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Vertebral arteriovenous fistulas are rare in children and the congenital form has been seldom reported in the literature. Prior to using endovascular therapy techniques, only surgery was the main treatment. The most common endovascular treatment is through the use of detachable balloons. This report describes the clinical and radiological findings of a congenital vertebral artery fistula in a 20-month-old child. Balloons could not be safely employed; therefore, embolization was performed with Guglielmi detachable microcoils. We review the history and treatment of these lesions, their clinical presentation, and imaging features, including their outcome, with particular attention to the pediatric population.

Study Design: This is a report of a series of 104 patients who underwent lumbar discectomy and chemonucleolysis at the University of Virginia between 1985 and 1989., Objective: The primary objective was to determine the safety of this procedure. A secondary objective was to begin studying its efficacy., Summary of Background Data: This is the first report on the use of chymopapain during open surgery., Methods: Patients with low back pain and radicular symptoms not cured with conservative therapy were selected for participation in the study. Intraoperatively, disc spaces were injected with 2 ml of chymopapain. Patients were followed-up for an average of 5 years. Patients were surveyed regarding pain relief, and failures of the procedure were analyzed., Results: Seventy percent of patients reported good or excellent pain relief. Operative failures, characterized by reoperation at the same level, totaled 9.6%. Recurrent disc herniation at the time of reoperation occurred in 4.8%., Conclusion: The procedure is safe and the relief of pain was similar to that in other published series. The suggestion is that the rate of recurrent disc herniation is reduced.

Several craniotomies have been described that allow extensive resection of skull base and low-lying cranial tumors that involve little disfigurement to the patient. These techniques should be of interest to plastic surgeons as they may be called to aid their neurosurgical colleagues in exposing the anterior skull base or may be involved in combined procedures to resect tumors that involve the face, sinuses, orbit, and cranial vault.