a shunt could be inserted.