bluuebunny/crossref_metadata_2025 huggingface dataset:
The relationship between the capillary structure and hemorrhage in gliomas
Authors: Liwnicz Boleslaw H. , Wu Shu Zhi , Tew John M.
Published: May 2009

✓ A 48-year-old man was admitted with the sudden onset of symptoms of stroke caused by hemorrhage in an oligodendroglioma. Despite surgery and antiedema treatment, the patient died. Histological evaluation revealed an oligodendroglioma with calcified capillaries of the retiform type. To further investigate this phenomenon, a total of 160 gliomas were reviewed: 90 glioblastomas multiforme, 30 oligodendrogliomas, and 40 astrocytomas. Sufficient data were available for clinical evaluation in 100 cases. Of these, 5% (two oligodendrogliomas and three glioblastomas multiforme) were related to clinically significant hemorrhages. Of the remaining cases, microhemorrhages were found in 53.0% of the glioblastomas, in 56.7% of the oligodendrogliomas, and in 10.0% of the astrocytomas. In each case reviewed, the capillaries were assigned to one of three groups: axial, retiform, or glomeruloid. Statistical analysis revealed a significant association between hemorrhages and retiform capillaries in all three types of tumors, except that in oligodendrogliomas the statistical significance held true when calcification of the capillaries was also present. Glomeruloid-type capillaries were only weakly associated with hemorrhages, and no association was found for axial capillaries. A large-scale prospective study is necessary to more precisely assess the role of each of the three types of capillaries in hemorrhages of gliomas. Based on data available so far, patients with glial tumors with retiform capillaries, confirmed on biopsy, should be carefully monitored to exclude possible intratumoral hemorrhage.
The impact-absorbing effects of facial fractures in closed-head injuries
Authors: Lee K. Francis , Wagner Louis K. , Lee Y. Eugenia , Suh Jung Ho , Lee Seung Ro
Published: May 2009

✓ A series of 210 patients with facial fractures sufficiently severe to require cranial computerized tomography (CT) to evaluate suspected closed-head injury (CHI) was studied. The injuries were separated into five grades of severity based on neurological examination, including cranial CT. The injuries were also grouped into three categories based on facial regional involvement, using chi-square contingency table analysis. The data demonstrated that patients with upper facial fractures were at greatest risk for serious CHI. Injuries to both the mandibular and the midfacial regions with no upper facial involvement more frequently resulted in mild CHI with a modest likelihood of no neurological deficits. Trauma to only the mandibular region or to only the midfacial region was least likely to involve CHI.
Effect of stimulation of the medullary reticular formation on cerebral vasomotor tonus and intracranial pressure
Authors: Nagao Seigo , Nishiura Tsukasa , Kuyama Hideyuki , Suga Masakazu , Murota Takenobu
Published: May 2009

✓ The authors report the results of a study to evaluate the effect of stimulation of the medullary reticular formation on cerebral vasomotor tonus and intracranial pressure (ICP) after the hypothalamic dorsomedial nucleus and midbrain reticular formation were destroyed. Systemic arterial pressure (BP), ICP, and local cerebral blood volume (CBV) were continuously recorded in 32 cats. To assess the changes in the cerebral vasomotor tonus, the vasomotor index defined by the increase in ICP per unit change in BP was calculated. In 29 of the 32 animals, BP, ICP, and CBV increased simultaneously immediately after stimulation. The increase in ICP was not secondary to the increase in BP, because the vasomotor index during stimulation was significantly higher than the vasomotor index after administration of angiotensin II. The vasomotor index was high during stimulation of the area around the nucleus reticularis parvocellularis. In animals with the spinal cord transected at the C-2 vertebral level, ICP increased without a change in BP.

These findings indicate that the areas stimulated in the medullary reticular formation play an important role in decreasing cerebral vasomotor tonus. This effect was not influenced by bilateral superior cervical ganglionectomy, indicating that there is an intrinsic neural pathway that regulates cerebral vasomotor tonus directly. In three animals, marked biphasic or progressive increases in ICP up to 100 mm Hg were evoked by stimulation. The reduction of cerebral vasomotor tonus and concomitant vasopressor response induced by stimulation of the medullary reticular formation may be one of the causes of acute brain swelling.
Effects of experimental intracerebral hemorrhage on blood flow, capillary permeability, and histochemistry
Authors: Nath Fredrik P. , Kelly Paul T. , Jenkins Alistair , Mendelow A. David , Graham David I. , Teasdale Graham M.
Published: May 2009

✓ Experimental intracerebral hemorrhage has been shown to cause extensive cerebral ischemia. This study was performed to ascertain the time course of these changes and also to examine the type of brain damage that may occur under such circumstances. Halothane anesthesia was induced in rats, and 25 µl autologous blood was injected into the caudate nucleus; the effects were studied with autoradiographic measurement of local cerebral blood flow and capillary permeability, and also by light microscopy and histochemical techniques. Blood flow returned to normal or to slightly increased levels within the first 3 hours, and ischemic levels of flow were found to persist only to a marginal degree beyond 10 minutes after the lesions were made. Capillary permeability was maximum during the first 30 minutes after the hemorrhage and diminished with time. Structural evidence of ischemic damage was localized to the cortex overlying the hemorrhage, but was not seen in the caudate nucleus. Nevertheless, histochemical investigation did reveal an area of disturbed enzyme function in the striatum. This finding of biochemical disturbance without structural evidence of ischemic damage reveals that there is an area around the hematoma that, although demonstrating disturbed function, does not show structural damage, and the milieu of this partially injured brain may be implicated in the delayed development of the ischemic brain damage that follows intracerebral hemorrhage in man.
Effect of the antiprogesterone RU-38486 on meningioma implanted into nude mice
Authors: Olson Jeffrey J. , Beck David W. , Schlechte Janet A. , Loh Pao-Min
Published: May 2009

✓ Meningiomas have been shown to have steroid-binding proteins. In vitro, estradiol, progesterone, and the antiestrogen tamoxifen stimulate tumor growth. However, incubation of tumor cells with an antiprogesterone agent results in tumor inhibition. In this investigation, a human meningioma was implanted subcutaneously in athymic nude mice. Two treatment groups were established, one receiving the antiprogesterone agent RU-38486 (10 mg/kg/day in suspension) and the other receiving only vehicle. After 3 months, the tumor growth index (defined as the tumor volume at 3 months divided by the initial tumor volume) was 0.25 ± 0.46 (mean ± standard deviation) in the group receiving antiprogesterone and was 1.54 ± 0.58 in the control group (p = 0.041). Further investigation of the effect of antiprogestational agents on the growth and hormone-binding proteins of other meningiomas will better define the mechanism of their effects.
Vertebrobasilar insufficiency
Authors: Spetzler Robert F. , Hadley Mark N. , Martin Neil A. , Hopkins Leo N. , Carter L. Philip , Budny James
Published: May 2009

✓ Extracranial vertebrobasilar artery thrombo-occlusive disease may cause repetitive transient ischemic episodes and, less frequently, brain-stem or cerebellar infarction. This report describes 40 patients who experienced repetitive vertebrobasilar ischemic symptoms despite maximal medical therapy. The natural history, pathogenesis, and treatment options for each causative lesion are reviewed. The operative approaches to symptomatic disease of the proximal vertebral arteries, arterial compression by cervical osteophytes, traumatic lesions of the vertebral arteries, and thrombo-occlusive pathology of the distal extracranial vertebral arteries are outlined. Specific anesthetic and surgical techniques that have proved successful while achieving zero operative mortality and low perioperative morbidity rates are reported.
The surgical treatment of childhood moyamoya disease
Authors: Olds Meredith V. , Griebel Robert W. , Hoffman Harold J. , Craven Marilyn , Chuang Sylvester , Schutz Hart
Published: May 2009

✓Moyamoya disease is a progressive disorder, predominantly seen in childhood, that can cause severe permanent disability. The search for effective treatment has largely been unsuccessful in the past, but recent efforts at surgical intervention have shown promising results.

The natural history of moyamoya disease, the options for treatment, and a series of patients from the Hospital for Sick Children in Toronto are reviewed. The results of surgical treatment are encouraging and the authors believe that it should be offered to all pediatric patients in the progressive stage of the disease.
Perioperative antibiotic prophylaxis for prevention of postoperative neurosurgical infections
Authors: Young Ronald F. , Lawner Pablo M.
Published: May 2009

✓ The authors report the results of a randomized, prospective study to assess the effectiveness of perioperative antibiotic prophylaxis in preventing postoperative infections following clean neurosurgical operations. The study group comprised 846 patients treated between October, 1979, and June, 1984. Antibiotics, including cefazolin and gentamicin, were administered only in the immediate preoperative and intraoperative periods. Sixteen patients, none of whom developed infections, were excluded from final statistical analysis because they had inadvertently been entered into the study while failing to meet entry criteria. Fifteen wound infections (3.64%) developed in the group of 412 patients who did not receive antibiotics, whereas only four infections (0.96%) were identified among the 418 patients who received antibiotics. The difference is statistically significant (p = 0.008) and represents a 74% reduction in infection rate with antibiotics. An analysis of subgroups of surgical procedures revealed a dramatic decrease in craniotomy infections from 6.77% to 0% (p = 0.003). Of the four infections that occurred among the antibiotic-treated patients, three were in cases where foreign bodies had been implanted.

No complications of antibiotic usage were identified. The rates of infection in areas of the body other than the surgical wound were no different in the antibiotic-treated and nontreated groups. All wound infections in both antibiotic-treated and nontreated patients involved similar types of Gram-positive organisms, suggesting that antibiotic prophylaxis did not produce infections with resistant or unusual organisms. This study, combined with other recently published analyses, suggests that routine perioperative antibiotic prophylaxis can significantly reduce the incidence of postoperative neurosurgical infections.
Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries
Authors: Levin Harvey S. , Amparo Eugenio , Eisenberg Howard M. , Williams David H. , High Walter M. , McArdle Craig B. , Weiner Richard L.
Published: May 2009

✓ Twenty patients admitted for minor or moderate closed-head injury were studied to investigate the relationship between magnetic resonance imaging (MRI) and neurobehavioral sequelae. The MRI scans demonstrated 44 more intracranial lesions than did concurrent computerized tomography (CT) scans in 17 patients (85%); most of these lesions were located in the frontal and temporal regions. Estimates of lesion volume based on MRI were frequently greater than with CT; however, MRI disclosed no additional lesions that required surgical evacuation. Neuropsychological assessment during the initial hospitalization revealed deficits in frontal lobe functioning and memory that were related to the size and localization of the lesions as defined by MRI. Follow-up MRI and neuropsychological testing at 1 month (13 cases) and 3 months (six cases) disclosed marked reduction of lesion size paralleled by improvement in cognition and memory. These findings encourage further investigation of the prognostic utility of MRI for the clinical management and rehabilitation of mild or moderate head injury.
Delayed postoperative dural arteriovenous malformations
Authors: Nabors Michael W. , Azzam Charles J. , Albanna Faisal J. , Gulya A. Julianna , Davis David O. , Kobrine Arthur I.
Published: May 2009

✓ The authors present two cases of dural arteriovenous malformations (AVM's) that developed at the site of previous suboccipital craniectomies. No other cases of delayed postoperative dural AVM's have been reported. Congenital and acquired dural AVM's are discussed, with reference to the similarity between postoperative dural AVM's and traumatic dural AVM's. Embolization is recommended in selected cases where the arterial supply is primarily from the external carotid system.
Repeated subarachnoid hemorrhages from a cervical meningioma
Authors: Scotti Giuseppe , Filizzolo Felice , Scialfa Giuseppe , Tampieri Donatella , Versari Pietro
Published: May 2009

✓ Magnetic resonance imaging (MRI) of the head and cervical spine unexpectedly revealed a cervical meningioma in a patient who had suffered repeated episodes of subarachnoid hemorrhage. The importance of MRI in the diagnosis of tumors in patients with unusual clinical presentation is stressed.
Late surgical treatment of unilateral coronal synostosis using methyl methacrylate
Authors: Persing John A. , Cronin Arthur J. , Delashaw Johnny B. , Edgerton Milton T. , Henson Scott L. , Jane John A.
Published: May 2009

✓ Three techniques combining the shaping of calvarial and facial bone with onlay of methyl methacrylate are presented for use in the late treatment of unilateral coronal synostosis deformities. The procedures described are suggested as possible alternatives to extensive bone repositioning procedures. They have the advantage of being quicker and are therefore potentially safer operations. Acrylic is malleable and does not resorb; thus, permanent superior esthetic results may be achieved. The two most serious risks when using this technique are infection and limitation of growth. The risk of infection may be reduced by attaching the acrylic implant securely to surrounding bone, under sterile conditions, beneath well-vascularized skin. Growth limitation may be obviated by not placing acrylic across sutures in children with enlarging skulls.
Choroid plexus tumors: problems in diagnosis and management
Authors: Boyd Michael C. , Steinbok Paul
Published: May 2009

✓ Choroid plexus tumors are uncommon neoplasms of the central nervous system. A series of 11 cases from the Vancouver General and British Columbia Children's Hospitals, treated during the last 12 years, are reviewed. Some of the management problems commonly encountered with these tumors are discussed. Many of these tumors are associated with severe hydrocephalus at the time of diagnosis, and the perioperative management of this hydrocephalus remains a matter of some debate. The timing of and the necessity for shunting are major considerations. Large subdural fluid collections are often discovered in the postoperative period, and these occasionally cause symptoms of increased intracranial pressure. Reasons for this problem are suggested and possible steps for its prevention are proposed.

The similarity between papillary ependymomas and choroid plexus papillomas has sometimes caused difficulty in pathological diagnosis. Choroid plexus carcinomas, of which there were two in this series, also present a diagnostic challenge. Differential diagnosis affects the further treatment and prognosis for the patient.
Symptomatic Arnold-Chiari malformation: review of experience with 22 cases
Authors: Bell William O. , Charney Edward B. , Bruce Derek A. , Sutton Leslie N. , Schut Luis
Published: May 2009

✓ Twenty-two patients with closed myelomeningoceles, shunted hydrocephalus, and symptomatic Arnold-Chiari malformations were studied retrospectively. Seventeen of the 22 patients were aged 6 months or younger; five patients were aged 3 to 23 years. Patients in the younger group presented with stridor, apnea, and/or feeding difficulty; those in the older group presented with hemiparesis, quadriparesis, oscillopsia, nystagmus, or opisthotonos. Fourteen of the 17 younger patients underwent surgical decompression of the Arnold-Chiari malformation: 10 within 18 days following the onset of symptoms and four on Day 19 or later. Of the 10 infants with early treatment, five eventually died secondary to continued symptoms and five survived. Of those surviving, three were asymptomatic and two had continuing symptoms but were improved over their preoperative state. Among the four patients undergoing surgery later, two died, one had lessening of stridor, and one had complete relief of symptoms. Of the three infants not undergoing decompression, two died and one eventually became asymptomatic. All five of the older patients underwent decompression and all had complete resolution of their preoperative symptoms and signs. The authors conclude that while decompression of a symptomatic Arnold-Chiari malformation may be effective in children and adults, this treatment does not always improve the clinical condition of infants. This may be the result of ischemic/hypoxic effects on the infant's brain stem, which may not be organized normally at birth.
Cerebral hyperperfusion following carotid endarterectomy
Authors: Schroeder Torben , Sillesen Henrik , Sørensen Ole , Engell Hans Christian
Published: May 2009

✓ Serial measurements of cerebral blood flow (CBF) were performed in 56 patients before and one to four times after uncomplicated carotid endarterectomy. The findings were related to the ratio between internal carotid artery (ICA) and common carotid artery (CCA) mean pressures.

Within the 1st postoperative day CBF increased by a median of 37% in the ipsilateral and 33% in the contralateral hemisphere. Later recordings showed a gradual return of CBF toward the preoperative level. Sixteen patients with an ICA/CCA pressure ratio below 0.7 showed a significantly more pronounced and longer-lasting flow increase than did 40 patients with a ratio above this level. On Day 1, the median CBF increase in the ipsilateral hemisphere was 61% and 24% in the two groups, respectively (p < 0.01). A significant improvement in side-to-side asymmetry, resulting from a higher gain in the ipsilateral hemisphere, occurred in the low pressure ratio group, while the hemispheric asymmetry on average was unchanged in the high pressure ratio group. This relative hyperemia was most pronounced 2 to 4 days following reconstruction.

The marked hyperemia, absolute as well as relative, in patients with a low ICA/CCA pressure ratio suggests a temporary impairment of autoregulation. Special care should be taken to avoid postoperative hypertension in such patients, who typically have preoperative hypoperfusion, to avoid the occurrence of cerebral edema or hemorrhage.
Magnetic resonance imaging of spinal arteriovenous malformations
Authors: Doppman John L. , Di Chiro Giovanni , Dwyer Andrew J. , Frank Joseph L. , Oldfield Edward H.
Published: May 2009

✓ Magnetic resonance imaging (MRI) was performed on 12 patients with spinal arteriovenous malformations (AVM's). Six lesions were intramedullary, five were dural, and one was in a posterior extramedullary location. Serpentine filling defects similar to the classic myelographic findings were demonstrated within the high-signal cerebrospinal fluid on T2-weighted coronal scans. The intramedullary nidus was identified by MRI as an area of low-signal intensity within the cord in all six intramedullary AVM's. Neither the dural nor the posterior extramedullary lesions showed intramedullary components. It is concluded that MRI may noninvasively provide the initial diagnosis of a spinal AVM and distinguish intramedullary from dural and extramedullary lesions.
Potent and specific killing of human malignant brain tumor cells by an anti-transferrin receptor antibody-ricin immunotoxin
Authors: Zovickian John , Johnson Virginia Gray , Youle Richard J.
Published: May 2009

✓ Immunotoxins are hybrid molecules which combine the exquisite selectivity of monoclonal antibodies with the potent toxicity of protein toxins. An immunotoxin was constructed by linking a murine monoclonal antibody against the human transferrin receptor (TR) to the plant toxin, ricin.

The cytotoxic activity of the anti-TR-ricin immunotoxin was tested in vitro and demonstrated highly potent and cell type-specific killing of cells derived from human glioblastoma, medulloblastoma, and leukemia. The anti-TR-ricin immunotoxin killed more than 50% of “target” cells at a concentration of 5.6 × 10−13 M after an 18-hour incubation with the ionophore, monensin. This potency exceeds that of any other anti-TR immunotoxin reported in the literature. When the activity of the anti-TR-ricin immunotoxin against “target” tumor-derived cells was compared with the immunotoxin's activity against “non-target” cells, it could be predicted that a selective toxicity of anti-TR-ricin immunotoxin between tumor cells and normal brain was more than 150- to 1380-fold. Solid-phase indirect radioimmunoassay techniques were used to demonstrate significantly higher levels of TR in the glioblastoma- and medulloblastoma-derived cell lines, as well as in surgical tissue samples of medulloblastoma and glioblastoma, as compared to normal brain.

Immunotoxins targeted to the TR may possess sufficient specificity to be of therapeutic importance, particularly to treat neoplastic disease of the central nervous system involving compartments (such as intrathecal, intraventricular, or cystic) where delivery of immunotoxins to tumor would not require transvascular transport.
Immune complexes and complement activation following rupture of intracranial saccular aneurysms
Authors: Østergaard John R. , Kristensen Bent Ø. , Svehag Sven-Erik , Teisner Børge , Miletic Tomislav
Published: May 2009

✓ Circulating immune complexes (CIC) and complement activation (plasma C3d levels) were monitored during a 2-week period in patients with ruptured cerebral aneurysms and also in patients with cerebral hematoma unrelated to saccular aneurysms. Thirteen of 18 aneurysm patients were found to have CIC on admission as compared to three of 21 healthy blood donors (p < 0.001). The presence of CIC in aneurysm patients was associated with a poor prognosis. Eight of nine patients who developed angiographic vasospasm had CIC on admission compared with one of four without vasospasm. Patients with vasospasm showed a twofold increase in plasma C3d levels at the time when the spasm occurred, whereas no significant changes in the C3d concentration could be demonstrated in aneurysm patients without spasm or in patients with hematoma unrelated to aneurysm rupture. These findings suggest that immunological processes involving complement-activating immune complexes are involved in the pathogenesis of cerebral vasospasm following rupture of saccular aneurysms.
Transmission characteristics of pulse waves in the intracranial cavity of dogs
Authors: Kasuga Yoichiro , Nagai Hajime , Hasegawa Yasuhiro , Nitta Masahiro
Published: May 2009

✓ Systems analysis of intracranial pressure pulse waveforms was carried out in six dogs under conditions of normocapnia and intracranial normotension to determine how the pressure pulse is transmitted through the intracranial cavity. Since the intracranial cavity can be regarded as a system, systems analysis was applied to it. The pressure pulse wave of the common carotid artery was used as the input signal and the epidural pressure pulse wave as the output signal. An attempt was made to randomize the input signal using a cardiac pacemaker or an aorta balloon. The transfer function of the system was estimated numerically from the autocorrelation function of the input signal and the cross-correlation function of the input and output signals by means of the least-squares method.

Some characteristics of pressure transmission through the system were observed. The gain curve of the system decreased between 1 and 7 Hz, then suddenly increased to form a marked peak at about 10 to 15 Hz, where the phase curve also changed from positive to negative. These results suggest that the lower frequencies of the pulse wave were suppressed during transmission through the intracranial cavity, whereas the greatest acceleration in transmission occurred at about 10 to 15 Hz. In addition, resonance was evident in the intracranial cavity under normal intracranial conditions. This is the first report of such resonance.
Axillary nerve entrapment in the quadrilateral space
Authors: McKowen H. Carson , Voorhies Rand M.
Published: May 2009

✓ The quadrilateral space syndrome is a recently established entity with seemingly consistent pathological and radiographic features. An example of this syndrome is reported. In this patient, entrapment of the axillary nerve by fibrous bands in the quadrilateral space caused shoulder pain with paresthesias in the upper extremity. Subclavian angiography provided the diagnosis by demonstrating that the posterior humeral circumflex artery, which was normal when the arm was in a neutral position, was occluded when the arm was abducted and externally rotated. Axillary neurolysis through a posterior approach resulted in relief of symptoms.
Cervical flexion myelopathy: a “tight dural canal mechanism”
Authors: Iwasaki Yoshinobu , Tashiro Kunio , Kikuchi Seiji , Kitagawa Mayumi , Isu Toyohiko , Abe Hirosi
Published: May 2009

✓ The authors describe a case of flexion myelopathy due to specific morphological changes of the cervical cord, termed a “tight dural canal mechanism.” The patient was an 18-year-old man with progressive weakness and muscle atrophy of the left arm. Neuroradiological examination revealed that the lower cervical cord was compressed during flexion of the cervical spine, but that there was no disc disease or cervical vertebral instability. The cord compression was attributed to a pinching mechanism by the posterior border of the vertebral body and the posterior component of the dura on flexion.
The molecular genetics of nervous system tumors
Authors: Schmidek Henry H.
Published: May 2009

✓ Major insights have resulted in the last few years from the application of the techniques of molecular genetics to problems of development, differentiation, growth control, and neoplasia. It is now recognized that these problems are often actually different facets of the central question: how are genes regulated under various circumstances? These problems are of particular interest to neurosurgeons insofar as they relate to the mechanisms of development and differentiation of the nervous system and its tumors. This review attempts to provide an introduction to the salient issues and to the current state of knowledge in these various fields in order to promote an understanding of nervous system neoplasia and of areas that bear potential importance for research and therapy.
Rerupture of intracranial aneurysms: a clinicoanatomic study
Authors: Hijdra Albert , Vermeulen Marinus , van Gijn Jan , van Crevel Hans
Published: May 2009

✓ In a series of 176 prospectively studied patients who survived for at least 24 hours after aneurysmal subarachnoid hemorrhage, 39 had at least one computerized tomography (CT)-proven rebleed within 4 weeks after the first rupture. There were peaks in the incidence of rebleeding at the end of the 2nd and 3rd weeks. Sudden loss of consciousness occurred in 35 patients, preceded in one-third of them by headache. A sudden increase in headache was a symptom of rebleeding in only one patient. Loss of brain-stem reflexes was recorded in 13 patients, respiratory arrest in six, and both symptoms in eight patients. Apnea was temporary in 11 patients. Rebleeding occurred as gross intraventricular hemorrhage in 20 patients, as a space-occupying hematoma in four, as both types of hemorrhage in three, and as a purely subarachnoid hemorrhage in 12. The location of the rebleed could not be inferred from the clinical features. Rebleeding was fatal in 51% of cases (two of 12 patients with a purely subarachnoid hemorrhage, and 18 of the other 27 patients (p < 0.005)). The risk of rebleeding could not be predicted from the patients' clinical condition on admission or from the amount of subarachnoid blood identified on the initial CT scan. The risk of further rebleeding was significantly increased in survivors of a first rebleed (47%: p < 0.01). Only seven (18%) of the 39 patients with rebleeding had survived at 3 months after the initial hemorrhage.
Long-term prospective study of lumbosacral discectomy
Authors: Lewis P. Jeffrey , Weir Bryce K. A. , Broad Robert W. , Grace Michael G.
Published: May 2009

✓ A long-term prospective study of 100 patients undergoing lumbosacral discectomy was carried out in an attempt to delineate the natural history of these patients and to assess the relative significance of preoperative factors as determinants of long-term outcome. Neurological findings were documented preoperatively and at 1 month, 1 year, and 5 to 10 years postoperatively. A questionnaire using subjective and objective data was given to patients at 1 year and 5 to 10 years postoperatively. An 83% long-term follow-up result was obtained. At a minimum of 5 years postoperatively, 62% of patients had complete relief of back pain and 62% had complete relief of leg pain; 96% were pleased that they had submitted to surgery and 93% were able to return to work. Nine percent reported that their back pain at 5 to 10 years was as severe as or worse than preoperatively and 11% reported that their leg pain was as severe as or worse than preoperatively. The reoperation rate was 18%. Preoperative factors found to be significantly associated with outcome at 1 year postoperatively were not significantly associated with outcome at 5 to 10 years postoperatively. The results of lumbosacral discectomy appear favorable as evaluated in this study. Preoperative factors useful as predictors of short-term outcome are much less reliable when considering the long-term results.
Basilar aneurysms: a new transclival approach via maxillotomy
Authors: Archer Daniel J. , Young Steven , Uttley David
Published: May 2009

✓ A transoral transclival approach to vertebrobasilar aneurysms, using a Le Fort I maxillary osteotomy rather than splitting the soft and hard palates, was employed successfully in three patients. This technique gave much improved access to the clivus, and eased exposure of the aneurysms without the need for traction on the brain stem or cranial nerves. There were no postoperative cerebrospinal fluid fistulae and no neurological complications. In one patient, a human-derived fibrin adhesive was used for dural repair. The postoperative cosmetic results were excellent and no problems relating to malocclusion were reported. This approach may have advantages when dealing with other diseases in or around the clivus.
Neoadjuvant chemotherapy for newly diagnosed germ-cell tumors of the central nervous system
Authors: Allen Jeffrey C. , Kim Jae Ho , Packer Roger J.
Published: May 2009

✓ A neoadjuvant (preradiotherapy) chemotherapy regimen consisting of either cyclophosphamide alone (60 to 80 mg/kg) or a modified multidrug regimen (vinblastine, bleomycin, cyclophosphamide, and cisplatin) was administered to 15 newly diagnosed patients with histologically confirmed, fully staged, primary germ-cell tumors (GCT's) of the central nervous system (CNS). There were 11 patients with germinomas and four with non-germinoma malignant GCT's. There were six females and nine males, whose median age was 13 years (range 4 months to 24 years). Seven germinoma patients (64%) had disseminated disease. For the germinoma patients, the subsequent radiotherapy dose was modified based on the response to the neoadjuvant chemotherapy, and craniospinal radiotherapy was given only to those with disseminated CNS disease at diagnosis. Ten of the 11 germinoma patients had complete disappearance of all evaluable disease after two courses of chemotherapy (cyclophosphamide in eight and multidrug in three) and one had a partial response. The planned dose of radiotherapy to the primary tumor was reduced from 5500 to 3000 rads, and the craniospinal dose was lowered from 3600 to 2000 rads. Ten patients remain in continuous disease-free remission 20+ to 89+ months after diagnosis (median follow-up period 47 months). All four patients with non-germinoma GCT's received the multidrug regimen, and two of three patients with evaluable disease had a partial response. High-dose regional and craniospinal radiotherapy was administered thereafter, but only two patients remain in their first remission.

Previously untreated germinoma is a highly chemosensitive disease and the neoadjuvant treatment strategy permits the identification of active chemotherapy regimens in newly diagnosed patients. Patients who have complete responses to neoadjuvant chemotherapy tolerate a significant radiotherapy dose reduction without compromising long-term survival, thereby allowing a reduction of some of the late effects of therapeutic radiation. Germinomas tend to disseminate early in the course of the disease and a pre-therapy staging evaluation permits individualized radiotherapy treatment planning.
Effect of total parenteral nutrition upon intracranial pressure in severe head injury
Authors: Young Byron , Ott Linda , Haack Dennis , Twyman Diana , Combs David , Oexmann J. B. , Tibbs Phillip , Dempsey Robert
Published: May 2009

✓ Animal investigations suggest that administration of hyperosmolar total parenteral nutrition (TPN) solutions may potentiate cerebral edema following head injury. Intravenous nutrition (TPN) is often required after head injury due to intolerance to enteral feeding (EN). This study evaluates the effect of TPN on intracranial pressure (ICP) measurements in severely brain-injured patients. Ninety-six severely brain-injured patients were randomly assigned to receive TPN or EN and were studied from hospital admission until 18 days postinjury. The TPN was started within 48 hours postinjury and the EN was started when tolerated. Peak daily ICP was not significantly different on admission and over time (overall mean ± standard error of the mean 32.01 ± 1.62 for TPN versus 32.5 ± 1.25 for EN). Intracranial pressure was greater than 20 mm Hg in 75% of TPN patients and 73% of EN patients. Conventional therapy failed to control elevated ICP in 36% of TPN patients and 38% of EN patients. Of these patients, subsequent barbiturate therapy failed to control ICP in 56% of TPN patients and 64% of EN patients. Serum osmolality was not significantly different between groups at admission or over the course of the study. The TPN group tended to have higher mean serum glucose levels for the first 13 days postinjury, while the EN group had a higher mean serum glucose content thereafter, but these differences were not statistically significant. This study shows that TPN can be given safely to the severely brain-injured patient without causing serum hyperosmolality or affecting ICP levels or ICP therapy.
The therapeutic value of nimodipine in experimental focal cerebral ischemia
Authors: Germano Isabelle M. , Bartkowski Henry M. , Cassel Mary E. , Pitts Lawrence H.
Published: May 2009

✓ Recent studies suggest that nimodipine, a potent calcium-channel antagonist that causes significant cerebrovascular dilatation, may improve neurological outcome after acute experimental permanent focal cerebral ischemia when given before or immediately after occlusion of the middle cerebral artery (MCA) in various animals. The authors describe the effect of nimodipine on cerebral ischemia in a rat model. At 1,4, or 6 hours after occlusion of the MCA, rats were treated in a double-blind technique with either nimodipine, placebo, or saline. Neurological and neuropathological evaluation was performed at 24 hours. Neurological outcome was better in rats treated with nimodipine 1, 4, or 6 hours after occlusion (p < 0.001, p < 0.01, p < 0.05, respectively), and the size of areas of infarction was statistically smaller in nimodipine-treated groups (p < 0.01, p < 0.01, p < 0.05, respectively) when compared with control rats treated with saline or placebo. The best neurological outcome and the smallest area of infarction were found in nimodipine-treated rats 1 hour after occlusion. Compared with controls, the size of the periphery of the infarcted area was smaller in nimodipine-treated rats. The results show that nimodipine improves neurological outcome and decreases the size of infarction when administered up to 6 hours after ischemic insult. These results suggest a possible mechanism of action of nimodipine on the “penumbra” of the ischemic area.
Evaluation of an intensive methylprednisolone sodium succinate dosing regimen in experimental spinal cord injury
Authors: Braughler J. Mark , Hall Edward D. , Means Eugene D. , Waters Thomas R. , Anderson Douglas K.
Published: May 2009

✓ Beginning 30 minutes after compression trauma of the upper lumbar (L-2) spinal cord, cats were treated with either a high-dose regimen of methylprednisolone (MP) administered as the sodium salt of the 21-succinate ester (Solu-Medrol sterile powder) or the MP vehicle. Animals were randomly assigned to either treatment group (10 cats per group), and all personnel were blind as to which animals received vehicle or drug. The intensive 48-hour dosing regimen was designed to maintain therapeutic tissue levels of MP and consisted of an initial 30 mg/kg intravenous bolus of MP; 2 and 6 hours later additional 15 mg/kg MP doses were administered by intravenous bolus. Immediately following the bolus given at 6 hours, a continuous MP infusion of 2.5 mg/kg/hr was started. The infusion was stopped abruptly at 48 hours with no dose tapering. Animals in the vehicle group received an equivalent volume of MP vehicle. The total MP dose administered over 48 hours was 165 mg/kg. Animals were evaluated weekly for neurological recovery based upon a 12-point functional scale which assessed general mobility, running, and stair-climbing. Mean recovery scores at 1 month after injury (± standard error of the mean) were: vehicle group (seven cats) 3.7 ± 0.9, and MP group (10 cats) 8.7 ± 0.2; (p < 0.001). Histological evaluation of the spinal cords revealed a strong negative correlation between neurological recovery and size of the spinal cord cavity at 1 month (r = −0.88). Three of 10 animals in the vehicle group became ill and had to be dropped from the study, whereas all of the 10 MP-treated animals survived in excellent health. The results demonstrate the therapeutic effectiveness and low incidence of side effects associated with an intensive MP dose regimen for treatment of experimental spinal cord injury.
A fluid percussion model of experimental brain injury in the rat
Authors: Dixon C. Edward , Lyeth Bruce G. , Povlishock John T. , Findling Robert L. , Hamm Robert J. , Marmarou Anthony , Young Harold F. , Hayes Ronald L.
Published: May 2009

✓ Fluid percussion models produce brain injury by rapidly injecting fluid volumes into the cranial cavity. The authors have systematically examined the effects of varying magnitudes of fluid percussion injury in the rat on neurological, systemic physiological, and histopathological changes. Acute neurological experiments showed that fluid percussion injury in 53 rats produced either irreversible apnea and death or transient apnea (lasting 54 seconds or less) and reversible suppression of postural and nonpostural function (lasting 60 minutes or less). As the magnitude if injury increased, the mortality rate and the duration of suppression of somatomotor reflexes increased. Unlike other rat models in which concussive brain injury is produced by impact, convulsions were observed in only 13% of survivors. Transient apnea was probably not associated with a significant hypoxic insult to animals that survived. Ten rats that sustained a moderate magnitude of injury (2.9 atm) exhibited chronic locomotor deficits that persisted for 4 to 8 days. Systemic physiological experiments in 20 rats demonstrated that all levels of injury studied produced acute systemic hypertension, bradycardia, and increased plasma glucose levels. Hypertension with subsequent hypotension resulted from higher magnitudes of injury. The durations of hypertension and suppression of amplitude on electroencephalography were related to the magnitudes of injury. While low levels of injury produced no significant histopathological alterations, higher magnitudes produced subarachnoid and intraparenchymal hemorrhage and, with increasing survival, necrotic change and cavitation. These data demonstrate that fluid percussion injury in the rat reproduces many of the features of head injury observed in other models and species. Thus, this animal model could represent a useful experimental approach to studies of pathological changes similar to those seen in human head injury.
Symptomatic subependymoma of the cervical spinal cord
Authors: Lee K. Stuart , Angelo Jean N. , McWhorter Joe M. , Davis Courtland H.
Published: May 2009

✓ Subependymomas are relatively unusual tumors with a distinctive histological appearance. They are generally considered to be benign, and they are often found incidentally at autopsy. Most are located intracranially, and the most common site of origin is the fourth ventricle. Only two cases of subependymoma of the spinal cord have been reported previously. The authors present two additional cases of subependymoma of the cervical cord; both were symptomatic, and both were treated by microsurgical removal.
Neuroepithelial cyst in the optic nerve
Authors: Isla Alberto , Palacios José , Roda José M. , Gutierrez Manuel , González Cesáreo , Blázquez Martín G.
Published: May 2009

✓ A 34-year-old woman presented with progressive loss of vision in her left eye of 2 months' evolution. Computerized tomography showed a hypodense lesion in the suprasellar region. At surgery a cystic lesion was found inside the optic nerve. Histological study proved it to be a neuroepithelial cyst. The pathogenesis of a neuroepithelial cyst in such an exceptional site is discussed.
Opioid receptor systems and the endorphins: a review of their spinal organization
Authors: Yaksh Tony L.
Published: May 2009

✓ A review of the spinal organization of opioid receptor systems and endorphins is presented. The review is a consideration of the physiological mechanisms underlying the effect of spinal opioids, the pharmacology of the opioid receptors that moderate a variety of spinal processing systems, and the endorphin systems that act upon the spinal receptors.
Observations on the current treatment of low-grade astrocytic tumors of the cerebral hemispheres
Authors: Piepmeier Joseph M.
Published: May 2009

✓ The records of 60 patients with low-grade astrocytic tumors of the cerebral hemispheres treated between 1975 and 1985 were examined to evaluate the results of current treatment methods. This analysis revealed that the patient's age and tumor enhancement on computerized tomography (CT) with intravenous administration of contrast material were the only factors that influenced survival time. Compared to prior studies, the patients in this report more frequently had normal preoperative neurological examinations and total resection of their lesions. These differences may have resulted from the use of CT scans over the past decade. Earlier diagnosis and improvement definition of the tumor location and extent are two reasons why the use of CT scans may have affected outcome statistics. A re-examination of treatment methods and the timing of those treatments is needed to define the optimal management of these lesions.
Chemonucleolysis with chymopapain: results in 150 patients
Authors: Shields Christopher B. , Reiss Steven J. , Garretson Henry D.
Published: May 2009

✓ Chemonucleolysis with chymopapain has been advocated for the treatment of lumbar disc disease. When polled by a mail questionnaire, 150 consecutive patients who had undergone chemonucleolysis reported an overall success rate of only 40% and a failure rate of 60%. However, 57% of the patients were active or had only mild restriction of daily activities. Of those patients employed prior to injection, only 63% had returned to work. Those with workmen's compensation benefits fared considerably worse than those covered by third-party insurance (17% vs. 51% success). These results cast doubt on the long-term benefits of chymopapain in the treatment of lumbar disc disease.
Hyperprolactinemia, intrasellar pituitary tissue pressure, and the pituitary stalk compression syndrome
Authors: Lees Peter D. , Pickard John D.
Published: May 2009

✓ The intrasellar pressure has been studied in a consecutive series of 24 patients undergoing transsphenoidal surgery for pituitary adenoma. The mean intrasellar pressure for the group was 23 ± 2.5 mm Hg (± standard error of the mean), with a mean pulse pressure of 3.5 ± 1 mm Hg. The waveform partly resembled the arterial configuration. The results are correlated with the radiological and endocrinological features of the tumors. A hypothesis is proposed to explain the mechanism of hyperprolactinemia associated with the pituitary stalk compression syndrome.
Long-term effects of head injuries sustained during life in three male populations
Authors: Carlsson Gudrun Silverbåge , Svärdsudd Kurt , Welin Lennart
Published: May 2009

✓ Data on defined head injuries, suffered during life, were related to possible long-term sequelae among 1112 men aged 30, 50, or 60 years who were sampled from the general population of Gothenburg, Sweden. There was a significant relationship between closed-head injury associated with reported impaired consciousness and occurrence of symptoms of the postconcussional type, self-assessed health variables, and the performance of finger-tapping and reaction-time tests. There was a cumulative effect of repeated head injuries: the more head injuries that were suffered, the more symptoms and more inferior performance were noted. Age at the time of the accident did not influence the occurrence of reported sequelae. Alcohol intake and smoking were powerful factors confounding the postinjury picture, but after taking these factors into account the results were generally the same. The study indicates that head injuries with impaired consciousness, no matter how short, are capable of causing permanent sequelae.
Estrogen receptor immunoreactivity in meningiomas
Authors: Lesch Klaus-Peter , Gross Silke
Published: May 2009

✓ Estrogen receptor (ER) analysis was performed in 70 meningioma samples by means of two assays: an enzyme immunoassay that used monoclonal antibodies against human ER protein (estrophilin), and a sensitive radioligand binding assay that used iodine-125-labeled estradiol as the radioligand. Low levels of ER immunoreactivity were found in tumors from 51% of patients, whereas ER binding activity was demonstrated in 40% of the meningiomas examined. In eight (11%) of the tissue samples, multiple binding sites for estradiol were observed. The immunoreactive binding sites corresponded to those of the classic high-affinity ER. In ligand binding studies, however, measurement of classic ER was considerably influenced by a second low-affinity high-capacity estrogen binding component, even at low ligand concentrations. Binding activity of the progesterone receptor (PR) and androgen receptor (AR) was determined concurrently using 17α-methyl-3H-promegestone (3H-R 5020) and 17α-methyl-3H-trienolone (3H-R 1881), a synthetic gestagen and androgen, respectively. High concentrations of PR were detected in 53 (76%) of the tumors, whereas a moderate number of AR binding sites were demonstraetd in 33 (47%) of the tumors. A positive correlation between ER immunoreactivity and AR binding activity is suggestive of estrogen regulation of AR via the ER system. The presence of gonadal steroid receptors in a large proportion of meningiomas and the tendency toward a dependence of receptor concentrations on the histological subtype of the meningioma could have implications for tumor therapy.