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Honoring our past
Harrison and Reynolds: Trapped Fourth Ventricle
exudate at the time of the first operation, resulting in outflow obstruction. In addition, chronic ventricular inflammation was present following shunting. W h e t h e r this was due to the shunt, ventricular coccidioidomycosis, local amphotericin B therapy, or a combination of all three is difficult to say. W h a t e v e r the cause, this inflammation resuited in one-way aqueductal occlusion, most likely through a ball-valve type action in the scarred ependyma of the aqueduct. Neurosurgeons will treat increasing numbers of children with ventriculoperitoneal shunts for relief of communicating hydrocephalus due to a variety of causes. Those with basilar meningitis as the underlying etiology will proportionately increase as therapy improves. It is important that we be aware of this complication of hydrocephalus, shunting, and chronic basilar meningitis.
199
References 1. Abbott KH, Cutler O1: Chronic coccidioidal meningitis: review of the literature and report of seven cases. Arch Pathol 21:320-330, 1936 2. Buss WC, Gibson TE, Gifford MA: Coccidioidomycosis of the meninges. Calif Med 72:167-169, 1950 3. Foltz EL, DeFeo DR: Double compartment hydrocephalus--a new clinical entity. Neurosurgery 7:551-559, 1980 4. FoltzEL, Shurtleff DB: Conversion of communicating hydrocephalus to stenosis or occlusion of the aqueduct during ventricular shunt. J Neurosurg 24:520-529, 1966 5. Hawkins JC, Hoffman HJ, Humphrey RP: Isolated fourth ventricle as a complication of venrticular shunting. J Neurosurg 49:910-913, 1978 6. Lourie H, Shende MC, Krawchenko J, Stewart DH Jr: Trapped fourth ventricle: a report of two unusual cases. Neurosurgery7:279-282, 1980 7. Raimondi AJ, Clark SJ, McLone DG: Pathogenesis of aqueductal occlusion in congenital murine hydrocephalus. J Neurosurg 45:66-77, 1976 8. Sifontes JE, Sordillo SVR, Lincoln EM: Pneumoencephalography in tuberculous meningitis. J Pediatr 50:695-707, 1957 9. Zimmerman RA, Bilaniuk LT, Gallo E: Computed tomography of the trapped fourth ventricle. Am J Roentgenol 130:503-506, 1978
Letters to the Editor Honoring Our Past
Sarcoidosis
I have read your Editorial Note, "We Need Your Help" (16:164, 1981), and I would personally like to comment that I find the historical and biographical notes published in Surgical Neurology very useful and hope that the journal will continue to include them. I consider it imperative that we record the place and time of everything that we have learned until now, and how and who made possible the total knowledge that we now possess. To know the life of this still young and growing organism that is Neurosurgery is as important as to know its actual content. We have a great deal to learn from Horsley, Cushing, Dandy, Clovis Vincent, Percival Bailey, Cajal, Asenjo, Puusepp, Burdenko, and many others. I do not think that one can separate a person from their work any more than one can separate a work from its time. I couldn't fully understand a painting by Picasso without the knowledge of whom Pablo Ruiz Picasso was or knowledge of the time in which he lived. The delightful biographical article on Puusepp, published recently in Surgical Neurology (16:85-87, 1981), is a good example of what I am expressing. Puusepp is still telling us that the basis of neurosurgery is neurology. Finally, I wish to stress that the content of Surgical Neurology is of such great value and scope, that if one were to exclude the historical and biographical articles, one would still find in the publication attractive, interesting, and up-to-date material to make the journal very worthwhile and rewarding to read and to add to one's library.*
I am writing in reference to the article "Sarcoidosis Presenting as a Posterior Fossa Mass" (Surg Neurol 15:455-457, 1981). The authors describe a posterior fossa mass. In Figure 1, there does not appear to be sufficient documentation of this mass. In Figure 1B, a uniformly enhancing midline lesion is identified; however, this may simply represent the pseudotumor appearance of the cerebellar vermis [ 1, 2]. No mention is made of any pathological correlation in the vermis. In fact, postmortem examination revealed a typical sarcoid infiltration of the basal meninges, which would be consistent with the CT findings. The presentation of sarcoidosis as a well-defined cerebral granulomatous mass has been well described in the literature. Posterior fossa lesions, as noted, are rather uncommon. It would be helpful to know if there is better documentation of the material presented in the article prior to assuming that the findings presented are, in fact, real.
Julio Sanchez Juan, M.D. Oviedo, Spain *This letter was translated from the Spanish by Mrs. Theresa MacVean.
John Meyer, M.D. Pittsburgh, Pennsylvania References I. Kramer RA: Vermian pseudotumor: a potential pitfall of CT brain scanning with contrast enhancement. Neuroradiology 13:229-230, 1977 2. Zimmerman RD, Russell EJ, Leeds NE: Axial CT recognition of anteroposterior displacement of fourth ventricle. AJNR 1:65-70, 1980
exudate at the time of the first operation, resulting in outflow obstruction. In addition, chronic ventricular inflammation was present following shunting. W h e t h e r this was due to the shunt, ventricular coccidioidomycosis, local amphotericin B therapy, or a combination of all three is difficult to say. W h a t e v e r the cause, this inflammation resuited in one-way aqueductal occlusion, most likely through a ball-valve type action in the scarred ependyma of the aqueduct. Neurosurgeons will treat increasing numbers of children with ventriculoperitoneal shunts for relief of communicating hydrocephalus due to a variety of causes. Those with basilar meningitis as the underlying etiology will proportionately increase as therapy improves. It is important that we be aware of this complication of hydrocephalus, shunting, and chronic basilar meningitis.
199
References 1. Abbott KH, Cutler O1: Chronic coccidioidal meningitis: review of the literature and report of seven cases. Arch Pathol 21:320-330, 1936 2. Buss WC, Gibson TE, Gifford MA: Coccidioidomycosis of the meninges. Calif Med 72:167-169, 1950 3. Foltz EL, DeFeo DR: Double compartment hydrocephalus--a new clinical entity. Neurosurgery 7:551-559, 1980 4. FoltzEL, Shurtleff DB: Conversion of communicating hydrocephalus to stenosis or occlusion of the aqueduct during ventricular shunt. J Neurosurg 24:520-529, 1966 5. Hawkins JC, Hoffman HJ, Humphrey RP: Isolated fourth ventricle as a complication of venrticular shunting. J Neurosurg 49:910-913, 1978 6. Lourie H, Shende MC, Krawchenko J, Stewart DH Jr: Trapped fourth ventricle: a report of two unusual cases. Neurosurgery7:279-282, 1980 7. Raimondi AJ, Clark SJ, McLone DG: Pathogenesis of aqueductal occlusion in congenital murine hydrocephalus. J Neurosurg 45:66-77, 1976 8. Sifontes JE, Sordillo SVR, Lincoln EM: Pneumoencephalography in tuberculous meningitis. J Pediatr 50:695-707, 1957 9. Zimmerman RA, Bilaniuk LT, Gallo E: Computed tomography of the trapped fourth ventricle. Am J Roentgenol 130:503-506, 1978
Letters to the Editor Honoring Our Past
Sarcoidosis
I have read your Editorial Note, "We Need Your Help" (16:164, 1981), and I would personally like to comment that I find the historical and biographical notes published in Surgical Neurology very useful and hope that the journal will continue to include them. I consider it imperative that we record the place and time of everything that we have learned until now, and how and who made possible the total knowledge that we now possess. To know the life of this still young and growing organism that is Neurosurgery is as important as to know its actual content. We have a great deal to learn from Horsley, Cushing, Dandy, Clovis Vincent, Percival Bailey, Cajal, Asenjo, Puusepp, Burdenko, and many others. I do not think that one can separate a person from their work any more than one can separate a work from its time. I couldn't fully understand a painting by Picasso without the knowledge of whom Pablo Ruiz Picasso was or knowledge of the time in which he lived. The delightful biographical article on Puusepp, published recently in Surgical Neurology (16:85-87, 1981), is a good example of what I am expressing. Puusepp is still telling us that the basis of neurosurgery is neurology. Finally, I wish to stress that the content of Surgical Neurology is of such great value and scope, that if one were to exclude the historical and biographical articles, one would still find in the publication attractive, interesting, and up-to-date material to make the journal very worthwhile and rewarding to read and to add to one's library.*
I am writing in reference to the article "Sarcoidosis Presenting as a Posterior Fossa Mass" (Surg Neurol 15:455-457, 1981). The authors describe a posterior fossa mass. In Figure 1, there does not appear to be sufficient documentation of this mass. In Figure 1B, a uniformly enhancing midline lesion is identified; however, this may simply represent the pseudotumor appearance of the cerebellar vermis [ 1, 2]. No mention is made of any pathological correlation in the vermis. In fact, postmortem examination revealed a typical sarcoid infiltration of the basal meninges, which would be consistent with the CT findings. The presentation of sarcoidosis as a well-defined cerebral granulomatous mass has been well described in the literature. Posterior fossa lesions, as noted, are rather uncommon. It would be helpful to know if there is better documentation of the material presented in the article prior to assuming that the findings presented are, in fact, real.
Julio Sanchez Juan, M.D. Oviedo, Spain *This letter was translated from the Spanish by Mrs. Theresa MacVean.
John Meyer, M.D. Pittsburgh, Pennsylvania References I. Kramer RA: Vermian pseudotumor: a potential pitfall of CT brain scanning with contrast enhancement. Neuroradiology 13:229-230, 1977 2. Zimmerman RD, Russell EJ, Leeds NE: Axial CT recognition of anteroposterior displacement of fourth ventricle. AJNR 1:65-70, 1980