bluuebunny/crossref_metadata_2025 huggingface dataset:
The anatomical basis for femoral nerve palsy following iliacus hematoma
Authors: Nobel Werner , Marks Sandy C. , Kubik Stefan
Published: May 2009

✓ With increased use of anticoagulant agents, femoral neuropathy subsequent to hemorrhage within the iliacus muscle has become a frequent clinical problem. The mechanism for this type of femoral nerve palsy was studied in dissections of the iliac region and by injections of latex into fascial planes in that area. In most dissections, up to four fascial layers, parallel to the iliacus sheath, could be identified. Variable states of fusion of these layers often produced up to three pouches, separated by loose connective tissue or fat. These fasciae (called “lamina peritonealis,” “lamina transversalis,” “lamina preiliaca,” and “lamina iliaca”) appear to be variable adult remnants of distinct fascial layers present in the posterior abdominal wall during embryological development, and serve to strengthen the intrinsic fascia of the iliacus muscle. Latex injected into the iliacus sheath spread from the midlumbar region to the femoral triangle, surrounding, compressing, and stretching the femoral nerve in different parts of its course. These observations suggest an anatomical basis for femoral nerve palsy during iliacus hematoma.
Traumatic dislocation of the atlanto-occipital articulation (AOA) with short-term survival
Authors: Dublin Arthur B. , Marks William M. , Weinstock David , Newton Thomas H.
Published: May 2009

✓ Three patients with traumatic atlanto-occipital articulation (AOA) dislocation are presented, and an additional 10 well documented cases are reviewed from the literature. Medulla oblongata and/or spinal cord deficits, and evidence of cranial nerve injuries were noted in eight patients. Angiographic evidence of vertebral occlusion or narrowing was demonstrated in four patients. One patient had systemic hypertension, presumably from bilateral traumatic ninth nerve injuries. Five patients ultimately died. A new method for measuring the AOA is introduced.
Compartmentalization of the cerebral ventricles as a sequela of neonatal meningitis
Authors: Kalsbeck John E. , DeSousa Alonso L. , Kleiman Martin B. , Goodman Julius M. , Franken Edmund A.
Published: May 2009

✓ Thirteen infants with compartmentalization of the lateral ventricles diagnosed by air encephalography, computerized tomography, or autopsy are reported. In each case, the body of one or both lateral ventricles was completely divided by a membrane posterior to the foramen of Monro. Recognition of this entity is important from both therapeutic and prognostic standpoints.
Cerebellar stimulation for cerebral palsy
Authors: Whittaker C. Keith
Published: May 2009

✓ Eight children with cerebral palsy, who had implanted cerebellar stimulators, were evaluated by a panel of six experienced physicians in a double-blind cross-over experiment with 3-week periods of real and sham stimulation. Neither the panel of physicians nor the patients could tell whether the stimulators were operating or not.
Anatomical observations of the development of the pituitary capsule
Authors: Chi Je G. , Lee Myung Ho
Published: May 2009

✓ A morphological study on the development of the pituitary capsule is reported, based on serial or step-sections of 56 pituitary glands from human embryos and fetuses ranging in gestational age from 4 to 40 weeks. Formation of the pituitary capsule is preceded at a very early embryonic stage by mesenchymal cell proliferation around Rathke's pouch when it forms the primitive adenohypophysis. The proportionally large adenohypophysis wraps around the neurohypophysis as it grows down from the diencephalon. Therefore, the fibrous capsule around the adenohypophysis represents the whole hypophysis as a membrane distinct from the dura mater or pia arachnoid membrane. The pituitary capsule appears not be to a derivative of either the dura mater or the pia arachnoid; instead it is a separate covering of the developing Rathke's pouch.
The intracranial pressure in infants
Authors: Welch Keasley
Published: May 2009

✓ In infancy, the intracranial pressure (ICP) is normally maintained at a level that is very low by standards that apply later in life. There is little or no overlap of normal pressure and the pressure in infantile hydrocephalus. Knowledge of the normal pressure may allow expectant management of milder instances of infantile hydrocephalus.

During the first few days after birth, as the volume of the brain decreases so does its turgor, and subatmospheric ICP is common. Hydrocephalus may be masked or attenuated in severity during that time or may be incorrectly suspected in a normal child because of the increase in circumference of the head accompanying the restitution of volume. The postnatal decrease in ICP may be responsible for ventricular hemorrhage in the newborn.
Thermosensitive determination of CSF shunt patency with a pair of small disc thermistors
Authors: Chiba Yasuhiro , Yuda Kenji
Published: May 2009

✓ A simple method is presented for detecting the patency of ventriculoperitoneal shunts with a pair of small disc thermistors. In an experimental model, the equipment detected definite temperature changes along the shunt tube. The extent of the temperature difference was proportional to the flow velocities, ranging from 5 to 60 ml/hr (120 to 1440 ml/24 hrs). A clinical study consisted of 26 trials in 23 hydrocephalic children and 10 trials in nine adult patients with normal-pressure hydrocephalus. Three of the 26 trials in the children were unsuccessful because of patient irritability and lack of cooperation. All trials for adult patients were successful. In all 25 patients, whose clinical pictures suggested functioning shunt, accurate confirmation of shunt patency was obtained. In six patients whose clinical pictures suggested questionable shunt function, this method revealed that all shunts were patent, and computerized tomography and follow-up clinical data supported this finding. In two patients whose clinical pictures suggested shunt malfunction, there was no indicator deflection, and shunt obstruction was proved at operation. This method is effective in checking shunt function, is simple, and may be repeated at frequent intervals.
Treatment of cerebral arteriovenous malformations
Authors: Cromwell Laurence D. , Harris A. Basil
Published: May 2009

✓ It is believed that surgical excision of arteriovenous malformations is the best treatment when technically feasible without causing significant damage to adjacent brain. The introduction of polymers or particulate emboli by catheter has been used either alone or as an adjunct in attempts to reduce the size of these lesions prior to surgery; however, it is seldom possible to embolize the entire malformation. The authors have used direct injection of a 50% mixture of bucrylate and iophendylate into the feeding arteries supplying the area at craniotomy, with success in three cases. The cases are described to illustrate the method.
Bilateral cortical blindness associated with carotid stenosis in a patient with a persistent trigeminal artery
Authors: Heeney David J. , Koo Andrew H.
Published: May 2009

✓ A patient with findings of bilateral cortical blindness and a unilateral carotid bruit is reported. A persistent trigeminal artery allowed emboli from a unilateral ulcerated internal carotid plaque to affect the visual cortex bilaterally. The angiographic findings and a brief discussion of this anomalous artery are presented.
Calcified herniated thoracic disc diagnosed by computerized tomography
Authors: Hochman M. Seth , Pena Constantino , Ramirez Raul
Published: May 2009

✓ A case is reported in which a calcified herniated thoracic disc was diagnosed by computerized tomography.
Extradural spinal meningioma arising from a nerve root
Authors: Kumar Sushil , Kaza Ramachandran C. , Maitra Tilak K. , Chandra Mithlesh
Published: May 2009

✓ A case is reported of spinal compression due to an extradural meningioma arising exclusively from the nerve root.
Regional cortical metabolism in focal ischemia
Authors: Ratcheson Robert A. , Ferrendelli James A.
Published: May 2009

✓ Regional cortical levels of organic phosphates and carbohydrates were measured in cat brains, enzymatically inactivated by the technique of “funnel freezing” 1 hour after occlusion of a middle cerebral artery (MCA). Significant metabolic alterations occurred in all hemispheres ipsilateral to the site of occlusion. However, there was marked interindividual variability, with changes ranging from only slight increases in lactate, pyruvate, and adenosine monophosphate (AMP) in small regions of cortex at one extreme, to profound depletion of high-energy phosphates, depression of glucose and pyruvate levels, and increased lactate, adenosine diphosphate (ADP) and AMP levels in much of the hemisphere of the most severely involved animals. In contrast, metabolic changes in the hemisphere contralateral to the site of occlusion were very few or nonexistent. In addition, in all ipsilateral hemispheres there were regions peripheral to the areas of greatest metabolic alteration where there was excessive elevation of glucose levels. The results demonstrate that occlusion of a major cerebral vessel does not produce metabolic changes that are consistent in their distribution or severity. However, the findings of this study probably depict some of the complicated metabolic events that occur clinically during thrombotic or embolic infarction of brain.
Susceptibility of brain and skin to bacterial challenge
Authors: Mendes Michael , Moore Paul , Wheeler Clara Belle , Winn H. Richard , Rodeheaver George
Published: May 2009

✓ The brain is a uniquely protected organ. Once the protective barriers are overcome, the brain is susceptible to bacterial infection. Using a reproducible rat model, the susceptibility of brain tissue to challenge by S. aureus or E. coli was quantitatively compared to that of skin. Brain was significantly more susceptible to the presence of bacteria than was the skin of the scalp. The development of infection in skin required at least 105 organisms, while brain infection could be produced with as few as 100 organisms.
The role of craniectomy in the treatment of chronic subdural hematomas
Authors: Tyson George , Strachan W. Ellis , Newman Peter , Winn H. Richard , Butler Albert , Jane John
Published: May 2009

✓ A consecutive series of 48 adult patients with a chronic subdural hematoma is reported. These patients were treated according to a protocol consisting of a sequence of conventional surgical procedures ranging from simple burr-hole drainage to craniotomy and subdural membranectomy. Seven patients (15%) continued to demonstrate severe neurological dysfunction, or suffered acute neurological deterioration after completion of this protocol. However, after undergoing excision of the cranial vault overlying the hematoma site, six of these seven patients demonstrated a significant clinical improvement. Based on analysis of these seven cases, the authors suggest that craniectomy be considered in those patients who suffer a symptomatic reaccumulation of subdural fluid following craniotomy and membranectomy, or who demonstrate further neurological deterioration as a result of cerebral swelling subjacent to the hematoma site. However, this procedure probably has no efficacy once extensive cerebral infarction has occurred.
Comparison of hydrogen clearance and 14C-antipyrine autoradiography in the measurement of spinal cord blood flow after severe impact injury
Authors: Cawthon David F. , Senter Howard J. , Stewart William B.
Published: May 2009

✓ Spinal cord blood flow was measured by two different techniques in normal and traumatized cat spinal cord. Flow was measured in the thoracic cord after severe (500 gm-cm) impact injury at T-6. Blood flow was measured sequentially at two sites for 7 hours after trauma using the hydrogen clearance technique, and spatially at many sites but at selected times by means of the 14C-antipyrine autoradiographic method. The two techniques gave similar results. Control white-matter blood flow in the lateral funiculus was 11.13 ± 1.29 ml/min/100 gm in the hydrogen clearance series, and 11.07 ± 3.16 gm blood/min/100 gmin the antipyrine series. Following injury, blood flow remained in the control range until 1 hour after trauma, when ischemia became the major pattern. From 4 to 8 hours following trauma, several categories of flow patterns emerged. In one group of animals, white-matter blood flow returned to control levels at some points along the length of cord surveyed, but remained depressed at adjacent cord levels. In another category of animals, most sites in the white matter had flows approaching control levels by 7 to 8 hours. In yet another group, all sites examined, although a limited number, showed ischemia. In contrast, gray-matter ischemia appeared earlier (25% of control levels at 1 hour), had a sharper focus, and persisted in the period examined. The differences in blood flow between gray and white matter and the longitudinal variation in white-matter flow suggested that the hydrogen clearance method should be verified by autoradiography for accuracy of spatial flow patterns.
Experimental syringomyelia
Authors: Hall Peter , Turner Michael , Aichinger Steven , Bendick Phillip , Campbell Robert
Published: May 2009

✓ The influence of ventricular pressure changes on syrinx pressure was investigated in this study of experimental canine kaolin-induced syringomyelia. The pressures of the ventricles, syrinx, and cervical subarachnoid space were measured. A complete ventriculosubarachnoid block occurred in the animals with syringomyelia. The baseline syringeal pressures exceeded those of both the ventricles and the subarachnoid space. Raising ventricular pressure elevated the syringeal pressure, but aspiration of ventricular fluid did not acutely lower the pressure. These findings suggest a ventriculosyrinx valve effect that may inflate the syrinx during transient rises of intracranial pressure.

A respiratory pressure pattern was found in the syrinx similar to that of the ventricles and subarachnoid space. This wave was reduced but not abolished by ligating the subarachnoid space distal to the syrinx. The arterial pulse was much diminished within the syrinx at rest. These findings indirectly support the possibility that transmission of thoracic pressures to the spinal subarachnoid space with compression of the syrinx is a principal force that enlarges the syrinx.
Holographic interferometry applied to the study of the human skull
Authors: Spetzler Robert F. , Spetzler Hartmut
Published: May 2009

✓ A laboratory technique that allows strain measurements of the skull is described. Holographic interferometry allows the entire surface displacement of the skull to be mapped within 1/10 of the wavelength of light. Holographic interferometric pictures are presented following various stress applications to the skull. The method, besides being exquisitely sensitive, allows strain measurements simultaneously in any desired direction over the entire skull. No physical contact with the skull is required, and the experimental set-up is simple.
Thorotrast-induced meningioma
Authors: Sussman Sydney , TerBrugge Karel G. , Solt Lillian C. , Deck John H. N.
Published: May 2009

✓ The authors report an adult patient with a symptomatic intracranial meningioma that was demonstrated by computerized tomography, angiography, and at surgery. The meningioma had occurred at a site where 19 years previously thorium dioxide had been injected into an abscess cavity. Pathological examination revealed the presence of thorium granules within the meningioma.
Osteochondroma with spinal cord compression
Authors: Palmer F. John , Blum Peter W.
Published: May 2009

✓ Multiple osteochondromatosis is the most common of the bone dysplasias, but neurological complications are rare. Osteochondromas of the spine usually arise from the neural arch. Tomography and myelography are useful in determining the site of origin and the relationship to the spinal cord. The tumor is benign, and surgical removal produces an excellent clinical result. Three cases are described illustrating the clinical and radiological manifestations of these tumors.
Villonodular synovitis in the spinal canal
Authors: Kleinman George M. , Dagi T. Forcht , Poletti Charles E.
Published: May 2009

✓ Villonodular synovitis is believed to be an inflammatory, proliferative reaction of synovial tissues. The case of a 65-year-old woman with a cervical epidural mass is presented in which histological examination showed that the lesion was villonodular synovitis, an extremely rare occurrence. Because of its cellularity and occasional multinucleated giant cells, villonodular synovitis may be confused with metastatic malignancies or giant-cell tumor of bone.
Lumbosacral meningismus complicating subdural injection of “blood patch”
Authors: Wilkinson Harold A.
Published: May 2009

✓ The published literature suggests that the technique of epidural “blood patch” injection is both safe and effective for the treatment and prevention of headache after spinal puncture. However, a case is reported in which the complications following a “blood patch” outweighed the disability and discomfort produced by the headache itself. The etiology is believed to have been inadvertent injection of blood into the subarachnoid space.
Aberrant regeneration in idiopathic oculomotor nerve palsy
Authors: Laguna Jose F. , Smith Michael S.
Published: May 2009

✓ Aberrant regeneration of the oculomotor nerve usually follows injury to the nerve by posterior communicating artery aneurysms or trauma. A case of idiopathic third nerve palsy with pupillary involvement occurred in an otherwise healthy 38-year-old man. Follow-up examination 32 months later showed evidence of oculomotor function with aberrant regeneration.
Anterior surgery for cervical disc disease
Authors: Lunsford L. Dade , Bissonette David J. , Jannetta Peter J. , Sheptak Peter E. , Zorub David S.
Published: May 2009

✓ Between 1971 and 1977, 334 patients at the Presbyterian-University Hospital underwent anterior surgery for treatment of hard or soft cervical disc herniation. Of these patients, 295 had radicular symptoms only. This retrospective study details the results of anterior cervical surgery for treatment of lateral disc herniation in 253 patients who survived 1 to 7 years postoperatively. Sixty-seven percent had excellent or good results. Although 77% initially noted complete relief of symptoms after surgery, 38% subsequently developed one or more recurrent symptoms at some time during the follow-up period. The overall results of surgery for soft disc cases were no different from the results for hard discs, although significantly more hard disc cases required postoperative conservative treatment. The results of surgery after anterior fusion were no different than the results after anterior discectomy alone. However, overall postoperative complications were more frequent and hospitalizations were longer in the patients who underwent fusion. Patients with multiple-level surgery had statistically similar results to those with single-level surgery. None of the nine preoperative clinical features reported by others to influence the results of anterior cervical surgery were found to consistently affect outcome in the present series.
Surgical treatment of asymptomatic and incidental intracranial aneurysms
Authors: Salazar Jose Luis
Published: May 2009

✓ A consecutive series of 78 patients underwent surgery for 106 aneurysms between 1972 and 1978; this group included 14 patients with subarachnoid hemorrhage who had multiple, unruptured, incidental aneurysms (20 additional aneurysms). These aneurysms were operated on with no mortality. In 15 other patients, who underwent angiography for various nonhemorrhagic disorders, a total of 18 asymptomatic aneurysms were found. These were also operated on with no mortality. Three of the 29 patients had postoperative hemiplegia, which persists in only one. The author recommends that all aneurysms should be considered for operation when diagnosed, if the patient's clinical condition is stable.
Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery
Authors: Spetzler Robert F. , Schuster Herbert , Roski Richard A.
Published: May 2009

✓ Thirteen patients with giant aneurysms of the internal carotid artery (ICA) were treated with ICA ligation and an extracranial-intracranial arterial bypass. A method for establishing a proper superficial temporal artery to middle cerebral artery pressure gradient while maintaining partial flow through the ICA is presented. This procedure allows the anastomosis to become established before full occlusion of the cervical ICA. None of these patients suffered any immediate or delayed ischemic or rebleed complications over an average follow-up period of 18 months.
Pitfalls in the angiographic diagnosis of serious head injury
Authors: Savolaine Edward R. , Gerber Arthur M. , Nowak Stephen F.
Published: May 2009

✓ The problems in interpretation of emergency cerebral arteriograms are discussed with relation to the apparent displacement of “landmark” vessels that is actually produced by rotation or by the type of anteroposterior projection of the vessels, rather than by mass lesions. Anterior cerebral artery, middle meningeal artery, and pineal displacements are reviewed, along with possible pitfalls of diagnosis and attempts at correction. Utilization of dried skulls afforded depth visualization of middle meningeal artery grooves as well as the radiographic projection. The most reliable region on each different type of anteroposterior projection is discussed with regard to the emergency situation where repeat angiographic detections or special views may not be possible.
Median and ulnar nerve transections treated with microsurgical interfascicular cable grafting with autogenous sural nerve
Authors: Haase Jens , Bjerre Per , Simesen Kurt
Published: May 2009

✓ Interfascicular nerve grafting was used in 37 median and 26 ulnar nerves, all completely transected. In a follow-up period of 2.5 to 5 years, useful motor recovery (M3 or higher) was achieved in 84% of median nerve lesions; in ulnar nerve lesions, useful motor recovery (M2+ or higher) was achieved in 73%. Sensory recovery with some return of two-point discrimination sense was found in 63% of low median and 50% of low ulnar nerve lesions. In the median nerve group, results for patients younger than 20 years of age were significantly better than in older patients. Neurophysiological investigations gave evidence for nerve regrowth through the grafts in all but one patient, although the loss of axons was probably considerable if the amplitudes of sensory potentials were used as a parameter. Grafts of 2.5 to 5 cm in length gave better results than longer grafts, and results for the distal median nerve lesions were superior to those for the distal ulnar nerve lesions. Use of interfascicular nerve grafting techniques for nerve gaps greater than 2.5 cm is recommended.
Bilateral innervation of the cerebral arteries by the superior cervical ganglion in cats
Authors: Marín Jesús , Salaices Mercedes , Rivilla Fernando , Burgos Javier , Marco Emilio J.
Published: May 2009

✓ The effect of removal of the left superior cervical ganglion on the contractile response to norepinephrine (NE) and 5-hydroxytryptamine (5-HT, serotonin) was studied in isolated segments of the middle cerebral artery (MCA) and posterior communicating artery (PCoA) of the cat. Fifteen days after the excision, each dose of NE elicited a potentiated response in both the MCA and the PCoA, whichever side they originated. By contrast, 5-HT induced enhanced vasoconstriction at each dose only in the MCA and PCoA from the left side. When segments of MCA and PCoA from the right side were challenged against 5-HT, a significantly increased response was found only at the first three doses. On the other hand, the NE content of pools made of MCA, PCoA, and anterior cerebral artery from each side was reduced to the same level on both sides after ganglion removal. These results indicate that the excised superior cervical ganglion innervated the MCA and PCoA from both sides of the circle of Willis.
A technique for evaluation of ventricular shunts using Amipaque and computerized tomography
Authors: Faria Miguel A. , O'Brien Mark S. , Tindall George T.
Published: May 2009

✓ A technique involving the combined use of Amipaque (metrizamide) and computerized tomography scanning is described for the evaluation of ventriculoperitoneal and ventriculoureteral shunt function. The results of three illustrative cases from a series of nine patients are given. In five patients, the technique demonstrated obstruction that was later confirmed at surgery. In the other four patients, it showed patency in the shunt system, and no surgery was performed, thereby obviating unnecessary shunt revisions.
Alternating Horner's syndrome and hyperhidrosis due to dural adhesions following cervical spinal cord injury
Authors: Ottomo Michinori , Heimburger Robert F.
Published: May 2009

✓ Alternating Horner's sign and hyperhidrosis appeared in this patient 8 years after a spinal cord injury at C6–7. An intramedullary cyst was suspected but was not found at operation. There was a striking improvement in both symptoms after adhesions between the spinal cord and the dura mater were freed.
Angiography and computerized tomography in the diagnosis of aneurysmal bone cyst of the skull
Authors: Luccarelli Giovanni , Fornari Maurizio , Savoiardo Mario
Published: May 2009

✓ An aneurysmal bone cyst of the occipital bone, presenting as an intracranial space-occupying lesion, is reported. Clinical and neuroradiological findings are described in detail. The significance of angiographic and computerized tomographic findings is discussed.
Schwannoma of the brain stem
Authors: Prakash Brahm , Roy Subimal , Tandon Prakash N.
Published: May 2009

✓ A case of intramedullary schwannoma of the brain stem is reported, and its possible origin discussed. The importance of a biopsy in brain-stem tumors is emphasized.
Intracranial arteriovenous malformations
Authors: Guidetti Beniamino , Delitala Alberto
Published: May 2009

✓ The authors present a consecutive series of 145 patients admitted to the Institute of Neurosurgery of Rome University with an intracranial arteriovenous malformation (AVM). Of these, 95 received surgical care, and 50 were treated conservatively. Total removal of the AVM was performed in all but three of the patients treated surgically, and all underwent postoperative angiography. The postoperative mortality was 6.3%. A long-term follow-up study showed a mortality rate of 20% in the group of patients receiving conservative treatment, while no recurrence of bleeding was observed in the surgical group. The choice of treatment of these malformations is still an open question. The authors' contribution to the discussion is based on the late results of both surgical and conservative treatment.
Global and regional cerebral blood flow
Authors: Granowska Maria , Britton Keith E. , Afshar F. , Wright Charles W. , Smyth Richard R. J. , Lee Ting Y. , Nimmon Cyril C.
Published: May 2009

✓ Since inert gas washout techniques for cerebral blood flow (CBF) measurement are not applicable to asymmetrical pathological states where assumptions about constancy of distribution, volume, and partition coefficients cannot be held to be valid, a new approach to regional and global CBF is described. Regional volume and regional mean transit time are measured independently to give regional volume flow in ml/min. In a pilot study, this noninvasive, quantitative technique has been applied to 37 patients with various clinical responses to subarachnoid hemorrhage. Global CBF and clinical grading were significantly associated. Reduction of regional CBF and spasm of the relevant arterial supply were also significantly associated in these patients.
Physiological features of the pressure-volume function of brain elasticity in man
Authors: Sklar Frederick H. , Beyer Chester W. , Clark W. Kemp
Published: May 2009

✓ The intracranial pressure-volume relationship of brain elasticity was examined in 20 patients with suspected disorders of the cerebrospinal fluid (CSF) system. Elasticity measurements were made as the patients were studied with a servo-controlled lumbar infusion technique to measure CSF absorptive capacity. The data were evaluated to determine the relationship between intracranial pressure (ICP) and volume, and between ICP variability and the level of ICP. The results confirm the exponential nature of the pressure-volume elasticity function in patients who are not critically ill. Eight of the 20 patients were shown to have normal CSF absorptive capacities, and there was no difference between their elasticity measurements and those of patients with absorptive defects. In addition, ICP variability was shown to be linearly related to the actual level of ICP.

The physiological features of the pressure-volume elasticity function are reviewed. Based on these considerations, the clinical value and significance of elasticity measurements is questioned.
Acute effect of the carbon dioxide laser on the epicerebral microcirculation
Authors: Toya Shigeo , Kawase Takeshi , Iisaka Youichi , Iwata Takanobu , Aki Toshio , Nakamura Tsuneo
Published: May 2009

✓ The effect of laser radiation on the central nervous system has been studied in cases of clinical and experimental tumors. However, no report yet exists on the effects of laser radiation on the cerebral microcirculation in vivo. Cerebral fluorescein angiography permits observations of small vessels that are not possible by conventional angiography. In this study, disturbance in the epicerebral microcirculation after carbon dioxide laser radiation was localized. On fluorescein angiograms, a circular zone of nonfilling of fluorescein dye around the site of impact, 1 to 1.5 mm in diameter, was seen throughout from the arterial to late venous phase. Around the nonfilling area, thrombus formation in small vessels and extravasation of the dye were demonstrated. Such extravasation of the fluorescein remained after the dye had faded from the venules and veins. Microscopically, coagulation necrosis was observed to coincide with the area of nonfilling of fluorescein dye in the fluorescein angiograms. In areas surrounding this, edema, dilatation or rupture of the capillaries, and thrombus formation in the arterioles were observed. Such areas coincided with those of extravasation of the fluorescein dye.
Microsurgical anatomy of the pineal region
Authors: Yamamoto Isao , Kageyama Naoki
Published: May 2009

✓ Thirty cadaver brains were examined under × 6 to 16 magnification in order to define the microsurgical anatomy of the pineal region, particularly the relationship of the pineal body, posterior cerebral artery, superior cerebellar artery, vein of Galen, basal vein of Rosenthal, internal cerebral vein, straight sinus, bridging vein, the size of the tentorial notch, and the third and the fourth cranial nerves. The infratentorial and supratentorial approaches to the pineal region are compared from the viewpoint of microsurgical anatomy.
Precise anatomic localization of atraumatic sphenoethmoidal cerebrospinal fluid rhinorrhea by metrizamide CT cisternography
Authors: Naidich Thomas P. , Moran Christopher J.
Published: May 2009

✓ Metrizamide computerized tomographic cisternography (MCTC) has proved 100% successful in documenting the precise anatomic location of the dural osseous defect in three patients with sphenoethmoidal rhinorrhea. In each patient, direct surgical approach to the site indicated by MCTC terminated the leakage in a single procedure. Clinical evaluation has disclosed no renewed leakage during a follow-up period from 6 to 18 months.
Thermocouple-monitored cordotomy electrode
Authors: Levin Allan B. , Cosman Eric R.
Published: May 2009

✓ A new cordotomy electrode with temperature monitoring is described. The electrode provides for a faster, more accurate procedure. The technique of cordotomy using this electrode is described.
Intracranial pressure during nitroglycerin-induced hypotension
Authors: Cottrell James E. , Gupta Bhagwandas , Rappaport Harry , Turndorf Herman , Ransohoff Joseph , Flamm Eugene S.
Published: May 2009

✓ Nitroglycerin was given intravenously to five anesthetized, hyperventilated (PaCO2 25 to 30 torr) patients during craniotomy, to facilitate surgery by creating a relatively bloodless field, and to decrease the potential need for blood transfusion. A subarachnoid screw and an indwelling radial artery catheter were inserted to monitor intracranial pressure (LCP) and mean arterial pressure (MAP). As MAP decreased from 104.4 ± 4.0 (SE) to 69.0 ± 1.8 torr, ICP increased from 14.2 ± 0.7 (SEM) to 30.8 ± 1.1 torr. Cerebral perfusion pressure decreased from 90.2 ± 3.6 (SEM) to 38.2 ± 2.3 torr (p < 0.0005). We attribute this nitroglycerin-induced ICP increase to capacitance vessel dilation within the relatively noncompliant cranial cavity, with subsequent cerebral blood volume increase.
Hypertrophic cervical osteophytes causing dysphagia
Authors: Gamache Francis W. , Voorhies Rand M.
Published: May 2009

✓ Problems associated with osteophytes of the spine are frequently called to the attention of the neurosurgeon. Diffuse idiopathic skeletal hyperostosis (Forestier's disease) is a common disorder of the spine; a small but important number of these patients present with spondylitic dysphagia. Anterior cervical decompression restores esophageal function. A patient with Forestier's disease is reported, and Forestier's disease is compared and contrasted with other disorders of the spine.
CCNU chemotherapy in adult patients with tumors of the basal ganglia and brain stem
Authors: Pompili Alfredo , Riccio Antonio , Jandolo Bruno , Fontana Maurizio
Published: May 2009

✓ The present investigation evaluates those few patients of our series with basal ganglia and brain-stem tumor who refused either surgical decompression and biopsy or radiation therapy. Four patients were suffering from tumors of the basal ganglia and three from brain-stem tumors; all the tumors were diagnosed by classical neuroradiological investigations and computerized tomography. The patients were given CCNU by mouth, 13 mg/sq m every 6 weeks. No toxicity was recorded. Mean survival was 19 weeks for patients with basal ganglia tumors and 48 weeks for those with brain-stem tumors. All patients were evaluated with respect to the quality of survival. Results were compared with those obtained in a control group of patients who received methylprednisolone therapy only.
The single supratentorial lesion
Authors: Voorhies Rand M. , Sundaresan Narayan , Thaler H. Tzvi
Published: May 2009

✓ The role of preoperative diagnostic tests was evaluated in 210 adult patients with single supratentorial lesions demonstrated by computerized tomography. At craniotomy, 59.5% of these patients proved to have primary brain tumors, 36.2% had metastatic tumors, and 4.3% had non-neoplastic lesions. In 23 (11%) of these patients, a single brain metastasis was the first manifestation of a systemic cancer. The primary site of cancer was identified in 14 patients (10 in the lung, three in the kidney, and one in the colon), and in nine patients the primary site could not be established. Using simple conditional probability theory, we established that the probability of a metastatic lesion in patients without a history of previously treated cancer is about 7%, if their chest x-ray film and intravenous pyelogram (IVP) are negative. Extensive preoperative testing to try to establish a primary site is unrewarding if the chest x-ray film and IVP are negative, since these are the only sites likely to be identified in these patients. In patients with a history of previously treated cancer, these tests are justified because they have prognostic value in determining treatment.
The effect of exogenous thyroid hormones on functional recovery of the rat after acute spinal cord compression injury
Authors: Tator Charles H. , van der Jagt Richard H. C.
Published: May 2009

✓ The effect of triiodothyronine (T3) or thyroxine (T4) on functional recovery after acute spinal cord compression injury in the rat was assessed. Rats treated with T3 for 14 consecutive days after injury showed significantly improved recovery at 12 and 16 weeks, and rats treated with T4 for 4 days after injury showed significantly improved recovery at 12 weeks as compared with control animals. The possible modes of action of these two hormones on the injured spinal cord are briefly discussed.
Effect of aminophylline and isoproterenol on spinal cord blood flow after impact injury
Authors: Dow-Edwards Diana , DeCrescito Vincent , Tomasula John J. , Flamm Eugene S.
Published: May 2009

✓ A study of the effects of spinal cord injury upon spinal cord blood flow was carried out in cats. A 400 gm-cm impact produced an overall reduction in spinal cord blood flow of 24% in the white matter and 30% in the gray matter, as determined by 14C-antipyrine autoradiography. At the level of the injury, white-matter flow was 8.1 ml/100 gm/min, a reduction of 49%, and in the gray matter, 12.5 ml/100 gm/min, a reduction of 76%. Treatment with aminophylline and isoproterenol improved the overall blood flow in the spinal cord. At the level of the injury, white-matter flow after this treatment was no longer significantly different from control values. The gray-matter flow remained decreased to 26.2 ml/100 gm/min, a reduction of only 47%. It is proposed that aminophylline and isoproterenol may increase cyclic adenosine monophosphate (AMP) and prevent platelet aggregation along the endothelial surfaces of the microcirculation, and may thereby help to maintain improved perfusion of the injured spinal cord.
Eighth nerve lipoma
Authors: Mattern William C. , Blattner Robert E. , Werth James , Shuman Robert , Bloch Solomon , Leibrock Lyal G.
Published: May 2009

✓ A case of lipoma of the right eighth cranial nerve in the cerebellopontine angle (CPA) is presented. The patient had a clinical, diagnostic, surgical, and postoperative course similar to that of patients with other small CPA tumors. The literature on this rare CPA tumor is reviewed and discussed.
Primary intracranial leiomyosarcoma
Authors: Anderson W. Robert , Cameron J. Douglas , Tsai S. H.
Published: May 2009

✓ Primary intracranial tumors of mesenchymal origin are exceedingly rare. This study describes the light microscopic and ultrastructural features of a leiomyosarcoma localized to the sellar and suprasellar region in a 35-year-old man. The probable origin of this tumor from blood vessels is discussed.
Intracranial dermoid cyst in Goldenhar's syndrome
Authors: Murphy Martin J. , Risk Winthrop S. , VanGilder John C.
Published: May 2009

✓ A patient with Goldenhar's syndrome and an ipsilateral intracranial dermoid cyst is reported. It is suggested that the combination of both entities may not be coincidental but due to their related embryological origin. This report also reemphasizes the value of computerized tomography in the preoperative diagnosis of intracranial dermoid cysts.
Direct retraction method in aneurysm surgery
Authors: Sugita Kenichiro , Kobayashi Shigeaki , Takemae Toshiki , Matsuo Koichi , Yokoo Akira
Published: May 2009

✓ A new technique of direct retraction of an aneurysm or major arteries using tapered brain retractors is introduced. The system requires three separate instruments: 1) a tapered brain retractor, 2) a flexible self-retaining retractor of light weight, and 3) a multipurpose head frame.
The lateral recess syndrome
Authors: Ciric Ivan , Mikhael Michael A. , Tarkington Joseph A. , Vick Nicholas A.
Published: May 2009

✓ Sixteen patients with a surgically proven lateral recess stenosis were studied retrospectively. Lateral recess stenosis should be suspected in patients with disabling intermittent neurogenic claudications. The neurological examination is usually unremarkable. The diagnosis is assured when the lateral recess measures less than 2 mm in height. A lateral recess of 5 mm or more rules out the possibility of a lateral recess stenosis. Surgical decompression of the lateral recess requires removal of the horizontal portion of the superior articular facet.
Craniocervical abnormalities
Authors: Menezes Arnold H. , VanGilder John C. , Graf Carl J. , McDonnell Dennis E.
Published: May 2009

✓ Guidelines are proposed for surgical management of symptomatic abnormalities of the craniocervical junction. Experience with 17 recent cases is described. Gas or metrizamide (Amipaque) myelograms with pluridirectional tomograms revealed the etiology and mechanisms of compression of the cervicomedullary junction, as well as its reducibility. Stabilization was the goal in treatment of reducible lesions. Decompression of the cervicomedullary junction was paramount in irreducible cases. Ventral compression was treated in nine patients by transoral transpalatine resection of the odontoid-clivus complex, and all nine improved. A posterior decompression was carried out when bone impingement was present from the dorsal aspect. Fusion was performed in cases in which stability was not achieved by either procedure.
Subclavian to middle cerebral artery saphenous vein bypass graft
Authors: Spetzler Robert F. , Rhodes Robert S. , Roski Richard A. , Likavec Matt J.
Published: May 2009

✓ A variation of an extracranial-intracranial arterial bypass is presented. The subclavian artery is used as the donor vessel and the saphenous vein as the graft; thus, a bypass to a cortical branch of the middle cerebral artery can be accomplished. The advantage of this modification is that the saphenous vein, when tunneled subcutaneously behind the ear, is positioned in a straight line from the donor to the recipient vessel. Since the vein lies in the axis of head rotation, turning of the head causes little displacement of the graft, as opposed to a graft from the common carotid artery to the middle cerebral artery. An additional advantage over the superficial temporal artery to middle cerebral artery bypass is the large flow obtained immediately after anastomosis.
Bioenergetics of acute vasogenic edema
Authors: Sutton Leslie N. , Welsh Frank , Bruce Derek A.
Published: May 2009

✓ The bioenergetic mechanisms of vasogenic edema were studied by measuring concentrations of adenosine triphosphate (ATP), phosphocreatine (CrP), and lactate in rapidly frozen edematous white matter in cats. When edema was produced using a cold lesion, it was found that both ATP and CrP were reduced to one-half of control values, and that lactate was elevated. When a correction was applied for dilution, however, it was found that high-energy phosphates were equal to control values, and that lactate was even more significantly elevated. This pattern contrasted with that seen in white-matter ischemia, in which CrP is depressed out of proportion to ATP. Finally, it was found that the white-matter lactate concentration in the plasma infusion model of edema was increased. It is concluded that vasogenic edema induces an increase in lactate, but does not deplete high-energy phosphate compounds in affected white matter.
Effect of experimental subarachnoid hemorrhage on the adrenergic innervation of cerebral arteries
Authors: Lobato Ramiro D. , Marín Jesús , Salaices Mercedes , Burgos Javier , Rivilla Fernando , García Antonio G.
Published: May 2009

✓ The effect of subarachnoid hemorrhage (SAH) on the adrenergic innervation of cat cerebral arteries was analyzed. Intracisternal injections of autologous blood reduced the noradrenaline content from the perivascular nerves. Dopamine beta-hydroxylase and the uptake of 3H-noradrenaline were also decreased. These changes returned to normal in a period of 2 to 3 weeks after the SAH. Superior cervical ganglionectomy and intracisternal injections of 6-hydroxydopamine also reduced these three parameters. It is suggested that SAH induces a transient adrenergic denervation of the cerebral arteries that might be involved in the production of the chronic cerebral vasospasm.
Dose responses of cerebral arteries of the dog, rabbit, and man to human hemoglobin in vitro
Authors: Wellum Glyn R. , Irvine Thomas W. , Zervas Nicholas T.
Published: May 2009

✓ Dose responses in vitro of the basilar arteries of the dog, rabbit, and man to human hemoglobin are reported. For each species, the response occurred over a range of 10−9M to greater than 10−5M hemoglobin. When compared to a maximum serotonin contraction, the relative constriction induced by 10−5M hemoglobin was greater in the rabbit than in the dog, which in turn was greater than in man. The comparatively weak response of the human arteries is probably attributable to postmortem changes.
Autoregulation of cerebral blood flow after experimental fluid percussion injury of the brain
Authors: Lewelt W. , Jenkins L. W. , Miller J. Douglas
Published: May 2009

✓ To test the hypothesis that concussive brain injury impairs autoregulation of cerebral blood flow (CBF), 24 cats were subjected to hemorrhagic hypotension in 10-mm Hg increments while measurements were made of arterial and intracranial pressure, CBF, and arterial blood gases. Eight cats served as controls, while eight were subjected to mild fluid percussion injury of the brain (1.5 to 2.2 atmospheres) and eight to severe injury (2.8 to 4.8 atmospheres). Injury produced only transient changes in arterial and intracranial pressure, and no change in resting CBF. Impairment of autoregulation was found in injured animals, more pronounced in the severe-injury group. This could not be explained on the basis of intracranial hypertension, hypoxemia, hypercarbia, or brain damage localized to the area of the blood flow electrodes. It is, therefore, concluded that concussive brain injury produces a generalized loss of autoregulation for at least several hours following injury.
Hyperextension injury of the cervical spine with esophageal perforation
Authors: Stringer W. Lynn , Kelly David L. , Johnston Frank R. , Holliday Robert H.
Published: May 2009

✓ A case is presented of esophageal perforation following a hyperextension-flexion cervical injury. The patient recovered without complication. Hyperextension-flexion injuries of the cervical spine have proved to be a rare cause of esophageal perforation. The mechanism may be impingement of the esophagus against an exostosis or the edge of a vertebral body, or entrapment of the esophageal wall between the vertebral bodies as hyperextension changes to flexion. If not detected and treated early, the perforation may cause mediastinitis, retropharyngeal abscess, aspiration pneumonia, or death.
Metastases outside the central nervous system from a presumed pineal germinoma
Authors: Rubery Eileen D. , Wheeler Terence K.
Published: May 2009

✓ A case of a presumed pineal germinoma in a 17-year-old boy is presented. Metastases in the left loin musculature developed 3 years after presentation, and on biopsy were found to be typical of a seminoma. Bone marrow and chest films showed no evidence of disease. It is therefore considered likely that spread occurred via the lumbar foramina by direct extension from known spinal metastases rather than via the ventriculoatrial shunt. The testes remained normal at all times, and a small testicular primary tumor giving rise to cerebral symptoms from mestastases is considered unlikely, since cerebral metastases from testicular tumors are rare without prior metastasis to the chest. Four previous cases of pineal tumors with chest metastases are reviewed.