bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraspinal Localization of the Somatosensory Evoked Potential
Authors: Cohen Alan R. , Young Wise , Ransohoff Joseph
Published: May 2010

Somatosensory evoked potentials (SEPs) are used widely for monitoring neurophysiological function in experimental spinal injury. Yet the spinal pathways for SEP conduction remain unclear. Consequently, we sought to define specific changes in the SEP after interruption of selected spinal pathways. We activated cortical SEPs with sciatic nerve stimulation in 11 anesthetized (25 mg of pentobarbital per kg) cats after a multilevel thoracic laminectomy. The most consistent wave form component was an initial positivity (IP) at a 17- to 19-ms onset latency. We then used a Cavitron ultrasonic surgical aspirator to interrupt specific spinal pathways. A unilateral dorsal column lesion abolished the ipsilateral IP, but did not affect conduction in the contralateral column. Bilateral dorsal column lesions obliterated the IP, but sometimes left some longer latency components. Interruption of all but the ventral columns abolished the SEPs. When we interrupted all spinal pathways but the dorsal columns, an intact IP remained. In fact, a distinct IP was conducted through a single dorsal column after the division of all other spinal cord pathways. We conclude that, in the barbiturate-anesthetized cat: (a) the most consistent SEP wave form is an initial positivity at a 17- to 19-ms onset latency, (b) the integrity of the dorsal columns is both necessary and sufficient to conduct a normal-appearing IP component of the SEP. (c) the lateral columns may carry some longer latency component of the SEP. (d) the ventral columns carry no component of the SEP, and (e) bilateral recording may be useful for detecting asymmetry of injury.
Chronic Encapsulated Intracerebral Hematoma
Authors: Hirsh Leonard F. , Spector Harvey B. , Bogdanoff Bruce M.
Published: May 2010

Intracerebral hematomas producing chronic neurological disability are reported rarely. Two cases of chronic intracerebral hematoma are described. Each case was associated with a thick, fibrous capsule found histologically to arise from an occult vascular malformation. When such encapsulation is discovered surgically, a vascular anomaly must be suspected.
Epidermoid Tumor of the Cerebellopontine Angle
Authors: Fein Jack M. , Lipow Kenneth , Taati Fashid , Lansem Thomas
Published: May 2010

The extent of spread of an epidermoid tumor in the posterior fossa may be difficult to discern preoperatively. Conventional computed tomographic (CT) studies may not outline the tumor capsule, and the low attenuation of the tumor itself may not allow a distinction from cerebrospinal fluid. CT metrizamide cisternography was helpful in delineating the inferior pole of an epidermoid tumor, which could then be delivered through a transtentorial approach.
Segmental Arachnoiditis after Posterior Fossa Operation
Authors: Epstein Fred , Allen Jeffrey
Published: May 2010

A 16-year-old boy was noted to have an apparent intradural sacral mass 6 weeks after the excision of a 4th ventricle ependymoma. Although spinal axis radiation was considered, it was decided to make a definitive tissue diagnosis. At sacral laminectomy, only segmental arachnoiditis was found. The implications of this finding are the subject of this case report.
Pituitary Hormone Response to Head Injury
Authors: King Lionel R. , Knowles Harvey C. , McLaurin Robert L. , Brielmaier Joan , Piziak Veronica K.
Published: May 2010

Measurements of the serum levels of pituitary hormones were made in six patients with uncomplicated head injury. Samples were obtained at 4-hour intervals for 72 hours to evaluate diurnal rhythms. Three of the six patients revealed elevations of serum growth hormone (GH) and prolactin, but no trends could be established. Likewise, three patients had marked elevations of luteinizing hormone and lesser elevations of follicle-stimulating hormone, but no pattern was discernible. The level of thyroid-stimulating hormone was stable and remained in the normal range throughout. GH was measured after intravenous glucose loading. A paradoxical rise reverted to normal at the late follow-up evaluation. It is suggested that the abnormal levels were related to abnormal hypothalamic function rather than to pituitary damage.
Intratumoral Hemorrhage after a Ventriculoperitoneal Shunting Procedure
Authors: Waga Shiro , Shimizu Takeo , Shimosaka Shinichi , Tochio Hiroshi
Published: May 2010

Ventriculoperitoneal shunting has been accepted as a safe and useful preliminary procedure that lowers the mortality and morbidity of definitive surgery for tumors causing obstructive hydrocephalus. We are reporting four patients with intratumoral hemorrhage as a complication of shunting. The hemorrhage was massive and fatal in two patients, one with an unverified pineal tumor and the other with a malignant astrocytoma of the thalamus. The hemorrhage was small and limited in the other two patients, one with a glioblastoma of the thalamus and the other with a cerebellar astrocytoma. On the basis of this experience, we conclude that the possibility of intratumoral hemorrhage should be taken into consideration when planning the preoperative management of obstructive hydrocephalus caused by brain tumors. It is possible that ventricular decompression may result in rapid motion and distortion of the intracranial structures and a sudden imbalance between intracranial and intratumoral pressures, leading to vascular insufficiency, congestion, and then hemorrhage within the tumor.
Chordoma of the Cervical Spine
Authors: Murali Raj , Rovit Richard L. , Benjamin M. Vallo
Published: May 2010

Etight cases of chordoma limited to the cervical spine are presented. The radiological features are analyzed. Although there is no single diagnostic feature, the combination of osteosclerosis and lysis, multiple vertebral involvement, and the presence of a pre- or paracervical mass is strongly suggestive of a chordoma. Although none of our patients can be considered cured, we recommend an anterior cervical approach with radical removal of the tumor and interbody fusion followed by immobilization in a halo vest and postoperative radiation therapy. The biological behavior of the tumor is extremely variable, and multiple operations for symptomatic recurrences may be helpful.
Postoperative Cervical Pseudomeningocele as a Cause of Delayed Myelopathy
Authors: Helle Todd L. , Conley Frances K.
Published: May 2010

A spinal cord-injured patient developed progressive myelopathy 6 months after operative decompression of the cervicomedullary junction. At the time of the initial operation, the dura mater had been left open. A computed tomographic body scan revealed a cervical pseudomeningocele, which was repaired surgically. After operation, there was reversal of the patient's progressive neurological dysfunction.
Diaphragm Pacing in Spinal Muscular Atrophy
Authors: Richardson Robert R. , Roseman Bruce , Singh Naunihal
Published: May 2010

A patient with a diagnosis of intermediate or benign spinal muscular atrophy was severely incapacitated from respiratory complications and alveolar hypoventilation and was confined to mechanical ventilatory support. After extensive diagnostic evaluation of her pulmonary status, including transcutaneous stimulation of the phrenic nerves associated with nasogastric and surface electrode recording of the diaphragmatic response, this patient had a phrenic neurostimulation system implanted bilaterally for diaphragm pacing. Although spinal muscular atrophy has not been previously recognized as an indication for diaphragm pacing, her subsequent social, physical, and psychological improvement indicate that it may be significantly beneficial in selected cases of alveolar hypoventilation due to spinal muscular atrophy or neuromuscular disease.
Hydromyelia:
Authors: Sehlesinger Edward B. , Antunes John L. , Michelsen Jost W. , Louis Kenneth M.
Published: May 2010

The clinical and radiographic features of 60 cases of hydromyelia are discussed. A combination of motor and sensory symptoms and signs is the usual presentation. but pure motor or sensory forms of the disease are not infrequent. Pain and scoliosis are usually associated with a high degree of blockage. A normal spinal fluid protein content in the presence of an enlarged spinal cord is of diagnostic value. Important radiographic clues include widening of the spinal cord without venous stagnation and collapse of the spinal cord visualized with the patient in the upright position. Metrizamide computed tomography is now used routinely. and the contrast agent may at times appear in the dilated central spinal canal. Decompression of the foramen magnum is the treatment of choice in the presence of an associated Arnold-Chiari malformation and is the treatment most likely to succeed. In selected cases. Decompressive laminectomy and syringostomy may be indicated. Percutaneous spinal cord puncture is a safe diagnostic-therapeutic procedure which. surprisingly, may afford relief equal to that of more drastic measures. Therefore, percutaneous spinal cord puncture may be an option of therapeutic value in a disorder that is frustrating to treat.
Disposable Ventricular Catheter
Authors: Ray Charles D.
Published: May 2010

A new 1.6-mm-diameter (5 French), flexible, plastic disposable ventricular catheter is described. It has a self-attached sealing cap and fits standard Luer terminations of syringes. There are a self-contained stylette, a radiopaque stripe, and a single, smooth, lateral hold drilled throgh to the lumen. It has been used primarily for selective catheterization of the 3rd ventricale for the injection of contrast media and the collection of ventricular fluid for neurotransmitter analysis during the implantation of deep brain stimulators, but may be used for perfusion, drainage, or connection to pressure transducers.
Subarachnoid Hemorrhage from an Intracranial Meningioma
Authors: Latchaw John P. , Dohn Donald F. , Hahn Joseph F. , von der Luft Eric
Published: May 2010

This paper describes a patient who suffered four episodes of subarachnoid hemorrhage from a clival meningioma. Factors influencing this rare event are discussed.
Spontaneous Ventral Spinal Epidural Hematoma with Anterior Cord Syndrome
Authors: Phillips Timothy W. , Kling Thomas F. , McGillicuddy John E.
Published: May 2010

The authors report a case of spontaneous ventral thoracic epidural hematoma presenting as an anterior cord syndrome. The epidural hematoma ws evacuated through a posterolateral approach to the spinal canal. A disseminated intravascular coagulopathy appeared intraoperatively. By 3 months after operation the neurological deficits had cleared.
Diagnosis of Acoustic Neuroma
Authors: Hart Robert G. , Davenport John
Published: May 2010

The acquistion and application of new techniques in diagnostic screening have changed the approach to patients with suspected acoustic neuroma. In this paper, we review the extensive recent literature on acoustic tumors and present a critical analysis of the various diagnostic investigations. The older tests for cerebrospinal fluid protein. vestibular testing, and arteriography have been supplanted by modern audiometry with acoustic reflex testing. brain stem evoked responses, and computed tomography (CT). The various types of plain radiography are confirmed as an extremely useful screening modality. CT is insufficiently sensitive to serve as a primary screening procedure, but is a valuable confirmatory test. We propose a logical method of screening patients suspected of having an acoustic neuroma that can be applied by any practitoner in any clinical situation.
Vertebral Artery Disease
Authors: Pritz Michael B. , Chandler William F. , Kindt Glenn W.
Published: May 2010

The neuroradiological evaluation, perioperative medical management, and microsurgical treatment of variously located vertebral artery lesions are presented. Four types of surgical procedures were undertaken: proximal vertebral artery to common carotid artery end-to-side anastomosis; external carotid artery to midcervical vertebral artery end-to-side anastomosis; external carotid artery to distal cervical vertebral artery end-to-end anastomosis; and occipital artery to posterior inferior cerebellar artery end-to-side anastomosis. Each case is used to demonstrate the evaluation and management involved, the type of and rationale for the surgical procedure selected, and the patency of the anastomosis performed. Two points are emphasized. One is that, after careful angiographic evaluation and improved perioperative medical management, lesions of the vertebral artery are indeed amenable to microsurgical intervention with relatively low risk to the patient. The other is that, whenever possible, anastomosis of the largest caliber of vessels with the least number of suture lines is the surgical treatment of choice.
Prevention of Intracranial Hypertension during the Insertion of a Pulmonary Artery Catheter
Authors: Bowe Edwin A. , Wolf Steven
Published: May 2010

The placement of a pulmonary artery catheter may be indicated to assess cardiac filling pressures and cardiac output during the treatment of intracranial hypertension. Because many patients with intracranial hypertension are hypovolemic, flotation of the catheter may be difficult and can cause an increase in intracranial pressure. We describe a method of catheter placement using barbiturates and calcium that prevented a rise in intracranial pressure.
Fungal Aneurysm
Authors: Mielke Bruce , Weir Bryce , Oldring Derald , von Westarp Christian
Published: May 2010

We report a 58-year-old woman with acromegaly whose invasive adenoma was treated by trans-sphenoidal removal and radiation. Six months after therapy, she experienced progressive headache and retro-orbital pain. At 10 months she developed unilateral blindness, mild proptosis, opthalmoplegia. and trigeminal sensory loss. Studies failed to show an expanding mass lesion. About 1 year after her operation, she suddenly became comatose and died. An autopsy examination revealed subarachnoid hemorrhage from a ruptured fungal aneurysm of the basilar artery. The literature on such aneurysms is reviewed.
Tuberculous Optochiasmatic Arachnoiditis
Authors: Navarro Ignacio Madrazo , Peralta Victor Hugo Rosas , Leon Jose Antonio Maldonado , Varela Enrique Antonio Sanchez , Cahrera Jose Maria Sanchez
Published: May 2010

Eighl cases of optochiasmatic arachnoiditis secondary to tuberculous leptomeningitis were treated with microsurgical intervention at the Department of Neurosurgery of La Raza Medical Center of the Mexican Social Welfare Institute. All of the patients had been amaurotic before the operation and displayed complete recovery of their vision during the immediate postoperative period. Microsurgical and pharmacological (antituberculous chemotherapy and steroids) treatment can cure such patients.
Improved Relapse-free Survival in Medulloblastoma Utilizing Modern Techniques
Authors: Norris Donald G. , Bruce Derek A. , Bruce Derek A. , Bruce Derek A. , Byrd Rebecca L. , Schut Luis , Schut Luis , Schut Luis , Littman Phillip , Bilaniuk Larissa T. , Zimmerman Robert A. , Capp Ronald
Published: May 2010

Between 1969 and 1979, 22 patients with medulloblastoma were treated by the same surgical group and radiation therapy group. The patients were divided into two groups because of the clinical availability in December 1974 of the computed tomographic (CT) scanner and of the operating microscope used in the initial surgical procedure. There were 11 patients in each group. The percentage of patients with a relapse-free survival in the group treated between 1969 and 1974 (Group 1) was 38% at 4 years. The survival in the 11 patients treated between 1974 and 1979 (Group 2) was 84% at 4 years. This improvement is statistically significant (P ≤ 0.001). All patients received the same dose of radiation. Efforts to minimize the tumor burden by total surgical resection did not increase postoperative morbidity or mortality. These results are discussed, along with the relative impact of the CT scan, total resection at operation. and increased focus for radiation therapy on the improved outcome.
Unilateral Hydranencephaly
Authors: Moser Richard P. , Seljeskog Edward L.
Published: May 2010

Unilateral hydranencephaly has been known to occur, yet may be confused with other pathological processes. We describe a case that seems to meet the criteria of hydranencephaly limited to one hemisphere. Its significance is discussed in terms of both pathogenesis and prognosis.
Primary Dural Melanoma
Authors: Naravan Raj K. , Rosner Michael J. , Povlishock John T. , Girevendulis Alexander , Becker Donald P.
Published: May 2010

This study reviews the literature pertaining to primary meningeal melanoma and reports the clinical and ultrastructural findings in a case where the tumor appeared to be of pachymeningeal (dural) origin. This is clearly a departure from all previously described cases, in which a leptomeningeal (pial-arachnoidal) origin was either defined or assumed. Clinically. this case was remarkable in its rarity. its presentation as a cerebellopontine angle syndrome, and its occurrence in a Negro. a race in which melanomas are uncommon. Ultrastructurally. the tumor did demonstrate the presence of basement membrane abnormalities and numerous endothelial fenestrations. However, it was found to be made up of a homogenous cell population, consisting only of electron-lucent, melanin-laden cells. The mixed cell population noted previously in a primary leptomeningeal melanoma was not found in this tumor. In view of the fact that this patient continues to do well 1/12; years after operation, with no evidence of tumor recurrence, it is suggested that a homogenous cell population noted on electron microscopy could indicate a better prognosis. In addition, it may also indicate a pachymeningeal rather than a leptomeningeal origin for the tumor. A plea is made for greater specificity in terminology when describing primary meningeal melanomas and for a concerted effort to distinguish between those of dural and those of leptomeningeal origin.
Interstitial Irradiation of Brain Tumors
Authors: Bernstein Mark , Gutin Philip H.
Published: May 2010

As an adjuvant to surgery, radiation therapy has consistently proven to be the most successful form of treatment for primary and secondary malignant brain tumors and possibly for inoperable benign tumors. Because the risk of radiation necrosis of normal brain limits the amount of radiation that can be given by external beam therapy at conventional dose rates, interstitial radiation of brain tumors is a logical alternative treatment approach. We discuss the radiobiological advantages of low dose rate irradiation and intratumoral placement of sources that make interstitial irradiation an attractive treatment for brain tumors and review the history of clinical brachytherapy for intracranial neoplasia.
Multiple Aneurysms of the Distal Posterior Inferior Cerebellar Artery
Authors: Hiscott Paul , Crockard Alan
Published: May 2010

We describe a patient with subarachnoid hemorrhage in whom three separate aneurysms arising from a distal segment of the right posterior inferior cerebellar artery were demonstrated. These aneurysms were successfully treated.
Chronic Cerebellar Stimulation for Cerebral Palsy
Authors: Penn Richard D.
Published: May 2010

Chronic cerebellar stimulation for cerebral palsy is a controversial procedure. It is difficult to evaluate objectively because cerebral palsy is not a single disease entity and the clinical syndrome may vary over time. Tests of neurophysiological function, signs of spasticity, and tests of motor function have documented changes, but double-blind evaluations have not. These studies are reviewed, as are the inherent problems in cerebellar stimulation and the physiology of cerebral palsy.
Microsurgical Anatomy of the Posterior Inferior Cerebellar Artery
Authors: Lister Richard J. , Rhoton Albert L. , Matsushima Toshiom , Peace David A.
Published: May 2010

Fifty cerebellar hemispheres from 25 adult cadavers were examined. The posterior inferior cerebellar artery (PICA), by definition, arose from the vertebral artery. The vertebral artery was present in 49 and the PICA was present in 42 of the 50 hemispheres. Forty-one of the 42 PICAs arose as a single trunk and 1 arose as a duplicate trunk. The PICA was divided into five segments: the anterior medullary segment lay on the front of the medulla; the lateral medullary segment coursed beside the medulla and extended to the origin of the glossopharyngeal, vagal, and accessory nerves; the tonsillomedullary segment coursed around the caudal half of the cerebellar tonsil; the telovelotonsillar segment coursed in the cleft between the tela choroidea and the inferior medullary velum rostrally and the superior pole of the cerebellar tonsil caudally; and the cortical segment was distributed to the cerebellar surface. Thirty-seven of the 42 PICAs bifurcated into a medial and a lateral trunk. The medial trunk supplied the vermis and the adjacent part of the hemisphere, and the lateral trunk supplied the cortical surface of the tonsil and the hemisphere. The PICA gave off perforating, choroidal, and cortical arteries. The cortical arteries were divided into vermian, tonsillar, and hemispheric groups. Sixteen of the 42 PICAs passed between the rootlets of the accessory nerve, 10 passed between the rootlets of the vagus nerve, 13 passed between the vagus and the accessory nerves, 2 coursed rostral to the glossopharyngeal nerve, and 1 passed between the glossopharyngeal and the vagus nerves.
Blood Pressure Response during Percutaneous Rhizotomy for Trigeminal Neuralgia
Authors: Kehler Chris H. , Brodsky Jay B. , Samuels Stanley I. , Britt Richard H. , Silverberg Gerald D.
Published: May 2010

We observed a consistent and marked hypertensive response during trigeminal rhizotomy with methohexital anesthesia in 11 consecutive patients. Percutaneous trigeminal rhizotomy should not be regarded as a benign surgical procedure in view of the potential morbidity associated with such acute hypertension. We recommend that patients undergoing this operation be continuously monitored.
Structural Changes in Human Pituitary Tumor after Bromocriptine Therapy
Authors: Rengachary Setti S. , Tomita Tatsuo , Jefferies Barry F. , Watanabe Itaru
Published: May 2010

The histological appearance of a prolactin-producing tumor and of a growth hormone-producing tumor after short term bromocriptine therapy was studied in detail using light microscopy with conventional and immunocytochemical methods and using transmission electron microscopy. The findings were correlated with clinical, radiological, and biochemical data. Histological changes consisting of clumping of nuclear chromatin and a marked reduction in cytoplasmic volume due to loss of ribosomes, rough endoplasmic reticulum, and Golgi complexes were observed only in the prolactin-producing tumor. Normalization of elevated serum prolactin levels and reduction in size of the tumor observed in serial computed tomograms correlated with striking histological changes found in the tumor. These changes were interpreted to represent a reversible inhibition of the protein-synthetic machinery of the neoplastic cell. Comparable clinical, biochemical, radiological, or structural changes were not observed in the growth hormone-secreting tumor.
Computer-assisted Stereotactic Laser Microsurgery for the Treatment of Intracranial Neoplasms
Authors: Kelly Patrick J. , Alker George J. , Goerss Stephan
Published: May 2010

This paper describes a stereotactic CO2 laser system for the removal of intra-axial, intracranial neoplasms. The volume of the neoplasm is transferred into stereotactic space by computer reconstruction of data derived by computed tomography (CT) performed under stereotactic conditions. The tumor volume is sliced in a plane orthogonal to the surgical approach, and slices at specific distances from the focal point of the stereotactic frame are displayed on a graphics monitor in the operating suite along with a cursor representing the position of the surgical laser. Laser vaporization of sequential slices of the tumor results in a cavity, the formation of which is monitored by anteroposterior and lateral roentgenograms. Fifteen stereotactic laser procedures have been performed on 13 patients, and the results are discussed. By this method, it is theoretically possible to remove all of an intracranial neoplasm detected by CT scanning.
Role of Radiation Therapy in the Management of Meningioma
Authors: Carella Richard J. , Ransohoff Joseph , Newall Joseph
Published: May 2010

Surgery is the accepted form of treatment of meningioma; the role of radiotherapy has not been clearly established. With this in mind, we have reviewed our experience with radiation therapy in the management of meningiomas at New York University Medical Center. Sixty-eight patients fell into three groups. Forty-three (Group A) underwent operation followed by radiation therapy, 14 patients (Group B) had radiation for recurrence after operation, and 11 patients (Group C) had radiation therapy as the primary treatment. In Group A, 41 of 43 are alive. During a follow-up of 1 to 10 years, only 2 have deteriorated. Five of 14 Group B patients showed neurological improvement and 7 showed deterioration, including 5 who died of tumor. All 11 patients in Group C are alive with follow-up periods of 3 to 6 years; 9 of these show improvement in neurological function. Eleven patients had malignant meningioma, of whom 8 are alive and stable. We present 4 case reports, including computed tomographic scans that show evidence of tumor necrosis after radiation therapy. Pathological verification of tumor necrosis is presented in 1 case. We believe that radiation therapy has an established role in the treatment of incompletely excised, recurrent, or malignant meningiomas and, in some cases, as the initial management of meningiomas. Indications for treatment and guidelines are presented.
Management of Infected Cerebellar Stimulation Systems
Authors: Davis Ross , Kudzma Joanne , Ratzan Kenneth
Published: May 2010

Over a 7-year period (February 1974 through February 1981), 318 patients underwent the implantation of cerebellar stimulation systems for the reduction of spasticity (98%) or epilepsy (2%). A total of 518 procedures were carried out to implant and maintain the equipment during this period. Fourteen patients developed infections in the tissue around their implanted systems, which represented 4.4% of the patients or 2.7% of the procedures performed. Staphylococcus aureus was the infectious agent in 7 cases (50%), the clinical features of which occurred usually within 1 month. Staphylococcus epidermidis infected 5 patients with features presenting late (more than 2 years) after the initial implantation. The management involved antibiotic therapy for 2 weeks in all 14 patients. In 12 patients, the entire system was removed, with 100% eradication of the infection. In the other 2 patients, the radio receiver and lead wires up to but not including the cerebellar electrode pads were removed. One of these 2 patients has been free of infection for 4 years. The other had S. aureus cultured from removed electrode pads after 6 weeks. Of the 14 cases, morbidity was severe in only 1 patient. Seven patients underwent reimplantation 6 weeks after the infection.
Spontaneous Intracranial Hemorrhage Caused by Brain Tumor
Authors: Wakai Susumu , Yamakawa Kenta , Manaka Shinya , Takakura Kintomo
Published: May 2010

Hemorrhage from brain tumor was confirmed clinically, surgically, or on autopsy in 94 of 1861 cases (5.1%) treated during the past 18 years: 49 of 311 pituitary adenomas (15.8%) and 45 of 1550 other brain tumors (2.9%). The higher incidence of hemorrhage from pituitary adenoma was statistically significant (Neurosurgery < 0.001). In brain tumors other than pituitary adenoma, the incidence of hemorrhage was significantly higher in the patients under 14 years old (17 of the 322 cases, 5.3%) than in the patients over 15 years old (28 of the 1228 cases; 2.3%) (Neurosurgery < 0.001). Nineteen patients showed no evidence of clinical symptoms related to bleeding. Twenty-six patients had a definite history of an acute episode that suggested sudden bleeding. In 11 of these, the apoplectic syndrome was the initial presenting symptom. The incidence of hemorrhage was not statistically correlated with sex. The hemorrhage was intratumoral in 30 cases, intracerebral in 7, subarachnoid in 7, and subdural in 1. The tumors were supratentorial in 36 cases, pineal in 1, and infratentorial in 8. Primary and metastatic choriocarcinoma and primary embryonal carcinoma seemed to cause hemorrhage most frequently. The following precipitating factors were found in 7 of the 17 patients aged under 14: ventricular drainage in 2, ventriculoperitoneal shunt in 2, carotid angiography in 1, head injury in 1, and leukemia in 1. Seven of the 17 patients under 14 years old died of massive bleeding from the tumor. Unless there is evidence of vascular disease such as cerebral aneurysm, vascular malformation, or hypertensive cerebrovascular disease, intracranial hemorrhage should be suspected of being due to a brain tumor.
Hemangiopericytomas of the Spine
Authors: Muraszko Karin M. , Antunes J. Lobo , Hilal Sadek K. , Michelsen Jost W.
Published: May 2010

Four cases of hemangiopericytoma of the spine are reported. These are rare tumors that arise from the pericytes. Due to their invasive nature and marked vascularity, a detailed radiological work-up including computed tomography and spinal angiography should be obtained before a direct surgical attack is performed. Embolization of the tumor may also be quite helpful before surgical excision and has allowed a gross total removal of the tumor in two of the cases.
Persistent Cervical Intersegmental Artery as a Cause of Recurrence of a Traumatic Carotid-Cavernous Fistula
Authors: Keller Herbert M. , Imhof Hans-Georg , Valavanis Anton
Published: May 2010

In a 16-year-old boy, minor symptoms of an arteriovenous shunt into the cavernous sinus recurred 3 months after the performance of a trapping operation of the internal carotid artery on the side of a traumatic carotid-cavernous sinus fistula. An arterial and venous cerebrovascular Doppler examination demonstrated increased blood flow in the periorbital veins of both sides, with a pathological flow direction, i.e., from intra- to extracranial. Furthermore, an internal-like artery was found at the level of the carotid bifurcation on the side of the trapped internal carotid artery, and increased blood flow was registered in the homolateral vertebral artery. Angiography confirmed occlusion of the internal carotid artery 0.5 cm distal to the carotid bifurcation, but showed blood flow from the homolateral vertebral artery through a persistent 3rd cervical intersegmental artery into the trapped portion of the internal carotid artery. The latter fed blood into the cavernous sinus through the still-existing arteriovenous fistula. Insufficient involution of the 3rd cervical intersegmental artery was assumed. Obviously, this collateral artery dilated in the presence of a major blood pressure gradient between the vertebral artery and the trapped segment of the internal carotid artery. Thus, a persistent cervical intersegmental artery can be a cause for a recurrent carotid-cavernous sinus fistula.
Transcallosal, Interfornicial Approaches for Lesions Affecting the Third Ventricle
Authors: Apuzzo Michael L. J. , Chikovani Oleg K. , Gott Peggy S. , Teng Evelyn L. , Zee Chi-Shing , Giannotta Steven L. , Weiss Martin H.
Published: May 2010

A group of 11 patients with a variety of lesions affecting the 3rd ventricle have been treated using a direct transcallosal interfornicial approach to the region. In 3 patients, no attendant hydrocephalus was present. In an effort to minimize potential cortical injury related to the approach, we studied the venous anatomy in the region of the coronal suture. Based on this study, appropriate flap placement and interhemispheric entry points were defined. Although no lasting, clinically apparent morbidity was observed in any of the 11 cases, we performed more sophisticated studies of the interhemispheric transfer of somesthetic and perceptual motor tasks, as well as psychometric testing related to parameters of intelligence and memory, 3 to 8 months postoperatively in 6 cases. The results and clinical material indicate that this surgical technique is a safe, feasible alternative in the management of a wide spectrum of pathological lesions within this region. A transcallosal, interfornicial approach offers excellent visualization of the entire 3rd ventricle without the dependence on hydrocephalus or an extensive extra-axial mass to enhance the exposure. With proper planning and technique. it may be accomplished with a minimum of physiological consequence.
Retromastoid Approach for Biopsy of Brain Stem Tumors
Authors: Baghai Parviz , Vries John K. , Bechtel Phillip C.
Published: May 2010

Brain stem tumors constitute about 10 to 20% of all pediatric brain tumors. The clinical manifestations are protean and may be produced by malignant as well as benign lesions. Although the computed tomographic (CT) scan has contributed considerably in the diagnosis of these lesions, it is not possible to differentiate these tumors from viral encephalitis of the brain stem, vascular malformations, and other benign lesions. Over the years, biopsy of brain stem lesions has been considered a low yield and high risk procedure. In one of the recent series, the incidence of nondiagnostic biopsy approached 20% and major deterioration of cranial nerve function also occurred in 20% of the cases. Traditionally, suboccipital craniectomy and biopsy of the floor of the 4th ventricle has been used. This is usually associated with aggravation of cranial nerve deficits. Review of pathological specimens indicates that brain stem gliomas most often involve the pons, with predominantly unilateral involvement, and frequently fill in part of the cerebellopontine angle. On this basis, we have recently used a retromastoid approach on five patients with brain stem tumors to obtain biopsies from the ventrolateral pons and the cerebellopontine angle. A diagnosis was made in each case without complication. Minimal morbidity might be anticipated from this approach, as all cranial nerve nuclei are far away from the biopsy site. The biopsy of brain stem lesions is extremely important because aggressive therapeutic decisions may be made only after a histological diagnosis has been made. In one of our cases, a diagnosis of medulloblastoma was made in a patient with a clinical and CT scan diagnosis of brain stem glioma; this diagnosis changed the treatment plan. The retromastoid approach for the biopsy of brain stem tumors is a safe procedure with minimal morbidity and a high diagnostic yield.
Pediatric Cerebellar Infarction
Authors: Harbaugh Robert E. , Saunders Richard L. , Reeves Alexander G.
Published: May 2010

Infarction in the vertebrobasilar system is uncommon in children. Cerebellar infarction presenting as a posterior fossa mass lesion is distinctly rare. We recently treated a 13-year-old boy with such a lesion as a complication of basilar artery migraine. A review of the literature on vertebrobasilar infarction in children is presented and the therapeutic alternatives in cerebellar infarction are discussed.
Intractable Facial Pain Associated with a Ganglioglioma of the Cervicomedullary Junction
Authors: Epstein Nancy , Epstein Fred , Allen Jeffrey C. , Aleksic Slobodan
Published: May 2010

A 6-year-old child with a brain stem tumor presented with the unusual complaint of intractable facial pain resembling trigeminal neuralgia in the absence of other symptoms or signs referable to the 5th cranial nerve. The radiological evaluation included a computed tomographic scan with intravenous contrast administration, which demonstrated an enhancing intramedullary lesion extending from the obex to C-4. After radiation and chemotherapy had failed to achieve symptomatic relief, the tumor, later proven to be a ganglioglioma, was radically removed with the ultrasonic aspirator. Postoperatively the patient experienced full pain relief.
Transthoracic Approach to an Intramedullary Vascular Malformation of the Thoracic Spinal Cord
Authors: Raynor Richard B. , Weiner Richard
Published: May 2010

A transthoracic approach with resection of a vertebral body was used to obtain access to an intramedullary vascular malformation of the thoracic spinal cord. The malformation consisted of three discrete intramedullary tufts of vessels fed by an abnormal branch of the anterior spinal artery arising from the T-9 intercostal artery. Although the abnormal branch of the anterior spinal artery did not appear to supply normal cord, the patient developed transient weakness postoperatively after occlusion of this artery. Follow-up angiography showed that one part of the malformation was still present and was fed by the T-6 intercostal artery.
Decerebrate Rigidity in Humans
Authors: Davis Richard A. , Davis Loyal
Published: May 2010

Decerebrate rigidity (DR) in humans results from a midbrain lesion and is manifested by an exaggerated extensor posture of all extremities. It is characterized by shortening and lengthening reactions and can be modified by tonic neck, labyrinthine (Magnus-de Kleijn), and phasic spinal reflexes. These criteria, and not extensor posture alone, reflect the observations of Sherrington and should form the basis of the clinical examination; however, the experimental-anatomical lesion and physiological findings can never be reproduced exactly in humans. “Tonic and cerebellar fits” are not the equivalent of DR, but are forms of muscle spasm that result in an extensor attitude. They are caused by irritation and excitation of the brain stem. The most common cause of DR in humans is trauma. The incidence of DR in head-injured patients may be as high as 40%, resulting in an average mortality rate of 80%; the presence of an extensor posture increases the mortality from 20 to 70%. The surgical removal of an intracranial lesion does not improve the high mortality rate in patients with craniocerebral trauma who are decerebrate. Although the Glasgow coma scale (GCS) does not consider the specific type of central nervous system abnormality caused by trauma, it is an accurate and accepted assessment of outcome after coma lasting longer than 6 hours. DR is a factor in the best motor response of the GCS and should be assigned major importance in the prognosis of comatose head-injured patients.
Preservation of Cochlear Nerve Function with the Aid of Brain Stem Auditory Evoked Potentials
Authors: Hardy Russell W. , Kinney Sam E. , Lueders Hans , Lesser Ronald P.
Published: May 2010

Somatosensory, visual, and auditory evoked potentials have been used to monitor neurological function in patients under general anesthesia. This paper describes the preservation of useful hearing in three patients with cerebellopontine angle tumors. In each case, cochlear function was monitored during the procedure, and confirmation of intact conduction intraoperatively was associated with preserved hearing postoperatively.
Carotid Angioplasty in the Management of External Carotid Artery Stenosis Associated with an Occluded Internal Carotid Artery
Authors: Rogers Larry A.
Published: May 2010

The author describes the surgical treatment of 14 patients in whom angiography demonstrated total occlusion of the internal carotid artery (ICA) associated with stenosis at the origin of the ipsilateral external carotid artery (ECA). Each patient underwent ECA endarterectomy followed by an angioplasty to enlarge the ECA outflow tract by incorporating the ICA stump into the proximal ECA. Nine patients subsequently underwent superficial temporal-middle cerebral artery anastomosis. There was no mortality or permanent neurological morbidity. This method of treating ECA stenosis is recommended because it is simple and effective and because it simultaneously eliminates the ICA stump as a potential source of cerebral emboli.
Melanotic Schwannoma of the Spinal Cord
Authors: Gregorios Jocelyn Bruce , Chou Samuel M. , Bay Janet
Published: May 2010

The eighth case of axial melanotic nerve sheath tumor involving the thoracic spinal cord is reported. The literature is reviewed, and proposed theories on the origin of these tumors are discussed. The present study further supports the melanogenic capacity of neoplastic Schwann cells.
Symptomatic Congenital Spinal Stenosis in a Child
Authors: Dauser Robert C. , Chandler William F.
Published: May 2010

A case of congenital lumbar stenosis producing lower extremity spasticity and bladder dysfunction in a young child is presented. Myelography demonstrated a marked stenosis of the spinal canal at L-2, L-3, and decompressive laminectomy resulted in a marked improvement in symptoms. A discussion of lumbar stenosis in general illustrates that it is extremely rare for this condition to become symptomatic during childhood. The literature on congenital lumbar stenosis is reviewed.
Recurrent Intracranial Hypertension and a Midbrain Glioma
Authors: Zant Julius D. , Collins George H. , King Robert B. , Kim Ronald C.
Published: May 2010

At the age of 36, this patient's clinical picture satisfied the criteria for the diagnosis of benign intracranial hypertension. After an essentially symptom-free interval, she developed new symptoms 17 years later that proved to be the result of a neoplasm in the midbrain and in the splenium of the corpus callosum. Postmortem examination revealed a mixed glioma associated with glial-lined cavities in the midbrain and malignant glioma in the splenium. Ths possibility of a relationship between these disparate events is considered.
Shunting for Hydrocephalus: An Oral History
Authors: Wallman Lester J.
Published: May 2010

Twelve neurosurgeons and an inventor-manufacturer, all veterans of the early days (1950s) of shunting for hydrocephalus, were interviewed and recorded on tape. Others were interviewed, but not recorded. Reminiscences that might illuminate the social context of this development in surgical practice were sought.
Moderate Head Injury: Completing the Clinical Spectrum of Brain Trauma
Authors: Rimel Rebecca W. , Giordani Bruno , Barth Jeffrey T. , Jane John A.
Published: May 2010

We have divided head injury into three categories based on the Glasgow Coma Scale (GCS) (severe, 3–8; moderate, 9–12; and minor, 13–15). In a previous report, we described significant disability after minor head injury. The present report describes 199 patients with moderate head injury, 159 of whom underwent follow–up examinations at 3 months. In contrast to patients with minor head injury, half as many were students (17%) and twice as many were intoxicated (53%). Seventy–five patients were studied with computed tomographic (CT) scanning; 30% of the scans were negative and 31% showed a space–occupying mass. As reported by Gennarelli et al. in patients with severe head injuries, those with moderate head injury and subdural hematoma had a very poor outcome: 65% died or were severely disabled and none made a good recovery as measured by the Glasgow Outcome Scale. At 3 months, 38% of the moderate head injury patients had made a good recovery compared with 75% of the minor head injury patients. Within the good recovery category, however, there was much disability (headache, 93%; memory difficulties, 90% difficulties with activities of daily living, 87%), and only 7% of the patients were asymptomatic. The Halstead–Reitan Neuropsychological Battery in an unselected subset (n = 32) showed significant deficits on all test measures. Sixty–six per cent of the patients previously employed had not returned to work, compared to 33% of the minor head injury patients. The major predictors of unemployment after minor head injury were premorbid characteristics (age, education, and socio–economic status). In contrast, all predictors in moderate head injury were measures of the severity of injury (length of coma, CT diagnosis. GCS on discharge). We conclude that: (a) moderate head injury, not described previously in the literature, results in mortality and substantial morbidity intermediate between those of severe and minor head injury; (b) unlike minor head injury, the principal predictors of outcome after moderate head injury are measures of the severity of injury; and (c) more attention should be directed to patients with moderate head injury than to those with the most severe injuries, in whom brain damage is probably irreversible and all forms of management have demonstrated little success.
Craniopharyngiomas in Children
Authors: Carmel Peter W. , Antunes Joao L. , Chang Chu H.
Published: May 2010

Forty-three children with craniopharyngiomas were operated upon at The Neurological Institute of New York between 1952 and 1977. The removal was thought to be total in 14 children and subtotal in 20, and cyst aspiration/biopsy was performed in 9 cases. Radiation was given as part of the initial therapy in 6 children after subtotal removal and to 8 others after aspiration/biopsy. There was 1 postoperative death. All children with tumors thought to have been removed totally are alive. The 10-year actuarial survival rates are 52% for subtotal removal alone and 87% for subtotal removal plus radiation. Tumors have recurred by 10 years in half of those thought to be totally removed, in more than 90% of those subtotally removed, and in less than 25% of those at risk after subtotal removal and radiation therapy. Tumors recurred in 22 children, and 17 underwent reoperation. Total removal was obtained in 4 cases, and 5 had radiation after subtotal removal. Radiotherapy alone was used in 2 cases. Recurrences usually occurred within 2 years. However, after “total” removal recurrences were quite delayed. Our data indicate that total removal allows excellent survival rates and that some of these children are potentially cured. The attempt at total removal did not inflict a severe hypothalamic or visual burden on these children. Where total removal is not possible, further therapy, either radiation or reoperation, will be required. Radiation dramatically decreased recurrence and improved survival after subtotal removal.
Cerebrospinal Fluid Rhinorrhea: A Complication of Therapy for Invasive Prolactinomas
Authors: Landolt Alex M.
Published: May 2010

The majority of invasive prolactinomas can be predicted with a high probability if the preoperative prolactin level is above 2000 ng/ml. As these tumors cannot be extirpated radically, adjunctive radiation therapy is used to improve the results of treatment. On the basis of reports that bromocriptine induces tumor shrinkage and has an antimitotic effect, we combined adjunctive irradiation with bromocriptine therapy in 14 patients who had particularly extensive invasion. Two of these patients developed cerebrospinal fluid rhinorrhea 3 and 5 months, respectively, after the completion of radiation therapy. In both patients, the fistula was localized in the sellar region and was closed successfully. Rapid tumor shrinkage caused by irradiation combined with bromocriptine therapy may be a factor causing this complication; postoperative rhinorrhea is otherwise extremely rare in our surgical series. We also observed a third patient who did not have an operation, but who developed rhinorrhea after a course of irradiation and bromocriptine treatment. The periods of rhinorrhea coincided with periods of bromocriptine treatment.