bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Management of Arteriovenous Malformations That Follow the Tentorial Ring
Authors: Solomon Robert A. , Stein Bennett M.
Published: May 2010

In a series of 200 intracranial arteriovenous malformations (AVMs) treated surgically, 33 malformations were situated very close to the tentorial incisura. All but one of these AVMs were totally removed. Four operative approaches were utilized in this group of patients: (a) an interhemispheric approach for lesions of the medial hemispheres, splenium of the corpus callosum, and posterior 3rd ventricle; (b) a subtemporal approach to the inferior and medial temporal lobe; (c) a supracerebellar-infratentorial approach to anterodorsal cerebellum and quadrigeminal regions; and (d) a subtemporal transtentorial exposure to the dorsolateral mesencephalon. There were no surgical deaths. Three patients had unsatisfactory outcomes. Our experience with this series indicates that deep cerebral AVMs in the region of the tentorial incisura may be safely removed if there is proper selection of operative approach and attention to surgical technique.
Successful Laser-assisted Excision of a Metastatic Midbrain Tumor
Authors: Tobler William D. , Sawaya Raymond , Tew John M.
Published: May 2010

Metastatic lesions to the midbrain are rare. They are found in 1 to 3% of autopsy series of solitary brain metastases. The consensus of opinion in the current literature is that they are inoperable lesions and should be treated by radiation therapy alone. This is the first case report of a completely excised metastatic adenocarcinoma to the midbrain. The patient's clinical course has been stable, and there is no computed tomographic evidence of recurrence at 18 months follow-up. (18:795-797, 1986)
Intracranial Extension of Orbital Pseudotumor: A Case Report
Authors: Noble Susan Cline , Chandler William F. , Lloyd Ricardo V.
Published: May 2010

A patient with intracranial extension of an orbital pseudotumor is reported. This rare consequence of an unusual inflammatory process has been reported on only two previous occasions. Our patient initially presented with unilateral loss of vision and a mass in the sphenoid sinus. Transsphenoidal biopsy revealed inflammatory tissue with a predominance of plasma cells. Over 2 years later, computed tomographic scanning demonstrated involvement of the ipsilateral frontal lobe, and craniotomy revealed invasion of both the dura mater and the cortex by this inflammatory process. Immunohistochemical staining for B and T cells was done to rule out lymphoma, and extensive cultures and staining were performed to identify any infectious process. Because this progressive lesion did not respond to steroid treatment, radiation therapy to the affected area was carried out. Orbital pseudotumor should be considered when an inflammatory process is identified in the meninges and cortex of the anterior fossa. (18:798–801, 1986)
Syringomyelia in a Man with Sarcoidosis
Authors: Rawlings Charles E. , Saris Stephen C. , Muraki Alan , Friedman Allan
Published: May 2010

Sarcoidosis, generally a systemic ailment, uncommonly affects the central nervous system. It only rarely affects the spinal cord alone or in combination with other areas. Syringomyelia has never been associated with sarcoidosis. We report the case of a 32-year-old man with sarcoidosis who presented with surgically verified syringomyelia. The pertinent literature is reviewed. The mechanisms by which sarcoidosis could cause a syrinx are discussed. (18:805–807, 1986)
Intraoperative Ultrasonography with a Cystoscope for the Biopsy of a Deep-seated Brain Lesion: Case Study
Authors: Greenberg I. M.
Published: May 2010

An intraoperative technique for deep brain biopsy is described. It features the use of an integrated surgical support system for the instruments and a rod that provides external topographical maintenance of the coordinates established ultrasonographically. A cystoscope, when supported mechanically by this system, permits multiple entries of the biopsy forceps to the lesion without further disturbance of the brain, as well as irrigation, coagulation, and visualization, if desired. When used in conjunction with real time intraoperative ultrasonography, the surgeon may view the entire procedure and be certain that the biopsy sample has been obtained from the lesion, major deep blood vessels have been avoided, and the biopsy site is stable after the procedure. The advantages of this technique include simplicity, low cost, accuracy, stability, and availability to every neurosurgeon in every hospital.
Somatosensory Evoked Potential Monitoring of Spinal Cord Ischemia during Aortic Operations
Authors: Kaplan Barry J. , Friedman William A. , Alexander James A. , Hampson Scott R.
Published: May 2010

Somatosensory evoked potentials were monitored in 22 consecutive patients undergoing surgical correction of an aortic coarctation. Induction of spinal cord ischemia by cross clamping of the aorta elicited a change in the evoked potential in 9 patients (41%). These alterations occurred within 5 minutes of aortic clamping in 3 cases and after 18 to 21 minutes in the remaining 6 cases. Loss of the somatosensory evoked potential for more than 14 minutes was associated with postoperative neurological deficit. Alteration of the evoked potential within 5 minutes of aortic cross clamping was significantly related to poor collateral circulation shown on the preoperative aortogram. The pathophysiology of evoked potential changes in spinal ischemia is discussed in detail.
Surgical Correction of Lesions Affecting the Second Portion of the Vertebral Artery
Authors: Diaz Fernando G. , Ausman James I. , Shrontz Carl , Pearce Jeffrey , Gehring Randy , Mehta Bharat , Dujovny Manuel
Published: May 2010

Substantial controversy has surrounded the diagnosis and management of vertebrobasilar ischemic events, with no consensus on the value of medical or surgical treatment of patients symptomatic with brain stem ischemia who have angiographically proven vertebral artery lesions. This report presents our experience with the surgical treatment of 12 of 88 patients with angiographically verifield lesions in the vertebral artery who were symptomatic for 1 to 12 months before their evaluation. None experienced symptomatic relief with antiplatelet agents, nor did the administration of anticoagulants in 4 of the patients provide any benefit. The lesions included bilateral vertebral artery occlusion with distal reconstitution through muscular collaterals in 6 patients, unilateral vertebral artery hypoplasia with contralateral long-tailed lesions from the vertebral artery origin to C-5 in 3 patients, and severe bilateral vertebral artery origin lesions extending beyond the C-5 level in 3 patients. A vertebral endarterectomy and vertebral-carotid transposition in the second portion of the artery were successfully used to reestablish flow and obtain symptomatic relief in 10 of the 12 cases; 1 of these procedures had to be redone because of a persistent stenosis at C-4. Another patient had a saphenous vein graft from the common carotid to the vertebral artery at C-5. The remaining patient had an anastomosis of the distal external carotid to the vertebral artery at C-3, but this failed and an anastomosis of the occipital artery to the anterior inferior cerebellar artery had to be completed to reestablish flow. We think that operation offers a possible means to reestablish flow and to obtain symptomatic relief for patients with symptoms of brain stem ischemia who have severe angiographic lesions in the first two portions of the vertebral artery.
Optochiasmatic Arachnoiditis with Treatment by Surgical Lysis of Adhesions, Corticosteroids, and Cyclophosphamide: Report of a Case
Authors: Marcus Alan O. , Demakas John J. , Ross H. Arlene , Duick Daniel S. , Crowell Robert M.
Published: May 2010

A 24-year-old woman presented with progressive optochiasmatic arachnoiditis causing progressively worsening visual loss associated with headache and amenorrhea. Treatment with the standard initial therapy of dexamethasone, warfarin, and dipyridamole was unsuccessful at halting her disease process. Surgical lysis of adhesions led to a temporary improvement and then deterioration. A course of therapy with cyclophosphamide was initiated and her response to this therapy resulted in resolution of her headaches, return of her vision to normal, and resumption of her normal menstrual cycles.
Pneumocephalus Secondary to Tension Pneumothorax Associated with Comminuted Fracture of the Thoracic Spine
Authors: McCall Charles S. , Nguyen Tai Q. , Vines Frederick S. , Bremer Alfonso M.
Published: May 2010

We present an unusual case of pneumocephalus secondary to a tension pneumothorax associated with fracture of the thoracic spine. Air from a pneumothorax entered the thoracic intraspinal compartment and the intracranial cavity through a comminuted fracture of the spine. The pneumocephalus and the pneumothorax resolved after aspiration of the intrathoracic air via an intercostal catheter. Diagnosis, therapeutic modalities, and potential complications of a pneumocephalus and of a communication between the thoracic cavity and the spinal dural space are discussed.
Primary Pontine Hematoma Presenting as a Cerebellopontine Angle Mass
Authors: Russell Brian , Rengachary Setti S. , McGregor Douglas
Published: May 2010

A case of hemipontine hematoma from the rupture of a cryptic vascular malformation presenting as a cerebellopontine angle tumor is reported. The clinical features of and surgical approaches to partial pontine hematomas are briefly reviewed.
Fibrous Xanthoma in the Gasserian Ganglion: Case Report
Authors: Morimura Tatsuo , Tani Eiichi , Yamaura Ikuya , Kochi Nobuo
Published: May 2010

Occurrence of fibrous xanthoma has been reported increasingly in the skull and the central nervous system, but is extremely rare in the gasserian ganglion. We report on the clinical presentation, radiological appearance, surgical treatment, and histological makeup of a fibrous xanthoma arising from the left gasserian ganglion.
Use of Intraoperative Ultrasound in Decision Making during Spinal Operations
Authors: Theodotou Basil C. , Powers Stephen K.
Published: May 2010

The use of intraoperative spinal ultrasonography in 14 cases and its effect on decision making during laminectomy procedures is discussed. The advantages of the technique in operations for syringomyelia, trauma, spondylosis, intramedullary tumors, and neuroablative procedures of the spinal cord are elaborated.
Technical Note: A New Lightweight Shunt Clamp for Use during Carotid Endarterectomy
Authors: Chandler William F.
Published: May 2010

A technique is described for using a modified Drake aneurysm clip as a lightweight vascular clamp for securing the distal end of an intraluminal shunt during carotid endarterectomy.
Surgically Treated Cerebral Arterial Ectasia with So-Called Moyamoya Vessels
Authors: Hanakita Junya , Miyake Hidenori , Nagayasu Shinji , Nishi Shyogo , Suzuki Takanori
Published: May 2010

The case of a 43-year-old woman with multiple intracranial arterial ectasia was reported. The arterial ectasia was accompanied by stenosis of the middle cerebral artery and so-called moyamoya vessels. After extracranial to intracranial bypass surgery, the size and contour of the arterial ectasia decreased. Because the arterial ectasia decreased in size after the extracranial to intracranial bypass surgery, this operation might be useful for space-occupying lesions due to arterial ectasia.
Electrical Injury to the Central Nervous System
Authors: Petty Peter G. , Parkin Geoffrey
Published: May 2010

A case of delayed spinal cord damage due to high voltage electric shock is presented. The literature on the subject is reviewed and discussed.
Aneurysmal Bone Cyst of the Cervicothoracic Spine: Computed Tomographic Evaluation of the Value of Preoperative Embolization
Authors: Disch Steven P. , Grubb Robert L. , Gado Mokhtar H. , Strecker William B. , Marbarger John P.
Published: May 2010

In this report, the management of an aneurysmal bone cyst in the cervicothoracic region of an 8-year-old girl is described. Aneurysmal bone cyst is a histologically benign lesion that is often extremely vascular. In the spine, it can cause extensive bone destruction and compress neural structures. Because this lesion may involve all parts of a vertebra, full delineation of the lesion before its excision is important in planning the surgical approach. The value of preoperative embolization to reduce tumor vascularity, allowing total excision, and the improved radiological evaluation of this lesion with computed tomographic scanning are demonstrated.
Three Models of Human Language
Authors: Black Peter McL. , Black Sandra E. , Droge Janet A.
Published: May 2010

Three models of human language processing can be discerned in contemporary neurobiology: the Wernicke-Broca model, primarily derived from studies of stroke and other brain lesions; the model developed by Dr. George Ojemann from electrical stimulation mapping of the cerebral cortex; and the linguistic model, evolved from Noam Chomsky's linguistic theories. The Wernicke-Broca model employs a posterior-sensory anterior-motor conception of brain language processing that is substantially different from the more modular conception developed from electrical stimulation mapping. The linguistic model attempts to explain language in terms of hierarchical mental function.
Operative Stabilization of the Posttraumatic Thoracic and Lumbar Spine: A Comparative Analysis of the Harrington Distraction Rod and the Modified Weiss Spring
Authors: Benzel Edward C. , Larson Sanford J.
Published: May 2010

To assess the efficacy of operative stabilization techniques, a retrospective study of Harrington distraction rod (HDR) and modified Weiss spring instrumentation was performed in 90 patients. An operation was performed for one or both of two indications: persistent spine instability or the presence of a neurological deficit in patients with incomplete neurological injuries and myelographic evidence of spinal cord or cauda equina compression. The lateral extracavitary operative approach to the spine for decompression and anterior interbody fusion was performed with an accompanying HDR (47 patients) or modified Weiss spring placement (43 patients). Eight HDRs failed, resulting in gross instability (17 per cent) that either resulted in further neurological injury (1 patient), further surgery (2 patients), or increased morbidity secondary to prolonged bed rest (5 patients). One Weiss spring failed, requiring further surgery (2.3 per cent). Nonsurgical complications were similar in both groups and appeared to be unrelated to the type of instrumentation utilized. The modified Weiss spring instrumentation technique, which offers a dynamic compression fixation of the spine, was clearly superior to the HDR technique, which offers a rigid distraction fixation. The biomechanics of distraction versus compression and rigid versus nonrigid spine stabilization are discussed.
Is Computed Tomographic Scanning Necessary in Patients with Tentorial Herniation?
Authors: Andrews Brian T. , Pitts Lawrence H. , Lovely Mary P. , Bartkowski Henry
Published: May 2010

Computed tomographic (CT) scans are performed on virtually all patients with severe head injury at the time of admission. Because of the time involved in obtaining these studies, the evacuation of significant intracranial mass lesions is delayed. To avoid such delays, the authors performed burr-hole exploration for the diagnosis of intracranial hematomas before CT scans were obtained in 100 consecutive head-injured patients with clinical signs of tentorial herniation or upper brain stem dysfunction upon admission to the emergency room. Patients in whom a hematoma was discovered had a craniotomy for evacuation of the clot: those in whom the exploration was negative had a CT brain scan immediately after operation. Burr-hole exploration revealed extracerebral mass lesions in 56 patients. In 38 patients, the exploration was negative, and postoperative CT scanning showed no significant hematoma. Of 6 patients in whom the CT scan demonstrated extraaxial hematomas requiring surgical evacuation, 4 had subdural hematomas that were missed because the exploration was incomplete: 1 patient had an epidural hematoma and 1 had a subdural hematoma contralateral to a craniotomy on the side of a positive initial burr-hole exploration. Our results indicate that the relatively small subgroup of head-injured patients with early tentorial herniation or upper brain stem compression have a high incidence of immediate extraaxial hematomas and a low incidence of intracerebral hematomas. This is particularly true of patients over 30 years of age and those who suffer low speed trauma, such as falls and vehicle-pedestrian accidents.
Primary Intraspinal Fibrosarcoma
Authors: Malat Jan , Virapongse Chat , Palestro Christopher J. , Richman Alan H.
Published: May 2010

Fibrosarcomas of dura mater are very rare tumors representing only 0.5% of all central nervous system sarcomas. A higher incidence of dural fibrosarcomas has been reported in patients with neurofibromatosis. We present a case of spinal dura mater fibrosarcoma in a patient without neurofibromatosis. The diagnostic and therapeutic strategy in the clinical management is discussed.
High Thoracic Disc Herniation
Authors: Alberico Anthony M. , Sahni Singh K. , Hall James A. , Young Harold F.
Published: May 2010

A case of T-1, T-2 disc herniation is reported. The patient presented with diminished hand strength, medial arm and shoulder pain, and medial arm, forearm, and hand paresthesias. After surgical decompression and removal of a disc fragment, the patient made a complete recovery. Routine cervical myelography was considered inadequate in view of this patient's symptoms. High thoracic myelography followed by computed tomographic scanning should be considered for patients with this presentation. Improved diagnosis with myelography and computed tomography is discussed.
Microvascular Relations of the Trigeminal Nerve: An Anatomical Study
Authors: Klun Boris , Prestor Borut
Published: May 2010

The neurovascular relationships in the trigeminal root entry zone were studied in 130 trigeminal root entry zones of 65 cadavers. No history of facial or trigeminal pain had been obtained during life in these subjects. The technique of intravascular injection, which allowed good visualization and evaluation of the neurovascular relationships, is described. A total of 42 examples of contact with the root entry zone and 10 examples of compression were identified. In 30 of the examples of contact, the finding could be related to an artery; in the other examples, it appeared to be due to veins. Of the arterial compressions, the superior cerebellar artery was responsible in 53.8%, the anterior inferior cerebellar artery was responsible in 25.6%, and pontine branches of the basilar artery were responsible for the remaining 20.6%. Only one instance of unequivocal compression by a vein was found. Other anatomical observations of interest are reported. The absence of a history of trigeminal neuralgia in the 7% of examined nerves in which root entry zone showed arterial compression is in marked contrast to the finding of 80% or more in the operative series for trigeminal neuralgia. It seems that vascular compressions may be the predominant but not the sole cause of trigeminal neuralgia.
Therapeutic Efficacy of Multiagent Chemotherapy with Drug Delivery Enhancement by Blood-Brain Barrier Modification in Glioblastoma
Authors: Neuwelt E.A. , Howieson J. , Frenkel E.P. , Specht H. David , Weigel R. , Buchan Colin G. , Hill S.A.
Published: May 2010

Reversible osmotic blood-brain barrier (BBB) modification was used in 38 patients with glioblastoma to enhance the delivery of chemotherapeutic agents. The patients ranged in age from 14 to 70 years (mean, 43), and all had prior surgery and radiation; 5 had also received systemic chemotherapy. Karnofsky Performance Status (KPS) scores ranged from 60 to 100% (mean, 79) on admission to the treatment program. Barrier modification was achieved by intracarotid or intravertebral artery infusion of mannitol, and a chemotherapy regimen of methotrexate, cytoxan, and procarbazine was given in conjunction with barrier modification. The 38 glioblastoma patients were compared to two control groups of patients with glioblastoma; these encompassed 14 patients treated with surgery and radiation and 8 treated with surgery, radiation, and systemic chemotherapy. Survival analysis using the Cox Proportional Hazards Regression Model (corrected for age, sex, presence or absence of necrosis, and functional status) showed that patients receiving chemotherapy with BBB modification had a statistically significant (P = 0.0006) longer expected survival (17.5 months) than the control groups (12.8 and 11.4 months, respectively). Presently 16 patients of the barrier-enhanced treatment group are alive at 5 to 42 months from diagnosis (median, 20) with KPS scores ranging from 40 to 90% (median, 65). The neurological complications seen included a stroke-like syndrome in 3 patients (1 with decreased motor movement in the hand, 1 with marked hemiparesis, and 1 with hemiplegia), transient exacerbation of preexisting neurological deficits lasting 2 to 3 days, and a 15% incidence of seizures during or within 24 hours of the BBB modification. In 2 of the 38 patients, radiographic documentation of central nervous system tumor regression concurrent with the development of new tumor nodule(s) in portions of the brain distant from the region of osmotic BBB opening was seen. These studies indicate that chemotherapeutic drug delivery to tumors (as well as surrounding brain) can be augmented by osmotic BBB modification and that such therapy can result in a prolongation of survival.
Myofascial Pain May Present Clinically as Occipital Neuralgia
Authors: Graff-Radford Steven B. , Jaeger Bernadette , Reeves John L.
Published: May 2010

Three case presentations illustrate that the clinical signs and symptoms of occipital neuralgia may be produced by myofascial pain. Assessment of myofascial trigger points is needed before making a diagnosis of occipital neuralgia. Myofascial trigger points can be effectively treated with minimally invasive procedures, thereby avoiding irreversible surgical interventions.
Spinal Arteriovenous Malformation Presenting at Birth: Case Report
Authors: Morgan Michael K. , Chaseling Raymond , Johnston Ian , de Silva M.
Published: May 2010

A newborn with paraplegia and evidence of a subarachnoid hemorrhage was found to have a spinal arteriovenous malformation. The arteriovenous malformation was managed by direct surgical obliteration. This patient is the youngest ever reported to have this disorder and the youngest so treated.
Cystic Cavernous Hemangioma of the Cerebellopontine Angle: Case Report
Authors: IplikÇioĞlu Celal A. , Benli Kemal , Bertan Vural , Ruacan Sevket
Published: May 2010

A case of cystic cavernous hemangioma of the cerebellopontine angle is described. The clinical findings, location of the tumor, and computed tomographic findings were unusual. This rare lesion must be considered in the differential diagnosis of cystic infratentorial masses.
Balloon Occlusion of a Recurrent Carotid-Cavernous Fistula Previously Treated by Carotid Ligations
Authors: Gerald V. O'Reilly , Shillito John , Haykal Hani A. , Kleefield Jonathan , Ay-Ming Wang , Rumbaugh Calvin L.
Published: May 2010

A carotid-cavernous fistula recurred 16 years after a Hamby procedure. The recurrence was manifested by subarachnoid hemorrhage originating from dilated draining pial veins. The fistula was closed with a balloon catheter introduced through a patent remnant of the cervical carotid artery. Patients who have previously undergone Hamby trapping and embolization should be reassessed for an occult fistula that could predispose them to intracranial bleeding.
Microsurgical Anatomy and Operative Approaches to the Lateral Ventricles
Authors: Erdener Timurkaynak , Albert L. Rhoton , Margaret Barry
Published: May 2010

The anatomy needed to plan microoperative approaches to the lateral ventricles was examined in 20 cadaveric cerebral hemispheres. The neural, arterial, and venous structures in the walls of the lateral ventricles and the relationship of the lateral ventricles to the third ventricle and basal cisterns were examined. The operative approaches to the lateral ventricle are reviewed.
Neglect Induced by Thalamotomy in Humans: A Quantitative Appraisal of the Sensory and Motor Deficits
Authors: Francisco Velasco , Marcos Velasco , Carmiña Ogarrio , Alfredo Olvera
Published: May 2010

Stereotactic lesions for the treatment of tremor and rigidity in patients with Parkinson's disease are occasionally followed by neglect of the use of contralateral extremities for spontaneous movement when there are no specific sensory or motor deficits. A group of patients with neglected extremities was compared with a group of patients in which thalamotomy did not produce neglect. Neglect was shown by changes in motor performance, somatosensory evoked potentials (SEP) and electroencephalographic frequency induced by the lesion, as well as radiological evidence of brain atrophy and place and extension of lesions. Reaction time to both auditory and somatosensory stimuli was significantly increased only in the extremities contralateral to the lesion of patients with neglect; tremor decreased equally in both groups, and other motor abilities remained unchanged. P-200 component of SEP decreased in amplitude and increased in latency only in cases with neglect, particularly ipsilateral to the lesion; early components and mean electroencephalographic frequency remained unchanged. Brain atrophy was significant in patients with neglect, particularly for the posterior portion of the 3rd ventricle. No differences in size and location of the lesions were found between the groups. Results indicate that this type of neglect is not secondary to lesions in specific sensory of motor pathways, but to lesions of structures coupling sensorimotor functions and the process of attention and that midline thalamic nuclei atrophy precipitates the neglect, perhaps by critically decreasing the amount of reticulothalamocortical projections engaged in selective attention.
Serum Immunocomplexes in Patients with Subarachnoid Hemorrhage
Authors: Luigi Pellettieri , Bo Nilsson , Carl-Axel Carlsson , Ulf Nilsson
Published: May 2010

Immunocomplexes (IC) in serum were analyzed in 54 patients with subarachnoid hemorrhage (SAH) from ruptured arterial aneurysms. A previous study had shown that patients with SAH and vasospasm had a significantly higher incidence of ICs in the blood than patients without vasospasm. The aim of the present study was to study how the IC content varied with time and compare this pattern with the clinical picture. Forty-two patients presented clinical or radiological signs of cerebral vasospasm during their hospital stays, whereas 12 patients showed no such signs. The patients with vasospasm had a significantly higher amount of ICs in serum than those without vasospasm. In 37 patients with vasospasm, the changes of IC content during the 1st weeks after SAH correlated well with the clinical course. Data indicated that a high IC content preceded the onset of vasospasm and a low content preceded clinical improvement. This observation supports the idea that the presence of ICs might be the cause and not the result of vasospasm.
Transtemporal Approach to the Skull Base: An Anatomical Study
Authors: Laligam N. Sekhar , Rodrigo Estonillo
Published: May 2010

The surgical anatomy of a transtemporal approach to the structures of the clivus was defined with the aid of dissections in 10 cadaver heads. The steps in the dissection consisted of first exposing the cervical internal carotid artery (ICA), the internal jugular vein, and the caudal cranial nerves, each at the skull base; then performing small retromastoid and temporal craniotomies; and, finally, drilling away the petrous and tympanic bone to expose the intratemporal parts of the facial nerve, the petrous ICA, the sigmoid sinus, and the jugular bulb. To expose the structures of the lower clivus, the sigmoid sinus was ligated and divided, the facial nerve was displaced anterosuperiorly, and the inner ear structures were preserved. Dural opening exposed the anterolateral and anterior surfaces of the medulla, the pontomedullary junction, and the spinomedullary junction. The ipsilateral vertebral artery and often the contralateral vertebral artery and the vertebrobasilar junction, the caudal cranial nerves, and the origin of the 6th, 7th, and 8th cranial nerves were well exposed. To expose the structures of the middle clivus, we drilled away the labyrinth, the cochlea, and a portion of the clival bone. The facial nerve was displaced posteroinferiorly. Dural opening exposed the ipsilateral anterior surface of the pons, the midbasilar artery, and the ipsilateral 5th, 6th, 7th, and 8th cranial nerves. A portion of the contralateral anterior surface of the pons was also exposed at times. The superior limit of this exposure was just above the origin of the trigeminal nerve. The exposure of the upper clival structures was limited with this approach, and required medial temporal lobe retraction. Two case reports are included to illustrate the application of the transtemporal approach to the exposure and clipping of aneurysms of the vertebrobasilar system. The advantages and disadvantages of this approach are discussed.
Recovery of Nerve Root Function after Complete Quadriplegia from Cervical Spine Fractures
Authors: Edward C. Benzel , Sanford J. Larson
Published: May 2010

Thirty-five patients with complete myelopathies secondary to cervical spine fractures from C-4 to C-7 underwent spinal decompressions and fusions between 1975 and 1981. Twenty-five of these patients underwent simultaneous nerve root decompressions, 23 with an accompanying anterior decompression and fusion and 2 with an accompanying posterior fusion. Substantial recovery of nerve root function occurred in 15 of these patients. A posterior reduction and fusion without nerve root decompression was performed in each of the remaining 10 patients. None of these patients demonstrated a significant improvement neurologically. Operation for nerve root decompression is indicated in selected victims of spinal cord injury.
Cranial Metastases from Prostate Cancer Simulating Meningioma: Report of Two Cases and Review of the Literature
Authors: Scott M. Lippman , Antonio C. Buzaid , Robert P. Iacono , Del V. Steinbronn , Thomas H. Stanisic , Margaret A. Rennels , Peter J. Yang , Harinder S. Garewal , Frederick R. Ahmann
Published: May 2010

Two cases of prostatic carcinoma metastatic to the cranium that presented with clinical and radiographic features simulating meningioma are described. The literature was reviewed, and 13 similar cases were identified. From the data gathered, we conclude that metastatic prostate cancer should be considered in the differential diagnosis of elderly males who present with characteristic clinical and radiological features of meningioma and that the classical description of meningioma is not specific.
Staphylococcus epidermidis Ventriculitis Treated with Vancomycin and Rifampin
Authors: Jeffrey S. Osborn , Stanley Sharp , Jerome E. Hanson , Edwin MacGee , Joseph H. Brewer
Published: May 2010

Two cases of ventriculitis with Staphylococcus epidermidis that failed on therapy with an antistaphylococcal penicillin are presented. Both infections responded to a combination of intravenous and intraventricular vancomycin and rifampin. Vancomycin and rifampin represent an important antibiotic regimen for the management of resistant infections of the central nervous system, especially with those due to S. epidermidis or methicillin-resistant Staphylococcus aureus.
Unusual Metastasis to the Cauda Equina: Case Report
Authors: Hargraves LCDR Ronald W. , Cotelingam CDR James D. , Harris CAPT Robert D. , Pulliam CDR Morris W.
Published: May 2010

A case of intradural metastasis from endometrial carcinoma to the cauda equina is presented. The clinical presentation and radiographic findings were misleading and suggested a herniated nucleus pulposus. Findings at operation were most suggestive of an ependymoma, but final pathological diagnosis revealed endometrial carcinoma. This has never been reported. Once again it demonstrates that surgeons managing lumbar disc disease must be prepared for possible intradural exploration with an appropriate team.
Supra- and Infratentorial Arteriovenous Malformations with an Aneurysmal Dilatation: A Case Report
Authors: Tsuyoshi Tada , Kenichiro Sugita , Shigeaki Kobayashi , Noriaki Watanabe
Published: May 2010

We report a rare case of supra- and infratentorial arteriovenous malformations (AVMs), which were separate and consisted of ancurysmal dilatations with two or three afferent arteries and efferent veins. Surgical resections were performed without the occurrence of additional neurological deficits. We discuss the treatment of multiple AVMs and stress that size and the structures involved are more important factors in the prognosis than the multiplicity of the lesions.
Eosinophilia of the Cerebrospinal Fluid in a Case of Shunt Infection: Case Report
Authors: Seiichiro Mine , Akira Sato , Akira Yamaura , Seiichi Tamachi , Hiroyasu Makino , Hisao Tomioka
Published: May 2010

A very rare case of eosinophilic granulocytosis of the cerebrospinal fluid (CSF eosinophilia) due to drug allergy caused by the intraventricular administration of gentamicin sulfate is presented with a review of the pertinent literature. An unusual clinical course and clinicoimmunological examination are also described.
Pediatric Central Nervous System Tumors: A Cell Kinetic Study with Bromodeoxyuridine
Authors: Murovic Judith A. , Nagashima Tadashi , Hoshino Takao , Edwards Michael S. B. , Davis Richard L.
Published: May 2010

Bromodeoxyuridine (BrdU), 150 to 200 mg/m2, was administered at the time of operation to 20 pediatric patients with neuroectodermal tumors to label tumor cells in the S phase. Immunocytochemical techniques were used on excised tumor specimens to detect cells containing BrdU, and the BrdU labeling index (LI) was calculated as the number of BrdU-labeled cells divided by the total number of cells counted. Four medulloblastomas, three glioblastomas multiforme, and two highly anaplastic astrocytomas had average BrdU LIs of 13.0 ± 3.0% (SE), 12.7 ± 4.3%, and 14.6 ± 6.7%, respectively. Three of nine moderately anaplastic astrocytomas had BrdU LIs of greater than 1% (average, 6.5 ± 2.4%), whereas six had LIs of less than 1%. In two juvenile pilocytic astrocytomas, which are considered slow-growing, the BrdU LIs were unexpectedly high, averaging 6.5 ± 1.4%. Thus, pediatric medulloblastomas, glioblastomas multiforme, highly anaplastic astrocytomas, and a minority of moderately anaplastic astrocytomas had high proliferative potentials, whereas most of the moderately anaplastic astrocytomas had low proliferative potentials. Although the number of cases in this study is still too small to yield statistically significant comparisons, the results indicate that some pediatric tumors have considerably higher LIs than histologically similar adult tumors studied previously.
Regrowth Patterns of Supratentorial Gliomas: Estimation from Computed Tomographic Scans
Authors: Tsuboi Koji , Yoshii Yoshihiko , Nakagawa Kunio , Maki Yutaka
Published: May 2010

To clarify the regrowth patterns of benign and malignant gliomas, we chose 27 intervals (between two operations or between an operation and autopsy) from 21 patients with pathologically verified recurrent supratentorial gliomas. Serial computed tomographic (CT) scans of these cases were analyzed to determine (a) the doubling time (Td) calculated from the change in volume of enhanced and low density areas, (b) the enhancement effect graded from 0 to 4 according to the Hounsfield number, and (c) the presence of dissemination and contralateral extension. We studied 5 benign gliomas (including 1 case of radiation necrosis), 8 malignant astrocytomas, and 8 glioblastomas. The Td's of enhanced areas on CT scans of benign gliomas, malignant astrocytomas, and glioblastomas were 937 ± 66.5 days, 65.1 ± 29.4 days, and 48.1 ± 20.9 days, respectively. The Td's of low density areas were 895 ± 130.6 days, 70.8 ± 22.2 days, and 50.5 ± 14.7 days. There was a significant correlation between the Td's of the enhanced and low density areas (0.97). The enhancement effect increased at recurrence in 55% of the cases, with an average increase of 1.1 grades. The increase in enhancement effect at recurrence showed a tendency to become smaller as the tumor's degree of anaplasia increased. Radiotherapy was effective in significantly retarding the growth rate of malignant gliomas, whose Td's were doubled. Although the Td's of both enhanced and low density areas of benign gliomas were significantly longer than those of malignant gliomas, there was no significant difference in the Td's of enhanced areas between malignant astrocytomas and glioblastomas. Dissemination and contralateral extension occurred at almost the same ratios in malignant astrocytomas and glioblastomas at recurrence. These data indicate that the regrowth pattern of malignant astrocytoma closely resembles that of glioblastoma in spite of morphological distinction. This method was easy and practical for evaluating the biological malignancy of supratentorial gliomas from CT scans, and it can offer us useful clinical information.
Successful Intraspinal Extradural Sacral Nerve Stimulation for Bladder Emptying in a Victim of Traumatic Spinal Cord Transection
Authors: Talalla Andrew , Bloom Joseph W. , Nguyen Quang
Published: May 2010

This report concerns a patient with a functionally complete spinal cord transection due to trauma at T-6. Her clinical syndrome of a motor and sensory paraplegia was accompanied by hyperreflexic detrusor dysfunction. Radiofrequency-coupled bilateral stimulation of the 3rd sacral nerves in their intraspinal but extradural course achieved reliable, effective emptying of the bladder. This single case suggests that successful stimulation of the sacral neural outflow may not require intrathecal placement of stimulating electrodes, sensory rhizotomy, or pudendal neurotomy. (Neurosurgery 19:955-961, 1986)
Operative Exposure and Management of the Petrous and Upper Cervical Internal Carotid Artery
Authors: Sekhar Laligam N. , Schramm Victor L. , Jones Neil F. , Yonas Howard , Horton Joseph , Latchaw Richard E. , Curtin Hugh
Published: May 2010

The exposure and operative management of the petrous and upper cervical internal carotid artery (ICA) in 29 patients is detailed. Twenty-seven of these patients had extensive cranial base neoplasms (benign or malignant), 1 had an inflammatory cholesteatoma, and 1 had an aneurysm of the upper cervical ICA immediately proximal to the carotid canal. Preoperative studies useful in the evaluation of these patients included computed tomography, magnetic resonance imaging, cerebral and cervical angiography, and a balloon occlusion test of the ICA with evaluation of neurological status and of cerebral blood flow. The exposure of the upper cervical and petrous ICA was useful to obtain proximal control of the cavernous ICA, aided in the operative approach to extensive petroclival, intracavernous, and parapharyngeal neoplasms, and enabled the total resection of 23 of 27 such tumors. A subtemporal and preauricular infratemporal fossa approach was most commonly used for the exposure of the artery. Intraoperative arterial management consisted of exposure and decompression only, dissection from encasing neoplasm, resection of the invaded arterial segment and vein graft reconstruction, or intentional arterial occlusion. Vascular complications included 1 stroke due to delayed arterial occlusion, 1 stroke and death due to infection spreading from the nasopharynx with bilateral ICA rupture, and 1 pseudoaneurysm formation secondary to wound infection necessitating postoperative balloon occlusion of the ICA. Nonvascular complications included facial nerve paralysis in 10 patients (usually temporary), glossopharyngeal and vagal paralysis in 13 patients requiring Teflon injection of the vocal cord in 9, temporary difficulties with mastication in 9 patients, and wound infection in 3. The surgical exposure and management of the upper cervical and petrous ICA may permit a total operative resection of extensive cranial base neoplasms and is also an alternative for the management of vascular lesions involving these segments of the artery. With malignant neoplasms extending from the nasopharynx, postoperative infection remains a problem and may best be resolved by the use of a vascularized rectus abdominis muscle flap to reconstruct defects of the nasopharynx. Bilateral ICA encasement by neoplasms is also a major problem to be solved. The value of such an aggressive approach to the management of malignant neoplasms remains to be proven.
Mural Tumors with Cysts in the Cerebral Hemispheres of Children
Authors: Tomita Tadanori , McLone David G. , Naidich Thomas P.
Published: May 2010

Thirteen infants and children with mural tumors (i.e., cysts with mural nodules) in the cerebral hemisphere are presented. The tumors comprise five benign astrocytomas, three ependymomas, two choroid plexus papillomas, one oncocytoma, one hamartoma, and one primitive neuroectodermal tumor. Computed tomography showed well-enhanced mural nodules. Cyst walls did not enhance in any but one, in which the enhancement was attributed to hemorrhage in the cyst. None of the cyst walls contained neoplastic cells. Cerebral angiography was performed in all patients, and five showed extensive vascularity in the tumor nodule. The importance of preoperative angiography is emphasized. Total extirpation of the mural nodule without excision of the cyst wall led to excellent prognosis for these patients.
Unilateral S-1 Root Compression Syndrome Caused by Fracture of the Sacrum
Authors: Epstein Nancy E. , Epstein Joseph A. , Carras Robert
Published: May 2010

Unilateral S-1 nerve root compression after an S-1 sacral fracture was found in an 18-year-old man after a motor vehicle accident. The positive myelogram, myelogram-computed tomogram, and magnetic resonance studies led to surgical intervention. Marked bony callous formation contiguous with the S-1 alar fracture protruded into the canal and was responsible for tethering the S-1 nerve root. A right L-5 hemilaminectomy, an L-4, L-5 and L-5, S-1 medial facetectomy, and foraminotomy facilitated nerve root decompression. Postoperatively, the patient was markedly improved. The authors suggest a more aggressive attitude in the diagnostic, radiographic, and surgical management of sacral fractures now that more specific technical facilities are available to define the precise character of the lesions involved.
Metastasizing Meningioma
Authors: Russell Tom , Moss T.
Published: May 2010

A very unusual case of metastatic spread of a meningioma is described. The clinical presentation was of extradural spinal cord compression, without evidence of a primary tumor. Computed tomography did not reveal any intracranial meningioma; the histopathology of the extradural spinal tumor was identical with that of two intracranial meningiomas previously excised.
Carotid Artery Occlusion and Ocular Ischemia: Therapy Control with Evoked Potentials
Authors: Mehdorn Maximilian H. , Nau Heinz-Eugen , FÖrster Michael
Published: May 2010

We present a patient with internal carotid artery occlusion and ischemic oculopathy in whom extracranial-intracranial arterial bypass improved vision. Visual evoked potentials were studied to obtain objective criteria for indication and follow-up evaluation and confirmed that the improved vision was due to improved retinal function. (Neurosurgery 19:1031-1034, 1986)
Neurofibromatosis Presenting with Aqueductal Stenosis Due to a Tumor of the Aqueduct: Case Report
Authors: Hosoda Kohkichi , Kanazawa Yasuhisa , Tanaka Junichi , Tamaki Norihiko , Matsumoto Satoshi
Published: May 2010

A 17-year-old boy with neurofibromatosis presented with delayed puberty and epileptic seizures of recent onset. A computed tomographic scan revealed aqueductal stenosis due to a tumor of the aqueduct. This tumor was found at autopsy to be a pilocytic astrocytoma. Aqueductal stenosis in neurofibromatosis is uncommon and has been considered to be a result of periaqueductal gliosis. This seems to be the first report of neurofibromatosis associated with a tumor of the aqueduct.
Burning Hands Syndrome Revisited
Authors: Wilberger James E. , Abla Adnan , Maroon Joseph C.
Published: May 2010

The burning hands syndrome of spinal cord injury was first described in 1977. The syndrome is characterized by burning dysesthesias and paresthesias in the hands and may be associated with either cervical fracture/dislocation or no detectable cervical spine abnormalities. A case of burning hands syndrome without cervical spine injury is presented in which somatosensory evoked potentials and magnetic resonance imaging were used to delineate the pathophysiology of this syndrome.
Contralateral Trigeminal Neuralgia as a False Localizing Sign in Intracranial Tumors
Authors: Florensa R. , Llovet J. , Pou A. , Galitó E. , Vilato J. , Colet S.
Published: May 2010

Three cases of contralateral trigeminal neuralgia as a false localizing sign in intracranial tumors are reported. In each patient (meningioma, 2 cases; cholesteatoma, 1 case) the tumor was asymptomatic, so that intracranial tumor had not been suspected preoperatively. In all cases, tumors were large and firm. The tumor was supratentorial in two cases. In one case, a cortically mediated mechanism may have caused the neuralgia, whereas in the remaining two cases distortion and displacement of the brain stem and compression of the contralateral Meckel's cave would explain the trigeminal nerve signs.
Cisternal Drainage after Early Operation of Ruptured Intracranial Aneurysm
Authors: Kawakami Yasuto , Shimamura Yutaka
Published: May 2010

The authors reviewed 22 cases of intracranial aneurysm of the anterior part of the circle of Willis. All patients presented with the signs and symptoms of subarachnoid hemorrhage (SAH) and were in good neurological condition on admission. In all cases, early operation was performed to obliterate aneurysm. Subarachnoid blood clots were extensively removed and cisternal drainage was done. With topical application of povidone-iodine and intravenous administration of antibiotics, cisternal drainage continued for 14 days or more after the onset of SAH in 21 cases. Five patients developed symptomatic vasospasm, which was treated with hypervolemia and hypertension, and three received shunts later for chronic hydrocephalus. The overall result demonstrated that 21 patients were independent and had returned to their previous social lives. Therefore, it was strongly recommended that patients is good neurological condition after SAH secondary to ruptured intracranial aneurysm be treated with early operation, removal of subarachnoid clots, and long term application of cisternal drainage.
Acute Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage
Authors: Milhorat Thomas H.
Published: May 2010

The incidence and clinical aspects of acute hydrocephalus were examined in 200 patients with recently ruptured intracranial aneurysms. The following conclusions were reached: (a) Acute hydrocephalus is an important complication of aneurysmal subarachnoid hemorrhage that occurs in approximately 20% of all cases and exhibits an incidence that tends to parallel clinical grade (Grade I, 3%; Grade II, 5%; “Good” Grade III, 21%; “Bad” Grade III, 40%; Grade IV, 42%; Grade V, 26%). (b) Impaired consciousness leading to a general downgrading of clinical status was the predominant clinical finding (93%), but neither this nor other nonspecific signs of increased intracranial pressure were distinguishable from the effects of the precipitating hemorrhage. (c) The computed tomographic signs of acute hydrocephalus are distinctive and consist of selective ballooning of the frontal horns, rostral-caudal enlargement of the cerebral ventricles, and a halo of periventricular hyperdensity (edema) that evolves in sequence with ventricular changes. (d) The treatment of choice is external ventricular drainage, which results in prompt and often dramatic improvement in approximately two-thirds of the patients.