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Hope, false hope, and self-fulfilling prophecy are important aspects in the practice of medicine for all practitioners but are especially important in the field of neurosurgery, which deals with devastating, terrifying, and often fatal illnesses. The American Board of Medical Specialties and the Accreditation Council of Graduate Medical Education have jointly defined 6 “general competencies” that define a competent physician and should be part of the curriculum of all residency programs. One of these 6 is interpersonal and communication skills. A true test of this competence is the ability to harness the powerfully beneficial forces of hope and motivation and to avoid the destructiveness of false hope and self-fulfilling prophecy.

A case of acute subdural hemorrhage caused by rupture of an anterior communicating artery aneurysm is presented. The patient is a young man who presented with an acute onset of neurologic symptoms; computed tomography revealed subdural hemorrhage in the absence of associated subarachnoid or intraparenchymal bleeding.

A method using chronically prepared, anesthetized dogs was devised for studying the effects of treatments of intracranial hypertension induced by applying a reversible extradural mass lesion while simultaneously measuring production of cerebrospinal fluid. This was measured with a ventricular-cisternal perfusion technique in which the rate of cisternal outflow could be controlled by a pump and matched to the inflow, allowing intracranial pressure to fluctuate despite simultaneous measurement of cerebrospinal fluid formation. Elevations of intracranial pressure to the range 20 to 35 Torr were induced and maintained during perfusion, but elevations above 35 Torr would not permit continued perfusion. At normal intracranial pressure, 10 Torr or less, rates of cerebrospinal fluid formation were the same whether the outflow controlling pump or free outflow was used. Formation of cerebrospinal fluid decreased progressively as intracranial pressure increased above 20 Torr. It also decreased with time after the start of perfusion during the course of 5 h, but returned to the initial range during the control phase of subsequent experiments in the same animal. Furosemide, 3 mg kg-1, i.v., had no significant effect on rate of formation but did induce a small decrease in ICP in time-controlled experiments in which i.v. fluid replacement limited net fluid losses to 20 ml kg-1 with no change in mean arterial or central venous pressures.

The bulk membrane fluidity of brain synaptosomes and kidney cortex microsomes of hibernating and active mammals have been compared using the steady-state fluorescence polarization technique. No consistent differences were observed indicating that homeoviscous adaptation may not be an important strategy during hibernation.

A simple technique of internal vertebral body screw fixation for stabilization of acrylic vertebral body replacements is described. The screw fixation prevents subluxation and rostrocaudal dislocation of the acrylic prosthesis. A case report is presented of a patient who underwent replacement of the second cervical body and odontoid with an intraoperatively molded methylmethacrylate prosthesis with rapid neurological recovery and good stabilization.

Silicone rubber tubing has been shown to be permeable to most anesthetic gases and has been used to fashion “chemodes” for stereotaxic intracerebral inplantation. The safety of these devices and their effectiveness in producing focal brain suppression was studied in cats with chronically implanted chemodes. The silastic chemodes were found to elicit little reaction after chronic implantation. When perfused through the chemodes, the anesthetic gas, Tefluorane, was found likewise to cause little cerebral reaction, while inducing satisfactory and reversible focal cerebral suppression. The effectiveness was evaluated in terms of sleep production with chemodes implanted in the reticular-activating system. Silastic rubber chemodes allow the focal introduction of various gases, liquids and solutions into the brain with no additional distortion of the brain. The membrane is impermeable to bacteria, so that nonsterile chemicals may be employed. This study demonstrated the safety of chronically implanting chemodes and their effectiveness in producing focal brain suppression. The use of brain stimulants as well as suppressants should make these devices useful for animal experimentation and human therapy.

The intrathecal administration of phenol, which is a relatively simple procedure and relatively free of significant complications, has proved to be a useful adjunct in the treatment of chronic severe pain, especially pain secondary to inoperable malignancy. It has been particularly useful in (1) bathing the lower sacral rootlets bilaterally in perineal and perianal pain, (2) relieving severe pain in frankly terminal and debilitated cancer victims who are not relieved by narcotics, and (3) relieving unilateral upper abdominal and thoracic pain. Since 1961 a modified technique has been used to treat 31 patients with intrathecal phenol for the relief of chronic pain. In the 1958–1961 series, 87 patients had been treated, and the results of the two groups are compared. Qualitatively better results were obtained with the more recent group. These improved results are attributed to: 1. (1) The almost exclusive use of solutions of phenol in anhydrous glycerine in preference to solutions of phenol in Pantopaque (iophendylate). 2. (2) The use of a multiple injection technique. Significantly better results were achieved in the relief of pain secondary to cancer than in pain of non-cancer origin. Complications have included mild weakness and bladder difficulty; late scarring may make subsequent surgical rhizotomy difficult. Only 2 of the last 31 patients required subsequent chordotomy.