174 ARTHUR ECKER
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174 ARTHUR ECKER neck, and temperature was elevated to 101 ~ (R). The wound was clean. Repeat lumbar punc- ture showed normal pressure; fluid was xanthochromic and sterile. On the 7th day, patient was more drowsy and showed a blood sulfa level of 8.5 mg. per cent. Skull x-rays were re- peated and showed no change in the position of the bullet. On the 9th (lay he broke out in a generalized rash interpreted as due to the sulfa drug. Rbc was 3,350,000. The sulfa was dis- continued and a transfusion of ~50 cc. of whole blood administered. All symptoms cleared promptly. A detailed neurological examination done on the 17th day was entirely normal. He was discharged well on the 18th day. S u b s e q u e n t Course. Repeat x-rays (Mar. 1, 1940--5 weeks) disclosed that the bullet had moved downward and forward to a position directly above the posterior clinoid processes and posterior half of the sella turcica. It was concluded that the bullet was now lodged in the anterior portion of the 3rd ventricle. The latest film (Jan. 11, 1947) and fluoroscopy showed the bullet to have remained encysted.in this position (Fig. 1). By July 1941 (18 months), the patient began to have polydypsia and polyuria--about 3,500 cc. fluid intake/~4 hours. By January 1947, this had slowly increased to 5,0OO cc./~4 hours, with urine sp. gr. 1.OlO. He was urged to use posterior pituitary substance by nasal insufflation, but this was refused as being unnecessary. On last examination (May 7, 1949), 989 years after the injury, he was entirely symptom free except for polydypsia and polyuria, which had increased to 10,O00 cc./~4 hours, with urine sp. gr. 1.001. He was ~O years of age, his height 6489 inches and weight 140 pounds. He is a sophomore at the University of Toledo and doing better than average work. General physi- cal and neurological examinations are entirely normal. All secondary sexual characteristics are fully developed and he shaves daily. He voids every ~89 hours and noeturia is 1-~ times. He still insists this does not bother him sufficiently to warrant taking posterior pituitary substance. REFERENCE 1. GREENWOOD, J., JR. Removal of foreign body (bullet) from the third ventricle. J . Neurosurg., 1950, 7: 169-17~. HYPEROSTOSING MENINGIOMA OF PTERION CLAY MODEL AS AID IN SURGICAL EXCISION WITHOUT BONE FLAP* ARTHUR ECKER, M.D.~ S y r a c u s e , N e w Y o r k (Received for publication July 14, 1949) The difficulty in visualizing the hyperostosis affecting the four bony surfaces that results from pteriona[ meningiomas e n p l a q u e is well known? In such a case, invaluable assistance was offered by a prepared skull on which clay had been added to simulate the thickened bone. Furthermore, the orientation gained by using this model in the operating room permitted direct removal of the hyperostosis. Thus, even without a bone flap, there resulted sufficient exposure to permit both excision of the meningiomatous plaque and lateral decompression of the orbit. A report of this case is the basis of this paper. CASE REPORT H i s t o r y . The patient was a 48-year-old woman referred by Dr. Louis Alkoff. Her com- plaints were protrusion of the right eye ball and a mass in the right temporal fossa. Both conditions had been present for 8 months. * Presented at meeting of the Harvey Cushing Society, New Haven, Connecticut, June 4, 1949. t 608 East Genesee Street, Syracuse ~, New York.
Transcript of 174 ARTHUR ECKER
174 ARTHUR ECKER
neck, and temperature was elevated to 101 ~ (R). The wound was clean. Repeat lumbar punc- ture showed normal pressure; fluid was xanthochromic and sterile. On the 7th day, patient was more drowsy and showed a blood sulfa level of 8.5 mg. per cent. Skull x-rays were re- peated and showed no change in the position of the bullet. On the 9th (lay he broke out in a generalized rash interpreted as due to the sulfa drug. Rbc was 3,350,000. The sulfa was dis- continued and a transfusion of ~50 cc. of whole blood administered. All symptoms cleared promptly. A detailed neurological examination done on the 17th day was entirely normal. He was discharged well on the 18th day.
Subsequent Course. Repeat x-rays (Mar. 1, 1940--5 weeks) disclosed that the bullet had moved downward and forward to a position directly above the posterior clinoid processes and posterior half of the sella turcica. I t was concluded that the bullet was now lodged in the anterior portion of the 3rd ventricle. The latest film (Jan. 11, 1947) and fluoroscopy showed the bullet to have remained encysted.in this position (Fig. 1).
By July 1941 (18 months), the patient began to have polydypsia and polyuria--about 3,500 cc. fluid intake/~4 hours. By January 1947, this had slowly increased to 5,0OO cc./~4 hours, with urine sp. gr. 1.OlO. He was urged to use posterior pituitary substance by nasal insufflation, but this was refused as being unnecessary.
On last examination (May 7, 1949), 9�89 years after the injury, he was entirely symptom free except for polydypsia and polyuria, which had increased to 10,O00 cc./~4 hours, with urine sp. gr. 1.001. He was ~O years of age, his height 64�89 inches and weight 140 pounds. He is a sophomore at the University of Toledo and doing better than average work. General physi- cal and neurological examinations are entirely normal. All secondary sexual characteristics are fully developed and he shaves daily. He voids every ~�89 hours and noeturia is 1-~ times. He still insists this does not bother him sufficiently to warrant taking posterior pituitary substance.
REFERENCE
1. GREENWOOD, J., JR. Removal of foreign body (bullet) from the third ventricle. J. Neurosurg., 1950, 7: 169-17~.
HYPEROSTOSING MENINGIOMA OF PTERION
CLAY MODEL AS AID IN SURGICAL EXCISION WITHOUT BONE FLAP*
ARTHUR ECKER, M.D.~ Syracuse, New York
(Received for publication July 14, 1949)
The difficulty in visualizing the hyperostosis affecting the four b o n y surfaces t h a t results f rom pteriona[ meningiomas en plaque is well k n o w n ? In such a case, invaluable assistance was offered by a prepared skull on which clay had been added to simulate the thickened bone. Fur thermore , the orientat ion gained by using this model in the operat ing room permi t ted direct removal of the hyperostosis. Thus , even wi thout a bone flap, there resulted sufficient exposure to permit bo th excision of the meningiomatous plaque and lateral decompression of the orbit. A repor t of this case is the basis of this paper.
CASE REPORT
History. The patient was a 48-year-old woman referred by Dr. Louis Alkoff. Her com- plaints were protrusion of the right eye ball and a mass in the right temporal fossa. Both conditions had been present for 8 months.
* Presented at meeting of the Harvey Cushing Society, New Haven, Connecticut, June 4, 1949. t 608 East Genesee Street, Syracuse ~, New York.
HYPEROSTOSING M E N I N G I O M A OF PTERION 175
FIQ. 1. Lateral view of patient. (A) Pre-operative. (B) Postoperative.
FIG. ~. Lateral views. (A) Pre-operative x-ray of patient's skull. (B) Photograph of model. (C) Post- operative x-ray of patient's skull. (D) X-ray of model.
