bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Treatment of Spinal Cord Compression in Patients with Lung Cancer
Authors: Sundaresan Narayan , Bains Manjit , McCormack Patricia
Published: May 2010

We analyzed the clinical features, radiological findings, and results of surgical treatment in series of 25 patients with lung cancer and invasion of the spine. In 12 of the 25 (40%) patients, involvement of the spine was present at the time of initial presentation of malignancy. Computed tomography revealed the presence of a large paravertebral soft tissue mass with destruction of adjacent ribs in the majority. The surgical approach consisted of an anterolarteral exposure through a formal thoracotmy in 22 patients and a thoracobadominal flank approach in the 3 patients with lumbar lesions. All gross tumor was resected from the involved paravertebral tissues, vertebral body, and epidural space. Immediate stabilization of the spine was then achieved with methyl methacrylate. Local brachytherapy (iridium-192 implants) was used in 19 patients. After treatment, 87% were ambulatory, and 67% maintained ambulation for more than6 months. Our data suggest that compression of the spinal cord in many patients with lung cancer results from direct extension of tumor through the chest wall. Because the majority of such patients often have localized disease involving the spine, aggressive surgical treatment is indicated.
Posttraumatic Acute Arterial Subdural Hematoma Manifested during Anesthesia
Authors: Mann Kirpal S. , Yue Chung P. , Ho Yik H. , Chan Fu L.
Published: May 2010

Traumatic acute arterial subdural hematomas are rare and are associated with a high mortality rate. The authors report a case in which the initial computed tomographic (CT) scan examination failed to reveal a hematoma. Within the subsequent 4 hours, while recovering from anesthesia given so that hemostasis of bleeding soft tissue injuries could be obtained, the patient suddenly developed bilaterally dilated pupils, both nonreactive to light. A repeat CT scan then revealed large subdural and intracerebral hematomas. The case is discussed and the pertinent literature is reviewed.
Persistent Primitive Trigeminal Artery, Cavum Septi Pellucidi, and Associated Cerebral Aneurysm in a Patient with Polycystic Kidney Disease: Case Report
Authors: Matsumura Masaru , Wada Hirociyo , Nojiri Ken
Published: May 2010

A 51-year-old man with polycystic kidney disease had a persistent primitive trigeminal artery, cavum septi pellucidi, and an unruptured cerebral aneurysm. He had a history of long-standing hypertension, but not of subarachnoid hemorrhage. Computed tomograms revealed cavum septi pellucidi. Because of the polycystic kidney disease, we performed four-vessel cerebral angiography, which revealed a persistent primitive trigeminal artery and a cerebral aneurysm at the bifurcation of the left internal carotid artery. The neck of the aneurysm was clipped successfully without producing any neurological deficit. The clinical significance of the combination of these multiple anomalies and cerebral aneurysms is discussed.
Falcine Chondrosarcoma: Case Report and Literature Review
Authors: Cybulski George R. , Russell Eric J. , D'Angelo Charles M. , Bailey Orville T.
Published: May 2010

We present a case of falcine chondrosarcoma in a 58-year-old man. Only a few other examples of chondrosarcomas in this location and a total of approximately 50 intracranial cases have been reported. Because its rarity prevents any group of neurosurgeons from collecting a large experience in managing this tumor, we reviewed descriptions of previous cases to determine the natural history of intracranial chondrosarcomas. The distinguishing features of this rare tumor are compared with previous examples of intracranial tumors derived from cartilage and more common tumors in the parasagittal region, such as meningioma.
Extradural and Hourglass Cervical Neurinomas: The Vertebral Artery Problem
Authors: George B. , Laurian C. , Keravel Y. , Cophignon J.
Published: May 2010

Eleven cases of cervical neurinomas with an extradural component were operated on with control of the vertebral artery as the first step of the surgical procedure. The lateral anterior approach was used first in each case with excellent results. In the case of hourglass tumors (seven cases), a complementary posterior approach was performed to remove the intradural portion. Primary control of the vertebral artery in cases of extradural or hourglass neurinoma is a logical and safe procedure in the attempt to achieve complete and bloodless tumor removal.
Gunshot Wound to the Pons with Functional Neuroanatomical and Electrophysiological Correlation
Authors: Clark Jonathan B. , Bellegarrigue Roberto B. , Salcman Michael
Published: May 2010

We describe a patient with a gunshot wound to the brain that traversed the left cerebellar hemisphere and terminated in the left lateral midpons. The clinical findings, operative course, neuroradiographic features, and evoked potential data are correlated with the functional anatomy of the pons. It is possible to demonstrate that a local lesion in the lateral pons causes a hemiparesis, worse in the upper extremity, thus suggesting a somatotopic localization of the pontine corticospinal tract not previously described.
Brain Biopsy in Cases of Neonatal Herpes Simplex Encephalitis
Authors: Baumann Robert J. , Walsh John W. , Gilmore Robin L. , Lee Charles , Wong Peter , Wilson H. David , Markesbery William R.
Published: May 2010

Neonatal herpes simplex encephalitis (HSE) can represent a difficult diagnostic problem when it occurs without concomitant mucocutaneus lesions and usually requires brain biopsy for diagnosis. Asymptomatic for the initial 2 to 4 weeks of life, the three infants we describe with localized HSE came to medical attention only because they developed persistent seizures and other nonspecific symptoms. Lumbar spinal fluid obtained from these children at clinical presentation showed an encephalitic pattern. Radionuclide brain scans revealed focal uptake of isotope in a variety of cortical areas, and electroencephalograms (EEGs) demonstrated repetitive, high amplitude, polyphasic sharp waves arising from analogous regions. Computed tomography (CT) showed nonspecific ill-defined areas of low density or contrast enhancement that did not correlate well with radionuclide, EEG, or clinical findings in two neonates. No infant had predominant temporal lobe involvement. Because these data suggested a multifocal, encephalitic process, all three infants underwent brain biopsy. A widespread infiltration of leukocytes and macrophages was observed in each specimen, and abundant intranuclear inclusions were present. Electron microscopy revealed abundant herpesvirus particles, and herpes simplex virus (HSV) was subsequently isolated from each sample. From our observations and our review of the literature, we propose the following criteria as indications for brain biopsy: Brain biopsy is warranted to rule out HSE when a neonate presents with seizures, cerebrospinal fluid mononuclear pleocytosis with a negative gram stain, and focal, cortical disease on EEG and radionuclide scan. Additionally, a history of maternal genital HSV infection is helpful but may be absent, the child may have an asymptomatic interval after birth, the CT data can be nonspecific, and, in contrast to adults and older children, neonates with HSV typically lack temporal lobe involvement. Early diagnosis combined with prompt institution of appropriate antiviral therapy could reduce the mortality and morbidity from this destructive illness.
Simulation of a Prolactin-secreting Adenoma by an Intrasellar Craniopharyngioma
Authors: Gamblin George T. , James L. Patrick , Thomas John , Six Eric , Eil Charles
Published: May 2010

We report here an unusual case of a 21-year-old woman who presented with amenorrhea, galactorrhea, and hyperprolactinemia (66 to 81 ng/ml) secondary to an unsuspected intrasellar craniopharyngioma. The results of preoperative endocrine testing were compatible with the presence of a prolactin-secreting adenoma. Moreover, high resolution computed tomographic scanning revealed an uncalcified hypodense sellar mass that did not enhance after contrast administration, a feature shared by many prolactinomas. This report illustrates that amenorrhea, galactorrhea, mild to moderate hyperprolactinemia, and a sellar mass should not automatically be attributed to the presence of a prolactin-secreting adenoma.
Technical Note: The Use of Nitroglycerin Ointment after Precarious Neurosurgical Wound Closure
Authors: Lehman Ralph A.W. , Page Robert B. , Saggers Gregory C. , Manders Ernest K.
Published: May 2010

It is suggested that the application of nitroglycerin ointment to neurosurgical wound closure exhibiting skin pallor or cyanosis can minimize necrosis and dehiscence. Examples of the use of this agent in patients undergoing myelomenin-gocele closure as well as in a premature infant undergoing ventriculoperitoneal shunting are described.
Magnetic Resonance Imaging of Acoustic Neuromas
Authors: DeFilipp Gary J. , Buchheit William A.
Published: May 2010

Ten patients with neurosensory hearing loss and computed tomographic (CT) evidence of acoustic neuromas were evaluated with magnetic resonance imaging (MRI). Tumors ranged in size from 0.8 to 3.7 cm. With the use of spin echo pulse sequences, all tumors were identified by MRI and appeared as masses with signal intensities greater than that of cerebrospinal fluid and equal to or greater than that of brain stem. Two patients who previously had undergone operation for acoustic neuromas were evaluated with MRI. In one patient with CT evidence of tumor recurrence, the lesion could not be identified by MRI. MRI holds promise of becoming a primary diagnostic modality for the evaluation of acoustic neuromas.
Limitations of Brain Stem Auditory Evoked Potentials for Intraoperative Monitoring during a Posterior Fossa Operation: Case Report and Technical Note
Authors: Piatt Joseph H. , Radtke Rodney A. , Erwin William C.
Published: May 2010

We have encountered an example of the insensitivity of brain stem auditory evoked potentials (BAEPs) for monitoring the brain stem during a posterior fossa operation. the addition of somatosensory evoked potential recording to conventional BAEP protocols is readily accomplished and is likely to improve the sensitivity of intraoperative electrophysiological assessment of brain stem function.
Chronic Encapsulated Intracerebral Hematoma during Infancy: Case Report
Authors: Terada Tomoaki , Okuno Takashi , Moriwaki Hiroshi , Nakai Ekini , Komai Norihiko
Published: May 2010

Chronic encapsulated intracerebral hematoma is a rare condition. Only four cases have been reported. The cause of this condition is unclear. A case of chronic encapsulated intracerebral hematoma in an 1-year-old infant is reported, and the characteristic findings and their causes are discussed with a literature survey.
Cranial Asymmetry and Lambdoid Synostosis in a Sibship
Authors: Lohse Dean C. , Duncan Charles C. , Ment Laura R.
Published: May 2010

In craniosynostosis, as in all congenital diseases, the interaction of hereditary and neonatal environmental factors can be separated only in rare cases. Four siblings with an asymmetry of the posterior right portion of the skull are presented. The youngest of the four suffered from severe cyanotic congenital heart diseases and secondarily suffered from ischemic/hypoxic cerebral injury. This child had complete synostosis of the right lambdoid and posterior sagittal sutures by the age of 5½; months. The cranial asymmetry was less pronounced in each of the older children and was nearly undetectable in the oldest, a 7½;-year-old girl. True synostosis was not present in any of the older siblings. It is suggested that an autosomal-dominant hereditary condition caused a hypotrophic mesenchymal relationship of occipitotemporal ontogenesis. This condition was compensated for through childhood by the molding effect of the brain in the older three siblings. The systemic disease and delayed cerebral growth in the youngest probably led to the complete picture of craniosynostosis.
Accessory Nerve Neurinoma Mimicking a Brain Stem Tumor on Angiography: Report of a Case
Authors: Matsushima Toshio , Fukui Masashi , Matsunaga Masayuki , Kitamura Katsutoshi , Hasuo Kanehiro
Published: May 2010

A case of accessory nerve neurinoma presenting with a so-called “intraaxial mass sign” on the angiograms is reported. The tumor originated from the intracranial portion of the accessory nerve and displaced the lateral medullary segment of the posterior inferior cerebellar artery posterolaterally. The displacement of the artery can be understood by the microanatomical relations.
Sacral Fracture with Pseudomeningocele and Cerebrospinal Fluid Fistula: Case Report and Review of the Literature
Authors: Hadley Mark N. , Carter Philip L.
Published: May 2010

A patient who sustained an isolated transverse sacral fracture is presented. A large ventral sacral pseudomeningocele with cerebrospinal fluid (CSF) fistula developed. Eighteen previous cases of traumatic pseudomeningocele have been documented. A review of those cases leads these authors to conclude that: (a) transverse sacral fractures are rare and have not been reported in association with a pseudomeningocele formation; (b) at the 4th sacral vertebra, this is the lowest reported pseudomeningocele; and (c) CSF fistula with sacral fracture is distinctly uncommon, reported in only one previous case. The presenting symptoms, diagnostic evaluation, treatment, and prognosis are discussed.
Intraventricular Morphine in Paraneoplastic Painful Syndrome of the Cervicofacial Region: Experience in Thirty-eight Cases
Authors: Lenzi Aberto , Galli Giuseppe , Gandolfini Massimo , Marini Giovanni
Published: May 2010

The authors report their personal experience with the administration of microdoses of morphine hydrochloride by the intraventricular route through a subcutaneous reservoir for the treatment of paraneoplastic painful syndrome of the cervicofacial region in 38 patients. The results obtained are very encouraging.
Cystic Supratentorial Gliomas: Natural History and Evaluation of Modes of Surgical Therapy
Authors: Loftus Christopher M. , Copeland Brian R. , Carmel Peter W.
Published: May 2010

The management of cystic supratentorial gliomas is hampered by lack of documentation of the natural history of these lesions and by a lack of evaluation of modes of surgical therapy. We analyzed these factors in 25 patients with solitary cysts operated upon over a 20-year period. Two distinctive patterns of symptoms were seen: short duration (increased pressure and hemiparesis), most often heralding a malignant lesion, and long duration (commonly seizure disorder), associated more often with a benign pathological condition. Large solitary cysts were found in tumors of all histological grades. Surgical procedures included extirpation, biopsy/partial resection, cyst communication to ventricle or marsupi-alization, burr hole aspiration, aspiration via an indwelling reservoir, and cyst-peritoneal shunting. Radiotherapy, given in all cases, did not prevent cyst recurrence. Of the 25 patients, 76% are alive and remain cystfree at follow-up intervals of 1 to 16 years (mean, 3.2). Five patients died from their tumors, with a mean survial of 33 months after decompression. In 7 of 8 patients with cysts largely or entirely within the basal ganglia or thalamus, successful operative cyst control was achieved. Patients with solitary cystic gliomas seem to have a favorable prognosis, and vigorous efforts to control cyst recurrence and limit disability are warranted. Analysis of our data suggests that craniotomy for tumor resection, cyst decompression, and tissue diagnosis is the initial procedure of choice. Cyst recurrence without major solid tumor should be controlled by computed tomography-guided tap or shunt drainage. Reexploration is indicated when cyst reaccumulation is accompanied by clear regrowth of a solid component.
The “Hyperacute” Extraaxial Intracranial Hematoma: Computed Tomographic Findings and Clinical Significance
Authors: Greenberg Jonathan , Cohen Wendy A. , Cooper Paul R.
Published: May 2010

Thirteen patients with acute subdural and epidural hematomas were found to have fresh, unclotted blood at the time of surgical decompression several hours after injury. Computed tomographic (CT) scans of these patients demonstrated areas of hyperdensity, corresponding to clotted hematoma, admixed with areas of isodensity, corresponding to liquid blood. Active bleeding from identifiable loci was found in 11 patients, 4 of whom had massive hemorrhages. Clotting abnormalities ranging from slightly elevated laboratory test results to a full-blown clinical picture of disseminated intravascular coagulation occurred in 8 patients. We describe the CT pictures of these “hyperacute” lesions, and we postulate that such CT presentations indicate either the presence of ongoing active intracranial bleeding or the onset of a coagulopathy complicating the management of these lesions.
Metastatic Meningioma to Cervical Vertebra: Case Report
Authors: Wu Julian K. , Kasdon David L. , Whitmore Erika L.
Published: May 2010

A case of recurrent occipital angioblastic meningioma metastasizing to the cervical vertebra is reported. The epidemiology and modes of metastasis are discussed.
Multiple Unusual Aneurysms and Arteriovenous Malformation in a Single Patient: A Case Report
Authors: Nehls Daniel G. , Carter Philip L.
Published: May 2010

A patient with multiple unusual aneurysms and an arteriovenous malformation (AVM) is presented. Aneurysms involving the meningohypophyseal trunk and the feeding vessel of the AVM were observed. Two additional aneurysms assumed a pantaloon appearance. The largest aneurysm was responsible for the patient's subarachnoid hemorrhage. This aneurysm and two adjacent aneurysms were clipped successfully, and the patient made an uneventful recovery. Subsequent angiography revealed a stable appearance of the remaining aneurysms and AVM. (Neurosurgery 17:97-100, 1985)
Evaluation of Spinal Cord Stimulation for Postapoplectic Spastic Hemiplegia
Authors: Nakamura Saburo , Tsubokawa Takashi
Published: May 2010

We used spinal cord stimulation (SCS) in patients with postapoplectic spastic hemiplegia in an attempt to reduce the spasticity. Three patients with spastic hemiplegia due to apoplexia were selected for the treatment. Reduction of spasticity was observed 3 to 9 days after the stimulation. Electrophysiological evaluation of the spasticity from the H reflex revealed a remarkable improvement in all three patients. The mechanism of reduction of spasticity has not yet been clarified, although a direct or indirect effect on the reticulospinal tract is thought to play a role.
An Unusual Spinal Meningioma in a Child: Case Report
Authors: Liu Hsiu Chih , De Armond Stephen J. , Edwards Michael S. B.
Published: May 2010

Meningiomas seldom occur in children, and spinal meningioma in a child is rare. We report the case of a boy, 3 years and 5 months of age, who had an unusual atypical meningioma involving the subarachnoid space from T-2 to the cauda equina. To our knowledge, no similar case has been reported previously.
Spinal Cord Compression Due to Postoperative Cervical Pseudomeningocele
Authors: Hanakita Junya , Kinuta Yuji , Suzuki Takanori
Published: May 2010

A case of spinal cord compression due to postoperative cervical pseudomeningocele is reported. A 63-year-old man had undergone osteoplastic laminectomy of the C-3 through C-6 laminae for quadriplegia after a traffic accident 1 year and 4 months earlier. Computer-assisted tomography with metrizamide injection showed a pseudomeningocele in the paraspinous area at the C-3 through C-6 level.
Giant Aneurysm of an Azygos Anterior Cerebral Artery: Report of Two Cases and Review of the Literature
Authors: Hayashi Minoru , Kobayashi Hidenori , Kawano Hirokazu , Handa Yuji , Kabuto Masanori
Published: May 2010

The authors present two cases of a largely thrombosed giant aneurysm of an azygos anterior cerebral artery. An aneurysm of an azygos artery is rare, and a giant aneurysm in this location is extremely rare.
Microwave Hyperthermia for Brain Tumors
Authors: Winter Arthur , Laing Joy , Paglione Robert , Sterzer Fred
Published: May 2010

Twelve patients with malignant brain tumors who had failed to respond to conventional therapies were treated with thermotherapy. Hyperthermic temperatures (∼43°C) were induced in the tumors using microwaves at a frequency of 2450 MHz that were guided into the tumors by one or more semirigid coaxial applicators. These applicators fit into 16 gauge tubes or needles and can be inserted into the brain with minimal damage to healthy tissues. During each treatment, the tumors were maintained at hyperthermic temperatures for 1 hour. Several treatments spaced a few days apart were usually administered. The procedure used for producing hyperthermia in brain tumors with microwaves proved to be safe and could be repeated several times without producing toxic effects. Objective tumor responses were obtained in 75% of the patients (decrease in tumor size, 3 patients; slowing of tumor growth, 2 patients; necrosis of tumor tissues verified by pathological examination, 4 patients). Favorable clinical responses were observed in 75% of the patients (rapid decrease in intractable headaches, 5 patients; improvements in clinical deficits, 4 patients). Also, in all patients, the microwave power required to heat for a given time or a given volume decreased during most of the thermotherapy sessions, possibly because of heat damage to the tumor vasculature. Our results, taken together with the results of other investigators, indicate that thermotherapy is a promising modality for treating malignant brain tumors, either as the sole therapy or in combination with radiotherapy and chemotherapy. The next logical steps would be Phase I/II type trials of subjects whose disease is less advanced than the disease of patients treated in the current series of investigations.
Recurrent Subarachnoid Hemorrhage Complicating a Traumatic Carotid-Cavernous Fistula
Authors: Dohrmann Peter J. , Batjer Hunt H. , Samson Duke , Suss Richard A.
Published: May 2010

Recurrent subarachnoid hemorrhage complicated a traumatic carotid-cavernous fistula in a young man. The fistula drained predominantly into the deep venous system of the brain, where the hemorrhage was thought to have occurred.
Angiographically Occult Angiomas: A Report of Thirteen Cases with Analysis of the Cases Documented in the Literature
Authors: Wakai Susumu , Ueda Yasuichi , Inoh Satoshi , Nagai Masakatsu
Published: May 2010

Thirteen cases of angiographically occult angioma (AOA) are reported. Nine of these presented with intraparenchymatous hemorrhage, and the other 4 patients had epilepsy. The pathological diagnosis was arteriovenous malformation in 12 cases and cavernous angioma in 1. All surgical speciments but 2 contained hemosiderin pigment. In addition to these 13 cases, we reviewed 159 cases of AOA reported in the literature and analyzed them in terms of age, sex, symptoms and signs at admission, computed tomographic findings, location and size of angioma, history of previous and recurrent hemorrhage, type of hemorrhage, and outcome of operation to determine the characteristics of AOAs. The results of these analyses are described in detail, and the indications for surgical treatment of suspected AOAs are discussed. Our microsurgical technique for detecting the angioma within or adjacent to the hematoma is also presented.
Comparison of the Failure Biomechanics of Spinal Fixation Devices
Authors: Maiman Dennis J. , Sances Anthony , Larson Sanford J. , Myklebust Joel B. , Chilbert Michael A. , Nesemann Sam P. , Flatley Thomas J.
Published: May 2010

The failure biomechanics of Harrington distraction rods, modified Weiss springs, and Luque rods were studied in intact cadavers and isolated spinal columns using flexion-compression loading. Most spines fractured at T-11 or T-12 at applied loads ranging between 556 and 4220 newtons (mean = 1833 N). After Harrington distraction rod placement, the same spines failed at a mean load of 859 N (42% of control), always as a result of hook extrusion and often including lamina fracture (seven cases). When modified Weiss springs were used, the spines failed at a mean load of 1128 N (54% of control) by allowing the spine to bend to the initial failure angle; in most instances, deformities resolved when the load was reduced. Luque rods were tested in four specimens; these provided the most rigid stabilization and failed at 83% of control values. Modified Weiss springs often maintain spinal stability better than Harrington distraction rods.
Translabyrinthine Removal of Cerebellopontine Angle Meningiomas
Authors: Giannotta Steven L. , Pulec Jack L. , Goodkin Robert
Published: May 2010

The authors report two cases of the microscopic total removal of meningiomas in the region of the cerebellopontine angle using the translabyrinthine approach. Although both tumors were larger than 4 cm, the only resulting neurological deficit was ipsilateral hearing loss. The translabyrinthine approach may be an alternative measure in dealing with these difficult lesions.
Surgical Treatment of V1 Trigeminal Neuralgia: Technical Refinement
Authors: Persing John A. , Jane John A.
Published: May 2010

A refinement in surgical technique for supraorbital and supratrochlear nerve avulsion for trigeminal neuralgia is presented. This modification uses an upper lid “blepharoplasty” incision.
Arteriovenous Malformations of the Superior Cerebellar Artery: Excision via an Occipital Transtentorial Approach
Authors: Salcman Michael , Nudelman Robert W. , Bellis Edwin H.
Published: May 2010

Arteriovenous malformations (AVMs) of the superior cerebellar artery (SCA) are unusual and difficult lesions to treat, representing less than half of all AVMs located in the posterior fossa. Traditional approaches for surgical extirpation include the subtemporal transtentorial and suboccipital supracerebellar routes. On the basis of our recent experience with three SCA-supplied AVMs, we advocate an occipital transtentorial approach similar to that used for neoplasms of the pineal gland. Exposure of the AVM from above and in the midline provides superior visualization of the deep veins, the SCA arborization in the retrocollicular space, and the rostral cerebellum, without exposing the temporal lobe and the 4th nerve to surgical trauma in a narrow, confined space. Superior cerebellar AVMs that arise from the caudal branch of the SCA on the superolateral aspect of the hemisphere are more easily handled by standard suboccipital methods.
Resolving Occlusive Lesions of the Basilar Artery
Authors: Little John R. , Furlan Anthony J.
Published: May 2010

Progression of severe basilar artery stenosis to occlusion is a well-recognized phenomenon, but regression of a severe basilar artery atherothrombotic lesion has not been described previously. In this report, two patients with a symptomatic severe basilar artery occlusive lesion showed substantial angiographic improvement after 3 months of anticoagulation in one case and 4 months after superficial temporal artery to superior cerebellar artery bypass in the other case. The findings in these cases indicate that clinical improvement in similar cases may reflect recanalization of a basilar artery occlusive lesion. The uncertain natural history and potential for regression of symptomatic basilar artery atherothormbosis make us hesitant to recommend posterior circulation revascularization immediately after such lesions are first demonstrated angiographically.
Postural Syncope and Trigeminal Neuralgia Relieved by Percutaneous Rhizotomy with Glycerol
Authors: Arias Manuel J.
Published: May 2010

A patient with typical trigeminal neuralgia experienced an episode of sudden loss of consciousness when she tried to sit up. Clinical neurological and neuroradiological studies revealed no known abnormalities. Percutaneous retrogasserian rhizotomy with glycerol with the patient in the prone position relieved the syncope and neuralgia.
Foreign Body Reaction to Rubber Torkildsen Catheters: A Report of Two Cases
Authors: Rossitch Eugene , Friedman Allan H. , Bullard Dennis E.
Published: May 2010

Two patients came to clinical attention because of foreign body reactions to rubber catheters. In one patient, the reaction presented as multiple levels of aseptic meningitis and, in the second patient, the reaction caused an intracranial mass with localized neurological dysfunction.
Quantitative Anatomy of the Thoracolumbar Epidural Space
Authors: Reynolds Arden F. , Roberts P. Alex , Pollay Michael , Stratemeier Phillip H.
Published: May 2010

Quantitative measurements of the epidural space between T-7 and L-4 were made in the sagittal and coronal planes utilizing x-ray films made after the injection of iodized oil into the epidural space in the low thoracic and upper lumbar areas. These data reveal a 1-mm ventral epidural space and a 2-mm lateral epidural space, with a sawtooth shape to the dorsal epidural space measuring between 1.1 and 2.9 mm at the rostral lamina and between 3.8 and 6.5 mm at the caudal lamina. Additionally, five patients with chronic pain were studied by computed tomography of T-8 to T-12, with confirmation of the sawtooth shape of the dorsal epidural space. Computed tomography showed the measurements of the epidural space at the rostral lamina to vary between 1.3 and 1.6 mm and those at the caudal lamina/interlaminar space to range from 6.9 to 9.1 mm.
Comparative Studies of the Diagnostic Value of Cerebrospinal Fluid Spectrophotometry and Computed Tomographic Scanning in Subarachnoid Hemorrhage
Authors: Tsementzis S.A. , Hitchcock E.R. , DeCothi A. , Gill J.S.
Published: May 2010

Serial spectrophotometric scans of cerebrospinal fluid (CSF) and computed tomographic (CT) scans of 99 patients with a subarachnoid hemorrhage (SAH) were examined. The xanthochromic index (i.e., the sum of the absorption values at 416 nm (oxyhemoglobin) and 460 nm (bilirubin)) yielded an accurate diagnosis in 82%, as did the CT scan. When both spectrophotometric and CT scans were used, the accuracy of SAH diagnosis increased to 96%. The xanthochromic index was valuable in estimating the date of hemorrhage and also correlated well with the clinical outcome of these patients. Only 42% of the recurrent hemorrhages were diagnosed by CSF spectrophotometry; in this capacity, its role seems less clear. However, a positive diagnosis of recurrent hemorrhage by CT scan was made in 83%.
Stab Wounds at the Craniocervical Junction
Authors: de Villiers J.C. , Grant A. R.
Published: May 2010

Between 1976 and 1984, 11 patients with stab wounds at the craniocervical junction were seen in the Department of Neurosurgery at Groote Schuur Hospital. The injury usually occurred in males, and the left side was predominantly involved. Because of the anatomical features of this region, the penetrating instrument is deflected by the occipital squama into the atlantooccipital or atlantoaxial interspace, and an almost predictable syndrome occurs. The dura mater is penetrated, so that cerebrospinal fluid leakage and meningitis are common complications (meningitis occurred in 5 patients). A meningocele may develop at this site and did occur in 4 patients, but only 2 required surgical repair. Because of the exposed position of the vertebral artery at this level, this vessel was injured in 4 patients; an arteriovenous fistula developed in 2, vertebral artery occlusion occurred in 1, and a false aneurysm developed in another patient. The neurological deficit varied in magnitude, was often transient, affected the upper limbs more than the lower, was asymmetrical (suggestive of lateralized injury), and at times showed a remarkable tendency to recover. Awareness of the existence of this syndrome may help in forestalling complications. The only warning sign may be an insignificant wound in the suboccipital or retromastoid region.
Vertebral Artery Thrombosis Accompanied by Burst Fracture of the Lower Cervical Spine: Case Report
Authors: Handa Yuji , Hayashi Minoru , Kawano Hirokazu , Kobayashi Hidenori , Hirose Satoshi
Published: May 2010

A case of thrombosis of the vertebral artery and an associated bursting fracture of the lower cervical spine is reported. Computed tomography revealed both the location and the spreading of the fractures of the injured spine. We recognized that the vertebral artery thrombosis was caused by an injury to the arterial wall within the fractured transverse foramen
Single Stage Composite Resection and Reconstruction of Malignant Anterior Skull Base Tumors
Authors: Rosen Harvey M. , Simeone Frederick A. , Bruce Derek A.
Published: May 2010

Operative morbidity, including osteomyelitis and meningeal and cerebral sepsis, remains high among patients undergoing the composite (bony and overlying soft tissue) resection of malignant skull base tumors. This is in part because of the poor wound healing afforded by free skin grafts and the poorly vascularized pericranial flaps routinely used to resurface the operative defect. In an effort to reduce the operative morbidity, single stage resection and reconstruction with distant vascularized flap tissue was performed in five consecutive patients who presented with malignant skull base tumors. We think that immediate flap reconstruction will allow skull base lesions previously considered unresectable or associated with a prohibitive complication rate to be safely resected. Case presentations illustrate operative techniques. The potential disadvantage of masking a tumor recurrence with immediate flap coverage is discussed.
Haemophilus influenzae Meningitis in the Presence of a Cerebrospinal Fluid Shunt
Authors: Pottage John C. , Petrak Russell M. , Harris Alan A. , Levin Stuart
Published: May 2010

Haemophilus influenzae meningitis in the presence of a cerebrospinal fluid shunt has been reported uncommonly. Staphylococcus aureus and Staphylococcus epidermidis, the most common etiological agents, are usually acquired by contiguous spread from an intraoperative or perioperative source. These infections usually occur within 2 months of shunt insertion and are rarely associated with bacteremia. Review of the literature shows that infection with H. influenzae typically occurs later than with the more common pathogens, is commonly associated with bacteremia, and frequently can be treated with antibiotics alone.
Delayed Ischemic Deterioration in Patients with Early Aneurysm Operation and Intravenous Nimodipine
Authors: Hans Säveland , Bengt Ljunggren , Lennart Brandt , Kenneth Messeter
Published: May 2010

A consecutive series of 100 individuals with aneurysmal subarachnoid hemorrhage were subjected to early aneurysm operation followed by subsequent intravenous administration of the calcium antagonist nimodipine during the critical period for symptomatic vasospasm. A total of 85 patients were in Hunt and Hess neurological Grades I through III, and 15 were in Grade IV or V before operation. In 39 individuals the aneurysm was located in the anterior cerebral artery complex (ACA), in 29 it originated from the internal carotid artery complex (ICA), and in 32 individuals the ruptured aneurysm arose from the middle cerebral artery (MCA). Of the patients, 71% made a good neurological recovery: the morbidity was 22%, and the mortality was 7%. Of the Grade I-III patients, 79% made a good neurological recovery, and the mortality was 6%. Delayed ischemic cerebral deterioration with permanent dysfunction occurred in five patients, all with ruptured ACA ancurysms. No single patient in the ICA or MCA populations developed delayed ischemic deterioration with fixed neurological deficit despite the presence of several potential risk factors, especially among the MCA aneurysm patients.
Cavernous Angioma: A Review of 126 Collected and 12 New Clinical Cases
Authors: Simard J. Marc , Francisco Garcia-Bengochea , Ballinger William E. , Mickle J. Parker , Quisling Ronald G.
Published: May 2010

The histopathological, clinical, and radiological features of the intracranial cavernous angioma are reviewed, based on an analysis of 138 symptomatic, histologically verified cases. Twelve of the cases are from our own series and 126 were collected from appropriately documented reports in the modern literature. The analysis indicated that, at the time of diagnosis, one-third of the patients (49 cases) were being evaluated for seizures, one-third (40 cases) for clinical evidence of hemorrhage, and one-third (49 cases) for mass lesions. Unlike the other two groups, the group presenting with clinical evidence of hemorrhage was distinguished by a dominant age at the time of diagnosis (41% were diagnosed during the 4th decade of life), by a high incidence of prior neurological evaluation (43%), by a higher rate of diagnosis at autopsy (28%) than at operation, and by the absence of microscopic calcification within the lesion.
Arachnoid Cysts of the Posterior Fossa
Authors: Rock J. P. , Zimmerman R. , Bell W. O. , Fraser R. A. R.
Published: May 2010

Arachnoid cysts of the posterior fossa are an uncommon clinical entity. The two cases presented in this review were evaluated without vertebral angiography. We think that the development of magnetic resonance imaging may obviate the need for angiography in selected cases.
Intrasellar Mucocele Simulating Pituitary Adenoma: Case Report
Authors: Abla Adnan A. , Maroon Joseph C. , Wilberger James E. , Kennerdell John S. , Deeb Ziad L.
Published: May 2010

Mucoceles occupying the sella turcica with suprasellar extension are quite rare. A case of intrasellar mucocele is reported. The preoperative clinical and computed tomographic appearance could not be differentiated from that of pituitary adenoma.
Klinefelter's Syndrome, Cerebral Germinoma, Chiari Malformation, and Syrinx: A Case Report
Authors: Ellis Simon J. , Crockard Alan , O. Barnard Robin
Published: May 2010

A case of Klinefelter's syndrome associated with intracranial germinoma and Chiari malformation is described. The case is discussed in view of the literature linking Klinefelter's syndrome with skeletal defects and germinoma.
Transient Neurological Deficit after Therapeutic Embolization of the Arteries Supplying the Medial Wall of the Hemisphere, Including the Supplementary Motor Area
Authors: Schell Gerald , Hodge Charles J. , Cacayorin Edwin
Published: May 2010

A 27-year-old, right-handed woman underwent intraoperative embolization for a left parasagittal arteriovenous malformation as part of a two stage plan that included subsequent surgical resection of the arteriovenous malformation. This report describes the neurological syndrome that developed after the first procedure. The relation of these deficits to localization of function within the supplementary motor area are correlated with recent advances in our understanding of this region.
Treatment of Cerebrospinal Fluid Leaks and Gram-negative Bacillary Meningitis with Large Doses of Intrathecal Amikacin and Systemic Antibiotics
Authors: Gilbert Verne E. , Beals Joe D. , Natelson Stephen E. , Tyler William A.
Published: May 2010

Six patients with cerebrospinal fluid (CSF) leaks and gram-negative bacillary meningitis (GNBM) were treated with large does of intrathecal amikacin (20 to 40 mg daily) and systemic antibiotics, Bactericidal activity was measured in the CSF of each patient, and the dose of intrathecal amikacin was increased if bactericidal activity was absent. Five of six patients had no bactericidal activity with systemic antibiotics alone and/or low dose intrathecal amikacin. All six patients were cured, and three of four patients with vertebral lesions had cessation of CSF leaks within 72 hours of the start of intrathecal amikacin. Intrathecal treatment for 7 to 10 days was adequate for five patients; the CSF of all patients was sterile within 72 hours, and all had a 90% reduction of pleocytosis in the CSF within 96 hours. One patient had radicular back pain after each intrathecal injection, but other side effects were not observed. These findings indicate that CSF leaks associated with GNBM can be effectively treated with large doses of intrathecal amikacin plus systemic antibiotics.
Hemorrhagic Infarction after Vasospasm Due to Ruptured Cerebral Aneurysm
Authors: Terada Tomoaki , Komai Norihiko , Hayashi Seiji , Moriwaki Hiroshi , Hyoutani Genhachi , Uematsu Yuji , Karasawa Jun , Kikuchi Haruhiko
Published: May 2010

Hemorrhagic infarction after vasospasm is a rare condition in patients with aneurysmal subarachnoid hemorrhage (SAH). Induced hypertensive therapy is used for patients with vasospasm, but this treatment has a risk of inducing hemorrhagic infarction. A total of 221 patients whose first computed tomographic (CT) scans were examined within 2 weeks after SAH were investigated for this study. There was symptomatic vasospasm in 99 (45%), cerebral infarction in 37 (17%), and hemorrhagic infarction in 13 (6%). Hemorrhagic infarction usually occurred 20 to 30 days after aneurysmal rupture; this period corresponds with the remission stage of the vasospasm. On CT scans, the hemorrhagic infarction was revealed as a leaky hemorrhage in a low density area in 11 cases, and a massive hemorrhage with mass effect was seen in 2 cases. These findings suggest that hemorrhagic infarction after vasospasm may sometimes be fatal. Cerebral blood flow autoregulation in patients with vasospasm was normal or of a hypertensive type during the remission stage of vasospasm, when hemorrhagic infarction usually appeared. This finding shows that induced hypertension therapy is ineffective during this stage; it should be stopped by this stage because it is ineffective and also may aggravate hemorrhagic infarction.
Failure of Naloxone to Improve Spinal Cord Blood Flow and Cardiac Output after Spinal Cord Injury
Authors: Wallace Christopher M. , Tator Charles H.
Published: May 2010

It has been reported that the narcotic antagonist, naloxone, can improve spinal cord blood flow (SCBF) and clinical recovery after experimental spinal cord injury produced by the weight-dropping technique. The purpose of the present study was to determine the effect of naloxone on SCBF, cardiac output (CO) and blood flow to other organs following clip compression injury. Rats were anesthetized, paralyzed and ventilated, with mean systemic arterial pressure (MSAP) recorded continuously, After a C-7-T-1 laminectomy and a 1-minute acute compression injury with a 50-g clip at T-1, rats were given injections of radioactive microspheres for measurement of SCBF, CO, and blood flow to other organs. The first determination was made 15 minutes after injury and a second was made after a 1-hour treatment with naloxone. Treated animals each received an intravenous bolus injection of naloxone (10 mg/kg) followed by a 1-hour intravenous infusion (2 mg/kg/hour). Naloxone failed to improve posttraumatic SCBF in the injured spinal cord. In addition, naloxone did not prevent posttraumatic hypotension or the progressive decline in CO seen between 15 and 75 minutes after injury. Thus, this study does not support the previous claims of a beneficial effect of naloxone on posttraumatic SCBF and MSAP.
Caudate Hemorrhage
Authors: Waga Shiro , Fujimoto Kiyoshige , Okada Masahiko , Miyazaki Masao , Tanaka Yutaka
Published: May 2010

Thirteen patients with caudate hemorrhage are described. All the hemorrhages were in the head of the caudate nucleus, and all the hemorrhages but one ruptured in the anterior horn of the lateral ventricle. In 9 patients, the hemorrhage was related to hypertension and the patients were older. In the other 4 patients, the hemorrhage resulted from rupture of an arteriovenous malformation (AVM) and the patients were under 40 years old. Clinical manifestations were nearly the same in both groups, suggestive of subarachnoid hemorrhage and including hemiparesis in most patients. In patients with hypertension, good recovery was obtained by conservative treatment and in those with reptured AVMs, resection of AVMs through an anterior transcallosal approach may be safe and recommended.
Supratentorial Intracerebral Hemorrhage after Posterior Fossa Operation
Authors: Seiler Rolf W. , Zurbrügg Heinz R.
Published: May 2010

OBJECTIVE

Three cases of supratentorial intracerebral hemorrhage after posterior fossa operation are described, and nine other cases reported in the literature are reviewed. The possible causes are discussed, but in eight cases no definite cause could be found. All eight patients were operated on in the sitting position, and all had hematomas in the subcortical white matter. A possible cause might be changes in intracranial dynamics in the sitting position with disruption of subcortical veins. Other authors mention the possibility of occlusion of carotid or vertebral vessels in the neck by improper positioning of the head leading to intraoperative infarction and to hemorrhage within the infarcted brain after repositioning of the patient. With the patient in a lateral or semilateral position, this complication should be preventable.
Reformatted Sagittal Images in the Differential Diagnosis of Meningiomas and Pituitary Adenomas with Suprasellar Extension
Authors: Clark Craig W. , Acker James D. , Robertson Jon H. , Eggers Frank , Muhlbauer Michael S.
Published: May 2010

Approximately 3 to 4 times a year, a tumor with suprasellar extension escapes classification on high resolution coronal and transaxial computed tomography. When arteriography failed to determine the diagnosis, the differential choices were usually meningioma or pituitary adenoma. The authors report the use of sagittal reformatted images in this differential diagnosis and conclude that these images may aid in the distinction between pituitary tumors with suprasellar extension and meningiomas located in this area.
Selective Posterior Rhizotomy in the Dorsal Root Entry Zone for Treatment of Hyperspasticity and Pain in the Hemiplegic Upper Limb
Authors: Sindou Marc , Mifsud Jean Jacques , Boisson Dominique , Goutelle Alain
Published: May 2010

The authors report a series of 16 hemiplegic patients suffering from harmful spasticity in the upper limb and treated with selective posterior rhizotomy (SPR) in the dorsal root entry zone (DREZ). This severe spasticity was associated with irreducible abnormal postures in flexion in 11 cases and painful manifestations in 12. The method was introduced in 1972 on the basis of anatomical studies of the DREZ in humans, in which a topographical segregation of the root afferents, according to their anatomicofunctional destinations, has been shown. It consists of a DREZ microsurgical lesion 1 to 2 mm in depth and directed at a 45° angle, performed ventrolaterally in the posterolateral sulcus of the spinal cord and into the internal part of the Lissauer's tract. The procedure is carried out in each rootlet of the posterior roots considered to be responsible for the harmful spasticity. SPR interrupts selectively the (lateral) nociceptive and (central) myotactic afferent fibers connecting the motor neurons, while sparing most of the (medial) lemniscal fibers and the inhibitory circuitry of Lissauer's tract and the dorsal horn. The results were evaluated after a 1- to 12-year follow-up. There were no deaths and no general complications; in 1 case a loss of motility in the leg ipsilateral to the procedure occurred. The excess of spasticity was slightly diminished (2 cases), markedly reduced (9 cases), or totally abolished (5 cases), making possible an improvement in voluntary movements in 8 patients and at least a good passive mobilization in 7 further case. In 1 case only, a marked tendency for spasticity to return was observed. Of the 12 patients with painful manifestations, 9 were completely relieved and 3 improved. These beneficial effects on both spasticity and pain led to a gain in functional status in 93% of cases. This was achieved without impairing sensation in the upper limb in 8 cases and with its diminution only in the 8 others.
Mycobacterium tuberculosis Meningitis: A Report of Twelve Cases and a Literature Review
Authors: Clark Craig W. , Metcalf James C. , Muhlbauer Michael S. , Dohan Curtis F. , Robertson Jon H.
Published: May 2010

Twelve recent cases of Mycobacterium tuberculosis meningitis are presented, and the literature is reviewed. Indications for neurosurgical intervention are outlined, and principles of therapy are reviewed.