Phlebography in tumours of the hemispheres and central grey matter

Microsurgery of tumours of the frontal white matter

Seventy eight microsurgical extirpations of tumours located in the frontal white matter led to adjustment of the normal anatomy of the frontal brain according to microsurgical requirements, and also to relation with modern diagnostic procedures, especially computerized tomography (CT-scanning). The advantages of microsurgical treatment have been demonstrated. Thus, only exact comprehension of topographical anatomy allows a methodical, careful, and radical procedure. As vessels were commonly saved, postoperative courses were relatively benign because of less tendency to oedema. Out of 78 patients, 3 died while in hospital, and two recurrences were observed in the following 23 months. Postoperatively 51 patients improved, 18 stayed unchanged neurologically, and 9 patients deteriorated permanently. The usual microsurgical instruments were employed. Vascular problems were dealt with by the routine techniques used at our hospital.

Identification of the anterior and posterior commissures by angiography

✓ A simple method has been developed by which the approximate location of the anterior and posterior commissures can be identified on the venous phase of the cerebral angiogram. The venous angle, and the junction of the internal cerebral vein and vein of Galen, are used as reference points since these structures were found by measurement on midline sagittally-sectioned brains to have a relatively constant spacial relationship to the commissures. This method for locating the commissures by angiography does not depend on the relationship of the deep venous structures to bone landmarks on the skull. Its chief limitation is that in 20% of the patients a true venous angle cannot be identified.