bluuebunny/crossref_metadata_2025 huggingface dataset:
Maffucci's Syndrome with Bilateral Cartilaginous Tumors of the Cerebellopontine Angle
Authors: Bushe Karl-August , Naumann Markus , Warmuth-Metz Monika , Meixensberger Jürgen , Müller Justus
Published: April 2011

Maffucci's syndrome is characterized by the combination of multiple enchondromas (Ollier's disease) and hemangiomatosis. These hemangiomas develop in the subcutaneous tissue and form red-blue tumors dispersed over the whole body. Intracranial involvement is rare, making a preoperative radiological diagnosis and differentiation from other tumors rather difficult. The radiological characteristics and successful removal of the intracranial part of a chondrosarcoma of the cerebellopontine angle in a case of Maffucci's syndrome are reported in this paper.
An Operative Complication in a Patient with a True Posterior Communicating Artery Aneurysm: Case report and Review of the Literature
Authors: Kudo Tadashi
Published: April 2011

Intraoperative oculomotor nerve injury in a patient with a true posterior communicating artery aneurysm is reported in detail. A comparison of internal carotid artery aneurysms at the posterior communicating artery junction with true posterior communicating artery aneurysms deserves special attention, because the vascular relationships of the aneurysm are more complex. A clip along the internal carotid artery does not occlude blood flow to the aneurysm, and the aneurysmal neck and the distal posterior communicating artery are closer to the oculomotor nerve. This is the 27th reported case of a true posterior communicating artery aneurysm. The incidence of true posterior communicating artery aneurysms ranges from 0.1 to 2.8% of all aneurysm patients. Such aneurysms constitute 4.6 and 11% of so-called posterior communicating aneurysms in two series. Difficulty associated with a preoperative diagnosis has been documented in at least 4 cases. An awareness of this rare aneurysm is stressed in order to avoid operative complications.
Esthesioneuroblastoma with Intracranial Extension
Authors: Meneses Murilo S. , Thurel Claude , Mikol Jacqueline , Ramina Ricardo , Maniglia João J. , Arruda Walter O. , Cophignon Jean
Published: April 2011

The authors present five cases of olfactory neuroblastoma with intracranial extension operated on in the Department of Neurosurgery in collaboration with otorhinolaryngologists. This tumor is most frequently reported as growing inside the nasal cavities, and it can extend to the paranasal sinuses. Cases presenting initially as intracranial tumors have been infrequently reported. At present, histological diagnosis of this tumor is aided by the use of electron microscopy and immunocytochemistry. Total resection combined with radiation therapy remains the most satisfactory treatment.
Cryptic Osteoid Osteoma of the Cranium: Case Report
Authors: Neff Samuel , Hansen Kristine , Domanowski Gerald F. , Wu Julian
Published: April 2011

Osteoid osteoma is an uncommon benign tumor of bone that rarely involves the cranium. It often causes local pain that is worse at night, characteristically relieved by aspirin, and does not correlate with the size of the lesion. The diagnosis depends on skull radiographs and computed tomography. This report describes a case in which radiographs showed nothing abnormal. The diagnosis and operative localization were accomplished with radionuclide bone scanning. Thus, the possibility of radiographically cryptic lesions must be considered in the evaluation of atypical head pain syndromes.
Pregnancy and the Risk of Hemorrhage from Cerebral Arteriovenous Malformations
Authors: Horton Jonathan C. , Chambers Wiley A. , Lyons Susan L. , Adams Raymond D. , Kjellberg Raymond N.
Published: April 2011

We conducted a retrospective analysis of 451 women with an arteriovenous malformation (AVM) of the brain to determine whether pregnancy is a risk factor for cerebral hemorrhages. A total of 540 pregnancies occurred among our patient population, resulting in 438 live births and 102 abortions. There were 17 pregnancies complicated by a cerebral hemorrhage. The hemorrhage rate during pregnancy for women with an unruptured AVM was 0.035 ±0.005 per person-year. The hemorrhage rate for nonpregnant women of childbearing age with an unruptured AVM was 0.031 ± 0.002 per person-year. Pregnancy did not increase significantly the rate of first cerebral hemorrhage from an AVM (P = 0.35). We found that women with an AVM face a 3.5% risk of hemorrhage during pregnancy. Pregnancy is not a risk factor for hemorrhage in women without a previous hemorrhage. This conclusion assumes no selection bias exists in our study population; a bias would be introduced if the risk of fatal outcome after a hemorrhage were greater in pregnant women than in nonpregnant women.
Occult, Bilateral Anterior Sacral and Intrasacral Meningeal and Perineurial Cysts: Case Report and Review of the Literature
Authors: North Richard B. , Kidd David H. , Wang Henry
Published: April 2011

None of the more than 180 cases of anterior sacral meningocele reported in the past 150 years has been bilateral, and only two have been associated with occult intrasacral meningocele. We report a unique case of bilateral anterior sacral cysts, communicating with the subarachnoid space, associated with occult intrasacral meningeal and perineurial (Tarlov's) cysts, in an asymptomatic woman. The pertinent clinical and diagnostic imaging literature is reviewed.
Suppression of the Cerebral Vasospastic Actions of Oxyhemoglobin by Ascorbic Acid
Authors: Kawakami Masahisa , Kodama Namio , Toda Noboru
Published: April 2011

Oxyhemoglobin (Oxy-Hb) produced a concentration-dependent contraction of monkey, dog, and bovine cerebral artery strips. Treatment of Oxy-Hb with ascorbic acid suppressed the ability of Oxy-Hb to contract the arteries, especially in the monkey arteries. The ability of intracisternally applied Oxy-Hb to constrict the basilar artery in anesthetized dogs was diminished when Oxy-Hb was treated previously with ascorbic acid (AsA-Hb). The contraction caused by Oxy-Hb was suppressed by treatment with indomethacin and aspirin in isolated bovine cerebral arteries. Endothelium-dependent relaxations elicited by substance P and relaxations induced by stimulation of the vasodilator nerves with nicotine were suppressed by treatment with Oxy-Hb and AsA-Hb; however, the inhibitory effect of AsA-Hb was markedly less. Oxy-Hb attenuated nitroglycerin-induced relaxations in a dose-dependent fashion, whereas AsA-Hb in concentrations up to 1.6 x 10-5 M did not significantly influence the relaxations. It is concluded that incubation of Oxy-Hb with ascorbic acid alters markedly the biological activity of Oxy-Hb; the vasoconstrictor activity is suppressed, and the ability to diminish vasodilator actions is minimized. These findings provide a rationale for the use of ascorbic acid in cisternal irrigation to prevent the development of cerebral vasospasm after a subarachnoid hemorrhage.
Spinal Cord Stimulation: A Contemporary Series
Authors: Spiegelmann Roberto , Friedman William A.
Published: April 2011

Forty-three patients with chronic pain disorders of different causes were selected for spinal cord stimulation. All underwent implantation of a ribbon electrode through a small laminotomy, under general anesthesia. Thirteen patients (30%) failed to obtain significant pain relief during a period of trial stimulation, and their electrodes were removed. The remainder underwent a definitive implant and were followed for a mean of 13 months (range, 3-33 months). Nineteen of them (63%) continued to experience pain relief. A detailed analysis of this series, as well as a literature review, is presented.
Chronic Headache Associated with a Functioning Shunt: Usefulness of Pressure Monitoring
Authors: Abbott Rick , Epstein Fred J. , Wisoff Jeffrey H.
Published: April 2011

Chronic headaches in a shunt-dependent patient with small ventricles has long been treated with little or no regard to intracranial pressure. In this study, pressure monitoring on 12 such patients demonstrated that they fell into three distinct categories: 3 had headaches caused by intracranial hypertension, 2 had headaches from hypotension, and 7 showed no relation of symptoms to pressure. As therapeutic procedures for treating these three categories are entirely different and sometimes opposing, it is clear that intracranial pressure monitoring is essential to successful management of this complaint.
Ectopic Retinoblastoma within the 3rd Ventricle: Case Report
Authors: Katayama Yoichi , Tsubokawa Takashi , Yamamoto Takamitsu , Nemoto Norimichi
Published: April 2011

Ectopic intracranial retinoblastomas arc rare. These tumors usually occur in the pineal, parasellar. or suprasellar regions several years after the successful treatment of ocular retinoblastomas with no evidence of direct extension or distant metastasis. We report here a case of ectopic retinoblastoma occurring within the third ventricle. The tumor was surgically excised by the transventricular approach. Ectopic retinoblastomas exhibit greater differentiation than one would expect to observe in a metastatic lesion of this tumor. The distinction of ectopic retinoblastomas and metastasis from ocular retinoblastomas is important, since ectopic retinoblastomas, unlike metastasis, can be successfully managed by intensive therapy including radical excision.
Epidural Tuberculoma of the Spine: Case Report
Authors: Hamada Junichirou , Sato Kyouichi , Seto Hiroshi , Ushio Yukitaka
Published: April 2011

Epidural tuberculomas of the spine have been reported only rarely during the past few decades. A case of a surgically treated epidural tuberculoma of the thoracic spine in a 76-vear-old woman is presented.
Asymptomatic versus Symptomatic Herniated Thoracic Discs: Their Frequency and Characteristics as Detected by Computed Tomography after Myelography
Authors: Awwad Eric E. , Martin David S. , Smith Kenneth R. , Baker Bradley K.
Published: April 2011

We retrospectively reviewed the myelograms of 433 patients and identified those who had no symptoms or signs referable to the thoracic cord, roots, or nerves. By post-myelography computed tomographic scan criteria, our frequency of asymptomatic thoracic herniated dises (ATHDs) was calculated. Post-myelography computed tomographic scans of 68 ATHDs were analyzed. Their imaging characteristics were compared with our own series of 5 symptomatic thoracic herniated discs and symptomatic thoracic herniated discs in the literature. We were unable to identify any imaging features that could reliably classify a disc as an ATHD or a symptomatic thoracic herniated disc. Our results call into question the propriety of prophylactic surgery for ATHDs, even when the lesions are radiographically impressive.
Cerebrospinal Fluid Flow Dynamics in Children with External Ventricular Drains
Authors: Drake James M. , Sainte-Rose Christian , DaSilva Marcia , Jean-François Hirsch
Published: April 2011

Fifty-five children had 64 external ventricular drains (EVDs) placed predominantly (95%) for cerebrospinal fluid (CSF) shunt infections. In 9 children, a computer monitoring system measured the CSF output each second continuously for up to 24 hours. The monitoring was repeated daily for up to 9 days. The state of arousal of the patients was recorded simultaneously. In all children, daily EVD outputs were related to age, sex, weight, method of establishing the EVD, height of the drip chamber, time since insertion, and type of infecting organism. Computer monitoring revealed wide fluctuations in flow rate, with peak rates frequently >20 ml/h and periods of flow arrest. These changes were usually associated with increased arousal, but also occurred with sleep. The mean EVD flow rate for all children was 6.3 ml/h. EVD output increased with age and weight. EVD output decreased with Gram-negative or multiple-organism infections and with elevation of the drip chamber. Resolution of the infection, sex of the patient, and method of establishing the EVD had no effect on output. These results predict that CSF production increases with brain growth in humans; that CSF production is depressed by Gram-negative and multiple-organism infections; that implanted CSF shunts with standard valves flow at equivalent rates to an EVD in the supine position; and that the CSF drainage requirements in this group are approximately equal to their EVD outputs.
An Experimental Compartmental Flow Model for Assessing the Hemodynamic Response of Intracranial Arteriovenous Malformations to Stereotactic Radiosurgery
Authors: Lo Eng H. , Fabrikant Jacob I. , Levy Richard P. , Phillips Mark H. , Frankel Kenneth A. , Alpen Edward L.
Published: April 2011

Stereotactic radiosurgery has proven to be an effective method of treating selected inaccessible or inoperable arteriovenous malformations (AVMs) of the brain. Radiation-induced obliteration of successfully-treated AVMs, however, occurs only after some latent period after treatment, depending on size, location, and dose. An experimental compartmental flow model is proposed to describe the hemodynamic alterations in the AVM as a result of the pathophysiological changes after radiosurgery, and to analyze temporal alterations in AVM blood flow rates and pressure gradients before complete obliteration. In representative small (low-flow, 150 ml/min) and large (high-flow, 440 ml/min) AVMs, it is found that increases in pressure gradients across certain vascular structures within the AVM occur during the normal course of radiation-induced flow decrease and AVM obliteration. The magnitude of these pressure alterations, however, may be within the normal physiological variations in cerebrovascular blood pressure. The effects of partial-volume irradiation of the AVM is examined by limiting radiosurgical treatment to varying portions of the flow compartments within the model. It is found that alterations in pressure gradients persist in unirradiated vascular shunts, even after complete obliteration of the treated AVM volume. These pressure alterations may increase the probability of hemorrhage from the untreated shunts of the AVM and cause redistribution of regional cerebral blood flow resulting in increased flow through these untreated shunts.
Percutaneous Transvenous Catheterization and Embolization of Vein of Galen Aneurysms
Authors: Casasco Alfredo , Lylyk Pedro , Hodes Jonathan E. , Kohan Gabriel , Aymard Armand , Merland Jean-Jacques
Published: April 2011

Seven cases of vein of Galen aneurysms treated by percutaneous transvenous endovascular occlusion of the aneurysmal vein are presented. In one case, the approach was via the femoral vein, and in the other six cases, by the jugular vein. All of the malformations were multipedicular and, additionally, in six of the seven there was an intervening arterial-arterial network between the posterior thalamoperforating arteries and the wall of the venous aneurysm. This fistulous network was interpreted as purely arterial and not as an associated arteriovenous malformation. For this reason, the transvenous approach was considered justified, and was performed without risk of hemorrhage caused by retrograde venous hypertension. Measurement of intra-aneurysmal pressure during the course of treatment allowed better understanding of the hemodynamics of the lesions, guided the amount of occlusion to be accomplished during each treatment session, and thus may have prevented the phenomenon of normal perfusion pressure breakthrough. The percutaneous transvenous approach offers all the advantages of the transtorcular approach but avoids surgery. Because of our excellent angiographic and clinical results—five complete and two partial occlusions, with favorable outcomes and no major complications—we believe that this technique is better for the treatment of multipedicular vein of Galen aneurysms than transarterial embolization or surgery.
Reversible Hearing Loss from Cerebellopontine Angle Tumors
Authors: Vellutini Eduardo A. S. , Cruz Oswaldo L. M. , Velasco Otavio P. , Miniti Aroldo , Almeida Gilberto M.
Published: April 2011

We report two patients who presented with a dramatic recovery from severe sensorineural hearing loss after total surgical removal of cerebellopontine angle tumors (meningioma and jugular foramen neurinoma). The factors that differentiate these “non-acoustic tumors” in relation to the prognosis for hearing are discussed. A surgical approach that maintains the labyrinthine structure and preserves the arachnoid membrane of the superior cerebellopontine angle cistern during tumor removal is stressed.
The Relevance of Anatomic and Hemodynamic Factors to a Classification of Cerebral Arteriovenous Malformations
Authors: Pasqualin Alberto , Barone Giovanni , Cioffi Fabrizia , Rosta Luisa , Scienza Renato , Da Pian Renato
Published: April 2011

Potential prognostic anatomic and hemodynamic factors were evaluated in 248 patients with cerebral arteriovenous malformations (AVMs), all treated by direct microsurgical removal. The size of each AVM was calculated by its volume, obtained by the multiplication of the three AVM diameters by 0.52. A surgical classification of AVM location (in 11 groups) is proposed. Types of feeders and of drainage were classified as superficial or deep; the extent of the drainage system was classified according to a four-degree scale. The mean flow velocity in the main AVM feeder, detected using transcranial Doppler ultrasonography, was used as an indirect measure of AVM shunt flow in a small number of patients (n = 29). AVM volume was a very important prognostic factor: the incidence of hyperemic complications and the morbidity and mortality rate were significantly higher when the volume of the lesion was >20 cm3 (P< 0.0001 for hyperemic complications; P < 0.001 for permanent morbidity and mortality). The incidence of hyperemic complications and the morbidity rate were higher in AVMs in rolandic, inferior limbic, and insular locations than in AVMs in other locations. As for other anatomic factors: a) the presence of deep feeders significantly increased the incidence of hyperemic complications, as well as the morbidity and mortality rate; b) the presence of deep drainage significantly increased permanent morbidity only; c) the extension of the venous system was significantly related to the development of hyperemic complications, and to morbidity and mortality. Transcranial Doppler examination showed that mean flow velocities >120 cm/s in the main feeder were associated with a significantly higher rate of postoperative hematomas and transient deficits. A classification of cerebral AVMs that takes into account AVM volume and location, the type of feeders, the extent of the drainage system, and the main feeder flow velocity is suggested.
Gonadotroph Adenoma of the Pituitary Mimicking a Prolactinoma
Authors: Yamada Shozo , Horvath Eva , Kovacs Kalman , Aiba Tadashi , Shimizu Taeko , Shishiba Yoshimasa , Hara Mitsuru
Published: April 2011

In a 41-year-old woman with mild hyperprolactinemia and amenorrhea, preoperative hormonal and neuroradiological findings suggested the diagnosis of a macroprolactinoma. She underwent transsphenoidal surgery since the tumor size had not changed in spite of bromocriptine administration for 5 months. Consequently. this case was diagnosed as a female-type gonadotroph adenoma on the basis of its characteristic ultrastructural features including a honeycomb Golgi complex, even though endocrinological and immunohistochemical findings were not those of a typical gonadotroph adenoma.
Delayed Facial Nerve Palsy after Temporal Lobectomy for Epilepsy: Report of Four Cases and Discussion of Possible Mechanisms
Authors: Anderson James , Awad Issam A. , Hahn Joseph F.
Published: April 2011

Four cases of idiopathic peripheral facial nerve palsy were documented after 110 consecutive resections of the temporal lobe for intractable epilepsy. In 3 of the 4 cases, the palsy was ipsilateral to the side of the temporal lobectomy. The onset of facial weakness was delayed 7 to 13 days after surgery (mean, 9.7 days). One patient underwent facial electroneurography, which documented 17% of normal facial motor function at the height of his weakness and the absence of the acoustic stapedius reflex. All patients were treated with prednisone (60-80 mg per day by mouth for 10-14 days, tapering off throughout the subsequent week). Facial function recovered fully in all patients within 6 to 8 weeks. Possible mechanisms are discussed, including heat and/or mechanical trauma to the facial nerve near the geniculate ganglion during resection of mesial temporal lobe structures.
Effect of Whole Brain Radiation on Local Cerebral Glucose Utilization in the Rat
Authors: d'Avella Domenico , Cicciarello Rocco , Albiero Francesca , Mesiti Mario , Gagliardi Maria Ester , Russi Elvio , d'Aquino Antonio , Princi Pietro , d'Aquino Saverio
Published: April 2011

We assessed, by means of the [14C]-2-deoxy-D-glucose autoradiography method, the effect of whole-brain x-radiation on local cerebral glucose utilization in the rat brain. Animals were exposed to conventional fractionation (200 ± 4 cGy/day, 5 days/week; total dose, 4000 cGy);. Metabolic experiments were made 2 to 3 weeks after completion of the radiation exposure. In comparison with control and sham-irradiated animals, cerebral metabolic activity was diffusely decreased after irradiation. Statistically significant decreases in metabolic activity were observed in 13 of 27 brain regions studied. In general, the brain areas with the highest basal metabolic rates showed the greatest percentage of decrease in glucose utilization. The concept that radiation suppresses glucose utilization before any morphological change takes place in the cell structures was the basis of this study. Metabolic alterations after irradiation may explain the syndrome of early delayed deterioration observed in humans after whole-brain radiotherapy. These studies have applications to observations made with the [18F]-fluorodeoxyglucose method in conjunction with positron emission tomographic scans in patients receiving radiation therapy for intracranial malignancies. The data reported here also have potential clinical implications for the evaluation of a risk/benefit ratio for radiotherapy in patients with benign neurosurgical diseases or children undergoing prophylactic treatment of the central nervous system.
Motor Evoked Potentials Elicited from Pyramidal Stimulation and Recorded from the Spinal Cord in the Rat
Authors: Ryder John , Zappulla Rosario , Nieves Julia
Published: April 2011

This study investigated the spinal evoked response to focal electrical stimulation of the sensorimotor cortex in 32 rats. The results demonstrate a long-latency response (beginning at 8 milliseconds); elicited by electrical stimulation, which is distinct from the short-latency motor evoked potential previously reported. The conduction velocity of this later response is similar to that reported for the pyramidal tract in the rat. Experiments confirm that the longer latency response depends upon the integrity of the pyramidal system. Focal stimulation outside the sensorimotor cortex failed to elicit a response. Experimental lesions of the pyramidal tract or ablating the sensorimotor cortex eliminated the spinal cord evoked response. The results demonstrate that focal stimulation of the sensorimotor cortex results in a spinal cord evoked response that represents activity within the pyramidal system. The utility of this response in the rat model for assessing experimental cord injury is discussed.
Neurenteric Cyst Located Dorsal to the Cervical Spine: Case Report
Authors: Macdonald R. Loughlin , Schwartz Michael L. , Lewis Anthony J.
Published: April 2011

A patient with a neurenteric cyst located dorsal to the cervical spine and associated with occult cervical spinal dysraphism is described. The embryological theories that might explain the occurrence of such a lesion are discussed.
Pineal Teratoma and Its Relationship to Intracerebral Development: Case Report
Authors: Sekhon Lali H. S. , Morgan Michael K.
Published: April 2011

A teratoma of the pineal region in a 20-year-old Australian Aborigine is presented in which an unusual location of the straight sinus and tentorium cerebelli suggests that the tumor arose before 4 months of gestation. In addition, this case provides some insight into the development of the falx cerebri, which might arise from the midline fusion of the left and right tentoria cerebelli caused by the dorsal development of the telencephalon.
Lymphoproliferative Lesion of the Hypoglossal Nerve: Case Report
Authors: Takaki Shuichi , Jun-Ichi Kuratsu , Mihara Yosuke , Takada Akira , Seto Hiroshi , Ushio Yukitaka
Published: April 2011

A rare case of a lymphoproliferative lesion in the hypoglossal nerve is reported. The patient, a 52-year-old woman, had symptoms identical with those of hypoglossal neurinoma. Computed tomography and magnetic resonance imaging revealed a lesion at the left cerebellomedullary angle. The tumor was removed, and histopathological studies revealed that the tumor consisted predominantly of lymphocytes.
Infected Intracranial Aneurysm in an Infant: Case Report
Authors: Whitfield Peter Cyril , Bullock Ross
Published: April 2011

The case of a ruptured, infected intracranial aneurysm occurring in a 34-day-old child is reported. The child was brought for examination after a sudden onset of screaming and pallor, followed by focal seizures. Blood cultures grew Staphy-lococcus aureus, and a computed tomographic scan revealed a large hematoma in the region of the left sylvian fissure. An angiogram demonstrated a 17-mm aneurysm arising from a small branch of the middle cerebral artery. At craniotomy, the hematoma was evacuated and an infected aneurysm was removed. The etiology, pathogenesis, and management of infected intracranial aneurysms is discussed. Our patient is the youngest in whom such an aneurysm has yet been reported.
Brain Tumor Resection Aided with Markers Placed Using Stereotaxis Guided by Magnetic Resonance Imaging and Computed Tomography
Authors: Hassenbusch Samuel J. , Anderson James S. , Pillay Prem K.
Published: April 2011

In the operative resection of brain tumors, defining and locating edges of deep-seated tumors or those with indistinct color and consistency can be difficult. This report presents a simple yet precise, alternative method, using the basic Brown-Roberts-Wells or Cosman-Roberts-Wells stereotactic frame, for placement of visual markers to aid in tumor resections. The method can also be extended to the Leksell system. Using routine computed tomographic scanning or magnetic resonance imaging after stereotactic frame application, multiple points along tumor edges were used as target points. In the operating room, standard techniques were used for the skin incision, removal of the bone flap, and opening the dura. At each target point, after opening the dura and using stereotactic coordinates and equipment, a microbiopsy forceps was used to place “micropatties” (each with a string tail) or small catheters with pledgets or catheter tips located at tumor edges. After removing the arc, the tumor resection was accomplished in a conventional nonstereotactic manner by simply following string tails or catheters to the tumor. Gross tumor edges were determined from positions of actual patties or catheter tips. These simple but accurate techniques offer the possibility of tumor resections under stereotactic guidance with equipment readily available to most neurosurgeons. The fidelity of marker placement is also maintained in relation to tumor edges despite shifts in the tumor and/or brain as cystic areas are drained or large amounts of the tumor are resected.
Prevention of Vasospasm by Clot Removal and Intrathecal Bolus Injection of Tissue-Type Plasminogen Activator: Preliminary Report
Authors: Mizoi Kazuo , Yoshimoto Takashi , Fujiwara Satoru , Sugawara Takayuki , Takahashi Akira , Koshu Keiji
Published: April 2011

In this study, we evaluated the efficacy of postoperative intrathecal injections of tissue-type plasminogen activator (tPA) in preventing cerebral vasospasm in cases with a diffuse severe subarachnoid hemorrhage. All 10 cases were graded Group 3 according to the classification of Fisher and associates, and the CT number (Hounsfield number) of the subarachnoid clot was over 75. After clipping the aneurysm and removing the clot, three cisternal drainage catheters were inserted into both sylvian cisterns and the prepontine cistern, and continuous ventricular drainage was performed routinely. Postoperatively, tPA (0.5 mg/2.5 ml) was infused as a bolus into both basal cisterns and the lateral ventricle twice daily for about 6 days. Angiography and cerebral blood flow studies using single photon emission computed tomography were performed on Day 4 or 5 and between Days 7 and 10 after onset of the hemorrhage. To date, there have been no cases that have shown angiographic vasospasm or delayed ischemic neurological deficits. This preliminary study indicates that the intrathecal bolus injection of tPA produces a marked effect on vasospasm.
Computed Tomography of the Postoperative Intervertebral Disc and Lumbar Spinal Canal: Serial Long-Term Investigation in 19 Patients after Successful Operation for Lumbar Disc Herniation
Authors: Heilbronner Raoul , Fankhauser Heinz , Schnyder Pierre , de Tribolet Nicolas
Published: April 2011

The first part of this work, published in 1988, included 25 patients who had computed tomographic (CT) scans without contrast enhancement and plain x-rays of the lumbar spine before, 1 week after, and 6 to 7 weeks after a successful operation for lumbar disc herniation. The present study extends the follow-up period to 3 years in 19 of the 25 original patients. Clinical examinations, lateral plain x-rays, and CT scans without contrast enhancement of the operated disc were repeated. The results indicate a decrease or even a disappearance of the hyperdense extradural material thought to represent fibrosis. An image suggestive of persistent disc herniation was still present in 5 of 8 patients with this finding on early postoperative CT scans. Persistent intradiscal gas was seen in nearly half of the patients. Total normalization of the posterior extraspinal structures was the rule. There was no correlation between CT appearance and residual complaints of the patients. CT scans without contrast enhancement may be sufficient to guide the surgeon in postoperative patients with massive signs and symptoms of recurrent root compression in whom a second operation is indicated on clinical grounds. In all other cases, myelography followed by CT scans is considered appropriate to investigate failed back surgery syndrome. (Neurosurgery 29:1-7, 1991)
Brain Tumors Occurring before 1 Year of Age: A Retrospective Review of 22 Cases in an 11-Year Period (1977-1987)
Authors: Haddad Souheil F. , Menezes Arnold H. , Bell William E. , Godersky John C. , Afifi Adel K. , Bale James F.
Published: April 2011

Congenital brain tumors have been reported infrequently and their management remains ill defined. An 11-year review (1977-1987) of all children with brain tumors with the onset of symptoms before 1 year of age was completed. Twenty-two children with the following histological diagnoses were treated: astrocytoma (7 patients), primitive neuroectodermal tumor (6 patients), papilloma or carcinoma of the choroid plexus (3 patients), malignant teratoma (2 patients), dermoid tumor (2 patients), embryonal rhabdomyosarcoma (1 patient), and chloroma (1 patient). Fifteen tumors were supratentorial in location, and 7 were infratentorial. Initial symptoms were hydrocephalus (32%), focal neurological deficit (23%), asymptomatic increase in head circumference (18%), failure to thrive (14%), and seizures (4.5%). The goal of treatment was a radical excision when possible, with primary chemotherapy in the last 6 years of the review period. Radiation therapy was the adjunct to surgery in the initial 5-year period. All patients with papillomas of the choroid plexus and dermoid lesions underwent a total resection with no recurrence. All 7 astrocytomas were supratentorial, with 6 occurring in the diencephalon. Five of the seven patients with astrocytomas survived more than 5 years. The 6 primitive neuroectodermal tumors were located equally between the supra- and infratentorial spaces. Four of the 6 infants with these tumors received chemotherapy (2 received chemotherapy alone; 2 received chemotherapy and radiation therapy) and are tumor free 2 to 9 years later. A fifth child received radiation therapy alone early in the series and survived only 4 months. The family of the other child refused adjunctive treatment. A radical resection with chemotherapy appears to be the rational approach, keeping additional operations and radiation therapy as options for recurrent disease while avoiding the effects of irradiation on the developing brain.
Sufentanil Citrate and Morphine/Bupivacaine as Alternative Agents in Chronic Epidural Infusions for Intractable Non-Cancer Pain
Authors: Hassenbusch Samuel J. , Stanton-Hicks Michael D. , Soukup James , Covington Edward C. , Boland Mary Beth
Published: April 2011

Intraspinal narcotic (usually intrathecal morphine) infusions with implanted pumps are increasingly used in patients with intractable chronic pain not caused by cancer. In some patients, pain control is difficult with infusions of morphine. Seven patients with diagnoses of arachnoiditis, epidural scarring, and/or vertebral body compression fracture were treated with alternative solutions in an epidural route. For maximal flexibility, Medtronic implanted programmable infusion pumps with catheters to T6-T10 were used, and pain was monitored by verbal pain scales. In three patients, epidural infusions of morphine in 0.5% bupivacaine (MS-MARC) resulted in little or no pain relief without significant side effects (e.g., headache, nausea, or vomiting). In these same patients, epidural infusions of sufentanil citrate resulted in pain scale reductions of 92%, 82%, and 40%, respectively, with no side effects. Four other patients found more effective pain relief when switched from initial sufentanil citrate infusions to MS-MARC. Pain scale reductions (with no side effects) were 92%, 76%, 59%, and 47% in these patients. Pain relief and minimal side effects with sufentanil citrate is theorized to result from its higher lipophilicity promoting local transdural diffusion to spinal cord and limiting upward diffusion to the brain stem. Sufentanil citrate is also advantageous for programmable pumps because it is 100 times more potent than morphine and therefore allows longer pump refill times and higher infusion doses. Although this study was done on a limited number of patients, sufentanil citrate and MS-MARC in epidural infusions using programmable infusion pumps for non-cancer patients provide significant alternative drug combinations and routes. (Neurosurgery 29:76-82, 1991)
Cervicocranial Arterial Dissection
Authors: Anson John , Crowell Robert M.
Published: April 2011

Dissection of the cervicocranial arteries is becoming more frequently recognized as a cause of neurological disorders. Typical clinical features seen with dissection include unilateral headache, oculosympathetic palsy, amaurosis fugax, and symptoms of focal brain ischemia. The diagnosis of carotid or intracranial dissection is usually best confirmed by angiography, although magnetic resonance imaging and computed tomography have been shown to visualize intimal dissection. The prognosis in cases of spontaneous dissection is generally benign unless the initial manifestation involves infarction with substantial deficit. The best approach to treatment appears to be the administration of the anticoagulant, heparin, followed by warfarin or antiplatelet therapy. Surgical intervention is reserved for cases of progressive or recurrent ischemic complication that occurs despite the administration of adequate doses of anticoagulants. (Neurosurgery 29:89-96, 1991)
Deafness after Bilateral Midbrain Contusion: A Correlation of Magnetic Resonance Imaging with Auditory Brain Stem Evoked Responses
Authors: Jani Niranjan N. , Laureno Robert , Mark Alexander S. , Brewer Carmen C.
Published: April 2011

A 46-year-old woman became deaf after a closed head injury. When a computed tomographic scan failed to disclose the cause, conversion disorder was suspected. Magnetic resonance imaging, however, showed bilateral contusions of the inferior colliculi, providing objective evidence for an organic cause of hearing loss. Auditory brain stem evoked responses and stapedial reflexes also provided objective evidence of brain stem injury. This case illustrates the phenomenon of dorsal midbrain injury after head trauma. It indicates the sensitivity of magnetic resonance imaging for small focal lesions after head trauma, and it demonstrates some difficulties in the diagnosis of “hysterical” deafness. (Neurosurgery 29:106-109, 1991)
Meningioma: The Role of a Foreign Body and Irradiation in Tumor Formation
Authors: Saleh Jamshid , Silberstein Howard J. , Salner Andrew L. , Uphoff Dean F.
Published: April 2011

A case of meningioma is reported. At the age of 18 years, the patient had undergone insertion of a Torkildsen shunt through a posteroparietal burr hole for obstructive hydrocephalus secondary to a tumor of the pineal region, of which no biopsy had been made. After the hydrocephalus was relieved, he underwent irradiation of the tumor. Thirty years later, he was treated for an intracranial meningioma wrapped around the shunt. The tumor followed the shunt in all of its intracranial course. Microscopy disclosed pieces of the shunt tube within the meningioma. The role of a foreign body and irradiation in the induction of meningiomas is discussed, and a comprehensive review of the literature is presented. (Neurosurgery 29:113-119, 1991)
Anterior Decompression in Cervical Spine Trauma: Does the Timing of Surgery Affect the Outcome?
Authors: Levi Lion , Wolf Aizik , Rigamonti Daniele , Ragheb John , Mirvis Stuart , Robinson Walker L.
Published: April 2011

To clarify the ideal timing of anterior decompression and stabilization for all patients with cervical spine trauma as well as its efficacy for patients with complete deficits, we reviewed the records of 103 consecutive patients with cervical spine trauma (50 incomplete deficits, Group A; 53 complete deficits, Group B) who underwent this procedure during a 5-year period at the Shock Trauma Center. We subdivided each group according to time of surgery: early and delayed (<24 and >24 hours past injury, respectively). In Group A, 10 patients underwent early surgery and 40 patients underwent delayed surgery (range, 2 to 77 days past injury; mean, 13 days). One patient (2.5%) in the delayed group died. The following data refer to the early and delayed subgroups, respectively: average acute hospitalization, 20 and 22 days; patient motor score improvement (at discharge), 37.2 and 45.0%; functional grade improvement (at discharge), 5 (50.0%) and 9 (22.5%) patients. At 1-year follow-up, every patient who had had a deficit had progressed to a higher functional grade. In Group B, 35 patients underwent early surgery and 18 underwent delayed surgery (range, 2 to 45 days past injury; mean, 13 days). One patient (2.9%) in the early group died. The following data refer to the early and delayed subgroups, respectively: average acute hospitalization, 38.7 and 45.2 days (P < 0.05); respiratory care (number of daily suction procedures), 6.0 and 9.86 (P < 0.05); patient motor score improvement (at discharge), 3.9 and 4.5%; functional grade improvement (at discharge), 4 (11.4%) and 1 (5.6%) patients. At 1-year follow-up, 16 (45.7%) and 7 (38.9%) patients, respectively, had progressed to a higher functional grade (mean motor score improvement, 15.0 and 16.7%, respectively). Only 5 patients (14.3%) did not gain the function of at lease one more segment. Although our study demonstrated no statistically significant difference in outcome between early surgery and delayed surgery subgroups, we feel early anterior decompression and stabilization is appropriate for selected patients because this process has a comparable adverse sequelae rate to that of delayed surgery; it provides superior ease of patient care, it facilitates earlier transfer to rehabilitation (an important parameter in decreasing medical expenses), and it may benefit even patients with complete deficits diagnosed on the first day.
Reversal of a Dense, Persistent, Holohemispheric Neurological Deficit after an Endarterectomy of the Carotid Artery: Case Report
Authors: McKenzie Rickey L. , Awad Issam A. , Sila Cathy A.
Published: April 2011

The role and timing of a carotid endarterectomy in the setting of an acute ischemic stroke-in-evolution remain controversial. Although computed tomographic (CT) scans typically show no abnormalities in the acute stage, it is generally agreed that a dense neurological deficit (hemiplegia) and/or multiple modality neurological disturbance (involving motor, sensory, gaze, and visual field impairment) represent contraindications to surgical intervention. We present a case of an acute right holohemispheric neurological deficit including dense hemiplegia, hemisensory loss, gaze disturbance, hemineglect, and impaired level of consciousness. This persisted for 4 days while serial CT scans showed no evidence of infarction. Angiography revealed pre-occlusive stenosis of the right internal carotid artery with sluggish antegrade flow. The anterior collaterals of the circle of Willis were impaired, and the right middle cerebral artery territory filled via the posterior communicating artery. Despite the dense neurological deficit persisting for 4 days, a carotid endarterectomy was performed. Gradual neurological improvement was noted within hours of the operation, and all neurological deficits resolved within the subsequent 3 days. This case is consistent with prolonged holohemispheric hemodynamic compromise below the threshold of neurological dysfunction, but above the threshold of tissue infarction (“idling neurons”). Features assisting in the recognition of this unusual scenario and the indications and risks of revascularization in this setting are discussed.
Hemorrhagic Venous Infarction after Excision of an Arteriovenous Malformation: Case Report
Authors: Miyasaka Yoshio , Yada Kenzoh , Ohwada Takashi , Kurata Akira , Tokiwa Kaiti , Suwa Tomoya , Yamada Masaru , Oka Hidehiro
Published: April 2011

A case of arteriovenous malformation (AVM) in which postoperative hemorrhagic infarction developed, probably because of occlusion of the former draining veins, is reported. The hemorrhage developed in the temporal lobe 3 days after the initial operation and was located in the immediate vicinity of the site of the AVM. The following findings suggest that the postsurgical hemorrhage probably resulted from a venous thrombosis: 1) no evidence of residual AVM; 2) delayed onset of the hemorrhage, inconsistent with the time course of a hemorrhage developing according to the breakthrough theory or with insufficient hemostasis with a high-pressure afterload; 3) good correlation between the location of the hemorrhage and the occlusion of the draining veins; and 4) multifocal hemorrhage affecting both the gray matter and the subcortical white matter. Postoperative hemorrhagic infarction caused by thrombosis in the draining veins is rare, but it should be considered as a distinct postoperative complication after removal of an AVM.
Sarcoidosis Presenting as an Isolated Intramedullary Tumor
Authors: Levivier Marc , Brotchi Jacques , Balériaux Danielle , Pirotte Benoit , Flament-Durand Jacqueline
Published: April 2011

We report a case of isolated intramedullary sarcoidosis. The patient developed progressive signs that indicated a spinal tumor, which were investigated with contrast-enhanced magnetic resonance imaging scans. Magnetic resonance imaging clearly revealed an intramedullary lesion, but the diagnosis of sarcoidosis was made on the pathological analysis of the surgical specimen. Magnetic resonance imaging with contrast enhancement is reported in a histologically proven case of intramedullary sarcoidosis. Only 12 other cases of isolated intramedullary sarcoidosis have been reported. We review and discuss these cases according to their clinical presentation, the segmental location of the granulomas in the spinal cord, preoperative and operative diagnoses, and signs for systemic sarcoidosis. In none of the cases was the diagnosis of intramedullary sarcoidosis made before surgery. We think that surgical therapy for intramedullary lesions is the best way to diagnose rare instances of benign lesions like sarcoidosis and to treat them in an appropriate manner.
Prominent Meningeal “Tail Sign” in a Patient with a Metastatic Tumor
Authors: Senegor Moris
Published: April 2011

A prominent enhancement of the dura adjacent to meningiomas has been described as being pathognomonic of these tumors. We describe a case where a classic meningeal “tail sign” was associated with an extra-axial metastatic tumor attached to the tentorium. There was no tumor invasion of the dura. We conclude that this sign is nonspecific and can be seen with dural-based tumors other than meningiomas.
Posterior Fossa Epithelial Cyst of Ectodermal Origin
Authors: Fleming Hilari , Murayama Shiego , Dacey Ralph G.
Published: April 2011

The case of a large ventral cyst of the posterior fossa of probable ectodermal origin in a 33-year-old patient is presented. Intracranial epithelial cysts are rare, and their histogenesis is a subject of controversy. Previous reports have hypothesized either a neuroepithelial or endodermal origin for the majority of these cysts. This case is unusual because it is the first case, to our knowledge, where melanocytes and melanin have been demonstrated within the cyst wall. These findings suggest an ectodermal origin for this cyst.
Spinal Invasion of Pulmonary Hydatidosis: Computed Tomographic Demonstration
Authors: Iplikçioğlu Celal A. , Kökes Fatih , Bayar Akif , Doğanay Saffet , Buharali Zeki
Published: April 2011

A case of pulmonary hydatidosis in which cysts caused spinal cord compression is presented. To our knowledge, spinal invasion after pulmonary hydatidosis has not been demonstrated previously.
Intradural Cervical Lipoma in a Neurologically Intact Patient: Case Report
Authors: Heary Robert F. , Bhandari Yashwant
Published: April 2011

The authors report an unusual intradural subpial lipoma of the cervical spinal cord in a neurologically intact adolescent. The patient sought treatment for neck pain and had a history of previous trauma. Magnetic resonance imaging revealed the lesion. There are no reported cases of a subpial lipoma detected in the absence of any neurological deficits. A subtotal excision was performed, and pathological studies confirmed the diagnosis. Postoperatively, the patient remained neurologically intact.