Image-guided transoral clipping of basilar aneurysm.
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Basilar Artery↗
Biomedical subjects
R J Stacey
Publications and source records attributed to R J Stacey.
Rapid growth in a cavernoma.
The availability of magnetic resonance imaging has greatly increased the detection of cavernous malformations of the central nervous system in both symptomatic and asymptomatic patients. These lesions may be responsible for previously unexplained neurological events or may even have been incorrectly diagnosed. We describe a patient presenting with focal neurological signs in whom an initial diagnosis of malignant glioma had been made. Following excision, the pathological diagnosis was cavernoma. This vascular lesion has continued to show rapid growth and aggressive behaviour despite multiple surgical resections. The indications for operative and non-operative intervention will be discussed.
Adolescent↗
Cavernomas in the central nervous system and the relevance of multiple intracranial lesions in the familial form of this disease.
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Adult↗
Magnetic resonance tomographic angiography of the arterial circle (of Willis).
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Circle of Willis↗
Idiopathic syringomyelia and the importance of occult arachnoid webs, pouches and cysts.
Syringomyelia is the condition in which longitudinal cavities are found within the spinal cord. The use of drainage procedures has been widely practised with good short term results. However, the long-term results in some large series have been less favourable. There are many associated conditions and in most forms a blockage to the normal flow of CSF, either at the foramen magnum or in the spinal canal, can be identified. Most surgeons would now direct their efforts to the establishment of normal CSF flow rather than a shunting procedure. In a certain group of patients, even with the advent of sophisticated MRI, no associated abnormality or CSF block is easily identified. This type of syringomyelia is often termed idiopathic. We report 10 patients with symptomatic syringomyelia without readily recognized predisposing factors. In eight patients preoperative myelography revealed a block to the flow of contrast compatible with subarachnoid obstruction. Eight patients underwent laminectomy and division of the obstructing arachnoid webs. Five experienced good improvement and three only moderate improvement. Two of the patients underwent syrinx shunting procedures only, which resulted in a worsening of their symptoms. At operation one patient was found to have an arachnoid cyst. We believe that patients with idiopathic symptomatic syringomyelia may need myelography to identify such arachnoid abnormalities. Subsequent surgery should be directed at the establishment of normal CSF flow by laminectomy and excision of the offending lesion.
Adult↗
An anomaly in the nerve supply of the trapezius muscle.
Controversy surrounds the nerve supply to the trapezius muscle. We report a single specimen, from a series of dissections designed to study the intradural and peripheral course of the spinal part of the accessory nerve (sp.XI), in which the nerve failed to supply the trapezius muscle, whose supply came entirely from the cervical plexus. This provides anatomical support for the view that the supply from the cervical plexus may contain motor fibers and helps to explain why the sacrifice of the accessory nerve in radical neck dissection does not always produce complete paralysis of the trapezius muscle.
Cervical Plexus↗
The innervation of the trapezius muscle: a cervical motor supply.
Controversy surrounds the nerve supply to the trapezius muscle. Anatomical studies have revealed independent connections from the C3 and C4 roots of the cervical plexus directly to the trapezius muscle. The objective of this study was to determine if these nerve bundles contain motor fibres and thus constitute an additional motor supply to trapezius. From a study of 32 cadavers, a representative example was chosen. Using a high powered operating microscope it was seen that such fibres were traceable to the ventral roots of the spinal cord. It is generally accepted that fibres in the ventral roots of the spinal cord are motor and thus, in this specimen, the trapezius muscle appeared to receive a direct motor supply from the cervical plexus independent of the accessory nerve.
Cervical Plexus↗