bluuebunny/crossref_metadata_2025 huggingface dataset:
Modification of focal cerebral ischemia by prostacyclin and indomethacin
Authors: Awad Issam , Little John R. , Lucas Fred , Skrinska Victor , Slugg Robert , Lesser Ronald P.
Published: May 2009

✓ The object of this investigation was to study the effects of prostacyclin (PGI2), with and without indomethacin, upon the evolution of cerebral infarction in the cat. Thirty-five fasted adult cats, lightly anesthetized with nitrous oxide, underwent right middle cerebral artery (MCA) occlusion. Eleven cats received an intracarotid infusion of 10 mg/ml PGI2 in buffered saline, pH 10.5, at a rate of 0.01 ml/kg/min (100 ng/kg/min), 10 cats received the same infusion plus a single dose of intravenous indomethacin (4 mg/kg) in buffered saline, and 11 cats received intracarotid buffered saline, pH 10.5, at a rate of 0.01 ml/kg/min, without therapeutic agents. Treatment with PGI2 was started upon MCA occlusion and continued for 6 hours, whereas indomethacin was given immediately prior to occlusion. Thirty minutes before perfusion, the animals were given fluorescein and Evans blue by intravenous injection. The cats were perfusion-fixed in vivo with carbon and buffered formalin 6 hours after MCA occlusion. Another five cats received tritium-labeled PGI2, and peripheral venous samples were collected and assayed for PGI2 and its alpha-keto metabolite. Mean arterial pressure was stable in treated animals during 6 hours of MCA occlusion, while untreated cats had significant (α = 0.05) progressive hypertension during that period. The regional cerebral blood flow (rCBF), measured by the intracarotid xenon-133 clearance method, decreased markedly in all animals immediately upon MCA occlusion. Untreated animals had a significant progressive improvement in rCBF during the occlusion period (α = 0.005), while treated animals had no such improvement. Quantitative electroencephalographic changes, gross edema, areas of fluorescein extravasation, and microscopic morphology (edema and infarct size) were not significantly different in the three groups. Prostacyclin appeared to reduce the extravasation of Evans blue dye. Systemic PGI2 levels were significant despite intracarotid administration. The authors conclude that 1) intracarotid PGI2 has a protective effect against the breakdown of the blood-brain barrier to protein-bound dyes seen in ischemic edema; 2) the systemic hemodynamic influence of PGI2, in the presence of impaired autoregulation, may compromise rCBF in the ischemic zone and offset any direct beneficial effects; and 3) indomethacin fails to modify the effects of PGI2.
Effects of naloxone on systemic and cerebral responses to experimental concussive brain injury in cats
Authors: Hayes Ronald L. , Galinat Brian J. , Kulkarne Pramod , Becker Donald P.
Published: May 2009

✓ This study examined the effects of bolus injections of naloxone hydrochloride, a specific narcotic antagonist, on systemic cardiovascular function, intracranial and cerebral perfusion pressures, blood gas status, and cortical encephalograms (EEG's) in 38 cats after two different grades of experimental brain injury. Naloxone had no prolonged effects on uninjured control animals. However, as compared to a saline-injected control group, naloxone significantly reversed the hypotension and reduction in pulse pressure seen after higher grades of injury. These changes persisted for at least 60 minutes after injection and were accompanied by increased intracranial and perfusion pressures. More severely injured hypotensive cats injected with naloxone also had higher values of arterial pO2 and pH, lower pCO2, as well as higher EEG amplitudes. In less severely injured normotensive cats, naloxone produced greater effects on cardiovascular variables and intracranial pressure when injected 15 minutes rather than 45 minutes after injury. These data suggest that endogenous opiates may contribute to some instances of hypotension seen after concussive brain injury. Levels of endogenous opiates may also increase transiently even with lesser degrees of injury not associated with hypotension. The possible clinical application of narcotic antagonists to the treatment of head injury is discussed.
Suprasellar epithelial cyst
Authors: Palma Lucio , Celli Paolo
Published: May 2009

✓ This case report describes an epithelial cyst lying above the diaphragma sellae and causing hypopituitarism and chiasmal compression in a 17-year-old girl. The epithelial lining of the cyst showed similarities with enteric epithelium rather than with “classic” Rathke's cleft. The problem of the true origin of Rathke's cleft, and of cysts so labeled, and the possible role played by neuroepithelium are discussed briefly.
Metastasis of prostatic carcinoma to intracranial meningioma
Authors: Bernstein Ronald A. , Grumet Kenneth A. , Wetzel Nicholas
Published: May 2009

✓ A surgically treated metastasis of a prostatic adenocarcinoma to an intracranial meningioma is reported. Literature review and discussion of such rare occurrences are presented.
Ectopic meningioma of a finger
Authors: Daugaard Søren
Published: May 2009

✓ A case of an ectopic meningioma in a 67-year-old woman is presented. The tumor was located subcutaneously on the little finger of her right hand. Microscopic examination revealed a typical psammomatous meningioma with no signs of malignancy. The location of this tumor is most unusual, and theories regarding its histogenesis are briefly discussed. A neuroectodermal origin is suggested.
Elastic tissue dysplasia of coiled internal carotid artery in an adult
Authors: Albanese Vincenzo , Spadaro Antonio , Iannotti Fausto , Picozzi Piero , Tomasello Francesco , Cioffi Fernando Antonio
Published: May 2009

✓ The authors describe a patient in whom a segment of the internal carotid artery (ICA) was coiled. The segment was excised and examined by light microscopy, and transmission and scanning electron microscopy. The elastic tissue in the tunica media of the coiled portion of the artery was absent or greatly reduced and showed no laminar structure. The elastic tissue dysplasia supports the congenital origin of coiling of the ICA.
Rehabilitation of the neurologically disabled patient: principles, practice, and scientific basis
Authors: Perry Jacquelin
Published: May 2009

✓ Rehabilitation is a therapeutic program specifically directed toward restoring the optimum level of function available to patients with severe permanent disabilities. It complements standard care, which focuses on curing the primary pathology. Preventive rehabilitation is designed to minimize the complications of inactivity that tend to develop during a protracted curative process (contractures, pressure sores, muscle atrophy, cardiopulmonary deconditioning, cognitive dulling). Comprehensive rehabilitation focuses on the restoration of function. It encompasses physical reconditioning, teaching new ways to accomplish the basic tasks of locomotion, object handling, personal care, relationships with family and society, employment, and recreation. The rehabilitation program is largely designed and provided by a team of allied health professionals, each an expert in one area of function. Reverting to a less dominant role, the physician provides leadership by defining the stress (activity) tolerance of the patient's pathology, coordinates the team, and manages intercurrent problems that arise. Comprehensive rehabilitation is an in-hospital program. Less intense elements can be provided in a skilled nursing facility, out-patient clinic, or the patient's home.

The details of the rehabilitation process vary with the nature of the patient's primary pathology. These have been illustrated in this review of the programs for two very diverse situations. Spinal cord injury introduces varying levels of physical incapacitation. Conversely, brain injury primarily creates a cognitive and behavioral deficit. Both are complex problems requiring comprehensive rehabilitation if the impairment is severe.
Direct microsurgical repair of intracavernous vascular lesions
Authors: Dolenc Vinko
Published: May 2009

✓ Three patients with aneurysms of the internal carotid artery (ICA) situated in the cavernous sinus (CS), and four patients with traumatic carotid-cavernous fistulas (CCF's) were treated by direct surgical approach. Two aneurysms were clipped, whereas the third (a giant aneurysm) was resected and the wall of the ICA reconstructed using interrupted sutures. In two CCF's, the shunt was excluded during reconstruction of the ICA wall by suturing. In the remaining two patients with CCF's, the shunt was excluded by clipping. The CS was attacked directly using a combination of three different techniques: the pterional, the subtemporal, and the petrosal approach. The ICA in its whole course through the CS, as well as the third through the sixth cranial nerves, were exposed. No special measures, such as hypotension, hypothermia, extracorporeal circulation and cardiac arrest, or dehydration, were taken during surgery. The aim of the direct approach to the CS was to exclude the aneurysm and/or the CCF and preserve the ICA patency. In all seven cases operated on, the lesions were excluded without inflicting any additional damage to the third through sixth cranial nerves, and in five cases carotid patency was preserved.
Long-term evaluation of ultra-early operation for hypertensive intracerebral hemorrhage in 100 cases
Authors: Kaneko Mitsuo , Tanaka Keisei , Shimada Tsutomu , Sato Kengo , Uemura Kenichi
Published: May 2009

✓ In the past 10 years, the authors performed microsurgical evacuation of hypertensive intracerebral hematoma in 100 cases during the ultra-early stage (within 7 hours) after the apoplectic attack. Operative indications were the presence of obvious hemiplegia and disturbed consciousness (from stupor to semicoma). Functional outcomes at 6 months postoperatively were as follows: 15 patients had returned to a full social life, 35 were capable of self-care at home, 33 required partial care at home, two were bedridden and in a vegetative state, and seven had died.
Regional blood-to-tissue transport in RT-9 brain tumors
Authors: Molnar Peter , Blasberg Ronald G. , Horowitz Marc , Smith Barry , Fenstermacher Joseph
Published: May 2009

✓ Regional blood-to-tissue transport, expressed as a unidirectional transfer rate constant (K), was measured in experimental RT-9 brain tumors using 14C-alpha-aminoisobutyric acid (AIB) and quantitative autoradiographic techniques. The magnitude of K depends on the permeability, surface area, and blood flow of the tissue capillaries. The transfer rate constant was variable within tumor tissue (range 0.001 to 0.178 ml/gm/min) and depended on tumor size, location (intraparenchymal, meningeal, or choroid plexus associated), and to a lesser extent on necrosis and cyst formation. Brain adjacent to tumor had higher K values, particularly around larger tumors (0.004 to 0.014 ml/gm/min), than corresponding brain regions in the contralateral hemisphere (0.001 to 0.002 ml/gm/min). Estimates of the fractional extraction of AIB by intraparenchymal tumors were between 0.008 and 0.4 ml/gm/min. Values of fractional extraction in this range indicate that tumor capillaries are not freely permeable to this solute. The values of K measured with AIB in this study, for the most part, approximate the permeability-surface area product of tumor and brain capillaries. The experimental data suggest that the permeability-surface area characteristics of the microvasculature in small RT-9 tumors are similar to those of the host tissue, whereas the microvasculature of larger RT-9 tumors is influenced more by intrinsic tumor factors.
Cortical somatosensory evoked potentials in response to hand stimulation
Authors: Lueders Hans , Lesser Ronald Peter , Hahn Joseph , Dinner Dudley S. , Klem George
Published: May 2009

✓ Somatosensory evoked potentials were recorded from chronically implanted subdural electrodes in six patients with intractable seizures. The following conclusions were reached: 1) The initial cortical negativity-positivity (N1 with a latency of about 20 msec and P2 with a latency of about 24 msec) recorded in the postcentral area was an expression of the classical primary surface positivity, but N1 was generated by the posterior pole of an early horizontal dipole in area 3b, and P2 was generated by the positive pole of a slightly delayed vertical dipole in area 1 and 2. 2) P2 permitted the most accurate localization of the primary somatosensory area. 3) No potentials were elicited in the primary somatosensory area by stimulation of the ipsilateral hand. 4) No cortical potentials were seen at stimulation intensities below the sensory threshold. The cortical distribution of evoked potentials evoked by weak and strong intensities had significantly different distribution. 5) The recovery function of cortical evoked potentials showed a U-curve with an early period of facilitation (10 to 30 msec) followed by a prolonged period of subnormality which peaked at about 50 msec. The recovery curve at different cortical loci differed.
Brain abscess in congenital cyanotic heart disease
Authors: Kagawa Mizuo , Takeshita Mikihiko , Yatō Seiji , Kitamura Kōiti
Published: May 2009

✓ Sixty-two cases of brain abscess with congenital cyanotic heart disease are reviewed. A sharp peak in the age distribution was seen at 4 to 7 years of age. Of 62 cases, 38 (61.2%) had a tetralogy of Fallot, and six had a transposition of the great vessels. The majority of these abscesses were supratentorial and 76% of abscesses were found in the frontal, temporal, and parietal lobes. Multiple abscesses were present in 19.4% of cases. Sterile cultures were obtained in 61% of the abscesses, and the increasing percentage of sterile cultures seems to be the result of broad-spectrum antibiotic therapy. The overall mortality rate was 37% but there were no deaths after surgical excision secondary to aspiration. Since the introduction of computerized tomography, aspiration without total excision has produced good results, and therefore it is believed that the number of cases which are cured with aspiration therapy alone will gradually increase in the future.
Leptomeningeal angiomatosis and aplasia congenita of the scalp
Authors: Pozzati Eugenio , Padovani Roberto , Frank Franco , Gaist Giulio
Published: May 2009

✓ This 9-year-old boy had two circular areas of aplasia congenita of the scalp in the territory of the first division of the trigeminal nerve and an ipsilateral parieto-occipital leptomeningeal capillary venous angioma. He had an associated giant aneurysm of the distal posterior cerebral artery on the same side as the vascular malformation. The patient had a long history of seizures and presented with intracerebral bleeding. This case may be considered as a variant of Sturge-Weber syndrome. Further observations must be added to consider this entity as a separate neurocutaneous disease.
Anomalous branch of the internal carotid artery supplying circulation of the anterior cerebral artery
Authors: Fujimoto Shunichiro , Murakami Masao
Published: May 2009

✓ Angiographic and operative investigations revealed an anomalous branch of the internal carotid artery (ICA) in a patient with an anterior communicating artery (ACoA) aneurysm. The anomalous vessel originated from the right ICA at the level of the ophthalmic artery, and pursued an infraoptic and prechiasmatic path to supply both pericallosal arteries. The clinical features and possible genesis of this anomaly are discussed. This irregularity is frequently associated with intracranial aneurysms, especially those of the ACoA, and with other anomalies.
Occurrence of meningioma 36 years after treatment for craniopharyngioma without radiation therapy
Authors: Arienta Cesare
Published: May 2009

✓ A meningioma occurred 36 years after surgical removal of a craniopharyngioma. No radiation therapy was instituted after the initial surgery.
Lumbosacral radiculopathy secondary to abdominal aortic aneurysms
Authors: Wilberger James E.
Published: May 2009

✓ Focal neurological deficits as the initial manifestation of expanding or ruptured abdominal aortic aneurysms are uncommon. When such a situation does occur, the femoral nerve is most often involved due to retroperitoneal or iliopsoas hematoma. Three cases of typical lumbosacral radiculopathy caused by an abdominal aortic aneurysm are reported to emphasize the importance of considering this diagnosis in the older patient with leg pain and radiculopathic findings.
Ruptured cerebral aneurysms: early and late prognosis with surgical treatment
Authors: Shephard Reginald H.
Published: May 2009

✓ An account is given of a personal prospective series of 815 patients with the syndrome of spontaneous subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm. It concerns all aneurysm patients at risk, both surgical and nonsurgical cases, referred to the author during two main periods: 606 patients were treated during the earlier period of 15 years, and 209 in the subsequent 7 years.

The early mortality rate was determined at 3 months, and all survivors in the first period were followed for a mean of 9 years. Only operation survivors were observed during the second period, for 3 years on average. Patients alive at 3 months were studied in detail with respect to disabilities, work capacity, and later mortality.

Of the 815 patients, 613, or 75%, were operated on. Comment is made on the influence of certain factors on early mortality. These include age, hypertension, condition of the patient at admission, and number of hemorrhages. From the results of this series, it is suggested that the preferable time to operate is between the 2nd and the 4th day after a single SAH. In this period, the early mortality rate is in the order of 10%. In this subgroup, a high proportion of the patients were in Botterell Grades 1 and 2, with only a few being in Grade 3. Also evident from the results was the protective value of operation against further aneurysm rupture in the 501 patients surviving at 3 months. However, the propensity of a second aneurysm to rupture in patients with multiple aneurysms has resulted recently in a change of operation policy.

The early mortality in the whole series and later mortality in patients surviving 3 months is shown in tabular and histogram form. From these, it is clear the majority of later deaths are from causes unrelated to aneurysm rupture.
Xenon-enhanced CT CBF measurements in cerebral AVM's before and after excision
Authors: Okabe Takashi , Meyer John S. , Okayasu Hiroyuki , Harper Richard , Rose James , Grossman Robert G. , Centeno Ricardo , Tachibana Hisao , Lee Ya Yen
Published: May 2009

✓ Unlike neurological deficits resulting from intracranial hemorrhage in patients with cerebral arteriovenous malformation (AVM), which have well defined etiology, the pathogenesis and treatment of progressive and/or fluctuating non-hemorrhagic neurological and psychological deficits require clarification. Values for local cerebral blood flow (LCBF) and local partition coefficients (Lγ) were measured by the method using stable xenon (Xe)-computerized tomography (CT-CBF) scanning, and were compared to 133Xe inhalation values using external probes in 16 patients with cerebral AVM's. Values were measured by both methods before and after total excision of AVM's in five cases. Neurological and mental status assessments were compared with LCBF results. Clinical improvement was most evident after total excision of AVM's. Other procedures, such as clipping of vessels, partial excision, and ventriculoperitoneal shunting for hydrocephalus, were associated with frequent complications. Embolization carried risks of cerebral infarction and was not efficacious unless combined with excision. Medical treatment resulted in poor or unsuccessful seizure control, with neurological deterioration despite anticonvulsant therapy. Compared with age-matched normal individuals, LCBF values in patients with AVM's were significantly reduced, particularly adjacent to the AVM's. Mean Lγ values for gray and white matter were normal. After excision, LCBF values in gray and white matter increased significantly up to normal. Due to overestimation of CBF by shunt flow with the 133Xe method of measurement, no correlation was found with results of the CT-CBF method before AVM excision, but significant correlation of the two methods resulted after excision. If accurate LCBF values are obtained by high resolution, direct measurement of tracer clearance from brain tissue, progressive and/or fluctuating neuropsychological deficits correlate with the degree of cerebral steal.
The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses
Authors: Sundt Thoralf M. , Piepgras David G.
Published: May 2009

✓ Arteriovenous malformations (AVM's) of lateral and sigmoid sinuses are acquired lesions evolving from a previously thrombosed dural sinus. Their natural history is usually that of gradual progression and hence surgery is frequently necessary. The preferred surgical treatment is complete excision coupled with packing of the sigmoid sinus. The operative approach is illustrated and discussed in detail. Results and complications are reviewed in 27 patients whose symptomatology had progressed under conservative management; 22 of these cases harbored primary lesions and five had recurrences. There were 22 excellent, one good, and two poor results (both of the latter from blindness that preceded surgery). There were two deaths, both in patients previously operated on with incomplete removal or obliteration of the AVM by attempted embolization.
Ocular pneumoplethysmography in carotid-cavernous sinus fistulas
Authors: Gee William , Morrow Robert A. , Stephens Harry W. , Lin Frank Z.
Published: May 2009

✓ Pulsatile exophthalmos in association with carotid-cavernous sinus fistulas has been well defined anatomically, by angiography. This paper presents the physiological assessment of this entity, as measured with ocular pneumoplethysmography (OPG-Gee). The abnormal arteriovenous communication lowers resistance to arterial flow. This is characterized by a lowered ophthalmic systolic pressure and an increased ocular blood flow. The OPG readily documents the physiological result of therapeutic intervention.
Ocular pneumoplethysmography in head-injured patients
Authors: Gee William , Rhodes Michael , Denstman Frederick J. , Jaeger Robert M. , Tilly David A. , Stephens Harry W. , Morrow Robert A. , Lin Frank Z.
Published: May 2009

✓ Severe head injury is frequently associated with multiple trauma. In the comatose patient, endotracheal intubation and ventilator support are often required, if there is associated dyssynchronous spontaneous effort. The latter is managed with therapeutic (drug) paralysis. An elaborate life-support and monitoring system coupled with controlled paralysis limits the mobility of the patient for diagnostic procedures, and a continuing reevaluation of neurological status is difficult. Under these circumstances the ocular pneumoplethysmograph provides a simple rapid noninvasive assessment of ocular blood flow, and this reflects cerebral blood flow and alterations in brain compliance. Alterations in the therapeutic regimen can be based on these observations.
Spinal metastases with neurological manifestations
Authors: Constans Jean Paul , de Divitiis Enrico , Donzelli Renato , Spaziante Renato , Meder Jean Francois , Haye Christine
Published: May 2009

✓ The authors have studied 600 cases of spinal metastasis causing a neurological syndrome. The most significant statistical data are reviewed. The cases are examined according to clinical characteristics, type of primary tumor, site of lesion, and survival. Each of these factors influenced the choice and results of treatment. As a general rule, combined treatment (surgery and radiotherapy) was used. Preliminary surgery was performed as an emergency, designed to halt progression of the neurological syndrome and to prevent its more serious manifestations. The technique and usefulness of surgery are discussed for different situations and the short-term results of treatment are related to the various factors involved.
Syndrome of the incidental herniated lumbar disc
Authors: Wilberger James E. , Pang Dachling
Published: May 2009

✓ Lumbar myelographic defects consistent with herniated disc were found in 108 asymptomatic patients undergoing myelography for other reasons. Within 3 years, 64% of these patients developed symptoms of lumbosacral radiculopathy. The clinical features of these patients comprise a syndrome significantly different from that typically associated with classical lumbar disc herniation: the syndrome described here carries a much higher incidence of silent root compression with minimal pain. Incidental lumbar myelographic defects are not necessarily benign findings, and patients in whom they are encountered deserve close clinical follow-up review and appropriate treatment if the defects become symptomatic.
Disseminated intravascular coagulation as a complication of ruptured intracranial aneurysms
Authors: Spallone Aldo , Mariani Guglielmo , Rosa Giovanni , Corrao Diana
Published: May 2009

✓ Two patients with recently ruptured intracranial aneurysms underwent surgical repair of these vascular lesions. Postoperatively, they showed clinical and laboratory evidence of disseminated intravascular coagulation (DIC). In both patients severe cerebral ischemic complications occurred. In one case the ischemic complications and the hematological changes were successfully reversed. This syndrome is a potential complication of aneurysmal subarachnoid hemorrhage (SAH), which requires prompt diagnosis and appropriate management. The relationship between hematological changes suggesting DIC and the ischemic complications of SAH should be extensively investigated.
Cerebral chromoblastomycosis complicated by meningitis and multiple fungal aneurysms after resection of a granuloma
Authors: Shimosaka Shinichi , Waga Shiro
Published: May 2009

✓ Cerebral chromoblastomycosis is a rare intracranial lesion. This lesion was found in a 23-year-old man, who presented with right proptosis and fainting attacks. Computerized tomography revealed a moderately enhanced irregular mass in the right frontal region. Angiography disclosed that the mass was avascular. At surgery, a hard elastic avascular tumor was totally removed piecemeal. Histological diagnosis was a granuloma of fungal origin. Characteristic brown pigments in the hyphae of fungus in the granuloma strongly suggested that the fungus was chromoblastomycosis. The postoperative course was complicated by meningitis and rupture of fungal aneurysms. The patient remained vegetative and died 2½ years later. The literature on such fungal aneurysms is briefly reviewed; no previous case of fungal aneurysms associated with cerebral chromoblastomycosis could be found.
Percutaneous transluminal carotid angioplasty in fibromuscular dysplasia
Authors: Dublin Arthur B. , Baltaxe Harold A. , Cobb Cully A.
Published: May 2009

✓ A patient with fibromuscular dysplasia (FMD) of the internal carotid artery was treated by balloon percutaneous transluminal angioplasty (PTA). This is the sixth reported case of FMD stenotic disease which was dilated by PTA. All previous cases including the current example were treated successfully with resolution of symptoms. This procedure is associated with a relatively low morbidity and is an alternative method of treatment to operative endarterectomy for this disorder.
Congenital hydrocephalus due to villous hypertrophy of the telencephalic choroid plexuses
Authors: Welch Keasley , Strand Roy , Bresnan Michael , Cavazzuti Valeria
Published: May 2009

✓ A case of villous hypertrophy or bilateral papilloma of the choroid plexus of the lateral ventricles is reported. The child exhibited known features associated with overproduction of cerebrospinal fluid, hydrocephalus that was difficult to control, ascites after ventriculoperitoneal shunting, and relief after surgical removal of the papillomatous tissue. A unique feature is the complexity of the telencephalic choroid plexuses as shown by computerized tomography and ultrasound in the newborn period.
Transsphenoidal microsurgical management of Cushing's disease
Authors: Boggan James E. , Tyrrell J. Blake , Wilson Charles B.
Published: May 2009

✓ The development of transsphenoidal microsurgery and the refinement of endocrinological and radiological diagnostic procedures have afforded therapeutic options appropriate to the individual case in patients with hypercortisolism. The present series of 100 cases is derived from 104 patients with the diagnosis of Cushing's disease who underwent transsphenoidal pituitary exploration between 1974 and 1981. Excluding four patients in whom the pituitary gland was not exposed because of intraoperative technical difficulties, an overall cure rate of 78% was achieved. Among 71 patients with tumors confined to the sella turcica, 87% had correction of their hypercortisolism, 11% represented therapeutic failures, and one patient had tumor recurrence. In contrast, among 25 patients with extrasellar extension, correction of hypercortisolism was achieved in only 48%, 40% failed to respond, and 12% of the patients had recurrence. Four patients who failed to respond to total hypophysectomy have ectopic sources of adenocorticotropic hormone.

The results indicate that transsphenoidal microsurgical exploration for a basophilic adenoma is the procedure of choice in adults and children with Cushing's disease. The diagnostic and surgical approach to these tumors, as well as pitfalls in the transsphenoidal treatment of Cushing's disease, are discussed.
Correlation between angiographic vasospasm, hematoma, and ischemic brain damage following SAH
Authors: Graham David I. , Macpherson Peter , Pitts Lawrence H.
Published: May 2009

✓ The correlation between angiographic vasospasm, hematoma, and ischemic brain damage was studied in 29 patients who died as a result of subarachnoid hemorrhage following rupture of a saccular aneurysm. None of these patients was treated surgically. A comprehensive neuropathological examination was undertaken in each case. A significant relationship between the presence and degree of vasospasm and ischemic brain damage was found. Furthermore, even though intracerebral hematoma probably increased the risk of infarction associated with vasospasm, hematoma per se did not increase the incidence of ischemic brain damage.
Failure of naloxone to affect focal incomplete cerebral ischemia and collateral blood flow in cats
Authors: Hubbard Jerry L. , Sundt Thoralf M.
Published: May 2009

✓ Focal incomplete cerebral ischemia was created in 20 adult cats by retro-orbital middle cerebral artery (MCA) occlusion under halothane anesthesia. Arterial blood gas, cerebral blood flow (CBF), bilateral electroen-cephalographic (EEG) recordings, and systemic arterial blood pressure (SABP) were monitored for the 1st hour of occlusion. Ten animals were treated with 10 mg/kg of naloxone within 10 minutes of MCA clipping, followed by a continuous infusion of naloxone at 2 mg/kg/hr for the duration of the occlusion (8 hours). Ten animals were treated in a similar fashion with physiological saline (control). Blood flow was restored after 8 hours. The brains were examined at the time of death or 7 days after the occlusion period. There was no difference between the two groups regarding cerebral infarction size or distribution, neurological outcome, SABP, PaCO2, or CBF. Minor changes in EEG amplitude observed in the naloxone-treated group appear to represent interaction of the drug with halothane after prolonged administration. The authors conclude that naloxone did not modify the outcome of focal cerebral ischemia in the cat.
Anterior cervical discectomy with and without fusion
Authors: Rosenørn Jarl , Hansen Elisabeth Bech , Rosenørn Mary-Ann
Published: May 2009

✓ A prospective randomized study to compare discectomy without (DE) and with fusion (DEF) included 63 patients operated on for cervical herniated disc. The clinical outcome 3 and 12 months postoperatively was significantly better after DE than after DEF (p < 0.05). Significantly more patients operated on with DE returned to work during the first 9 weeks postoperatively than patients operated on with DEF (p < 0.005 to 0.05). The prognosis is significantly better for men than for women after DEF (p < 0.005), while no difference can be shown after DE.
A reproducible spinal cord injury model in the cat
Authors: Ford Ronald W. J.
Published: May 2009

✓ Allen's weight-drop method for producing experimental spinal cord injuries was improved by placing a curved stainless steel plate anterior to the spinal cord to provide a smooth, hard surface for the receipt of posterior cord impact. In addition, an electronic circuit was used to ensure that cord injury was produced by a single impact, thereby enhancing the reproducibility of the injury mechanism. Using a spinal cord injury model with these modifications, the author found that the recovery of hindlimb function and the histopathological appearance of the injured cord 6 weeks after upper lumbar injury were closely related to injury magnitude. The curve of functional recovery versus injury magnitude has a sharp transition centered at 10 gm × 15 cm, and indicates that an injury of 10 gm × 20 cm produces a “threshold” lesion suitable for the future evaluation of spinal cord treatment methods.
The National Traumatic Coma Data Bank
Authors: Marshall Lawrence F. , Toole Belinda M. , Bowers Sharon A.
Published: May 2009

✓ The records of the first 325 patients entered into the pilot phase of the National Traumatic Coma Data Bank were reviewed. Thirty-four severely head-injured patients who talked prior to deteriorating to a Glasgow Coma Scale (GCS) score of 8 or less were identified. Of those 34 patients, 18 died or were left vegetative and 16 recovered. While there were certain common factors between those who talked and died and those who talked and recovered, there were also significant differences. The common factors between the two groups were the length of time to deterioration or operative intervention (16 versus 18 hours, respectively), and the initial GCS scores (12.6 versus 12.4, respectively).

The primary differences between the groups included the mean age, the degree of midline shift seen on computerized tomography (CT), and the presence of subdural hematoma. Those who talked at some point postinjury, but who subsequently died, had a mean age of 50 years. Those who talked, deteriorated, and then recovered were found to have a mean age of 32 years. Seven of the 18 patients who talked and died had a shift of greater than 15 mm on CT, while this degree of shift was demonstrated in only one of 16 patients who talked, deteriorated, and recovered.

Subdural hematomas were significantly more common in the “talk and die” group, as was the overall need for operation. Since the overwhelming majority of patients with marked shift on CT have surgical lesions, early operative intervention is strongly recommended in these patients, prior to their inevitable deterioration.
The role of endothelial gap junctions in the enlargement of chronic subdural hematomas
Authors: Yamashima Tetsumori , Yamamoto Shinjiro , Friede Reinhard L.
Published: May 2009

✓ The structure of macrocapillaries (also called “sinusoids”) in the outer membrane of chronic subdural hematomas was investigated by electron microscopy, with particular attention paid to vascular permeability. One characteristic of macrocapillaries is the frequent formation of gap junctions between adjacent endothelial cells. In endothelial gap junctions 0.6 to 8 µm in diameter, numerous blood components, including red blood cells and plasma, can be seen squeezing or spilling into the interstitial space of the outer membrane. Irregularly deformed erythrocytes are located around the macrocapillaries, and amorphous material is seen among scattered thin collagen fibers. It is suggested that endothelial gap junctions of macrocapillaries play an important role in the leakage of blood, causing enlargement of chronic subdural hematomas.
Bicompartmental analysis of cerebrospinal fluid circulation
Authors: Cabanes Jerónimo , Marti José , Orozco Miguel , Beltran Andrés
Published: May 2009

✓ A new model for cerebrospinal fluid (CSF) circulation is proposed. Specific activity/time curves for CSF kinetics determined after intraventricular injection of a radiotracer were produced by fitting a biexponential function to data points and developing a two-compartmental model. Calculation of kinetic parameters of the model provides quantitative data about CSF dynamics. The study of each compartment separately and of the intercompartmental relationship is possible with this model. Sequential scan images and graphic plots of the variations of radioactivity in both compartments, derived from this model, add supplementary information in the evaluation of patients.

Ventriculography was performed in 80 patients, who fell into four groups: those with normal CSF circulation, hydrocephalus, infantile hydrocephalus, and functioning ventricular shunts. Normal and hydrocephalic patients showed significant differences between the two groups in the means of some numerical parameters calculated from the new model. An increase of intraventricular radioactivity at 24 hours (p < 10−4) and of the volume of Compartment 1 (p < 0.01) with decreased volume of Compartment 2 (p < 10−4) and total flow outside the system (p < 10−3) were found in patients with hydrocephalus. The limiting values for normal patients were also estimated. Communicating and obstructive hydrocephalus could be differentiated by this method; however, no differences in mean values were found relating to the etiology or clinical course of the hydrocephalus. Normal-pressure hydrocephalus and cerebral atrophy produced significantly different mean values for the volume of Compartment 2 (p < 0.01), flow out of the system (p < 0.01), and intercompartmental flow (p < 0.01).
Giant-cell tumor of the sphenoid bone
Authors: Wolfe James T. , Scheithauer Bernd W. , Dahlin David C.
Published: May 2009

✓ Giant-cell tumor rarely affects the sphenoid bone. Ten cases of this tumor seen at the Mayo Clinic are reviewed, bringing the number of cases in the world literature to 31. These tumors, which present in the second and third decades of life and are slightly more frequent in women than in men, may present with various symptoms, including headache, visual field defects, blindness, and diplopia. The symptom complex and roentgenographic findings are seldom, if ever, sufficiently characteristic to allow preoperative diagnosis. The microscopic differential diagnosis of giant-cell tumor of the sphenoid region includes giant-cell reparative granuloma, aneurysmal bone cyst, fibrous dysplasia, and “brown tumor” of hyperparathyroidism. Interesting features of this series include the presence of multifocal giant-cell tumor in one case, and the absence of Paget's disease of bone in every case. Complete follow-up review in these cases allowed a discussion of therapy and prognosis; it appears that subtotal excision with postoperative radiation therapy is the treatment of choice. While the histological appearance of giant-cell tumor is characteristic, caution must be exercised in interpreting small samples, and various reparative and metabolic disorders must be considered in the differential diagnosis.
Cerebral histoplasmoma
Authors: Vakili Saeed T. , Eble John N. , Richmond Bruce D. , Yount Robert A.
Published: May 2009

✓ A 55-year-old man presented with dementia and seizures of recent onset. A computerized tomography scan revealed a ring-like lesion in the left occipital lobe, which on resection was found to be a histoplasmoma. Cerebral histoplasmoma is rare and simulates a metastatic brain tumor. Only eight cases of this entity have been reported.
A microsucker for use in neurosurgery
Authors: MacFarlane Martin R.
Published: May 2009

✓ A microsucker for use in microneurosurgery is described. It has a small-caliber tip, is of light weight, and has the special feature of infinitely variable suction from zero to maximum pressure, achieved by thumb movement only.
Intracerebral electrode implantation system
Authors: Siegfried Jean , Comte Pierre , Meier Remy
Published: May 2009

✓ A new technique for deep-brain electrode implantation is described. A very flexible nontraumatic electrode guided by a central stylet and a new electrode head-fixation screw are the two unique features of this system. Electrodes can be guided precisely and their watertight fixation to the bone by means of the special screw is reliable and totally reversible. The system has been designed to fit most of the stereotaxic frames currently in use.
Clinical use of pre- and postsurgical evaluation of abnormal GH responses in acromegaly
Authors: Arosio Maura , Giovanelli Massimo A. , Riva Elisabetta , Nava Claudio , Ambrosi Bruno , Faglia Giovanni
Published: May 2009

✓ The criteria by which acromegalic patients are considered “cured” after surgical therapy are still controversial. Since the abnormal growth hormone (GH) increase after the administration of some agents has been demonstrated to be characteristic of the tumoral somatotrophs, its disappearance after surgery may be taken as an index of the complete removal of the tumor. Serum GH increases after thyrotropin-releasing hormone (TRH, 200 µg intravenously), gonadotropin-releasing hormone (Gn-RH, 100 µg intravenously), and sulpiride (100 mg intramuscularly) injected during dopamine infusion (DA-Slp test), were evaluated in 68 acromegalic patients before and after transnasosphenoidal adenomectomy, and every 12 to 18 months during a follow-up period of 6 months to 11 years (average 42 months). Forty-two patients had abnormal responses to at least one test before surgery: 32 out of 68 (47%) to TRH, six out of 40 (15%) to Gn-RH, and 20 out of 28 (71 %) to the DA-Slp test. Of 18 patients who underwent all three tests, 78% had abnormal responses to at least one of them. Twenty-three patients became unresponsive after surgery, and none of them had a recurrence or became abnormally responsive again during the follow-up period. Three out of six patients with postoperative serum GH levels between 5.1 and 10 ng/ml and three out of six patients with postoperative serum GH levels between 2.1 and 5 ng/ml remained abnormally responsive: one of them relapsed 1 year after the operation. The abnormal responses were lost in all 11 patients whose postoperative serum GH levels were below 2 ng/ml, and abnormal responses were maintained in all the patients in whom surgery was considered unsuccessful because postoperative serum GH levels were higher than 10 ng/ml. The TRH, Gn-RH, and DA-Slp tests should thus be considered useful tools in verifying the total removal of an adenoma. The reappearance of active acromegaly in the patient with low postoperative GH levels, who was still responsive to TRH, should be regarded as a reactivation and not a true recurrence of the disease.
Neurological and psychophysiological sequelae following different treatments of craniopharyngioma in children
Authors: Cavazzuti Valeria , Fischer Edwin G. , Welch Keasley , Belli James A. , Winston Ken R.
Published: May 2009

✓ The authors present neurological findings and data from psychophysiological tests administered during the follow-up period of 35 patients with craniopharyngioma. Group I patients who were treated by irradiation alone or by radiotherapy and conservative surgical procedures (including biopsy, cyst aspiration, and shunting), showed significantly less frontal lobe and visual perceptual dysfunction than Group II patients, in whom radical tumor resection was attempted by a subfrontal exposure. Frontal lobe dysfunction was demonstrated in sorting tests by perseverative responses, inflexibility of behavior, and lack of inhibitory control, while intelligence quotients remained relatively unaffected. Immediate memory defects and decreased manual dexterity were present, to different degrees, in both treatment groups. On the basis of these preliminary data and a maximum follow-up period of 10 years, the authors conclude that primary irradiation of a craniopharyngioma appears associated with a lower morbidity rate and may avoid the frontal lobe disorders seen in the patients with extensive tumor resection.
Acute responses to blunt head trauma
Authors: Tornheim Patricia A. , Liwnicz Boleslaw H. , Hirsch Charles S. , Brown David L. , McLaurin Robert L.
Published: May 2009

✓ This study of blunt craniocerebral trauma describes an experimental model that involves delivery of forceful blows to the resting movable skulls of anesthetized cats. Injuries inflicted by this method included skull fractures in 81% of cases, epidural hemorrhages in 50%, subdural hemorrhages in 80%, subarachnoid hemorrhages in 100%, and brain contusions in 84%. In the majority of instances the subdural and epidural hemorrhages were thin films of blood that did not compress or distort the subjacent brain. The distribution of cerebral contusions was restricted to the cerebral parenchyma beneath the locus of cranial impact except for contusions associated with skull fractures. This experimental model recapitulates clinically realistic human cranial trauma and produces pathological lesions suitable for investigation of the pathophysiology of blunt head trauma.
Cerebral circulation after head injury
Authors: Overgaard Jørn , Tweed William A.
Published: May 2009

✓ A considerable body of evidence suggests that posttraumatic disturbances of the cerebral circulation contribute to poor neurological outcome after blunt head injury, especially when regional cerebral blood flow (rCBF) falls to the ischemic range (below 17 ml/100 gm/min). Cerebral infarction concentrated in the arterial boundary regions has been described in patients who died. Since arterial boundary zones are the cortical areas most susceptible to cerebral ischemia, the authors have investigated the relationship between neurological outcome and the anatomic pattern of rCBF values in the acute phase. The bolus-injection xenon-133 washout technique was used to measure rCBF in 35 regions of the hemisphere during the 1st week after head injury. Eighty-eight hemispheres were studied in 80 patients whose Glasgow Coma Scale (GCS) score was less than 8 on admission to the neurosurgical department.

A characteristic pattern of rCBF was found in patients who later died of neurological complications, or who survived in a persistent vegetative state, with low flows in regions conforming to the arterial boundary zones. These patients also had lower average global cerebral blood flow (CBF), GCS scores, and cerebral perfusion pressure compared with those who recovered, with or without neurological deficits; the latter group had an rCBF pattern similar to that of normal individuals.

There was little change in the GCS score between the time of hospital admission and CBF measurement, suggesting that the major neurological injury had occurred prior to admission. It was not possible to determine whether boundary-zone ischemia preceded neurological deterioration, but the rCBF pattern of boundary-zone flow deprivation was clearly related to poor neurological outcome. These observations suggest that elevated intracranial pressure and arterial hypotension were important etiological factors. Measures to protect regional cerebral perfusion should be instituted as early as possible after injury, preferably before the patient reaches the hospital.