bluuebunny/crossref_metadata_2025 huggingface dataset:
Etiology and definitive microsurgical treatment of hemifacial spasm
Authors: Jannetta Peter J. , Abbasy Munir , Maroon Joseph C. , Ramos Francisco M. , Albin Maurice S.
Published: May 2009

✓ The clinical and operative findings are reviewed in 47 patients with intractable hemifacial spasm. The syndrome was classical in its features in 45 patients and atypical in two. Mechanical compression distortion of the root exit zone of the facial nerve was noted in all 47 patients. In 46 the abnormality was vascular cross-compression, usually by an arterial loop. In one patient, a small cholesteatoma was discovered and removed. Morbidity and postoperative results are discussed.
Treatment of experimental spinal cord compression caused by extradural neoplasms
Authors: Ushio Yukitaka , Posner Roslyn , Kim Jae-Ho , Shapiro William R. , Posner Jerome B.
Published: May 2009

✓ Epidural spinal cord compression was produced in rats by injection of Walker 256 carcinoma cell suspension anterior to the T-12 or T-13 vertebral body. The tumor grows through the intervertebral foramina to compress the spinal cord and produce paraplegia in 3 to 4 weeks. The effect of several treatments upon clinical signs was assessed. Dexamethasone caused a significant but transient improvement in neurological function. Radiation therapy likewise improved neurological function, and was more effective when given by a high-dose protracted course than when given either in a single dose or a low-dose protracted course. Laminectomy was not helpful in relieving neurological symptoms. Dimethyl sulfoxide did not relieve neurological symptoms. Cyclophosphamide was most effective in relieving neurological symptoms, and most of the animals that were treated with that drug when they were severely weak but still able to move their hind limbs recovered fully. Some animals that were totally paraplegic when treatment began recovered function after radiation therapy or cyclophosphamide treatment, but recovery was better if treatment was started when animals could still move their hind limbs. This animal model appears to be a useful way of studying the treatment of human spinal cord compression produced by epidural neoplasms.
Prolonged vasospasm produced by the breakdown products of erythrocytes
Authors: Osaka Kunihiko
Published: May 2009

✓ The cause of cerebral vasospasm has been generally attributed to the vasoconstrictive substances released from platelets. The role of extravasated erythrocytes in vasospasm has never been well analyzed. To elucidate this point, the basilar arteries of cats were exposed and subjected to topical application of various blood fractions in their fresh state and after prolonged incubation for 1 to 7 days. Incubation was done to test stability of the vasoconstrictors. Severe vasospasm was induced by application of fresh and incubated fractions of lysed erythrocytes. Fresh, intact erythrocytes had no vasoactivity, but by incubation they lysed and gained vasoconstrictors. Vasospasm induced by lysed erythrocytes both in their fresh state and after prolonged incubation never relaxed, and tended to increase in severity during observation up to 24 hours. Fresh serum and platelet-rich plasma had vasoconstrictors, but they were lost after incubation. Apparently platelet-induced vasoconstriction is of short duration and contributes only to the early phase of vasospasm. Later, 12 to 24 hours after hemorrhage, iron pigments released by lysis of extravasated erythrocytes (oxyhemoglobin or methemoglobin) irritate the arterial wall and induce prolonged vasospasm. It is emphasized that the study of cerebral vasospasm should be focused on the role of the breakdown products of extravasated erythrocytes.
Thrombus formation and endothelial alterations in microarterial anastomoses
Authors: Rosenbaum Thomas J. , Sundt Thoralf M.
Published: May 2009

✓ The sequential hematological and endothelial responses in the postoperative period after end-to-side arterial anastomosis in 1- to 1.3-mm vessels were assessed by scanning electron microscopy. Two minutes after restoration of flow, an amorphous coating covered the vessel lumen around the suture line, and oozing of blood from the suture line ceased. Within 15 minutes, a partially occluding thrombus was present, which was maximal at the anastomotic bifurcation point. The thrombus underwent partial lysis or embolization within 30 minutes, and gross intraluminal thrombi did not recur. The initial thrombi that formed within 2 minutes were composed of platelets and erythrocytes in a loose reticular fibrin network, but the intraluminal thrombi present at the branch point 15 minutes after flow restoration appeared to be composed solely of platelets. Thrombi that did not undergo complete dissolution had a loss of distinct cellular elements at later time intervals. The fibrin-platelet matrix coating the lumen remained unchanged during the initial 24 hours. When examined at 9 days, normal endothelium was present throughout the vessel with the exception of the suture line, which remained covered by a smooth coagulum. This sequence of events suggests that if surgical manipulation is to result in complete occlusion of the anastomosis, it will likely occur in the initial 30 minutes after resumption of blood flow.

Anticoagulant regimens were evaluated. Pretreatment with aspirin and intraoperative heparin irrigation of the vessel lumen were not beneficial in altering the quantity of thrombus. All systemic heparin regimes tested resulted in a quantitative decrease of thrombotic material. Five minutes of intravenous heparin therapy after resumption of blood flow was as effective as long-term heparin in decreasing the transient intraluminal thrombotic response.
Primary pigmented carcinoma of the choroid plexus
Authors: Lana-Peixoto Marco A. , Lagos Julio , Silbert Shirley W.
Published: May 2009

✓ Pigmented carcinoma of the choroid plexus was found in a 33-year-old man. Autopsy revealed no primary tumor in the skin or eyes. A slightly cystic pigmented tumor was present in the right lateral ventricle infiltrating the thalamus and striatum. Metastatic implants were found in both temporal lobes and the cerebellum. The spinal cord was covered by black meningeal nodules, and the cauda equina was completely encased by the tumor. Metastases were found in the liver, pancreas, and kidney. Microscopically the mass contained normal choroid plexus with psammoma bodies adjacent to carcinomatous epithelium forming prominent papillae and tubules. Melanin granules were found within the neoplastic cells and in the stroma. Electron microscopy demonstrated melanin granules in various stages of development in the cells, which were joined one to another by desmosome-like structures. This is the second reported case of pigmented carcinoma of the choroid plexus and the first with metastases outside the central nervous system.
Symptomatic Rathke's cleft cyst
Authors: Yoshida Jun , Kobayashi Tatsuya , Kageyama Naoki , Kanzaki Masaki
Published: May 2009

✓ A rare case is reported in which a symptomatic Rathke's cleft cyst was studied by light and electron microscopy and tissue culture. The findings are compared with those of a craniopharyngioma studied in the same way. The patient was a 26-year-old woman presenting with headache, chiasmatic syndrome, and hypopituitarism. A cyst containing a mural nodule was partially removed and an Ommaya reservoir placed in the operative site for further treatment. The cyst wall was composed of connective tissue and three kinds of epithelial cells: non-ciliated squamous, ciliated columnar, and mucous-secreting cells. The morphology of these cells in vitro was similar to prickle cells seen in craniopharyngioma and the epidermis. It is concluded that both Rathke's left cyst and craniopharyngioma originate in remnants of Rathke's pouch, but at times may show some histological differences.
Sacrum fractures and neurological damage
Authors: Byrnes Dermot P. , Russo G. Lee , Ducker Thomas B. , Cowley R Adams
Published: May 2009

✓ Two cases are presented in which automobile collision caused transverse sacral fracture involving neurological elements. The patients were admitted within 2 weeks of each other to the Maryland Institute for Emergency Medicine. An attempt was made to assess the incidence of this condition and its relation to fractured pelvis. A literature search was conducted, and several points of diagnosis and management are discussed.
Fractured aneurysm clip
Authors: Quest Donald O. , Countee Roger W.
Published: May 2009

✓ The authors report a case of mechanical failure of a medium-straight Heifetz aneurysm clip that resulted in the blades being widely open 10 months postoperatively. The need for postoperative angiography after intracranial aneurysm surgery is reemphasized. Plain skull film examination is also recommended should signs and symptoms suggest an intracranial event in the postoperative course.
Primary intracerebral osteoblastoma
Authors: Messina Albert V. , Abbott Gerald F. , Gray George , Patterson Russel H.
Published: May 2009

✓ This is the first reported case of primary intracerebral osteoblastoma. The radiological and pathological features are reported. Possible sites of origin are discussed.
The outcome from severe head injury with early diagnosis and intensive management
Authors: Becker Donald P. , Miller J. Douglas , Ward John D. , Greenberg Richard P. , Young Harold F. , Sakalas Romas
Published: May 2009

✓ In the belief that secondary cerebral compression, hypoxia, and ischemia materially influence the outcome from severe head injury, a standardized protocol was followed in 160 patients, with emphasis on early diagnosis and evacuation of intracranial mass lesions by craniotomy, artificial ventilation, control of increased intracranial pressure, and aggressive medical therapy. Of these patients, 36% made a good recovery, 24% were moderately disabled, 8% were severely disabled, 2% were vegetative, and 30% died. The mortality rate compares favorably with outcomes in similar patients reported from other centers and there has been no increase in the numbers of severely disabled or vegetative patients. It is proposed that vigorous surgical and medical therapy, by preventing or reversing secondary cerebral insults, enables some patients who would have died to make a good recovery without increasing the proportion of severely disabled patients.
Concentration of 3′,5′ cyclic adenosine monophosphate in ventricular CSF of patients following severe head trauma
Authors: Fleischer Alan S. , Rudman Daniel R. , Fresh C. Babson , Tindall George T.
Published: May 2009

✓ Previous studies have demonstrated that cerebrospinal fluid (CSF) from the lateral ventricle of patients without disturbance of sensorium or intracranial pressure, contains 15 to 30 nM 3′,5′ cyclic adenosine monophosphate (cAMP). The concentration of this cyclic nucleotide was measured by radioimmunoassay in 133 samples of CSF from the lateral ventricle of 26 patients who were comatose following acute head trauma for periods up to 40 days. Concentration of CSF cAMP in diminishing coma Grades V, IV, III, II, and I was 1.5 ± 0.1 nM; 1.24 ± 0.34 nM; 3.14 ± 0.7 nM; 10.06 ± 3.47 nM; and 13.36 ± 1.38 nM, respectively. After the sensorium cleared (coma Grade 0), cAMP was 22.0 ± 1.7 nM. The correlation between the grade of coma and cAMP concentration was −0.80 (p > 0.01). These results imply that alteration in the level of consciousness following head trauma is associated with a disturbance of cAMP metabolism within the central nervous system. Possible mechanisms explaining this observation as well as therapeutic implications are discussed.
Experimental cerebral concussion
Authors: Bakay Louis , Lee Joseph C. , Lee George C. , Peng Jiun-Rong
Published: May 2009

✓ Cerebral concussion was produced in rats by an iron pendulum hitting the external occipital protuberance. This resulted in loss of consciousness lasting from 3 to 10 minutes with prompt recovery and no focal neurological signs. The energy absorbed by the head at the impact was calculated to be about 1450 gm/cm. Light microscopic survey showed only minor pathological changes. However, electron microscopic observation revealed considerable alteration which began at 30 minutes, reached a peak at 1 hour, and disappeared at 24 hours after concussion. The salient changes included severe swelling of the neuronal mitochondria at the point of impact (occipital cortex), and extracellular edema at the site of contre coup (frontal lobe). Topographically, the most severe alteration was seen in structures at the craniospinal junction (medulla oblongata and upper cervical cord), consisting of both mitochondrial and edematous changes. Although there was no visible opening of the capillary interendothelial junctions, extravasated ferritin particles were accumulated in the edematous regions, indicating a transient increase in the permeability of the blood-brain barrier.
The physiological basis of intracranial pressure change with progressive epidural brain compression
Authors: Sullivan Humbert G. , Miller J. Douglas , Becker Donald P. , Flora Roger E. , Allen Gilbert A.
Published: May 2009

✓ Sequential cerebrospinal fluid (CSF) pressure-volume studies were carried out in seven cats during the expansion at a constant rate of an epidural balloon. The same studies were performed in three control cats. Beginning after 20 minutes of inflation and continuing to the point of pupillary dilatation there was a progressive increase in the pressure-volume index (volume required to change intracranial pressure (ICP) by tenfold). During the course of balloon inflation, there was also a progressive increase in CSF elastance (instantaneous ICP change per unit change in CSF volume). At the point of pupillary dilatation there was a marked, abrupt increase in the pressure-volume index and an equally dramatic decrease in CSF elastance. The CSF outflow resistance increased to a variable extent during balloon inflation. The plot of the CSF pressure versus balloon volume (the mass lesion pressure-volume curve) was of the classical configuration with an initial relatively flat segment and a final steep segment. A hypothesis is presented that interprets the shape of the mass lesion pressure-volume curve in terms of changes occurring in the elastic properties of the tissues surrounding the CSF space and the volume of the CSF space. It is proposed that this hypothesis will explain most of the commonly observed variations in CSF pressure. Confusion regarding the ICP-volume relationships has arisen because of lack of specificity regarding which anatomical spaces are being perturbed.
Anterior cervical discectomy without bone graft
Authors: Wilson Donald H. , Campbell Dwight D.
Published: May 2009

✓ Anterior cervical discectomy without bone grafting may become the procedure of choice for acute cervical disc protrusions. This operation was performed on 71 patients, all of whom were followed from 1 to 6 years. Complications were minor in nature. The results were excellent and sustained.
Objective clinical assessment of motor function after experimental spinal cord injury in the rat
Authors: Rivlin Alex S. , Tator Charles H.
Published: May 2009

✓ A new method was developed for the clinical assessment of motor function in rats after experimental spinal cord injury. The method consists of placing the animal on an inclined plane which can be adjusted to provide a slope of varying grade, and then assessing the maximum angle of the plane at which the animal can maintain its position without falling. The method was used to quantitate motor function in normal rats and in rats subjected to myelectomy, and consistently showed major differences between the two groups. The method has many positive features: the plane is easy to construct and of low cost; and the test is rapid, non-invasive, repeatable, and consistent.
Cerebrospinal fluid GABA reductions in seizure patients evoked by cerebellar surface stimulation
Authors: Wood James H. , Glaeser Bruce S. , Hare Theodore A. , Sode Jonas , Brooks Benjamin R. , Van Buren John M.
Published: May 2009

✓ Lumbar cerebrospinal fluid (CSF) gamma-aminobutyric acid (GABA) levels determined by fluorometric assay in four seizure patients were found to be significantly lower during bilateral, continuous cerebellar stimulation than those determined after a 7-day period without stimulation. The CSF GABA concentrations during chronic unilateral, alternating cerebellar stimulation were reduced in three seizure patients but unchanged in a fourth patient. The percentage decrease in CSF GABA appeared to be independent of cerebellar stimulation frequency. These findings suggest that GABA-mediated neuronal transmission is depressed during cerebellar surface stimulation and this evoked reduction in GABA activity may compromise the efficacy of cerebellar stimulation in the treatment of epilepsy.

Lumbar CSF cyclic guanosine monophosphate levels determined by radio-immunoassay were not significantly altered by either mode or frequency of cerebellar stimulation.
Vermian agenesis and unsegmented midbrain tectum
Authors: Calogero John A.
Published: May 2009

✓ A male infant had spells of tachypnea leading to apnea. He had vermian agenesis and an unsegmented midbrain tectum. This identifies the time of teratogenesis at about embryonic stage XVII to XVIII (40 days gestation).
Bilateral persistent trigeminal arteries
Authors: Binet Eugene F. , Young Ronald F.
Published: May 2009

✓ A case is presented of bilateral persistent trigeminal arteries associated with reticulum cell sarcoma of the cerebellum.
Localization of velum interpositum AVM with metrizamide ventriculography and simultaneous stereoangiography
Authors: Lunsford L. Dade , Maroon Joseph C. , Bank William O. , Drayer Burton P. , Rosenbaum Arthur E.
Published: May 2009

✓ The combination of metrizamide (Amipaque) ventriculography and vertebral angiography with stereoradiography provided precise localization of an arteriovenous malformation of the velum interpositum and an associated hematoma in the lateral ventricles that had not been detected by computerized tomography. This dual technique is recommended for precise localization of suspected intra- or periventricular lesions before surgery.
Aneurysmal bone cyst of the skull
Authors: Rao K. V. Chalapati , Rao B. Subba , Reddy C. Pulla , Sundareshwar B. , Reddy C. R. R. M.
Published: May 2009

✓ A case of giant aneurysmal bone cyst of the skull is reported. Treatment was by total excision in three-staged surgery. The patient made a good recovery.
Transoral, transsphenoidal microsurgical exposure of the pituitary gland and infundibulum in the rhesus monkey
Authors: Tindall George T. , Patton John , Neill Jimmy D.
Published: May 2009

✓ A transoral, transsphenoidal microsurgical technique for exposing the pituitary stalk and gland of the rhesus monkey is described and illustrated. The technique has proved to be a safe and practical method for performing a variety of pituitary operations in a total of 37 animals. The procedures have included complete hypophysectomy, posterior lobe resection, pituitary stalk section, collection of portal venous blood, collection of pituitary venous blood, and placement of lesions in the organum vasculosum of the lamina terminalis.
Decerebrate rigidity in acute head injury
Authors: Bricolo Albino , Turazzi Sergio , Alexandre Alberto , Rizzuto Nicola
Published: May 2009

✓ A comprehensive study of the motor patterns, usually grouped under the heading “decerebrate rigidity,” was carried out in a series of 800 patients with severe head injuries. The incidence of these manifestations was 39.6%, and when they were present chances of survival were reduced from 79.4% to 28.1%. Clinical and electromyographic investigations revealed heterogeneous and unstable motor manifestations that did not fit into the classical groups of experimental models of decerebrate rigidity. Combinations of extensor and flexor attitudes and/or responses were frequently found in the same patient, but could be separated into homogeneous groups. Each recognized postural pattern had its own distinct neurological signs and prognosis. Age did not significantly affect the outcome; however, intracranial expanding lesions (73.5%), impairment of the brain-stem oculomotor system (49.8%), and deep coma (88.9%) all contributed to an unfavorable course. Surgical treatment was effective when performed for intracranial hematomas and in patients with incomplete extensor rigidity. Good recovery was achieved in 16% of decerebrate patients, while 12.1% survived in prolonged coma or with severe disabilities.

All clinical and neuropathological data suggest that extensor motor abnormalities in the acute phase of cerebral traumatic disease do not always conclusively indicate structural brain-stem damage. A critical analysis of so-called “decerebrate rigidity” (rejecting in some instances its Sherringtonian implications) may allow for a more accurate clinical assessment of the severity of head injury.
Late morbidity and mortality of common carotid ligation for posterior communicating aneurysms
Authors: Winn H. Richard , Richardson Alan E. , Jane John A.
Published: May 2009

✓ The long-term evaluation of 60 patients who suffered a subarachnoid hemorrhage and survived 6 months is reported. By bilateral carotid arteriography, all patients were shown to have a single aneurysm at the vicinity of the posterior communicating artery at its junction with the internal carotid artery. The patients had previously been randomly assigned to treatment either by bed rest or by common carotid ligation. Average duration of survival among those followed is 8 years. Late rebleeding episodes were found to occur at a similar rate, irrespective of mode of treatment in the studied populations, but morbidity following operation continued to remain somewhat less over the ensuing years of follow-up study compared with the patients treated conservatively. On final assessment many years after the original hemorrhage, there is little improvement in degree of morbidity in either treatment group, and hypertension is noted to develop in the patients undergoing carotid ligation. A larger number of cases will be required to validate these findings.
Comparison of fascicular, interfascicular, and epineural suture techniques in the repair of simple nerve lacerations
Authors: Levinthal Robert , Jann Brown W. , Rand Robert W.
Published: May 2009

✓ Simple lacerations of dog anterior tibial nerves were repaired utilizing fascicular, interfascicular, and epineural suture techniques. Two months following repair, the involved regions of the nerves were removed and stained with hematoxylin and eosin, Weil, Bielschowsky, and Masson trichrome stains. An independent, unbiased observer rated proximal and distal myelin, connective tissue responses, and proximal to distal axon counts. The proportion of proximal to distal axons revealed no significant difference between fascicular (77%) and epineural (67%) neurorrhaphy, but showed a significant beneficial effect of fascicular suture to the interfascicular (52%) repair (significance at < 0.02). Masson stain revealed dense connective tissue responses, but the axon counts were adversely affected only when the separate fascicles showed internal disruption by connective tissue. In general, distal myelinization was mildly superior with the fascicular neurorrhaphy technique.

It appears that in simple lacerations in nerves which are repaired via direct end-to-end suture, there is no significant advantage to fascicular over epineural repair; however, there is a definite deleterious effect of interfascicular neurorrhaphy. The theoretical and technical implications of these findings are discussed.
Femoral nerve repair with nerve autografts
Authors: Osgaard Ole , Husby Jakob
Published: May 2009

✓ Two cases of femoral nerve lesions are reported, one in the pelvic region, and one in the femoral triangle. In both cases, secondary microsurgical autografting resulted in a good functional and electrophysiological recovery.
Closure of large skin defect associated with thoracolumbar rachischisis
Authors: Winston Ken , Mickle Parker , Schuster Samuel
Published: May 2009

✓ The management of a premature infant with a large skin defect associated with thoracolumbar rachischisis is presented. Full-thickness closure was achieved in 8 days using a new technique, adapted from a method of closing large omphaloceles.
A simple method of measuring aneurysm clip tension
Authors: DeLong W. Bradford
Published: May 2009

✓ The opening force of aneurysm clips can be determined easily with a dynamometer tension gauge. The method is described.
A new method of cranioplasty
Authors: Asimacopoulos Takis J. , Papadakis Nikolas , Mark Vernon H.
Published: May 2009

✓ A new method of cranioplasty is described. The skull defect is exposed, and an impression is taken which is used for the construction of a plaster of Paris model of the defect. Methyl methacrylate is molded to the model and thus an accurate reproduction of the skull defect is produced. The technique has the main advantage of good cosmetic appearance and strength.
Reinforcement with gauze wrapping for ruptured aneurysms of the middle cerebral artery
Authors: Taylor Julien C. , Choudhury Abdur R.
Published: May 2009

✓ A 2- to 15-year follow-up study is presented of a series of 35 consecutive patients treated for ruptured aneurysms of the middle cerebral artery by reinforcement with gauze wrapping. Only one patient suffered early recurrent hemorrhage in the postoperative period, and none had a late hemorrhage. The procedure carried a relatively low mortality rate (8.6%). Morbidity was the direct sequel of preoperative conditions. Wrapping is an effective and safe treatment of these aneurysms, with a low mortality and morbidity, and freedom from occlusive infarcts.
Does dexamethasone inhibit the growth of human gliomas?
Authors: Sherbet Gajanan V. , Lakshmi M. S. , Haddad Salim K.
Published: May 2009

✓ Dexamethasone (104M) was shown to inhibit the growth of human gliomas in culture. This was indicated by the inhibition of incorporation of radioactively labeled thymidine into the deoxyribonucleic acid (DNA) of the cells, and by the increase in the generation time of cells exposed to the drug in vitro. On the other hand, tumors obtained from patients who had received dexamethasone before craniotomy grew considerably faster in vitro than tumors from patients who had not been given the drug before operation.
Immunobiology of primary intracranial tumors
Authors: Woosley Ronald E. , Mahaley M. Stephen , Mahaley Jane L. , Miller Gary M. , Brooks William H.
Published: May 2009

✓ Fifty-six in vitro microcytotoxicity assays were conducted on 30 patients with intracranial tumors at various times during their postoperative course. Significant specific cellular cytotoxic responses were found in nine of 56 assays, humoral cytotoxic responses in nine of 54 assays, and host effector cell-dependent, antibody-dependent cytotoxic responses in four of 28 assays. Variables that might influence the occurrence of cytotoxicity were studied, and the relationship of these findings to other immune parameters was discussed.
Genetic perspectives on craniosynostosis and syndromes with craniosynostosis
Authors: Cohen M. Michael
Published: May 2009

✓ Thirty-seven syndromes in which craniosynostosis is a feature are presented in tabular form, allowing the clinician to rapidly identify a given syndrome and gain immediate access to the pertinent literature. A plea is made to delineate unknown genesis syndromes with craniosynostosis as rapidly as possible. As an unknown genesis syndrome becomes delineated, its phenotypic spectrum, its natural history, and its inheritance pattern or risk of recurrence become known, allowing for better patient care and family counseling.
A pressure-balanced radio-telemetry system for the measurement of intracranial pressure
Authors: Zervas Nicholas T. , Cosman Eric R. , Cosman Bernard J.
Published: May 2009

✓ A fully implantable radio-telemetric differential intracranial pressure sensor is described with a zero-point calibration that can be confirmed repeatedly. Intracranial pressure (ICP) is measured with the device by the principle of applying a known external pressure to the scalp above the sensor and simultaneously detecting by radiotelemetry the zero-point of the sensor corresponding to a balance of pressures across it. The radio-telemetry is implemented by a resonant circuit in the sensor of which the resonant radiofrequency is detected outside the body. The sensor is passive, has built-in barometric compensation, negligible permeability or temperature drift, no calibration ambiguities, and fast dynamic response. The implanted sensor has been used successfully for short-term as well as long-term ICP monitoring. It has been implemented primarily for intermittent ICP measurements, but also adapted to continuous recording. Preliminary clinical experience with the system indicates that it is effective, safe, and simple to operate.
Focal eosinophilic granuloma of the temporal lobe
Authors: Sivalingam Selvadurai , Corkill Guy , Ellis William G. , Claiche John R.
Published: May 2009

✓ The authors describe the clinical, pathological, and therapeutic aspects of a case of focal temporal lobe eosinophilic granuloma, presenting with otitis media and meningitis, and evolving subsequently into a temporal lobe mass. This triad, otitis media, meningitis, focal cerebral lesion with systemic manifestations of inflammation, eosinophilia of blood and cerebrospinal fluid, should suggest eosinophilic granuloma in the differential diagnosis. The lesion is sensitive to relatively small doses of radiation.
Choroidal epithelial cyst
Authors: Koto Atsuo , Horoupian Dikran S. , Shulman Kenneth
Published: May 2009

✓ A supratentorial cyst in the leptomeninges of an 8-month-old infant was studied with the electron microscope. The lining of the cyst consisted of a single layer of pegshaped epithelial cells rich in organelles and glycogen. Their free border had numerous microvilli but no cilia, and their basal portions rested on a basement membrane. Tight junctions and interdigitations were frequent between contiguous cells. The blood vessels were fenestrated. Since these features characterize developing choroidal epithelial cells, we felt the diagnosis of choroidal epithelial cyst was justified. Cysts lined by choroidal epithelium may continue to secrete cerebrospinal fluid after surgical extirpation when this is incomplete. Accumulation of the fluid in the partially excised cyst bed may therefore account for recurrence of symptoms.
Spontaneous subarachnoid hemorrhage first from an intracranial and then from a spinal arteriovenous malformation
Authors: Parkinson Dwight , West Michael
Published: May 2009

✓ A patient presented with spontaneous subarachnoid hemorrhage (SAH) from a cerebral arteriovenous malformation (AVM) which was later totally removed at surgery. The patient presented again with a new SAH from a spinal AVM that was also totally removed at surgery. Coexistence of spinal and cerebral arteriovenous malformations are exceedingly rare and hemorrhage from each is not previously reported. This case emphasizes the importance of investigating the spinal canal in otherwise unexplained spontaneous SAH.
A critical comparison of neurosurgical and otolaryngological approaches to acoustic neuromas
Authors: Ditullio Michael V. , Malkasian Dennis , Rand Robert W.
Published: May 2009

✓ Neurosurgeons have traditionally advocated the transmeatal suboccipital craniectomy as the procedure of choice in treating acoustic neuromas of all sizes. With this technique, complete tumor removal was achieved in 91% of our patients. Facial motor activity was fully preserved in 59% and it was only partially deficient in an additional 29%. Conversely, recent otological reports have proposed a more flexible attitude in which the size of the tumor dictates the form of surgical therapy. In that scheme, the universally applicable and clinically proven suboccipital craniectomy is replaced by a series of procedures (translabyrinthine, middle fossa, transsigmoidal), each of which differs in its anatomical and technical requirements. This necessity for several operations seems to stem from the failure of any particular approach either to provide adequate visualization of the entire pathological process, or to afford maximum opportunity for complete tumor removal. By employing these various techniques, total capsular removal has been generally achieved in only 71% of cases. A careful comparison and analysis of these individual procedures reaffirms the superiority of the posterior fossa approach.
Survival status of children with cerebellar gliomas
Authors: Leviton Alan , Fulchiero Anita , Gilles Floyd H. , Winston Ken
Published: May 2009

✓ The goals of this study were: 1) to determine how well a multivariate analytic procedure shortly after surgery would have classified children with cerebellar glioma according to expected survival status (alive or dead) 5 years later, and 2) to identify histological, clinical, and other features that contributed most to the classification. Fifteen of the 76 (20%) children in this study died before the end of the fifth postoperative year. The linear discriminant function (LDF) constructed with the four histological features of microcysts, high cell density, oligodendroglia, and endothelial proliferation, misclassified outcome in only eight children and discriminated as well as the LDF constructed with 12 additional histological features. The LDF constructed with eight symptoms and 12 signs had a misclassification rate of 9.2%, and was no more successful than the LDF constructed with the single symptom of lethargy. The LDF constructed with all 42 variables misclassified only three children. The variables that contributed most to successful analysis were altered consciousness, microcysts, oligodendroglia, high cell density, endothelial proliferation, and perivascular desmoplasia. Multivariate analysis of histological features, symptoms, and signs appears to classify children with cerebellar glioma according to survival status with an acceptably low error.
The dilemma of childhood optic gliomas
Authors: Oxenhandler Donald C. , Sayers Martin P.
Published: May 2009

✓ A retrospective series reviewing 28 cases of optic glioma in childhood is reported from the Columbus Children's Hospital. The literature is reviewed from a clinical and pathological standpoint; in the pathological literature there is support for consideration of these lesions as a neoplastic entity, but none for designation of these gliomas as “hamartomas.” An approach to the management of optic gliomas is presented. Treatment should be tailored to the individual patient; no clear therapeutic protocol appears to be supported by available data.
Brain monoamine metabolites and tryptophan in ventricular CSF of patients with spasm after aneurysm surgery
Authors: Vapalahti Matti , Hyyppä Markku T. , Nieminen Vappu , Rinne Urpo K.
Published: May 2009

✓ Intraventricular pressure was followed continuously after operation for intracranial arterial aneurysm in 20 patients. Ventricular cerebrospinal fluid (CSF), homovanillic acid (HVA), tryptophan, and 5-hydroxyindole acetic acid (5-HIAA) were analyzed daily for 5 days, beginning before the clipping of the aneurysm. Postoperatively, seven patients had spasm, verified clinically and angiographically. Seven other patients with no clinical or angiographic signs of spasm, hydrocephalus, or increased intracranial pressure (ICP) served as controls. Nine of the 20 patients were hydrocephalic.

The mean ± SE values of HVA, tryptophan, and 5-HIAA in the controls were 264 ± 40, 1116 ± 85, and 88 ± 8 ng/ml, respectively, in the controls, and 182 ± 20, 982 ± 89, and 78 ± 3 ng/ml, respectively, in the patients with spasm. The differences are not statistically significant. However, the low values of HVA may have been produced by ischemic changes caused by the spasm. In hydrocephalic patients ventricular CSF tryptophan levels were statistically significantly higher, and 5-HIAA levels lower than in controls. In patients with increased ICP, neither alterations nor intercorrelations of monoamine metabolites and tryptophan were found. The results do not give direct support to prophylactic neuropharmacological treatment of postoperative arterial cerebral spasm. However, ventricular HVA, tryptophan, and 5-HIAA measurements can be used for prognostic purposes during the first few days after the operation.
Acute fractures of the odontoid process
Authors: Apuzzo Michael L. J. , Heiden James S. , Weiss Martin H. , Ackerson Truman T. , Harvey J. Paul , Kurze Theodore
Published: May 2009

✓ Between 1969 and 1974, 45 cases of acute odontoid fracture were diagnosed and treated at this institution. The group consisted of 35 men and 10 women; 24 were between 19 and 40 years of age, and 21 were over 40 years old. Detectable myelopathy was appreciated in eight cases (18%). Diagnosis was established within 72 hours of the traumatic event. Initial evaluation disclosed displacement of the fracture in 17 cases (38%). Following reduction, the initial treatment was posterior fusion in three cases, and external immobilization in 42 cases. Excluding two deaths within the first week of treatment, 40 cases were available for follow-up analysis. Bone union failed to occur following periods of immobilization ranging from 4 to 6 months in 13 cases (33%). Fibrous union with no evidence of instability was apparent in two cases. Nonunion in displaced fractures was seen in 60%, with a rate of 88% in those displaced more than 4 mm. The rate of nonunion in undisplaced fractures was 16%. The rates of incidence of displacement (53% vs 26%) and nonunion (78% vs 33%) in those displaced were higher in individuals over 40 years of age than in those under 40 years. The incidence of nonunion in individuals aged under 40 with nondisplaced fractures was 12%; it was 25% for individuals over 40 years old. A total of 13 patients underwent posterior fusion. All eventually manifested stability at the C1–2 level. However, 69% failed to show bone union at the fracture site in a 6- to 18-month follow-up period.

This review indicates that in consideration of the fracture, external immobilization is the initial treatment of choice in all nondisplaced fractures. Displaced fractures occurring in patients over 40 years old, and those displaced more than 4 mm are candidates for internal stabilization and fusion as a primary mode of treatment.
Prolonged survival following excision of dural chondroma
Authors: Hardy Russell W. , Benjamin Sanford P. , Gardner W. James
Published: May 2009

✓ A patient is reported with a survival period of 44 years following excision of an intracranial chondroma.
Herniated thoracic disc at T1–2 level associated with Horner's syndrome
Authors: Gelch Melvyn M.
Published: May 2009

✓ A case of symptomatic herniation at the first thoracic disc level is reported. The patient presented with hand weakness, Horner's syndrome, and pain radiating along the medial aspect of the upper extremity. Myelography demonstrated a smooth lateral defect at T1–2. Three sequestrated epidural disc fragments were removed with postoperative relief of pain. A slightly miotic pupil remains.
Spinal cord vasculitis presenting as a spinal cord tumor in a heroin addict
Authors: Judice Donald J. , Leblanc Hector J. , McGarry Paul A.
Published: May 2009

✓ Progressive quadriparesis in a heroin addict was diagnosed on the basis of clinical and myelographic findings as an intramedullary cervical spinal cord tumor. A biopsy of the enlarged cervical spinal cord showed myelomalacia, vasculitis, and many doubly refractile bodies in the parenchyma and vessel walls.
Mobile schwannoma of the cauda equina
Authors: Hollin Sidney A. , Drapkin Allan J. , Wancier Jaime , Huang Yun Peng
Published: May 2009

✓ A patient with a mobile schwannoma of the cauda equina is described. The wide discrepancy between the myelographic and surgical locations of the tumor is most unusual. Awareness of the possibility of such an extreme degree of motility is important when dealing with cauda equina tumors.
Camurati-Engelmann disease (progressive hereditary craniodiaphyseal dysplasia)
Authors: Yen John K. , Bourke Robert S. , Popp A. John , Wirth Carl R.
Published: May 2009

✓ In a patient with Camurati-Engelmann disease, orbital and optic nerve decompression resulted in improvement of papilledema. Subsequent x-ray films of the optic canals, however, revealed reconstitution of osseous optic canals bilaterally, and papilledema has returned in one eye. Definitive treatment of this dysplastic metabolic bone disorder rests in the control of rapid abnormal bone formation.
Inferior vena cava and hepatic vein thrombosis as a rare complication of ventriculoatrial shunt
Authors: O'Shea Patricia A.
Published: May 2009

✓ A case is reported of hepatic vein thrombosis (Budd-Chiari syndrome) complicating ventriculoatrial shunt for tumoral hydrocephalus. The diagnosis of hepatic vein thrombosis requires specific radiographic investigations that are unlikely to be undertaken unless the condition is specifically suspected. An awareness of this rare and frequently fatal complication is essential for proper diagnosis and treatment.
Migration of ventriculoperitoneal shunt into the chest
Authors: Cooper Jack R.
Published: May 2009

✓ A case is presented of a baby in whom the abdominal catheter of a ventriculoperitoneal shunt entered the thoracic cavity. It is believed that the catheter migrated along the xiphocostal margin beneath the rectus abdominis muscle.
Blood-group antigens and antibodies in human brain-tumor cysts
Authors: Murray Kenneth J. , Kay Neil E. , Douglas Steven D.
Published: May 2009

✓ Cyst fluids from 12 human brain tumors were studied for their blood-group content and compared to autologous saliva, serum, and cerebrospinal fluid (CSF). Lewisa substance, which is a fucolipid, was present in four of 12 cysts studied. Lewisb, which differs from Lewisa by a single fucose, was found in eight of 12 sera and/or saliva and in one CSF specimen; Lewisb substance, however, was not detected in any corresponding cyst fluids. Isohemagglutinins, blood-group antibodies anti-A and/or anti-B, were present in nine of nine cyst fluids studied, were of lower titers as compared to autologous serum, and occurred as either IgG or IgM immunoglobulins. The results further delineate the biochemical requirements necessary for molecular penetration into human brain-tumor cysts.
Mannitol dose requirements in brain-injured patients
Authors: Marshall Lawrence F. , Smith Randall W. , Rauscher L. Andrew , Shapiro Harvey M.
Published: May 2009

✓ There is little information as to the optimal use of mannitol. To determine the dose-response relationship, the osmotic gradient required, and the time course of intracranial pressure (ICP) reduction produced by mannitol, eight patients with acute head injury were studied in whom ICP was monitored with a ventriculostomy and found to be elevated. Ventilation was controlled to a pCO2 of 25 ± 3 mm Hg and all were paralyzed with Pavulon. None had received barbiturates. Before mannitol administration the intracranial volume-pressure response was determined. Mannitol was administered as a bolus of 0.25 gm/kg, 0.5 gm/kg, and in six patients, 1 gm/kg, separated by at least 8 hours.

In all patients the ICP reduction with 0.25 gm/kg (41.3 ± 10.2 mm Hg→16.4 ± 5.6, p < 0.01) was equivalent to that achieved with the larger doses. Serum osmolality rises of 10 mOsm or more were associated with a reduction in ICP. Much smaller doses than those previously recommended were effective in reducing the ICP acutely, although at 5 hours there was a trend toward persistent reduction when the larger dose is used. This trend was small and indicates that smaller and more frequent doses are as effective in reducing the ICP while avoiding the risk of osmotic disequilibrium and severe dehydration.
Time course of vasospasm in man
Authors: Weir Bryce , Grace Michael , Hansen John , Rothberg Charles
Published: May 2009

✓ Measurements were made at eight predetermined positions on 627 sets of angiograms from 293 patients with aneurysms. A ratio between the sum of the vessel diameters in the subarachnoid space to the sum in the base of skull and neck was calculated and plotted against time. Vasospasm has its onset in man about Day 3 after subarachnoid hemorrhage, is maximal at Days 6 to 8, and is gone by Day 12. There is a tendency for patients in poor clinical grades to have more vasospasm. The patients with most vasospasm have a significantly higher mortality than those with the least.
Fibrinolytic enzyme in the lining walls of chronic subdural hematoma
Authors: Ito Haruhide , Komai Toshio , Yamamoto Shinjiro
Published: May 2009

✓ Active plasmin, available plasmin, and total plasminogen were measured by Enzodiffusion fibrin plate techniques in 11 cases and level of tissue activator and tissue fibrinolytic activities in another 11 cases with chronic subdural hematoma. The values were too small to be measured in some instances. Anti-plasmin in the hematoma was less than in the blood plasma. The outer membrane contained about three times more tissue activator than the dura mater, although the inner membrane contained none. Increased tissue activator, which exudes from the extremely vascular outer membrane, transforms plasminogen into plasmin in subdural hematoma, so that plasmin breaks down fibrin and fibrinogen and induces continuous hemorrhage.
Effect of dexamethasone on cerebral edema from cranial impact in the cat
Authors: Tornheim Patricia A. , McLaurin Robert L.
Published: May 2009

✓ A Remington humane stunner was used to deliver blows to the skulls of anesthetized cats. Alternate animals were post-treated with either dexamethasone (4 mg/kg/day) or a comparable volume of saline. Each animal was tested for cerebral edema 48 hours after impact by measurement of the change in density of white matter from normal values. Dexamethasone therapy did not reduce the change in density of hemispheres with contusions involving both cortex and underlying white matter. For hemispheres with contusions limited to cerebral cortex, there was minimal edema of the white matter, which was reduced a slight amount by dexamethasone.
Effects of laminectomy on spinal cord blood flow
Authors: Anderson Douglas K. , Nicolosi Gregory R. , Means Eugene D. , Hartley L. Edward
Published: May 2009

✓ The effect of a one-segment (L-2) laminectomy on spinal cord blood flow (SCBF) was determined by the reference sample method using isotope-labeled microspheres. The SCBF was measured before laminectomy (control) and at 15 minutes postlaminectomy with the dura exposed (Series 1), 1 hour postlaminectomy with the laminectomy site closed (Series 2), 24 hours postlaminectomy with the laminectomy site closed (Series 3), and 24 hours postlaminectomy with the dura exposed (Series 4). With the laminectomy site open, SCBF was significantly depressed (22% to 45%) along the entire length of the spinal cord at 15 minutes postlaminectomy. At 1 hour postlaminectomy (with the laminectomy site closed), SCBF approached control values, although areas with significantly lowered flow were still observed in all portions of the spinal cord. By 24 hours postlaminectomy, SCBF had returned to prelaminectomy levels. However, if within 1 hour preceding the 24-hour SCBF measurement, the laminectomy site was reopened, SCBF tended to fall at and caudad to the laminectomy site. These data indicate that laminectomy can cause a significant decline in SCBF. At the present time, the mechanism(s) for this laminectomy-induced depression of SCBF are unknown, although a temperature-induced vasoconstriction is suspected.