The authors report 257 patients who underwent 338 craniotomies for the removal of meningiomas. The average duration of observed survival was 9.0 years, while that with acceptable quality of life was 8.3 years. Multiple factors including the size and location of tumors, the degree of tumor excision, the histological features, and the preoperative condition of the patients are important in both duration of survival and quality of life following surgery for intracranial meningiomas. Computerized tomography permits early diagnosis and is invaluable in follow-up assessment. It allows for recognition of small recurrent tumors, and offers a better opportunity for complete removal and, subsequently, a longer duration of reasonable survival. Radiation therapy may prolong survival time in patients with malignant meningiomas, but it fails to delay further tumor recurrences following its delivery to patients with recurrent tumors. There are multiple predisposing factors responsible for the development of postoperative seizures. These include tumor recurrence involving highly functional anatomical areas of the brain, history of preoperative seizures, and intraoperative factors such as excessive brain retraction and the sacrifice of major draining or bridging veins. Intraoperative complications may be decreased by using osmotic diuretics and subarachnoid drains, meticulous dissection, and with the increased awareness and preservation of the important venous structures.

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Subarachnoid hemorrhage (SAH) was induced in 50 rabbits by injecting 1.25 cc/kg of autologous, well heparinized, fresh arterial blood into the cisterna magna, followed by suspending the animals in a head-down position at 30 degrees for 15 minutes. The animals were evenly divided into five groups: a control group, or groups receiving post-SAH prostacyclin (PGI2), carbacyclin, thromboxane A2 (TXA2) synthetase inhibitor (OKY-1581), or nutralipid. Radiographic vertebrobasilar arterial spasm was demonstrated on the 3rd day post-SAH in the control animals. This was decreased in the prostacyclin and the carbacyclin groups and was absent in the OKY-1581 and the nutralipid groups. Cerebral blood flow (CBF) measurements on the 4th day post-SAH using the xenon-133 technique failed to reveal any significant difference between the prostacyclin, the carbacyclin, and the control groups, but flows in the nutralipid and the OKY-1581 groups were significantly higher. There was a good correlation between the clinical status and the CBF. Intracytoplasmic vacuolation and detachment of the vascular endothelium, seen ultrastructurally, may account for the impaired synthesis of prostacyclin. Exogenous prostacyclin and carbacyclin decreased vasospasm but failed to improve cerebral perfusion. OKY-1581 blocked the synthesis of the potent vasoconstrictor, TXA2, which is not only formed during platelet aggregation but also induces platelet aggregation. Nutralipid contains linolenic acid, a precursor of eicosapentaenoic acid (EPA), which is more potent in inhibiting platelet aggregation and in blocking TXA2 production. The various fatty acid constituents of nutralipid bind to albumin and thereby shorten the half-life of TXA2.

The authors report a case of symptomatic arachnoid diverticulum, which was located anterior to the spinal cord and covered the entire length of the spinal canal. The patient underwent cervical laminectomy and cystoperitoneal shunting with subsequent neurological improvement. The causes, clinical manifestations, diagnosis, and management of spinal arachnoid diverticulum are discussed.