bluuebunny/crossref_metadata_2025 huggingface dataset:
Microvascular anatomy of the interpeduncular fossa
Authors: Pedroza Alfredo , Dujovny Manuel , Ausman James I. , Diaz Fernando G. , Artero Jose Cabezudo , Berman S. Kim , Mirchandani Haresh G. , Umansky Felix
Published: May 2009

✓ An understanding of the microvascular anatomy of the midbrain and posterior diencephalon is essential in the surgical management of lesions in that region. A description of the arterial pattern of blood supply to these areas is the purpose of this study.

Perforating branches originating from the last 5 mm of the basilar artery, from the initial 7 mm of both superior cerebellar arteries (SCA's), and from the initial segment (P1 segment) of the posterior cerebral artery were studied in 56 unfixed human cadaver brain hemispheres. The brains were injected with polyester resin. The perforating branches penetrated through a small space in the upper part of the interpeduncular fossa. The anterior two-thirds of this space was occupied by the posterior perforated substance (PPS), and the posterior one-third was the site of penetration of the branches that supply the inferior mesencephalon. The PPS was divided into anterior and posterior halves. The anterior half was perforated by the paramedian thalamic arteries (diameter 0.57 ± 0.11 mm) while the superior paramedian mesencephalic arteries (diameter 0.20 ± 0.06 mm) perforated the posterior half. The perforating arteries originated from a trunk exclusive to the anterior half in 30%, from a trunk supplying both halves in 57%, and from a trunk exclusive to the posterior half in 13% of specimens. There were 26 naturally occurring anastomoses between the perforating branches. The paramedian inferior mesencephalic arteries penetrating the posterior one-third of the upper part of the interpeduncular fossa arose from the P1 segment in 32% of the brains studied, from the proximal 7 mm of the SCA in 45%, and from the last 5 mm of the basilar artery in 23%.
Familial acromegaly with pituitary adenoma
Authors: Abbassioun Kazem , Fatourehchi Vahab , Amirjamshidi Abbass , Meibodi Nemotallah Aghai
Published: May 2009

✓ The authors report the cases of three brothers with pituitary adenomas who had classical findings of acromegaly and gigantism. Two had irreducibly elevated growth hormone (GH) values and underwent transsphenoidal microsurgical extirpation of their tumors. The third acromegalic brother had a normal GH value and evidence of panhypopituitarism; he had a small intrasellar tumor and a partially empty sella. The pattern of inheritance was probably autosomal recessive. A review of literature indicated that familial incidence of isolated acromegaly with pituitary adenomas is rare.
Nasal glioma and encephalocele: two separate entities
Authors: Younus Mohammod , Coode Peter E.
Published: May 2009

✓ The term “nasal glioma” is a confusing misnomer as it implies a neoplastic condition with malignant potential, which it is not. Nasal glioma is a rare developmental abnormality and should be differentiated from glioma, which is a malignant tumor of the brain, and from a primary encephalocele, which is herniation of the cranial contents through a bone defect in the skull, through which it retains an intact connection with the central nervous system. Two cases of nasal glioma, one with and one without intracranial connections, are described and the literature is reviewed.
Spontaneous subarachnoid hemorrhage and negative cerebral panangiography
Authors: Alexander Mark S. M. , Dias P. S. , Uttley David
Published: May 2009

✓ One hundred and forty consecutive patients who sustained proven spontaneous subarachnoid hemorrhage (SAH) with negative cerebral panangiography were studied retrospectively. Attention was directed to the presence, amount, and distribution of subarachnoid blood on computerized tomography (CT) scans. It was determined that the finding of blood on CT had a significant association with clinical grade, loss of consciousness, ventricular ratio, fixed ischemic deficit, and total of all complications, but not with epilepsy, hypertension (previously known or detected on admission), treated hydrocephalus, rebleeding, angiographic spasm, and eventual outcome (which was generally excellent on follow-up examination). The distribution of blood, predominantly around the basal cisterns, suggests leakage from ventriculostriate and thalamoperforating vessels as the cause of SAH, and closer study of these vessels is suggested.
Intracranial tuberculoma and the CT scan
Authors: Vengsarkar Umesh S. , Pisipaty Ramkrishna Prasad , Parekh Bharat , Panchal Venilal G. , Shetty Manohar N.
Published: May 2009

✓ Computerized tomography (CT) has greatly influenced the diagnosis and management of intracranial tuberculomas and has helped us to formulate guidelines for the management of these lesions. Solid and ringenhancing lesions seen on CT scans are diagnostic of tuberculoma if supported by other clinical and ancillary criteria. Conservative management of intracranial tuberculoma is usually indicated because serial CT scans have shown complete disappearance of these lesions with antituberculous therapy. Only lesions associated with raised intracranial pressure and CT evidence of a mass effect should be considered for surgery. Nonresponse to antituberculous therapy, as judged by serial CT scanning, should raise doubts regarding the diagnosis of a tuberculomatous lesion, and therefore such lesions should be subjected to surgery and histopathological confirmation. Representative clinical cases illustrating the principles of diagnosis and management of intracranial tuberculoma with the help of CT scanning are briefly described and discussed.
Cerebral vasospasm evaluated by transcranial ultrasound correlated with clinical grade and CT-visualized subarachnoid hemorrhage
Authors: Seiler Rolf W. , Grolimund Peter , Aaslid Rune , Huber Peter , Nornes Helge
Published: May 2009

✓ In 39 patients with a proven subarachnoid hemorrhage (SAH), the clinical status, the amount of subarachnoid blood on a computerized tomography scan obtained within 5 days after SAH, and the flow velocities (FV's) in both middle cerebral arteries (MCA's) measured by transcranial Doppler sonography were recorded daily and correlated. All patients had pathological FV's over 80 cm/sec between Day 4 and Day 10 after SAH. The side of the ruptured aneurysm showed higher FV's than did the unaffected side in cases of laterally localized aneurysms. Increase in FV preceded clinical manifestation of ischemia. A steep early increase of FV's portended severe ischemia and impending infarction. Maximum FV's in the range of 120 to 140 cm/sec were not critical and in no case led to brain infarction. Maximum FV's over 200 cm/sec were associated with a tendency for ischemia, but the patients may remain clinically asymptomatic. In cases of no or only a little blood in the basal cisterns, mean FV's in both MCA's increased only moderately whereas, with thick clots of subarachnoid blood, there was a steeper and higher increase of mean FV's.
Surgical experience following intervertebral discolysis with collagenase
Authors: Fisher Robert G. , Bromley John W. , Becker George L. , Brown Mark , Mooney Vert
Published: May 2009

✓ Of 410 patients with refractory herniated lumbar disc disease treated with intradiscal collagenase, 82 (20%) did not respond to enzyme treatment and subsequently underwent surgery. Failure to improve in 6 to 8 weeks was the predominant cause for surgical intervention (53 patients). Increased pain (18 patients), progressing neurological deficit (10 patients), and disc-space infection (one patient) were the other indications for surgery. At surgery, extrusions and/or sequestrations were found in 46 patients, undigested protrusions in 16 patients, and other causes of treatment failure in 14 patients. Six patients had normal findings. There was no evidence of adverse enzyme activity on the surrounding structures. Surgical results showed an overall success rate of 87%, and did not appear to be compromised by the previous enzyme therapy.
Repair of a vertebral artery dissection
Authors: Alexander J. Jeffrey , Glagov Seymour , Zarins Christopher K.
Published: May 2009

✓ The case is presented of a 38-year-old woman who suffered multiple cerebellar infarctions as a result of emboli from a vertebral artery dissection. Surgical therapy led to a satisfactory recovery. This case emphasizes the importance of an aggressive approach to such lesions.
Peripheral nerve entrapment due to steroid-induced lipomatosis of the popliteal fossa
Authors: Rawlings Charles E. , Bullard Dennis E. , Caldwell David S.
Published: May 2009

✓ A case of peroneal nerve entrapment is reported in a patient with scleroderma. Compression was due to a lipoma in the popliteal fossa and resulted in increasingly severe foot-drop. Complete recovery occurred after the lipoma was resected. A brief review of peroneal nerve palsies and lipomatosis is presented.
The right hemisphere: neuropsychological functions
Authors: Heilman Kenneth M. , Bowers Dawn , Valenstein Edward , Watson Robert T.
Published: May 2009

✓ In the past two to three decades, clinicians and neuroscientists have been studying the functions of the right hemisphere. Neither hemisphere seems to be dominant in the absolute sense. Each appears to be specialized and is dominant for different functions. However, most functions require the cooperation of both hemispheres. When one is damaged, the other can often compensate for the damaged one. Lesions of the left hemisphere are associated with language (speech, reading, and writing) and praxic disorders, and lesions of the right hemisphere can result in visuospatial, attentional, and emotional disorders.

The authors review some of the major behavioral disorders associated with right hemisphere dysfunction and concentrate on three major types of disorders — visuospatial, attentional, and emotional. Although not all the behavioral defects associated with right hemisphere damage can be subgrouped under these three types, they are the ones most often associated with right hemisphere lesions.
Correlation of radiological features to failure of lumbar intervertebral disc chemonucleolysis
Authors: Houser O. Wayne , Onofrio Burton M. , Forbes Glenn S. , Baker H. L.
Published: May 2009

✓ Chemonucleolysis was performed in 103 patients for lumbar disc prolapse. Multiple (two) interspaces were injected in only seven patients. Radiographically, all patients had myelographic or computerized tomography evidence of disc prolapse. Eighty-seven of 100 patients who were available for follow-up review had improved. Ten of 13 patients with persistent symptoms required a laminectomy. Altered spinal alignment was evident in five of the 13 patients with persistent symptoms: retrolisthesis in three and myelographic disc defect on the convex aspect of the scoliosis in two. Review of radiographic studies was carried out in an attempt to establish guidelines for patient selection so as to decrease the rate of failure in chymopapain treatment.
Interleukin-2 and autologous lymphokine-activated killer cells in the treatment of malignant glioma
Authors: Jacobs Steven K. , Wilson Debra J. , Kornblith Paul L. , Grimm Elizabeth A.
Published: May 2009

✓ Nine patients with malignant glioma were treated with the lymphokine interleukin-2 (IL-2) or with lymphokine-activated killer (LAK) cells, and one patient received combination therapy with both LAK cells and IL-2. The LAK cells were generated by culturing recombinant IL-2 with peripheral blood lymphocytes obtained from brain-tumor patients. Escalating doses of LAK cells (108 to 1010) or IL-2 (104 to 106 U) were administered intraoperatively by direct injection into the brain tissue surrounding the cavity left by debulking the tumor. There were no signs of systemic or neural toxicity following treatment. The selective killing of the tumor by LAK cells used for these treatments was demonstrated by a chromium release microcytotoxicity assay which showed in vitro the ability of the LAK cells to lyse glioma cells but not normal cells.
Computerized tomography, magnetic resonance imaging, and positron emission tomography in the study of brain trauma
Authors: Langfitt Thomas W. , Obrist Walter D. , Alavi Abass , Grossman Robert I. , Zimmerman Robert , Jaggi Jurg , Uzzell Barbara , Reivich Martin , Patton Dreux R.
Published: May 2009

✓ Results of computerized tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), xenon-133 measurement of cerebral blood flow (CBF), and neuropsychological assessments are described in three head-injured patients. The patients were selected because they presented with intracranial hemorrhage diagnosed by CT. Two of the patients were studied acutely and again approximately 6 months later. In the acute stage, MRI was superior to CT in identifying the precise location and extent of intracranial hemorrhage and associated edema. Small subdural hematomas diagnosed on MRI were missed with CT scanning. The extent of apparent encephalomalacia in the chronic stages of injury was also better defined with MRI. Position emission tomography showed disturbances of glucose metabolism that extended beyond the structural abnormalities demonstrated by MRI and CT; anterior temporal lobe dysfunction was particularly evident in all three patients. Regional CBF studies failed to detect a number of the abnormalities seen on MRI and CT, and even ignored the metabolic dysfunction evident on PET that should have been accompanied by changes in regional CBF. The neuropsychological studies localized frontal lesions, but did not reveal abnormalities attributable to the structural lesions and the reduced metabolism in the anterior temporal lobes.
Distribution, retention, and phototoxicity of hematoporphyrin derivative in a rat glioma
Authors: Kostron Herwig , Bellnier David A. , Lin Chi-Wei , Swartz Mitchell R. , Martuza Robert L.
Published: May 2009

✓ The distribution, retention, and phototoxicity of the sensitizer hematoporphyrin derivative (HPD) were studied following intraperitoneal and direct intraneoplastic injections of the agent into subcutaneous or intracerebral gliosarcomas in rats. Forty-eight hours after intraperitoneal injection, the ratio of tritiated (3H) HPD in subcutaneous tumor:adjacent normal skin was about 1.4:1 and the ratio in tumor:normal brain was 3:1. In contrast, direct injection of 3H-HPD into subcutaneous tumors resulted in tumor:adjacent normal skin concentration ratios of approximately 44:1 and tumor:normal brain ratios of about 61:1. For rats bearing intracerebral gliosarcomas, intraperitoneal administration of 3H-HPD resulted in approximately 1.3-fold sensitization in tumor tissue relative to adjacent edematous brain. In contrast, after direct injection into intracerebral tumors, the tumor:adjacent edematous brain and tumor:skin 3H-HPD ratios were 3:1 and 32:1, respectively. In all cases, 3H-HPD was found in every portion of the tumor, even at a distance from the injection site. For the 3H-HPD doses used in this study, after direct injection both subcutaneous and intracerebral tumor tissue contained about three to four times more 3H-HPD than tumors in rats receiving intraperitoneal 3H-HPD. Both in vitro and in vivo clonogenic assays demonstrated that the photodynamic inactivation of the tumors was significantly greater after direct injection than after intraperitoneal injection.
Effects of fluid-percussion brain injury on regional cerebral blood flow and pial arteriolar diameter
Authors: DeWitt Douglas S. , Jenkins Larry W. , Wei Enoch P. , Lutz Harry , Becker Donald P. , Kontos Hermes A.
Published: May 2009

✓ The effects of two levels of fluid-percussion brain injury on cerebral blood flow (CBF) and pial arteriolar diameter were investigated in cats. Regional CBF was measured using the radioactive microsphere technique. Experimental brain injury resulted in changes in arterial blood pressure, CBF, and pial arteriolar diameter that were related to the severity of the injury. Low-level injury (1.88 ± 0.11 atm, mean ± standard error of the mean) resulted in a slight transient increase in CBF which had returned to preinjury levels by 30 minutes. High-level injury (2.68 ± 0.19 atm) resulted in larger, statistically significant (p < 0.01) increases in whole-brain CBF, decreases in cerebrovascular resistance, and increases in pial arteriolar diameter 1 minute postinjury. One hour after injury, CBF had returned to preinjury levels while cerebral perfusion pressure was significantly (p < 0.01) reduced. There was no evidence of reduced CBF in any region studied. Pial arterioles dilated during the posttraumatic hypertensive period and then returned to control diameters within 1 hour after injury. Changes in the diameter of pial arterioles were significantly correlated with posttraumatic changes in CBF.
Delayed brain abscess related to a retained foreign body with culture of Clostridium bifermentans
Authors: Pencek Terrence L. , Burchiel Kim J.
Published: May 2009

✓ Although it is well documented that retained foreign bodies are associated with delayed intracranial abscess, there are few reports of anaerobic organism growth. A case is presented in which a left parieto-occipital abscess surrounded a metallic fragment implanted when a mortar shell exploded in Vietnam 15 years before. The diagnostic evaluation and surgical management of this case are presented.
Table-fixed retractor system for noncranial surgery
Authors: Saunders Richard L.
Published: May 2009

✓ A retractor system based on the principle of table fixation of the retraction device has been fabricated and utilized in a broad range of noncranial procedures. Based on the refinement of self-retaining brain retractor methods, this device allows an atraumatic fixed exposure without the danger of “self-retained devices” impaling soft tissue and the compromises of hand-held retractors.
A new microclip for vascular occlusion
Authors: Andrews Brian T. , Lutz Arthur , Bederson Joshua B. , Pitts Lawrence H.
Published: May 2009

✓ A new microclip for use on blood vessels 300 µ to 1 mm in diameter is described. This clip is suitable for either temporary or permanent occlusion and has been used in experimental applications. Potential clinical applications are described.
Miniclips and microclips for surgical hemostasis
Authors: Sundt Thoralf M. , Kees George
Published: May 2009

✓ The authors have designed a miniclip and a microclip for occlusion of small perforating vessels deep in the operative wound. These clips are intended for permanent occlusion but may be used for temporary hemostasis.
Intracranial arachnoid cysts in children
Authors: Harsh Griffith Rutherford , Edwards Michael S. B. , Wilson Charles B.
Published: May 2009

✓ The clinical and radiographic findings, surgical treatment, and outcome in 16 pediatric patients with intracranial arachnoid cysts are reviewed. The clinical presentation reflected the anatomical location of the lesions. Computerized tomography or magnetic resonance imaging scans were diagnostic in all cases. Of the nine cysts treated primarily or secondarily by craniotomy for fenestration and drainage into the basilar cisterns, five recurred. Cyst-peritoneal shunting led to diminished cyst size and clinical improvement in all seven cases in which it was used as the initial treatment and in all four cases in which fenestration had been unsuccessful. The results in this series show that cyst-peritoneal shunting is the treatment of choice for most intracranial arachnoid cysts in children.
Operative management of tumors involving the cavernous sinus
Authors: Sekhar Laligam N. , Møller Aage R.
Published: May 2009

✓ In the past, neurosurgeons have been reluctant to operate on tumors involving the cavernous sinus because of the possibility of bleeding from the venous plexus or injury to the internal carotid artery (ICA) or the third, fourth, or sixth cranial nerves. The authors describe techniques for a more aggressive surgical approach to neoplasms in this area that are either benign or locally confined malignant lesions.

During the last 2 years, seven tumors involving the cavernous sinus have been resected: six totally and one subtotally. The preoperative evaluation included axial and coronal computerized tomography, cerebral angiography, and a balloon-occlusion test of the ICA. Intraoperative monitoring of the third, fourth, sixth, and seventh cranial nerves was used to assist in locating the nerves and in avoiding injury to them. The first major step in the operative procedure was to obtain proximal control of the ICA at the petrous apex and distal control in the supraclinoid segment. The cavernous sinus was then opened by a lateral, superior, or inferior approach for tumor resection. Temporary clipping and suture of the ICA was necessary in one patient.

None of the patients died or suffered a stroke postoperatively. Permanent trigeminal nerve injury occurred in three patients; in two, this was the result of tumor invasion. One patient suffered temporary paralysis of the third, fourth, and sixth cranial nerves, and in another the sixth cranial nerve was temporarily paralyzed. Preoperative cranial nerve deficits were improved postoperatively in three patients. Radiation therapy was administered postoperatively to four patients. These seven patients have been followed for 6 to 18 months to date and none has shown evidence of recurrence of the intracavernous tumor.
BSS Plus: a potential irrigating solution for neurosurgery
Authors: Meyer Glenn A. , Maiman Dennis J. , Edelhauser Henry F. , Lorenzetti O. J. , Garancis John
Published: May 2009

✓ BSS Plus is a pH-stable balanced salt solution similar to glutathione bicarbonate Ringer's solution. Extensively used in ophthalmology, it is of potential value in neurosurgery. In comparative tests of its effectiveness, 28 cats underwent bilateral irrigation of the surface of the cerebral cortex with normal saline on one side and BSS Plus on the other. After 2 hours, a marked decrease was seen in the surface pH of the hemisphere irrigated with normal saline but not of the hemisphere treated with BSS Plus. Blood-brain barrier changes (measured with Evans blue dye techniques) were more evident following saline irrigation. Somatosensory evoked potentials and cerebral blood flow were not significantly altered. Conventional light microscopy using three standard stains did not reveal a significant difference. Transmission electron microscopy studies were performed in 14 animals and scanning electron microscopy in six. In five animals both transmission and scanning electron microscopy studies were conducted after irrigation with both agents without a cottonoid cover and with immediate harvest of superficial layers from the living brain and immersion-fixation in glutaraldehyde. Tissue preservation was superior on the BSS Plus side in all studies. This agent may represent an improved irrigation solution for neurosurgery, but further studies are required.
Effect of vasopressin on cold-induced brain edema in cats
Authors: Reeder Ralph F. , Nattie Eugene E. , North William G.
Published: May 2009

✓ Centrally released arginine vasopressin (AVP) has been implicated in the regulation of intracranial pressure (ICP) and brain water, and is elevated in the cerebrospinal fluid (CSF) of some patients with pseudotumor cerebri or subarachnoid hemorrhage. The authors have examined the relationship of AVP levels in CSF to ICP and brain water content in three experimental groups of cats with and without cold-induced vasogenic edema. With the cats under general anesthesia, a cold lesion was made and cannulas were placed in the cisterna magna, lateral ventricle, and aorta. Subsequent central and systemic measurements were made while the animals were awake and free-roaming.

In Experiment 1, endogenous AVP levels in CSF were measured every 12 hours over a 48-hour period by radioimmunoassay in cats with sham craniotomy, mild edema, or moderate edema; no significant difference was found between groups although a diurnal variation was seen (range 2 to 18 pg/ml). In Experiment 2, either carrier solution or AVP, in doses of 1.5 or 30 ng, was administered via a lateral ventricle every 2 hours over 24 hours in unlesioned cats. In Experiment 3, cats received 2 or 35 ng of carrier solution or AVP in a similar manner, but coupled with a cold lesion. The CSF AVP levels ranged from an average of 100 to 681 pg/ml and 1.4 to 11.9 ng/ml in the two dose groups in both experiments. Neither the low nor the high dose had an effect on brain water content in normal white matter (Experiment 2), but both doses increased brain water content in edematous white matter (p < 0.05 in Experiment 3), as determined by wet and dry weight measurements of standardized pieces of white matter. The ICP was decreased by high-dose AVP in normal cats (p < 0.01 at 24 hours), but in lesioned cats was unchanged by low-dose and increased by high-dose AVP (p < 0.05 at 18 hours). The authors conclude that pharmacological doses of central AVP facilitate the production of vasogenic edema.
A pharmacological analysis of the pathophysiological mechanisms of posttraumatic spinal cord ischemia
Authors: Hall Edward D. , Wolf Daniel L.
Published: May 2009

✓ A pharmacological analysis was carried out to determine the possible role of aberrant calcium fluxes, vasoactive arachidonic acid metabolites, and microvascular lipid peroxidation in the development of posttraumatic spinal cord white matter ischemia. Pentobarbital-anesthetized cats were treated intravenously 30 minutes before a 500-gm-cm contusion injury to the lumbar spinal cord with one of the following test drugs: the Ca++ channel antagonists verapamil, diltiazem, or nifedipine; the cyclo-oxygenase inhibitors ibuprofen or meclofenamate; the thromboxane A2 (TXA2) synthetase inhibitor furegrelate sodium; or the stable epoprostenol (prostacyclin, or PGI2) analogue ciprostene calcium alone or in combination with furegrelate sodium. Another group of animals was pretreated for 5 days before spinal injury with a combination of the antioxidants vitamin E and selenium in high doses. The hydrogen clearance technique was used to make repeated measurements of spinal cord blood flow (SCBF) in the dorsolateral funiculus of the injured segment before and for 4 hours after injury. In 11 untreated uninjured cats, the mean preinjury SCBF was 12.7 ± 1.5 ml/100 gm/min. Following contusion, there was a progressive decline in SCBF to 6.8 ± 0.4 ml/100 gm/min, or 53.5% of the preinjury level at 4 hours. In comparison, the Ca++ antagonists diltiazem and nifedipine (but not verapamil) prevented a significant posttraumatic decrease in SCBF. Similarly, both cyclo-oxygenase inhibitors (ibuprofen and meclofenamate) maintained SCBF within normal limits (10 ml/100 gm/min or greater). However, neither TXA2 synthetase inhibition nor the stable PGI2 analogue alone had a significant effect in preventing ischemia, whereas a combination of the two agents did serve to support SCBF. The most impressive preservation of posttraumatic SCBF, however, was observed in the antioxidant-treated animals. Based upon these results, a hypothesis is presented concerning the pathogenesis of posttraumatic central nervous system ischemia which integrates an injury-induced rise in intracellular Ca++, the increased synthesis of vasoactive prostanoids (such as prostaglandin F2α and TXA2), and progressive microvascular lipid peroxidation.
The long-term results of chymopapain chemonucleolysis for lumbar disc disease
Authors: Maciunas Robert J. , Onofrio Burton M.
Published: May 2009

✓ The long-term clinical outcome is evaluated for 268 patients after chymopapain chemonucleolysis for radicular complaints referrable to documented intervertebral disc disease. The follow-up period for 92% of these patients was 10 years. No complications due to chymopapain toxicity were observed; 80.1% of patients were relieved of their presenting radicular leg pain and 75.1% were employed at a capacity equal to or more strenuous than before injection. Chemonucleolysis was demonstrated to be a safe and effective treatment modality, with long-term results that compare favorably with those of similarly selected patients undergoing open surgical procedures. In the patients whose chymopapain therapy failed, the outcome of subsequent open surgical procedures was not necessarily compromised by prior chemonucleolysis. A higher rate of failure and subsequent surgical intervention was seen in those patients with injections performed soon after an unsuccessful open procedure on the same side and at the same interspace, those with workmen's compensation or litigation pending, those with a history of work-related injury, those whose employment involved heavy manual labor or extensive driving, and those whose preinjection spine x-ray films indicated retrograde spondylolisthesis.
Percutaneous retrogasserian glycerol rhizotomy for treatment of trigeminal neuralgia
Authors: Beck David W. , Olson Jeffrey J. , Urig Edward J.
Published: May 2009

✓ The treatment of trigeminal neuralgia by percutaneous retrogasserian glycerol rhizotomy was assessed in a series of 58 patients with a follow-up period ranging from 2 to 40 months postoperatively. All patients were considered medical failures prior to the procedure. Idiopathic trigeminal neuralgia was the diagnosis in 54 patients, and four patients had trigeminal neuralgia associated with multiple sclerosis. Forty-two patients (72%) reported complete relief from the procedure and are taking no medications. Four patients (7%) are much improved and require only minimal drug therapy. Twelve patients (21%) were considered treatment failures. The recurrence rate after initial relief of symptoms was 11%. Ten patients (17%) noticed a mild decrease in facial sensation following the procedure, and one additional patient had a profound sensory loss including loss of corneal reflex. The authors conclude that, while percutaneous retrogasserian glycerol rhizotomy may be useful in the treatment of trigeminal neuralgia, more clinical series and documentation of recurrence rate and complications are needed before any firm conclusions can be reached as to the efficacy of this therapy.
Observations on the perioperative management of aneurysmal subarachnoid hemorrhage
Authors: Finn S. Sam , Stephensen Sigurdur A. , Miller Carole A. , Drobnich Laura , Hunt William E.
Published: May 2009

✓ Thirty-two patients with aneurysmal subarachnoid hemorrhage (SAH) were managed according to a protocol based on pain control and hemodynamic manipulation, monitored by an arterial line and Swan-Ganz catheter. Hemodynamic parameters were adjusted to four clinical situations. 1) For the unoperated patient with no neurological deficit, the regimen aims to maintain pulmonary wedge pressure (PWP) at 10 to 12 mm Hg, and the cardiac index (CI) and blood pressure (BP) at normal levels. 2) For the unoperated patient presenting with or developing neurological deficit, the PWP is increased until the deficit is reversed or the CI falls; the CI is high, and the BP normal. 3) For the postoperative patient with no neurological deficit, the PWP is maintained at 12 to 14 mm Hg, the CI is a high normal, and the BP is normal. 4) For the postoperative patient developing neurological deficit but showing no surgical complication on the computerized tomography scan, the PWP is increased until the deficit is reversed or the CI falls; the CI is high and the BP is increased with vasopressors if necessary.

Fourteen patients developed neurological deficits either preoperatively, postoperatively, or both. Neurological deficits were repeatedly reversed by increasing the PWP, as measured hourly. In several patients an optimal wedge pressure was determined, below which deficits would reappear. In one patient whose neurological deficit was reversed on several occasions by increasing the PWP, the optimal PWP rose after each episode until it reached 22 mm Hg.

Detailed event-related analysis of these patients' course illustrates these phenomena well. The optimal PWP varied from patient to patient, but ranged most frequently from 14 to 16 mm Hg. Meticulous monitoring of the patients' neurological status coupled with prompt correction of low PWP (assuming an adequate CI) has proven to be an effective way to prevent and reverse neurological deficits following aneurysmal SAH.
Inhibition of proliferative growth in glioma cells by calmodulin antagonists
Authors: Suzuki Nobuyuki , Kanno Tetsuo , Nagata Yutaka , Kato Taiji
Published: May 2009

✓ The effects of several calmodulin antagonists, such as N-(6-aminohexyl)-5-chloro-1-naphthalene-sulfonamide hydrochloride (W-7) and its dechlorinated structural analogue (W-5), on the growth and proliferation of cultured and transplanted glioma (GA-1, chemically induced from rat glioblasts) were evaluated. Under culture conditions, the concentration of W-7 necessary to exert 50% inhibition of GA-1 glioma cell growth was 50 µM. However, W-5, with a lower binding affinity to calmodulin than W-7, caused no definite inhibition of the proliferation of GA-1 cells in culture. When a low concentration of W-7 (12.5 µM) was added to the culture medium, deoxyribonucleic acid (DNA) synthesis in the GA-1 glioma cells was not markedly affected, whereas both ribonucleic acid (RNA) and protein syntheses were strongly suppressed on incubation for 24 hours. When a high concentration of W-7 (25.0 to 75.0 µM) was applied to the medium, synthesis of DNA, RNA, and protein was distinctly inhibited. When W-7 (50.0 µM) was added to the incubation medium, the calmodulin concentration in the cultured GA-1 was reduced to as much as half the control level within 2 hours, and thereafter remained at this level. Whereas control rats intraperitoneally transplanted with GA-1 cells could survive for 14 to 21 days, daily intraperitoneal injections of W-7 at concentrations of 1.0, 3.0, and 10.0 mg/kg body weight prolonged the survival span to between 21 and 26 days; this corresponded to an increased life span of about 40% compared to the controls.
Morphometric assessment of drug effects in experimental spinal cord injury
Authors: Iizuka Hideaki , Iwasaki Yuzo , Yamamoto Teiji , Kadoya Satoru
Published: May 2009

✓ The effect of large doses of methylprednisolone sodium succinate (MPSS) and two protease inhibitors, leupeptin and bestatin, on experimental acute spinal cord injury was evaluated by morphometric analysis of degenerating axons with the aid of an automated image analyzer. Spinal cord injury was produced by epidural compression with a surgical clip on the T-11 segment in rats. The extent of axonal damage was assessed in Rexed's lamina VIII in the L-6 segment by measuring the amount of silver grains, representing degenerating axons and their terminals, using the Fink-Heimer method. The severity of axonal damage was expressed as the degeneration index: that is, the amount of silver grains in experimental animals/the amount of silver grains in cord-transected animals. When examined on the 7th postoperative day, axonal degeneration in MPSS-treated rats was significantly decreased, with an average degeneration index difference of 6 (p < 0.05). Increased preservation of axons was seen in the leupeptin-treated rats sacrificed 7, 10, and 14 days after trauma. The difference in the degeneration index between the leupeptin-treated and untreated groups was 16 on Day 7 (p < 0.001), 12 on Day 10 (p < 0.001), and 13 on Day 14 (p < 0.01). Bestatin had no beneficial effect. The implications for the use of calcium-activated neutral protease inhibitors in acute spinal cord injury are discussed.
Cruciate paralysis
Authors: Dumitru Daniel , Lang James E.
Published: May 2009

✓ A rare case of cruciate paralysis is reported in a 39-year-old man following a motor-vehicle accident. The differentiation of this syndrome from a central cervical spinal cord injury is delineated.
Rheumatoid arthritis and positional vertebrobasilar insufficiency
Authors: Robinson Burke P. , Seeger Joachim F. , Zak Steven M.
Published: May 2009

✓ The authors report a case of positional occlusions of the vertebral arteries in a 45-year-old patient with juvenile rheumatoid arthritis. The occlusions were documented angiographically by placing the head in various positions during digital subtraction angiography using aortic arch injections.
A new neurosurgical irrigating sucking cutter
Authors: Bleasel Kevin F. , Frost Richard B.
Published: May 2009

✓ A new instrument has been developed for the removal of tumors located in areas difficult to reach. It operates by suctioning and cutting tissue, and is equipped with an irrigating sucker. This device is described and its successful use in clinical practice is summarized.
Meningiomas of the clivus and apical petrous bone
Authors: Mayberg Marc R. , Symon Lindsay
Published: May 2009

✓ Between March, 1966, and June, 1985, 23 women and 12 men underwent partial or total resection of apical petrous or clivus meningiomas at The National Hospital for Nervous Diseases. Presenting symptoms were typically of long duration (mean 29 months) and consisted primarily of gait disturbance, headache, hearing loss, and facial pain. Cranial nerve deficits, especially affecting the fifth, seventh, and eighth nerves, were observed in nearly every patient. Tumor size, but not location, was generally associated with degree of preoperative disability. Plain skull films were usually unremarkable, but computerized tomography (CT) proved highly accurate in determining tumor location and size. A characteristic pattern of vascular displacement was seen on vertebral angiograms, although blood supply to the tumors was derived primarily from branches of the internal and external carotid arteries.

Subtotal or total resection was undertaken in all cases; nine patients required adjunctive cerebrospinal fluid shunting procedures. Although surgical techniques evolved during the course of the 20-year study, a combined supra- and infratentorial approach proved a relatively safe and effective means of surgical treatment. New or worsened postoperative deficits, especially cranial nerve palsies, and complications in the immediate postoperative period frequently resulted in temporary deterioration of the clinical status during this period; the total operative mortality rate was 9%. Follow-up periods ranged up to 9 years; 70% of patients resumed an independent existence, and none is known to have required subsequent tumor surgery. The size of the lesion was the only significant factor in determining outcome. These data suggest that meningiomas of the clivus and apical petrous bone can be accurately diagnosed by CT and three-vessel angiography, and effectively treated by microsurgical resection.
Recurrence of intracranial meningiomas: the role played by regional multicentricity
Authors: Borovich Bernardo , Doron Yaffa , Braun Jacob , Guilburd Joseph N. , Zaaroor Menashe , Goldsher Dorit , Lemberger Anshel , Gruszkiewicz Jan , Feinsod Moshe
Published: May 2009

check; Globular single meningiomas are generally regarded as benign tumors that can be completely removed. Nevertheless, after a total macroscopic resection including the insertion zone (Grade 1 operation according to Simpson's classification), the incidence of recurrence ranged from 9% to 14% at the 5-year follow-up review. The authors have shown that single meningiomas represent only the visible predominant growth in the midst of a wide neoplastic field in the dura mater. Regional multiplicity in meningiomas would thus seem to be the rule. With this in mind, the authors propose to divide recurrences after Grade 1 operations into 1) true local and 2) false regional. A local recurrence is defined as a regrowth within the limits of the previous dural flap. Regional recurrence is when new growth develops outside the previous craniotomy site; this should not be considered as a recurrence but as a new primary site. These regional recurrences might explain some unexpected late tumor growth occurring after a Grade 1 operation. Five illustrative cases in which regional recurrence was detected by computerized tomography are presented. The authors also propose to add a supplementary grade to Simpson's surgical grading: Grade 0. This operation would entail a wide resection of the dura around the attachment zone of the meningioma. The authors hope that with a Grade 0 operation the incidence of recurrence might be reduced.
Permeability of human brain tumor to 99mTc-glucoheptonate and 99mTc-albumin
Authors: Neuwelt Edward A. , Specht H. David , Hill Suellen A.
Published: May 2009

✓ The variable penetration of chemotherapeutic drugs into brain and tumor is more dependent upon lipid solubility than upon size. In contrast, the molecular weight of virus- and tumor-specific monoclonal antibodies appears to limit uptake. The authors have studied eight patients with malignant brain tumors in order to compare tumor uptake of an iodinated contrast agent evaluated by computerized tomography scanning with uptake of the low and high molecular weight imaging agents technetium-99m (99mTc)-glucoheptonate and 99mTc-albumin, respectively, measured by radionuclide brain scanning. The agent 99mTc-labeled albumin was chosen for evaluation because its molecular weight (68,000) is similar to that of the most clinically promising monoclonal antibody fragment, the immunoglobulin (Ig) G Fab monomeric fragment. The radionuclide brain scans in the eight patients showed highly variable permeability of brain tumor to these markers, with uptake of the high molecular weight marker in the tumor being much less than that of the low molecular weight radionuclide. A clinical implication of these studies is that the success of monoclonal antibody therapy in the treatment of malignant brain tumors may require techniques to increase permeability of the blood-brain barrier and blood-tumor barrier to protein.
Neurosurgical complications after apparently minor head injury
Authors: Dacey Ralph G. , Alves Wayne M. , Rimel Rebecca W. , Winn H. Richard , Jane John A.
Published: May 2009

✓ A small number of patients with an apparently minor head injury will develop a life-threatening intracranial hematoma that must be rapidly detected and removed. To assess the risk of a significant intracranial neurosurgical complication after apparently minor head injury, the authors collected data prospectively on 610 patients who had sustained a transient posttraumatic loss of consciousness or other neurological function and who had a Glasgow Coma Scale (GCS) score of 13, 14, or 15 in the emergency room. Skull x-ray films were obtained in 583 patients, 66 of whom (10.8% of the study population) had cranial fractures. Eighteen of the 610 patients (3.0%) required a neurosurgical procedure. Three acute subdural hematomas, one epidural hematoma, and one traumatic intracerebral hematoma required craniotomy. Of the 66 patients who had skull fracture, 7.6% required a craniotomy for intracranial hematoma. Thirteen (19.7%) of the 66 patients with skull fracture required an operative procedure as compared to five (1.0%) of the 517 patients without skull fracture. Two patients with a normal GCS score of 15 and normal skull x-ray films subsequently underwent operative treatment.

The cost of three alternative management schemes for these patients was estimated. A 50% reduction in cost of management could be effected by the use of computerized tomography (CT) scans (or possibly skull x-ray films) in determining which of the patients who are alert at the time of presentation should be admitted for observation. Several other conclusions can be drawn from this study. First, an initial GCS score between 13 and 15 does not necessarily indicate that a patient has sustained a trivial head injury, since 3% of such patients will require an operative procedure despite an initially normal level of alertness. Second, an abnormal skull x-ray film increases by a factor of 20 the probability that a patient will need neurosurgical treatment. Third, it is very unusual for patients who have a GCS score of 15 and a normal skull x-ray film to have a significant neurosurgical complication. Fourth, the alternative management schemes that depend on selective use of skull films and CT scans may significantly reduce the cost of caring for patients with minor head injury.
Computerized tomography and prognosis in early aneurysm surgery
Authors: Auer Ludwig M. , Schneider Gerhard H. , Auer Thomas
Published: May 2009

✓ A study of computerized tomography (CT) scans was performed in a consecutive series of 100 patients with ruptured saccular cerebral aneurysms who were admitted, diagnosed, and operated on within 72 hours after subarachnoid hemorrhage (SAH) and treated with calcium antagonists. The aneurysms were in the anterior portion of the circle of Willis in 95% of patients and in the posterior portion in 5%; 12% had multiple aneurysms. Preoperative neurological grades according to Hunt and Hess were I to III in 74% of patients and IV or V in 26%. Subarachnoid hemorrhage as determined by CT scanning was minor in 20%, moderate in 43%, and severe in 37% of patients. All patients received intraoperative and postoperative administration of the calcium antagonist nimodipine. Three days postoperatively, SAH (as measured by CT) was significantly reduced in the majority of patients but was still moderate in 18%. In the postoperative course, 2% of patients developed delayed ischemic neurological symptoms due to vasospasm. In two additional patients, ischemic symptoms were transient and fully reversible. At the 6-month follow-up interval, a significant prognostic difference was found between two patient groups with different CT scan findings. Among the patients with SAH only, the rate of good outcome (no or minimal deficit) was 93% when the preoperative neurological Grade was I or II; but even with a Grade of III to V, there was a good outcome in 84% of patients. By contrast, in patients with additional intracerebral and/or intraventricular hemorrhage, the good-outcome rate was only 44%. From these data it is concluded that morphological preoperative CT findings are of prognostic value and may even be superior to clinical grading in predicting outcome.
Cardiorespiratory effects of venous air embolism in dogs receiving a perfluorocarbon emulsion
Authors: Tuman Kenneth J. , Spiess Bruce D. , McCarthy Robert J. , Ivankovich Anthony D.
Published: May 2009

✓ The cardiorespiratory effects of a nonlethal venous air embolism were studied in dogs in the presence of a perfluorocarbon emulsion (PFE). Prior to embolization, five dogs received 20 cc/kg of hydroxyethyl starch (6% HES) and five received PFE oxypherol (20% FC-43). Determinations of mean systemic arterial pressure (MAP), pulmonary artery pressure (PAP), left ventricular pressure (LVP), first and second derivatives of LVP with respect to time (dP/dt and Vmax), cardiac index (CI), stroke index, left and right ventricular stroke work index (LVSWI and RVSWI), PaCO2, PaO2, and venous admixture (Qs/Qt) were made before and then 1, 5, 10, and 30 minutes after placement of the venous air emboli (0.75 cc/kg/min for 5 minutes). After emboli were introduced, PaO2, MAP, LVSWI, dP/dt, Vmax, and CI decreased; the average decrease during the first 5 minutes was significantly less in the PFE group. Following introduction of venous air emboli, PAP, PaCO2, RVSWI, and Qs/Qt increased less in the PFE group than in the HES group, with statistical significance achieved at various times during the first 10 minutes after embolism. All parameters returned toward baseline values by 30 minutes in both groups. This study indicates that FC-43, when administered before venous air embolism, helps to attenuate some of the detrimental cardiorespiratory effects of the embolism.
Spinal intramedullary spread of medulloblastoma
Authors: Barnwell Stanley L. , Edwards Michael S. B.
Published: May 2009

✓ The case of an 11-year-old boy is reported in whom two intramedullary lesions developed at the thoracic-cervical and thoracic-lumbar junctions 2½ years after resection and irradiation of a medulloblastoma in the posterior fossa. There was no evidence of subarachnoid spread of the tumor. Magnetic resonance imaging was used to localize these lesions, and provided much better diagnostic information than either computerized tomography scans or myelograms.