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Objective: To evaluate the efficacy of anterior surgery for the treatment of cervical spondylotic myelopathy, we have reviewed our experience with anterior cervical corpectomy (ACC) at the University of Florida, specifically analyzing neurological outcomes and complications. These results have been compared with historical control subjects receiving laminectomy or "no treatment.", Methods: Between 1982 and 1992, 93 ACC operations were performed for the primary diagnosis of cervical spondylotic myelopathy. This consecutive series of patients was reviewed retrospectively. Age, gender, pre- and postoperative myelopathy severity, number of levels decompressed, and neurological complications were assessed. Myelopathy severity was graded using the Nurick myelopathy grading system. The average follow-up period was 39 months (range, 2-137 mo)., Results: Symptomatic improvement was achieved for 92% of patients (F = 28.9, df = 2172, P < 0.001). Nurick scores reflected improvement for 86% of patients, with the conditions of 13% remaining unchanged and only one patient showing worsening. Preoperative myelopathy severity was weakly correlated with age (P < 0.05) but was not correlated with gender or number of levels decompressed. Similarly, postoperative myelopathy severity was not significantly correlated with age, gender, preoperative myelopathy severity, or number of levels decompressed. ACC-treated patients showed an average improvement of 1.24 points on the Nurick scale, compared with an improvement of 0.07 points for patients treated with laminectomy (P < 0.001) and a deterioration of 0.23 points for patients undergoing conservative treatment (P < 0.001). Complications were slightly more likely to occur in older patients (P < 0.05). The number of levels decompressed was not significantly correlated with complications. Only one permanent neurological complication was seen in this series of patients., Conclusion: We conclude that ACC is a safe and effective treatment for cervical spondylotic myelopathy. In an average of 39 months, ACC showed improved results in terms of myelopathy scores, compared with historical control subjects receiving either no treatment or laminectomy. Age, gender, preoperative myelopathy severity, and extent of disease were not negative predictors of clinical outcomes.

Objective and Importance: Unresectable cystic brain stem lesions are often responsible for neurological dysfunction. Stereotactic aspiration of such lesions can lead to clinical improvement, but cyst recurrence is common and multiple aspirations may be necessary., Clinical Presentation: Three children with unresectable cystic brain stem lesions were treated at the University of Florida. Two patients initially underwent stereotactic biopsy and cystic aspiration, both improving after cystic decompression. Both patients returned 3 months later with symptomatic cyst recurrences requiring further intervention. Six years after surgical resection of a posterior fossa medulloblastoma, the third patient presented with a dorsal midbrain cyst., Intervention: All three patients had catheters placed into the cyst cavities under stereotactic guidance. A subcutaneous Ommaya reservoir was attached to the existing catheter. In the event of symptomatic cyst recurrence, the Ommaya reservoir can be tapped in an outpatient setting., Conclusion: Cystic decompression resulted in clinical improvement in all three children. Multiple aspirations were necessary in two patients for symptomatic cyst recurrences. The Ommaya reservoir allows for cyst aspiration in an outpatient setting and avoids multiple stereotactic manipulations. This system may also be used to instill radioisotopes or it may be converted to a cyst-peritoneal shunt if multiple aspirations fail to achieve cystic control.

A 12-year-old caucasian boy presented with a thoracic myelopathy. Magnetic resonance T1-weighted images revealed an enhancing lesion infiltrating the lower thoracic spinal cord to the level of the conus. Evaluation of the lesion by open biopsy revealed granulomatous angiitis of the spinal cord. Granulomatous angiitis is a rare vasculitic process that typically involves the brain and, less frequently, the spinal cord. Diagnosis must be established early by histopathological examination so that treatment with corticosteroids and/or cytotoxic agents may be instituted. When left untreated, patients with granulomatous angiitis of the spinal cord have developed fatal intracranial manifestations.