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There are at present strong indications for surgery in patients suffering from symptomatic extracranial carotid stenoses of >70%. Surgery of coincidental aneurysms is a still debated problem, but there is general agreement that it is indicated in selected cases according to the patient's life-expectancy and size and site of the aneurysm. The coexistence of these two lesions raises a decisionmaking problem. We reviewed 389 endarterectomies and found 12 intracranial berry aneurysms in 10 (2.6%) patients. All the 10 patients were harbouring a symptomatic carotid stenosis of >70%. Since the correction of a stenosis increases blood flow to an aneurysm, our approach was to first operate on the intracranial lesion and then the stenosis in 7 patients harbouring aneurysms >5 mm. Two patients affected by small aneurysms <5 mm of an A2 azygos and left internal carotid artery underwent left endarterectomy only. The last patient was submitted first to percutaneous angioplasty of a left stenosis, then to open surgery of a contralateral middle cerebral aneurysm and finally to intravascular occlusion of a small aneurysm of the left internal carotid bifurcation by menas of a coil; this policy was adopted in order to restore normal haemodynamic conditions before the intracranial procedure. There was no mortality or permanent morbidity following surgery for aneurysm or endarterectomy. Transient morbidity occurred in 2 cases after clipping of aneurysms of the anterior communicating and middle cerebral arteries. Our results suggest that surgery of coincidental aneurysms may give good results even when there is a severe symptomatic stenosis in the neck. Moreover, the presence of a small intracranial aneurysm does not seem to be an additional risk factor for endarterectomy. When the lesions are on different sides, it may be better to treat the stenosis first if it decreases the ipsilateral cerebral blood flow. [ABSTRACT FROM AUTHOR]

Over the past 4 years 11 patients with Cushing's disease have been operated on by a transsphenoidal microsurgical technique. All patients had small intra-hypophyseal adenomas found at operation. Eight of the 11 patients had a remission of the disease on the basis of clinical evaluation and hormonal studies. The endocrinological results revealed a transient state of hypocorticism in all successfully treated patients. Within 6-8 months after operation recovery of hypothalamic-pituitary-adrenal function and other tropin function took place. These findings, together with the absence of recurrence up to now, further confirm the efficacy of transsphenoidal surgery in the management of patients with Cushing's disease. [ABSTRACT FROM AUTHOR]

Of 600 patients submitted to radioisotope cisternography carried out with radioiodinated human serum albumin (I-HSA) a group of 140 had head injuries. Our investigation was intended to study the modifications of CSF circulation and absorption which accompany cranio-cerebral trauma. Of 88 head injured patients who did not undergo operation 44 had transient loss of consciousness, and 44 were in prolonged coma. Fifty-two patients underwent operation. Of these 5 had skull fractures with dural lesions, 7 had extradural haematomas, 19 had subdural haematomas, and 21 had brain contusions. Cisternograms were performed at different time intervals after trauma, and in some instances the test was repeated in order to study the possible long term alterations of CSF circulation and absorption. Abnormalities of cisternographic pictures are classified into the following groups: 1° asymmetric diffusion; 2° operative cavity stagnation; 3° ventricular reflux; 4° associated abnormalities. Cisternographic features are analysed in relation to the corresponding clinical and pneumoencephalographic patterns in the patients examined. These investigations may enable us to recognise possible indications for shunt procedures in the management of CSF absorption defects, which are so frequently apparent after head injury. [ABSTRACT FROM AUTHOR]

The authors report their experience of isotope cisternography and ventriculography with I or Tc labelled albumin. Eighty-nine patients with different neurosurgical diseases responsible for alterations of the C.S.F. circulation and absorption were studied during a twenty months' period. The codition studied included; communicating hydrocephalus, obstrucsive hydrocephalus, pseudotumor cerebri, hemispherectomy, alteration of C.S.F. circulation following neurosurgical procedures, and C.S.F. rhinorrhoea. [ABSTRACT FROM AUTHOR]

The authors describe the techniques of isotope cisternography and ventriculography with high specific activity I and Tc albumin in children and adult patients. They have studied 35 patients including different type of obstructive and communicating hydrocephalus, microcephalic patients and patients with no intracranial pathology. The value, the limitations, and the potential damage of the test are discussed and the proper use of the two different tracers is assessed. [ABSTRACT FROM AUTHOR]