bluuebunny/crossref_metadata_2025 huggingface dataset:
Giant Cell Reparative Granuloma of the Cranial Vault: Exceptional Bone Lesion
Authors: Garza-Mercado Román , Cavazos Elisamaría , Hernández-Batres Francisco
Published: May 2010

Giant cell reparative granuloma (GCRG) is an uncommon nonneoplastic lesion of bone. It is even rarer in the bones of the skull, particularly in the calvarial bones. Originally considered to be peculiar to the jawbones, GCRG has been described in some other locations, such as the short tubular bones of the hand and foot and the facial (paranasal) bones. Only one GCRG has been found in the skull, this one in the temporal bone. The authors were unable to find a report of such a lesion in the bones of the calvarium. The etiology of GCRG is unknown, but it is believed to result from a traumatic intraosseous hemorrhage or periosteal reaction. A GCRG was diagnosed in a 31-month-old male infant who presented with a nonpainful, slow-growing, right frontal swelling, apparently related to a head contusion that had occurred 21 months earlier. The lesion was removed surgically. The main differential diagnosis is giant cell tumor.
Treatment of Tandem Lesions of the Extracranial Carotid Artery
Authors: Pritz Michael B. , Smolin Michael F.
Published: May 2010

The authors present a patient with bihemispheric transient ischemic attacks attributed to stenosis of the left common carotid origin and stenosis and ulceration of the left cervical internal carotid artery. Because of precarious cerebral blood supply secondary to occlusions of the right common carotid and left vertebral arteries, several measures were undertaken perioperatively to provide protection from cerebral ischemia during vessel occlusion. These included Swan-Ganz catheter monitoring to maximize cardiac output and maintain satisfactory hydration, normocarbia, satisfactory oxygenation, and moderate hypertension and barbiturate infusion. With these adjuncts, both lesions were treated together. Retrograde balloon angioplasty under fluoroscopic control of a significant stenosis of the common carotid artery origin was performed before carotid endarterectomy. Postoperative digital subtraction angiography demonstrated a satisfactory technical result. The management of tandem lesions of the extracranial carotid artery is discussed. Balloon angioplasty coupled with extracranial vascular reconstructive procedures may allow the management of lesions not treated safely or effectively by either technique alone.
Meningioma with Intracerebral Hematoma
Authors: Kohli Chander M. , Crouch Rebecca L.
Published: May 2010

A case of spontaneous intracranial hemorrhage associated with a meningioma is presented. Intracranial hemorrhage has been reported to be associated with meningioma in 45 cases. A comprehensive review of the subject is presented. The importance of the diagnosis of associated hemorrhage and subsequent surgical intervention is emphasized.
Giant Granular Cell Tumor of the Suprasellar Area; Immunocytochemical and Electron Microscopic Studies
Authors: Liwnicz Boleslaw H. , Liwnicz Boleslaw H. , Liwnicz Regina G. , Huff Stephen J. , McBride Bert H. , Tew John M. , Tew John M.
Published: May 2010

We describe a case of a granular cell tumor (GCT) of the suprasellar region with an 11-year history in a 26-year-old woman. The computed tomographic scan showed a midline, contrast-enhancing, noncalcified mass. The biopsy was diagnosed as GCT. The tumor was treated with radiation therapy. At necropsy, a large, homogeneous GCT surrounded by gliosis was found. The tumor cells were filled with granules positive for periodic acid-Schiff, diastase-resistant. The cells did not contain glial fibrillary acidic protein or S-100 protein. Electron microscopy showed tumor cells filled with innumerable lysosomal structures. No intermediate filament was found within the cytoplasm. The tumor cells were not surrounded by a basement membrane. Based on this study and on our review of the literature, the suggestion that GCT has a multicellular origin is upheld.
Cerebellopontine Angle Gumma
Authors: Eltomey Atef A. , Olin Michael S. , Roberts Melville P.
Published: May 2010

A rare lesion, a gumma in the cerebellopontine angle, is reported. Gumma may mimic other more commonly occurring cerebellopontine angle tumors. The computed tomographic (CT) appearance and histological characteristics are discussed. The literature of cerebral gumma is reviewed. This is the only reported case of cerebellopontine angle gumma seen on CT scan and verified histologically at operation.
Nocardial Osteomyelitis of the Spine with Epidural Spinal Cord Compression-a Case Report
Authors: Awad Issam , Bay Janet W. , Petersen John M.
Published: May 2010

A 53-year-old man presented with complaints of back pain and weakness in his lower extremities. Physical examination demonstrated a thoracic myelopathy with a sensory level at T-4, The diagnostic work-up revealed vertebral osteomyelitis of the thoracic spine with epidural compression at T-2-T-4 causing a nearly complete block on myelography. A decompressive laminectomy and debridement were performed, followed by anterior spinal fusion. Nocardia asteroides was cultured from the epidural space. The patient was concurrently treated with sulfonamides. No underlying malignancy or immunosuppression could be demonstrated, but a primary pulmonary nocardial infection was suspected. A satisfactory recovery was accomplished. Only four other cases of nocardial osteomyelitis of the spine have been reported in the literature. These are discussed, and possible mechanisms are proposed for the pathophysiology of this rare manifestation. Current recommendations on the specimen processing, diagnosis, and therapy of nocardial infections are briefly reviewed.
Motor Evoked Potentials from Transcranial Stimulation of the Motor Cortex in Humans
Authors: Levy Walter J. , York Donald H. , McCaffrey Michael , Tanzer Fred
Published: May 2010

Electrical monitoring of the motor system offers the potential for the detection of injury, the diagnosis of disease, the evaluation of treatment, and the prediction of recovery from damage. Existing evoked potentials monitor one or another sensory modality, but no generally usable motor monitor exists. We have reported a motor evoked potential using direct stimulation of the spinal cord over the motor tracts in cats and in humans. To achieve a less invasive monitor, we used transcranial stimulation over the motor cortex in the cat, thus stimulating the motor cortex. We report here the initial application of this method to humans. A plate electrode over the motor cortex on the scalp and a second electrode on the palate direct a mild current through the motor cortex which will activate the motor pathways. This signal can be recorded over the spinal cord. It can elicit contralateral peripheral nerve and electromyographic signals in the limbs or movements when the appropriate stimulation parameters are used. In clinical use to date, this has been more reliable than the somatosensory evoked potential in predicting motor function in patients where the two tests differed. It offers a number of possibilities for the development of valuable brain and spinal cord monitoring techinques, but requires further animal studies and clinical experience. Studies to date have not demonstrated adverse effects, but evaluation is continuing.
Preliminary Report: Intracranial Cholinergic Drug Infusion in Patients with Alzheimer's Disease
Authors: Harbaugh Robert E. , Roberts David W. , Coombs Dennis W. , Saunders Richard L. , Reeder Teddi M.
Published: May 2010

After toxicity studies in dogs, a preliminary feasibility trial of the continuous intracranial infusion of a muscarinic agonist was begun in four patients with biopsy-documented Alzheimer's disease. During the last 8 months, a totally implantable infusion system has been used to deliver bethanechol chloride into the cerebrospinal fluid of these patients at doses of 0.05 to 0.7 mg/day. Complications have been few and resolved spontaneously or were easily reversible. The subjective response to this treatment has been encouraging, with reports of improved cognitive and social function during drug infusion and a return to base line function with single-blind saline placebo infusions. Obviously, further evaluation will be necessary to demonstrate the efficacy of this treatment, and a double-blind placebo-controlled crossover trial is now being done. However, we think the preliminary results are encouraging and warrant the consideration of this approach as a potential treatment in patients with Alzheimer's disease.
Extracranial Metastasis of Cerebral Glioblastoma Multiforme: Case Report
Authors: Sadik Rasul A. , Port Robert , Garfinkel Burton , Bravo Jose
Published: May 2010

A patient with glioblastoma multiforme of the right cerebral hemisphere that was treated by surgical removal followed by cobalt therapy is presented. The patient's only neurological deficit at the initial presentation had been a left homonymous hemianopsia, which remained unchanged after operation. He had maintained a good functional state for about 18 months. Then, because of low backache, he was restudied thoroughly, and a bony destructive lesion was found in the body of the 4th lumbar vertebra. A computed tomographic scan-guided biopsy of this lesion revealed a histopathological picture similar to that of the primary cerebral glioma. This metastatic glioma of the spine was treated with cobalt therapy with good clinical (i.e., pain relief) response. The case represents extracranial metastasis of cerebral glioblastoma, which is rarely seen. A brief review of the literature and of the theories concerning dissemination is presented.
Familial Osteodysplasia Associated with Trigeminal Neuralgia: Case Report
Authors: Niijima Kyo Huang , Kondo Akinori , Ishikawa Jun-ichiro , Kim Choigon , Itoh Hiraji
Published: May 2010

A 24-year-old woman suffering from left trigeminal neuralgia presented with the familial occurrence of skeletal anomalies simulating Hajdu-Cheney syndrome. She was of a short stature and had low-set ears, protrusion of the bilateral temporal and occipital bones, platybasia, basilar impression, and dental anomaly. Vertebral angiography disclosed marked displacement to the left and dorsally of the basilar artery, which was confirmed during the operation to have compressed the left trigeminal nerve in the cerebellopontine angle narrowed by the unusually protruded bony structure. Cases of Hajdu-Cheney syndrome have occasionally been reported, a few combined with facial spasm, but Hajdu-Cheney syndrome with trigeminal neuralgia is very rate. The patient's family members were surveyed. The possible cause of the neuralgia with its relation to the osteodysplasia is briefly discussed.
Massive Preoperative Pulmonary Embolism and Suprasellar Brain Tumor: Case Report and Review of the Literature
Authors: Sawaya Raymond , Decourteen-Meyers Gabriella , Copeland Bradley
Published: May 2010

A 57-year-old man presented to our facility with the diagnosis of a suprasellar mass and died on the 2nd post-admission day from a massive pulmonary embolism. At autopsy, the mass was diagnosed as craniophyarngioma. This case report and review of the literature suggest an intimate relation between brain tumors and thromboembolic complications as evidenced by the high incidence of this association, the frequent occurrence of coagulopathies in patients with brain tumors, and the prevalence of tumors in the suprasellar location. The specific mechanisms that may be at play are reviewed.
How Do Vessels Proliferate in the Capsule of a Chronic Subdural Hematoma?
Authors: Yamashima Tetsumori , Yamamoto Shinjiro
Published: May 2010

An ultrastructural study was performed to define the mechanisms of proliferation of macrocapillaries and capillaries in the capsule of chronic subdural hematoma. Mitotic activities of endothelial cells and vascular sprouts may contribute to the vascular proliferation. Platelets may also play an important role. Endothelial cells of proliferating macrocapillaries were highly attenuated except for the nuclear portion and showed variable electron densities. The adjacent endothelial cells had less intimate cellular junctions than the proliferating capillaries. The proliferating endothelial cell sometimes contacted the opposing endothelial cell across the lumen, separating the latter into two compartments. The pericytes varied remarkably in size, shape, and electron density. Proliferating capillaries had a narrowed vascular lumen and were characterized by cuboidal or thickened endothelial cells with enlarged nuclei, numerous pinocytotic vesicles, and cytoplasmic protrusions into the vascular lumen. They occasionally had intimate cellular junctions with interdigitations and slender pericytes of high electron density. Proliferating vessels occasionally had some clear endothelial cells that contained filamentous material and a few dense bodies. These cells might represent degenerated or swollen endothelial cells. However, they showed no evidence of increased permeability. Postdegranulation platelets were sometimes trapped in the endothelial linings. These data indicate that the most important factor for the development of chronic subdural hematoma exists in the vessels of the capsules, which have a marked proliferation potential and a fragile nature. The possibility of transition from proliferating capillaries to macrocapillaries is discussed.
Effectiveness of Cefotaxime in Gram-negative Meningitis
Authors: LeFrock Jack L. , Molavi Abdolghader , Smith Bruce , Black Perry , Rosenberg Manuel , Rolston Kenneth , Brodner Robert , Chandrasekar Pranatharthi , Henao Libia , Kannangara Don W.
Published: May 2010

We treated 12 adult patients who had gram-negative bacillary meningitis with cefotaxime administered intravenously at a dose of 2 g every 4 hours. The etiological organisms included Haemophilus influenzae (3 cases), Serratia marcescens (3 cases), Klebsiella pneumoniae (3 cases), Escherichia coli (2 cases), and Enterobacter (1 case). The infection followed a neurosurgical procedure in 6 cases. The mean inhibitory and bactericidal concentrations of cefotaxime for the isolates ranged from 0.125 to 0.25 ug/ml. The cerebrospinal fluid (CSF) concentrations of cefotaxime ranged from 5.0 to 15.2 ug/ml, and the CSF bactericidal titers were 1:64 to 1:128. The CSF in all patients was sterilized within 96 hours. All 12 patients recovered, and there were no relapses.
A Comparison of Pressure-Volume Models in Hydrocephalus
Authors: Simon Richard H. , Lehman Ralph A. W. , O'Connor Sean J.
Published: May 2010

Traditional descriptions of the pressure-volume properties of the craniospinal axis have expressed pressure as a function of volume. This study develops a theoretical and practical rationale for expressing volume as a function of pressure. We tested the rationale by comparing the two functions using pressure and volume data collected from 37 hydrocephalic patients during ventricular fluid removal. Two equivalent expressions were evaluated, one expressing pressure as an exponential function of volume and one relating volume as an exponential function of pressure. Each expression had three parameters, adjustable to the specific case. We used a nonlinear curve-fitting algorithm to determine the best estimate of the parameters. We could fit three-parameter exponential functions of either type to the data in all cases. We found a superior goodness-of-fit to aggregated data when expressing volume as a three-parameter exponential function of pressure changes. This finding is discussed in the context of the preferable number of parameters in a model and the interpretation of the terms in the models. This “reversed” volume-pressure relationship has importance in the development of more complicated models involving these same relationships.
Traumatic Aneurysm of the Supraclinoid Internal Carotid Artery: Report of a Case
Authors: Enomoto Hitomi , Shibata Takayuki , Ito Akio , Harada Tsutomu
Published: May 2010

A case of traumatic aneurysm of the supraclinoid internal carotid artery is presented. Formation of the aneurysm was thought to be due to a direct injury to the wall of the internal carotid artery from a basal skull fracture of the anterior cranial fossa.
Total Removal of a Falcotentorial Junction Meningioma by Biparietooccipital Craniotomy in the Sea Lion Position: A Case Report
Authors: Suzuki Mikio , Sobata Eiji , Hatanaka Mitsuaki , Suzuki Shigeharu , Iwabuchi Takashi , Makiguchi Kohichi
Published: May 2010

The successful total removal of a huge falcotentorial junction meningioma in a 59-year-old woman by biparietooccipital craniotomy with the patient in the sea lion position (prone with a hyperextended neck and with 20° elevation of the upper and lower halves of the body) is reported, with some comments on the advantages of this approach and position. Taking advantage of the exposure of the dural sinus, the confluens sinuum pressure was measured by direct catheterization with the patient in various positions. The pressure was 3.6 cm H2O in the sea lion position, 2.4 cm H2O in the reverse jackknife position (supine with 20° elevation of the upper and lower halves of the body), and - 12 cm H2O in the sitting position.
Intracranial Space-occupying Lesions in Acquired Immune Deficiency Syndrome Patients
Authors: Snow Robert B. , Lavyne Michael H.
Published: May 2010

The recent description of the acquired immune deficiency syndrome (AIDS) followed the observation of an increased incidence of unusual neoplasms and opportunistic infections in previously healthy homosexual men, intravenous drug abusers, Haitians, hemophiliacs, and certain infants. Active research efforts on this group of patients established a defect in cellular immunity. Six patients with AIDS who underwent neurosurgical procedures for intracranial space-occupying lesions are presented. Two of the patients had toxoplasmosis brain abscesses, one had primary central nervous system lymphoma, one had cytomegalovirus encephalitis, one had progressive multifocal leukoencephalopathy, and one patient remained undiagnosed despite pathological examination of the brain tissue specimen. We recommend brain biopsy in AIDS patients with space-occupying lesions because the regimen for the various conditions differs. Although the central nervous system diseases found in AIDS patients are associated with a high mortality rate, four of the six patients responded favorably to specific treatment.
External Stereotactic Irradiation by Linear Accelerator
Authors: Colombo Federico , Benedetti Antonio , Pozza Franco , Avanzo Renzo Carlo , Marchetti Cristina , Chierego Giorgio , Zanardo Agostino
Published: May 2010

Stereotactic radiotherapy has two advantages: (a) the possibility of giving high radiation doses to small but spatially well-defined target volumes and (b) the presence of a stepped dose gradient between the target volume and the surrounding healthy tissues. To utilize these advantages, the authors built a new stereotactic head frame by which the intracranial target is fixed to the rotational isocenter of a 4-MV linear accelerator. The collimator openings are selected according to the volume and the three-dimensional configuration of the target, and the radiation dose is based on the radiosensitivity of the lesion. After the patient is fixed to the frame, the radiation source and the patient are rotated so that the target is irradiated through infinite portals distributed over the convexity of the skull. It is thereby possible to obtain very high radiation doses centered into the target with a stepped dose gradient. The preliminary radiodosimetric tests and the operative technique are described. The advantages of this technique compared to interstitial radiotherapy and Leksell's radiosurgery are emphasized. This noninvasive procedure has been used to treat a series of intracranial tumors.
Chronic Subdural Hematomas: To Drain or Not to Drain?
Authors: Markwalder Thomas Marc , Seiler Rolf W.
Published: May 2010

A consecutive series of 21 adult patients with chronic subdural hematoma was studied in respect to postoperative resolution of subdural collections and clinical improvement after burr hole evacuation without subdural drainage. This series was compared to a previously studied series of patients with chronic subdural hematoma in whom postoperative closed system drainage had been installed. Using the identical protocol for treatment and postoperative follow-up, we obtained identical results with respect to time-related neurological improvement and persistence of subdural collections in the undrained and drained series, except that the steadily progressive clinical improvement during the early postoperative phase (24 hours) in all cases of the drained series was not universal in the undrained cases. Our study suggests that, to avoid the possibility of early postoperative clinical deterioration, burr hole craniostomy and closed system drainage is advisable. We think that subdural drainage is not necessary when the installation of the drainage system seems to be technically difficult, as it may be in cases with considerable perioperative cortical expansion.
Control of Spasticity by Implantable Continuous Flow Morphine Pump
Authors: Erickson D.L. , Blacklock J.B. , Michaelson M. , Sperling K.B. , Lo J.N.
Published: May 2010

Continuous flow pumps are being used for the delivery of morphine sulfate to the intrathecal and epidural spaces for control of pain. We have encountered several patients who had a combination of pain and spasticity or who had spasticity so intense that it was the source of pain. One to two milligrams of intrathecal morphine dramatically relieved their spasticity and pain. Three such patients have subsequently undergone pump implantation with prolonged control of their spasticity. This has initiated a formal clinical investigation directed at determining the physiological mechanism of this phenomenon, as well as its long term efficacy.
Giant Posttraumatic Aneurysm of the Intracranial Carotid Artery: Evolution and Regression Documented by Computed Tomography
Authors: Saleman Michael , Botero Ernesto , Bellis Edwin
Published: May 2010

Posttraumatic aneurysms of the proximal intracranial internal carotid artery are rare, A case is presented in which the evolution and regression of such an aneurysm is documented by computed tomography as well as by arteriography. The coexistence of a proximal dissection of the cervical carotid artery probably contributed to the growth of the aneurysm.
Bilateral Mycotic Aneurysms of the Intracavernous Carotid Artery
Authors: Abbassioun Kazem , Amirjamshidi Abbass , Rahmat Hamid
Published: May 2010

A rare case of bilateral intracavernous internal carotid artery aneurysms is presented. The clinical and laboratory data strongly suggested the mycotic nature of the aneurysms. Internal carotid artery ligation was performed because of clinical evidence of progressive enlargement of the right-sided aneurysm. The left-sided aneurysm was managed medically. It remained asymptomatic and, 14 months later, a control angiogram showed no significant change in its size and configuration.
Occipital Interhemispheric Acute Subdural Hematoma Treated by Lambdoid Suture Tap
Authors: Brill Charles B. , Jarath Veena , Black Perry
Published: May 2010

We present the case of a 6-week-old infant with acute subdural hematoma secondary to hemorrhagic disease of the newborn. Computed tomographic scan localization of the collection in the posterior portion of the supratentorial compartment allowed for its removal by lambdoid suture taps. The procedure is described.
Malignant Change in an Intradiploic Epidermoid: Report of a Case and Review of the Literature
Authors: Yanai Yoshimi , Tsuji Reizoh , Ohmori Shigehiro , Tatara Naoto , Kubota Satoru , Nagashima Chikao
Published: May 2010

An unusual case of intradiploic epidermoid tumor is reported. In this case, a soft mass located over the parietal bone was noted shortly after birth. The mass gradually enlarged. The tumor underwent malignant change after several excisions and repeated inflammations. The patient was successfully treated with extensive excision, radiotherapy, and chemotherapy. Compiling a summary of reported cases with a tabulation of pertinent information, we discuss the incidence, pathogenesis, prognosis, and therapy of malignant intradiploic epidermoid.
Real Time Ultrasound Diagnosis of Hemorrhagic Pathological Conditions in the Posterior Fossa of Preterm Infants
Authors: Bejar Raul , Coen Ronald W. , Ekpoudia Ikpe , James Hector E. , Gluck Louis
Published: May 2010

Real time echoencephalography (RTE) was used to diagnose and serially follow intracranial pathological conditions in the posterior fossa of infants with a gestational age of <34 weeks. The posterior fossa was studied in four planes (coronal, modified coronal, sagittal, and parasagittal) with a sector scanner equipped with a high frequency transducer that was placed on the fontanelles and the sutures. Hemorrhagic complications were easily differentiated from normal anatomy. RTE diagnosis was confirmed with computed tomographic scans (5 patients) and postmortem examination of the brain (18 infants). RTE is a precise and noninvasive technique to visualize hemorrhagic and other forms of abnormalities in the infratentorial compartment.
Microsurgical Excision of Paraventricular Arteriovenous Malformations
Authors: Hoi Sang U
Published: May 2010

Periventricular arteriovenous malformations (AVMs) have often been deemed inoperable because of their location in critical structures. Furthermore, the excision of large lesions may be complicated by the potential for serious brain swelling and hemorrhage due to “autoregulation breakthrough.” Nonetheless, the unfavorable natural history of the untreated disease in a symptomatic young patient has induced us to approach these lesions using staged microsurgical excision combined with elective barbiturate coma for maximal cerebral protection. Between 1979 and 1983, six patients (four female, aged 12 to 60 years, and 2 male, aged 14 and 29) who harbored large AVMs in the basal ganglia, thalamic, and hypothalamic areas presented with subarachnoid hemorrhage (2 cases), progressive neural deficits (3 cases), and intractable headache (1 case). Nineteen staged operations were performed for the complete excision of these lesions. Among the first three patients, there was one death due to “autoregulation breakthrough” hemorrhage into the lateral ventricle during the excision of a lesion approached through the sylvian fissure using standard anesthesia techniques. This led to the adoption of the transventricular surgical approach and elective barbiturate coma to facilitate exposure of the lesion and to protect the adjacent vital structures from potential ischemia. Three patients were treated in this fashion uneventfully. Of the five successfully treated patients, two have returned to their preoperative status and one has completely recovered from global hemispheric ischemia and hemiplegia. The hemiparesis in one patient worsened as a result of postoperative hypertensive intraventricular hemorrhage, and one patient developed mild dysphasia and hemiparesis. This experience suggests that this approach offers a valid therapeutic regimen for the treatment of this disease. During the same period, three patients-one man (age 23) and two women (aged 29 and 22)-harboring four intraventricular AVMs presented with intraventricular hemorrhage. After the acute effects of chemical ventriculitis and hydrocephalus were overcome with cerebrospinal fluid diversion, all four lesions were excised microsurgically using the transtemporal approach. One patient demonstrated significant and progressive improvement of her preoperative memory deficit. The remaining two patients have both returned to their preoperative employment. Homonymous visual defects in two patients were transient, and seizure activity developing after operation was easily controlled medically. This experience confirms that intraventricular AVMs can be excised with minimal morbidity and should be treated aggressively in the symptomatic young patient.
Developments in the Treatment and Prognosis of Multiple Cerebral Abscesses
Authors: Rousseaux Marc , Lesoin Francis , Destee Alain , Jomin Michel , Petit Henri
Published: May 2010

Multiple cerebral abscesses have been recognized with increasing frequency because of the use of computed tomography and have been the subject of various therapeutic proposals. Their prognosis has been considerably improved thanks to high does antibiotic therapy. However, diagnostic and therapeutic problems persist.
General Metabolism in Patients with Acute Paraplegia and Quadriplegia
Authors: Kaufman Howard H. , Rowlands Brian J. , Stein Debra K. , Kopaniky Dennis R. , Gildenberg Philip L.
Published: May 2010

This study measured the nutritional status of eight spine-injured patients during their first 10 to 14 days in the hospital. Initial and follow-up nutritional assessment showed that their nutritional status deteriorated at least partly due to an inadequate supply of protein and calories. Infective complications and prolonged respiratory support were common and may have been caused in part by impaired nutrition. This suggests that a prospective study of aggressive nutritional support for patients with spinal cord transection should be initiated to determine whether this acquired malnutrition and its associated complications can be prevented.
Microsurgical Removal of Suprasellar Meningiomas
Authors: Al-Mefty Ossama , Holoubi Abdulmoti , Rifai Ayman , Fox John L.
Published: May 2010

The authors report 17 cases of large suprasellar meningiomas operated on during the 2-year period from February 1982 through March 1984. The tumors ranged from 4 to 9 cm in diameter. These patients presented with severe visual loss (4 were blind) and optic atrophy or papilledema. These tumors were noteworthy in their encroachment against and around the carotid arteries and optic nerves laterally, as well as against the hypothalamus with extension into the interpeduncular cistern and frontal foss. Advanced microsurgical technique assisted in total removal of all tumor tissue with preservation of vital sturctures. There were three deaths: two from pulmonary embolism and one from gastrointestinal hemorrhage. The surgical technique for the total removal of these very large tumors is described.
Surgical Resection of a Pineal Tumor Containing Elements of Germinoma and Astrocytoma
Authors: Neuwelt Edward A. , Buchan Colin , Blank Nathan K. , Lewy Alfred J.
Published: May 2010

A 15-year-old boy presented with hydrocephalus due to a pineal tumor presumed to be a germinoma. After a shunting procedure, gross total tumor resection was carried out via an occipital transtentorial approach. Histopathological examination of the tissue demonstrated that, in addition to the expected germinoma, the tumor also contained areas of astrocytoma and areas that, taken in isolation as in a needle biopsy, could have been diagnosed as pineocytoma. The diagnosis and therapy of a pineal tumor of mixed histological types such as this lesion would be seriously compromised by “conventional” empiric radiation and even a stereotactic needle biopsy may not have provided an adequate tissue sample.
Scalp Meningioma: Case Report
Authors: Altinoörs Nur , çetin Abdullah , Pak Işin
Published: May 2010

The authors report a case of scalp meningioma. The mass was removed totally, and all of the following neuroradiological studies proved the absence of an intracranial meningioma.
Hemangiomatous Anomaly of Bone in Crouzon's Syndrome: Case Report
Authors: Alpers Charles E. , Edwards Michael S.B.
Published: May 2010

A striking and diffuse hemangiomatous architecture was identified by microscopic examination of bone specimens obtained at cranial synostectomy and from the craniofacial area of a young boy with Kleeblättschadel deformity and Crouzon's syndrome. A retrospective review of the histopathological appearance of bone specimens from other patients with Crouzon's syndrome treated on our service and a review of the literature on craniosynostosis suggest that the hemangiomatous pattern seen in this patient is rare if not unique. The unusual pathological findings provide evidence that the underlying pathophysiology of this disorder may be heterogeneous.
Microvascular Decompression in Hemifacial Spasm: Intraoperative Electrophysiological Observations
Authors: Møller Aage R. , Jannetta Peter J.
Published: May 2010

Facial muscle responses in patients with hemifacial spasm undergoing microvascular decompression operations were recorded. Two peripheral branches of the facial nerve were stimulated and the electrical responses of muscles innervated by these branches were studied to see how the lateral spread of activity that is known to be present in these patients was affected by decompressing the facial nerve. In some of the patients the hemifacial spasm ceased when the dura mater was opened, in some it ceased when the arachnoid was opened, and in others the spasm persisted until the offending vessel was dissected away from the nerve. The lateral spread of activity elicited by antidromic stimulation of a branch of the facial nerve was less affected by opening of the dura mater or arachnoid: it usually persisted until the blood vessel that had been compressing the facial nerve was removed and reappeared when the vessel that had been compressing the facial nerve was allowed to slip back onto the nerve. This seems to indicate that microvascular decompression of the facial nerve is effective in alleviating hemifacial spasm because it removes the actual cause of the disorder rather than simply causing local injury to the nerve as a result of the procedure.
Spinal Vascular Tumors: Dilemmas in Diagnosis and Management
Authors: Cawthon David F. , Cacayorin Edwin D. , Modesti Luciano M. , Lin Luke , King Robert B.
Published: May 2010

Three case reports of spinal vascular tumors illustrate the need for well-organized and thorough neuroradiological and neurosurgical planning to achieve an initial cure without delay and to avoid inadequate operative procedures.
Late Stenosis of a Superficial Temporal-Middle Cerebral Artery Bypass: Angiographic and Histological Findings
Authors: Gumerlock M.K. , Coull B.M. , Howieson J. , Buchan C. , Neuwelt E.A.
Published: May 2010

The course of a patient with an initially widely patent superficial temporal artery-middle cerebral artery (STA-MCA) bypass and an enlarged donor vessel is presented. Over 17 months, the STA became markedly stenotic. Serial angiography is correlated with autopsy histological findings showing severe atherosclerotic changes throughout the donor vessel. The potential causative factors, both medical and surgical, are discussed and the appropriate literature is reviewed. Parallels are drawn from the cardiac bypass experience. The bypass itself may have precipitated or accelerated intimal hyperplasia, which stenosed (and may have eventually occluded) the vessel. Is this phenomenon more frequent than we realize?
Bifrontal Epidural Hematoma after Transsphenoidal Operation: Report of a Case with a Rare Complication
Authors: Saitoh Youichi , Mori Shintaro , Nii Yasuo , Abekura Makoto , Arita Norio , Hayakawa Toru , Moriwaki Kaname , Mogami Heitaro
Published: May 2010

We report a patient with a growth hormone-secreting adenoma who developed bifrontal epidural hematomas after a transsphenoidal operation. To our knowledge, this is the first report of such a complication.
Arteriovenous Malformation in the Territory of the Occluded Middle Cerebral Artery with Massive Intraoperative Brain Swelling: Case Report
Authors: Aoki Nobuhiko , Mizutani Hiroshi
Published: May 2010

We present an extremely rare case of an arteriovenous malformation (AVM) in the territory of the middle cerebral artery, the main trunk of which was occluded asymptomatically. Immediately after an uneventful excision of the entire AVM, massive brain swelling occurred unexpectedly and was treated successfully with high dose barbiturate therapy associated with other standard measures of controlling increased intracranial pressure. The underlying pathophysiological mechanisms leading to the massive intraoperative brain swelling in this case are discussed.
Left Atrial Myxoma with Cerebral Emboli
Authors: Branch Charles L. , Laster D. Wayne , Kelly David L.
Published: May 2010

Infarction of the central nervous system secondary to embolism from left atrial myxoma is a recognized phenomenon. However, myxoma as the source of an embolus may be overlooked if an index of suspicion is not present during the evaluation of the patient with a stroke without a known cause. We present a case report that illustrates some of the pitfalls and characteristic findings present in the evaluation of these patients. The magnetic resonance image of multiple cerebral aneurysms and infarction associated with this condition is presented along with a unique, arteriographically proven resolution of a fusiform cerebral aneurysm after the removal of the cardiac tumor. A review of published case reports suggests that, if the cardiac tumor is recognized and treated quickly, the ultimate prognosis, while uncertain, is usually good. However, because the potential exists for recurrence of the cardiac tumor, for enlargement of the cerebral lesions, or for late development of cerebral lesions, long term follow-up is mandatory and a vigorous work-up must be pursued if the patient again becomes symptomatic or develops central nervous system manifestations for the first time.
Adult Onset of Tethered Spinal Cord Syndrome Due to Fibrous Diastematomyelia: Case Report
Authors: Chehrazi Bahram , Haldeman Scott
Published: May 2010

Adult onset of the symptoms of tethered spinal cord is a rare entity that is occasionally associated with diastematomyelia. Only one case of fibrous diastematomyelia in an adult has been reported. The fibrous nature of this disease may present a diagnostic difficulty. A 32-year-old man with the adult onset of impairment of sacral functions with lumbar fibrous diastematomyelia is reported. Surgical release of the spinal cord was followed by improvement of the patient's function.
Cerebral Etiology of Acute Mountain Sickness: A Case Report
Authors: Wohns Richard N. W. , Colpitts Michael , Clement Tom , Karuza Anton
Published: May 2010

The authors report a case of acute mountain sickness (AMS) experienced by a support member of the Ultima Thule Everest Expedition. The subject arrived at the 17,000-ft base camp by truck and then developed the symptoms of AMS over the following 72 hours. Flash-induced visual evoked responses (VERs), tetrapolar impedance pulmonary plethysmography, and oxygen saturation measurements were performed. These changed from normal before the onset of his symptoms to abnormal during the height of the symptoms and reverted to normal after treatment. This is the first reported case of AMS monitored with VERs. It has been postulated that AMS may be an early form of cerebral edema, and this report corroborates this hypothesis.
Symptomatic Rathke's Cleft Cysts Located Entirely in the Suprasellar Region: Review of Diagnosis, Management, and Pathogenesis
Authors: Barrow Daniel L. , Spector Robert H. , Takei Yoshio , Tindall George T.
Published: May 2010

Three cases of an entirely suprasellar symptomatic Rathke's cleft cyst, two of which were associated with normal sella turcicas, are reported. In all cases, the cysts caused compression of the optic chiasm, and two produced hypothalamic dysfunction. The diagnosis of these entirely suprasellar masses was enhanced by metrizamide cisternography. Two cases were treated by frontal craniotomy and one was treated transsphenoidally, with good results in all cases. The radiology, pathology, and surgical treatment of these unusual cases is presented. An embryological pathogenesis for the occurrence of an entirely suprasellar Rathke's cleft cyst is discussed.
Tuberous Sclerosis with an Atypical Radiological Skull Change: Case Report
Authors: Terada Tomoaki , Nakai Ekini , Moriwaki Hiroshi , Hayashi Seiji , Komai Norihiko
Published: May 2010

The authors describe a case of tuberous sclerosis with atypical radiological skull change in a 8-year-old Japanese child. A plain roentgenogram showed thinning and convolution of the left occipital bone, and a cortical tuber adjacent to the thinned bone was shown by computed tomography. This kind of skull change may suggest the existence of a cortical tuber in patients with tuberous sclerosis, although this finding has not been reported previously, The mechanism of this skull change is discussed.
Ruptured Intracranial Aneurysms in Cases of Sickle Cell Anemia
Authors: Love Lucy C. , Mickle Parker J. , Sypert George W.
Published: May 2010

The authors present two cases of ruptured cerebral aneurysms in patients with sickle cell anemia. Only three previous cases with similar presentations have been reported. The various complications of sickle cell anemia and ruptured aneurysms are reviewed. The importance of early aggressive adjunctive medical management, including the use of partial exchange transfusions and surgical intervention, is emphasized.
Metastasis of an Occult Gastric Carcinoma Suggesting Growth of a Prolactinoma during Bromocriptine Therapy: A Case Report with a Review of the Literature
Authors: van Seters Arnoud P. , Bots Gerard T.A.M. , van Dulken Hans , Luyendijk Willem , Vielvoye Jan G.
Published: May 2010

The treatment of a slowly growing invasive prolactinoma with bromocriptine for 8 months resulted in a substantial decrease in plasma prolactin levels despite rapid suprasellar tumor expansion. On exploration, this uncommon observation could be attributed to hematogenous metastasis from an occult gastric adenocarcinoma to the pituitary tumor. Apart from infiltration of neighboring parts of the hypothalamus, autopsy revealed no other hematogenous metastases. This extraordinary type of neoplasm-to-neoplasm metastasis was not shown by computed tomography. This possibility should be considered whenever progressive growth of a pituitary mass is accompanied by a decrease in hormonal overproduction.
Bifrontal Osteoplastic Craniotomy Utilizing the Anterior Wall of the Frontal Sinus: Technical Note
Authors: Colohan A.R.T. , Jane J.A. , Park T.S. , Persing J.A.
Published: May 2010

There are various flaps for bifrontal exposure of the anterior fossa classically described in the neurosurgical literature. This article describes a bifrontal split osteoplastic flap that is characterized by removal of the anterior wall of the frontal sinus without the placement of burr holes on the external surface of the frontal bone. The procedure is safe and rapid, gives the same exposure as other techniques, and allows a superior cosmetic result.
Aneurysms of the Distal Posterior Inferior Cerebellar Artery: Experience with Three Cases and Review of the Literature
Authors: Nishizaki Tomoyuki , Tamaki Norihiko , Nishida Yoshimitsu , Fujita Katsuzo , Matsumoto Satoshi
Published: May 2010

We report 3 surgically treated aneurysms of the distal posterior inferior cerebellar artery (PICA) and review 36 cases in the literature. More than half of the distal PICA aneurysms arose distal to the choroidal arch. These lesions often arose at a turning point (i.e., a hairpin curve) of an artery instead of at a junction of vessels. Distal PICA aneurysms are likely to be missed and it is necessary to investigate carefully with four-vessel angiography even if computed tomography is done. Eighty-two per cent of the surgically treated 39 patients had good recoveries and 8% had fair results. The mortality rate was 10%. Although clipping of the aneurysm neck is preferable, trapping is useful when neck clipping is impossible in segments distal to the choroidal arch.
Synovial Cyst of a Cervical Facet Joint: Case Report
Authors: Cartwright Mont J. , Nehls Daniel G. , Carrion Carlos A. , Spetzler Robert F.
Published: May 2010

Intraspinal synovial cysts are rare. Those reported have occurred in the lumbar region. We report a case of an extradural true synovial cyst of the cevical spine causing spastic paraparesis. The cyst occurred after a cervical spine fracture and, hence, was probably related to trauma. Surgical therapy resulted in a satisfactory recovery.
Posttraumatic Meningioma
Authors: Schiffer J. , Avidan D. , Rapp A.
Published: May 2010

This report concerns three patients with intracranial meningioma developing at the site of an old head injury with skull fracture. These cases, along with literature reports, suggest a causal relationship between head trauma and the subsequent development of meningioma.
Multiple Intracranial Arteriovenous Malformations: Case Report
Authors: Zellem Ronald T. , Buchheit William A.
Published: May 2010

The authors describe a case of multiple supratentorial intracranial arteriovenous malformations in a patient with a family history of cerebrovascular disease. There was no sign of any other vascular dysplasia. A brief review of this rare entity is given. (Neurosurgery 17:88-93, 1985)
Use of Acrylic in Anterior Cervical Discectomy: Technical Note
Authors: Alemo-Hammad Saeid
Published: May 2010

Acrylic was inserted into the intervertebral space after anterior cervical discectomy in five patients. The application of the acrylic was simple and quick to perform and atraumatic to the patient. The intervertebral space was preserved satisfactorily and consistently in all five patients. With this technique, the complications associated with bone grafts can be avoided. (Neurosurgery 17:94-96, 1985)
The Chymopapain Clinical Trials
Authors: Haines Stephen J.
Published: May 2010

The three published randomized clinical trials of chymopapain injection vs. placebo injection for the treatment of herniated lumbar discs are reviewed. Despite some differences, the similarities in selection criteria, technique, and outcome assessment are great enough to justify pooling the results to obtain an overall assessment of chymopapain efficacy. These pooled results suggest that the odds of successful outcome (at least some improvement in symptoms after injection) are 2.6 times as great with chymopapain injection as those after placebo injection. This corresponds to a 50% greater probability of success with chymopapain than with placebo or a 23% increase in the number of patients successfully treated with chemonucleolysis over those successfully treated with placebo. The fact that data from 234 patients evaluated in randomized clinical trials could resolve a controversy over therapeutic efficacy that the uncontrolled evaluation of over 20,000 patients could not answer suggests that the current controversy over the relative efficacy of chymopapain and discectomy should be studied in the same way. The difficulties of such a study are discussed. (Neurosurgery 17:107-110, 1985)
Moyamoya-like Diseases Associated with Ventricular Hemorrhages: Report of Three Cases
Authors: Sato Masaharu , Kohama Akitsugu , Fukuda Atsuhiro , Tanaka Shigeru , Fukunaga Masao , Morita Rikushi
Published: May 2010

Three rare cases of moyamoya-like diseases with moyamoya type vessels caused by spontaneous internal carotid artery occlusion, spontaneous middle cerebral artery occlusion, and internal carotid artery occlusion due to cervical irradiation are presented. They resulted in ventricular hemorrhages. One patient died and two survived. Postoperatively, the collateral circulation of the survivors was evaluated by single photon emission tomography using N-isopropyl-[123I]-p-iodoamphetamine. The effectiveness of reconstructive surgery is shown, and moyamoya-like diseases that have been reported are reviewed.
Complications of Cerebral Revascularization with Autogenous Vein Grafts
Authors: Diaz Fernando G. , Pearce Jeffrey , Ausman James I.
Published: May 2010

Autogenous veins were used for cerebral revascularization 29 times. There were 17 long grafts to the cortex and 12 shorter grafts for reconstruction of cervical vessels. Of the long cortical grafts, 5 occluded and 3 patients developed intracerebral hemorrhage. With the shorter grafts, all remained patent and there were no hemorrhagic complications. A combination of a relatively low flow rate and endothelial damage in the graft was thought to be largely responsible for early graft failure. Revascularization of an infarct and hypertension were implicated in cases with intracerebral hemorrhage.