bluuebunny/crossref_metadata_2025 huggingface dataset:
The Calmodulin Antagonist Trifluoperazine Provides Mild Prophylactic protection against Cerebral Vasospasm after Subarachnoid Hemorrhage, but No Therapeutic Value
Authors: Peterson John W. , Candia Guillermo , Spanos Athanasios J. , Zervas Nicholas T.
Published: April 2011

In vitro studies of the canine basilar artery have demonstrated that calmodulin antagonism can effectively inhibit cerebral arterial smooth muscle contractility. The prophylactic and therapeutic effectiveness of a potent calmodulin antagonist. the phenothiazine compound tnfluoperazine (TFP). was investigated in vivo over a wide range of doses in the well-documented “double-subarachnoid hemorrhage” canine model of cerebral vasospasm. The compound is perhaps more well-known under its trade name. Stelazine. as a classic antipsychotic drug. The drug demonstrated no therapeutic relief of preexisting chronic cerebral vasospasm at any time during 2 days of systemic administration at any practical dose. At doses far in excess of the normally accepted therapeutic range in humans. a prophylactic regimen reduced the severity of chronic cerebral vasospasm after subarachnoid hemorrhage by approximately 35% compared to untreated dogs.
Fatal Phenytoin-Related Toxic Epidermal Necrolysis: Case Report
Authors: Kelly Daniel F. , Hope Donald G.
Published: April 2011

Toxic epidermal necrolysis is a rare but often fatal hypersensitivity reaction to numerous agents, including most anticonvulsants. The authors present a case of fatal phenytoin-related toxic epidermal necrolysis in a patient who was given prophylactic anticonvulsant therapy after he sustained a moderately severe closed head injury. The typical course and current management of toxic epidermal necrolysis are reviewed, as are the indications for the prophylaxis of posttraumatic epilepsy.
Balo's Concentric Sclerosis: A Variant of Multiple Sclerosis Associated with Oligodendroglioma
Authors: Shankar Susarla K. , Rao Tirupattur Vasudev , Srivastav Vinod K. , Narula S. , Asha Thota , Das Sarala
Published: April 2011

We report a case of Balo's concentric sclerosis, a rare and acute variant of multiple sclerosis, which coexisted with an oligodendroglioma. The demyelinating lesion was clinically silent and was detected at necropsy. The pathogenesis of concentric sclerosis and the relationship of the demyelinating lesion to the evolution of the glial neoplasm is briefly discussed.
Implantation of a Reservoir for Recurrent Subdural Hematoma Drainage
Authors: Laumer Rudolf , Schramm Johannes , Leykauf Karin
Published: April 2011

In a prospective study 144 adult patients with chronic subdural hematomas were randomly divided into three treatment groups after burr-hole evacuation. The two commonly used procedures (external closed system drainage and aspiration and irrigation without any drainage) were compared to a modified technique: permanent subdural drain with subcutaneous reservoir. After the hematoma was washed out with saline solution, a silicon catheter with multiple perforations was introduced into the subdural cavity and connected to a Rickham reservoir, fixed in the frontoparietal burr hole. In patients who showed secondary deterioration or enlargement of the residual hematoma as proven by computed tomographic scan, the reservoir was punctured and the subdural fluid aspirated. The great advantage of this method is that it is practicable at the bedside as well as in the outpatient department, thus making it possible to reduce the number of additional operations. The incidence of symptomatic residual or recurrent hematoma was similar in all three groups. The reoperation rate was 4-fold greater in the groups treated with conventional therapy, when compared to the group with the implanted system. At the same time there was no indication that the implantation of the drain was less safe, as judged by the incidence of seizures and infections.
Cavernous Hemangioma in the Cavernous Sinus: Case Report
Authors: Sawamura Yutaka , de Tribolet Nicolas
Published: April 2011

The case of a middle-aged woman with a cavernous hemangioma of the right cavernous sinus who showed ipsilateral hemianopsia associated with contralateral blindness caused by left retrobulbar optic neuritis is presented. Total removal of the tumor was followed by recovery of the visual function of the right eye. (Neurosurgery 26:126-128, 1990)
Leptomeningeal Cyst Resulting from Adulthood Trauma: Case Report
Authors: Halliday Andrea L. , Chapman Paul H. , Heros Roberto C.
Published: April 2011

The authors report a rare sequelae of a skull fracture in an adult, a leptomeningeal cyst. A unique method for repairing this defect is described as well. (Neurosurgery 26:150-153, 1990)
Somatosensory and Auditory Brain Stem Conduction after Head Injury: A Comparison with Clinical Features in Prediction of Outcome
Authors: Lindsay Kenneth , Pasaoglu Aydin , Hirst David , Allardyce Gwen , Kennedy Ian , Teasdale Graham
Published: April 2011

Evoked potential conduction times in brain stem auditory (BCT) and central somatosensory pathways (CCT) were recorded from 23 normal subjects and 101 patients with severe head injury. Abnormalities in the CCT and the BCT findings correlated with the clinical indices of brain damage (coma score, motor response, pupil response, and spontaneous and reflex eye movements) in the head-injured patients and each correlated with outcome at 6 months from the injury. The CCT in the “best” hemisphere produced the strongest correlation with outcome (P<0.001). The correlation of the CCT with outcome was stronger in the 47 patients examined 2 to 3 days after the injury (P<0.001) compared to the 34 patients examined within 24 hours after the injury (P<0.02). No such difference was noted for the BCT. Serial studies within the first 2 weeks of injury did not show a consistent pattern and repetition of the investigation over this period did not provide any additional information. We used an INDEP-SELECT discriminant analysis program to determine whether information from the evoked potential data could improve prediction of outcome based on clinical data alone. With the addition of the CCT, the predictive accuracy (expressed as the correct classification probability) increased only slightly from 77 to 80%, and the difference was not significant. We conclude that central somatosensory and auditory brain stem conduction times provide useful prognostic information in paralyzed or sedated patients, but when neurological examination is feasible the benefits of evoked potential analysis do not justify the effort involved in data collection.
Treatment of a Giant Aneurysm of the Cavernous Internal Carotid Artery Associated with a Persistent Primitive Trigeminal Artery: Case Report
Authors: Miyatake Shin-ichi , Kikuchi Haruhiko , Kondoh Soh-ichirou , Higashi Toshio , Yamagata Sen , Nagata Izumi
Published: April 2011

A case of an unruptured giant aneurysm of the cavernous portion of the left internal carotid artery associated with a persistent primitive trigeminal artery (PTA) is presented. The usual surgical approach to giant aneurysms at this site. including ligation of the ipsilateral internal carotid artery (ICA) and an extracranial-intracranial (EC-IC) bypass, was inadequate because of continued blood supply to the aneurysm via the PTA from the vertebrobasilar system. The patient was successfully treated with a combination of EC-IC bypass surgery, ICA ligation, and simultaneous intravascular balloon obliteration of the ICA just distal to the junction of the PTA and immediately proximal to the aneurysmal neck. Follow-up radiological investigations showed thrombosis of the aneurysm.
Hyperprolactinemia in a Patient with a Pituitary and an Ovarian Dermoid Tumor: Case Report
Authors: Klonoff David C. , Kahn Douglas G. , Rosenzweig William , Wilson Charles B.
Published: April 2011

A patient with galactorrhea. amenorrhea, and hyperprolactinemia caused by a dermoid tumor of the pituitary gland is presented. The patient had a prior history of an ovarian dermoid tumor. The pathology of dermoid tumors is discussed along with the management of pituitary tumor-associated hyperprolactinemia. This is the first reported case of an intracranial and an ovarian dermoid tumor occurring in the same patient.
Tumor Localization of Human Brain Malignant Glioma Xenograft in Nude Mice with a Radiolabeled Monoclonal Antibody
Authors: Lee Wei-Hwa , Yeh Ming-Yang , Tu Yen-Chang
Published: April 2011

A murine monoclonal antibody designated as MAb 3H9 (IgGl subclass immunoglobulin, k light chain) expressed specific antibody binding activity to a human brain malignant glioma cell line (GBM8401/TSGH, NDMC) and many formalin-fixed and paraffin-embedded malignant gliomas that have been produced in our laboratory by hybridoma technology. The immunohistochemical indirect immunofluorescence, peroxidase-antiperoxidase assays, and specific electron microscopic immunogold staining revealed that 3H9 probably recognized a distinct glioma-associated surface antigen on the GBM8401 cultured cells. In vivo radioimmunolocalization of GBM8401 xenografts in nude mice by external scintigraphy with radiolabeled 3H9 has been performed to evaluate potential clinical application as diagnostic or therapeutic reagents. On the 3rd day after an intravenous injection of 15 MCi, the 125I- or 131I-radiolabeled 3H9 was successful in immunolocalization of a human brain GBM8401 xenograft in the nude mouse. In large xenografts, the radioactivity ratios of tumor to brain and tumor to blood were 11.0 and 2.4, respectively. In small xenografts, the tumor to brain and tumor to blood ratios were 14.0 and 2.9, respectively. The clearance of radiolabeled 3H9 in the bloodstream of the nude mouse was not affected by the presence of a GBM8401 xenograft. This preliminary experiment reveals that human brain GBM8401 xenografts in nude mice can be detected in vivo by radiolabeled 3H9.
The Perforating Branches of the Internal Carotid Artery: The Microsurgical Anatomy of Their Extracerebral Segments
Authors: Marinkovié Slobodan V. , Milisavljevié Milan M. , Marinkovié Zorica D.
Published: April 2011

The perforating branches of the internal carotid artery (ICA) were examined in 30 forebrain hemispheres. These branches were present in all the cases studied, and varied from 1 to 6 in number (mean, 3.1). Their diameters ranged from 70 to 470 Mm (mean, 243 Mm). The perforating branches arose from the choroidal segment of the ICA, that is, from its caudal surface (52.3%), caudolateral surface (34.1%), or caudomedial surface (13.6%). They rarely originated from the bifurcation point of the ICA (10%). The distance of the remaining 90% of the perforators from the summit of the ICA measured between 0.6 and 4.6 mm. The perforating branches most often originated as individual vessels, and less frequently from a common stem with another vessel or by sharing the same origin site with another perforator or with the anterior choroidal artery. The bifurcation of the ICA, which is a frequent site for cerebral aneurysms, is surrounded by many perforating branches. Hence, great care must be taken to avoid damage to these important vessels during operations in that region.
Neuronal Migration Anomalies Causing Extensive Ventricular Indentation
Authors: Yasumori Kotaro , Hasuo Kanehiro , Nagata Shinji , Masuda Kouji , Fukui Masashi
Published: April 2011

Neuronal migration disorders include various anomalies of the brain, and cortical heterotopia is the most common type. In this report, we present the radiological findings of two adults with unusually large cortical heterotopia associated with fused-lip schizencephaly that caused extensive ventricular indentation. The lesion showed density on a computed tomographic scan and signal intensity on a magnetic resonance imaging scan similar to normal gray matter. Perifocal edema, contrast enhancement, and calcification were not seen. An abnormally decreased volume of the ipsilateral cerebral hemisphere, the presence of adjacent microgyri, and deep fissures that contained blood vessels were also characteristic findings, indicating abnormal development. Knowledge of this entity is important in differentiating true intracerebral neoplasms.
Median Nerve Injury from Local Steroid Injection in Carpal Tunnel Syndrome
Authors: Linskey Mark E. , Segal Ricardo
Published: April 2011

Local steroid injections for symptomatic relief of carpal tunnel syndrome have become common in the evaluation and treatment of this disorder; yet reports of median nerve injection injury from this practice are rare. We present a case of nerve injury from a steroid injection in a 24-year-old man with carpal tunnel syndrome that was successfully treated by division of the transverse carpal ligament and neurolysis. The histopathological characteristics of the lesion are presented. and the pathogenesis and treatment of this injury are discussed. Means of avoiding this complication include careful attention to anatomic landmarks as well as to the patient's subjective response during injection and avoidance of the use of local anesthetics.
Resolution of a Recurrent/Residual Bacterial Aneurysm during Antibiotic Therapy
Authors: Meyer Yves J. , Batjer Hunt H.
Published: April 2011

Management of patients harboring infectious intracranial aneurysms remains controversial because of the technical problems associated with the obliteration of these lesions as well as their frequent regression during antibiotic therapy. A case of a ruptured bacterial aneurysm of the distal middle cerebral artery in which a segment of the artery was found to be inflamed and necrotic is presented. The ruptured portion of the sac was clipped, leaving a small tag of aneurysmal tissue. Five days later, this tag was found to have expanded into a second aneurysm. This second lesion resolved with antibiotic therapy. Because of the responsiveness of infected cerebral arteries to the appropriate antibioties, a less than radical surgical tactic may be a successful alternative to excision of the diseased arterial segment followed by distal revascularization in treating these lesions.
Efficacy of Tissue Plasminogen Activator in the Lysis of Thrombosis of the Cerebral Venous Sinus
Authors: Alexander Lon F. , Yamamoto Yoshihiro , Ayoubi Samer , Al-Mefty Ossama , Smith Robert R.
Published: April 2011

Therapy for thrombo-occlusive disease of the cerebral venous sinuses remains controversial. Although several thrombolytic agents, such as urokinase and anticoagulants, are recommended for treatment, major significant risks include cerebral hemorrhage, especially in patients with venous infarction. Tissue plasminogen activator (tPA) has shown a high affinity for fibrin-bound plasminogen, while exhibiting a low affinity for circulating plasminogen. The purpose of this study was to evaluate this drug for use in cerebral sinus thrombo-occlusive disease. Eleven adult male rabbits were chosen as experimental animals. All animals underwent microsurgical dissection of their major dural venous sinuses. Direct compression was used to form a thrombus within the sinus. The presence of significant venous thrombosis was confirmed radiographically by iohexol sinography. Subsequently. tPA was delivered systemically via the marginal ear vein at a dose of 3000 units/h; the result was total lysis of the clot documented by a sinogram 1 hour after the drug was administered. Postmortem pathological examination confirmed total lysis in seven of eight animals. One animal showed partial retained clot fragments. No significant coagulopathic state was observed. In three control animals, saline was infused without clot lysis. We conclude that tPA is a highly effective agent for the lysis of acute induced venous sinus thrombosis in an experimental model.
Hydrosyringomyelia Associated with a Chiari I Malformation in Children and Adolescents
Authors: Isu Toyohiko , Iwasaki Yoshinohu , Akino Minoru , Abe Hiroshi
Published: April 2011

The clinical presentation, radiological features, and results of surgical treatment were analyzed in 17 cases of hydrosyringomyelia associated with a Chiari malformation, in children and adolescents younger than 20 years of age. The initial symptoms were a skeletal abnormality (71%), such as scoliosis (11 patients) or pes cavus (1 patient), pain or numbness (24%), and motor weakness (6%). Frequently seen signs on admission were sensory deficit (100%), scoliosis (85%), muscle weakness (64%), muscle atrophy (35%), and lower cranial nerve palsy (35%), The characteristic neurological findings were unilateral sensory and motor deficits (65%) with decreased or absent deep tendon reflexes on the same side. The localization of the syrinx on the axial section varied according to the level, even in the same patient. In 11 patients with unilateral sensory disturbances or unilateral sensory and motor deficits, the syrinx was located in the region corresponding to the posterolateral portion on the same side as that of sensory disturbance at the cervical or thoracic level. On the other hand, in 6 patients with bilateral sensory and motor deficits, the syrinx was located in the central portion and extended into the posterolateral portion of the more affected side. A syringosubarachnoid shunt was placed in 16 patients, foramen magnum decompression without closure of the obex was performed in 1 patient, ventriculoperitoneal shunt in 1 patient, terminal syringostomy in 1 patient, and foramen magnum decompression with terminal syringostomy in 1 patient. In 15 of 17 patients (88%), the neurological symptoms improved after an average follow-up of 4 years and 1 month. We think that as a surgical treatment, placement of a syringosubarachnoid shunt is effective.
Microsurgery of Midbrain Lesions
Authors: Pendl Gerhard , Vorkapie Peter , Koniyama Masaki
Published: April 2011

Of 41 patients with midbrain lesions, 25 underwent definitive surgical exploration. In 16 patients surgical exploration was not warranted, since the patients had only slight neurological deficits and longstanding histories or consent was not given. The infratentorial supracerebellar approach proved to be the ideal method of exposure in 20 patients, in whom the lesion was located in the more dorsal aspect of the midbrain. In 6 of these patients the mass lesion extended from the cerebellum into the midbrain and, therefore, a transcerebellar route was also needed for exposure. In 5 patients the subtemporal approach was chosen. Three patients died as a result of the operation, but in the other 22 patients no increase in morbidity after surgery was apparent and the immediate postoperative course was normal. Five patients with malignant tumors died from recurrence despite radiotherapy. The remaining 17 patients have been doing well up to 14 years after surgery, but 3 had only limited follow-up. This experience with surgical exploration and total resection or evacuation of midbrain lesions in 25 patients should prove the safety of modern microsurgical techniques. Emphasis is placed on the benefit of microtopographic considerations in the choice of the most suitable approach to these deepseated lesions.
Spinal Cord Compression Secondary to Idiopathic Retroperitoneal Fibrosis
Authors: de Sá João , Pimentel José , Carvalho Mamede , Evangelista Pedro , Martins Paulo
Published: April 2011

Retroperitoneal fibrosis is a rare disorder in which the abnormal fibrotic tissue compresses retroperitoneal organs. In the majority of patients no obvious cause can be found, hence the name idiopathic retroperitoneal fibrosis. The process can also arise from other anatomic areas, suggesting a multifocal origin. We report a case of dorsal epidural compression in a 63-year-old patient harboring idiopathic retroperitoneal fibrosis. A magnetic resonance imaging scan revealed the precise location of the lesion. It is suggested that retroperitoneal fibrosis should be considered in the differential diagnosis of epidural spinal cord compression.
Neurotoxicity of Local Administration of Two Nitrosoureas in Malignant Gliomas
Authors: Yamashima Tetsumori , Yamashita Junkoh , Shoin Katsuo
Published: April 2011

The neurotoxicity of local administration of nitrosoureas in malignant gliomas was investigated clinicopathologically, Twenty patients were entered into this study: 13 were treated with 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) and 7 with methyl 6-[3-(2-chloroethyl-3-nitrosoureido]-6-deoxy-α-D-glucopyranoside (MCNU). On the average, a single dose of 20 mg of ACNU was administered 15 times, for a total dose of 295 mg in each case, while a single dose of 11 mg of MCNU was given 2 times, for a total dose of 24 mg. These nitrosoureas provoked greater toxicity when the administration dose was larger or the indwelling multiperforated Silastic basket was in direct continuity with the ventricle or the basal cistern. Usually ACNU was well tolerated, whereas MCNU induced marked brain edema. Side effects consisted of headache, nuchal stiffness, vomiting, motor weakness, and cranial nerve palsy for ACNU, and headache, vomiting, abnormal respiration, and arrhythmia for MCNU. Pathological changes were represented by capsule formation, spongy degeneration and reactive gliosis of adjacent white matter, occlusion of neighboring arteries, and demyelination of cranial nerves in the patients treated with ACNU, while they were represented by focal brain necrosis in two patients treated with MCNU. The differences in neurotoxity of ACNU and MCNU conceivably derive from the different blood-brain delivery of these drugs.
Inflammatory Intracranial Mass Lesion: An Unusual Complication Resulting from the Use of Gelfoam
Authors: Guerin Christopher , Heffez Dan S.
Published: April 2011

There are few reported complications associated with the use of Gelfoam. We report the case of a 29-year-old woman who developed signs and symptoms of meningeal inflammation and an expanding intracranial mass related to the intracranial use of Gelfoam. Findings were confirmed by surgical exploration. Signs and symptoms resolved promptly after therapy with intravenous dexamethasone. but complete resolution of radiological findings required 5 months. As the use of Gelfoam is essential to neurosurgical practice, it is important to be aware of significant complications related to its use.
Spontaneous Spinal Epidural Hematoma with Associated Platelet Dysfunction from Excessive Garlic Ingestion: A Case Report
Authors: Rose Ken D. , Croissant Paul D. , Parliament Connie F. , Levin Murray B.
Published: April 2011

The authors report a case of spontaneous spinal epidural hematoma causing paraplegia secondary to a qualitative platelet disorder from excessive garlic ingestion. The case also demonstrates satisfactory recovery from thoracic spinal epidural hematoma in a nonagenarian. Recovery from severe spinal cord compression can occur even in the very elderly.
Intraventricular Neurocytoma: A Clinical and Pathological Study of Three Cases and Review of the Literature
Authors: Barbosa Marcos Daniel , Balsitis Margaret , Jaspan Timothy , Lowe James
Published: April 2011

Three patients with a recently described tumor of neuronal origin, intraventricular neurocytoma, are presented. These tumors occur as intraventricular lesions in young patients, and the prognosis after surgical treatment is favorable. The initial pathological diagnosis of intraventricular neurocytoma may be difficult because of the striking resemblance of these tumors to oligodendroglioma and, to a lesser extent, ependymoma on light microscopic examination. Despite the use of wide-ranging panels of monoclonal antibodies, previous authors have not found any characteristic immunohistochemical staining patterns, but in our three patients, the use of synaptophysin, glial fibrillary acidic protein, and Leu-7 demonstrated staining patterns that may be useful in the diagnosis of this tumor. The monoclonal antibody Ki-67 was used to stain one tumor and showed a low cell proliferation rate. We have reviewed the clinical, radiological, and pathological features of these 3 patients and 17 previously described patients in an attempt to determine the important diagnostic features of intraventricular neurocytoma. Intraventricular neurocytoma should be considered in any young patient with symptoms of raised intracranial pressure and radiological evidence of an intraventricular lesion. Pathological diagnosis requires the use of electron microscopy to show features of neuronal differentiation; however, immunohistochemical demonstration of a neuronal phenotype is also a useful adjunct to diagnosis. Failure to use specialized techniques for pathological diagnosis will lead to misdiagnosis of these lesions as oligodendrogliomas, as was the initial diagnosis in 2 of our patients before review.
Adenoid Cystic Carcinoma with Intracranial Extension: Report of Three Cases
Authors: Wakisaka Shinichiro , Nonaka Akitsugu , Morita Yoshihiro , Fukui Masashi , Kinoshita Kazuo
Published: April 2011

Adenoid cystic carcinoma (cylindroma) usually arises from the salivary, lacrimal, or other exocrine glands, and is rarely encountered by neurosurgeons. The authors describe three cases involving intracranial extension. An intraorbital tumor in a 71-year-old man extended directly into the epidural space of the frontal base and destroyed the orbital roof. In a 53-year-old woman, the tumor arose from the area adjacent to the eustachian tube and invaded the Gasserian ganglion. In the third patient, a 58-year-old man, the tumor originated in the maxillary sinus and extended directly into the middle cranial fossa. In all these cases, the tumors were removed to the fullest extent possible. Although residual tumor was markedly reduced by radiation therapy, recurrence and metastases occurred within a few years. Thus, adenoid cystic carcinoma appears to be radiosensitive, but not curable by irradiation. In treating a recurrent tumor in one patient, we applied the so-called “two-route” chemotherapy (cisplatin and its antidote) in combination with radiation therapy. The tumor responded well to this therapy, although multiple pulmonary and bone metastases eventually led to the patient's death.
Interventional Neuroradiological Management of Vein of Galen Malformations in the Neonate
Authors: Ciricillo Samuel F. , Edwards Michael S. B. , Schmidt Klaus G. , Hieshima Grant B. , Silverman Norman H. , Higashida Randall T. , Halbach Van V.
Published: April 2011

Since 1978, the authors have seen 14 neonates with vein of Galen malformations who were born with severe congestive heart failure. The 5 infants treated before 1983 underwent craniotomy and clipping of feeding vessels; all died in the perioperative period. Since 1983, 8 neonates have been treated with combined arterial and venous interventional neuroradiological techniques; 6 infants survived. Two-dimensional echocardiography, color Doppler flow imaging, and pulsed Doppler ultrasound were used to assess blood flow within the malformation before and after staged transluminal embolic procedures were performed. The results of the diagnostic studies and the clinical status of the infants were used to evaluate the success of embolic therapy and the need for further neuroradiological intervention.
Ruptured Cerebral Aneurysms Missed by Initial Angiographic Study
Authors: Iwanaga Hideaki , Wakai Susumu , Ochiai Chikayuki , Narita Jun-ichi , Inoh Satoshi , Nagai Masakatsu
Published: April 2011

The authors reviewed the computed tomographic (CT) scans of patients with subarachnoid hemorrhage whose initial angiograms were negative, to investigate the validity of CT scans in predicting the presence of an angiographically missed aneurysm in such patients. During the past 14 years, additional angiograms have been obtained for 38 of the 45 patients with subarachnoid hemorrhage whose initial angiograms disclosed no aneurysm. Aneurysms were found in 8 patients; 7 on the anterior communicating artery and 1 at the junction of the internal carotid and posterior communicating arteries. CT scans were taken within 4 days after subarachnoid hemorrhage in 31 patients. Analysis of these scans showed that the second angiogram revealed 1) an aneurysm in 21% of the patients with a thin layer of subarachnoid blood and in 63% of those with a thick layer; 2) no aneurysm in the patients without subarachnoid blood; and 3) an aneurysm of the anterior communicating artery in 70% of the patients who showed a considerable amount of blood in the basal frontal interhemispheric fissure. These results suggest that if CT scans show thin or thick subarachnoid blood, angiographic study should be repeated early in the course. If a considerable amount of blood is shown in the basal frontal interhemispheric fissure, it is highly probable that an aneurysm is hidden on the anterior communicating artery, even if the angiogram is negative for an aneurysm.
Potential Misinterpretation of Cervical Spondylosis with Cord Compression Caused by Metallic Artifacts in Magnetic Resonance Imaging of the Postoperative Spine
Authors: Levitt Myron , Benjamin Vallo , Kricheff Irvin I.
Published: April 2011

Tiny metallic particles produced by the contact of untempered surgical instruments with a diamond drill produce magnetic susceptibility artifacts that can both limit the diagnostic quality of postoperative magnetic resonance imaging of the cervical spine and cause diagnostic error. A case of cervical pseudospondylosis with apparent cord compression due to such an artifact is presented. The source of these metallic particles is considered, and the nature of the susceptibility artifact is discussed.
Hydrocephalus and Cavernoma of the Cauda Equina
Authors: Ramos F. , de Toffol B. , Aesch B. , Jan M.
Published: April 2011

The association of a tumor of the cauda equina and hydrocephalus is unusual. We report a case of hydrocephalus with normal pressure associated with an equally rare affliction, a cavernous angioma of the cauda equina, which regressed after surgical ablation. The physiological mechanism involved is discussed.
Clinical and Pathological Analysis of Spinal Cord Astrocytomas in Children
Authors: Rossitch Eugene , Zeidman Seth M. , Burger Peter C. , Curnes John T. , Harsh Carter , Anscher Mitchell , Oakes Jerry W.
Published: April 2011

Twelve children with pathologically confirmed, well-differentiated spinal cord astrocytomas were studied, and correlations among the degree of resection, pathological characteristics, and time of recurrence were examined. Eight tumors were sampled for biopsy or subtotally resected, and 4 were thought to have been totally removed. Clinical recurrence was seen in 4 of 12 patients, 2 of whom died of their disease. The time to recurrence was 1, 2, 2, and 35 years, respectively. The other 8 children remain free of symptoms, with follow-up ranging from 6 months to 35 years (mean, 8.8 years). In 3 of 8 patients who underwent biopsy or subtotal resection, the tumor recurred, and 2 patients died, whereas there was one recurrence in the patients in whom a “total” resection had been obtained. The histologically well-differentiated nature of the lesions correlated well with the relatively prolonged clinical course seen in this series during the period of observation. The relatively long clinical courses seen in our limited series should be considered before high-risk therapy for spinal cord astrocytomas in children is implemented. The presence of four pilocytic astrocytomas in this group was of special interest, and it seems likely that these discrete neoplasms can be distinguished from the more infiltrating fibrillary astrocytic neoplasms by magnetic resonance imaging with enhancement with gadopentetate dimeglumine.
Magnetic Resonance Imaging of Kernohan's Notch
Authors: Cohen Alan R. , Wilson John
Published: April 2011

Compression of the cerebral peduncle against the tentorial incisura contralateral to a supratentorial mass, the so-called Kernohan's notch. can be a cause of false localizing motor signs. The authors present a case of Kernohan's notch secondary to a traumatic extradural hematoma. The patient developed an oculomotor palsy and a dense motor deficit ipsilateral to the extra-axial hematoma. Magnetic resonance imaging in the postoperative period clearly showed the midbrain lesion. The motor deficit and 3rd nerve palsy subsequently resolved.
Acute Tissue Tear Hemorrhages of the Brain: Computed Tomography and Clinicopathological Correlations
Authors: Wilberger James E. , Rothfus William E. , Tabas Janet , Goldberg Andrew L. , Deeb Ziad L.
Published: April 2011

Tissue tear hemorrhages (TTHs) are often seen on high-resolution computed tomographic scans after closed head injury. Generally, TTHs have been thought to be visible manifestations of more severe forms of diffuse axonal injury and thus portend a poor prognosis. Computed tomographic scans from 600 patients with head injuries were reviewed: 48 (8%) were found to have TTHs. The clinical spectrum of TTHs was characterized. No direct relationship could be established between either the presence or the number of TTHs and the severity and/or outcome from the head injury in this group, except that patients with TTHs in both the brain stem and the corpus callosum uniformly had a poor outcome. Magnetic resonance imaging provided more sensitive information than computed tomography in evaluating TTHs.
Blood Component Induction of Cerebral Vasospasm
Authors: Harada Tsutomu , Suzuki Yoshio , Satoh Shin-ichi , Ikegaki Ichiro , Asano Toshio , Shibuya Masato , Sugita Kenichiro
Published: April 2011

The role of blood components in cerebral vasospasm was evaluated using an in vivo canine model. An intracisternal injection of 5 ml of washed red blood cells (RBCs) and platelet-rich plasma (PRP) resulted in acute vasospasm of the basilar artery as seen by angiography. This was comparable with the degree of vasospasm induced by an injection of the same amount of whole blood. Repeated injections of blood components or whole blood on Days 1 and 3 induced chronic vasospasm. as shown by angiography on Day 7. Results clearly indicate that chronic vasospasm was produced by RBCs and PRP. and it was in a dose-dependent manner with increasing concentrations of RBCs (hematocrit: 30, 50. and 70%). The vasospasm induced by both components closely reproduced that seen with whole blood. Neither acute nor chronic vasospasm induced by blood component injection was associated with clot formation in the subarachnoid space, as confirmed by an autopsy. These results suggest that the extravasation of RBCs and PRP into the subarachnoid space produces cerebral vasospasm by mechanisms independent of blood clot formation.
Bilateral Arteriovenous Malformations of the Choroid Plexus and Retina
Authors: İplikçioğlu Celal A. , Özek Memet M. , Özcan Osman Ekin , Çizmeli Olcay , Sağlam Süleyman
Published: April 2011

A unique case is described in which an epileptic patient with bilateral vascular malformations of the retina was found to have bilateral arteriovenous malformations of the choroid plexus.
Extracerebral Cavernous Angiomas of the Middle Fossa
Authors: Rigamonti Daniele , Pappas Conrad T. E. , Spetzler Robert F. , Johnson Peter C.
Published: April 2011

Three cases of extracerebral cavernous angiomas of the cavernous sinus in the middle fossa are reported. These are rare lesions that primarily affect women and are usually associated with acute or subacute onset of visual symptoms: diplopia, exophthalmos, and decreased visual acuity. The growth of the lesion often erodes the bone in the area of the cavernous sinus. Angiography usually depicts a vascular mass. The lesions represent a formidable surgical problem because of their tendency to cause intraoperative life-threatening hemorrhages. Morbidity and mortality can be drastically reduced by not attempting to resect the lesion further after biopsy and by giving a course of radiation therapy before definitive surgical treatment.
Atypical Subependymoma of the Spinal Cord: Ultrastructural and Immunohistochemical Studies
Authors: Lach B. , Russell N. , Benoit B.
Published: April 2011

A 76-year-old woman with a 2-year history of progressive weakness of the left arm and leg underwent a laminectomy for an intradural, extramedullary, pedunculated subependymoma involving the meninges and spinal nerve roots at C7-T1. Eight months later, another operation was necessary for an intramedullary neoplasm at C3-T4. This latter tumor consisted of small. poorly developed cells, large atypical astrocytes, and ependymal cells. Neither ependymal rosettes nor papillary formations were present. Ultrastructural studies showed some features of ependymal differentiation of the large “astrocytic” cells. This case illustrates an unusual pattern of extramedullary and intramedullary presentations of subependymoma and a spectrum of cellular differentiation of neoplastic subependymal glia.
Functional Results of Facial Nerve Suture after Removal of Acoustic Neurinoma: Analysis of 25 Cases
Authors: Jääskeläinen Juha , Pyykkö Ilmari , blomstedt Göran , Porras Matti , Palva Tauno , Troupp Henry
Published: April 2011

The facial nerve is sometimes severed during the removal of acoustic neurinomas, either intentionally to ensure complete removal, or unintentionally because of difficulties in identification. In such cases we have, if possible, sutured the nerve stumps microsurgically, either end to end or by use of an intervening nerve graft. We analyzed the outcome of 25 instances of facial nerve suturing in a series of 219 patients operated on for acoustic neurinoma from 1979 to 1987. The first signs of recovery appeared at an average of 12 months, and there was continued improvement for several years. Recovery was graded from 1 to 6. The anastomosis was successful in 24 of the 25 sutured nerves, in that at least some facial movement and tone were restored (Grade 5 or higher). In 11 of the 25 cases, facial appearance at rest and with movement was moderately good (Grade 2 or 3). A Grade 1 result, with no perceivable facial dysfunction, was never achieved. Typically, oral muscles showed the most improvement and frontal muscles the least. Facial appearance was better at rest than with movement, which was always complicated by some degree of synkinesis. Closure of the eye was so good in 13 of the 25 cases that neither tarsorrhaphy nor an eyelid spring was necessary. When the facial nerve is severed, intraoperative suture is recommended, because it provides a chance for moderately good restoration of facial appearance.
Extracranial Repair of Cerebrospinal Fluid Fistulas: Technique and Results in 37 Patients
Authors: McCormack Bruce , Cooper Paul R. , Persky Mark , Rothstein Stephen
Published: April 2011

Although neurosurgeons have traditionally preferred intracranial repair for the management of cerebrospinal fluid (CSF) fistulas, this approach is associated with the complications of a craniotomy, anosmia, and a high incidence of recurrent fistulas. Extracranial repair, on the other hand, produces no central nervous system morbidity, preserves olfaction, and is associated with a low incidence of recurrence. Although there have been several reports of extracranial repair of CSF fistulas by otorhinolaryngologists, this approach has received scant mention in the neurosurgical literature. We report here our experience with 37 patients with CSF rhinorrhea or otorrhea who underwent extracranial repair. The etiology of the fistula was postoperative in 22, traumatic in 6, and spontaneous in 9. The fistulas were repaired using one of four techniques: external ethmoid-sphenoid in 18 patients, transmastoid in 9, transseptosphenoid in 7, and osteoplastic frontal sinusotomy in 3. In 32 of the 37 patients (86%) the fistulas were successfully repaired with the initial procedure. Of the 5 patients requiring a second operation, the fistula was successfully closed in 4 for an overall success rate of 97%. Complications were few and consisted of a transient facial paresis in a patient undergoing transmastoid repair and one death from meningitis. The authors conclude that because of low morbidity and mortality and a high success rate in closing fistulas, extracranial repair is the preferred technique for the operative management of CSF rhinorrhea and otorrhea.
Chronic Lyme Disease with an Expansive Granulomatous Lesion in the Cerebellopontine Angle
Authors: Mokry Michael , Flaschka Gerhard , Kleinert Gertrude , Kleinert Reinhold , Fazekas Franz , Kopp Wolfgang
Published: April 2011

Expansive granulomatous lesions in the posterior cranial fossa are rare and have not been reported in conjunction with Lyme disease. We report a patient with verified Borrelia burgdorferi infection who developed a tumor in the cerebellopontine angle. Rapid growth of the tumor led to signs of cerebral compression and to hydrocephalus. Surgical intervention was required despite florid meningitis. The histological examination showed inflammatory, nonspecific granulation tissue. The origin of this tissue is almost certainly causally related to the B. burgdorferi infection. Signs of inflammation resolved rapidly after subtotal resection. The clinical, radiological, and biochemical course is documented. This is the first report of an expansive cerebral lesion in the chronic phase of Lyme disease.
Vagal Schwannoma Associated with Syncopal Attacks and Postural Hypotension: A Case Report
Authors: Sawamura Yutaka , de Tribolet Nicolas
Published: April 2011

A case of vagal schwannoma in the cerebellomedullary angle is reported. Preoperatively, the patient had paroxysmal episodes of postural hypotension with syncope. After total removal of the vagal tumor, her systemic blood pressure returned to normal.
Traumatic Aneurysm of the Superior Cerebellar Artery: Case Report and Review of the Literature
Authors: Quattrocchi Keith B. , Nielsen Surl L. , Poirier Virginia , Wagner Franklin C.
Published: April 2011

Less than 10% of the 250 reported cases of traumatic intracranial aneurysms have involved the posterior circulation. Traumatic aneurysms of the superior cerebellar artery are extremely rare, with only three cases previously reported. This is the first report of a traumatic superior cerebellar artery aneurysm in which the diagnosis was suggested by computed tomographic scan. The potential for a good outcome suggests the value of early angiography when the history and diagnostic imaging studies suggest the possibility of a traumatic aneurysm.
An Unusual Complication of Silastic Dural Substitute: Case Report
Authors: Ng Thomas H. K. , Chan Kwan Hon , Leung Suet Yi , Mann Kirpal S.
Published: April 2011

A case is presented in which a patient developed an unusual complication after the use of Silastic dural substitute. In 1983. the patient underwent removal of a meningioma with the involved dura. Five years later, he developed around the graft material a very thick connective tissue capsule, which simulated a recurrent meningioma clinically and radiologically.
Serial Ultrasonographic Evaluation of Neonatal Vein of Galen Malformations to Assess the Efficacy of Interventional Neuroradiological Procedures
Authors: Ciricillo Samuel F. , Schmidt Klaus G. , Silverman Norman H. , Hieshima Grant B. , Higashida Randall T. , Halbach Van V. , Edwards Michael S. B.
Published: April 2011

Two-dimensional echocardiography complemented with color-flow imaging and pulsed Doppler ultrasound was used to evaluate one fetus and five neonates with a vein of Galen malformation who had severe high-output congestive heart failure and cranial bruits at birth. Intracranial blood flow through the vein of Galen malformations, cardiac status, and direction of aortic blood flow were assessed before and after staged interventional neuroradiological treatment with transarterial and transvenous embolization procedures. Color-flow imaging in each infant displayed the major vascular anatomy including feeding vessels and the patterns of filling of the vein of Galen malformations. Pulsed Doppler ultrasound performed on the descending aorta above the diaphragm showed the degree of diastolic flow reversal indicative of runoff into the vein of Galen malformations. A reduction in blood flow through the vein of Galen malformation was seen on color-flow imaging in four patients treated successfully by embolic procedures. The ratio of diastolic retrograde flow velocity in the descending aorta to systolic antegrade velocity decreased from 0.51 ± 0.15 (mean ± standard deviation) to 0.15 ± 0.20 (P < 0.05). Color-flow imaging and pulsed Doppler ultrasonography provided anatomical and pathophysiological information regarding cardiac hemodynamics and intracranial blood flow; with the patient's clinical status, these methods provided a reliable, noninvasive means to evaluate the effectiveness of therapy and the need for further treatment in neonates with vein of Galen malformations.
Spinal Cord Thromboplastin-induced Coagulopathy in a Rabbit Model
Authors: Pattisapu Jogi V. , Miller Jimmy D. , Bell Warren N. , Smith Robert R. , O'Neal Robert M. , Reddy Vijay N.
Published: April 2011

Coagulopathy results from many diverse events, including several neurogenic causes. Using a rabbit model, we produced coagulopathy by injecting autologous spinal cord and extracted thromboplastin intravenously. Serial coagulation panels were performed to evaluate the activation of the thrombotic and fibrinolytic pathways. Group 1 animals (n = 4) received intravenous injections of homogenized spinal cord tissue. Coagulopathy was not produced with 36 mg of homogenized spinal cord tissue, but 50 mg or more resulted in death. Group 2 animals (n = 12) received intravenous injections of extracted rabbit cord thromboplastin, which contained approximately 60% activity of a commercially purified rabbit brain thromboplastin. Five animals receiving 2.5 to 5.5 mg of thromboplastin per kilogram of body weight survived with evidence of coagulopathy. Seven animals receiving 2.5 to 100 mg of thromboplastin per kilogram of body weight died. Group 3 (4 control animals) received normal saline injections without changes in clinical or laboratory status. The thrombotic pathway was activated in all animals as evidenced by decreased platelet counts and fibrinogen levels. Activation of the fibrinolytic system was demonstrated by increased concentrations of protamine sulfate and abnormal euglobulin clot lysis times. The most sensitive parameters were the platelet count, protamine sulfate concentration, and white cell count (margination), which became abnormal within 15 minutes after the injections and returned to normal within 1 hour.
Pharmacological Reversibility of Experimental Cerebral Vasospasm
Authors: Nakagomi Tadayoshi , Kassell Neal F. , Hongo Kazuhiro , Sasaki Tomio
Published: April 2011

Using a morphometric technique, the pharmacological reversibility of luminal narrowing after experimental subarachnoid hemorrhage (SAH) was investigated. For vasodilation, a “cocktail” consisting of 10−4 M papaverine, 2 × 10−4 M sodium nitroprusside, and 10−5 M adenosine was administered intra-arterially. Forty-two rabbits were divided into six groups: control (normal animals); control plus cocktail (normal animals perfused with the cocktail before fixation); SAH (animals sacrificed 48 hours subsequent to intracisternal injection of 1.5 ml/kg of arterial blood); SAH plus cocktail (SAH plus perfusion with the cocktail); BaCl2 (animals sacrificed 10 minutes after intracisternal injection of 2 ml of 3 × 10−3 M BaCl2); and BaCl2 plus cocktail (BaCl2 animals perfused with the cocktail). The diameter of the basilar arteries in the control and the control plus cocktail groups was not significantly different. BaCl2 reduced the diameter 44% and SAH reduced the diameter 27%. There were no significant differences between the diameter of the BaCl2 plus cocktail group and SAH plus cocktail group when compared with the control or the control plus cocktail group. Morphological examination by light and transmission electron microscopy showed luminal narrowing and corrugation of the elastic lamina with few degenerative or proliferative changes of the vessel wall in animals with SAH. These results suggest that cerebral vasospasm is caused initially by smooth muscle contraction rather than by proliferative vasculopathy and that it is not an irreversible process.