bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute hydrocephalus after aneurysmal subarachnoid hemorrhage
Authors: Gijn Jan van , Hijdra Albert , Wijdicks Eelco F. M. , Vermeulen Marinus , Crevel Hans van
Published: May 2009

✓ Hydrocephalus, defined as a bicaudate index above the 95th percentile for age, was found in 34 (20%) of 174 prospectively studied patients with subarachnoid hemorrhage (SAH) who survived the first 24 hours and who underwent computerized tomography (CT) scanning within 72 hours. The occurrence of acute hydrocephalus was related to the presence of intraventricular blood, and not to the extent of cisternal hemorrhage. The level of consciousness was depressed in 30 of the 34 patients. Characteristic clinical features were present in 19 patients, including a gradual obtundation after the initial hemorrhage in 16 patients and small nonreactive pupils in nine patients (all with a Glasgow Coma Scale score of 7 or less). In the remaining 15 patients (44%), the diagnosis could be made only by CT scanning. After 1 month, 20 of the 34 patients had died: six from rebleeding (four after shunting), 11 from cerebral infarction (eight after an initial improvement), and three from other or mixed causes. Only one of nine patients in whom a shunt was placed survived, despite rapid improvement in all immediately after shunting. The mortality rate among patients with acute hydrocephalus was significantly higher than in those without, with the higher incidence caused by cerebral infarction (11 of 34 versus 12 of 140 cases, respectively; p < 0.001). Death from infarction could not be attributed to the extent of cisternal hemorrhage, the use of antifibrinolytic drugs, or failure to apply surgical drainage, but could often be explained by the development of hyponatremia, probably accompanied by hypovolemia.
Surgical treatment for fungal infections in the central nervous system
Authors: Young Ronald F. , Gade George , Grinnell Verity
Published: May 2009

✓ The hospital records of 78 patients who underwent surgical therapy for fungal infections of the central nervous system (CNS) between 1964 and 1984 are summarized. Nine different fungal types were identified, but Coccidioides immitis and Cryptococcus neoformans accounted for most (67.1%) of the infections. A variety of clinical syndromes were seen, including chronic basal meningitis (45 patients), intracranial mass lesions (12 patients), and communicating hydrocephalus (six patients). Thirteen patients had rhinocerebral forms of fungal infection, and two presented with spinal involvement. Delays in diagnosis were frequent and ranged from 2 months to 11 years. In 31 patients the CNS lesion was the first indication of a fungal infection, and lesion biopsy or cerebrospinal fluid (CSF) examination confirmed the diagnosis. A total of 144 surgical procedures were carried out, including lesion biopsy or excision in 13 patients, primary CSF shunting in 22, and placement of an Ommaya reservoir for administration of intraventricular or intracisternal antifungal agents in 48. All patients received parenteral and, in some cases, intrathecal or oral antifungal chemotherapy in addition to surgical therapy. Overall mortality was 43.6% (34 deaths). With prompt diagnosis and treatment, the mortality rate was 39% whereas, when appropriate treatment was delayed, the mortality rate was 64%. An additional 14 surviving patients (17.9%) exhibited permanent morbidity due to neurological deficits, seizure disorders, or renal toxicity following treatment with amphotericin B. The combined mortality and morbidity rate was 62.8%. Clinical symptoms were resolved completely in 29 patients, although in 10 evidence of disease persisted and chemotherapy was continued. Fungal infections of the CNS are being recognized with increased frequency. It is suggested that a high index of suspicion, aggressive attempts to obtain a diagnosis, and early and vigorous therapy may reduce the unfortunate outcome seen in a relatively high proportion of patients with CNS fungal infections.
Carotid endarterectomy
Authors: Tippett Troy M. , Sisco Alton B. , Chapleau Charles E.
Published: May 2009

✓ The authors have reviewed 150 consecutive carotid endarterectomies in 140 patients performed by three neurosurgeons. These were performed in two small community hospitals. There was an overall mortality rate of 1.3%; major or minor stroke was seen in 2.7% of patients and transient neurological dysfunction in 2.7%. Preoperative symptoms included major or minor stroke in 39.3% of patients and transient neurological dysfunction in 43.3%; 17.3% of patients were asymptomatic. The patients were continuously monitored intraoperatively with electroencephalography. There were two operative deaths, both related to myocardial infarction and both on the 2nd postoperative day. These statistics appear to compare favorably with those of series reported by major institutions. The average number of carotid endarterectomies per surgeon per year was 10. These were performed over a 7-year period (October, 1976, through November, 1983). Previous series have implied the need for higher frequency in performing the procedure to assure low morbidity and mortality rates. This series appears to offer evidence to the contrary. A key to these results has been that in 148 of the 150 operations, the primary surgeon has been assisted by one of the other two neurosurgeons. This affords the primary surgeon the benefit of excellent technical assistance, and also broadens the experience of the assisting surgeon, thereby allowing maximum experience from the small volume of cases.
A Phase I trial of naloxone treatment in acute spinal cord injury
Authors: Flamm Eugene S. , Young Wise , Collins William F. , Piepmeier Joseph , Clifton Guy L. , Fischer Boguslav
Published: May 2009

✓ Results of a Phase I trial of the opiate antagonist naloxone for treatment of patients with acute spinal cord injury are reported. Naloxone was administered in doses ranging from 5 to 200 mg/sq m (0.14 to 5.4 mg/kg) for up to 48 hours. The patients ranged in age from 16 to 79 years (mean 37 years). Twenty patients received naloxone as a loading dose of 5 to 50 mg/sq m (0.14 to 1.43 mg/kg), followed by a maintenance dose of 20% of the loading dose given as a continuous infusion hourly for 47 hours (Group 1). Nine patients received a loading dose of 100 to 200 mg/sq m (2.7 to 5.4 mg/kg) and a maintenance dose of 75% of the initial dose hourly for 23 hours (Group 2). These higher doses (2.7 to 5.4 mg/kg) have been found to be effective in experimental spinal cord injury. Neurological examinations were performed and somatosensory evoked potentials (SEP's) were obtained as soon after admission as possible and again 1, 2, 3, and 7 days, 3 weeks, and 6 weeks to 6 months after admission.

The 20 Group 1 patients who received 1.43 mg/kg or less of naloxone showed no improvement in neurological status or SEP's. All but three (15%) of these patients had a complete neurological deficit at the time of admission. Treatment was begun an average of 12.9 hours after injury. Among the nine Group 2 patients treated with 2.7 mg/kg or more, there were five patients (56%) with incomplete deficits. This group received naloxone an average of 6.6 hours after admission. Two of the five Group 2 patients with incomplete lesions showed improvement in their neurological condition and/or SEP's within 36 hours of receiving the drug. One of the four Group 2 patients with a complete lesion at the time of admission was able to localize pressure sensation in his legs 36 hours after completion of the drug infusion. Four Group 2 patients (two with complete and two with incomplete lesions) have shown improvement in their SEP's, suggesting recovery of SEP's in a dose-related fashion. Four patients experienced increased pain after administration of the loading dose and during the maintenance infusion; in only one patient was this severe enough to require discontinuation of the drug. Of the 29 patients treated with naloxone, four died within 6 weeks of admission, for a mortality rate of 13.8%.

This study demonstrates that, in spinal cord-injured patients, naloxone given as an intravenous loading dose of 200 mg/sq m, followed by a continuous infusion of up to 150 mg/sq m/hr for 23 hours, has minimal side effects. The observed improvement in the clinical examination and SEP's at the higher doses, while not statistically verified in this Phase I trial, is encouraging.
Fluid balance and secretion of antidiuretic hormone following transsphenoidal pituitary surgery
Authors: Whitaker Stephen J. , Meanock Colin I. , Turner Gillian F. , Smythe Patricia J. , Pickard John D. , Noble Alan R. , Walker Valerie
Published: May 2009

✓ Hyponatremia developing some days after transsphenoidal pituitary adenectomy is a treacherous complication of uncertain cause. Of 19 patients monitored in a pilot study at the Wessex Neurological Centre, plasma sodium fell below 125 mmol/liter in three patients at times ranging from 6 to 9 days postoperatively. One patient had evidence of inappropriate secretion of arginine vasopressin (AVP), and the other two probably had steroid insufficiency despite apparently adequate steroid cover. In a more detailed study, the fluid and sodium balance of a further 16 patients was monitored for 7 to 11 days following transsphenoidal surgery together with plasma cortisol, renin, and AVP concentrations. No patient became severely hyponatremic. Three developed partial diabetes insipidus. Two patients with Cushing's disease had evidence of postoperative corticosteroid insufficiency despite normal steroid protection. An inappropriately low plasma cortisol concentration was recorded in both. Plasma AVP concentrations did not show a delayed surge postoperatively. Delayed hyponatremia appears to occur most often in patients with hypoadrenalism, as glucocorticoid cover is decreased. It results from water retention combined with natriuresis, and is reversed by glucocorticoid treatment.
Barrier disruption in the major cerebral arteries following experimental subarachnoid hemorrhage
Authors: Sasaki Tomio , Kassell Neal F. , Yamashita Masanori , Fujiwara Shigeru , Zuccarello Mario
Published: May 2009

✓ The effects of experimental subarachnoid hemorrhage (SAH) on the blood-arterial wall barrier in the major cerebral arteries were studied in 20 normotensive dogs. Horseradish peroxidase (HRP) was given intravenously before the animals were sacrificed to assess the integrity of the barrier. Transient elevation of intracranial pressure (ICP) produced by cisternal injection of saline solution resulted in HRP leakage at the branching points of the major cerebral arteries. Extensive disturbance of the blood-arterial wall barrier was consistently observed in the major cerebral arteries after SAH, with or without elevation of ICP. These results suggest that both subarachnoid clot and a sudden rise in the ICP are important factors causing the breakdown of the blood-arterial wall barrier, but that the effect of the clot is the most profound. Electron microscopy revealed that opening of the interendothelial junctions is one of the important mechanisms responsible for the HRP leakage in the major cerebral arteries following SAH. Disturbance of arterial permeability in the major cerebral arteries following SAH probably accounts for the abnormal post-contrast enhancement that occurs in patients who are prone to develop vasospasm following aneurysm rupture, and is probably involved in the pathogenesis of vasospasm.
Ventriculoperitoneal shunt malfunction during pregnancy
Authors: Hanakita Junya , Suzuki Takanori , Yamamoto Yoshisuke , Kinuta Yuji , Nishihara Kiyoshi
Published: May 2009

✓ Malfunction of a ventriculoperitoneal shunt is reported in a 25-year-old woman at 32 weeks of gestation. Pregnancies and delivery in women with cerebrospinal fluid shunts are rarely reported, and malfunction of a shunt system during pregnancy is extremely unusual.
The human tail: a benign stigma
Authors: Spiegelmann Roberto , Schinder Edgardo , Mintz Mordejai , Blakstein Alexander
Published: May 2009

✓ Thirty-three cases of true human tails have been reported in the modern English literature. A new case is described and its radiological and pathological features are presented. A review of the literature and analysis of the pathological characteristics of this interesting lumbosacral stigma indicate that the true human tail is a benign condition not associated with any underlying cord malformation.
Fibrosis surrounding a silicone implant simulating recurrent orbital meningioma
Authors: Abla Adnan A. , Maroon Joseph C. , Kennerdell John S. , Deeb Ziad L.
Published: May 2009

✓ A patient with the preoperative diagnosis of recurrent orbital apical meningioma was found to have a fibrotic capsule surrounding a silicone plate implanted 3 years previously to reconstruct the orbital roof. Caution is urged in using alloplastic orbital implants for reconstructive purposes in patients undergoing orbital surgery, because associated fibrous capsule formation may mimic tumor recurrence.
Electron microscopic diagnosis of cerebral toxoplasmosis
Authors: Cerezo Lizardo , Alvarez Marcelino , Price George
Published: May 2009

✓ Rapid and specific diagnosis of infections involving patients with acquired immunodeficiency syndrome (AIDS) is imperative. Toxoplasmosis is one of the most frequent causes of central nervous system disease in these patients. The authors present a case of cerebral toxoplasmosis in an AIDS patient, diagnosed by electron microscopy of brain biopsy tissue using rapid techniques.
Odontoid upward migration in rheumatoid arthritis
Authors: Menezes Arnold H. , VanGilder John C. , Clark Charles R. , El-Khoury George
Published: May 2009

✓ Lack of correlation between the severity of rheumatoid subluxation of the upper cervical vertebrae and supposed absence of neurological damage has led to the erroneous supposition that this finding is innocuous. Incomplete autopsy studies in rheumatoid arthritis have failed to recognize the cause of death, despite previously proven dramatic occipito-atlanto-axial dislocations. The most feared entity of rheumatoid basilar invagination, namely “cranial settling,” is poorly understood. Between 1978 and 1984, the authors treated 45 rheumatoid arthritis patients who were symptomatic with “cranial settling.” This consisted of vertical odontoid penetration through the foramen magnum (9 to 33 mm), occipito-atlanto-axial dislocation, lateral atlantal mass erosion, downward telescoping of the anterior arch of C-1 on the axis, and rostral rotation of the posterior arch of C-1 producing ventral and dorsal cervicomedullary junction compromise.

Cervicomedullary junction dysfunction has mistakenly been called “entrapment neuropathy,” “progression of disease,” or “vasculitis.” Occipital pain occurred in all 45 patients, myelopathy in 36, blackout spells in 24, brain-stem signs in 17, and lower cranial nerve palsies in 10. Four patients had prior tracheostomies. Four previously asymptomatic patients with “cranial settling” presented acutely quadriplegic.

The factors governing treatment were reducibility and direction of encroachment determined by skeletal traction and myelotomography. Transoral odontoidectomy was performed in seven patients with irreducible pathology. All patients underwent occipitocervical bone fusion (with C-1 decompression if needed) and acrylic fixation. Improvement occurred during traction, implying that compression might be the etiology for the neurological signs. There were no complications. Thus, “cranial settling” is a frequent complication of rheumatoid arthritis; although it is poorly recognized, it has serious implications and is treatable.
Evaluation of acute nonpenetrating cervical spinal cord injuries with CT metrizamide myelography
Authors: Allen Robert L. , Perot Phanor L. , Gudeman Steven K.
Published: May 2009

✓ Computerized tomography metrizamide myelography was performed in 46 patients with acute, nonpenetrating cervical spinal cord injuries. By visualizing the spinal canal, spinal cord, and any compressive lesion, the study proved valuable in the decision as to whether surgical decompression was indicated and what approach should be used. Eleven patients were found to have significant spinal cord compression, 10 of whom were treated surgically. The technique, results, and complications resulting from the study are discussed.
Results of extracranial-intracranial arterial bypass for bilateral carotid occlusion
Authors: El-Fiki Mohamed , Chater Norman L. , Weinstein Philip R.
Published: May 2009

✓ The results of superficial temporal to middle cerebral artery bypass surgery for bilateral internal carotid artery occlusion were reviewed in 39 patients. Preoperative symptoms included recurrent transient ischemic attacks (TIA's) in 31 patients (80%) and mild or moderate stroke in 15 (29%). Deficits were unilateral in 23 cases and bilateral in 14. Dementia or personality changes were observed in 19 patients (49%). Operative morbidity occurred in six of 39 cases and was neurological in one; the surgical mortality rate was 8% (three of 39 patients), including two cases of cerebral hemorrhage. The outcome was good or excellent (relief of TIA's and reduction of neurological deficit) in 82% of patients over a follow-up period of 3 to 139 months. Five patients had a late postoperative stroke, which occurred in the unoperated hemisphere in each case; one patient had an ipsilateral TIA 6 years after the bypass procedure. These results suggest that an extracranial-intracranial arterial bypass procedure to augment collateral cerebral blood flow can be performed safely in patients with bilateral internal carotid artery occlusion and may be associated with relief of ischemic symptoms. Future studies may document a role for this procedure in the prevention of stroke.
Skull metastasis of thyroid carcinoma
Authors: Nagamine Yoshihide , Suzuki Jiro , Katakura Ryuich , Yoshimoto Takashi , Matoba Naoya , Takaya Kiyoshi
Published: May 2009

✓ Over the past 33 years the authors have treated 12 cases of skull metastasis from thyroid carcinoma, accounting for 2.5% of a total of 473 cases of thyroid cancer. A study of these 12 cases revealed the following characteristics. 1) The mean age of the patients was 60.4 years and the predominant incidence was in the seventh decade of life. 2) The incidence of skull metastasis from thyroid cancer was higher among women than among men. 3) The primary sign was a soft hemispheric tumor resting on the skull. 4) The tumors were rich in vascularity with osteolytic changes in the skull. 5) The average period from diagnosis of the thyroid tumor until thyroidectomy was 14.3 years, and until discovery of the skull metastasis was 23.3 years. The clinical course was thus very long. 6) The most frequent histopathological presentation was follicular adenocarcinoma. Such lesions were morphologically well differentiated, with little pleomorphism and atypism, but detailed examination showed infiltration into the vascular lumen or capsule. 7) The mean survival time in these patients was 4.5 years from the time of diagnosis. The prognosis in this lesion was relatively poor, considering its long clinical course.
Pneumocephalus in patients with CSF shunts
Authors: Ruge John R. , Cerullo Leonard J. , McLone David G.
Published: May 2009

✓ The authors present two cases of pneumocephalus occurring in patients with permanent shunts and review nine previously reported cases. Mental status changes and headache are the most common presenting symptoms. Six of the 11 cases of pneumocephalus occurred in patients with shunt placement for hydrocephalus secondary to aqueductal stenosis. In these patients, thinned cerebrospinal fluid barriers secondary to longstanding increased intracranial pressure may predispose them to pneumocephalus. Temporary extraventricular drainage is an effective method of treatment in this group of patients. Two other etiologies are identified with significance to treatment, and the role of craniotomy is discussed.
Survival times and case fatality rates of brain-injured persons
Authors: Kraus Jess , Conroy Carol , Cox Pamela , Ramstein Karen , Fife Daniel
Published: May 2009

✓ Survival time after injury (the time from injury to death) imposes an important constraint on the timing of the delivery of postinjury medical care. From a population-based study of brain-injured people, the survival times in 542 cases with fatal outcomes were studied. Prehospital deaths as well as hospital deaths were included.

Survival times were considerably shorter for 95 people with untreatable injuries (Abbreviated Injury Scale level 6) than for the remaining 447 whose injuries were potentially treatable. For the former group, the median survival time was 10 minutes; for the latter, it was 2 hours. For those with potentially treatable injuries, the median time from injury to receiving medical assistance was approximately 30 minutes and 82% received medical assistance within 1 hour of injury. Short survival time was associated with prehospital death, young age, high Injury Severity Score, and having a nonbrain injury as the most severe injury. For patients who arrived alive at a hospital, intracranial surgery was associated with increased survival time.
Brain blood volume and blood flow in patients with plateau waves
Authors: Hayashi Minoru , Kobayashi Hidenori , Handa Yuji , Kawano Hirokazu , Kabuto Masanori
Published: May 2009

✓ Plateau waves, characterized by acute transient rises of the intracranial pressure (ICP), are accompanied by a marked decrease of the cerebral perfusion pressure. Patients with plateau waves, however, often show no clinical symptoms of ischemia of the brain stem, such as vasopressor response or impairment of consciousness during the waves. The authors studied brain blood volume and blood flow with dynamic computerized tomography using rapid-sequence scanning in patients with plateau waves identified during continuous ICP recording. Following an intravenous bolus injection of contrast medium, density-versus-time curves were obtained for the regions of interest; that is, the frontal lobe, the temporal lobe, the caudate nucleus, the putamen, and the pons. The dynamic studies were undertaken when the ICP was high during a plateau-wave phase and when it was low during an interval phase between two plateau waves. The results indicate that, in the cerebral hemisphere (frontal lobe, temporal lobe, caudate nucleus, and putamen), plateau waves were accompanied by an increase in blood volume and, at the same time, a decrease in blood flow. In the pons, however, both the blood volume and blood flow showed little change during plateau waves as compared with the intervals between two plateau waves. These observations may explain why there is no rise in the systemic blood pressure and why patients are often alert during plateau waves.
Thymidine kinase in brain-tumor cysts
Authors: Persson Lennart , Boethius Jörgen , Gronowitz J. Simon , Källander Claes , Lindgren Lars
Published: May 2009

✓ A recently developed method for deoxythymidine kinase (TK) determination was applied to brain-tumor cyst fluid and fluid from a non-neoplastic intracerebral cyst. The fluid from all tumors tested positive for TK whereas the non-neoplastic cyst lacked TK. Cyst fluid was also analyzed for TK before and after intracystic instillation of BCNU. It is suggested that TK activity in the fluid in cystic brain lesions could prove useful in deciding whether an intracerebral lesion is neoplastic. Also, TK activity can be used to evaluate the effect of topical therapy.
Clinical evaluation of two methods of subdural pressure monitoring
Authors: Barlow Philip , Mendelow A. David , Lawrence Audrey E. , Barlow Marion , Rowan John O.
Published: May 2009

✓ Recordings from two different types of subdural pressure monitor with simultaneous intraventricular pressure (IVP) tracings are compared in 20 head-injured patients. In the first 10 patients a fluid-filled catheter was placed subdurally and connected to an external transducer, and in the second 10 the Gaeltec model ICT/b solid state miniature transducer was used. The latter system has the advantage that both zero and calibration checks can be carried out after insertion. Only 44% of the fluid-filled catheter readings corresponded with IVP in series of 10-mm Hg ranges, while 53% of readings were lower; this tendency was more marked at higher pressures. With the Gaeltec transducer, 72% of subdural pressure readings corresponded with IVP, while only 9% were lower and 19% were higher than IVP. The differences may have been due to technical causes or to true pressure differentials. The subdural catheter appears too unreliable for routine clinical use, but the Gaeltec transducer may be a satisfactory alternative to ventricular pressure monitoring.
ACNU-resistant mutants of 9L rat glioma cell line
Authors: Kokunai Takashi , Tamaki Norihiko , Matsumoto Satoshi
Published: May 2009

✓ Three ACNU-resistant subclones were isolated and characterized from a wild-typed 9L rat glioma cell line in culture. At an early stage after cloning, these ACNU-resistant subclones showed a high frequency of chromosomal aberrations compared with nonresistant 9L cells. These ACNU-resistant subclones revealed a cross resistance to BCNU, CCNU, methyl CCNU, nitrogen mustard, cyclophosphamide, and cis-platinum, which are alkylating agents. Further studies are necessary to clarify the mechanisms of ACNU-resistance from the aspect of repair of DNA alkylation damage.
The risk of cerebral damage during graded brain retractor pressure in the rat
Authors: Rosenørn Jarl , Diemer Nils
Published: May 2009

✓ A considerable reduction in regional cerebral blood flow has been demonstrated with brain retraction at a pressure of 30 mm Hg. The authors undertook a neuropathological study to assess the effect on brain tissue of brain retractors applied at varying pressures for 15 minutes. The following changes were found: after 20 mm Hg of brain retractor pressure (BRP) only one of six brains revealed infarction involving all cortical layers; after 30 mm Hg of BRP cortical infarction, partly hemorrhagic, was found in five of six brains; after 40 mm Hg of BRP all six animals showed cortical damage. There were no signs of cerebral damage outside the retractor application area or in deeper brain structures. It was concluded that only if BRP did not exceed 20 mm Hg for 15 minutes could damage be avoided in this model.
Accessory nerve palsy following carotid endarterectomy
Authors: Swann Karl W. , Heros Roberto C.
Published: May 2009

✓ Two patients who had an accessory nerve palsy following carotid endarterectomy are presented. Both patients had high carotid bifurcations necessitating unusually high retraction and dissection. The ipsilateral accessory nerve was injured in the anterior cervical triangle in both cases. It is believed that vigorous lateral retraction of the superior aspect of the sternocleidomastoid muscle led to a stretch injury of the nerve. The symptoms completely resolved in both patients within 6 months.
Chronic spinal subdural hematomas
Authors: Khosla Virender K. , Kak Vijay K. , Mathuriya Suresh N.
Published: May 2009

✓ Two patients with chronic spinal subdural hematomas are described. Both had a fluctuating clinical course, not previously documented in the literature. Surgical evacuation resulted in almost complete recovery. The pathogenesis of spinal subdural hematoma is discussed and the pertinent literature is reviewed.
Neoplastic cerebral aneurysm from metastatic gestational choriocarcinoma
Authors: Pullar Michael , Blumbergs Peter C. , Phillips Gael E. , Carney Paul G.
Published: May 2009

✓ This case of metastatic gestational choriocarcinoma presented as intracerebral hemorrhage from an atypical distal middle cerebral artery aneurysm. Operative evacuation of the intracerebral hematoma was undertaken and histopathological examination revealed choriocarcinoma invading the vessel wall. Neoplastic cerebral aneurysms are unusual, being reported in metastatic choriocarcinoma, cardiac myxoma, bronchogenic carcinoma, and undifferentiated carcinoma. Metastatic choriocarcinoma should be considered in the differential diagnosis of intracerebral hemorrhage in women of child-bearing age. Recent advances in treatment have resulted in a 75% cure rate for metastatic choriocarcinoma.
Eicosanoids in the central nervous system
Authors: Leslie John B. , Watkins W. David
Published: May 2009

✓ All mammalian tissue investigated to date is capable of eicosanoid biosynthesis in response to various activating stimuli. While the importance of these metabolites as major mediators of many normal physiological processes and some pathophysiological conditions has not been proven, it is evident that these compounds are at least important modulators of many cellular and organ system functions. This review is intended to provide the reader with a brief overview of eicosanoid biology, with specific reference to the neurosciences. The increasing knowledge about the role of the eicosanoids in neurobiology may contribute to the understanding and treatment of many neurological diseases.

The eicosanoids comprise several groups of biologically active unsaturated fatty acids: the “primary” prostaglandins, the cyclic endoperoxides, the prostanoids, the leukotrienes, and other acid lipids. This article includes a review of the enzymatic pathways of biosynthesis and metabolism of eicosanoids in man, and the pertinent structural nomenclature. The general basic and clinical pharmacological effects of the more important compounds on vascular perfusion, platelet function, intracellular enzyme activity, and interactions with other mediators of cellular activity are reviewed. A more detailed review of the actions of eicosanoids as mediators or modifiers of central nervous system physiology and pathophysiology is presented. Recent animal and human studies on the use and alterations of the eicosanoid metabolites is summarized, specifically where they relate to several clinical problem areas of interest to the neurosurgeon and neurobiologist. These areas include cerebrovascular circulation physiology, cerebral ischemia, cerebral vasospasm following subarachnoid hemor-rhage, migraine headaches, hypothalamic function, neurotransmission, and nociception. A bibliography of 92 articles for further review is also included.
Astrocytomas of the spinal cord in children and adolescents
Authors: Reimer Ronald , Onofrio Burton M.
Published: May 2009

✓ The authors review 32 cases of spinal cord astrocytoma in patients under 20 years of age who were treated at the Mayo Clinic between 1955 and 1980. There was a 1.3:1 male to female ratio. Twenty patients were between 6 and 15 years of age at the time of diagnosis. The duration of symptoms prior to definitive diagnosis varied from 5 days to 9 years, with an average of 24 months. The most common symptoms were pain (62.5%), gait disturbance (43.7%), numbness (18.8%), and sphincteric dysfunction (18.8%). The most common neurological findings were a Babinski response (50.0%), posterior column sensory dysfunction (40.6%), and paraparesis (37.5%). A median follow-up period of 8.6 years (range 0.8 to 25.5 years) revealed that the survival time diminished with increased histological grade of the astrocytoma (p < 0.001).

The development of postlaminectomy spinal deformities represented a serious postoperative complication. This occurred in 13 patients and was first recognized between 8 and 90 months postoperatively. Six deformities occurred following cervical laminectomy, and eight patients required at least one orthopedic procedure. It is crucial to follow these patients for an extended period of time to watch for postoperative spinal deformities.
Aneurysmal bone cysts of the spine
Authors: Ameli Nosrat O. , Abbassioun Kazem , Saleh Hossein , Eslamdoost Ahmad
Published: May 2009

✓ Seventeen cases of aneurysmal bone cyst of the spine are reported. Clinical manifestations, methods of investigation, differential diagnosis, treatment, and pathogenesis are discussed. The condition is essentially a benign lesion, affects a young age group, and grows rapidly, often producing a paravertebral mass. Occasionally it becomes acutely exacerbated, causing irreversible damage to the spinal cord. For these reasons, prompt diagnosis and timely treatment are important. Excision of the lesion is the treatment of choice but, if not feasible, thorough curettage and radiotherapy not exceeding 2000 rads are indicated. With a two-stage operation, excision of the lesion is often possible, and the stability of the vertebral column is assured with bone-graft fusions.
Dipyridamole and postoperative ischemic deficits in aneurysmal subarachnoid hemorrhage
Authors: Shaw Malcolm D. M. , Foy Patrick M. , Conway Michael , Pickard John D. , Maloney Peter , Spillane John A. , Chadwick David W.
Published: May 2009

✓ Recent evidence has suggested that the delayed cerebral ischemic deficits that often follow surgery for aneurysmal subarachnoid hemorrhage (SAH) may be due to a proliferative vasculopathy. This vascular pathology may result from an interaction between the platelets and the vessel wall. A single-blind controlled trial of dipyridamole administration in 677 patients presenting with SAH (of whom 348 came to surgery) was undertaken to test the hypothesis that the modification of platelet behavior might reduce the incidence of ischemic deficits. Blind independent assessment of the outcome in the surgical group based on the Glasgow Outcome Scale and the specific neurological deficits revealed no significant differences between the control and treatment groups.
Methylprednisolone and neurological function 1 year after spinal cord injury
Authors: Bracken Michael B. , Shepard Mary Jo , Hellenbrand Karen G. , Collins William F. , Leo Linda S. , Freeman Daniel F. , Wagner Franklin C. , Flamm Eugene S. , Eisenberg Howard M. , Goodman Joseph H. , Perot Phanor L. , Green Barth A. , Grossman Robert G. , Meagher John N. , Young Wise , Fischer Boguslav , Clifton Guy L. , Hunt William E. , Rifkinson Nathan
Published: May 2009

✓ A multi-center double-blind randomized clinical trial was conducted by the National Acute Spinal Cord Injury Study Group to examine the efficacy of high-dose methylprednisolone (1000-mg bolus and 1000 mg daily thereafter for 10 days) compared with that of a standard dose (100-mg bolus and 100 mg daily for 10 days). No significant difference was observed in neurological recovery of motor function, pinprick response, or touch sensation 1 year after injury between the two treatment groups, after adjustment for other potentially confounding factors. Analyses that specifically took into account the patients' total steroid dose and relative weight confirmed the lack of a steroid treatment effect. The case fatality rate was 10.7% during the 1st year after injury, and this was not associated with the steroid treatment protocol or the patient's gender. Deaths did occur significantly more frequently among patients who were completely (15.3%) and partially (8.6%) plegic than among those who were paretic (2.5%, p = 0.0005), and among patients aged 50 years or older (38.6%, p = 0.0001).
Steroid administration and nitrogen excretion in the head-injured patient
Authors: Robertson Claudia S. , Clifton Guy L. , Goodman J. Clay
Published: May 2009

✓ The effect of steroid administration on metabolic rate and nitrogen excretion was examined in 20 head-injured patients alternately assigned to receive either methylprednisolone for 14 days or no steroid treatment. Although metabolic rate, caloric intake, and nitrogen intake were not different between the two groups, the patients who received steroids had a 30% higher excretion of nitrogen during the first 6 days after injury than did the patients not receiving steroids. All patients had an increase in nitrogen excretion through the 2nd week, peaking on Day 11. By Day 21 after injury, the patients had an average cumulative nitrogen loss of 162 gm and had lost an average of 5 kg body weight regardless of whether they had received steroids. Serum albumin levels decreased in the steroid-treated patients but returned to nearly normal by Day 21 in the untreated group. Immunosuppression, evidenced by a lower initial total lymphocyte count and a higher incidence of infections, was present in the steroid group; hyperglycemia requiring insulin treatment was more common in those patients.
Immunohistochemical study of placental alkaline phosphatase in primary intracranial germ-cell tumors
Authors: Shinoda Jun , Miwa Yoshiaki , Sakai Noboru , Yamada Hiromu , Shima Hiroto , Kato Kazuo , Takahashi Masayoshi , Shimokawa Kuniyasu
Published: May 2009

✓ Indirect immunoperoxidase staining by the peroxidase-antiperoxidase (PAP) technique was carried out on 23 human primary intracranial germ-cell tumors (17 germinomas, one embryonal carcinoma, one yolk-sac tumor, three teratomas, and one teratoma with embryonal carcinoma) and on six human primary pineal nongerm-cell tumors (one pineocytoma, two pineoblastomas, two astrocytomas, and one glioblastoma multiforme). The technique used specific rabbit antisera against placental alkaline phosphatase (PLAP), alpha-fetoprotein (AFP), and human chorionic gonadotropin (HCG). Thirteen of 17 intracranial germinomas (76.5%) showed positive staining for PLAP mainly on the tumor cell membrane. In six primary intracranial non-seminomatous germ-cell tumors, there was weak positive staining indicating the presence of PLAP in only a few cells of one embryonal carcinoma, and in some glandular epithelial cells of one teratoma; this staining was limited to the cytoplasm. None of the other six primary pineal non-germ-cell tumors showed any positive PLAP reaction. From these results, PLAP was shown to be very useful in histopathology as a diagnostic tumor marker of intracranial germinoma.

Positive AFP staining was seen in several yolk-sac tumor cells and a few embryonal carcinoma cells. However, no intracranial germinomas and non-germ-cell tumors of the pineal region showed positive reaction. As for HCG, only one suprasellar germinoma and one pineal embryonal carcinoma among 29 specimens contained a few positive-staining tumor cells.
Anterior cervical interbody fusion with threaded cylindrical bone
Authors: Otero Vich Jose M.
Published: May 2009

✓ The author describes some modifications of the original Cloward method of cervical intervertebral body fusion. These modifications include the intraoperative threading of the standard cylindrical graft dowel (either autologous or heterologous) and the development of two new instruments designed to insert the graft into the intervertebral space. This modified technique was tested in an experimental study using the cervical spine of cadavers, after which a series of 37 patients were operated on with this method. The results of both series are presented. The chief advantages of this type of interbody fusion over the standard technique are: 1) easier insertion of the graft into the intervertebral space; and 2) decrease in complications. Complications with cervical interbody fusion, both minor (such as partial displacement of the graft, vertebral angulation, and radicular injury) and major (such as spinal cord compression and/or contusion), are fortunately infrequent, but they are important because of their irreparable consequences.
Neuronal effects of experimentally induced hydrocephalus in newborn rats
Authors: McAllister James P. , Maugans Todd A. , Shah Mitseh V. , Truex Raymond C.
Published: May 2009

✓ To determine the effects of increased cerebrospinal fluid (CSF) pressure on neuronal morphology, obstructive hydrocephalus was induced by injecting kaolin into the fourth ventricle and cisterna magna of 1-day-old rats. The animals were sacrificed 10 to 12 days later, at which time severe ventriculomegaly and cortical thinning were apparent in the parieto-occipital region. Tissue from this area was processed by rapid Golgi methods. Well impregnated pyramidal neurons were examined by light microscopy, and their somatic and dendritic features compared to those of age-matched littermate controls. The somata of medium pyramidal neurons were unaffected, but their basilar dendrites had fewer branches and those that remained were shorter. A variable reduction in dendritic spines occurred, such that some branches were totally denuded while others exhibited spine densities similar to those seen in control animals. The most striking alteration was the occurrence of frequent dendritic varicosities. These enlargements of the dendritic shaft separated by extremely thin constrictions gave the affected segment a beaded appearance. Both dendritic spine loss and varicosity formation were most notable on distal portions of individual branches and within regions of the dendritic tree closest to the ventricular and meningeal surfaces. These alterations are consistent with other reports of dendritic changes associated with aging, mental retardation, and alcohol exposure. These observations suggest that hydrocephalus causes dendritic deterioration or retardation of dendritic maturation. The fact that neuronal morphology was not more severely affected may indicate that these effects are reversible.
Spasmodic torticollis due to neurovascular compression of the 11th nerve
Authors: Pagni Carlo A. , Naddeo Michele , Faccani Giuliano
Published: May 2009

✓ An unusual case of spasmodic torticollis caused by posteroinferior cerebellar artery compression of the spinal accessory nerve is reported. The spasmodic torticollis was cured by abolishing the neurovascular compression.
Cystic cavernous angiomas of the posterior fossa
Authors: Bellotti Carlo , Medina Massimo , Oliveri Giuseppe , Barrale Salvatore , Ettorre Francesco
Published: May 2009

✓ Three histologically verified cases of cystic cavernous angioma of the posterior fossa are reported. The clinical history of these patients is presented, and the diagnostic and surgical problems arising from the extreme rarity of the combination of cerebellar site and cystic nature of the lesion are discussed.
Frontal sinus approach to the orbit
Authors: Colohan Austin R. T. , Jane John A. , Newman Steven A. , Maggio William W.
Published: May 2009

✓ The authors have previously advocated a supraorbital approach to tumors of the orbit. In this paper, they describe a technique in which they take advantage of a large frontal sinus as a means of entering the orbit without the necessity of intracranial exposure, as required by the more conventional supraorbital approach. This is achieved without frontal burr holes, allowing for a superior cosmetic result. The anterior wall of the frontal sinus is removed, and with it the roof of the orbit as a single bone flap. A case in which this technique was used is described.
Anterior osteophytectomy for cervical spondylotic myelopathy in developmentally narrow canal
Authors: Kadoya Satoru , Nakamura Tsutomu , Kwak Ryungchan , Hirose Genjiro
Published: May 2009

✓ The authors present 19 cases of cervical spondylotic myelopathy in patients with developmentally narrow canal treated by microsurgical anterior osteophytectomy with interbody fusion, with follow-up periods of 1 to 8 years (mean 38 months). Postoperatively, the lower limb function, evaluated by Nurick's six-grade classification, improved two or three grades in 16 cases, one grade in two cases, and remained unchanged in one case. The upper limb function, evaluated by the authors' own four-grade classification, improved two or three grades in 11 cases, one grade in seven cases, and remained unchanged in one case. No deterioration caused by the osteophytectomy was seen. During the follow-up period, spondylolisthesis appeared 31 months postoperatively in one patient and soft disc hernia occurred 66 months postoperatively in another; these two patients were treated by a second operation and cervical traction, respectively. The authors conclude that anterior osteophytectomy with interbody fusion is applicable as a surgical treatment of cervical spondylotic myelopathy even where developmental canal stenosis is present.
Transpetrosal approach for aneurysms of the lower basilar artery
Authors: Kawase Takeshi , Toya Shigeo , Shiobara Ryuzo , Mine Toru
Published: May 2009

✓ Extradural subtemporal access to the petrosal ridge and a resection of the anterior pyramidal bone produced direct observation of the lower basilar artery, with minimum retraction of the temporal lobe and preservation of the temporal bridging veins. Two patients, with lower basilar trunk aneurysms facing toward the brain stem, were operated on by the “transpetrosal approach,” with successful clipping of the aneurysms. Auditory function was preserved in one case. This approach decreases the possibility of retraction damage to the temporal lobe, brain stem, or cranial nerves, and may be helpful for surgery of aneurysms arising around the vertebrobasilar junction or at the origin of the anterior inferior cerebellar artery.
The rationale and methodology for intra-arterial chemotherapy with BCNU as treatment for glioblastoma
Authors: Hochberg Fred H. , Pruitt Amy A. , Beck Deborah O. , DeBrun Gerard , Davis Kenneth
Published: May 2009

✓ The rationale for, methodology of, and experience with intra-arterial BCNU infusion therapy of malignant glioma are described. This approach achieves tumor levels of drug four times greater than equal doses infused intravenously, and has been used to treat 79 patients over the course of 4 years. The drug was given in 192 infraophthalmic and 66 supraophthalmic carotid artery infusions. Patients who were treated via infraophthalmic carotid artery infusion following tumor recurrence (after both operation and irradiation) survived 54 additional weeks (92 weeks after initial diagnosis). Patients who were treated with BCNU immediately after initial irradiation therapy survived 64 weeks (infraophthalmic carotid artery infusion) and 49.5 weeks (supraophthalmic carotid artery infusion). The major ocular complications (pain and diminished visual acuity) associated with infraophthalmic carotid artery infusion are avoided by selective balloon-guided supraophthalmic carotid artery administration. However, both approaches were associated with white-matter changes, seen as diminished absorption on computerized tomography scans, in 20% of patients treated following irradiation therapy. This toxicity appears to preclude intra-arterial BCNU treatment in the immediate postirradiation period. Better results are being achieved with our current therapy, which involves four infusions of BCNU (400 mg every 4 weeks) into the infraophthalmic or supraophthalmic carotid artery in advance of irradiation. Cisplatin infusions (60 to 90 mg/sq m every 5 weeks) are offered for recurrent glioblastoma.