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Meningiomas arising from the optic nerve or secondarily invading the orbit from the intracranial cavity are uncommonly encountered in children. Ectopic (extradural) meningiomas are exceedingly rare orbital tumors that do not originate from either the optic nerve or the intracranial meninges. We evaluated and treated two boys aged 7 and 10 years with probable primary ectopic (extradural) orbital meningiomas. Both patients presented with a gradual onset of progressive, painless proptosis. In addition, computed tomographic scans demonstrated involvement of the superomedial orbit without bony erosion or hyperostosis, but with expansion of the adjacent sinus. Neither tumor demonstrated attachment to the optic nerve or intracranial extension at the time of surgery. Both patients were successfully treated with complete surgical excision. Evaluation did not reveal the presence of neurofibromatosis in either child.

Electrothermal atomic absorption spectrophotometry was employed to measure the concentrations of manganese, platinum, and strontium in the cerebrospinal fluid (CSF) of 47 patients with brain neoplasms (34 benign and 13 malignant), 17 leukemic patients, 10 patients with lymphoma or non-cerebral solid tumors, and 27 control patients. According to the data obtained, manganese appears to be significantly (p less than 0.015) depleted from the CSF of leukemic patients, whereas platinum is diminished in CSF of patients with brain tumors, leukemia, lymphoma, or noncerebral solid tumors; the ratios for the mean CSF concentration of platinum in these tumor patients/control patients ranged between 0.52 and 0.7. There was no significant difference in CSF concentrations of strontium among the groups examined.

The case of a 4-year-old boy with 4 months' history of progressive quadriplegia is presented. The neuroradiological work-up, which included computed tomography scanning and magnetic resonance imaging, showed changes consistent with the diagnosis of a large mass lesion in the area of the foramen magnum. At operation a meningioma was completely excised. There was a gradual and almost complete neurological recovery.

Following cryptococcal meningitis, symptoms of cervical syringomyelia developed in a young heroin addict. Myelography confirmed syringomyelia and angiography demonstrated severe hydrocephalus. Ventriculoperitoneal shunting resulted in complete resolution of signs and symptoms of both hydrocephalus and syringomyelia.

Cysticercosis cerebri is a rare neurological diagnosis, which is usually made at the time of operation or at autopsy. Few cases have been reported in North America, and these were usually found in immigrants and in domestic travelers who lived in infested countries. Cysticercosis cerebri is classically divided into four general types: 1) intraparenchymal, 2) basilar cisternal, 3) ventricular, and 4) diffuse cerebral. We are presenting a unique case of solitary ventricular cysticercosis occluding the foramen of Monro, and producing an asymmetrical obstructive hydrocephalus.

A case of an encapsulated organizing hematoma of the sciatic nerve is reported. Hemorrhage-induced neuropathy as a complication of anticoagulant therapy, leukemia, hemophilia, and other bleeding diatheses has been frequently reported. While trauma is the most common etiology of a hemorrhagic neuropathy, actual hematoma formation beneath the epineurium is very rare.

A case of acute rupture of a right middle cerebral bifurcation aneurysm with extravasation of blood into a distant arachnoid cyst is reported.

Transcutaneous electrical neurostimulation (TENS) has been shown to be very effective in providing acute postoperative and delivery pain relief. We specifically applied this modality ot Northwestern Memorial Hospital using constant postoperative neurostimulation to patients who had had cervical or lumbar laminectomies for a variety of reasons, but mainly for herniated intervertebral discs and osteoarthritic spurs. The results in both groups were compatible with earlier findings by Hymes and co-workers, who reported decreased narcotic intake, decreased pain behavior or subjective complaints, and increased physical recovery. Patients who responded to TENS showed an average 50% decrease in dosage of narcotic analgesics, expressed fewer complaints of pain, and appeared to show more rapid postoperative physical recovery than the patients who were not treated with TENS. Seventy-nine percent of the lumbar laminectomy group and 87.5% of the cervical laminectomy group showed 50% or greater relief of acute, severe postlaminectomy pain. Other advantages of using TENS included ease of application and lack of major complaints.

Transcutaneous electrical neurostimulation (TENS) has recently emerged as a distinct therapeutic modality in the alleviation of acute and chronic pain. We applied this modality to 15 nonsurgical low-back pain patients having diagnoses of functional pain, with 40% initially having significant pain relief (50% of greater). However, this pain-alleviating effect of TENS did not last longer than two months. After initiation of neurostimulation, increased pain and/or bizarre and inappropriate sensations and behavior frequently developed. We also applied this modality in the diagnostic evaluation and treatment of 24 patients having diagnoses of postsurgical chronic intractable low-back pain of psychosomatic origin and achieved similar results. In both groups, we utilized a simplified poststimulation "normal-saline-sterile-water intramuscular injection test" to confirm the findings from transcutaneous electrical neurostimulation and to verify the functional basis of the present low-back pain.

Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Hashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

Since 1972, Kiel Surgibone (calf bone) dowels have been inserted in the cervical intervertebral space of 221 patients. The anterior approach was used for cervical interbody fusion. Fusion occurred in every patient who survived long enough for it to occur. No complications occurred that specifically could be attributed to use of this type of grafting material. Kiel surgibone has the advantage of eliminating the need for osteotomy when autologous bone is used or for a bone bank when homologous bone is employed. Kiel Surgibone is supplied sterile and is precisely preshaped.

The authors report two cases in which the appearance of sacral perineural cysts, as seen in the computerized tomography scan, prompted the possible diagnosis of a neoplastic lesion. Additional investigation led to the proper diagnosis.

It should be obvious from the magnitude of the problem, its persistence in our society, and the failures of our treatment methods to date, though much improved over our past efforts, that much remains to be learned and understood about low back pain and sciatica. The causes, the treatments, and the methods of prevention all need to be researched further. The intellectually honest, inquiring clinician has an opportunity to make a meaningful contribution in this area.

A hematoma in the left iliacus muscle induced by anticoagulant therapy and causing a femoral neuropathy was demonstrated by CT scan. The scan returned to normal after the surgical evacuation of the hematoma. Other possible uses of the CT scan to demonstrate neurological lesions in this region are discussed.

Percutaneously inserted spinal epidural neurostimulation has been derived as a simplified safe alternative to surgically implanted, dorsal column stimulation that is used in the effective treatment and control of spasticity and intractable pain. Twenty-seven tissue specimens from fifteen patients having had percutaneous epidural neurostimulation systems implanted were studied with the aid of light microscopy. The biopsies from tissues around the cables, around the receivers, and at the actual site of epidural stimulation (at the metallic contact), were studied at time intervals varying from one week to two years postimplantation. Long-term results, which only show dense fibrous encapsulation of the cables and the receiver, substantiate clinical belief regarding the "histological safety" of this electronic modality.

Three cases of glioblastoma multiforme are presented. These cases have in common the fact that all three patients were relatives but not blood relatives. There had been prolonged intimate contact between them before the development of the neoplastic lesion.

The increase in the prevalence of head injury in the civilized world has become the focus of worldwide attention. With the aid of modern technology and a high index of suspicion, early diagnosis and definitive treatment with acceptable outcome has become within reach. This article reviews recent developments in diagnosis and advances in therapy.

Surgical treatment of diastematomyelia, with removal of the spur and dural septum, is indicated in adults with progressive symptoms. The patient may improve, or at least the progression of the neurological damage may be halted. The utilization of microneurosurgical techniques was found to be of value in decreasing the danger of spinal cord or nerve injury during the procedure. The seventh case reported in the literature of diastematomyelia with onset of symptoms in adult life is presented.