A 24-year-old right-handed woman with a right temporal hematoma showed marked left visual neglect for far but not near space in a variety of tasks systematically given in near and far distance conditions. This case thus provides the dissociation opposite to Halligan and Marshall's patient, who had neglect for near but not far space after a right parietal stroke. Furthermore, although she made rightward errors in bisecting far-distant lines, our patient made smaller opposite leftward errors for near-distant lines. The evidence that unilateral neglect of far and near visual space may exist independently supports a division in the neural systems subserving attention to different compartments of the extrapersonal space in humans.

Object. The authors conducted a retrospective study to provide an independent evaluation of posterior lumbar interbody fusion (PLIF) in which impacted carbon cages were used. Interbody cages have been developed to replace tricortical interbody grafts in anterior and PLIF procedures. Superior fusion rates and clinical outcomes have been claimed by the developers. Methods. In a retrospective study, the authors evaluated 71 consecutive patients in whom surgery was performed between 1995 and 1997. The median follow-up period was 28 months. Clinical outcome was assessed using the Prolo scale. Fusion results were interpreted by an independent radiologist. The fusion rate was 90%. Overall, 67% of the patients were satisfied with their outcome and would undergo the same operation again. Based on the results of the Prolo scale, however, in only 39% of the patients were excellent or good results achieved. Forty-six percent of the work-eligible patients resumed their working activity. Clinical outcome and return-to-work status were significantly associated with socioeconomic factors such as preoperative employment (p = 0.03), compensation issues (p = 0.001), and length of preoperative sick leave (p = 0.01). Radiographically demonstrated fusion was not statistically related to clinical outcome (p = 0.2). Conclusions. This is one of the largest independent series in which PLIF with cages has been evaluated. The results show that the procedure is safe and effective with a 90% fusion rate and a 66% overall satisfaction rate, which compare favorably with those of traditional fixation techniques but fail to match the higher results claimed by the innovators of the cage techniques. The authors' experience confirms the reports of others that many patients continue to experience incapacitating back pain despite successful fusion and neurological recovery.

Background and Purpose-The purpose of the present study was to evaluate the feasibility and safety of a locoregional cervical sympathetic block to improve cerebral perfusion in patients suffering from cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Methods-Nine consecutive patients with symptoms of delayed ischemic deficits, induced by angiographically confirmed cerebral vasospasm, were treated with the injection of locoregional anesthesia to block the ascending cervical sympathetic chain at the level of the superior cervical ganglion. Neurological status was recorded before and after the procedure, and cerebral angiography was performed before and after the procedure. Results-No complications occurred in this short series. The procedure appeared to be simple and safe. Horner's signs appeared within 12Ϯ0.1 minutes and lasted for an average of 6.3Ϯ4 hours. In all patients, improved cerebral perfusion was detected at the confirmatory angiography but without change in vessel caliber. One patient died of the complications of the initial hemorrhage, and 2 died of the consequences of the severe vasospasm despite maximal medical treatment. In all the other cases, the neurological status promptly returned to normal within 48 hours after the locoregional treatment. Conclusions-Patients

Background: Cerebral vasospasm is the most common cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). This study is designed to determine whether the incidence of symptomatic vasospasm and the overall clinical outcome differ between patients treated with surgical clipping compared with endovascular obliteration of aneurysms. Methods: In this prospective study, 98 patients with aneurysmal SAH were treated. Seventy-two patients underwent surgery and clipping and 26 had coil embolization. The incidence of symptomatic vasospasm, permanent neurologic deficit due to vasospasm and clinical outcome were analyzed. Patients with better clinical and radiological grades (World Federation of Neurological Surgeons grades I–III and Fisher grades I–III) were analyzed separately. Results: Symptomatic vasospasm occurred in 22% of the patients; 25% in the surgical group and 15% in the endovascular group. Nine percent of the patients in the surgical group and 7% in the endovascular group suffered ischemic infarction with permanent neurological deficit. These differences did not reach statistical significance (p = 0.42). For patients with better clinical and radiological grades, no significant difference was found for the rate of symptomatic vasospasm; 23% in the surgical and 12% in the endovascular group (p = 0.49). The overall clinical outcome was comparable in both groups, with no difference in the likelihood of a Glasgow Outcome Scale score of 3 or less (15% in the surgical and 16% in the endovascular group; p = 0.87). The same results for outcome were obtained for the subgroup of patients with better clinical grades on admission. Conclusion: Symptomatic vasospasm and ischemic infarction rate seem comparable in both groups, even for patients with better clinical and radiological admission grades. There is no significant difference in the overall clinical outcome at the long-term follow-up between both groups.

A case of cystic degeneration of the transverse ligament located posteriorly to the dens and causing compression to the lower medulla and upper cervical spinal cord is reported. The clinical, pathological, and radiological findings are described and compared to the literature to characterize this syndrome more fully. The advantages of a posterolateral surgical approach are stressed.