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NEUROLOGICAL SURGEONS: 60Th MEETING J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.23.1.81 on 1 February 1960. Downloaded from J. Neurol. Neurosurg. Psychiat., 1960, 23, 81 PROCEEDINGS OF THE SOCIETY OF BRITISH NEUROLOGICAL SURGEONS: 60th MEETING The 60th meeting of the Society of British Neurological Surgeons was held at the Guy's-Maudsley Neurosurgical Unit, London, on November 13-14, 1959. The President, G. S. CLARK-MAXWELL (Derby), was in the Chair. The Treatment of Encephalotrigeminal Angiomatosis described by Vallebona in 1930 to obtain detail of the (Sturge-Weber Disease) by Hemispherectomy bones at the base of the skull. Ziedses des Plantes (1950) MURRAY A. FALCONER (London) reported the results applied the technique to pneumography in 1949 referring of hemispherectomy in five patients who had since been to it as "stratigraphie modii&e". This method would followed for from three to eight years after operation. often produce information which was obtained formerly All were well-marked instances of the condition, the only by using positive contrast ventriculography. essential lesion of which appeared to be a venous Adequate visualization of the front and back of the third angiomatosis of the leptomeninges over one cerebral ventricle aqueduct, and fourth ventricle would result by hemisphere, associated with a port-wine naevus of the using this manoeuvre. The use of positive contrast skin of the face in one or more divisions of the ipsilateral ventriculography could be reduced to a minimum. trigeminal nerve. The affected areas of the cortex Autotomography was not intended to supplant the became atrophic with the secondary deposition of positive contrast technique since under certain cir- guest. Protected by copyright. calcium and iron materials that on x-ray examination cumstances the ventricular system might be distorted to showed characteristic double curvilinear outlines of the such a degree that the minute quantities of air accom- sulcal pattern. Occasionally ocular lesions such as modated would not be sufficient to cast a diagnostic buphthalmos were present. Incomplete forms of the shadow on a radiograph. Under these circumstances disease might occur. positive contrast would have to be resorted to. Auto- The ages of the five patients described by the author tomography could be used during encephalography and ranged from 3j to 16 years at the time of operation. All during ventriculography. The advantages of this had shown the facial naevus from birth, but epilepsy and technique over other techniques of tomography were as infantile hemiplegia had not appeared until some months follows: (1) Specialized equipment was not required; later. Four of the five patients showed well-marked (2) The procedure might take only one minute and add behavioural disorders and all five were backward in approximately two minutes to the total time of the varying degrees. Radiological evidence of gross atrophy examination; (3) It could be incorporated into the routine of the affected cerebral hemisphere was forthcoming in examination of encephalography; (4) There was no each care, but the extent and variety ofcalcification varied. need to transport the patient to another room or to other After operation all five patients had been completely equipment, thereby losing air from the area of free of fits and they had all shown an improvement in examination; (5) It could be performed at any stage personality as well as in their intelligence quotients. during the encephalogram; (6) Without moving the The four that were operated on during the first decade of patient who was either uncooperative or under general life had become educable. anaesthesia, it could be performed conveniently in Similar results in individual cases had been recorded the sitting position; (7) It could be used after ventriculo- by other neurosurgeons, and Obrador (1958) had recently graphy for the routine brow-up or brow-down pro- http://jnnp.bmj.com/ collected six such cases from the literature. Occasionally jections ; (8) It was performed in the sitting position when the angiomatous lesion was circumscribed, a which was that normally used for encephalography. localized extirpation or a lobectomy would suffice, but During the rotation of the head the axis of rotation these limited excisions were more likely to be followed passed through the fourth ventricle, aqueduct, and third by continuance of epilepsy. ventricle. Since these were midline, the shadows cast by these structures would move far less than those placed REFERENCE more laterally. The optimum degree of rotation ap- Obrador, S. (1958). Acta Neurol. Latinoamer., 4, 70. peared to result from a movement through 10°. The Autotomography of the Third Ventricle, Aqueduct, and rate of rotation was unimportant, but the movement on September 30, 2021 by Fourth Ventricle must be smooth and regular. G. G. DE GUTIERREZ-MAHONEY (New York City) said The radiographic factors were: Exposure time- that autotomography was a technique for demonstrating 4 seconds, 50 mA, 66kV. a specific plane radiographically by the movement of the REFERENCES part of the subject being examined rather than by move- Vallebona, A. (1930). Radiol. med. (Torino), 17, 1090. ment of the apparatus in use. The technique was first Ziedses des Plantes, B. G. (1950). Acta radiol. (Stockh.), 34, 399. 81 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.23.1.81 on 1 February 1960. Downloaded from 82 PROCEEDINGS OF SOCIETY OF BRITISH NEUROLOGICAL SURGEONS Intraspinal Epidermoid Tumours in Children be established on one side or if there was a prominent J. SCHORSTEIN (Glasgow) reported five examples of unilateral reduction of fast activity. this condition which he had operated on during the past Should there be bilateral foci with no dominance and two years. One was congenital, in a spina bifida and no asymmetry of fast activity, lateralization of the connected to the skin by a sinus. The boy had always epileptogenic lesion could sometimes be achieved if a had a stiff back and suffered from intermittent attacks seizure was induced by the slow intravenous injection of of meningitis. a convulsant drug. Either metrazol (leptazol) or megi- Four occurred in children between the ages of 9 and mide (bemigride) might be used and the activation was 13; they had all been treated by intrathecal injection of carried out under synchronized cinematographic and an antibiotic from seven to nine years before they were electrographic observation. The ideal case showing seen. Three had suffered from tuberculous meningitis; reproduction of the habitual aura and fit pattern together one had had an undiagnosed feverish illness and had been with a clearly related focal discharge in the E.E.G. was given intrathecal penicillin. The main complaints were not always seen. Useful lateralizing or localizing in- pain in the low back and inability to flex the lumbar spine. formation could often be obtained but caution was Spinal rigidity was present in all, but only one had serious needed in the interpretation of results. This method of signs of compression of the cauda equina. Myelography activation (which might be combined with recording confirmed the diagnosis. One patient had multiple from multiple intracerebral electrodes) should be tumours. complementary to and not a substitute for the more The tumours were regarded as implantation epider- generally useful pentothal-sphenoidal technique. moids, entirely similar to the ones reported by Choremis, Economos, Papadatos, and Gargoulas in 1956. Since conditions in tuberculous meningitis Regeneration of the Anterior Lobe of the Human appeared more favourable to their development, the Pituitary Gland after Section of the Infundibulum tumours were likely to become extinct, for intrathecal PETER H. SCHURR (London) reported the histological streptomycin therapy had been largely abandoned. findings in the anterior lobes of the pituitary glands of eight patients suffering from breast or prostatic cancer guest. Protected by copyright. REFERENCE with multiple metastases, treated by division of the Choremis, C., Economos, D., Papadatos, C., and Gargoulas, A. infundibulum and insertion of a plastic plate to prevent (1956). Lancet, 2, 437. neurovascular union between the pituitary and the hypothalamus. These patients died of their disease from 30 hours to 11 months after operation. The glands A Comparison of Seizure and Sleep Activation in Temporal were studied by Professor P. M. Daniel and Miss Lobe Epilepsy M. M. L. Prichard. These workers had previously W. A. KENNEDY and M. V. DRIVER (London) com- shown that a very extensive infarct was produced in the pared the value of sleep and seizure activation in the anterior hypophysis of sheep, goats, rats, and other investigation of temporal lobe epilepsy and illustrated animals after stalk section (Daniel and Prichard, 1958) their techniques with a film. but there was nearly always a small peripheral rim and a They stated that in temporal lobe epilepsy the aura central tongue of living pituitary tissue. The survival of had little value for lateralization which, unless there was these cells depended on the arrangement of the blood a frank anatomical lesion, could be determined finally supply to the anterior lobe. Similar areas of infarction only by the E.E.G. In the absence of an E.E.G. record and surviving cells were found in man (Daniel, Prichard, of a spontaneous seizure-usually impossible to obtain and Schurr, 1958, and unreported cases). repeated recordings of activity between seizures were The animals studied in the above experiments showed necessary. These should include pentothal-sleep spheno- evidence of regeneration of anterior lobe cells. In some idal records, the advantages of which included: sheep the anterior hypophysis had virtually reformed by (1) More epileptic activity might be seen at the the end of three months after stalk section. It was now sphenoidal than at the surface electrodes since the former shown that a comparable series of changes took place in http://jnnp.bmj.com/ lay near the site of the pathological changes. In some man, and almost complete regeneration might occur in cases discharges appeared solely at the sphenoidal about a year.
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