bluuebunny/crossref_metadata_2025 huggingface dataset:
Electrical stimulation of the stellate ganglion and the vertebral nerve
Authors: Nagashima Chikao , Iwama Kazuo
Published: May 2009

✓ Vestibular responses elicited by electrical stimulation of the stellate ganglion and of the periarterial nerve around the proximal vertebral artery were observed in 15 cases of intermittent vertebral artery compression (Powers' syndrome) during surgical treatment under local anesthesia. Stimulation of the periarterial nerve produced many varieties of pupillary change with or without ocular movements, nystagmus, posterior headache, and dizziness. The ocular changes included mydriasis or miosis of the ipsilateral or contralateral pupil, inconsistent hippus, conjugate or disconjugate eye movements, and horizontal or vertical nystagmus. Stimulation of the stellate ganglion, however, produced prompt and full mydriasis of the ipsilateral pupil without other eye changes, headache, or dizziness. From the data available it seems likely that the periarterial neural structure including the vertebral nerve and plexus (“deep or posterior cervical sympathetic system”) is functionally different from the cervical sympathetic system including the stellate ganglion (“anterior cervical sympathetic system”).
Treatment of fractures of the atlas and axis by wiring without fusion
Authors: McLaurin Robert L. , Vernal Raul , Salmon James H.
Published: May 2009

✓ Fractures and dislocations involving C-1 and C-2 vertebrae have usually been treated by prolonged external immobilization or by internal fixation and fusion. This is a report of 12 patients treated by internal fixation by wiring only. Follow-up studies, up to 4 years, demonstrated healing of the bone and no late neurological sequelae. The advantage of internal fixation in reducing hospitalization and immobilization is accepted. The authors believe that in most instances the addition of bone fusion to the operative procedure is not essential and may increase morbidity.
Primary carcinoma of the pituitary with metastasis to the brain stem
Authors: Fleischer Alan S. , Reagan Thomas , Ransohoff Joseph
Published: May 2009

✓ A case of primary carcinoma of the pituitary with metastasis to the brain stem is presented. Although both tumors had the microscopic appearance of benign adenomas, the infiltrative characteristics necessitated the diagnosis of carcinoma.
Disposable system for intraventricular pressure measurement and CSF drainage
Authors: Shapiro Harvey M. , Wyte S. R. , Harris A. B. , Galindo A.
Published: May 2009

✓ A simple disposable system for controlled cerebrospinal fluid drainage and monitoring of ventricular fluid pressure is described. The unit is connected between the patient's external ventriculostomy and a standard pressure transducer. This drainage system is easily assembled, incorporates an adjustable mechanism for releasing pressure, provides a continuous record of ventricular fluid pressure, and permits hourly measurement of CSF drainage. The pressure recording is continued even when the ventricular fluid pressure falls below a predetermined maximal value.
Cell kinetics of human gliomas
Authors: Hoshino Takao , Barker Marvin , Wilson Charles B. , Boldrey Edwin B. , Fewer Derek
Published: May 2009

✓ Eleven selected patients with brain tumor were given 3H-thymidine intravenously at the time of operation. Parts of the excised tumor were fixed for routine histological studies as well as for simple radioautography. Other parts were minced immediately after excision and incubated at 37°C with 14C-thymidine, and were thus doubly labeled. Simple radioautography of the tumor specimen showed fairly even distribution of labeled cells in the astrocytoma group and uneven labeling of tumor cells in malignant gliomas, including glioblastomas. In most glioblastomas, the labeling index (percentage of cells labeled with 3H-thymidine) varied from near 0% in the necrotic areas to approximately 20% in the most viable parts of the same tumor; the labeling index of viable parts of the tumor ranged from 5% to 10% with the exception of astrocytomas in which the index was 1% or less. The duration of DNA synthesis ranged from 7 to 10 hours in the majority of tumors regardless of the nature or grade of malignancy.
Upper gastrointestinal bleeding as a complication of intracranial disease
Authors: Karch Steven B.
Published: May 2009

✓ Review of 2206 consecutive necropsies showed evidence of hemorrhagic ulceration of the upper gastrointestinal tract in 7.2%. The incidence in patients dying from intracranial disorders was found to be twice that of those dying from all other causes (12.5% vs 6.0%). The distribution of lesions within the two groups was also different in that esophageal ulceration was more common in the neurological group (p < .001), while duodenal ulcers were more common in the non-neurological group (p < .001).
Regional cerebral blood flow studies in subarachnoid hemorrhage
Authors: Heilbrun M. Peter , Olesen Jes , Lassen Niels A.
Published: May 2009

✓ Regional cerebral blood flow (rCBF) studies using the intra-arterial 133xenon method were performed on 10 patients with subarachnoid hemorrhage. Both preoperative and postoperative studies showed evidence of decreased flow in the entire hemisphere studied, and, in addition, evidence of focal ischemia, focal hyperemia, focal vasoparalysis, and often global impairment of autoregulation. The degree of flow abnormalities correlated well with the clinical grading of the neurological deficit. It is suggested that analysis of the state of autoregulation might be useful in determining the time for surgical intervention and that rCBF studies are important in defining the effects of drugs used to counteract the ischemic effects of spasm.
Histochemical studies in the zone of ischemia following middle cerebral artery occlusion in cats
Authors: MacDonald Vance D. , Sundt Thoralf M. , Winkelmann R. K.
Published: May 2009

✓ Representative enzymes in brain were studied by histochemical techniques at intervals varying between 6 hours and 8 weeks after permanent middle cerebral artery occlusion in 18 cats. Unequivocal enzyme changes did not develop until 12 hours after occlusion, and no specific enzyme system was demonstrated to fail prior to others. That the ischemia of the first 6 hours is reversible in the cat was further substantiated by histological studies in a separate group of animals subjected to temporary middle cerebral artery occlusion for 6 hours. This study demonstrated progressive axonal changes, after the period of reversibility, bordering the core area of ischemia and resembling neural tissue reaction to injury in the spinal cord. Correlation of this study with previous biochemical determinations suggests that a self-induced and self-perpetuated toxicity might explain, in part, progressive changes in ischemic areas.
Non-neoplastic expanding lesions of the vermis cerebelli
Authors: Sundbärg Göran , Brun Arne , Efsing Hans-Olof , Lundberg Nils
Published: May 2009

✓ This report describes the clinical, roentgenological, and histopathological findings in 13 patients in whom the preoperative roentgen diagnosis was tumor of the vermis cerebelli but in whom no neoplasm was found at operation nor suggested by postoperative course. There was a striking clinical conformity; the majority of the patients were between 50 and 70 years of age, had a history of rheumatoid arthritis and/or cardiovascular disease, and a histological picture characterized by small cavernous-capillary hemangiomas and spongiosis indicating perifocal edema. The pathogenesis and clinical significance of the lesions are discussed.
Anterior cervical discectomy without interbody bone graft
Authors: Murphy Michael G. , Gado Mokhtar
Published: May 2009

✓ Twenty-six patients had anterior cervical discectomy without interbody bone graft for lateral cervical disc syndrome. Twenty-four (92%) had a good clinical result. Radiological follow-up was obtained in 20 cases. The incidence of fusion was 72% for discectomy at a single level. Patients undergoing discectomy at two adjacent levels were too few to permit a statement regarding the incidence of fusion. In those cases of incomplete fusion, dynamic films demonstrated stability at the operated site. Half of the cases who had posterior osteophytes preoperatively showed some degree of resorption after 12 months. Neither incomplete fusion nor failure of osteophyte resolution was incompatible with a good clinical result.
Neurinoma of the labyrinthine portion of the facial nerve
Authors: Liliequist B. , Thulin Carl-Axel , Tovi D. , Wiberg A. , Öhman J.
Published: May 2009

✓ A case is reported in which the diagnosis of a neurinoma and its growth from the labyrinthine part of the facial nerve were established preoperatively on the basis of functional disturbances of the intermedius nerve and characteristic radiological changes. Specific tests for differential function of the facial nerve are discussed and the relation of the site of origin to symptoms in comparable reported cases analyzed.
Detection of experimental and clinical brain edema using an electrical impedance method
Authors: Fujita Shigekiyo , Ueda Tsukio , Yagi Masahiro
Published: May 2009

✓ To clarify the development of brain edema, the electrical impedance of white matter was measured with intracerebral implanted electrodes in cold-induced edema in the cat and in cases of edema after major intracranial surgery. Impedance measurements were made at 50 kc using a tetrapolar electrode method with a pair of concentric platinum electrodes. The impedance of the brain gradually decreased 25% after several hours of cold application. The amount of increase of sulfate space of brain showed a good correlation with decrease of impedance. In four postoperative cases of brain tumor, a 7.5% to 25% decrease of impedance was observed within several hours of surgery. A severe case of brain edema, in which the prognosis was poor, showed marked intracranial pressure and 25% decrease of impedance.
Prognostic factors in the persistence of posttraumatic epilepsy
Authors: Weiss George H. , Caveness William F.
Published: May 2009

✓ A group of 356 patients who received head injuries in the Korean War during 1951–1953 have been reviewed with special concern for the prognostic indicators in posttraumatic epilepsy. Factors that operate in the occurrence of seizures after craniocerebral trauma are degree of brain destruction, length of coma, and, to a lesser extent, site of injury. None of these factors is related to the persistence of attacks once they have begun. For the latter, the most useful prognostic factors are derived from the time of onset and frequency of seizures.
Intracranial pressure measurements and rheological behavior of the intracranial system in dogs
Authors: Schettini Alfonso , Mahig Joseph
Published: May 2009

✓ A method for determining cerebrospinal fluid and surface brain pressures, based on the coplanar principle, is described. A previously developed coplanar transducer was revised so that accurate control in the rate and penetration depth during pressure measurements is now assured. In anesthetized dogs, measurements were made by two methods. In the first method, as the transducer was inserted and withdrawn at a constant rate and penetration depth, a typical pressure curve was obtained. In its ascending part, the subarachnoid and subpial compartments could be defined at two distinct inflection points. On its descending part the curve became asymmetric. In the second method of measurement, as the transducer was inserted to a fixed pressure displacement, a pressure decay curve was obtained which was interpreted as a stress relaxation phenomenon. The asymmetry of the pressure curve and the stress relaxation curve were ascribed to the viscoelastic properties of the intracranial system in vivo. These data suggest that, with our current method, one can determine intracranial pressures at the steady state and estimate some of the mechanical properties of the intracranial system.
Analysis of the treatment of 12 consecutive cases of brain abscess
Authors: Kapsalakis Zacharias , Askitopoulou Helen C. , Gregoriades Athanasios
Published: May 2009

✓ An analysis of 12 consecutive cases of brain abscess is reported. In nine patients a distant focus of infection was identified in the middle ear, the cranial sinuses, the lungs, the pleura, the tonsils, or the skull. The most frequent early symptoms and signs were headache, vomiting, papilledema, focal neurological abnormalities, and pyrexia. Angiography, electroencephalography, and brain scans were abnormal in all cases in which they were obtained. Therapy was based on early diagnosis with accurate location, aspiration or excision of the abscess, use of chloramphenicol instead of penicillin, use of steroids, the accomplishment of simultaneous treatment of the primary source of infection, and reevaluation of the patient some time after discharge. The mortality rate was 8% and the morbidity 8%; the six patients with postoperative epilepsy have returned to normal life.
Central physiological effects of experimental intravenous procaine hydrochloride
Authors: Livingston Kenneth E. , Perrin Richard G.
Published: May 2009

✓ In acute experiments with adult cats, a 5 mg/kg bolus of procaine hydrochloride blocked the reflex vagal slowing elicited by stimulation of the carotid sinus nerve. That this blockade does not represent a generalized depression of central nervous system function is indicated by the fact that the superficial reflexes appeared undiminished when the cardiac response was completely abolished. In unanesthetized, freely-moving cats with chronically-implanted cortical and depth electrodes, the electroencephalogram and behavior were not altered at doses well in excess of those required to abolish the baroreceptor reflex. This central reflex blockade was not altered in animals immobilized with succinylcholine. Procaine hydrochloride was several times more effective than lidocaine in blocking the central reflex response, suggesting a mechanism not directly dependent on anesthetic potency. Interruption of the reflex and its continuing blockade were dose-related.
A review of the central response to peripheral nerve injury and its significance in nerve regeneration
Authors: Engh Chardes A. , Schofield Brian H.
Published: May 2009

✓ Chromatolysis is a morphological term used to describe a sequence of light microscopic changes occurring in the cell bodies (perikarya) of peripheral neurons after injury to their peripherally directed axons. The authors have attempted to interpret the significance of chromatolysis to peripheral nerve regeneration and to describe how central regenerative activity may be affected by peripheral regeneration. Electron microscopic perikaryal changes following peripheral nerve injuries initially appear to be manifestations of a nonspecific cellular insult with possible loss of trophic influence, and secondarily a reflection of neuronal readjustment to a decrease in peripheral axon demands. Sectioning of peripheral axons results initially in decreased perikaryal axonal cytoplasm synthesis. Return of normal and sometimes greater than normal perikaryal cytoplasm production and a return of normal perikaryal morphology are characteristics of the maturation phase of peripheral nerve regeneration and occur only if peripheral axon regrowth is successful.
Bypass anomaly of the vertebral artery associated with cerebral aneurysm and arteriovenous malformation
Authors: Mizukami Masahiro , Tomita Takashi , Mine Toru , Mihara Hiroshi
Published: May 2009

✓ In a series of 1107 patients with cerebrovascular disease studied by four-vessel angiography, the authors have found 10 cases of a bypass anomaly of the vertebral artery. Six of the cases also had cerebral aneurysms, and two cerebral arteriovenous malformations. The authors discuss the possible origins for this relationship.
Successful evacuation of acute pontine hematoma
Authors: Murphy Michael G.
Published: May 2009

✓ A patient with acute onset of signs and symptoms pointing to a left pontine lesion is described. Rapid decompensation prompted contrast studies; air injection demonstrated hydrocephalus and a mass arising from the floor of the fourth ventricle. Twenty hours after the onset of symptoms, operative evacuation of a pontine hematoma which had ruptured into the fourth ventricle produced a good result.
Treatment of multiple intracerebral cryptococcal granulomas with 5-fluorocytosine
Authors: Roberts Melville , Rinaudo Peter A. , Tilton Richard C. , Vilinskas Juliet
Published: May 2009

✓ The use of 5-fluorocytosine in the treatment of three intracerebral suppurative cryptococcal granulomas in one patient is described. Except for a transient rise in the serum glutamic pyruvic transaminase the drug was well tolerated during the 10 weeks it was administered. One year following treatment the patient was well and apparently free of cryptococcal infection.
Aneurysmal parietal bone cyst
Authors: Cacdac Manuel A. , Malis Leonard I. , Anderson Paul J.
Published: May 2009

✓ An aneurysmal bone cyst of the parietal bone is reported. A typical hemangioma was seen in the central part of the lesion. The pathological findings are described in detail and the theory of a pre-existing lesion discussed.
Preliminary percutaneous dorsal column stimulation prior to permanent implantation
Authors: Hosobuchi Yoshio , Adams John E. , Weinstein Philip R.
Published: May 2009

✓ Percutaneous dorsal column stimulation was done as a screening procedure in 34 candidates before implantation of a permanent dorsal column stimulator for the treatment of intractable pain. This procedure was useful in forecasting the tolerance of the patient to the “vibratory sensation” produced by a dorsal column stimulator, and the efficacy of the device in relieving pain. Eight patients termed the “vibratory sensation” intolerable. Sixteen found it unpleasant but preferable to the pain, and two found it actually pleasant.
Self-irrigating bipolar diathermy forceps
Authors: King Thomas T. , Worpole Roy
Published: May 2009

✓ A method for providing continuous saline drip in bipolar diathermy is described, which uses stainless steel tubing fixed to one blade of a standard bipolar forceps and connected to the irrigating line.
Neurological surgery in our changing times
Authors: Odom Guy L.
Published: May 2009

The President of the AANS evaluates the need for more neurosurgeons in the United States and concludes, on the basis of detailed surveys and analyses, that the field is nearing saturation. His evidence includes the effects of curricular change, the complicated process of accreditation, the shifting course of Federal support, the geographic distribution of neurosurgeons, the specific number of operations performed, and the effect of fragmentation within the specialty of neurosurgery.
Pituitary apoplexy: a review and reappraisal
Authors: Rovit Richard L. , Fein Jack M.
Published: May 2009

✓ The authors report their experience with nine cases of acute pituitary apoplexy; eight had proven chromophobe adenomas, and two of these patients had the clinical stigmata of Cushing's syndrome. One patient who displayed acromegalic features was treated with x-ray, and no pathological specimen was obtained. The outstanding clinical features of acute pituitary apoplexy were sudden headache, depressed consciousness, ophthalmoplegia, meningismus, and signs of compression of the optic nerve or chiasma. Clinical or laboratory evidence of severe hypopituitarism was rare. The apoplectic syndrome was the first indication of the presence of a pituitary tumor in all nine cases. In one case anticoagulant therapy (for an acute myocardial infarction) appeared to have precipitated hemorrhage in an unrecognized chromophobe adenoma. The authors suggest that acute pituitary apoplexy is a surgical emergency resulting from sudden ischemia, necrosis, and hemorrhage when an expanding pituitary neoplasm has become impacted at the diaphragmatic notch.
A modified cytological technique for rapid differentiation of pituitary adenomas
Authors: Landolt Alex M. , Krayenbühl Hugo
Published: May 2009

✓ The toluidine blue technique for the cytological examination of pituitary tumors has been modified by the addition of orange G as cytoplasmatic stain. This combined method allows the differentiation of somatotropic, lactotropic, and endocrine inactive tumors in the rapid wet film technique.
Cerebral blood flow evaluation of prolonged experimental vasospasm
Authors: Simeone Frederick A. , Trepper Peter J. , Brown Daniel J.
Published: May 2009

✓ Prolonged experimental cerebral vasospasm, determined by angiography, can be produced in animals by puncture of an intracranial artery (IAP) or subarachnoid injection of blood (SAI). Following these stimuli, several patterns of blood flow evolve. The biphasic pattern, seen only with hemorrhage from mechanical trauma to the vessel, seems to resemble most closely the clinical phenomenon. Presumably because of autoregulation, only angiographic constriction of cerebral arteries to less than one-half of their control value is associated with significant reduction of cerebral blood flow. Cerebral blood flow recordings and vessel caliber measurements should complement experiments in cerebral vasospasm to ascertain whether the spasm is producing significant ischemia and to assess the efficacy of subsequent treatment techniques.
The posterior fossa approach to aneurysms of the vertebral and basilar arteries
Authors: Hammon William M. , Kempe Ludwig G.
Published: May 2009

✓ The posterior fossa surgical approach to aneurysms arising from the vertebral and basilar arteries and their branches is presented. The importance of detailed preoperative angiography is stressed, particularly as related to regional anatomy.
Multiple intracranial aneurysms and vascular malformations in an infant
Authors: Arai Hiroyuki , Sugiyama Yoshiaki , Kawakami Senshi , Miyazawa Noboru
Published: May 2009

✓ A case is presented in which an infant had angiographic evidence of two aneurysms of the middle cerebral artery, arteriovenous malformations, aneurysmal dilatation of the left transverse sinus, and kinking of both internal carotid arteries. The literature on intracranial aneurysms in infants and children is reviewed; the clinical and pathological features differ greatly from those in adults.
An aneurysm in infancy presenting with diabetes insipidus
Authors: Shucart William A. , Wolpert Samuel A.
Published: May 2009

✓ A 6-month-old child presenting with diabetes insipidus was found to have irregularities of some of the intracranial arteries as well as a large aneurysm at the bifurcation of the left internal carotid artery. The case is described and discussed.
Role of prostaglandin F2a in the genesis of experimental cerebral vasospasm
Authors: Pennink Menno , White Richard P. , Crockarell John R. , Robertson James T.
Published: May 2009

✓ An angiographic study of experimental cerebral vasospasm was performed in 40 dogs. Vasospasm was caused by injection of 4 ml of blood or 4 ml of blood mixed with prostaglandin F2a into the chiasmatic cistern. A statistically significant difference (chi-square test, p < 0.01) was found between the incidence of cerebral vasospasm obtained with injection of blood alone (6 out of 18 cases, 33%) and the cerebral vasospasm induced with blood and prostaglandin F2a (12 of 13 cases, 92%). In addition, cerebral vasospasm was obtained with injection of prostaglandin F2a alone, whereas prostaglandin E1 had no such effect. These findings, together with reports in the literature that the brains is rich in prostaglandin F2a which it releases into the CSF, suggest a role of prostaglandin F2a in the genesis of cerebral vasospasm seen clinically.
Stereotaxic apparatus and operations in Russia in the 19th century
Authors: Kandel Edward I. , Schavinsky Yuri V.
Published: May 2009

✓ The authors trace the early history of human stereotaxic apparatus and its use with particular reference to the work of D. N. Zernov in 1889, N. V. Altuchov in 1891, and G. I. Rossolimo in 1907, as well as the better known apparatus described by Horsley and Clarke in 1906.
Pathological characteristics of experimental thermal lesions
Authors: Zervas Nicholas T. , Kuwayama Akio
Published: May 2009

✓ Experimental thermal lesions were produced in the liver and brain of rats and rabbits by induction-heating, radiofrequency electrocoagulation, and surface-heating. Pathological examination revealed similar destructive changes from all three methods and demonstrated that lesions were essentially similar in histological character. The safety of different techniques appears to be more related to technical problems in the generation of the lesions than to the physical characteristics of the lesions themselves.
Adult hydrocephalus
Authors: Salmon James H.
Published: May 2009

✓ Eighty adults with hydrocephalus were treated with a shunt operation. Twenty-four had nonabsorptive hydrocephalus with obstruction at the level of the basal cisterns and 56 had hydrocephalus plus cerebral atrophy without apparent obstruction to the flow of cerebrospinal fluid. Thirty-four patients improved but in only 16 (20%) was the improvement dramatic. The material was analyzed to identify criteria for future case selection. History, evidence of tissue damage, and thickness of cerebral mantle were considered important. Antibiotics reduced infection rate from 19% to 3%.
Dissociation of limbic and neocortical EEG patterns in cats under ketamine anesthesia
Authors: Weingarten Seth M.
Published: May 2009

✓ Studies in cats under ketamine anesthesia indicate a dissociation between the electrical activity of the thalamoneocortical areas and that of the ventral hippocampal structures. The medial area of the septum verum and the dorsal hippocampus react similarly to the thalamoneocortical circuit; however, the electrical activity of the septum verum has no direct relationship to that of the ventral hippocampal structures. Another group of cats under barbiturates did not show this dissociation in the EEG. It is suggested that the trance-like state of patients undergoing ketamine anesthesia and the hallucinatory experience in the early recovery phase may be related to the dissociated effects of the drug on the limbic and neocortical systems of the brain.
Crouzon's disease (craniofacial dysostosis)
Authors: Kushner Jack , Alexander Eben , Davis Courtland H. , Kelly David L. , Kushner Annetta Horwitz
Published: May 2009

✓ This article discusses the nature and treatment of Crouzon's disease and reproduces a translation of part of Crouzon's original description. Six typical patients with this disease are presented, and the reasons for surgical treatment emphasized.
Extradural spinal meningiomas
Authors: Calogero John A. , Moossy John
Published: May 2009

✓ Four patients with extradural spinal meningiomas are reported; one had relapsing neurological deficits in two postpartal periods. In a bibliographic review of 35 cases, nearly as many extradural spinal meningiomas occurred in men as in women, five were in children, and three were lumbar or lumbosacral neoplasms in men.
Agenesis of the internal carotid artery with an unusual primitive collateral
Authors: Smith Robert R. , Kees C. Jay , Hogg Ira D.
Published: May 2009

✓ A 22-year-old man admitted to the hospital following a head injury was found to have agenesis of the right internal carotid artery with a large carotid-cavernous anastamosis at the level of the dorsum sellae.
Osteomyelitis and disc infection secondary to Pseudomonas aeruginosa in heroin addiction
Authors: Selby Roy C. , Pillay K. V.
Published: May 2009

✓ Two cases of osteomyelitis of the spine caused by Pseudomonas aeruginosa are described. The organism apparently was introduced by contaminated syringes or needles used by heroin addicts. This organism and the pathology should be kept in mind in patients known to have been heroin addicts and who are suffering from spinal problems especially if there is evidence of infection.
Late malignant recurrence of childhood cerebellar astrocytoma
Authors: Bernell William R. , Kepes John J. , Seitz Elson P.
Published: May 2009

✓ Two cases are presented in which childhood cerebellar astrocytomas recurred 20 and 23 years after gross total excision. Both recurrent tumors showed histological or clinical evidence of malignancy. The cases indicate that even two decades of symptom-free follow-up are not necessarily a guarantee of cure with this glioma.
Transsphenoidal meningohydroencephalocele
Authors: Wiese G. Michael , Kempe Ludwig G. , Hammon William M.
Published: May 2009

✓ A case of transsphenoidal meningohydroencephalocele with its associated anomalies is presented. Review of the embryological development of the sphenoid bone suggests that this defect occurs prior to the tenth week of intrauterine life. The associated abnormalities in this patient support this conclusion.
Evolution and significance of giant parietal foramina
Authors: Fein Jack M. , Brinker Ray A.
Published: May 2009

✓ Parietal foramina normally occur in most skulls but on rare occasion evolve into “giant” defects. A family, all of whose siblings were so affected, is analyzed. The trait appears to be inherited as a Mendelian dominant, and may be more noticeable in infancy than in adult life. The problems related to giant parietal foramina are discussed.
Carotid-cavernous fistula due to extradural subtemporal retrogasserian rhizotomy
Authors: Wepsic James G. , Pruett Ronald C. , Tarlov Edward
Published: May 2009

✓ The development of a carotid-cavernous fistula following retrogasserian rhizotomy in a 50-year-old man is described. The fistula was eliminated by surgical trapping and embolization.
The symptomatic empty sella
Authors: Olson Donald R. , Guiot Gerard , Derome Patrick
Published: May 2009

✓ Visual difficulty in association with an empty sella, resulting from downward migration of the optic system and secondary stretching or kinking of the optic nerves, is presented as a surgical entity best managed by the transsphenoidal approach. Pertinent case reports with characteristic pneumoencephalograms and schematic drawings are used to develop this thesis.
Cervical spinal cord in experimental hydrocephalus
Authors: Dohrmann George J.
Published: May 2009

✓ Adult dogs were rendered hydrocephalic by the injection of kaolin into the cisterna magna. One group of dogs was sacrificed 1 month after kaolin administration, and ventriculojugular shunts were performed on the other group. Hydrocephalic dogs with shunts were sacrificed 1 day or 1 week after the shunting procedure. All dogs were perfused with formalin at physiological pressure, and the brain stem and cervical spinal cord were examined by light microscopy. Subarachnoid granulomata encompassed the superior cervical spinal cord and dependent surface of the brain stem. Rarefaction of the posterior white columns and clefts or cavities involving the gray matter posterior to the central canal and/or posterior white columns were present in the spinal cords of both hydrocephalic and shunted hydrocephalic dogs. Predominantly in the dogs with shunts, hemorrhages were noted in the spinal cord in association with the clefts or cavities. A mechanism of ischemia followed by reflow of blood is postulated to explain the hemorrhages in the spinal cords of hydrocephalic dogs with shunts.
Early descriptions of the Arnold-Chiari malformation
Authors: Carmel Peter W. , Markesbery William R.
Published: May 2009

✓ John Cleland described an unusual congenital anomaly of the brain stem in 1883 in which the medulla was elongated, the fourth ventricle extended into the cervical canal, and the inferior vermis distorted caudally. In 1891 Chiari described two types of brain stem malformation; in one the cerebellar tonsils extended into the cervical canal without medullary deformation, while in the other there was caudal extension of the brain stem and cerebellum and prolongation of the inferior vermis into the cervical canal. The second type was termed the “Arnold-Chiari” malformation by other authors in 1907, and corresponds to the condition described earlier by Cleland. The anatomical features and differences between the types of malformation are tabulated.
Subdural hematoma as a complication of shunting procedures for normal pressure hydrocephalus
Authors: Samuelson Stephen , Long Don M. , Chou Shelly N.
Published: May 2009

✓ The authors report five patients with normal-pressure hydrocephalus (NPH) who developed subdural hematomas following shunt procedures. None of the hematomas was directly related to surgery, and all appeared after the patients had shown initial clinical improvement; one was conceivably related to trauma. These patients appear to be especially susceptible to this complication, as the high incidence of 5 of 24 cases is not seen in the treatment of high-pressure hydrocephalus. The symptoms and signs of this complication, diagnosis, and treatment are described and emphasized. It is concluded that shunting procedures for NPH should not be undertaken lightly, and rigid criteria should be applied in the selection of patients to exclude other causes of dementia.
Arteriovenous malformations of the brain
Authors: Forster David M. C. , Steiner Ladislau , Håkanson Sten
Published: May 2009

✓ The quality of survival of 150 patients with arteriovenous malformations of the brain is presented. The mean period of follow-up was over 15 years. The surgically operated and conservatively managed groups are compared, a comparison that in the long run appears to favor the operated cases. The results are discussed and indications for surgery summarized.
Cerebral angiomas: the sequelae of surgical treatment
Authors: Amacher A. Loren , Allcock John M. , Drake Charles G.
Published: May 2009

✓ Fifty patients underwent 55 operations upon intracerebral angiomas; 86% had suffered intracerebral or subarachnoid hemorrhage, 8% intractable seizures, and 6% intractable headache and progressive ischemic symptoms. There was one postoperative death, a mortality rate of 2%. The operative results are considered in relation to the indications for operation and the degree of removal. The importance of postoperative angiography is stressed.
Tumors of the nervous system induced by ethylnitrosourea administered either intracerebrally or subcutaneously to newborn rats
Authors: Grossi-Paoletti Enrica , Paoletti Pietro , Pezzotta Stefano , Schiffer Davide , Fabiani Armando
Published: May 2009

✓ Tumors of the nervous system grew in rats treated at birth with ethylnitrosourea through intracerebral or subcutaneous routes and in fetal rats treated through the mother. In 80% to 85% of the rats, single and multiple tumors developed in the brain and spinal cord regardless of the route of administration. Gasserian neurinomas, oligodendrogliomas, and oligogendroglial foci were the most frequent neoplasms. General morphological aspects and frequency of tumor localizations in relation to drug administration route are discussed. Thymidine incorporation into DNA, and RNA/DNA ratio, were evaluated in order to estimate tumor proliferation rate and growth. Desmosterol, a characteristic sterol of brain tumors, was detected in all the tumors. Regions of the brain and spinal cord of treated rats showed the presence of microscopic pretumoral areas (oligodendroglial foci) which incorporated thymidine into DNA in contrast to the brains of control rats.
Postmortem findings following the embolization of an arteriovenous malformation
Authors: Fleischer Alan S. , Kricheff I. , Ransohoff Joseph
Published: May 2009

✓ A case of a cerebral arteriovenous malformation treated by embolization with Silastic pellets is described, and the postmortem findings presented.
Osteoma of the middle cranial fossa
Authors: Bhandari Y. S. , Jones R. A. C.
Published: May 2009

✓ The removal of an unusually large osteoma projecting into the middle cranial fossa is reported. The presenting symptom was a solitary generalized epileptic seizure.
Ipsilateral exophthalmos in subfrontal epidural hematomas
Authors: Gruszkiewicz Jan
Published: May 2009

✓ Four cases of subfrontal epidural hematoma with progressive ipsilateral exophthalmos are described, and the pathogenesis discussed.
Asymptomatic perforated viscus and gram-negative ventriculitis as a complication of valve-regulated ventriculoperitoneal shunts
Authors: Rubin Robert C. , Ghatak Nitya R. , Visudhipan Pongsakdi
Published: May 2009

✓ Two cases of small bowel perforation secondary to valve regulated ventriculoperitoneal shunts are reported. In both instances the shunts continued to function. There were no abnormal abdominal signs or symptoms. In one patient it is believed that recurrent gram-negative ventriculitis resulted from the distal small bowel perforation, and that this may be a clue to otherwise asymptomatic small bowel perforations.
Experimental cervical myelopathy: effects of compression and ischemia on the canine cervical cord
Authors: Hukuda Sinsuke , Wilson Charles B.
Published: May 2009

✓ Maximal tolerable compression was produced in 28 dogs by advancing a screw through the anterior portion of the C-5 vertebral body into the spinal canal until limb weakness occurred. Chronic vascular insufficiency was established in the cervical cord of 17 dogs by blocking or ligating the spinal and vertebral arteries and their branches in various combinations. Vascular insufficiency was also established in combination with maximal compression. Neurological, microangiographic, and histological findings in all groups of dogs were compared. Dogs in the last group with the most severe injury had more abnormal findings in surface vessels than did all other dogs. When the dogs were bled to the point of weakness, that point also appeared soonest in the last group. From these findings, the authors conclude that the effects of vascular insufficiency and compression are additive and that this may be an explanation of the clinical signs in patients with cervical spondylotic myelopathy who appear to have relatively slight mechanical compression.
Cervical myelopathy due to ossification of the posterior longitudinal longitudinal ligament
Authors: Nagashima Chikao
Published: May 2009

✓ Ten patients who had cervical myelopathy due to ossification of the posterior longitudinal ligament of the cervical spine are described. This disease is characterized by an abnormal longitudinal strip of ossified ligamentous tissue along the posterior margin of vertebrae from C-3 to C-6; the primary lesion appears to be a degeneration of the intervertebral disc. This distinct clinical, radiological, and pathological entity should be included in the differential diagnosis of cervical myelopathy. All 10 patients were treated by extensive decompressive laminectomy and multiple bilateral facetectomies, with or without foramen magnum decompression. The results were favorable, and postoperative myelography demonstrated dorsal migration of the entire dural contents.
Cerebrospinal fluid shunts: an experimental comparison of flow rates and pressure values in various commercial systems
Authors: Fox John L. , McCullough David C. , Green Robert C.
Published: May 2009

✓ The flow-rate characteristics of selected cerebrospinal fluid (CSF) shunt systems under a constant hydrostatic pressure differential were studied and compared with measurements of the opening pressure (OP) and closing pressure (CP). The usual technique of measuring the CP correlated poorly with actual flow rates. The OP measurement revealed variations from 5 to 600 mm H2O in the hydrostatic pressure actually needed to open the valve. The flow-rate values are important in that some shunt systems will not deliver distilled water at rates significantly in excess of 0.35 ml/min (the probable average normal CSF production rate) at hydrostatic pressure differentials of 150 mm H2O. However, this may not be apparent clinically since much higher hydrostatic pressure differentials are present in the erect patient with a CSF shunt where the ventricular pressure and shunt siphoning pressures are additive.
Removal of an ossified ventral thoracic meningioma
Authors: Freidberg Stephen R.
Published: May 2009

✓ A case is presented of a calcified meningioma ventral to the thoracic cord. It was successfully removed by isolating the tumor and its dural attachment by blindly dividing the dura ventral to the cord.
Association of ossified subdural hematomas and a meningioma
Authors: Cusick Joseph F. , Bailey Orville T.
Published: May 2009

✓ An example of the association of massive bilateral ossified subdural hematomas and a large meningioma is presented. The enlargement of the head led to a clinical diagnosis of hydrocephalus. Change in clinical findings 3 years before death could be correlated with the growth of the meningioma. Possible relationships between the two lesions are discussed.
Paravertebral lumbar meningomyelocele
Authors: Sogani K. C. , Kalani B. P.
Published: May 2009

✓ Two cases of paravertebral lumbar meningomyelocele are reported and the literature reviewed.
Clip-grafts for aneurysm and small vessel surgery.
Authors: Sundt Thoralf M.
Published: May 2009

✓ Analysis of the use of the clip-graft for intracranial aneurysms indicates that the clip-graft is chiefly applicable to internal carotid and anterior communicating artery aneurysms. The development of the right-angle clip holder has extended its use to anterior communicating artery aneurysms that project posteriorly or superiorly. The dangers of dissection in the septal region are discussed. With few exceptions, the clip-graft is not applicable to the vertebrobasilar system or middle cerebral artery trifurcation aneurysms, although it has been used for aneurysms arising from the trunk of the latter vessel.
Traumatic cerebrospinal fluid fistulas in children
Authors: Caldicott W. J. H. , North J. B. , Simpson Donald A.
Published: May 2009

✓ The postnatal development of the skull base was studied by dissection and radiography in 15 subjects, and the findings were correlated with the occurrence of traumatic cranionasal and crainioaural cerebrospinal fluid fistulas in seven children. The authors conclude that indications for operative repair of these fistulas are as strong in the child as in the adult, although diagnosis is sometimes more difficult.
Alteration of orbicularis oculi reflex by posterior fossa tumors
Authors: Kimura Jun , Lyon Lynn W.
Published: May 2009

✓ The orbicularis oculi reflex response to electrical stimulation of the supraorbital nerve was studied in 14 cases of intrinsic brain stem lesions (2 mesencephalic, 6 pontine, and 4 medullary neoplasms, and 2 pontine syrinxes) and 20 cases of lesions extrinsic to the brain stem (6 cerebellar and 14 cerebellopontine angle tumors). The early reflex was abnormal in all but three cases of medullary tumors and one case of cerebellar tumor. Alteration of the early reflex by posterior fossa tumors reflects either delayed conduction through the pons due to intrinsic pontine lesions or extrinsic compression of the pons, or indicates trigeminal or facial nerve involvement by tumor. The late reflex with its direct and consensual components is useful in distinguishing afferent from efferent delay (or block). Mixed patterns suggest combined involvement of the trigeminal and facial nerves or a relatively widespread brain-stem lesion. This simple technique appears to be a useful addition to clinical observation in assessment of posterior fossa tumors.
Observations on the effects of intrathecal papaverine in experimental vasospasm
Authors: Ogata Masahiro , Marshall B. M. , Lougheed W. M.
Published: May 2009

✓ Subarachnoid hemorrhage was produced in monkeys by injecting fresh arterial blood. Serial angiographic studies of the basilar artery then showed vasospasm, occurring as a biphasic response similar to that seen following subarachnoid hemorrhage in man. Papaverine had previously been found to be the most potent vasodilator for topical use to release spasm resulting from experimentally induced subarachnoid hemorrhage. This drug was therefore administered, in various dilutions, as a slow infusion into the subarachnoid space of these monkeys. In a concentration of 0.03%, papaverine proved to be effective in reducing the vasospasm without toxicity.
Effects of prostaglandins E1, E2, A1, A2, and F2α on canine carotid arterial blood flow, cerebrospinal fluid pressure, and intraocular pressure
Authors: Nakano Jiro , Chang Alvin C. K. , Fisher Robert G.
Published: May 2009

✓ The effects of intra-arterial (i.a.) or intravenous (i.v.) injection of prostaglandins E1, (PGE1), E2 (PGE2), A1 (PGA1), A2 (PGA2), and F2α (PGF2α) on the carotid circulation, intraocular pressure (IOP), and cerebrospinal fluid pressure (CSFP) in anesthetized dogs are reported. Direct i.a. injection of PGE1, PGE2, or PGA2 decreases the carotid vascular resistance whereas PGF2α increases it. The i.v. injection of PGE1, PGE2, and PGA2 increases heart rate, carotid arterial blood flow, IOP, and CSFP as systemic arterial pressure decreases, while the i.v. injection of PGF2α decreases all but the IOP. Both systemic arterial pressure and IOP increase during a single i.v. infusion and decrease during a continuous i.v. infusion of PGF2α. This suggests that the changes in IOP and CSFP by the prostaglandins are not only a direct effect but also reflect indirect influence on carotid arterial blood flow. During a continuous i.v. infusion of PGE1, PGE2, or PGA2, carotid arterial blood flow gradually decreases toward control values after its initial marked increase. It is concluded that a single i.a. or i.v. injection or a short i.v. (10 min) infusion of PGE1 or PGE2 may be more effective than a prolonged continuous i.v. infusion of PGE1 or PGE2 for alleviating cerebral vascular spasm.
Torulomas (cryptococcal granulomata) of the central nervous system
Authors: Selby Roy C. , Lopes Nilo M.
Published: May 2009

✓ Three new cases of cryptococcal granuloma of the central nervous system are reported and compared with 37 previously described cases. The lesion may appear with or without evidence of meningitis. Resection of the granuloma followed by prophylactic or therapeutic chemotherapy is recommended as the treatment of choice. Serial lumbar punctures and blood and CSF antigen levels are of value in determining response to treatment.
Diencephalic cysts
Authors: Brocklehurst Gordon , Chir. M.
Published: May 2009

✓ Four cases of extensive cystic dilatation of the third ventricle associated with agenesis of the corpus callosum are described. This condition is termed “diencephalic cyst”; the clinical and radiological features are described. The embryological development of the diencephalon, the telencephalon, and the corpus callosum are described in relation to this malformation. The associated hydrocephalus is also discussed. The treatment and clinical course of the patients is outlined.
Spinal cord blood flow patterns in experimental traumatic paraplegia
Authors: Dohrmann George J. , Wick Katherine M. , Bucy Paul C.
Published: May 2009

✓ Alterations in spinal cord blood flow patterns in experimental traumatic paraplegia were studied by using thioflavine S, a fluorescent dye that stains the endothelium of blood vessels. Feline spinal cords, exposed by laminectomy, were traumatized with a 400 gm-cm contusion, and a rapid intravenous injection of thioflavine S administered. The spinal cords were excised within one circulation time after the injection, and the resulting spinal cord sections were examined under ultraviolet light. As thioflavine S is a fluorescent substance that binds to the blood vessel walls and as the spinal cord was excised within one circulation time, it was possible to determine in which vessels blood was flowing at the time of injection. Control animals showed blood flow in all parts of the spinal cord. At 15 min postcontusion there was a marked decrease in the number of vessels perfused in the white matter; however, at 30 min many of the vessels had evidence of renewed blood flow. By 1 hr postcontusion the entire gray matter showed hemorrhagic infarction. The number of fluorescing vessels in the white matter decreased considerably between 1 and 8 hrs postcontusion. At 8 hrs the thioflavine S-stained vessels were limited to the peripheral half of the white matter; however, by 24 hrs most of the vessels again fluoresced, but the gray matter remained without perfusion. In this experimentally-produced lesion, the gray matter of the spinal cord was infarcted by 1 hr postcontusion; the white matter was ischemic between 1 and 8 hrs with resumed blood flow by 24 hrs.