Long-term results of cervical interbody fusion with PMMA were evaluated in a retrospective study. X-ray films of 83 patients were obtainable. Post-operative follow-up in this series was between 15 and 20 years. The results show that PMMA is engrafted after about 2 years. Stable vertebral interbody fusion is obtained in about 90% of cases. Development of malignoma was not observed. Resorptive bone alterations, which can be seen in about 2% of cases one to two years after operation are shown not to be progressive. This process heals and stable fusion develops.

Three cases of symptomatic vasospasm after spontaneous subarachnoid hemorrhage are reported. Vasospasm occurred preoperatively in two instances and postoperatively in another. All three cases received an intraarterial perfusion with 0.2 mg nimodipine (BAY e 9736) per hour for 90 minutes. Resolution of the spasms was demonstrated by angiography. As there were no side effects attributable to this form of treatment, new possibilities for neuroradiological intervention may arise in selected cases.

Stereotactic cysto-ventricular shunting in three patients with congenital (subependymal cyst of the 3rd ventricle, subependymal cyst of the foramen of Monro, cyst of cavum septi pellucidi) and in a female patient with a large cystic suprasellar craniopharyngeoma is dealt with in this paper. The first operation was performed in May 1992 and the latest, being considered in this paper, in October 1993. All patients were admitted to our hospital suffering from signs of increased intracranial pressure. CT-scans revealed on the one hand an obstructive hydrocephalus subjected to the cystic arachnoid lesions, on the other hand a large hypodense suprasellar cystic tumor. After stereotactic puncture of the arachnoid cysts, aspiration of their contents as well as biopsy of the wall, a silicone catheter was implanted, thus constructing a permanent communication between the cyst and the lateral or third ventricle. The internal catheter was connected to a subcutaneous burr-hole reservoir. All these patients recovered uneventfully without neurological deficits. There were no operative complications. Follow-up CT-scans showed no recurrences of the cysts and obstructive hydrocephalus. In the patient with the suprasellar craniopharyngeoma at first a stereotactic puncture of the cyst was performed. After recurrence the tumor was directly approached by an frontotemporal craniotomy. The histological examination revealed now a craniopharyngeoma. After renewed recurrence a stereotactic cysto-ventriculostomy with internal shunt implantation was performed. However, in this case this method was unsuccessful, documented by follow-up CT-scans. Resulting from our experiences, it is quite obvious that the stereotactic internal shunt implantation seems to be a safe, proper and reliable method in the treatment of arachnoid cystic lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

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The term "juxta facet cyst" was coined in 1974 by Kao et al. and combines synovial cysts arising from the synovial outpouchings through areas of weakened or destroyed capsular tissue and ganglion cysts developing from mucinous degeneration of periarticular connective tissue. We have operated on 16 patients with juxta facet cysts during the last 3 years. One cyst was located in the thoracic spine, causing a transverse syndrome; 15 cysts were located in the lumbar spine, causing nerve root compression. Diagnosis was established preoperatively by MR in 10 and CT in 3 cases, respectively. The definite classification of the cystic processes was made by histopathologic examination. Surgical treatment consisted of resection of the cyst. Postoperatively, all but 2 patients were free of complaints and no recurrence was observed in the mean follow-up period of 15.5 months. Juxta facet cysts are an uncommon finding, but must be considered in the differential diagnosis of epidural compressive syndromes of the spine.