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Show Literature Abstracts was evidenced by CT or cerebral angiography. The ventricles were o'f normal size and there was no evidence for defective venous drainage. Cerebrospinal t1uid studies revealed an elevated protein level, lymphocytosis, and normal pressure. Disc swelling and visual symptoms had resolved by 11/2 months after discectomy. Possible pathogenetic mechanisms between spinal cord lesions and raised intracranial pressure are reviewed. However, this patient's acuity was markedly decreased, which seems to represent a papillitis that mayor may not be related to the herniated disc. This article reiterates the need to educate our nonophthalmologic colleagues as to the difference between papilledema and papillitis. Thomas C. Spoor, M.D., FACS • • • 26. Reference: Ehisevich, K. V., Ford, R. M., Anderson, D. T., et al.: Visual abnormalities with multiple trauma. Surg. Neural. 22: 565-575, 1984. Reprints: Robert M. Ford, M.D., Department of Neurosurgery, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada HZ6 1A4. Mechanisms involved in posttraumatic visual impairment were reviewed retrospectively in 24 patients with multiple injuries. Patients with direct ocular injury were excluded. Bilateral or monocular loss of vision occurred in 63% of patients. Seventy percent of injuries involved the anterior visual pathways. Traumatic optic neuropathies accounted for 35%. Pathogenetic mechanisms for visual loss included vitreous hemorrhage and optic atrophy secondary to elevated intracranial pressure, retinal hypoXia secondary to C-C fistulas, shearing and compression injury to the optic nerve, traumatic chiasmaI syndrome, temporoparietal and occipital contusions, and transtentorial herniation with occipital infarction. Visual deficits ranged from moderately reduced acuity and diverse hemianopias and scotomas to blindness. Thomas C. Spoor, M.D., FACS • • • 27. Reference: Arias, M. J.: Bilateral abducens nerve palsy without skull fracture and with a cervical spine fracture. Neurosurgery 16: 232-234, 1985. Reprints: M. J. Arias, Calle Marbella, 10, Fuengirola, Malaga, Spain. Possible mechanisms for abducens palsies after closed head injury without skull fracture are discussed. T~e most probable mechanism is thought to be c~ntuslOn and stretch of the nerve trunk against the ridge of the petrous bone and the rigid dural hole of entrance in the extradural space at the basilar process. Thomas C. Spoor, M.D., FACS • • • 206 28. Reference: Symon, L., and Sprich, W. J.: Radical excision of craniopharyngioma-results in 20 patients. Neurosurgery 62: 174-181, 1985. Reprints: Lindsay Symon, T.O., F.R.C.S., GoughCooper Department of Neurological Surgery, The National Hospital, Institute of Neurology, Queen Square, London, WCSE 3BG, England. The author describes a subtemporal approach for the radical excision of craniopharyngiomas. Twenty patients were operated upon between 1977 and 1981, with an average follow-up of 3.1 years. Seventy-four percent of these patients presented with visual failure. The operative mortality rate was 5%, and the major morbidity was about 20%. Any patient requiring a second surgical procedure or developing a major neurologic deficit (motor, sensory, or visual) was regarded as suffering major morbidity. There was no significant postoperative visual loss. Minor operative complications included a partial, ipsilateral third-nerve palsy (four patients). These resolved spontaneously. One complete third-nerve palsy resolved in 6 months. During the follow-up period of 1.6-6.8 years (average years 3.1), one patient had a recurrence requiring reevacuation and radiation therapy. The authors compare their series favorably with those utilizing conventional procedures and postoperative irradiation. Radical excision may offer an alternative to partial excision and irradiation of craniopharyngiomas, avoiding possible late visual sequelae due to radiation-induced optic neuropathy. Thomas C. Spoor, M.D., FACS • • • 29. Reference: Berger, M. S., and Wilson, C. B.: Epidermoid cysts of the posterior fossa. J. Neurosurg. 62: 214-219, 1985. Reprints: M. S. Berger, M.D., c( The Editorial Office, 1360 Ninth Avenue, Suite 210, San Francisco, CA 94122. Epidermoid cysts originating in the paramedian . basal cisterns of the posterior fossa are congenItal leSIOns that enlarge through slow accumulation of desquamated epithelium. The author describes 13 patients treated over a lO-year period with conservative rather than radical surgery. Patients presented With trigemInal neuralgia over the lower face (three patients). hemifacial spasm (one patient), or signs and symptoms of an expanding mass in the cerebelloponhne angle (diplopia, nystagmus, vertigo, decreased hearing, and facial weakness). CT scanning of the posterior fossa facilitates the diagnosis demonstrating a noncontrast-enhancing hypodense mass. The authors advocate a conservative surgical approach, Including excision of unattached tumor capsule and evacuation of contents. This alleviates the patient's symptoms and retards progression of the disease. SInce the capsule is adherent to vital neurovascular structures, complete removal should be avoided. Thomas C. Spoor, M.D., FACS • • • Journal of Clinical Neuro-ophthalmology |