bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical evaluation of intravenous nitroglycerin for neurosurgery
Authors: Chestnut Julian S. , Albin Maurice S. , Gonzalez-Abola Evelyn , Newfield Philippa , Maroon Joseph C.
Published: May 2009

✓ Moment-to-moment control of blood pressure is important in the management of the neurosurgical patient. The ideal agent to control blood pressure or induce hypotension should be non-toxic, maintain cerebrovascular autoregulation, and not alter cardiac output or change intracranial pressure. Intravenous nitroglycerin has been used to control blood pressure in 54 neurosurgical cases. This agent produces a rapid, controllable, but not precipitous fall in blood pressure without rebound, is non-toxic, may not alter cerebrovascular autoregulation, and does not raise intracranial pressure. Our clinical experience with intravenous nitroglycerin indicates that it has an important role as a hypotensive agent for the neurosurgical patient.
Value of cerebrospinal fluid cytology for the diagnosis of malignancies in the central nervous system
Authors: Balhuizen J. Chris , Bots Gerard Th. A. M. , Schaberg Aart , Bosman Fré T.
Published: May 2009

✓ The authors present a retrospective analysis of the results of the cytological examinations of cerebrospinal fluid (CSF) samples and tumor-cyst aspirates deriving from 262 patients treated for malignant intracranial primary and secondary tumors, and vertebral and peridural metastastic processes. Positive preoperative CSF samples were found in 15.3% of all cases of primary cerebral malignancies (13.9% of all gliomas) and positive postoperative CSF samples were found in 40% (91% of the medulloblastoma cases). In all cases of single or multiple secondary cerebral tumors, positive preoperative CSF samples were found in 20%.
Clearance of edema fluid into cerebrospinal fluid
Authors: Reulen Hans J. , Tsuyumu Matsutaira , Tack Anne , Fenske Andreas R. , Prioleau George R.
Published: May 2009

✓ The authors present the results of an investigation studying the resolution of vasogenic brain edema using cold injury in cats. The appearance of RISA-I131 and sucrose-C14 labeled edema fluid in the ventricular cerebrospinal fluid (CSF) was assessed by means of ventriculocisternal perfusion. The effect of low- or high-pressure perfusion on edema spread was determined by measuring the water, sodium, RISA-I131, and sucrose-C14 content of serial tissue blocks taken from the injured cortex through the white matter to the ventricular ependyma. The findings indicate that increasing the hydrostatic pressure gradient between edematous brain and CSF enhances the clearance of edema fluid into the ventricular CSF. This was conclusively demonstrated with low-pressure ventricular perfusion which markedly diminished the amount of edema close to the ventricles compared to the controls. The concentration of albumin, sodium, and potassium in the fluid removed from the tissue during low-pressure perfusion indicates that bulk flow was the primary method of edema movement through the extracellular space. With high-pressure perfusion the concentration profiles suggested alternative mechanisms of edema resolution, such as diffusion and reabsorption into capillaries.
Spectrum of complications in the use of intrathecal fluorescein
Authors: Moseley John I. , Carton Charles A. , Stern W. Eugene
Published: May 2009

✓ The authors describe a case in which 0.5 cc of 5% fluorescein diluted in 10 cc of cerebrospinal fluid (CSF) was injected at the L4–5 level for evaluation of nasal CSF leakage. Within minutes, tone increased in lower extremities accompanied by knee and ankle clonus and subjective numbness up to the waist. Non-preserved saline irrigation of the lumbar CSF was administered until it became clear, and the patient's head was elevated to retard the developing symptomatology. Although a transient temperature elevation was observed with negative CSF cultures, all signs and symptoms cleared within 48 hours. In a survey of the members of the American Association of Neurological Surgeons regarding frequency of use and complications stemming from intrathecal fluorescein, the response rate was 58.3% (1111) of the 1907 members, of which 6.8% (76) had used intrathecal fluorescein, and among those, 25% (19 of the 76) had observed complications involving lower extremity weakness, numbness, generalized seizure activity, opisthotonos, and cranial nerve deficit. No complications were permanent. The authors recommend caution if intrathecal fluorescein must be used. Means should be available to clear the CSF of the agent and elevate the head if complications arise.
A surgical approach through the pedicle to protruded thoracic discs
Authors: Patterson Russel H. , Arbit Ehud
Published: May 2009

✓ Three cases of thoracic disc herniation presenting with signs of spinal cord compression are reported. The patients were operated on by an approach through a midline incision in which a pedicle is removed. Two patients were cured and one has improved.
Re-evaluation of differential sacral rhizotomy for neurological bladder disease
Authors: Rockswold Gaylan L. , Chou Shelley N. , Bradley William E.
Published: May 2009

✓ The authors describe long-term follow-up results (4 to 6 years) in 13 patients who underwent differential sacral rhizotomy for urgency incontinence. Six patients were originally presented in a preliminary report in 1973. In the last seven patients, a highly selective rhizotomy of sacral fascicles innervating only the urinary bladder was performed. Results in the original six patients appear to be superior to those in patients who underwent a more refined rhizotomy. Possible explanations for this as well as alternative approaches to the treatment of urgency incontinence are briefly discussed.
Cerebellar stimulation in man
Authors: Penn Richard D. , Gottlieb Gerald L. , Agarwal Gyan C.
Published: May 2009

✓ The effects of chronic anterior lobe cerebellar stimulation on patients with cerebral palsy have been investigated using a new method of quantifying muscle rigidity and stretch reflexes. The ankle is oscillated sinusoidally, compliance is measured at several frequencies, and electromyographic activity of the extensor and flexor muscles is recorded. In some patients stimulation can reduce rigidity and coactivation of muscles immediately or slowly over days or months. In others no change is found.
Holoprosencephaly in neurosurgical practice
Authors: Osaka Kunihiko , Matsumoto Satoshi
Published: May 2009

✓ The clinical, angiographic, and pneumoencephalographic features of seven cases with holoprosencephaly are reported. Three of the alobar type in this series revealed the facial dysmorphia characteristic of the anomaly. In the other four cases (one alobar, one semilobar, and two lobar), such facial anomaly was absent, and the diagnosis was achieved only after contrast studies.

An azygous anterior cerebral artery running over the cerebral surface due to a defective interhemispheric fissure is pathognomonic for alobar and semilobar holoprosencephaly. Dysgenesis of the deep venous system was found in alobar, semilobar, and lobar holoprosencephaly, a finding helpful in diagnosis, especially of the lobar type. Air study and computerized tomography scan revealed incomplete separation of the ventricular system. The basic nature of holoprosencephalization and its differentiation from non-holoprosencephalic malformation are discussed. Six of the seven patients reported had hydrocephalus.
Fracture of the anterior superior iliac spine following anterior cervical fusion using iliac crest
Authors: Reynolds Arden F. , Turner Paul T. , Loeser John D.
Published: May 2009

✓ A case is presented in which fracture of the right anterior superior iliac spine occurred 2 weeks after the right iliac crest had been used as the donor site for a two-level anterior discectomy and fusion.
Epidermoid cyst in the brain stem
Authors: Leal Oscar , Miles John
Published: May 2009

✓ A patient is reported with an epidermoid cyst of the brain stem, presenting as a progressive brain-stem mass, together with recurrent aseptic meningitis.
Vertebral and epidural hemangioma with paraplegia in Klippel-Trenaunay-Weber syndrome
Authors: Gourie-Devi M. , Prakash Brahm
Published: May 2009

✓ A patient with a rare case of Klippel-Trenaunay-Weber syndrome presented with paraplegia due to compression by a vertebral and epidural cavernous hemangioma. The metameric distribution of the large cutaneous vascular nevus provided the clinical clue to the nature of the spinal lesion. The association of the two lesions is explained on the basis of developmental anomaly.
Meningeal melanocytoma with invasion of the thoracic spinal cord
Authors: Steinberg Joel M. , Gillespie John J. , MacKay Bruce , Benjamin Robert S. , Leavens Milam E.
Published: May 2009

✓ A case is presented of meningeal melanocytoma that invaded the thoracic spinal cord of a 71-year-old woman. The light and electron microscopic features of the lesion indicate that it derives from melanocytes normally found in the leptomeninges. This tumor closely resembles the dermal cellular blue nevus and does not have the ultrastructure of a meningioma. “Melanotic meningioma” is consequently a misnomer and the name “meningeal melanocytoma” is more appropriate. These tumors may appear to be benign histologically, but they are locally aggressive. Total surgical excision offers the best chance for cure.
Lacertus fibrosus compression of the median nerve
Authors: Laha Ranjit K. , Lunsford L. Dade , Dujovny Manuel
Published: May 2009

✓ A 47-year-old guitar player presented with inability to use his right hand because of progressive weakness and numbness. Examination suggested compression neuropathy of the median nerve at the elbow. Exploration of the median nerve revealed compression by a tight aponeurosis of the biceps tendon. Release resulted in prompt recovery of function.
Effects on speech of chronic cerebellar stimulation in cerebral palsy
Authors: Ratusnik David L. , Wolfe Virginia I. , Penn Richard D. , Schewitz Sheila
Published: May 2009

✓ Chronic cerebellar stimulation of the anterior lobe is undertaken for relief of motor dysfunction in cerebral palsy, but the effect on speech and vocal ability has been uncertain. The present study evaluated speech before cerebellar stimulation and during the immediate postoperative period in seven severely spastic/athetoid patients with congenital cerebral palsy and one patient with traumatic brain damage. Structured listening tasks were completed in blind fashion by a trained panel of speech pathologists. Group analysis revealed no significant improvement in speech intelligibility or articulatory accuracy after stimulation. With the exception of strain/strangle vocal quality, which improved considerably, vocal characteristics were not affected by cerebellar stimulation. In three of eight patients, however, improvement in certain speech characteristics was noted.
Direct administration of methotrexate into the central nervous system of primates
Authors: Kimelberg Harold K. , Kung David , Watson Robert E. , Reiss Frederick L. , Biddlecome Sandra M. , Bourke Robert S.
Published: May 2009

✓ Levels of methotrexate (MTX) measured by both 3H radioactivity and dihydrofolate reductase assays were determined in cerebrospinal fluid (CSF), plasma, urine, and both neural and non-neural tissues at varying times after a single intraventricular injection into Cynomolgus monkeys (Macaca fascicularis). Clearance of the MTX from CSF was rapid after injection. A relatively constant level of 3HMTX was reached in plasma 2½ hours after injection, and about 30% of the 3HMTX dose was excreted in the urine within 4 hours after injection. Maximum levels in CNS tissues were obtained by 4 hours after injection, and average concentrations of 10−6M MTX (moles/kg wet weight) were maintained in CSF for up to 12 hours and in brain for up to 24 hours after injection. Conversion of MTX to non-MTX products was detected in CSF between 4 and 12 hours, and in brain tissue between 12 and 24 hours after injection, and the amount of these products increased with time. Regional distribution studies in the cerebrum showed a U-shaped distribution curve for 3HMTX up to 12 hours after injection, which closely followed the 14C inulin distribution. Thus, the levels in deep cerebral tissue were less than the average level for brain, and this suggests that treatment of CNS tumors by intraventricular injection may have variable results, partly due to complex tissue distribution patterns.
Direct administration of methotrexate into the central nervous system of primates
Authors: Yen John , Reiss Frederick L. , Kimelberg Harold K. , Bourke Robert S.
Published: May 2009

✓ The kinetics of distribution of 3H methotrexate (3HMTX) in the central nervous system, plasma, and urine after intraventricular, lumbar percutaneous puncture, and spinal catheter injections were compared. Levels of 3HMTX in whole brain after lumbar percutaneous injection were 40 times less than after intraventricular injection. Injection of 3HMTX via a spinal catheter increased the level of 3HMTX in whole brain but this was still tenfold less than after direct intraventricular instillation. Also, it was found that a disproportionately high amount of 3HMTX was in the brain-stem-cerebellum region which would further reduce the concentration of methotrexate in the cerebral hemispheres. Both intraventricular and lumbar spinal catheter administration of 3HMTX produced 3HMTX levels greater than 10−6M (moles/kg wet weight) in spinal cord tissue as measured by 3H specific activity between 2 to 8 hours after injection. Administration by lumbar percutaneous puncture, however, rarely resulted in this suggested therapeutic level of 10−6M. Initial 3HMTX levels in plasma after lumbar percutaneous instillation was 24 times greater than after intraventricular or lumbar spinal catheter injections. This indicated significant and unavoidable extradural leakage after lumbar percutaneous puncture, which may account for the substantially lower levels of 3HMTX in the brain and spinal cord tissue. It is concluded that intraventricular instillation of methotrexate is the best route of administering the drug to achieve therapeutic levels of methotrexate in both whole brain and throughout the spinal cord.
Occipital to posterior inferior cerebellar artery bypass surgery
Authors: Sundt Thoralf M. , Piepgras David G.
Published: May 2009

✓ The results, complications, and technical aspects of occipital to posterior inferior cerebellar artery (PICA) bypass surgery are reviewed. Patients were divided into two groups: those considered to be a high risk for posterior circulation infarct but not disabled by the symptoms or deficits (eight patients), and those moderately or severely disabled at the time of admission (eight patients). Postoperative angiography revealed that 15 of the 16 grafts were patent. In 10 of the 15 patent grafts, the bypass graft served as a sole or major blood supply of the vertebral basilar system; in five patients, flow was limited to the distribution of the PICA. Eight patients achieved full employment or normal activity, six were improved but did not return to full employment, and two patients were unchanged. Ataxia was the major residual deficit in these patients.
Evaluation of the central canal of the spinal cord in experimentally induced hydrocephalus
Authors: James A. Everette , Flor William J. , Novak Gary R. , Strecker Ernst-Peter , Burns Barry
Published: May 2009

✓ The central canal of the spinal cord has been proposed as a significant compensatory alternative pathway of cerebrospinal fluid (CSF) flow in hydrocephalus. Ten dogs were made hydrocephalic by a relatively atraumatic experimental model that simulates the human circumstance of chronic communicating hydrocephalus. The central canal was studied by histopathology and compared with 10 normal control dogs. In both groups the central canal of the spinal cord was normal in size, configuration, and histological appearance. In this experimental model dilatation of the canal and increased movement of CSF does not appear to be a compensatory alternative pathway.
Origin of somatosensory evoked responses recorded from the cervical skin surface
Authors: Shimoji Koki , Shimizu Hiroyuki , Maruyama Yoichi
Published: May 2009

✓ Somatosensory evoked response from the cervical skin surface over the spine (the cervical SER) was recorded, and compared with the cord dorsum potential (CDP) simultaneously recorded from the posterior epidural space at the same segment. The cervical SER evoked by segmental nerve stimulation consisted of an initially positive spike (P1), the peak latency being the same as that of the P1 of the CDP, followed by a smaller negative wave with two peaks. The latency of the second peak of the negative wave (N1) coincided with that of the N1 of the CDP. Subsequent to this negative wave, a slow positive wave (P2) with peak latency similar to that of the P2 of the CDP, could be noticed in some subjects. The cervical SER could not be evoked even by strong stimulation of the cauda equina. Thus, the cervical SER might reflect a segmental phenomenon rather than the conducted potential along the cord, and originate from the spinal root and cord in the same way as the segmentally evoked CDP.
The histopathology of experimental spinal cord trauma
Authors: Rawe Stephen E. , Lee William A. , Perot Phanor L.
Published: May 2009

✓ The early sequential histopathological alterations following a concussive paraplegic injury to the posterior thoracic spinal cord in cats were studied. The lack of significant progression of hemorrhages over a 4-hour period after injury indicates that most hemorrhages probably occur within the first hour. The marked enhancement or retardation of hemorrhages in the post-injury period, when the blood pressure was increased or decreased, respectively, demonstrates the loss of autoregulation of spinal cord vasculature at the trauma site after a concussive paraplegic injury. Progressive edema formation was evident over a 4-hour period following injury, and it could be enhanced or retarded by elevation or reduction of the systemic blood pressure.
Localization of fibrinolytic activity and inhibition of plasmin in the spinal cord of rat, guinea pig, and rabbit
Authors: Smokovitis Athanasios , Astrup Tage
Published: May 2009

✓ Fibrinolytic activity (caused by a plasminogen activator) in the spinal cord was highest in the rat, lowest in the rabbit, and intermediate in the guinea pig. In all species the activity was highest in relation to the pia mater. The central spinal canal was active in the rat and the rabbit, but mostly inactive in the guinea pig. Foci of activity were more numerous in the gray matter than in the white matter corresponding to the greater vascularity of the former. In all species ability to inhibit plasmin was related mainly to the gray matter, with an additional area related to the dura mater. The high fibrinolytic activity of the spinal leptomeninges may play a role in the pathogenesis of hemorrhagic processes related to the spinal cord.
Complications following intraspinal injections of steroids
Authors: Dougherty John H. , Fraser Richard A. R.
Published: May 2009

✓ Intraspinal steroids have been recommended for the treatment of sciatica and various other conditions. The procedure is controversial; moreover, evidence suggests that the steroid hormones can be delivered to the site of inflammation more easily by systemic administration. Serious complications that have arisen from the procedure are reviewed. The courses of two women who received intraspinal steroids for the treatment of sciatica and who developed severe meningitis as a consequence are reported. It is suggested that the value of intraspinal steroids in the treatment of disc-related sciatica is unproven and if they are used, one must be alert to the complications.
Moyamoya syndrome as a complication of radiation therapy
Authors: Servo Antti , Puranen Matti
Published: May 2009

✓ A case is reported with occlusion and stenosis of the internal carotid arteries in association with basal telangiectasia. Fifteen years after postoperative irradiation for an optic glioma, radiological signs typical of the moyamoya syndrome were observed. Radiation therapy is discussed as the cause of the vascular damage in this case.
Preoperative diagnosis of a ruptured intracranial dermoid cyst by computerized tomography
Authors: Amendola Marco A. , Garfinkle William B. , Ostrum Bernard J. , Katz M. Richard , Katz Richard I.
Published: May 2009

✓ A case of ruptured intracranial dermoid cyst in the right middle fossa is reported. A definitive diagnosis of the lesion and the fact that it had ruptured was made possible by specific computerized tomographic findings. The findings were confirmed at surgery.
A new combined neurosurgical headholder and cassette changer for intraoperative serial angiography
Authors: Parkinson Dwight , Legal Jules , Holloway Arthur F. , Walton Richard J. , Lafrance Robert R. , MacEwan Douglas W. , Johnson Jane
Published: May 2009

✓ A new apparatus that can provide immediate intraoperative x-ray study or serial angiography is described.
Continuous suturing for microvascular anastomosis
Authors: Little John R. , Salerno Tomas A.
Published: May 2009

✓ A continuous suture technique for the microsurgical end-to-side anastomosis of extracranial to intracranial arteries is described. This method combines the speed and even tension of a continuous suture line with improved visualization of the arteries to be anastomosed.
Occlusive arteriopathy and brain tumor
Authors: Mori Koreaki , Takeuchi Fuji , Ishikawa Masatsune , Handa Hajime , Toyama Mitsuo , Yamaki Tarumi
Published: May 2009

✓ Four cases with the association of occlusive arteriopathy and brain tumor are presented. A clinical analysis of these cases and cases reported in the literature revealed that occlusive arteriopathy at the base of the brain was often associated with a slowly growing basal tumor in children. Possible causes of occlusive arteriopathy in these cases were compression of the circle of Willis by a slowly growing basal tumor, secondary arterial occlusive changes by radiation therapy for a basal tumor, or vasculopathy associated with neurocutaneous syndrome. Symptoms of sudden onset or episodic nature suggest the presence of occlusive arteriopathy rather than the mass effect of a tumor. Cerebral angiography is mandatory whenever computerized tomography (CT), performed to rule out recurrence of a basal tumor, shows an ischemic lesion with low-density areas without any evidence of mass effect of the tumor. Cerebral angiography is also necessary when a basal tumor is suspected in children, particularly in cases associated with neurocutaneous syndrome and a basal tumor. Care should be taken not to scarify the abnormal vascular network at the base of the brain at the time of operation, because it is considered to be functioning as collateral circulation. The potential hazards of radiotherapy to radiation-induced occlusive changes of the circle of Willis must be considered in treating a benign basal brain tumor in children. Even in adults, repeated large doses of irradiation could cause occlusive arteriopathy.
Functional treatment of acromegaly by transsphenoidal microsurgery
Authors: García-Uría José , del Pozo Jose M. , Bravo Gonzalo
Published: May 2009

✓ The authors have analyzed the results from 41 acromegalic patients who underwent transsphenoidal surgery. In 31 patients, postoperative growth hormone (GH) levels fell and remained below 10 ng/ml. This represents an endocrinological “cure” of 78%. In the remaining 10 cases, postoperative GH values have not stabilized below 10 ng/ml, although seven show some clinical improvement. The results were particularly good in those cases of localized adenomas, which allowed a selective removal while maintaining pituitary function within normal limits in 65.5% of cases. The postoperative GH level in this group fell and remained below 10 ng/ml in more than 90% of cases.

Four patients required reoperation to normalize the GH levels which had not been sufficiently modified after the first operation; only one of them remained with plasma GH levels above normal limits. There were no deaths in this series. Rhinorrhea occurred as a postsurgical complication in four cases. In three this disappeared with bed rest and lumbar drainage; in the other, surgical repair was necessary. The occurrence of surgical complications has decreased as our experience has increased, and the need for reoperation has been unusual after the first year of our study.
Suprasellar germinoma
Authors: Takeuchi Juji , Handa Hajime , Nagata Izumi
Published: May 2009

✓ The clinical features of 18 cases of suprasellar germinoma were reviewed, and the following points stressed: 1) The incidence of intracranial germinoma and teratoma seems to be much higher in Japan than elsewhere. 2) Germinomas in the pineal region, the third ventricle, and the lateral ventricle were observed to be predominant in males. In suprasellar germinoma, however, males were not affected predominantly and the male:female ratio was 1:1. 3) Suprasellar germinomas caused three symptoms: diabetes insipidus, visual disturbances, and pituitary dysfunctions. 4) Pituitary functions were disturbed to various degrees. Some cases showed hypopituitarism but some showed an elevation of plasma concentrations of cortisol or luteinizing hormone and follicle stimulating hormone. 5) Some abnormalities showing a suprasellar mass were usually found on neuroradiological examination. 6) Suprasellar germinomas were very sensitive to radiotherapy and some of them rapidly disappeared on follow-up computerized tomography scanning after irradiation with as little as 1200 rads.
Carotid-cavernous fistula
Authors: Barnes Barbara D. , Rosenblum Mark L. , Pitts Lawrence H. , Winestock David P. , Parker Howard , Nohr Mary Lou
Published: May 2009

✓ Abnormal distribution of cerebral vascular flow was studied in a patient who had a traumatic carotid-cavernous sinus fistula. Serial studies were performed using a method for determining relative cerebral vascular flow: 99mtechnetium-diethylenetriamine pentaacetic acid (99mTc-DTPA) was injected intravenously and flow data were processed by a digital computer. Serial studies documented the occurrence of a vascular “steal” during temporary carotid occlusion; postoperative studies showed disappearance of the steal and obliteration of the fistula. This method for performing vascular flow studies may have broad applications in detailing arterial structures and capillary filling in the brain, and in demonstrating alterations in the cerebral circulation.
Interhemispheric steal
Authors: Tulleken Cornelis A. F. , van Dieren Andries
Published: May 2009

✓ In 21 cats the pressure in the occluded middle cerebral artery (MCA) was recorded by way of a catheter, introduced in the most proximal portion of this artery by way of the transorbital approach. The effect of temporary occlusion of the ipsilateral and contralateral common carotid artery on the pressure in the occluded MCA was studied. The results seem to prove the existence of the so-called “interhemispheric steal” syndrome.
Effect on the Cushing response of different rates of expansion of a supratentorial mass
Authors: Zidan Abdul Hamid , Girvin John P.
Published: May 2009

✓ The effects on the three components (respiration, blood pressure, and heart rate) of the Cushing response (CR) were studied in cats by the continuous expansion of a supratentorial balloon. The rate of expansion was varied over the range of 0.006 to 0.6 ml/min, during which systemic arterial pressure, heart rate, respiratory rate, and blood gases were monitored. For the different rates the time the CR took to develop, and the balloon volume required for that development were measured. The final volume (“critical volume”) for eliciting the CR was more or less constant over the full range of rates of infusion (balloon expansion), a fact that supports the Monro-Kellie doctrine. This constancy of critical volume (CCV) gives rise to a highly statistically significant relationship between the rate of infusion and the latency to the production of the CR, and it is described by a power curve. Thus the development of cerebral dysfunction under these experimental conditions is independent of the rate of expansion and only dependent upon this critical volume. Exceptions to this concept of a critical volume, at the extreme of rates of expansion of lesions in patients, are predicted.
Cerebral mycotic aneurysm of fungal origin
Authors: Ahuja Gulshan K. , Jain Neeraj , Vijayaraghavan Malini , Roy Subimal
Published: May 2009

✓ A young man who had a long history of sinusitis developed subarachnoid hemorrhage and died. Autopsy showed a mycotic aneurysm of fungal origin at the junction of the right posterior cerebral and internal carotid arteries. Four of five reported cases of fungal aneurysm were due to Aspergillus infection.
Malignant transformation in benign cerebellar astrocytoma
Authors: Kleinman George M. , Schoene William C. , Walshe Thomas M. , Richardson Edward P.
Published: May 2009

✓ The authors give follow-up information on Case 59 of Cushing's 1931 series of cerebellar astrocytomas. The patient died with a malignant cerebellar astrocytoma 48 years after partial removal of a previously benign astrocytoma at the same site. Including the present one, there have been only five reported cases in which this has occurred. Ordinarily, juvenile pilocytic astrocytomas are of extremely benign character, and it is well established that even with incomplete resections patients have survived for years without progression of the tumor. Not all of the cases so reported can be wholly accepted as representing malignant transformation of the tumor, but may instead be instances of recurrence of an inherently benign glioma since the presence of features such as endothelial hyperplasia or nuclear atypicality in a juvenile pilocytic astrocytoma does not warrant its being classified as malignant. Features truly suggestive of malignancy are hypercellularity, frequent mitoses, necrosis, and, in some instances, a diffusely infiltrative growth pattern; all of these features were found in the present case.
Traumatic cerebrospinal fluid fistula simulating tears
Authors: Joshi Kiran K. , Crockard H. Alan
Published: May 2009

✓ A young child developed delayed cerebrospinal fluid (CSF) rhinorrhea and CSF leak from the eye presenting as tears. The “tears” were CSF which had tracked from the cribriform plate through the ethmoidal air sinuses to the medial aspect of the left orbit. There was marked chemosis and it was considered likely that the tears had leaked through damaged conjunctiva.
Unilateral septal technique for transsphenoidal microsurgical approach to the sella turcica
Authors: Tindall George T. , Collins William F. , Kirchner John A.
Published: May 2009

✓ A modification of the transseptal, transsphenoidal approach to the sella turcica is described; it consists of a unilateral separation of the nasal mucosa from the nasal septum. Experience with the technique in 215 cases has indicated that it is a useful, practical approach. The advantages are that the septum is spared, reoperation is made easier, and the procedure is quicker than the bilateral septal procedure. Asymptomatic nasal septal perforations (less than 3 mm) were seen in eight of 215 cases, and represented the only complication related to the operation.
Long-term prognosis in children with benign cerebellar astrocytoma
Authors: Gjerris Flemming , Klinken Leif
Published: May 2009

✓ In 44 children with benign cerebellar astrocytoma, operated on between 1935 and 1959, two histological types could be distinguished, namely, a so-called juvenile type (31 children) and a diffuse type (13 children). All the children were followed to April, 1976, and the histological review was performed without knowledge of the survival in the single patient. For children with the juvenile type of cerebellar astrocytoma the 25-year cumulative survival rate was 94%, as against 38% for children with the diffuse type. It has thus been demonstrated that the morphological difference between the two types corresponds to a marked difference in survival rate.
Civilian gunshot wounds of the brain
Authors: Kirkpatrick Joel B. , Di Maio Vincent
Published: May 2009

✓ The authors report on 42 fatal gunshot wounds to the brain in civilians. The firearms used were those commonly available to civilians, ranging from a .22 revolver to a .45 semiautomatic pistol. Missile tracks were measured and the volume computed. The relatively low-velocity missiles produced by these weapons do not create the devastation that characterizes wounds from high-velocity military firearms. Instead, there is much variation in the size of the missile tracks, and they cannot be directly related to caliber. Pressure marks and contusions, impaction of bone chips, internal ricochet, and cerebral edema occurred frequently. The missile passed through the brain completely in every case but was retained by the skull or soft tissues in a large percentage of cases. The mechanism of death may be acute pressure on the brain stem from the passage of the missile through the brain.
Cerebral vasospasm and ultrastructural changes in cerebral arterial wall
Authors: Tanabe Yusuke , Sakata Kazuki , Yamada Hiromu , Ito Takao , Takada Mitsuaki
Published: May 2009

✓ Subarachnoid hemorrhage (SAH) was produced experimentally by injecting normal dog's blood as well as reserpinized dog's blood into the chiasmal cistern of the dog. The following observations were made: 1) After SAH with normal dog's blood, the intima of the basal truncal arterial wall showed some or all of such ultrastructural changes as appearance of vacuoles and dense bodies in endothelial cells, detachment of endothelial cells, appearance of intimal cells, and intimal thickening. The changes first appeared 2 hours after SAH, culminated at 3 to 7 days after SAH, and persisted up to 1 month after SAH. 2) After SAH with normal dog's blood, the media of the basal truncal arterial wall showed some or all of such ultrastructural changes as moth-eaten contour of muscle cells, appearance of intracytoplasmic vacuoles and dense bodies, appearance of cell debris, enlargement of interstitial space, and appearance therein of dense particles. These findings, which, in short, are to be expressed as myonecrosis and its repairing process, first appeared 2 hours after SAH, culminated at 1 to 4 months after SAH, and persisted up to 1 year after SAH. 3) Three and 5 days following SAH with reserpinized dog's blood, ultrastructural findings of the intima and media of the basal truncal arterial wall were entirely normal.

On the basis of the above findings, it was concluded that the ultrastructural changes in the cerebral arterial wall observed after SAH with normal dog's blood occurred as a consequence of vasospasm. The possibility that late spasm, in turn, might be facilitated by myonecrosis, could not be denied.
Radiographic diagnosis of meningioma of the lateral ventricle
Authors: Mani Richard L. , Hedgcock Marcus W. , Mass Stuart I. , Gilmor Richard L. , Enzmann Dieter R. , Eisenberg Ronald L.
Published: May 2009

✓ Review of 22 cases of meningioma indicates that this lesion occurs slightly more frequently on the left but without predilection for sex or age of the patient. The presenting symptoms were nonspecific. Plain radiographs of the skull sometimes demonstrated calcification in the tumor, but more often did not. Cerebral angiography frequently showed enlargement and displacement of the anterior choroidal artery on the side of the tumor; the lateral posterior choroidal artery on the side of the tumor was also enlarged and displaced in seven of nine patients who underwent vertebral arteriography. Pneumoencephalography accurately demonstrated the site and size of the lesion, as did radionuclide scanning if the lesion was vascular. Computerized tomographic (CT) scanning also determined the location and size of the tumors, as well as their mass effect and vascularity; CT scanning also demonstrated calcification that was not visible on the plain skull radiographs in two of six patients who underwent CT scanning and had calcification.
Long-term intracranial pressure recording in the management of pseudotumor cerebri
Authors: Gücer Gündüz , Viernstein Lawrence
Published: May 2009

✓ Long-term monitoring of intracranial pressure (ICP) was used as an aid for the management of four patients with pseudotumor cerebri. After the implantation of a small experimental pressure sensor in the skull, most of the subsequent ICP measurements were made noninvasively by an external interrogator. During the initial study of the patient, baseline ICP recordings were made in the hospital before treatment. Pressure recordings on a 24-hour basis were continued during treatment, which, depending on the case, was with Diamox (acetazolamide), steroids, or thecoperitoneal shunting. After discharge these patients returned weekly over 10 to 22 months for ICP measurement and for ophthalmological examination. Intracranial pressure before treatment showed irregular variations ranging from 100 to 500 mm H2O over a 24-hour period. The efficacy of treatments could be assessed in a few hours by the degree of ICP stabilization. Shunt malfunction was detected by a slow but continuous rise in pressure before full clinical signs were evident.
Treatment of fusiform aneurysms of the peripheral cerebral arteries
Authors: Dolenc Vinko
Published: May 2009

✓ Two patients with fusiform aneurysms and at least one previous subarachnoid hemorrhage were treated by excision of the aneurysms and reconstruction of the arteries. The first case presented with two fusiform aneurysms, the larger of which involved the angular and the smaller one the temporal branch of the left middle cerebral artery (MCA). Both aneurysms were totally excised. The angular artery was reconstructed with a 1.5 cm long arterial graft taken from the left superficial temporal artery. Excision of the temporal aneurysm was followed by an end-to-end suture of the central and distal parts of the vessel. The second case had a fusiform aneurysm involving the temporal branch of the left MCA. The aneurysm was excised and an arterial graft 1 cm long cut from the superficial temporal artery was used in reconstruction of the affected vessel. In each case left carotid angiography was done 1 week postoperatively. In the first case the angiogram showed that the angular artery reconstructed with a graft was patent, whereas the temporal artery reconstructed without a graft was not visualized. In the second patient, whose temporal artery was reconstructed with a graft, angiography did not show the reconstructed artery. Left carotid angiography was repeated 1 year after the operation in both cases, and all the reconstructed vessels were well visualized.
Giant thrombosed aneurysm associated with an arteriovenous malformation
Authors: Aarabi Bizhan , Chambers John
Published: May 2009

✓ The authors describe a case of giant anterior cerebral artery aneurysm associated with an anatomically related arteriovenous malformation (AVM). The aneurysm was almost completely thrombosed and was resected along with the AVM.
Intraneural hematoma of the sciatic nerve
Authors: Richardson Robert R. , Sun Hahn Yoon , Siqueira Edir B.
Published: May 2009

✓ A case of an encapsulated organizing hematoma of the sciatic nerve is reported. Hemorrhage-induced neuropathy as a complication of anticoagulant therapy, leukemia, hemophilia, and other bleeding diatheses has been frequently reported. While trauma is the most common etiology of a hemorrhagic neuropathy, actual hematoma formation beneath the epineurium is very rare.
Cerebral aspergillosis following intracranial surgery
Authors: Galassi Ercole , Pozzati Eugenio , Poppi Massimo , Vinci Attilio
Published: May 2009

✓ The authors report a case of cerebral aspergillosis. This is only the fifth case following intracranial surgery noted in the literature. Pathogenesis, angiographic findings, and results of cerebrospinal fluid culture are discussed.
Angiographic changes to induced hypertension in cerebral vasospasm
Authors: de Araujo Luiz Carlos , Zappulla Rosario A. , Yang Wen C. , Hollin Sidney A.
Published: May 2009

✓ A case of cerebral vasospasm complicating intracranial aneurysm surgery is presented. Angiographic findings under hypertension and normotension revealed a paradoxical response of involved vessels suggesting that normal autoregulation is either lost or overcome by spasm.
Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas
Authors: Walker Michael D. , Alexander Eben , Hunt William E. , MacCarty Collin S. , Mahaley M. Stephen , Mealey John , Norrell Horace A. , Owens Guy , Ransohoff Joseph , Wilson Charles B. , Gehan Edmund A. , Strike Thomas A.
Published: May 2009

✓ A controlled, prospective, randomized study evaluated the use of 1,3-bis(2-chloroethyl)-l-nitrosourea (BCNU) and/or radiotherapy in the treatment of patients who were operated on and had histological confirmation of anaplastic glioma. A total of 303 patients were randomized into this study, of whom 222 (73%) were within the Valid Study Group (VSG), having met the protocol criteria of neuropathology, corticosteroid control, and therapeutic approach. Patients were divided into four random groups, and received BCNU (80 mg/sq m/day on 3 successive days every 6 to 8 weeks), and/or radiotherapy (5000 to 6000 rads to the whole brain through bilateral opposing ports), or best conventional care but no chemotherapy or radiotherapy. Analysis was performed on all patients who received any amount of therapy (VSG) and on the Adequately Treated Group (ATG), who had received 5000 or more rads radiotherapy, two or more courses of chemotherapy, and had a minimum survival of 8 or more weeks (the interval that would have been required to have received either the radiotherapy or chemotherapy). Median survival of patients in the VSG was, best conventional care: 14 weeks (ATG: 17.0 weeks); BCNU: 18.5 weeks (ATG: 25.0 weeks); radiotherapy: 35 weeks (ATG: 37.5 weeks); and BCNU plus radiotherapy: 34.5 weeks (ATG: 40.5 weeks). All therapeutic modalities showed some statistical superiority compared to best conventional care. There was no significant difference between the four groups in relation to age distribution, sex, location of tumor, diagnosis, tumor characteristics, signs or symptoms, or the amount of corticosteroid used. An analysis of prognostic factors indicates that the initial performance status (Karnofsky rating), age, the use of only a surgical biopsy, parietal location, the presence of seizures, or the involvement of cranial nerves II, III, IV, and VI are all of significance. Toxicity included acceptable, reversible thrombocytopenia and leukopenia.
Head injury and coagulation disorders
Authors: van der Sande J. Jaap , Veltkamp Jan J. , Boekhout-Mussert Ria J. , Bouwhuis-Hoogerwerf Marijke L.
Published: May 2009

✓ Coagulation studies (plasma fibrinogen, ethanol gelation test, and fibrin/fibrinogen degradation product concentration) were done in 150 patients who were admitted after blunt head injury. Results were abnormal in 60 patients and were found to be correlated with the level of consciousness and with the presence of neurological signs. Many of these patients had fractures, but findings in a control group of 26 patients with major fractures without head injury indicate that fractures were not of paramount importance in causing clotting changes. Conclusive evidence of disseminated intravascular coagulation was found in 12 patients. Cases with a fatal clinical course were mostly associated with very high fibrin/fibrinogen degradation product concentrations. Some case histories are reported, confirming the hypothesized correlation between coagulation results and brain tissue destruction rather than brain compression. It was concluded that some degree of disseminated intravascular coagulation in patients with blunt head injury occurs more often than expected and that coagulation studies might have both diagnostic and prognostic value.
Reproducibility of regional cerebral blood flow measurements in acute severe head injury
Authors: Enevoldsen Erna M. , Jensen Finn T.
Published: May 2009

✓ In order to evaluate the reproducibility of regional cerebral blood flow (rCBF) measurements in pathological brain tissue, serial measurements were carried out in 13 determinations performed in patients who were comatose after severe head injuries within the first 2 weeks after the head trauma. The xenon-133 intra-arterial method was used for the flow measurements, and the flow was studied separately in 16 areas of the brain, producing 197 regional double determinations. The patients were maintained in a steady state during and between the measurements, and only differences of less than 2 mm Hg in the arterial CO2 pressure and less than 5 mm Hg in the perfusion pressure were tolerated. The reproducibility was found to be reasonably good as regards initial slope-flow indices and height/area flow values, whereas that of the compartmentally calculated flow parameters was poorer. On dividing the series into severely and moderately pathological areas, it could be shown that the reproducibility of the flow values in the moderately pathological brain areas was acceptable and similar to the results reported by others, whereas the reproducibility in the most severely pathological areas of the brain was rather poor, as regards the flow in the fast compartments. The correlation between the various flow parameters was found to be fairly good.
Deep vein thrombosis and low-dose heparin prophylaxis in neurosurgical patients
Authors: Cerrato Dario , Ariano Cesare , Fiacchino Folco
Published: May 2009

✓ By the use of 125I-labeled fibrinogen test, the incidence of postoperative deep vein thrombosis (DVT) and the effectiveness of prophylactic low-dose heparin treatment were investigated in 110 patients who underwent elective neurosurgical procedures. Fifty patients were appointed randomly to a control group and 50 to a heparin group (10 patients were excluded since they had DVT before surgery). The incidence of DVT was reduced from 34% in the control group to 6% in the heparin group (p < 0.005). No statistically significant differences were observed in transfusion requirements, postoperative hemoglobin concentration, and the occurrence of postoperative hematomas between the two groups. Positive correlation was observed between DVT and motor deficit (p < 0.05). Preoperative assessment of patients' sensitivity to the standard 5000-unit dose of heparin was performed in all treated patients and is thought an important factor in improving the safety of heparin prophylaxis.
Luteinizing hormone-releasing hormone in human pituitary blood
Authors: Antunes J. Lobo , Carmel Peter W. , Housepian Edgar M. , Ferin Michel
Published: May 2009

✓ Luteinizing hormone (LH) and LH-releasing hormone (LHRH) were measured by radioimmunoassay in blood samples collected from the pituitary gland during transsphenoidal surgery in 19 patients. Detectable levels of LHRH were present in 12 patients. Wide fluctuations of LHRH were seen in sequential samples collected at 10-minute intervals, suggesting a pulsatile mode of release. This technique may yield useful data on hypothalamic control of pituitary secretion.
Computerized tomography in hydatid cyst of the brain
Authors: Abbassioun Kazem , Rahmat Hamid , Ameli Nosrat O. , Tafazoli Mansour
Published: May 2009

✓ From among 1500 patients who underwent computerized tomography (CT) during an 18-month period, five cases of hydatid disease of the brain were diagnosed. The preoperative diagnosis is of paramount importance as the cyst has to be removed unruptured. The CT features of this condition are practically pathognomonic. The authors discuss the CT findings in these cases and differential diagnosis with other cystic lesions of the brain. The help that this safe and sure method of investigation gives to attain preoperative diagnosis is emphasized.