bluuebunny/crossref_metadata_2025 huggingface dataset:
Moyamoya Disease Presenting as Intracerebral Hemorrhage during Pregnancy: Case Report and Review of the Literature
Authors: Enomoto Hitomi , Goto Hiroshi
Published: May 2010

Intracranial hemorrhage during pregnancy is rare. The authors present a case of moyamoya disease associated with pregnancy. A 32-year-old woman who was at 32 weeks of gestation experienced sudden severe headache followed by loss of consciousness. Computed tomography revealed an intracerebral hematoma in the left temporal lobe, and left carotid angiograms revealed moyamoya disease. The patient underwent emergency craniotomy, the hematoma was removed, and encephaloduroarteriosynangiosis was performed. The patient showed good recovery and, 2 months later, delivered a child vaginally without any trouble. Most intracranial hemorrhages during pregnancy result from cerebral aneurysms or arteriovenous malformations (AVMs), and few cases due to moyamoya disease have been reported. It is generally believed that subarachnoid hemorrhage due to cerebral aneurysms is likely to occur during the middle trimester of gestation, with the risk increasing progressively toward the third trimester. This may be explained by the fact that the cardiac output increases rather acutely from the first to the middle trimester. There seems to be no significant correlation between the stage of pregnancy and the occurrence of hemorrhage due to AVM. Most authors think that the operative indications for intracranial hemorrhage during pregnancy should be the same as for the nonpregnant state.
Raeder's Syndrome Associated with Intracranial Internal Carotid Artery Aneurysm
Authors: Kashihara Kengo , Ito Haruhide , Yamamoto Shinjiro , Yamano Kiyotoshi
Published: May 2010

Raeder's syndrome consists of oculosympathetic paresis and ipsilateral facial pain, with variable involvement of the trigeminal and oculomotor nerves. A 63-year-old woman experienced severe facial pain, a partial Horner's syndrome, and restriction of ocular movements on the left side. A left carotid angiogram disclosed a giant aneurysm of the cavernous portion of the internal carotid artery. This is the third reported case of Raeder's syndrome due to aneurysm of the intracranial internal carotid artery. Her facial pain was relieved by carotid ligation, and serial computed tomographic scans showed decrease of aneurysmal size.
Pituitary Apoplexy, Bilateral Carotid Vasospasm, and Cerebral Infarction in a 15-Year-Old Boy
Authors: Pozzati Eugenio , Frank Giorgio , Nasi Maria Teresa , Giuliani Giuliano
Published: May 2010

The authors report a case of pituitary apoplexy associated with oculomotor defects and focal cerebral signs; the visual pathways were intact. Computed tomography documented a mass of heterogeneous density within an enlarged sella turcica and a right parietal infarct. Angiograms revealed bilateral carotid spasm and occlusion of the right angular artery. Treatment was conservative. Control angiograms showed spontaneous resolution of the vasospasm and recanalization of the cortical artery. The patient made a complete neurological recovery; he needed only treatment with vasopressin due to transient diabetes insipidus. The risk of vasospasm and brain ischemia should be kept in mind when treating pituitary apoplexy. The early occurrence of vasospasm in our case suggests the participation of powerful vasoactive agents liberated from the tumor.
Civilian Gunshot Wounds to the Spinal Cord and Cauda Equina
Authors: Benzel Edward C. , Hadden Theresa A. , Coleman James Edward
Published: May 2010

We evaluated 42 patients with neurological deficits after civilian gunshot wounds to the spine. Thirty-five of these patients (the study population presented here) received their initial and follow-up care at Louisiana State University Medical Center in Shreveport over a 4-year period. Each patient had incurred a single gunshot wound to the spinal cord or cauda equina with an accompanying neurological deficit. The patient population was divided into three groups. Group 1 patients had incurred a complete motor and sensory loss below the injury (20 patients (57%)). Group 2 patients had incurred incomplete spinal cord injuries (9 patients (26%)), whereas Group 3 patients had cauda equina injuries (6 patients (17%)). Myelography was performed for all Group 2 and 3 patients as well as Group 1 patients in whom the trajectory of the bullet did not explain a higher level of neurological injury (3 patients (15%)). A decompressive operation was performed in the patients whose myelography showed neural compression. Three patients in Group 1 (15%), 5 patients in Group 2 (56%), and 5 Group 3 patients (83%) underwent operation. All 3 Group 1 patients who underwent operation had some improvement of nerve root function postoperatively. All operated Group 2 and 3 patients had improvement of myelopathic or radicular function postoperatively. All began improving within several days of operation, implying a cause and effect relationship. None of the 17 nonoperated Group 1 patients improved neurologically, whereas 3 of the 4 nonoperated Group 2 patients improved. The single nonoperated Group 3 patient improved neurologically. It is concluded that patients with incomplete neurological injuries after civilian gunshot wounds to the spine can expect radicular or myelopathic improvement. Decompressive operation is indicated in selected cases with unexpected radicular injuries or incomplete myelopathic injuries with myelographic evidence of neural compression. A stepwise improvement in neurological function over that expected without operation should be realized in these cases.
Synovial Cyst of the Cervical Spine
Authors: Jabre Anthony , Shahbabian Set , Keller Jeffrey T.
Published: May 2010

A case of acute posttraumatic myelopathy resulting from hemorrhage into synovial cysts bilaterally at the C-6, C-7 facet joints is presented. The pathogenesis of synovial cysts remains unclear, although reports in the literature have implicated trauma leading to cyst enlargement. Hemorrhage into the cavity of the synovial cysts resulted in epidural compression of the spinal cord in this patient. Because spinal synovial cysts cannot be unequivocally diagnosed preoperatively, other more common conditions must be considered in the differential diagnosis. Radiographic analysis including plain films, computed axial tomography, and metrizamide myelography are of value in establishing a neurological diagnosis. Surgical decompression and excision of the lesion may result in significant neurological improvement.
Lumbar Spinal Stenosis Associated with Renal Osteodystrophy
Authors: Spatola Mark A. , Apfelbaum Ronald I.
Published: May 2010

A case of coexisting lumbar spinal stenosis and renal osteodystrophy is reported. The presence of renal osteodystrophy is known to have predated the onset of neurological complaints. The patient's symptoms were relieved with surgery. Although a causative relationship between renal osteodystrophy and spinal stenosis has not been reported previously, it seems likely in this case.
Persistent Nerve Root Compression by Buckling of the Longitudinal Ligament after Chemonucleolysis
Authors: Beatty Robert M.
Published: May 2010

Buckling of the posterior longitudinal ligament with compression against the thecal sac was the cause of persistent positional back pain after chemonucleolysis. Computed tomography in the supine and prone positions was helpful in making the diagnosis, and the cause was confirmed at laminectomy.
Metrizamide-enhanced Computed Tomography as an Adjunct to Metrizamide Myelography in the Evaluation of Lumbar Disc Herniation and Spondylosis
Authors: Voelker Joseph L. , Mealey John , Eskridge Joseph M. , Gilmor Richard L.
Published: May 2010

Eighty patients with operatively proven lumbar disc herniation or lumbar spondylosis were preoperatively evaluated with metrizamide myelography followed by metrizamide-enhanced computed tomography (CT). The x-ray films were reviewed without knowledge of the operative findings, and the patients were subdivided into those with disc extrusions, spondylosis, or recurrent abnormalities. For the group as a whole, CT was correct in 82% and myelography was correct in 77%. Both CT and myelography together were accurate in 91%, a significant improvement (P<0.02). The authors conclude that, if both studies are performed, the percentage of cases correctly diagnosed is increased. Therefore, both metrizamide myelography and metrizamide-enhanced CT should be obtained in selected cases. A review of the literature is included.
Electrophysiological Monitoring during Basilar Aneurysm Operation
Authors: Little John R. , Lesser Ronald P. , Luders Hans
Published: May 2010

Intraoperative brain stem auditory evoked potential (BAEP) and somatosensory evoked potential (SEP) monitoring was evaluated in 16 patients each undergoing intracranial operation for basilar artery aneurysm. The 16 patients had 18 posterior circulation aneurysms, including 2 patients with 2 aneurysms. Fourteen aneurysms arose from the rostral basilar artery, 2 arose from the midbasilar artery, 1 arose from the vertebrobasilar junction, and 1 arose from the proximal segment of the posterior cerebral artery. Five aneurysms were classified as giant (i.e., >25 mm), and 5 aneurysms were large (i.e., 15 to 25 mm). Ten patients had BAEP and SEP monitoring, 4 had BAEP monitoring only, and 2 had SEP monitoring only. Two patients showed significant abnormalities during operation, including 1 patient with transient changes in the BAEP when the lower pons and the 8th cranial nerve were retracted. Another patient had progressive increases in latency and decreases in amplitude and subsequent loss of the SEP cortical components during a period of intermittent temporary rostral basilar artery occlusion. Wave P13 was also lost during that period. The cortical components as well as Wave P13 returned after circulation was restored. The BAEPs were unchanged in the same patient during the period of temporary basilar artery occlusion. Fourteen patients had no significant abnormalities. There were no consistent changes during the various stages of operation. BAEP and SEP monitoring failed to identify ischemic events in 4 patients with neurological findings of brain stem ischemia immediately after operation (i.e., 25% false-negative studies). Failure of these techniques to predict brain stem ischemia seemed to be the result of two factors: (a) the ischemic events involved relatively small areas and (b) the ischemic zones did not include the neural pathways that were being monitored. These limitations were particularly relevant for the aneurysm at the basilar bifurcation, the most common location for posterior circulation aneurysm.
Percutaneous Minidose Metrizamide Endomyelographic Computed Tomography in Syringomyelia
Authors: Blumenkopf Bennett
Published: May 2010

Two patients presented with syringomyelia, each unusual. After neuroradiographic diagnosis with delayed metrizamide computed tomography (CT) or magnetic resonance imaging (MRI), an interesting diagnostic question arose. A percutaneous minidose metrizamide endomyelographic CT (PMDMECT) study clarified each situation and directly affected the neurosurgical approaches. The features of each case, the technique of PMDMECT, and postoperative follow-up data are reported.
Osteoplastic Opening of the Sellar Floor in Transsphenoidal Surgery: Technical Note
Authors: de Divitiis Enrico , Spaziante Renato
Published: May 2010

The authors propose a technique of opening the sellar floor during a transsphenoidal approach by means of two small bone flaps hinged sideward. Both opening and reconstruction of the sellar floor may be improved by this method, which may be used when the floor is paper-like.
Magnetic Resonance Imaging of Intradural Spinal Lipoma
Authors: Lantos George , Epstein Fred , Kory Leslie A.
Published: May 2010

Intradural lipomas are rare tumors of the spinal canal. We report the occurrence of this neoplasm in a 19-year-old girl. Magnetic resonance accurately depicted both the exact location within the spinal canal and the precise tumor histology and was more informative than myelography. This case illustrates the value of magnetic resonance imaging in patients presenting with myelopathy. In many instances, this modality may be all that is needed in preoperative planning.
Brain Stem Abscess Managed with Computed Tomographyguided Stereotactic Aspiration
Authors: Nauta H. J. W. , Contreras F. L. , Weiner R. L. , Crofford M. J.
Published: May 2010

The importance of stereotactic aspiration to the successful management of three cases of brain stem abscess is discussed with special reference to the advantages offered over medical treatment alone. Stereotactic aspiration allows evacuation of pus, accurate bacteriological diagnosis, selection of an optimal antibiotic regimen, and instillation of antibiotics directly into the abscess cavity. In two of the three cases described here, the abscess reaccumulated after initial aspiration despite appropriate maximal medical therapy. A repeat aspiration was required before resolution occurred. We conclude that medical management alone is not adequate for some cases of brain stem abscess. There was no morbidity that could be attributed to the procedure, suggesting that the risk of stereotactic aspiration is probably quite low and is likely to be less than the risk of incorrect diagnosis, suboptimal choice of antibiotics, or progression of the lesion despite appropriate maximal medical therapy.
Brain Metastasis of an Invasive Thymoma
Authors: Dewes Werner , Chandler William F. , Gormanns R. , Ebhardt G.
Published: May 2010

A rare case of a thymoma metastatic to brain is reported. This tumor was localized intraoperatively with the use of transdural ultrasound imaging, and gross total resection was accomplished. Radiation therapy was administered to both brain and mediastinum. The growth characteristics, classification, and treatment of thymomas are discussed.
Prediction and Prevention of Delayed Ischemic Dysfunction after Aneurysmal Subarachnoid Hemorrhage and Early Operation
Authors: Messeter Kenneth , Brandt Lennart , Ljunggren Bengt , Svendgaard Niels Aage , Algotsson Lars , Romner Bertil , Ryding Erik
Published: May 2010

Mean hemispheric cerebral blood flow (CBF) was studied after the intravenous administration of xenon-133 in 20 anesthetized patients with aneurysmal subarachnoid hemorrhage. Before early aneurysm operation, repeated CBF measurements were made to evaluate the cerebral vascular reactivity to controlled hyperventilation. Thirteen individuals received intravenous treatment with the calcium channel blocker nimodipine, whereas the other seven patients did not receive such specific antiischemic treatment. Five of the latter patients had an impaired CO2 response, and three showed delayed ischemic deterioration (DID), whereas none of the seven nimodipine-treated patients with impaired CO2 response showed DID. One nimodipine-treated patient with a preserved CO2 response, in whom operation was complicated, developed DID. The observed findings indicate that DID after uncomplicated early aneurysm operation may be associated with an early disturbance of cerebral vasoreactivity. Treatment with nimodipine may counteract the development of DID in patients with an impaired CBF CO2 response.
Histological and Morphometric Observations on the Reticular Fibers in the Arterial Beds of Patients with Ruptured Intracranial Saccular Aneurysms
Authors: Østergaard John R. , Reske-Nielsen Edith , Oxlund Hans
Published: May 2010

Histological and morphometric studies on the collagenous, reticular, and elastic fibers of the tunica media were performed on the middle cerebral and brachial arteries of patients with ruptured intracranial saccular aneurysms and controls. There was no difference between aneurysm patients and controls in the amount of collagenous and elastic fibers. The amount of reticular fibers was, however, reduced about 35% in aneurysm patients within both the middle cerebral artery (P < 0.01) and the brachial artery (P < 0.02). The reticular fibers were irregularly distributed and often appeared shorter and coarser than normally. The observations point to a generalized abnormality of the arterial bed in some patients with rupture of saccular aneurysms.
Radiation Control in the Intensive Care Unit for High Intensity Iridium-192 Brain Implants
Authors: Sewchand Wilfred , Drzymala Robert E. , Amin Pradip P. , Salcman Michael , Salazar Omar M.
Published: May 2010

A bedside lead cubicle was designed to minimize the radiation exposure of intensive care unit staff during routine interstitial brain irradiation by removable, high intensity iridium-192. The cubicle shields the patient without restricting intensive care routines. The design specifications were confirmed by exposure measurements around the shield with an implanted anthropomorphic phantom simulating the patient situation. The cubicle reduces the exposure rate around an implant patient by as much as 90%, with the exposure level not exceeding 0.1 mR/hour/mg of radium-equivalent 192Ir. Evaluation of data accumulated for the past 3 years has shown that the exposure levels of individual attending nurses are 0.12 to 0.36 mR/mg of radium-equivalent 192Ir per 12-hour shift. The corresponding range for entire nursing teams varies between 0.18 and 0.26. A radiation control index (exposure per mg of radium-equivalent 192Ir per nurse-hour) is thus defined for individual nurses and nursing teams; this index is a significant guide to the planning of nurse rotations for brain implant patients with various 192Ir loads. The bedside shield reduces exposure from 192Ir implants by a factor of about 20, as expected, and the exposure from the lower energy radioisotope iodine-125 is barely detectable.
Magnetic Resonance Imaging and Intraoperative Neurosonography in Syringomyelia
Authors: Wilberger Jack E. , Maroon Joseph C. , Prostko Richard E. , Baghai Parviz , Beckman Irwin , Deeb Ziad
Published: May 2010

Treatment of syringomyelia remains a difficult and controversial problem. However, the recent advent of magnetic resonance imaging (MRI) and intraoperative ultrasound allows a more precise approach to the diagnosis and management of this disorder. Experience with 27 cases of syringomyelia has shown that MRI is superior to all other forms of diagnostic imaging for the exact anatomical delineation of syrinxes and other spinal cord cavities. One-third of the syrinxes demonstrated by MRI were either not adequately visualized or missed by myelography and/or computed tomographic scanning. Intraoperative ultrasound has been used to allow more precise operative approaches to the syrinx as well as to guide the exact placement of shunt tubes into syrinx cavities. A method has also been developed to allow intraoperative ultrasound of the spinal cord with patients in the sitting position.
Uptake of Indium-111-labeled Leukocytes by Brain Metastasis
Authors: Balachandran Suppiah , Husain Muhammad M. , Adametz James R. , Pallin John S. , Angtuaco Tesesita L. , Boyd Charles M.
Published: May 2010

Uptake of indium-labeled leukocytes was seen in two cases of histologically proven brain metastasis. In one, this led to misdiagnosis of the lesion as an abscess. On histological evaluation, a large number of white blood cells or macrophages was seen at the neoplastic sites. Reasons for leukocyte accumulation around metastatic brain neoplasms are discussed. In contrast to the current reports that indium-labeled leukocyte scans can differentiate intracranial infection from tumor, these cases demonstrate their lack of specificity in the detection of brain abscess.
Neuroschisis of the Cervical Spinal Cord in a Patient with Klippel-Feil Syndrome
Authors: Nagib Mahmoud G. , Larson David A. , Maxwell Robert E. , Chou Shelly N.
Published: May 2010

During the neurological work-up of a young patient with Klippel-Feil syndrome, the presence of a neuroschisis of the cervical spinal cord was detected. The patient presented with a transient and acute hemisensory loss and a Horner's syndrome of the opposite side. The unusual presentation and radiological findings in a patient with Klippel-Feil syndrome prompted this report.
Malignant Fibrous Histiocytoma of the Clivus: Case Report
Authors: Cook Bruce R. , Vries John K. , Martinez Julio A.
Published: May 2010

A case of malignant fibrous histiocytoma of the clivus in a 21/2;-year-old boy is reported. There are no prior reports of this tumor in this location. The child was treated with operation, radiation therapy, and chemotherapy. The tumor recurred locally 21 months later. The recurrence was palliated by operation and chemotherapy, permitting an additional 20-month survival.
Chronic Encapsulated Intracerebral Hematoma in a Young Chinese Adult: Case Report
Authors: Chan Sze-tong , Tse C. H. C.
Published: May 2010

Chronic encapsulated intracerebral hematoma is rare. Six cases have been reported. A case of chronic encapsulated intracerebral hematoma in a young Chinese adult is presented. The possible pathoetiology underlying these cases is discussed.
Aneurysms of the Distal Anterior Cerebral Artery and Associated Vascular Anomalies
Authors: Wisoff Jeffrey H. , Flamm Eugene S.
Published: May 2010

Between July 1975 and July 1985, 20 patients with 24 congenital distal anterior cerebral artery (DACA) aneurysms were admitted to our institution and underwent microsurgical clipping of their aneurysms. This group composes 4% of the 588 aneurysms managed surgically during this period. The clinical presentations included subarachnoid hemorrhage, transient ischemic attacks, headaches, and seizures. Fourteen patients had additional vascular anomalies documented by angiography: multiple aneurysms, bilateral DACA aneurysms, arteriovenous malformation distal to incidental DACA aneurysms, and azygous DACA. Computed tomography was performed in 19 patients and was valuable in preoperative planning and prognosis: intracerebral hematoma and intraventricular hemorrhage were associated with poor preoperative grade and the development of vasospasm. Operative management, case morbidity/mortality, and the high incidence of multiple aneurysms and other vascular anomalies associated with DACA aneurysms are discussed. Because of the devastating effects of subarachnoid hemorrhage from these aneurysms, they should be carefully searched for and treated before hemorrhage occurs.
Successful Resection of Choroid Plexus Papillomas Diagnosed at Birth: Report of Two Cases
Authors: Tomita Tadanori , Naidich Thomas P.
Published: May 2010

The authors report two cases of large, vascular choroid plexus papillomas that were detected at birth and surgically excised shortly thereafter. Both patients made excellent recovery and demonstrate normal psychomotor development. Experience suggests that it is proper to be aggressive in managing these benign neonatal tumors.
Metastases of a Spinal Glioblastoma Multiforme into an Intracranial Arachnoid Cyst
Authors: Kendrick Donovan F. , Bonnin Jose M. , Garcia Julio H.
Published: May 2010

Spread of spinal cord glioblastoma multiforme to the intracranial compartment is uncommon. This report documents a case of metastatic spread of glioblastoma multiforme from the spinal cord to an intracranial arachnoid cyst. Seeding of the cyst cavity could have occurred by direct permeation of the cyst wall by the neoplastic glial cells spreading via the cerebrospinal fluid or by direct access of the cells through a defect in the arachnoid cyst wall and their subsequent entrapment by a ball valve type mechanism, leading to multiple implants.
Lymphocytic Adenohypophysitis of Pregnancy with Complete Recovery
Authors: McGrail Kevin M. , Beyerl Brian D. , Black Peter McL. , Klibanski Anne , Zervas Nicholas T.
Published: May 2010

A case of lymphocytic adenohypophysitis in a postpartum woman who became symptomatic during her 8th month of pregnancy is presented. The clinical presentation, endocrine findings, pathological findings, and operative management are discussed. Transient hypopituitarism is documented. Unlike most previously published cases, this woman had complete recovery of anterior pituitary function.
Communicating Fourth Ventricular Hydrocephalus: Case Report
Authors: Aoki Nobuhiko
Published: May 2010

The case of an infant with hydrocephalic enlargement of the 4th ventricle and dilatation of the basal cisterns is presented. Although the lateral ventricular shunt was proved to be functioning, the patient developed supratentorial hypertension marked by a tense fontanelle. Placement of a 4th ventricle-peritoneum shunt was followed by shrinkage of the 4th ventricle and resolution of the supratentorial hypertension. Work-up, including computed tomographic ventriculography and cisternography, demonstrated occlusion of the aqueduct of Sylvius and of subarachnoid spaces. This unique pathological process, differentiated from an isolated 4th ventricle, could be referred to as communicating 4th ventricular hydrocephalus.
Normal Pressure Hydrocephalus in Children and Young Adults
Authors: Barnett Gene H. , Hahn Joseph F. , Palmer Joann
Published: May 2010

Normal pressure hydrocephalus (NPH) is generally considered to be a disorder of adult and geriatric patients. We report four patients who are children or young adults with chronic neurological disorders, recent deterioration of their levels of function, normal cerebrospinal fluid (CSF) pressures, and ventricular enlargement. All four patients improved after the placement or revision of a ventriculoperitoneal shunt. Frequent symptoms and signs included irritability (three patients), vomiting (three patients), and abnormal limb posturing (two patients). Correct diagnosis was hampered by two factors: (a) Multiple or prolonged recordings of CSF pressures were invariably well within the normal ranges with respect to age, and (b) the patients had chronic neurological deficits. After ventriculoperitoneal shunting, subjective and objective improvement was seen in all cases. Young patients with large ventricles may benefit from shunting procedures despite low CSF pressures. These patients may be clinically identified by symptoms of new neurological dysfunction in cases of previously static neurological disease or acceleration of slowly progressive neurological dysfunction. Some of these underlying neurological disorders may predispose children and young adults to NPH.
Balloon Compression Rhizolysis in the Surgical Management of Trigeminal Neuralgia
Authors: Belber Carl J. , Rak Richard A.
Published: May 2010

To overcome some of the disadvantages of the current percutaneous surgical approaches to trigeminal neuralgia, we offer balloon compression rhizolysis (BCR) as an alternative. Guided by fluoroscopy, a 4 French Fogarty catheter is introduced into Meckl's cave, and its balloon is inflated tightly for a few minutes with soluble contrast agent to compress the gasserian ganglion and rootlets, under light endotracheal anesthesia. All patients experience immediate pain relief, with mild numbness in all three divisions, but with corneal sparing. Often, weakness of ipsilateral mastication appears transiently. In 33 procedures performed in 25 patients aged 48 to 86, with a follow-up period of 6 months to 7 years, there were 25 long-lasting cures (76%) and 8 recurrences. These results are fully comparable to those of other “destructive” procedures. There was no anesthetic complication and no mortality. The advantages of this procedure, besides its efficacy and low rate of dysesthesia, include absence of discomfort for the patient, short operative time, technical ease for the neurosurgeon, minimal morbidity, and no risk to corneal sensation. We think that microvascular decompression (MVD) should be the first operation considered for trigeminal neuralgia, but we advocate BCR as the procedure of choice in the aged and medically infirm, especially when V1 pain is present, in patients with multiple sclerosis, for recurrences after other procedures, and in virtually any situation in which MVD is, for some reason, not feasible.
Ruptured Middle Cerebral Artery Aneurysm with Intracerebral Hemorrhage in Younger Patients Appearing Moribund: Emergency Operation?
Authors: Brandt Lennart , Sonesson Bengt , Ljunggren Bengt , Säveland Hans
Published: May 2010

Four women, aged 39 to 46 years, were urgently admitted to our neurosurgical unit after strokes. On admission, all appeared moribund, presenting with deep coma, pupils bilaterally dilated and fixed, decerebrate posture, and markedly abnormal respiratory patterns. Computed tomography revealed subarachnoid hemorrhage with an associated large intracerebral hematoma and pronounced shift of midline structures in all four cases. Because of the clinical appearance, the patients were given urea and were operated without preceding angiography. The origin of the hemorrhage was identified as a middle cerebral artery (MCA) bifurcation berry aneurysm in one patient and giant MCA aneurysms in the other three. The hematomas were evacuated, and the aneurysms were occluded. All four patients received intravenous nimodipine, none showed any sign of delayed ischemic deterioration, and all regained full consciousness within a few days. One patient died 3 weeks later from a pulmonary embolus. Three patients are presently at home with moderate focal neurological deficits and moderate to marked cognitive impairment. The psychosocial readjustment was very good in a patient with a left giant aneurysm, satisfactory in a patient with a right giant aneurysm, and unsatisfactory in a patient with a right berry aneurysm. The indications, ethical considerations, and technical aspects of operating on seemingly moribund patients who probably harbor a ruptured MCA aneurysm are discussed.
Segmental Neurofibromatosis
Authors: Rawlings Charles E. , Wilkins Robert H. , Cook Wesley A. , Burger Peter C.
Published: May 2010

Of the various forms of neurofibromatosis, the best known are peripheral neurofibromatosis (von Recklinghausen's disease) and central neurofibromatosis. There is a rare form called segmental neurofibromatosis, in which the cutaneous and neural changes are limited to one sector of the body and with which there is usually no family history of neurofibromatosis. We report four patients with this disorder and stress the value of repetitive, limited excision of peripheral nerve tumors in their management.
Supratentorial Gliomas: Surgical Considerations and Immediate Postoperative Results Gross Total Resection versus Partial Resection
Authors: Ciric Ivan , Ammirati Mario , Vick Nicholas , Mikhael Michael
Published: May 2010

Forty-two patients with supratentorial gliomas not involving the basal ganglia (extraganglionic) were studied pre- and postoperatively with computed tomographic (CT) scans to evaluate the effect of the extent of surgical resection on the immediate postoperative results. Thirty-three patients (79%) had malignant astrocytic gliomas (glioblastoma or anaplastic astrocytoma), 4 patients (10%) had well-differentiated astrocytomas, and 5 (12%) had oligodendrogliomas. The median age was 58 years, and the median Karnofsky rating was 70. There was no operative mortality. Six patients (14%) had surgical complications. A gross total resection was defined as the absence of any abnormal enhancement on the postoperative CT scan. A nearly gross total resection had been accomplished when less than 10% of the preoperatively enhancing mass was still seen. A partial resection was indicated by the presence of more than 10% of the enhancing lesion on the postoperative CT scan. A gross total or nearly gross total resection was accomplished in 36 patients (86%), and an improved or stable postoperative neurological status was present in 35 of these patients (97%). In contrast, the rate of neurological morbidity after a partial resection was 40%. Supratentorial extraganglionic gliomas, regardless of their histological type, generally were well-circumscribed lesions except at the level of the ventricular wall, where glioblastomas and anaplastic astrocytomas blended with the subependymal white matter from which they seemed to arise. (Neurosurgery 21: 21-26, 1987)
Cerebellopontine Angle Tumor Causing Contralateral Trigeminal Neuralgia: A Case Report
Authors: Snow Robert B. , Fraser Richard A. R.
Published: May 2010

A case of trigeminal neuralgia caused by a contralateral acoustic neurinoma is reported. The patient's tic pain was completely alleviated after removal of the tumor. Previously reported cases of trigeminal neuralgia caused by contralateral cerebellopontine angle tumors are reviewed, and the pathophysiology of this disorder is discussed. (Neurosurgery 21: 84-86, 1987)
Optic Nerve Avulsion Secondary to Traumatic Enucleation
Authors: Middleton Troy H. , Smith Robert R.
Published: May 2010

Optic nerve injuries may be associated with craniofacial trauma. Actual avulsion of the optic nerve secondary to traumatic enucleation, however, is a unique injury that has secondary neurosurgical complications. Two cases of such an injury are presented. (Neurosurgery 21: 89-91, 1987)
Transclival Penetrating Injury
Authors: Miller P. , Lipschitz R.
Published: May 2010

A case of a stab wound of the cranium with a retained knife blade is presented. The blade had an unusual course through the base of the skull-the point of the knife penetrated the clival line to end in the posterior fossa. Although the blade was in close proximity to the basilar artery, it was judged safe to extract the knife by blind removal. The patient had no neurological deficit postoperatively. (Neurosurgery 21: 92-94, 1987)
Sciatica: An Early Manifestation of Thoracic Vertebral Osteochondroma
Authors: Buckler Richard A. , Chad David A. , Smith Thomas W. , Davidson Robin I.
Published: May 2010

We describe a 36-year-old woman with a thoracic vertebral osteochondroma who presented with radicular leg pain. This benign tumor is uncommon in the vertebral column, and radicular pain is an unusual manifestation of a thoracic spinal lesion. Myelography and computed tomography aided in diagnosis; surgical resection resulted in an excellent clinical response. (Neurosurgery 21: 98-100, 1987)
Combined Intraarterial and Systemic Chemotherapy for Intracerebral Tumors
Authors: Stewart David J. , Grahovac Zvonimir , Hugenholtz Herman , Russell Neville , Richard Michael , Benoit Brien
Published: May 2010

Twenty-six patients with intracerebral tumors (predominantly gliomas) were treated with intraarterial BCNU, VM-26, and cisplatin combined with the systemic administration of VM-26, methotrexate, vincristine, bleomycin, and procarbazine. Oral glycerol was given before i.v. VM-26. Twelve patients responded (46% of all patients and 63% of the fully evaluable patients). The response rate for gliomas was 50% if all patients were considered and 71% if only fully evaluable patients were considered. The response rate did not seem to be affected by glioma grade, prior chemotherapy, or pretreatment performance status. Median time to tumor progression for responders was 19 weeks. Median survival from initiation of treatment was 21 weeks for evaluable patients and 17 weeks for all patients. Median survival from initial diagnosis was 55 weeks. Myelosuppression was dose-limiting for the systemic chemotherapy. Reversible neurological toxicity was common, but tolerable. One patient developed ipsilateral blindness, and two patients developed prolonged neurological toxicity. Pulmonary toxicity was also seen. Vertebral artery infusions proved feasible, although difficult and more toxic than carotid infusions. Overall, this regimen was not more active than the intraarterial combination of BCNU, VM-26, and cisplatin without the systemic chemotherapy. Further studies of more intensive intracarotid therapy combined with different systemic drugs are being initiated.
Spinal Granular Cell Tumor with Subarachnoid Hemorrhage: Case Report
Authors: Strümblad Lars-Güran , Brun Arne , Cameron Robert , Cronquist Sten
Published: May 2010

A granular cell tumor in the spinal canal that presented with subarachnoid hemorrhage is reported. The tumor was totally excised. The pathogenic and clinical aspects are discussed.
Magnetic Resonance Imaging of Syringomyelia Associated with an Extramedullary Spinal Cord Tumor: Case Report
Authors: Rhyner Patricia A. , Hudgins Roger J. , Edwards Michael S. B. , Brant-Zawadzki Michael
Published: May 2010

The association of syringomyelia and extramedullary spinal cord tumors is rare. We present the case of a patient with this association documented by magnetic resonance imaging and discuss the unusual features of the syrinx.
Malignant Recurrence of Childhood Cerebellar Astrocytoma: Case Report
Authors: Ushio Yukitaka , Arita Norio , Yoshimine Toshiki , Ikeda Takuya , Mogami Heitaro
Published: May 2010

A 15-year-old boy developed a glioblastoma in a cerebellar hemisphere 7 years after surgical excision and local irradiation of a pilocytic astrocytoma in the cerebellar vermis. Clinical and histopathological details are presented, and the literature on late malignant recurrence of childhood cerebellar astrocytoma is reviewed.
Intragastric Migration of a Ventriculoperitoneal Shunt Catheter
Authors: Oi Shizuo , Shose Yoshiteru , Asano Noboru , Oshio Takehito , Matsumoto Satoshi
Published: May 2010

A child developed bacterial meningitis and shunt dysfunction 2 years after the insertion of a ventriculoperitoneal shunt for posttraumatic hydrocephalus. The distal end of the shunt catheter had penetrated the gastric wall. We found no other report of intragastric shunt catheter migration with successful treatment
Intrahepatic Migration of a Peritoneal Shunt Catheter: Case Report
Authors: Touho Hajime , Nakauchi Mikio , Tasawa Toshiaki , Nakagawa Jyoji , Karasawa Jun
Published: May 2010

The intrahepatic migration of a peritoneal shunt tube of a ventriculoperitoneal shunt system (low pressure Pudenz valve and low pressure Pudenz peritoneal catheter) is reported. This is a rare complication of ventriculoperitoneal shunting and was diagnosed by metrizamide shuntography and abdominal computed tomography. To our knowledge, this is the second case complicated with migration of a peritoneal shunt tube into the liver.
Peroral Extrusion of a Ventriculoperitoneal Shunt Catheter
Authors: Griffith James A , DeFeo Donald
Published: May 2010

A case of retrograde migration and peroral extrusion of a ventriculoperitoneal catheter is reported. A patient population at risk is defined, and preventive measures are discussed.
Management of Inoperable Cerebral Aneurysms by the Navigational Balloon Technique
Authors: Weil Stuart M. , van Loveren Harry R. , Tomsick Thomas A. , Quallen Barbara L. , Tew John M.
Published: May 2010

Intravascular navigation with nondetachable balloons is a safe, effective method of treatment for inaccessible aneurysms of the internal carotid artery. The rate of ischemic complications is lower than that associated with carotid ligation, and the rate of subsequent hemorrhage is lower than that associated with either carotid ligation or direct clipping. Therefore, for many internal carotid artery aneurysms that originate at or proximal to the ophthalmic artery, the nondetachable balloon technique is an alternative treatment choice. During a 7-year period, 21 aneurysms of the internal carotid artery were treated by the nondetachable balloon technique. All 21 aneurysms were successfully excluded from the circulatory system by either proximal occlusion or trapping of the aneurysm neck. This series consisted of 8 carotid-ophthalmic artery aneurysms, 11 carotid-cavernous aneurysms (6 spontaneous, 5 traumatic), 1 petrous segment aneurysm, and 1 cervical segment aneurysm. At 3 years of follow-up, the following incidences were noted: transient ischemia, 4.7%; infarction, 9.6%; and hemorrhage, 0%. The complications were 1 case of transient hemiparesis and 2 late ischemic events. Fifty per cent of the patients underwent follow-up computed tomography, and thrombosis of the aneurysm was confirmed in all except one case, which was partially thrombosed.
Effects of Intravascular Volume Expansion on Cerebral Blood Flow in Patients with Ruptured Cerebral Aneurysms
Authors: Yamakami Iwao , Isobe Katsumi , Yamaura Akira
Published: May 2010

To clarify the effect of intravascular volume expansion on cerebral blood flow (CBF) in patients after subarachnoid hemorrhage (SAH), we performed 55 pairs of regional CBF measurements using the xenon-133 inhalation method before and after volume expansion in 35 patients with ruptured cerebral aneurysms. CBF was calculated as the hemispheric mean value of the initial slope index. To accomplish volume expansion, we transfused 500 ml of 5% human serum albumin in half an hour. After volume expansion with albumin, the hemoglobin value decreased significantly (P < 0.005). Volume expansion did not change the mean arterial blood pressure. During the first 2 weeks after SAH, CBF decreased significantly after volume expansion (P < 0.005). During the 3rd week after SAH and subsequently to the 4th week after SAH, volume expansion produced no change in CBF. In patients with symptomatic vasospasm, CBF decreased significantly after volume expansion (P < 0.005). In patients without symptomatic vasospasm, volume expansion produced no change in CBF. The results of this study suggest that increasing the intravascular volume above normal by volume expansion does not increase CBF or reverse symptomatic vasospasm.
Subarachnoid Hemorrhage of Unknown Cause
Authors: Suzuki Shinsuke , Kayama Takamasa , Sakurai Yoshiharu , Ogawa Akira , Suzuki Jiro
Published: May 2010

After the institution of computed tomography (CT), 814 cases of spontaneous subarachnoid hemorrhage (SAH) were treated during a period of 6 years and 9 months (April 1978 through December 1984). In 9 (22.0%) of 41 patients whose cause of SAH was not determined by the first four-vessel study (cerebral panangiography), ruptured aneurysms were found by repeated four-vessel study. Thus, of 814 cases, only 32 (3.9%) were diagnosed as cases of unknown etiology at discharge. The 32 cases were monitored by follow-up examination for 5 to 67 months (median, 27.1 months) after onset. No recurrence of SAH was reported, and all patients were rehabilitated except 2 who suffered terminal carcinoma. A third follow-up four-vessel study was performed 8 to 44 months (median, 22.0 months) after the second study in 14 of the 16 patients with SAH initially demonstrated by CT. In 1 of these cases, an aneurysm found 9 months after the initial SAH was treated surgically. Ultimately, 31 cases (3.8%) were diagnosed as cases of SAH of unknown cause. This incidence is low when compared with those in previous reports. Because of the strict examination schedule including repeated angiography, the incidence is lower and the prognosis is relatively favorable.
Intradural Spinal Lipomas
Authors: McGillicuddy Gerald T. , Shucart William , Kwan Edward S. K.
Published: May 2010

Intradural spinal lipomas are rare, and their origin is unknown. Although the clinical presentation may not be distinctive, the neuroradiographic presentation is. Total excision is usually not possible, although subtotal resection is easily accomplished using an ultrasonic aspirator.
Pituitary Tumors Composed of Adenohypophysial Adenoma and Rathke's Cleft Cyst Elements: A Clinicopathological Study
Authors: Nishio Shunji , Mizuno Junichi , Barrow Daniel L. , Takei Yoshio , Tindall George T.
Published: May 2010

Nine cases of pituitary tumors composed of mixed tissue elements of adenohypophysial adenoma and Rathke's cleft cyst are reported. All cases were associated with hyperprolactinemia and were managed by transsphenoidal adenomectomy with good results. The clinical and pathological features are presented, and embryological pathogenesis for the occurrence of this unique association is discussed in connection with the high incidence of immunoreactive S-100 protein cells identified in tumor tissues. Patients with this kind of pituitary tumor can be managed in the same fashion as patients with other types of pituitary adenoma.
Median Nerve Somatosensory Evoked Potentials as an Indicator of Ischemia in a Case Involving an Aneurysm of the Internal Carotid Artery
Authors: Hyman Steve Alan , Skelley Cynthia C. , Arendall Rex , Woncik Karen S. , Berman Lawrence M.
Published: May 2010

We present a case report demonstrating that somatosensory evoked potentials (SEPs) suggested ischemia when an internal carotid aneurysm ruptured during surgical clipping. SEPs were also recorded from the contralateral cortex and subcortical and peripheral sites and remained unchanged. The use of multiple bilateral recording sites for SEP recording simplified the interpretation of acute changes.
Preservation of the Supraspinous Ligament for Spinal Stenosis: A Technical Note
Authors: Joson Raymond M. , McCormick Kathryn J.
Published: May 2010

Laminectomies and bilateral laminotomies for spinal stenosis have been performed over a period of 16 years at the Mercy Catholic Medical Center by preserving the supraspinous ligament along with the tips of the lumbar spines. More recently, this has been done utilizing a unilateral approach. This operation is technically feasible and with practice can be done routinely for extensive spine decompression, even for spinal tumor resection or spinal fusion.
Supraorbital-Pterional Approach to Skull Base Lesions
Authors: Al-Mefty Ossama
Published: May 2010

A surgical approach to the skull base is described. It allows excellent exposure of the cranial base with minimal brain retraction. Deep lesions can be handled via subfrontal, transsylvian, or subtemporal routes during the same operation. This approach is most suitable for large lesions in the suprasellar, parasellar, and retrosellar areas and for those that extend into the cavernous sinus, along the tentorial notch, or into the orbit. After the single bone flap is replaced, there is little or no functional, anatomical, or cosmetic deficit. Our experience in 16 cases and suggestion for the use of this approach are presented.
Radiofrequency Hyperthermia for Malignant Brain Tumors: Preliminary Results of Clinical Trials
Authors: Tanaka Ryuichi , Kim Choong Hong , Yamada Nobuhisa , Saito Yoshiaki
Published: May 2010

Local hyperthermia by 13.56-MHz radiofrequency (RF) capacitive heating was evaluated in 16 patients with malignant brain tumors. Intracranial heating during operation was performed in 4 patients. RF applicators with a cooling system were placed on the cerebral convexity and medial brain surface with the tumor between them. RF power was controlled to maintain the brain temperatures under 40°C. Under this condition, the highest temperature of each tumor varied from 44 to 49°C. After heating for about 60 minutes, 2 tumors showed regression on computed tomographic (CT) scans. Extracranial heating was performed in 12 patients with cerebral glioblastoma. RF applicators were placed on the lateral sides of the scalp and applied to diametrically opposite sides of the tumor. To avoid the influence of the skull on RF conduction, we performed a bilateral craniectomy slightly larger than the applicator at the initial operation. Heating was performed for approximately 60 minutes at each session and was repeated twice a week for a total of 4 to 10 times in combination with radiation and ACNU chemotherapy. No anesthetic agent was used during heating. Brain temperatures were maintained under 42°C. The scalp under the applicators remained at 28-35°C during heating, and no heat injury of the scalp was observed after repeated heating. The highest temperatures of the tumor or cavity after tumor removal were 45-46°C in 3 cases, 43-44°C in 3 cases, 42-43°C in 4 cases, and 40-41°C in 2 cases, respectively. Six of 10 evaluable tumors on CT scan showed regression after treatment. Low density lesions appeared transiently in the RF field in the brains of 2 patients. The present study showed that RF capacitive heating can be used safely to heat malignant tumors in the human cerebrum.