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Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 33 - N° 4 - p. 351

(1993). Huw Griffith 1930–1993. British Journal of Neurosurgery: Vol. 7, No. 6, pp. 597-598.

Neurosurgical classics II . Edited by robert h wilkins andgloria k wilkins. (pp 592, US$95.00). Published by American Association of Neurological Surgeons, Rolling Meadows, 2000. ISBN 1 897284 74 X. The first volume of this book, which was published in 1965 under the auspices of the Harvey Cushing Society, now The American Association of Neurological Surgeons, republished 52 papers of outstanding interest in the history of neurosurgery which had been published before 1940. Those papers which had been originally printed in languages other than English were translated into the English language. Because of demand the first volume was reprinted in 1992. This second volume of neurosurgical classics reprints a further 58 papers published since …

We construct an idealized three-dimensional model of Saturn's magnetosphere. The total magnetospheric field is a sum of three contributions; the first two contributions are internal, in the form of a planetary dipole and an equatorial ring current deduced from Voyager observations. We concentrate on the third contribution, resulting from the interaction of the solar wind with the Kronian magnetosphere. From the balance between the solar wind ram pressure and the magnetospheric pressure, we provide simultaneously models of the magnetopause and of the magnetic field due to the surface currents on the magnetopause. The resulting magnetopause has characteristics intermediate between those of analogous Earth and Jupiter magnetospheric models. A natural day-night asymmetry arises in the total magnetospheric field. Its intensity is tested with Voyager 1 data: the third contribution improves the agreement between data and models in the outer magnetosphere. This work extends the range of a physically reliable model of Saturn's magnetosphere in latitudinal and longitudinal directions from regions where there have been observations to regions where there have not. We discuss several possible applications, particularly some relevant to the future Cassini mission.

Four cases are described of focal contusion and swelling of the temporal lobe after head injury, giving rise to acute cerebral compression. The clinical features, pathology and treatment of this condition are discussed. It is suggested that this occurrence may be a common treatable complication of closed head injuries which may easily be overlooked, with fatal results, if exploratory cranial surgery is undertaken without preliminary cerebral angiography.

In 76 consecutive patients with spinal cord compression the process of diagnosis and referral was investigated. This investigation was carried out at the time of admission to the neurosurgical unit when it was possible to obtain fresh information about each patient's pre-admission management. All the patients had been referred from District General Hospitals and 71 had previously consulted their general practitioners. Sixty-two per cent took over a week from the time they first saw their own doctor to reach the referring hospital, after reaching hospital 47% of patients waited a week or more before they were referred to a neurosurgeon. During the process of referral, the proportion of patients able to walk unaided and control their sphincters fell from 68% to 10% while the proportion with complete cord lesions rose from 1.5% to 28%. In 48% of cases there had been delays in diagnosis and referral which appeared avoidable. The reasons for these delays and their effect on the eventual outcome are assessed.

Three cases are reported of raised intracranial pressure associated with spinal tumours. The theories which have been advanced to explain this complication are discussed and it is suggested that in many of the reported cases the underlying mechanism may have been intracranial spread of the tumour and not a blockage of the cerebrospinal fluid pathways with proteinaceous deposits, as has been widely maintained. Autopsy revealed the former process to have operated in 2 of the 3 cases and it may have done so in the third. Two cases had unusual features in common: they were malignant schwannomas (a very rare spinal tumour) and they had both developed within the field of irradiation given for benign conditions many years previously.

A sentinel health information system using a telematics system to collect epidemiological data from a network of general practitioners (GPs) making up 5% of the GP population was set up in October 1986 in Aquitaine, France. In the first year, four topics were under surveillance. The GPs reported data for each case diagnosed by filling out a questionnaire displayed on their home terminal (Minitel), which transmitted the data by standard telephone lines to a central minicomputer located in the Bordeaux University Medical Centre. Regular feedback was provided to the participating GPs, public health officials and the Bordeaux Medical School. A detailed report of GP participation is presented, the reliability of our findings is discussed in terms of the motivational factors of participants, and the usefulness of the system is evaluated both for immediate teaching implications and for future research possibilities.

Resume La prescription des antibiotiques par le generaliste est appreciee au travers d'une enquete epidemiologique realisee en Aquitaine en 1983 et portant sur 11 300 patients dont 22 % ont recu une telle prescription.

In a series of 50 consecutive tumours involving the frontal lobes, seven cases (14%) were found who exhibited the syndrome, first described by Andrew and Nathan in 1964, of frequency of micturition, urgency, and incontinence causing distress to the patient. This suggests that this syndrome may occur rather more commonly than those authors had indicated. In 100 consecutive intracranial tumours, no instances were found with non-frontal tumours, indicating that the syndrome may be of localizing value.

Fourteen cases of simulated paraplegia and tetraplegia encountered amongst 4,800 neurosurgical admissions are described. The classification of such cases is difficult. Use of the term "hysteria" depends on whether the behaviour is judged to be conscious or not, but this can rarely be decided. In most of the patients the paralysis was of relatively short duration and recovered rapidly with simple methods of treatment which permitted this to occur without loss of face, but such cases presenting as acute neurological emergencies represent only one relatively simple form of pretended or "hysterical" illness. Many of these patients are probably never seen by psychiatrists.

✓ Two cases are reported of separate but superimposed chronic subdural collections occurring over one cerebral hemisphere convexity. It is suggested that this phenomenon may account for some apparent recurrences of chronic subdural collections after simple burr-hole evacuation.

Summary Reports of three patients with tuberculomas of the brain are presented. The mode of presentation and clinical features of this condition are reviewed.

A case of disc prolapse expanding the lumbar spinal canal by eroding the dorsal aspect of the body of L4 vertebra is reported. Despite no previous reports this condition is not considered to be extremely rare.

The outcome of treatment with an antifibrinolytic agent (tranexamic acid) for six weeks after rupture of an intracranial aneurysm was assessed in a randomised controlled trial. Twenty-two out of 25 (88%) treated patients survived at follow-up of three to 33 months compared with 14 out of 25 (56%) control patients. Among the patients who did not undergo operation the survival rate was 81% (13 out of 16) in treated patients and 42% (8 out of 19) in controls. Antifibrinolytic treatment has so far been assumed merely to postpone rebleeding and has been used to enable surgery to be deferred. These findings suggest that tranexamic acid may actually prevent rebleeding without operation. Prolonged antifibrinolysis may therefore prove useful in those patients in good condition whose aneurysms do not lend themselves to surgical obliteration.

Involvement of the lower cranial nerves as false localizing signs of intracranial tumour is very rare. A laterally placed posterior fossa meningioma gave rise to contralateral cerebellar ataxia and palsies of the fifth, ninth, and tenth cranial nerves.

In giving the following I would say, by way of preface, that though the matter may not be of sufficient importance to be made the subject of a formal communication to the Society, or to be embodied...

Three cases of a form of focal hydrocephalus are described which the authors term "entrapment of the temporal horn". Obstruction of one lateral ventricle in the region of the trigone isolates the temporal horn. Continued secretion of cerebrospinal fluid within the temporal horn causes it to behave as a mass lesion. In the cases described the causes of the condition were recurrent glioma, previous tuberculous meningitis and surgical excision of an arteriovenous malformation which extended into the trigone. Shunting of the trapped temporal horn provides satisfactory treatment.

We report two patients with acoustic neuromas which spread upwards through the petrous temporal bone into the middle fossa as well as medially through the porus acousticus into the posterior fossa. There appear to be no previous reports of such transpetrous spread of an acoustic neuroma.

Two cases are reported of patients with spinal dysraphism who developed abscesses within the spinal cord. In one case the infection had spread to the cord through a dermal sinus, as in the six cases previously recorded in the literature. In the other patient the sepsis developed within an intramedullary epidermoid tumour, but the route of infection was not clear. Each patient made a virtually full neurological recovery after open drainage of the abscess.

Ficus can only reproduce if they are pollinated by mutualistic wasps that breed within the figs. Pollen-loaded wasps enter the figs when the female flowers are receptive. Several weeks later, their offspring load pollen within the fig and then emerge. As individual trees typically produce crops of synchronous figs at long intervals, the shortlived wasps have to move to another, receptive, tree. The wasp population can only survive, and hence the fig population reproduce, if there are trees fruiting all over the year. When only few trees are present within a population gaps in the flowering sequence may lead to the extinction of the local pollinator population. Two models are presented. One investigates the number of trees necessary in order to sustain a local pollinator population when the tree population has a seasonal pattern of fruiting. The second model investigates how such a seasonal pattern may evolve within a fig population as a result of individual selection on the trees. It is shown that pollinator populations are fragilized under seasonal conditions. Hence, the breeding system ofFicus limits their expansion into highly seasonal habitats. Seasonal habitats may also lead to seasonal adjustment of male versus female investments and to the evolution of dioecy.

The hypothesis is put forward that the disturbance of gait seen with tumours of the posterior fossa is largely due to subacute dilatation of the ventricular system and not to the involvement of midline cerebellar structures concerned with balance or the coordination of truncal muscles, as is widely taught. This hypothesis is examined in the light of the clinical evidence provided by the symptomatology and treatment of 19 consecutive cases of intracranial mass lesions exhibiting truncal ataxia.

The operative management of intracerebral abscesses remains controversial, with both primary radical excision and repeated aspiration having their advocates. This paper describes a surgical technique which combines the advantages while avoiding the disadvantages of the two surgical approaches. At open operation the abscess is widely incised, all pus removed from within the capsule and any daughter loculi under direct vision and the empty capsule irrigated with antibiotic solution before closure of the wound without drainage. Fifteen cases were treated by this method. There were no deaths, 13 patients made full neurological recoveries and two were left partially disabled. In only one case was a second operation necessary to remove pus which had re-formed after an adequate primary clearance. There were no cases of wound sepsis or of late recurrence of the abscess.

An attempt is made to assess the overall impact of current treatment of ruptured intracranial aneurysms, based on the outcome in 200 consecutive patients, unselected in that they were transferred to neurosurgical care as soon as they were referred, regardless of clinical condition. Overall mortality at 1 year was 35.5%. It is estimated that at the present time treatment improves the one-year survival of patients who reach the primary care hospital by no more than 12-15%. In assessing the apparent benefits of treatment, it is easy to overlook the effects of patient selection and the way in which data are presented. Other admission policies in line with current practice but involving greater selectivity and delay in transfer, could have reduced the one-year mortality of this series of patients to 16.1%, by excluding from neurosurgical care patients who were in a poor condition or about to deteriorate. The outcome data in this series could be presented in different ways so as to represent the surgical mortality as ranging between 13.8% and 3.3%.

Twenty-seven of 29 consecutive patients with brain abscess were treated by 'open evacuation of pus'. This technique involves wide exposure of the brain so that the abscess capsule may be incised and cleared of pus under direct vision. The empty capsule is left in situ after antibiotic irrigation and the wound is closed without drainage. Of the 27 patients, one died (3.7%), two were partly disabled and 24 (88.9%) were left with no neurological disability caused by the abscess. In only one case was a further operation required to remove pus which had reformed after an adequate primary clearance. There were no cases of wound sepsis or of late recurrence of the abscess. The author believes that 'open evacuation of pus' is the most satisfactory surgical technique for an intracerebral abscess.

In three patients, trigeminal sensory symptoms remitted with treatment of associated hydrocephalus, two with facial pain resembling trigeminal neuralgia, and one with facial paraesthesiae. The pathological basis of these phenomena and their relationship to idiopathic trigeminal neuralgia are discussed.

British consultant neurosurgeons in post for at least one year were sent a postal questionnaire about the way in which they managed patients with ruptured aneurysms; 87% replied. Wide differences were evident in almost all aspects of treatment, before, during and after surgery. A consensus of opinion appeared in only a few areas: the employment of magnification during surgery, the use of clipping as the preferred method of surgical treatment, and a general reluctance to operate on patients with a depressed conscious level within a week of haemorrhage.

A case is reported of a cryptococcal granuloma occurring within the lateral ventricle. The findings on angiography and brain-scanning led to a preoperative diagnosis of intraventricular meningioma. There are no previous reports of an isotope brain-scan in this condition and angiography usually shows an avascular swelling.