A study of 114 surgically treated patients with intracranial meningiomas was carried out to evaluate factors influencing recurrence. The data of the initial surgery extended over a 24-year period from January, 1956, to December, 1979. The patients ranged in age from 1 1/2 years to 82 years. Seventy-one (62.3%) were females and 43 (37.7%) were males. The surgical procedure was graded according to Simpson's classification from 1 to 5 (Grade 1 = complete excision, Grade 5 = simple decompression). In this series, 33 procedures (28.9%) were Grade 1, 55 (48.2%) were Grade 2, seven (6.1%) were Grade 3, 18 (15.8%) were Grade 4, and one (0.9%) was Grade 5. There were eight (7%) postoperative deaths. Approximately 60% of the tumors were located in the sphenoid wing (23.7%), convexity (21.1%), and parasagittally (14.9%). Histological diagnosis in 96% of the patients was transitional (42.1%), syncytial (34.2%), and fibroblastic (20.2%) meningiomas. Eight (7%) patients received postoperative radiotherapy. There was evidence of recurrence in 22 patients (19.3%). Twenty-one underwent a second surgical procedure. Using survival analysis, it was determined that 80% of the patients were free of recurrence 5 years after the initial surgery, and approximately 50% showed no recurrence 20 years after the initial surgery. Only the grade of the initial surgery had a statistically significant influence on recurrence. Sex of patients, site and histology of the tumor, and postoperative radiotherapy had no statistically significant influence on recurrence. Angioblastic and malignant meningiomas were rare (only four cases), and recurred relatively quickly.

A multicenter, randomized placebo-controlled double-blind trial of nimodipine in poor-grade aneurysm patients was carried out in 17 Canadian hospitals. Of 188 patients enrolled in the trial, 32 were excluded for protocol violations and two were excluded due to statistical considerations, leaving 154 patients for valid outcome analysis. Nimodipine treatment was associated with a significantly better outcome (p less than 0.001): 21 (29.2%) of 72 nimodipine-treated patients had a good outcome at 3 months after subarachnoid hemorrhage (SAH) compared to eight (9.8%) of 82 placebo-treated patients. Delayed ischemic deficits from vasospasm alone were significantly less frequent in the nimodipine group (p less than 0.05) with permanent deficits occurring in five nimodipine-treated patients (6.9%) and in 22 placebo-treated patients (26.8%). Improvement in the good outcome rate and reduction in delayed ischemic deficits from vasospasm alone occurred in both Grade 3 and 4 patients, with no difference between nimodipine- and placebo-treated patients being found in Grade 5 patients. Repeat angiography after Day 4 was carried out in 124 patients. There was no significant difference in the incidence of moderate or severe diffuse spasm, which was seen in 64.3% of nimodipine-treated patients and 66.2% of placebo-treated patients. The authors conclude that nimodipine treatment in poor-grade patients with SAH results in an increase in the number of good outcomes and a reduction in the incidence of delayed neurological deterioration due to vasospasm. This effect occurs by a mechanism other than prevention of large-vessel spasm as visualized on angiography.

The complications arising from 195 shunting procedures are described and correlated with patient and operative variables. Neither the patient's age, sex, type of hydrocephalus, length of surgery, nor the use of prophylactic antibiotics correlated significantly with subsequent shunt complications. However, the surgeon performing the procedure and the type of shunt used were highly significant correlates.

Intraventricular hemorrhage (IVH) from aneurysm rupture is generally considered to be of grave prognostic significance. Ninety-one cases have been studied retrospectively from seven medical centers. The overall mortality rate was 64%. The dramatically poor condition of these patients leads to their rapid admission to the hospital. Eighty-seven percent were admitted on Day 0 or 1, and more than half were classified neurologically as Grade 4 or 5. A multiple regression analysis explained 56% of the variance in survival, using the variables of ventriculocranial ratio (VCR), day of admission, diastolic blood pressure, location of aneurysm, associated intracerebral hematoma, age, grade on admission, sex, and systolic blood pressure. No patient with a VCR of more than 0.25, as calculated from the initial computerized tomography (CT) scan, survived. No patient whose smallest VCR was 0.23 or more survived. This ratio can be simply measured with a millimeter ruler from the CT scan. Patients with IVH usually had enlarged ventricles, even initially. The overall results suggest that early management of intracranial hypertension should be more generally considered, although even when this was done the prognosis was still guarded. The timing of surgery was not an important determinant of outcome, although a significant number of patients died awaiting surgery.

SUMMARY: Three techniques to produce experimental spinal cord injuries in the rat are compared; 1) the weight dropping method aneurysm clip compression method and 3) the extradural balloon compression method. In principle, different forces were use technique one, while a constant force for different durations is maintained in techniques two and three. The relationship betwee different types of injuries and subsequent clinical recovery was assessed quantitatively by the inclined plane method of Rivli Tator. The weight dropping technique was found unreliable for experimental spinal cord injury in the rat while the aneurysm cli compression technique resulted in consistent cord injuries with respect to subsequent clinical recovery. The extradural balloo compression method invariably resulted in complete recovery after three and five minutes but no recovery after seven minutes of 0.inflated balloon compression of the cord indicating a steep dose -response curve. However, using a 0.2 cc air inflated balloon recovery was noted after one minute compression. The major factor in the pathogenesis of spinal cord injury produced by th dropping technique is believed to be mechanical, while both mechanical and vascular factors seem to operate in the clip an compression techniques. RESUME:Nous avons compare trois techniques de production experimental de lesion de la moelle chez le rat: (1) chute d'un poids compression par pince a anevrisme, (3) compression par ballon extradural. En principe, dans la technique un, la variable resid force employee alors qu'une force constante de duree variable est appliquie dans les techniques deux et trois. Nous avon ces differentes methodes de lesion par la methode du plan incline de Rivlin et Tator en les comparant au degre de recuperation m6thode de chute d'un poids s'avera non fiable alors que la compression par pince produisit des lesions constantes. La method ballon extradural produisit une recuperation complete en 3-5 minutes, mais aucune recuperation apres 7 minutes de compressio ballon gonfie de 0.1 cc d'air. A 0.2 cc d'air aucune recuperation ne fut notee apres compression de 1 minute. Le facteu mecanique predomine dans la methode du poids echappe, alors que les facteurs mecanique predomine dans la methode du poid echappe, alors que les facteurs mecaniques et vasculaires sont en action dans les deux autres procedures.Can. J. Neurol. Sci. 1983; 10:161-165 gradual cord compression technique in ferrets. Subsequently Rivlin and Tator (1978) described a new acute cord injur model in the rat using a modified aneurysm clip. We are reporting our experience with different experimenta models of cord injury in the rat. Rats were chosen in this projec because they are relatively inexpensive, readily available an have been used by previous researchers who utilize the weigh dropping and aneurysm clip compression techniques. To ou knowledge, the balloon compression technique has not previousl been used to produce experimental spinal cord injury in rats the past, that might have been technically di...