To reach the upper thoracic vertebrae, a number of extensive approaches have been proposed combining thoracotomy, sternotomy, or clavicle resection with anterior dissection into the superior mediastinum. We present a simple anterior cervical approach for patients with disease limited to one vertebral level, in which midline ventral decompression is the goal of surgery. Regardless of the anterior approach used, the caudal extent of exposure is limited to T3 by the great vessels of the mediastinum, whereas the angle of the approach to the cervicothoracic junction is dictated by the manubrium. In the anterior cervical approach, lateral exposure to the uncovertebral joints is easily achieved. Five patients are reviewed in whom this anterior cervical approach was used at the first or second thoracic level. Decompression and instrumentation resulting in neurological improvement and axial stability were achieved in all five patients. The surgical anatomy of the cervicothoracic junction is reviewed with attention to the recurrent laryngeal nerves and the thoracic duct as they relate to the side of approach chosen.

We analyzed our recent stereotactic radiosurgery (SRS) experience to determine the radiographic response of intracranial metastatic melanomas to SRS. Twelve patients with 21 intracranial melanoma metastases treated with SRS were evaluated. Fifteen (72%) metastases were hemispheric, 3 (14%) were cerebellar, and 3 (14%) were in the basal ganglion or thalamus. All lesions were 2.5 cm or less in maximum diameter. Eleven patients also had whole brain external beam radiotherapy. Mean SRS dosage was 1,800 cGy to the 85% isodose surface and median dose was 1,800 cGy to the 80% isodose surface (range 1,100–3,100 cGy at the 80–95% isodose surface). Overall, 12 (57%) lesions showed decrease or stabilization of tumor volume (i.e., local control), while 9 (43%) showed enlargement. Division of metastases into small (≤1.0 cm diameter) and large (>1.0 cm diameter) tumors showed that the small tumors were more likely to regress than the large tumors (chi‐square test; P < 0.03). Only 1 of 9 (11%) large lesions regressed as opposed to 7 of 12 (58%) small lesions regressed with SRS. We conclude that SRS is suited for small melanoma brain metastases, but lesions between 1.0 and 2.5 cm in diameter, while still generally considered appropriate for SRS, may not be as responsive to SRS at currently employed dosages. Radiat. Oncol. Invest. 5:72–80, 1997. © 1997 Wiley‐Liss, Inc.

The coronary arteries of the goat heart were studied using angiographic techniques and molds of the coronary vessel trees. Blood supplies to the left and right ventricles, interventricular septum, atrioventricular node, and apex of the caprine heart were studied. The goat possesses a left dominant pattern of coronary supply with relatively uniform coronary anatomy and may provide a good large animal model for testing cardiovascular assist devices.

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