bluuebunny/crossref_metadata_2025 huggingface dataset:
Potentiation of vincristine effect in human and murine gliomas by calcium channel blockers or calmodulin inhibitors
Authors: Kaba Keizo , Tani Eiichi , Morimura Tatsuo , Matsumoto Tsuyoshi
Published: May 2009

✓ The effects of calcium channel blockers and calmodulin inhibitors on vincristine cytotoxicity were studied in vitro with five glioma cell lines: three human glioblastomas, one rat glioma, and one mouse ependymoblastoma. One human glioblastoma and the rat glioma were resistant to vincristine in contrast to other glioma cells. The resistance to vincristine was considerably decreased by nontoxic or marginally toxic concentrations of calcium channel blockers or calmodulin inhibitors, although the former was more effective than the latter. In the presence of verapamil, the vincristine cytotoxicity, as measured by cell doubling times, increased 90- and 84-fold in the vincristine-resistant human glioblastoma and rat glioma, respectively. The decrease in the resistance to vincristine was related to a marked increase in the intracellular level of that drug, probably mediated by inhibiting its outward transport. The in vivo studies showed that verapamil or nicardipine administered daily with vincristine for 10 days significantly enhanced the chemotherapeutic effect of vincristine in an intracranially transplanted rat glioma model. An approximately 32% to 118% increase in life span occurred with 15 mg/kg/day of verapamil, depending on the doses of vincristine.
Establishment of a brain-tumor model in adult monkeys
Authors: Tabuchi Kazuo , Nishimoto Akira , Matsumoto Kengo , Satoh Toru , Nakasone Susumu , Fujiwara Takashi , Ogura Hajime
Published: May 2009

✓ A brain-tumor model in adult monkeys may be significant because of the biological similarity to humans as well as the feasibility for surgical manipulation and for sequential computerized tomography (CT) scanning. In the present study, brain tumors were successfully produced in Japanese monkeys (Macaca fuscata), each weighing 2 to 10.8 kg, with an average age of 5.1 years old. Tumor cells were implanted by intracerebral inoculation of 4 × 107 chick embryo fibroblasts infected with the Schmidt-Ruppin strain of Rous sarcoma virus (RSV). With a 15- to 67-day latency, brain tumors were induced in 11 (73.3%) of 15 RSV-inoculated monkeys. Contrast-enhanced CT scans delineated all solitary intracerebral tumors greater than 4 to 6 mm in diameter. The CT images were proved at autopsy to be accurate within 2 mm in determining the size of tumor. Five of the 11 monkeys with intracerebral tumors died, with an average survival time of 26.6 days after RSV inoculation. The induced tumors were classified as either glioma or sarcoma by the presence or absence of glial fibrillary acidic protein (GFAP) and S-100 protein. A chromosome analysis of cultured tumor cells showed a diploid number of 42, indicating monkey origin. It is concluded that the reproducible brain tumor in the adult Japanese monkey inoculated with RSV can serve as a good experimental brain-tumor model for the further study of human malignant brain tumors.
Effect of hematoporphyrin derivative photoradiation therapy on survival in the rat 9L gliosarcoma brain-tumor model
Authors: Boggan James E. , Bolger Catherine , Edwards Michael S. B.
Published: May 2009

✓ Intracerebral tumors were produced in 99 rats by stereotaxic implantation of 9L gliosarcoma brain-tumor cells. Hematoporphyrin derivative (HPD), 10 or 20 mg/kg, was administered as an intravenous bolus 24 or 48 hours before irradiation of the tumor region with light from an argon pumped-dye laser (632 nm). Laser light, at a dose of 30, 60, or 200 joules/sq cm, was delivered through a craniectomy 10 or 13 days after tumor implantation. Survival times were significantly prolonged in rats exposed to laser light at a dose of 200 joules/sq cm 24 hours after administration of HPD, 20 mg/kg.
Cerebral amyloid angiopathy presenting as transient ischemic attacks
Authors: Smith Don B. , Hitchcock Michael , Philpott Peter J.
Published: May 2009

✓ Cerebral amyloid angiography can cause ischemic stroke and transient ischemic attacks (TIA's), as illustrated by this case report and literature review. It is possible that the use of anticoagulant or platelet-antiaggregant drugs in elderly patients with TIA's but no angiographic abnormalities may increase the risk of hemorrhage from unsuspected amyloid angiopathy.
Intracerebral hemorrhage due to cerebral amyloid angiopathy
Authors: Roosen Norbert , Martin Jean-Jacques , De La Porte Christian , Van Vyve Michel
Published: May 2009

✓ The case is presented of a 59-year-old man with cerebral amyloid angiopathy and three consecutive hemorrhages in the occipital lobes. The clinicopathological features and the relationship to Alzheimer's dementia are discussed. The correct treatment of intracerebral hemorrhage related to cerebral amyloid angiopathy is a matter of controversy.
Posterior fossa arteriovenous malformations
Authors: Drake Charles G. , Friedman Allan H. , Peerless Sydney J.
Published: May 2009

✓ The authors report their treatment of 66 infratentorial arteriovenous malformations (AVM's) in patients aged 5 to 69 years. Sixty-one of them presented with hemorrhage, three with headache, and two with focal neurological deficits. Five patients underwent surgical exploration only, one was treated with ventriculostomy, three had ligation of the AVM feeding arteries, four underwent intraoperative embolization, and two had pontine hematomas removed; complete excision was attempted in 51 patients and accomplished in 47. Twelve of the patients also had aneurysms (nine of which had ruptured). Of this series, 71% had a good result, 14% a poor result, and 15% died. Most of the operative morbidity was due to massive postoperative hemorrhage, probably related to inadequate hemostasis.
Transsphenoidal extracapsular approach to pituitary tumors
Authors: Hashimoto Nobuo , Handa Hajime , Yamagami Tatsuhito
Published: May 2009

✓ Two years' experience with an extracapsular transsphenoidal approach to pituitary adenomas is presented. Some pituitary tumors contain an inordinate amount of connective tissue that often makes transsphenoidal resection difficult. By opening the tumor capsule and adjacent arachnoid membrane, such tumors with suprasellar extension can be safely removed. In some cases of functioning adenoma, resection of the diaphragma sellae and adjacent arachnoid membrane results in hormonal control. Among 62 cases of transsphenoidal surgery for pituitary adenomas, eight cases required this procedure. The surgical procedure is described and the cases are summarized. The indication and limitations of this procedure are discussed.
Incidence and etiology of intracerebral hemorrhage following carotid endarterectomy
Authors: Solomon Robert A. , Loftus Christopher M. , Quest Donald O. , Correll James W.
Published: May 2009

✓ In a consecutive series of 1930 carotid endarterectomies there were eight cases of postoperative intracerebral hemorrhage. One of these patients was operated on 2 weeks following cerebral infarction and had severe uncontrollable hypertension after surgery. A second patient had an intraoperative embolus and bled while fully heparinized on the 3rd postoperative day. Only one patient in the series bled into an area of documented cerebral infarction. The remainder of the cases represented hemorrhage into essentially normal brain.

Seven of the eight patients with intracerebral hemorrhage had high-grade internal carotid artery stenosis preoperatively. Although several factors have contributed to the brain hemorrhages in this series of patients, postoperative cerebral hyperperfusion which often follows endarterectomy may have played an important role. Defective cerebrovascular autoregulation in chronically ischemic brain regions may predispose patients to intracerebral hemorrhage after removal of a high-grade stenosis of the internal carotid artery.
Surgical stabilization of traumatic cervical spine dislocation using methyl methacrylate
Authors: Duff Thomas A.
Published: May 2009

✓ Twenty-six patients with traumatic cervical spine fracture-dislocations had spinal stabilization with methyl methacrylate (acrylic) as the primary support. In most cases a ¾-in. stainless steel screw was inserted into the articular pillars of the fractured vertebra and of the two adjacent vertebrae, followed by application of the acrylic in the form of an oblong mold over the heads of the screws. The follow-up period in these 26 patients ranged from 6 months to 7 years. There were no instances of wound infection or increased neurological impairment. Vertebral elements remained aligned in 25 of the 26 patients. Breakage of the acrylic support was documented in two patients, but in only one was surgical repair required. The results of this study indicate that the procedure is a safe and effective method for both immediate and long-term stabilization of cervical spine fracture-dislocations.
CSF dynamics and pressure-volume relationships in communicating hydrocephalus
Authors: Kosteljanetz Michael
Published: May 2009

✓ Twenty-nine patients consecutively admitted with a diagnosis of communicating hydrocephalus underwent 1) continuous intracranial pressure (ICP) monitoring; 2) pressure-volume studies; and 3) measurement of resistance to outflow of cerebrospinal fluid (Rout). The two latter calculations were made by the bolus injection and pressure-volume index (PVI) techniques. In 19 patients mean ICP never exceeded 15 mm Hg. In the other 10 patients varying degrees of mildly raised ICP was noted. The frequency of waves at ½ to 2/min varied from 3% to 58%. The ICP pulse amplitude ranged from 0.5 to 10 mm Hg, and PVI from 4.6 to 18.2 ml. The Rout ranged from 2.5 to 31.4 mm Hg/ml/min, and was linearly correlated to the ICP. Thus, patients with a higher Rout also had a higher ICP as compared with patients with lower Rout, yet ICP could still be within limits considered normal. The cerebrospinal fluid dynamics (formation rate × resistance) contributed much more to the ICP than in normal individuals. It is postulated that communicating hydrocephalus represents one endpoint of a continuum, where the preceding phase is high-pressure and high-resistance hydrocephalus as, for instance, is seen after subarachnoid hemorrhage. In some patients, there is a possibility of cerebral atrophy accompanied by otherwise insignificant increased Rout. In this study, the PVI technique proved to be a fast and safe method of measuring Rout.
Spinal cord stimulation in peripheral arterial disease
Authors: Broseta Jaime , Barberá José , de Vera J. A. , Barcia-Salorio Juan Luis , Garcia-March Guillermo , González-Darder José , Rovaina Francisco , Joanes Vicente
Published: May 2009

✓ Percutaneous epidural Stimulation of the low thoracic spinal cord was carried out in 41 patients with pain from peripheral arterial disease of the lower limbs. Results are reported relating to pain, claudication distance, peripheral blood flow, and trophic lesion changes. Following a trial period of stimulation, 37 patients had stimulators permanently implanted. After a mean poststimulation follow-up period of 25 months, substantial pain relief (75% to 100%) was obtained in 29 cases; claudication distance significantly increased in 15 cases; Doppler ultrasound recordings of lower-limb distal arteries showed a tendency toward normalization of pulse-wave morphology, with increase of amplitude in 12 of the 23 patients studied; a rise in skin temperature was also detected by thermography. Distal arterial blood pressure remained unchanged with stimulation. Ischemic cutaneous trophic lesions of less than 3 sq cm healed, but gangrenous conditions were not benefited. A placebo effect or the natural history of the disease can be excluded as the reason for these improvements. It is concluded that spinal cord stimulation is a valid alternative treatment for moderate peripheral arterial disorders when direct arterial surgery is not possible or has been unsuccessful.
Effect of high-dose dexamethasone on outcome from severe head injury
Authors: Dearden N. Mark , Gibson John S. , McDowall D. Gordon , Gibson R. Myles , Cameron Malcolm M.
Published: May 2009

✓ The conflicting evidence concerning the influence of high-dose steroids on intracranial pressure (ICP) and outcome following severe head injury has led to the institution of the prospective double-blind controlled trial reported here. Severely head-injured patients admitted to intensive care during a 3-year period were randomly allocated to a dexamethasone- or placebo-treated group. Adults in the steroid group received dexamethasone, 50 mg intravenously, as a bolus on admission to the neurosurgical unit, then 100 mg on Days 1, 2, and 3, 50 mg on Day 4, and 25 mg on Day 5 on continuous intravenous infusion. Children received proportionate intravenous dosages calculated on a weight basis. Severity of head injury was assessed from admission Glasgow Coma Scale (GCS) scores and the appearance of the admission computerized tomography scan. Intracranial pressure (ICP) was monitored in all patients from the surface subarachnoid space. Outcome at 6 months was assessed using the Glasgow Outcome Scale. Steroid and placebo groups were similar in terms of admission GCS score, intracranial pathology, incidence of associated injuries, and time interval from injury to admission to intensive care. The ICP generally increased during the first 48 hours of intensive therapy; there was no difference in this trend between the steroid and placebo groups. A poorer outcome was observed in patients with elevated ICP who received steroids. No increase in the incidence of pulmonary, gastrointestinal, or other extracranial complications was seen in the steroid group. The 6-month outcome did not differ between the steroid and placebo groups. No advantage of high-dose dexamethasone on ICP trends or clinical outcome in the treatment of severe head injury has emerged from this study.
Physiological and metabolic response to isolated closed-head injury
Authors: Deutschman Clifford Scott , Konstantinides Frank N. , Raup Sandra , Thienprasit Phudiphorn , Cerra Frank B.
Published: May 2009

✓ Studies of the metabolic and physiological response to closed-head injury have intimated the presence of persistent hypermetabolism. To more fully define and evaluate the metabolic response to head trauma, a prospective study was conducted in patients with isolated closed-head injuries. Metabolic and cardiopulmonary data were obtained for a 7-day period. Patients with multiple injuries or infections, or those who received steroids, were excluded. The basic treatment regimen utilized hyperventilation, bed rest with head elevation, intracranial pressure monitoring, mild fluid restriction, and mannitol as needed. No exogenous nutritional support was given. Intrastudy trends and comparsion with data from unstressed fasting patients and stressed patients were noted. Mean Glasgow Coma Scale scores were 4.4 ± 1.5 initially, but rose to a mean of 8.2 ± 3.7 by Day 7. While the responses of cardiac index, CO2 production, lactate/pyruvate ratio, and arteriovenous O2 content difference (AVO2D) were initially elevated, these parameters declined over the course of 7 days. The AVO2D was equivalent to the fasting level by Day 5. Metabolic data, including most amino acid levels in plasma, showed an initial equivalence to stress control levels and a pattern similar to that in non-stressed control subjects by Day 7. Nitrogen and 3-methyl histidine excretion were persistently elevated for the full 7 days. Patients with isolated closed-head injury seemed to be initially hypermetabolic, but this process appeared to resolve by 1 week; the persistent nitrogen excretion may reflect equilibration of muscle mass to the existing level of activity (bed rest). After the first few days, nitrogen excretion may give an erroneous index of the level of metabolic stress and the type or amount of nutritional support needed.
Effects of Nd:YAG and CO2 lasers on cerebral microvasculature
Authors: Kuroiwa Toshihiko , Tsuyumu Matsutaira , Takei Hidenori , Inaba Yutaka
Published: May 2009

✓ The effect of Nd:YAG and CO2 laser beams on cerebral microvasculature was examined in experimental animals. Soft x-ray microangiography and histological examination of the brain after Nd:YAG laser exposure revealed broad avascular or oligovascular zones in the irradiated and the surrounding edematous tissue, in which the surviving vessels were narrowed and tapered without significant leakage of blood. After CO2 laser exposure, a wedge-shaped tissue defect surrounded by layers of charring, coagulation, and edema was observed. The main finding in the surrounding coagulation and edematous layers was dilatation of the vessels. Hemorrhage was sometimes observed, mainly in the edematous layer. These findings seem to explain the effective hemostatic capability of the Nd:YAG laser and the occasional hemorrhage following CO2 laser exposure, especially at high energy output.
Intracranial and intraspinal dissemination from a growth hormone-secreting pituitary tumor
Authors: Hashimoto Nobuo , Handa Hajime , Nishi Shogo
Published: May 2009

✓ A 48-year-old woman developed multiple intracranial and intraspinal metastases from an invasive growth hormone-secreting pituitary adenoma after surgery and radiation therapy. This is the first reported case to show that the cells in the metastatic tumors and in the cerebrospinal fluid contained growth hormone.
Tremor and peripheral nerve entrapment
Authors: Little James W. , Burchiel Kim , Nutter Paul
Published: May 2009

✓ A patient is described in whom pain, paresthesias, weakness, and resting tremor gradually developed 8 years after an ulnar nerve transposition. Electromyography revealed that the tremor occurred at 4 to 5 Hz, was abolished by voluntary muscle contraction, and was localized to ulnar-innervated muscles. Ulnar nerve conduction was focally slowed at the elbow; therefore, ulnar neurolysis was performed and a fusiform neuroma-in-continuity was found. Mechanically tapping the neuroma elicited repetitive discharges at 4 to 5 Hz in the intrinsic muscles of the hand; these discharges were abolished by anesthetic block proximal to the neuroma. Although the pain, paresthesias, and weakness were abolished by the neurolysis, the tremor persisted. Possible neurophysiological mechanisms underlying the appearance of tremor with peripheral nerve entrapment are discussed.
Post-craniotomy wound infection caused by Pseudallescheria boydii
Authors: Lazarus Howard S. , Myers Joseph P. , Brocker Robert J.
Published: May 2009

✓ The authors describe the first reported case of post-craniotomy wound infection due to Pseudallescheria boydii. The patient was a 24-year-old man who sustained a direct blunt injury to the calvaria, resulting in a large subdural hematoma that was surgically evacuated. Subsequently, the surgical wound became infected with a fungus, P. boydii, and was successfully treated with intravenous miconazole.
Anorectal pressure monitoring during surgery on sacral lipomeningocele
Authors: Ikeda Kiyonobu , Kubota Toshihiko , Kashihara Kengo , Yamamoto Shinjiro
Published: May 2009

✓ Intraoperative monitoring of anorectal pressure was used in a case of sacral lipomeningocele accompanied by congenital dermal sinus to protect the physiological function of the anorectal sphincters. This monitoring system consists of a manometric anorectal balloon and neural electrical stimulation. The system was able to differentiate functioning neural structures from surrounding tissues during the operation.
Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery
Authors: Suzuki Jiro , Mizoi Kazuo , Yoshimoto Takashi
Published: May 2009

✓ The authors review their experience with the bifrontal interhemispheric approach in 603 cases of single anterior communicating artery (ACoA) aneurysms and describe the operative technique. With this approach, the olfactory tracts are dissected, and both A1 segments of the anterior cerebral arteries are identified subfrontally. The interhemispheric fissure is then dissected and A2segments are followed from the distal portion toward the ACoA complex. Following the administration of a combination of mannitol, vitamin E, and dexamethasone, a temporary clip is placed on at least the dominant A1 segment prior to dissection of the aneurysm itself. Once the aneurysm has been completely freed from the surrounding structures, the neck is ligated and clipped. If the aneurysm ruptures during surgery, temporary clips are placed on both A1 and A2 segments bilaterally and the operation proceeds in a completely dry field. With this method, it is possible to occlude any of the intracranial vessels for up to 40 minutes within 100 minutes of drug administration.

To prevent the possibility of rerupture and the development of vasospasm in the period before aneurysm surgery, the authors have adopted a policy of performing ultra-early operations within 48 hours of the onset of symptoms. Among the 257 cases operated on during the 9 years since 1975, one-fifth have been operated on within 48 hours of rupture, and the in-hospital mortality rate has been only 4.3% (11 cases). Follow-up studies have shown that 87% of the 246 surviving patients have returned to useful lives.
Intracranial and orbital cavernous angiomas
Authors: Yamasaki Toshiki , Handa Hajime , Yamashita Junkoh , Paine Jonathan T. , Tashiro Yuzuru , Uno Akira , Ishikawa Masatsune , Asato Reinin
Published: May 2009

✓The authors review 30 documented cases of intracranial and orbital cavernous angiomas treated at their institution between 1965 and 1984. The diagnosis was based on computerized tomography (CT) or surgery; three patients were treated in the pre-CT era (1965 to 1976) and 27 since the advent of CT. The number of cases diagnosed preoperatively markedly increased after the introduction of CT, and 22 cases were verified histopathologically at surgery. Six cases were in children (aged 2 months to 17 years) and 24 in adults (aged 19 to 73 years). There was no significant sex difference (male:female ratio was 14:16). Nineteen lesions were intraparenchymal, five were intraventricular, three were in the middle fossa, two were intraorbital, and one originated from the tentorium. Symptoms varied according to the site of the lesion; hemorrhage occurred in 11 cases. Calcifications were seen on CT scans in all cases, but on plain skull films in only two. Angiography revealed hypovascular masses in all cases excluding those with lesions in the middle fossa; in two cases, tumor stain could be detected only with prolonged-injection angiography. Radionuclide brain scanning showed a dense hot area in eight of 19 patients. Recent experience has shown that magnetic resonance imaging clarified anatomic relationships that were obscure on CT. The overall outcome was favorable except for one patient who died in the postoperative period. The clinical results in this series are summarized and some diagnostic and therapeutic problems are discussed.
Sudden deterioration and death in patients with benign tumors of the third ventricle area
Authors: Ryder John W. , Kleinschmidt-DeMasters B. K. , Keller Ted S.
Published: May 2009

✓ Although sudden deterioration and death is a widely recognized complication in patients with benign tumors of the third ventricle area, the exact incidence of this dreaded occurrence is unknown and the reports in the literature on the subject are largely anecdotal. Neither risk factors nor the etiology of the sudden death have been analyzed. The vast majority of these benign tumors are colloid cysts, and the presence and degree of ventricular dilatation and herniation associated with these tumors as cited in the reports are quite variable. The authors report a case of sudden death in a 27-year-old woman with a subependymoma of the left lateral and third ventricles. A review of the literature is included in an attempt to discern identifiable risk factors for sudden death in patients with tumors of the third ventricle area. Since this potential complication is known to exist in patients with otherwise benign tumors amenable to surgical resection, the authors recommend either prompt removal of the tumor on discovery or close monitoring of the patient if surgery is to be delayed.
Cerebral hemodynamics in patients with acute severe head trauma
Authors: Messeter Kenneth , Nordström Carl-Henrik , Sundbärg Göran , Algotsson Lars , Ryding Erik
Published: May 2009

✓ Mean hemispheric cerebral blood flow (CBF) was studied in 11 comatose brain-injured patients following intravenous administration of xenon-133. Repeated measurements were performed in order to evaluate cerebral vasoreactivity following a decrease in PaCO2. In addition, the effect of induced barbiturate coma was evaluated in patients with intracranial hypertension. The cerebral vasoreactivity and the CBF response following induction of barbiturate coma varied. In patients with normal CO2 reactivity, barbiturate treatment was accompanied by a considerable decrease in CBF as compared to patients with decreased or abolished CO2 response. During barbiturate treatment the intracranial pressure (ICP) became normal in three of four patients with preserved CO2 response, but reached normal levels in only one of five patients with impaired CO2 reactivity. Patients whose ICP became normal recovered. The data suggest a positive correlation between CO2 reactivity and the effect of barbiturate treatment. Furthermore, preserved cerebral vasoreactivity after severe head injury may be of prognostic value.
Medulloblastoma in childhood: results of radical resection and low-dose neuraxis radiation therapy
Authors: Tomita Tadanori , McLone David G.
Published: May 2009

✓ This review concerns 22 children who were treated from 1980 through 1983 for medulloblastoma in the posterior fossa. Treatment included attempts at radical resection of the tumor and postoperative craniospinal radiation therapy, with 5000 to 5500 rads directed to the posterior fossa and 2500 rads to the remaining craniospinal axis. This lower radiation dose to the neuraxis was used to avoid late adverse effects upon the growing central nervous system of the children. Gross confirmation of total resection was obtained in 13 patients (the “total resection group”); however, nine patients had a subtotal resection leaving a small portion of the tumor extending into the cerebellar peduncles or the cerebellopontine angle, or else encasing the posterior inferior cerebellar artery (the “subtotal resection group”). Six patients in the total resection group demonstrated tumor extension into the cerebellar peduncles, which was removed by means of a surgical carbon dioxide laser without neurological sequelae. Biopsy of the arachnoid membrane from the cisterna magna and cytological examination of the cerebrospinal fluid (CSF) prior to manipulation of the tumor werecarried out in 12 patients. All but one showed dissemination of medulloblastoma cells. Myelography and CSF cytological study were undertaken 2 months after radiation therapy in 12 patients and were positive in two. There were no case mortalities in the total resection group during the 24- to 67-month follow-up period, whereas the 1-year survival rate in the “subtotal resection group” was only 44.4%. This study suggests that medulloblastoma can be controlled with a low radiation dose to the neuraxis, should a grossly confirmed total resection be achieved at craniotomy.
Early results of ion beam radiation therapy for sacral chordoma
Authors: Saunders William M. , Castro Joseph R. , Chen George T. Y. , Gutin Philip H. , Collier J. Michael , Zink Sandra R. , Phillips Theodore L. , Gauger Grant E.
Published: May 2009

✓ The authors report on eight patients with sacral chordoma treated with ion beam radiation therapy. Ion beams have favorable physical and biological characteristics when compared to conventional radiation therapy beams of x-rays, gamma rays, or electrons. This treatment technique has been developed to exploit those advantages. With this technique it is possible to deliver a much higher tumor dose than that usually given with conventional beams, and to date no significant normal-tissue morbidity has been noted. Seven of the eight patients currently have local control of their tumor; however, follow-up time is too short to judge the longterm local control rate of this treatment technique.
Antifibrinolytic therapy of experimentally grown malignant brain tumors
Authors: Sawaya Raymond , Mandybur Thaddeus , Ormsby Illona , Tew John M.
Published: May 2009

✓ This study was designed to evaluate the effect of an inhibitor of plasminogen activation on the growth of a human glioblastoma line grown in nude mice up to the seventh passage. The tumors produced plasminogen activators and showed histological characteristics similar to those of the original tumor. Three groups of mice were studied. Group A received 5% epsilon aminocaproic acid (EACA); Group B received 2.5% EACA; and Group C served as a control. There was no statistical difference among the three groups with regard to: 1) age at time of tumor transplantation; 2) the interval between implant and treatment; or 3) tumor volume at time of treatment. Blood measurements of EACA, performed in a limited number of animals, have shown that the drug at 5% concentration had reached toxic levels. Statistically significant differences between the three groups were noted in the following categories: 1) rate of tumor growth; 2) tumor volume at time of death, where Group A had smaller tumors than Group C; and 3) mean survival times of Groups A and B as compared to Group C.

A statistically significant negative correlation was found between the rate of tumor growth and the length of survival of animals in Group C, while no correlation could be found for either Group A or B, indicating that the antifibrinolytic therapy modified this important biological variable. This study supports the hypothesis that the fibrinolytic system plays a role in the growth and development of malignant gliomas and that interference with the fibrinolytic system may retard the growth of these tumors grown in nude mice.
The kallikrein-kinin system as mediator in vasogenic brain edema
Authors: Unterberg Andreas , Dautermann Claudia , Baethmann Alexander , Müller-Esterl Werner
Published: May 2009

✓ Evidence has previously been provided that administration of kinins to the cerebrum causes edema and opening of the blood-brain barrier. It has further been shown that these highly active compounds are formed in the brain under pathophysiological conditions. Their formation was enhanced when cerebral blood flow became compromised by an increase in intracranial pressure. Final evidence, however, was not available as to whether specific inhibition of the kallikrein-kinin (KK) system has a therapeutic function in acute head injury. The authors have demonstrated in rabbits that inhibition of the activating enzyme kallikrein by aprotinin or by aprotinin plus soybean trypsin inhibitor (SBTI), which interfere with plasma and tissue kallikrein, is associated with a decrease in formation of posttraumatic swelling after a standardized cold lesion to the brain. Saline-treated control animals with cerebral cold-induced injury had an increase in hemispheric weight 24 hours later of 13.0% ± 0.8% (standard error of the mean) in the damaged hemisphere compared to the contralateral nondamaged hemisphere. Administration of aprotinin or aprotinin plus SBTI led to a significant reduction of hemispheric swelling of 10.1% ± 0.7% or 10.4% ± 0.7%, respectively. In animals receiving SBTI only, hemispheric swelling evolving from cold injury was not significantly reduced. Therapeutic reduction of brain edema by aprotinin cannot be attributed to a nonspecific effect on the blood pressure, which in the experimental groups remained almost normal as compared to the control animals. Failure of SBTI to influence posttraumatic brain swelling may have resulted from disturbances in intravascular coagulation. Measurements of aprotinin in plasma and tissue demonstrate that the inhibitor doses employed are within an effective therapeutic range. Attenuation of brain edema by specific inhibition of the KK system provides evidence for a mediator role of kinins in vasogenic edema. Clinical trials with inhibitors of the KK system in acute forms of traumatic lesions associated with vasogenic edema appear worthwhile.
Ultrastructural evidence of arterial denervation following experimental subarachnoid hemorrhage
Authors: Duff Thomas A. , Scott Grayson , Feilbach John A.
Published: May 2009

✓ Loss of catecholamine histofluorescence, increased sensitivity to norepinephrine, and changes in alpha1 receptor binding have led to the proposal that denervation hypersensitivity may play a role in cerebrovascular spasm. Because the significance of these alterations has remained unclear, the present study was undertaken to determine whether there was direct ultrastructural evidence of arterial denervation following experimental subarachnoid hemorrhage. Under general anesthesia, adult cats were subjected to pre-pontine injection of blood or serum (5 to 7 ml) via a transclival approach. The animals were sacrificed 4, 7, or 10 days later and basilar artery segments were prepared for electron microscopy. Control vessels appeared normal, whereas those bathed in blood revealed unequivocal changes in neural and supporting elements, including: 1) disintegration of both clear- and dense-core vesicles; 2) fragmentation of varicosities; 3) loss of Schwann cell cytoplasm; and 4) axonal degeneration. These changes were most pronounced 7 days after instillation of blood, and correlated in time with maximal injury of the media and endothelium. Although the development of smooth-muscle hypersensitivity remains unsettled, this study indicates that prolonged exposure to blood can cause extensive denervation of cerebral arteries.
Inadvertent middle cerebral artery embolism by a detachable balloon: management by embolectomy
Authors: Swann Karl W. , Heros Roberto C. , Debrun Gerard , Nelson Curt
Published: May 2009

✓ A case of middle cerebral artery embolism by a detachable intra-arterial balloon is presented. The balloon migrated after being detached in an effort to occlude the internal carotid artery proximal to an unclippable giant paraclinoid aneurysm. Volume expansion, induced hypertension, anticoagulation therapy, rapid middle cerebral artery embolectomy, and good collateral circulation are factors that may have contributed to the patient's complete recovery from hemiplegia.
Spinal cord arteriovenous malformation in a neonate
Authors: Park T. S. , Cail Wayne S. , Delashaw Johnny B. , Kattwinkel John
Published: May 2009

✓ A 2-day-old neonate with a spinal cord arteriovenous malformation developed severe paraparesis. The abrupt neurological deterioration was not associated with hemorrhage or aneurysmal dilatation. Ischemic damage of the spinal cord is suggested as the cause of the clinical manifestation.
Aneurysmal bone cyst with fibrous dysplasia of the parietal bone
Authors: Branch Charles L. , Challa Venkata R. , Kelly David L.
Published: May 2009

✓ The diagnostic and surgical aspects of aneurysmal bone cysts contiguous to fibrous dysplasia of the parietal bone are reported in two adolescents. While aneurysmal bone cyst and fibrous dysplasia are known to be associated, the association is rare and has not been reported previously in the calvaria.
Carotid body tumors: a subject review and suggested surgical approach
Authors: Meyer Fredric B. , Sundt Thoralf M. , Pearson Bruce W.
Published: May 2009

✓ Carotid body tumors are a rare but potentially difficult surgical entity. Their pathology, physiology, and natural history are reviewed along with surgical results reported in the literature. A surgical approach for removal of these tumors is presented which differs significantly from the recommended techniques in that emphasis is placed on intraoperative monitoring of cerebral blood flow, the selective use of shunts, a tumor-adventitial plane of dissection, preservation of the carotid artery complex, and mobilization of the parotid gland. Thirteen cases using these techniques are reviewed. The mortality rate and the incidence of cerebrovascular sequelae were both 0%. The major morbidity consisted of injury to the lower cranial nerves in five patients (39%) with tumors larger than 5 cm in length.
Phase II trial of interferon-β for treatment of recurrent glioblastoma multiforme
Authors: Duff Thomas A. , Borden Ernest , Bay Janet , Piepmeier Joseph , Sielaff Karen
Published: May 2009

✓ Twelve patients were admitted to a Phase II study on the treatment of recurrent glioblastoma multiforme with interferon-β (IFN-β). All patients had previously undergone craniotomy and received a standard course of radiation therapy. Recurrence was inferred from enlargement of the lesion on computerized tomography (CT) scanning and in each case was confirmed by CT-guided stereotaxic biopsy. Treatment consisted of combined intravenous (10 × 106 IU/day) and intratumoral (1 × 106 IU every other day) administration of IFN-β over three 10-day cycles. This regimen was well tolerated, with toxicity requiring temporary dose modifications in five patients. As judged from data from historical cases, however, the patients admitted to this study demonstrated no clear improvement in mean survival time. The findings of this study also emphasize the importance of distinguishing between radiation necrosis and tumor recurrence.
Computer-assisted stereotaxic laser resection of intra-axial brain neoplasms
Authors: Kelly Patrick J. , Kall Bruce A. , Goerss Stephan , Earnest Franklin
Published: May 2009

✓ Computer interpolation of stereotaxic computerized tomography (CT) scanning data allows the transposition of a tumor volume in stereotaxic space. A stereotaxically directed and computer-monitored CO2 laser is then utilized to vaporize that volume as the surgeon monitors the position of a cursor representing the laser beam against planar contours of the tumor displayed on an operating room computer monitor. Computer-assisted stereotaxic laser microsurgery provides precise three-dimensional control for aggressive resection of deep-seated tumors from neurologically important areas with acceptable postoperative results. Thus, a significant cytoreduction can be achieved in addition to providing a tissue diagnosis and internal decompression.

The authors report 83 computer-assisted stereotaxic laser procedures for tumor excision in 78 patients. The tumors were located in the thalamus/basal ganglia in 15 patients, ventricular system in five, corpus callosum in four, brain stem in three, and deep and centrally in the hemispheres in 51. Histologically, there were 26 glioblastomas, seven grade III astrocytomas, 14 grade II astrocytomas, 14 metastatic tumors, nine vascular lesions, and eight miscellaneous lesions. Resection of these subcortical lesions was confirmed by postoperative contrast-enhanced CT scanning. Neurological examinations performed 1 week after the 83 procedures revealed that 48 patients had improved from their preoperative level and 23 were unchanged (12 were neurologically normal preoperatively). Twelve patients had an increase in a preoperative neurological deficit, three of whom died in the postoperative period: one from infection, one from pulmonary emboli, and one from brain-stem edema.

The average survival period (37.6 weeks) of patients having glioblastomas treated by this technique and irradiation was no different from that of patients having glioblastomas in more favorable locations treated by conventional surgery and irradiation. Patients with circumscribed lower-grade astrocytomas did better in terms of morbidity and completeness of resection than those with infiltrative neoplasms. Other circumscribed lesions, such as metastatic tumors, vascular lesions, and intraventricular tumors, were easily resected by the technique described.
Echocardiographic detection and treatment of intraoperative air embolism
Authors: Sato Shuzo , Toya Shigeo , Ohira Takayuki , Mine Tohru , Greig Nigel H.
Published: May 2009

✓ A real-time two-dimensional echocardiogram was used to detect the presence of an air embolism in patients undergoing neurosurgical procedures in the sitting position. The technique could with good sensitivity detect the appearance of a single air bubble intraoperatively, thus allowing early intervention to prevent development of further air emboli. Two types of air embolism could be differentiated; the single-bubble type and the “stormy-bubble” type. The single-bubble type was observed during skin and muscle incisions, craniotomy, and brain lesion excision. Further embolism development was prevented by electrocoagulation and application of bone wax. The stormy-bubble type occurred during dura and muscle incisions and was prevented by electrocoagulation, reflection of the dura, or suturing the affected muscle.

The routine use of a Swan-Ganz catheter for removal of air embolism by suction proved effective for the treatment of the stormy-bubble type of air embolism. Masking the operative field with saline-soaked cotton strips was of moderate benefit in the stabilization of the single-bubble type of air influx, but proved to be of little value in controlling the entrance of the stormy-bubble type.
In situ cell kinetics studies on human neuroectodermal tumors with bromodeoxyuridine labeling
Authors: Hoshino Takao , Nagashima Tadashi , Murovic Judith A. , Wilson Charles B. , Edwards Michael S. B. , Gutin Philip H. , Davis Richard L. , DeArmond Stephen J.
Published: May 2009

✓ Thirty-eight patients undergoing surgical removal of neuroectodermal tumors of the central nervous system were given a 1-hour intravenous infusion of bromodeoxyuridine (BUdR), 150 to 200 mg/sq m, to label tumor cells in the deoxyribonucleic acid (DNA) synthesis phase (S-phase). The excised tumor specimens were divided into two portions: one was fixed with 70% ethanol and embedded in paraffin and the other was digested with an enzyme cocktail to make a single-cell suspension. The paraffin-embedded tissues were stained by an indirect peroxidase method using anti-BUdR monoclonal antibody (MA) as the first antibody. Single-cell suspensions were reacted with fluorescein isothiocyanate (FITC)-conjugated anti-BUdR MA's for flow cytometric analysis. S-phase cells that had incorporated BUdR into their DNA were well stained by both methods. The percentage of BUdR-labeled cells, or S-phase fraction, was calculated in tissue sections by microscopic examination and in single-cell suspensions by flow cytometric analysis. The biological malignancy of the tumors was reflected in the S-phase fractions, which were 5% to 20% for glioblastoma multiforme, medulloblastoma, and highly anaplastic astrocytoma, but less than 1% in most moderately anaplastic astrocytomas, ependymomas, and mixed gliomas. Two juvenile pilocytic astrocytomas and two low-grade astrocytomas from children had high S-phase fractions despite the fairly benign and slow-growing nature of these tumors. These results indicate that the S-phase fraction obtained immunocytochemically with anti-BUdR MA's may provide useful information in estimating the biological malignancy of human central nervous system tumors in situ.
Effect of parenteral nutrition on cold-induced vasogenic edema in cats
Authors: Waters David C. , Hoff Julian T. , Black Keith L.
Published: May 2009

✓ The effect of standard parenteral nutritional formulas on cold-induced vasogenic edema formation in cats was examined and compared to the effects of 5% dextrose, 0.9% saline, and 40.5% mannitol. The amount of vasogenic edema formed during a 3-hour period of fluid infusion following cold injury was quantified by a computerized graphics tablet determination of the volume of Evans blue-dyed white matter. Specific gravity measurements were taken as a measure of white matter water content. Serum osmolality, urine output, arterial blood gases, hematocrit, body temperature, and systolic blood pressure were measured periodically throughout the infusion period. Parenteral nutritional formulas and a 40.5% mannitol solution produced greater changes in serum osmolality than did 5% dextrose or 0.9% saline. Greater changes in serum osmolality were associated with larger calculated volumes of edema in the injured hemisphere and lower water contents in the uninjured hemisphere. The data indicate that hyperosmolar solutions may potentiate vasogenic edema formation when the blood-brain barrier is open.
Ultrastructural morphology of the olfactory pathway for cerebrospinal fluid drainage in the rabbit
Authors: Erlich Stephanie S. , McComb J. Gordon , Hyman Shigeyo , Weiss Martin H.
Published: May 2009

✓ Previous physiological studies indicate that the olfactory region serves as a major pathway for cerebrospinal fluid (CSF) drainage into the lymphatic system. The present study was undertaken to determine the ultrastructural characteristics of this egress route. New Zealand White rabbits received a single bolus injection of the tracer ferritin (MW 400,000) into both lateral ventricles in such a manner as not to raise the intraventricular pressure above the normal level. The animals were sacrificed via intracardiac perfusion of fixative between less than 12 minutes and 4 hours following injection. The cribriform region was removed en bloc, decalcified, sectioned coronally, and prepared for light and electron microscopic examination.

The arachnoid, dura, and periosteum surrounding the fila olfactoria passing through the cribriform plate merge together and form the perineurium, which consists of multiple layers of loosely overlapping cells with widely separated junctions and few vesicles. The perineurium surrounding the olfactory filaments at the superficial submucosal level is only one cell thick. The subarachnoid space freely communicates with the perineural space surrounding each filament. No morphological barrier between the perineural space and the loose submucosal connective tissue was identified. Whether or not the perineurium was multi- or singlelayered, ferritin was noted in abundance between the loosely overlapping perineural cells and in the submucosal connective tissue. The distribution of ferritin at 12 minutes was similar to that at 4 hours; however, the quantity of ferritin was increased at 4 hours. These results indicate that no significant barrier to CSF drainage is present at the rabbit cribriform region and that CSF reaches the submucosal region rapidly via open pathways.
Effects of collagenase and chymopapain on spinal nerves and intervertebral discs of Cynomolgus monkeys
Authors: Zook Bernard C. , Kobrine Arthur I.
Published: May 2009

✓ In order to test the safety and efficacy of Nucleolysin, a collagenase for intradiscal chemotherapy, laminectomies were performed on the L2–3 intervertebral discs of four groups of three young adult Cynomolgus monkeys. One primate from each group was injected with half the recommended human dose of Nucleolysin, chymopapain, or the same volume of sterile water. The remaining half of the human dose of each drug or equal volume of sterile water was equally divided and placed upon the right L-3 and L-4 nerve roots at their vertebral foramina. The right L-4 nerve root was first compressed for 10 seconds with an aneurysm clip. These procedures were done to simulate inadvertent contact of enzyme with spinal nerves in patients undergoing chemonucleolysis. After 4 weeks of observation, the 12 primates were humanely killed and examined post mortem. The effects of both enzymes were limited to those tissues with which they came in direct contact. Complete digestion of the nucleus pulposus of all enzyme-injected intervertebral discs was observed. Variable portions of the anulus fibrosus (from 2.3% to 57.4%) were also dissolved. Direct contact of Nucleolysin with lumbar nerve roots caused minor perineural reaction and no more intraneural changes than seen in sterile water controls. Chymopapain induced mild to severe perineural skeletal muscle necrosis and fibrosis with perineural arterial lesions as well as a degenerative neuropathy which was more marked in the traumatized nerve. The results of this study suggest that Nucleolysin and chymopapain are approximately equally effective on intervertebral discs, and that Nucleolysin is less injurious to spinal nerve roots and perineural tissue at the doses used.