Biomedical subjects
Publications and source records attributed to G L Viale.
Some arteriovenous malformations fed by the striate arteries and lying within the claustrolenticular region can be excised by using microsurgical techniques. Three patients operated on with successful removal of the malformation are discussed here.
The uptake of labelled uridine is reduced in the whole ischaemic hemispheres of gerbils subjected to unilateral carotid artery occlusion. Following circulatory restoration, brain structures that had an ischaemic insult of moderate intensity exhibit a progressively increased uptake. However, during reperfusion there is a tendency towards a clear cut definition of dead zones. This progression of the lesions seems to be related to a maturation phenomenon occurring in areas with an irreversible damage at the end of the ischaemic period.
Seven patients with ruptured carotid-choroidal aneurysms were operated on in a three-year period. The anterior choroidal artery was thought to have been left intact in all cases at the operation. However, postoperative angiography revealed impairment of the choroidal circulation in two cases. These were the only patients who developed postoperative morbidity. Preservation of the anterior choroidal artery seems to be of paramount importance in dealing with carotid-choroidal aneurysms.
Nine cases of arteriovenous malformations of the posterior fossa were operated upon, using microsurgical techniques. The excision was radical in eight patients. Seven of them, as well as the sole patient who had a partial removal of the malformation, returned to their previous occupations without neurological signs. In one case the preoperative deficit was unchanged. Some lesions that appear to penetrate the brain stem actually lie on its surface and can be dissected through an extrapial plane of cleavage. Extension of the malformation into the cerebellar peduncles requires dissection of the tangle and opening of the IVth ventricle.
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Some arteriovenous malformations that are apparently located in the pons are in reality located on its surface. Thus, their extrapial dissection is possible. This is carried out under the surgical microscope and by means of the microtechnique. To nine available descriptions, the results obtained in four of our own patients are added: Three angiomas were in an extrapial antero-lateral position, one angioma reaching into the cerebellar hemisphere and causing a cerebellar haematoma. The fourth angioma was in the Brachium pontis and reached to the Flocculus and Loculus quadrangularis inferior. The patients (2 females, 2 males) were subjected to a subtemporal-transtentorial operation, the brachium-pontis angioma was operated on occipitally. Complete restoration was reached after the operation and the former activites were taken up again. The diagnosis was based on series angiography and computer tomography. The afferent vessels stemmed from one or several cerebellar vessels. The removal of the angioma requires the most subtile preparation.
Six personal cases of giant cell tumours of the sellar region, as well as 19 cases collected from the literature are reported. Clinical findings are described, and the factors affecting the post-operative course are discussed. Radical excision of the growth and recurrence-free course were exceptional. As a general rule, biopsy and partial excision were performed. Progression of signs and symptoms was frequent in the follow-up.
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