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The substitute of the superior sagittal sinus by a new method namely a vessel prosthesis (Gore-Tex) and special connecting pieces in relationship with drug treatment is represented. The method is very simple and can also be carried out by microsurgically untrained operators. Moreover, this method allows a clear faster operation without using a bypass. The sinus was ligated, partially resected or incised and replaced by the described prosthesis in 15 pigs. 3 experiments were without any assertion at all. The sufficiency of the prosthesis was provable in 10 of the 12 remaining pigs. With that a high sufficiency quota was obtained in comparison with the literature. An open prosthesis for a longer time makes possible the formation of a collateral circulation. Furthermore, the prosthesis enables the microsurgical implantation of bigger pontine veins.

Anatomic study of 20 injected specimens dissected under operating microscope allowed evaluation of anatomic site of Galen's ampulla, venous confluents of Galen's ampulla, and internal cerebral veins' terminations and their arterial connections in this region. Findings demonstrated that even the wall of the great vein of Galen was supplied by arterioles, as though it was vascularized in the same way as durameter.

Successful surgical treatment of a case of aneurysm of the vein of Galen is presented. An 11-month-old boy was admitted with episodes of convulsive attacks. Neuroradiological examination revealed an aneurysm of the vein of Galen filled by branches of posterior cerebral arteries and left thalamoperforating artery. Regional cerebral blood flow, which was measured by a method of xenon-enhanced computed tomography, showed a low flow area in the frontal and occipital regions. The aneurysm was approached through the bilateral parietooccipital interhemisphere, freed from the feeders, and ligated. During the operation, cortical blood flow was monitored for prevention of normal perfusion pressure breakthrough. After the feeders were successfully clipped, the blood flow increased and became normalized in the related cortex. There was no postoperative neurological deterioration.

A 12-day-old infant in intractable cardiac failure due to a vein of Galen malformation was treated successfully with serial ligation of the majority of the vessels feeding the malformation. Despite some residual vascular supply to the malformation, the congestive heart failure has disappeared and growth and development have been normal over a 3-year follow-up period.

A variety of cerebrovascular abnormalities may become manifest in the first years of life. We present our recent experience with 7 children, ages 1 week to 7 months of age, who presented with congestive heart failure and progressive head enlargement (3), heart failure alone (1) and head enlargement alone (2). The anomalies include vein of Galen aneurysm (3), complex arteriovenous fistula (2) and posterior fossa dural arteriovenous malformations (2). Computed tomographic scanning was invaluable in delineating the site of the lesion while arterial digital subtraction angiography was utilized to obtain the high-quality images, reduced dye volume and rapid filming. Direct surgical intervention was accomplished in 5 cases, while embolization was utilized in 2. One child underwent direct partial occlusion and embolization. Congestive heart failure resolved in 2 of 3 operated cases and improved in those undergoing embolization. Hydrocephalus improved in 2 cases with the elimination of the fistula. Morbidity included seizures and a hemorrhagic infarction in 1 case. Neurologic outcome was satisfactory and there was no surgical mortality.

An analysis of 57 patients with trigeminal neuralgia (TN) treated with microvascular decompression (MVD) is presented. Mean follow-up time was 3.1 years. Vascular compression of the trigeminal nerve root was noted in 54 cases. In the remaining 3 patients, adhesions were observed in two, whereas no obvious cause was found in one case. Among the patients with vascular compression, 43 (80%) became painfree immediately after surgery, and have remained so during the observation period. There was an indisputable relationship between the degree of observed vascular compression of the nerve and long-term complete pain relief. There was no mortality in association with the surgery. Major morbidity was seen in 3.6%, and partial facial sensory loss was seen in seven patients (12%). The implications of these findings are discussed.

A thirty-two-year-old male developed multiple neurologic symptoms. Medical evaluation disclosed hypertension, obesity, and a type IV hyperlipoprotein electrophoresis. A nuclear cerebral arteriogram showed reduced flow in the right middle cerebral artery. Arteriographic examination revealed an occlusion at the origin of this artery. The ipsilateral superficial temporal artery was too small to be used in an EC-IC bypass procedure. To correct these conditions, a two-stage procedure was performed. First, an arteriovenous fistula was created between the superficial temporal artery and its accompanying vein. Second, four and one-half months later, the temporal vein, which had by then enlarged, was resected and grafted from the proximal superficial temporal artery to the right angular artery. Angiography three months after the latter procedure showed that the anastomosis was patent.

The structural topographic features of a constantly present surgically significant formation--the superior petrosal vein--were disclosed on the basis of postmortem examination of the region of the cerebellopontile angle (204 cases) by means of fine endofibroscopes introduced through a small trephination opening behind the mastoid process of the temporal bone. The method provides for detailed appraisal of the microtopography of the vessel in three-dimensional space without disturbing the regional structural relationships, and makes it possible to disclose more exactly the character of the connection of the vein with the meninges and to determine the variants of the topography of its orifice and the types of formation of the main venous collector without damaging this easily injured vessel. The surgical significance of the recorded features of the structure of the superior petrosal vein is shown.

A technique for reconstruction of a cerebral cortical vein which has been sacrificed during an interhemispheric or subtemporal surgical approach is described. The method involves the use of silicone tubing. The author's clinical experience in six patients is summarized.