bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolution of the crossed-action intracranial aneurysm clip
Authors: McFadden Joseph T.
Published: May 2009

✓ The helical coiled-spring aneurysm clip with crossed legs evolved from clips designed by Mayfield and Scoville. The problems encountered during its development stimulated an evaluation of metals used in neurosurgery, the creation of implant standards, and the use of metals with greater strength and tissue compatibility; these metals later proved to be safe during magnetic resonance imaging.
Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia
Authors: Bederson Joshua B. , Wilson Charles B.
Published: May 2009

✓ Outcome after 252 posterior fossa explorations for the treatment of trigeminal neuralgia was determined by a retrospective review. Patients with distortion of the fifth nerve root caused by extrinsic vascular compression underwent microvascular decompression, those with no compression underwent partial sensory rhizotomy, and those with vascular contact but no distortion of the nerve root underwent decompression and rhizotomy. The mean follow-up period was 5.1 years. An excellent (75%) or good (8%) clinical outcome was achieved in 208 patients; 13 patients (5%) experienced little or no pain relief. Thirty-one patients (12%) suffered recurrent trigeminal neuralgia an average of 1.9 pain-free years after operation; recurrence continued at a rate of approximately 2% per year thereafter. Reoperation for recurrent or persistent pain provided excellent or good results in 85% of reoperated patients, but partial sensory rhizotomy was required in most of these patients. Outcome was affected by previous surgical procedures. A previous percutaneous radiofrequency lesion was associated with a significantly greater incidence of fifth nerve complications and a worse outcome after posterior fossa exploration. Because of this finding, the authors recommend that percutaneous radiofrequency rhizolysis be reserved for patients who have failed posterior fossa exploration or who are not candidates for surgery. Patients with compressive nerve root distortion and a short duration of symptoms before surgery had a significantly better outcome than patients with a longer duration of symptoms. In contrast, there was no relationship between the duration of symptoms and outcome of patients without nerve root distortion. Vascular decompression may cause dysfunction of the trigeminal system in tic douloureux, but in patients who remain untreated for long periods an intrinsic abnormality develops that may perpetuate pain even after microvascular decompression. Posterior fossa exploration is recommended as the procedure of choice for patients with trigeminal neuralgia who are surgical candidates.
Subtorcular occipital encephaloceles
Authors: Chapman Paul H. , Swearingen Brooke , Caviness Verne S.
Published: May 2009

✓ Three cases of occipital encephalocele, one with associated myelomeningocele, are presented. All received preoperative evaluation with magnetic resonance imaging. Such studies provide optimal demonstration of the cerebral and hindbrain anatomy to guide operative treatment and formulate prognosis. Review of available radiographic, operative, and pathological information suggests that most, if not all, occipital encephaloceles are associated with an anomaly of the hindbrain, and the usual anomaly is a rhombic roof encephalocele. In such cases, the site of cranial herniation is caudal to the torcula, regardless of the presence or absence of occipital lobe tissue within the sac. Experimental and clinical analysis suggests that occipital encephaloceles most likely arise from abnormalities in the development of the skull base.
The effect of nimodipine and dextran on axonal function and blood flow following experimental spinal cord injury
Authors: Fehlings Michael G. , Tator Charles H. , Linden R. Dean
Published: May 2009

✓ There is evidence that posttraumatic ischemia is important in the pathogenesis of acute spinal cord injury (SCI). In the present study spinal cord blood flow (SCBF), measured by the hydrogen clearance technique, and motor and somatosensory evoked potentials (MEP and SSEP) were recorded to evaluate whether the administration of nimodipine and dextran 40, alone or in combination, could increase posttraumatic SCBF and improve axonal function in the cord after acute SCI. Thirty rats received a 53-gm clip compression injury on the cord at T-1 and were then randomly and blindly allocated to one of six treatment groups (five rats in each). Each group was given an intravenous infusion of one of the following over 1 hour, commencing 1 hour after SCI: placebo and saline; placebo and dextran 40; nimodipine 0.02 mg/kg and saline; nimodipine 0.02 mg/kg and dextran 40; nimodipine 0.05 mg/kg and saline; and nimodipine 0.05 mg/kg and dextran 40.

The preinjury physiological parameters, including the SCBF at T-1 (mean ± standard error of the mean: 56.84 ± 4.51 ml/100 gm/min), were not significantly different (p > 0.05) among the treatment groups. Following SCI, there was a significant decrease in the SCBF at T-1 (24.55 ± 2.99 ml/100 gm/min; p < 0.0001) as well as significant changes in the MEP recorded from the spinal cord (MEP-C) (p < 0.0001), the MEP recorded from the sciatic nerve (MEP-N) (p < 0.0001), and the SSEP (p < 0.002). Only the combination of nimodipine 0.02 mg/kg and dextran 40 increased the SCBF at T-1 (43.69 ± 6.09 ml/100 gm/min; p < 0.003) and improved the MEP-C (p < 0.0001), MEP-N (p < 0.04), and SSEP (p < 0.002) following SCI. With this combination, the changes in SCBF were significantly related to improvement in axonal function in the motor tracts (p < 0.0001) and somatosensory tracts (p < 0.0001) of the cord. This study provides quantitative evidence that an increase in posttraumatic SCBF can significantly improve the function of injured spinal cord axons, and strongly implicates posttraumatic ischemia in the pathogenesis of acute SCI.
Malignant pseudotumor cerebri
Authors: Kidron Daphne , Pomeranz Shlomo
Published: May 2009

✓ Two young Arab women presented with a very rapid loss of vision, ophthalmoplegia, florid papilledema, areflexia of the lower limbs, and normal mentation. Lumbar puncture pressure was above 60 cm H2O, but no intracranial structural lesion was found in either patient. An exhaustive evaluation as to an etiology was negative in both. Under continuous lumbar cerebrospinal fluid drainage and administration of steroids, furosemide, and acetazolamide, both patients had significantly improved vision and ocular movement. In both, lumboperitoneal shunting was considered but only one eventually underwent this procedure. These two patients with pseudotumor cerebri are unique in their fulminant clinical course and severely increased intracranial pressure. Virtually inevitable blindness was prevented by timely intervention.
Paraplegia caused by brown tumor in primary hyperparathyroidism
Authors: Yokota Naoto , Kuribayashi Tadanobu , Nagamine Motohisa , Tanaka Masayuki , Matsukura Shigeru , Wakisaka Shinichiro
Published: May 2009

✓ A brown tumor is a secondary disorder of bone associated with hyperparathyroidism that arises predominantly in the metacarpals, phalanges, jaw, pelvis, or femur. Rarely does this tumor involve the spine. The authors describe a case of brown tumor in primary hyperparathyroidism, causing spinal cord compression. The first step in diagnosing this lesion in an unusual site is a high index of suspicion. Essentially, this tumor is benign but emergency surgery for tumor removal is recommended in patients showing acute spinal cord compression.
Lazarus sign and extensor posturing in a brain-dead patient
Authors: Heytens Luc , Verlooy Jan , Gheuens Jan , Bossaert Leo
Published: May 2009

✓ A man was declared brain dead after having sustained a gunshot wound to the head. All clinical criteria for the diagnosis of brain death were met. The electroencephalogram was isoelectric, and four-vessel angiography demonstrated the absence of cerebral blood flow. However, stereotypic spontaneous movements were observed which persisted for several hours. The possible mechanism is discussed and a short review of the literature is given.
Preparation of adrenal medullary tissue for transplantation in Parkinson's disease: a new procedure
Authors: López-Lozano Juan J. , Brera Begoña , Abascal Javier , Bravo Gonzalo
Published: May 2009

✓ The authors describe a technique by which adrenal medullary tissue can be easily dissected from the adrenal cortex. The method involves perfusion with Locke's modified buffer, dissection of adrenal gland in buffer free of calcium or magnesium, and storage in a culture medium before implantation into the caudate nucleus of patients with Parkinson's disease. This method seems to increase the viability and purity of adrenal medullary tissue. The results obtained in 15 parkinsonian patients implanted with perfused adrenal medulla indicate the potential value of this technique.
Needle for use during percutaneous compression of gasserian ganglion for trigeminal neuralgia
Authors: Gerber Arthur M.
Published: May 2009

✓ A needle system is described that facilitates the performance of percutaneous compression of the gasserian ganglion.
AANS Presidential Address, 1989: Trends in neurosurgery
Authors: Tindall George T.
Published: May 2009

✓ This overview of neurosurgical practice examines patterns of case management, using several areas such as head injury, brain tumors, and the delivery of health care to illustrate the changes that have taken place over the past 40 years and the changes that might be expected in the next 40 years. The rapid pace of progress has indicated further exciting growth of this specialty into the 21st century; however, what remains constant is the dynamic character of the neurosurgeon. This view of the past and the possibilities for future innovation enables neurosurgeons of all generations to have a sense of pride in the achievements generated by their peers.
Intracerebroventricular bethanechol chloride infusion in Alzheimer's disease
Authors: Harbaugh Robert E. , Reeder Teddi M. , Senter Howard J. , Knopman David S. , Baskin David S. , Pirozzolo Francis , Chui Helena Chang , Shetter Andrew G. , Bakay Roy A. E. , Leblanc Richard , Watson Robert T. , DeKosky Steven T. , Schmitt Frederick A. , Read Stephen L. , Johnston Jimmie T.
Published: May 2009

✓ The use of intracerebroventricular bethanechol chloride infusion in patients with Alzheimer's disease was first reported in 1984. An initial trial in four patients demonstrated the feasibility of this approach for cholinergic drug delivery to the brain, but objective improvement in cognitive function was not documented. A collaborative placebo-controlled double-blind crossover study has now been carried out in 49 patients with biopsy-documented Alzheimer's disease. The results demonstrate a statistical improvement in Mini-Mental State scores and significantly slower performance on Trails A testing during drug infusion. Other neuropsychological test scores were not similarly affected. The degree of improvement was not sufficient to justify further treatment of Alzheimer's disease patients by intracerebroventricular infusion of bethanechol chloride. The drug delivery system used in the study was well tolerated, with two irreversible complications in more than 50,000 patient days.
Supratentorial anaplastic gliomas in adults
Authors: Winger Michael J. , Macdonald David R. , Cairncross J. Gregory
Published: May 2009

✓ A retrospective analysis is presented of factors affecting the length of survival of 285 consecutive adults with newly diagnosed biopsy-proven supratentorial anaplastic glioma (188 cases of glioblastoma multiforme, 76 of anaplastic astrocytoma, 11 of anaplastic mixed glioma, and 10 of anaplastic oligodendroglioma) treated at a regional cancer center from July, 1982, through December, 1987. The approach to initial therapy included maximum feasible resection and radiotherapy. The median survival time for all patients was 35 weeks. Multivariate analysis demonstrated that age, duration of symptoms, preirradiation performance status, tumor histology, accessibility to resection, extent of resection, radiotherapy, and prior low-grade glioma were significant independent variables influencing survival. The prognostic importance of age, duration of symptoms, performance status, and tumor histology are already recognized, but three “new” findings are reported. First, patients with anaplastic oligodendroglioma had the longest median survival time (278 weeks). Second, corrected for accessibility and all other variables, patients with gross total resection lived longer than those with partial resection, and patients with any degree of resection lived longer than those who underwent only a biopsy procedure. Third, patients with anaplastic glioma in whom there was a prior history of low-grade glioma lived significantly longer after the diagnosis of anaplastic glioma than did patients in whom the anaplastic glioma apparently arose de novo.
Brain shift, level of consciousness, and restoration of consciousness in patients with acute intracranial hematoma
Authors: Ross Donald A. , Olsen Walter L. , Ross Amy M. , Andrews Brian T. , Pitts Lawrence H.
Published: May 2009

✓ Recently, Ropper reported that horizontal brain shift caused by acute unilateral mass lesions correlated closely with consciousness, and suggested that recovery of consciousness was unlikely to occur after surgical evacuation if the shift was insufficient to explain the observed diminution of consciousness. The authors have sought to confirm the correlation of pineal shift with level of consciousness and to assess the prognostic value of brain shift measurements in a prospective study. Forty-six patients (19 with subdural hematoma, 14 with intracerebral hematoma, and 13 with epidural hematoma) were accrued to the study group consecutively. A correlation was found between a decrease in the level of consciousness and a significant increase in the mean lateral brain displacement at the pineal gland (from 3.8 to 7.0 mm) and septum (5.4 to 12.2 mm). When outcome was examined in patients who were stuporous or comatose on admission, a significant increase in septal shift was found among patients with a poor outcome, but there was no significant relationship between outcome and degree of pineal or aqueductal shift. A poor outcome was more likely with effacement of both perimesencephalic cisterns or the ipsilateral cistern, but not the contralateral cistern, although this difference did not reach statistical significance. These results do not substantiate the value of brain shift as an independent prognostic factor after evacuation of an acute unilateral mass lesion. The decision to operate and the determination of prognosis should be based rather on established criteria such as the clinical examination, age of the patient, and the mechanism of injury.
Repeat transsphenoidal surgery for Cushing's disease
Authors: Friedman Robert B. , Oldfield Edward H. , Nieman Lynnette K. , Chrousos George P. , Doppman John L. , Cutler Gordon B. , Loriaux D. Lynn
Published: May 2009

✓ Transsphenoidal resection of adrenocorticotrophic hormone (ACTH)-producing pituitary adenomas has the potential of curing most patients with Cushing's disease. However, transsphenoidal exploration of the pituitary is not always curative, and patients who have remission of hypercortisolism following surgery occasionally develop a recurrence. Whether repeat pituitary surgery should be performed for recurrent or persistent Cushing's disease has not been evaluated previously. To determine the efficacy of transsphenoidal surgery in recurrent or persistent Cushing's disease, we performed transsphenoidal surgery in 31 patients (22 women and nine men) who had previously undergone a transsphenoidal operation and two female patients who had had previous pituitary irradiation only.

In 24 (73%) of the 33 patients, remission of hypercortisolism was achieved by surgery. Although preoperative computerized tomography (CT) scanning identified an adenoma in only three of the 33 patients, in 20 patients a discrete adenoma was identified at pituitary exploration. The incidence of remission of hypercortisolism was greatest if an adenoma was identified at surgery and the patient received selective adenomectomy (19, or 95% of 20 patients), if there was evidence at surgery or by preoperative CT scanning that the previous surgical exposure of the pituitary was incomplete (seven, or 78% of nine patients), if an adenoma was seen on preoperative CT scanning (three of three patients), or if the patient had had prior pituitary irradiation without surgery (two of two patients). In contrast, only five (42%) of 12 patients who received subtotal or total hypophysectomy had remission of hypercortisolism. Surgically induced hypopituitarism occurred in six (50%) of these 12 patients, but in only one (5%) of the 20 patients who underwent selective adenomectomy. Three (13%) of the 24 patients who were in remission from hypercortisolism following repeat surgery developed recurrent hypercortisolism 10 to 47 months postoperatively.

Repeat transsphenoidal exploration of the pituitary and treatment limited to selective adenomectomy should be considered in patients with hypercortisolism despite previous pituitary treatment. If an adenoma is identified during surgery, the chance of remission of Cushing's disease is high and the risk of hypopituitarism is low; however, if no adenoma can be found and partial or complete hypophysectomy is performed, remission of hypercortisolism is less likely and the risk of hypopituitarism is about 50%.
Characterization of lymphoid cells isolated from human gliomas
Authors: Farmer Jean-Pierre , Antel Jack P. , Freedman Mark , Cashman Neil R. , Rode Harold , Villemure Jean-Guy
Published: May 2009

✓ To analyze the phenotypic profile of lymphoid cells freshly isolated from surgically resected human gliomas, a double-immunostaining technique was developed which permitted the investigators simultaneously to distinguish between hematogenous and tumor cell populations and to detect expression of lymphocyte-mono-cyte subset-specific antigens on hematogenous cells. With this technique, the profiles of tumor-infiltrating lymphocytes (TIL's) derived from high- and low-grade gliomas were compared with phenotypes of lymphocytes concurrently isolated from peripheral blood. The total leukocyte cell yield from high-grade glioma cases exceeded that of low-grade cases. In nine high-grade glioma cases the proportion of CD8-positive cells was increased within the TIL population (41.2% ± 1.9%, mean ± standard error of the mean) as compared to the corresponding peripheral blood lymphocyte (PBL) population (30.8% ± 4.1%, p < 0.05). The proportion of natural killer HNK-positive cells, some of which bear the CD8 antigen (although not necessarily the pan T cell antigens CD2 and CD3), was also increased in the TIL's (41.9% ± 4.2%) compared to that found in PBL's (32.1 ± 5.6%, p < 0.05) of high-grade glioma cases. The observed phenotypic pattern of high-grade glioma TIL's is similar to that reported based on immunohistochemical analysis of tumor tissue sections, suggesting that the techniques described here resulted in isolation of lymphoid cells representative of TIL's.
Synaptic reorganization within the human central nervous system following injury
Authors: Grady M. Sean , Jane John A. , Steward Oswald
Published: May 2009

✓ Behavioral recovery following brain injury in humans is well recognized; however, the anatomical basis for such recovery has not been demonstrated. Two cases are presented that show reorganization of synaptic connections (plasticity) in the dentate gyrus of human brain following uncal herniation. The neurohistological appearance of these cases is very similar to a well-described animal model of anatomical, physiological, and behavioral recovery following experimental surgical injury.
Effect of nordihydroguaiaretic acid on cultured rat and human glioma cell proliferation
Authors: Wilson Diana E. , DiGianfilippo Anthony , Ondrey Frank G. , Anderson Kenning M. , Harris Jules E.
Published: May 2009

✓ When cultured malignant cells derived from rat gliomas (C6 and 9L) and human gliomas (A-172 and T98G) were treated for 4 hours with 1 to 80 µm nordihydroguaiaretic acid (NDGA) or 5,8,11,14-eicosatetraynoic acid (ETYA), a dose-dependent inhibition of deoxyribonucleic acid (DNA) synthesis occurred. In a series of three experiments for each cell line, 40 µM NDGA suppressed 3H-thymidine incorporation in the rat and human glioma lines to an average of less than 3.1% and 5.6% of control uptake (counts per minute), respectively. Incubation with a higher concentration of ETYA (80 µM) resulted in inhibition of rat and human DNA synthesis to less than 53% and 62% of control levels, respectively. This inhibition was not associated with any loss of cell viability, as judged by trypan blue exclusion studies. Prolonged incubation (for 72 hours) of the rat and human glioma cells with NDGA markedly decreased cell proliferation with no loss of cell viability. The inhibition of human glioma cell division by NDGA was rapidly reversible after incubation for 24 hours and at least partially reversible after incubation for 96 hours. It is concluded that the inhibitors of eicosanoid biosynthesis, NDGA and (to a lesser extent) ETYA, reduce in vitro cell proliferation in two glioma lines from both the rat and human. Since neither indomethacin nor acetylsalicylic acid altered DNA synthesis in these cell lines, this implicates the lipoxygenase products of arachidonic acid metabolism as important positive modulators in glioma cell division. These findings warrant further study in an in vivo system.
Effect of indomethacin pretreatment on acute mortality in experimental brain injury
Authors: Kim Hun Joo , Levasseur Joseph E. , Patterson John L. , Jackson George F. , Madge Gordon E. , Povlishock John T. , Kontos Hermes A.
Published: May 2009

✓ The effect of indomethacin administration on the mortality rate of brain-injured rats was studied in four groups of animals subjected to a level of injury with a fluid-percussion apparatus predetermined to cause 50% mortality (50% lethal dose, or LD50). There were 24 animals in each of the following groups: 1) a control group, on which the LD50 was evaluated; 2) an ethanol-treated group with a mean blood serum level of 0.32 ± 0.03 gm% (± standard error of the mean); 3) an indomethacin-treated group at a dose level of 3 mg/kg body weight administered intraperitoneally 10 to 15 minutes before injury; and 4) an indomethacin/ethanoltreated group. Significant differences in mortality rates were found in these experimental groups; namely, 50%, 58%, 8.3% (p < 0.005), and 25% (p < 0.05), respectively. The predetermined LD50 level of a 2.5- to 2.6-atm peak pressure pulse produced immediate apnea in all animals, which was either sustained (Type III), followed by temporary respiratory recovery (Type II), or followed by permanent resumption of breathing (Type I). The most important effect of indomethacin on respiratory function was manifested by a much higher percentage of Type I respiratory responses and a much lower percentage of Type II and III responses (hence a lower mortality rate). There was also a more rapid return to normal breathing in the postapneic period of recovery. Suppression of prostaglandin synthesis and of superoxide anion production at the onset of trauma may explain, at least in part, these favorable effects of indomethacin.
Attenuation of decompressive hypoperfusion and cerebral edema by superoxide dismutase
Authors: Schettini Alfonso , Lippman H. Robert , Walsh Edward K.
Published: May 2009

✓ This study tested the hypothesis that ischemia-reperfusion injury initiated by the superoxide anion radical is a major component of postdecompression hypoperfusion and cerebral edema, and could be attenuated by superoxide dismutase (SOD). A supratentorial extradural balloon was placed in 20 fasting, lightly anesthetized, mechanically ventilated dogs and inflated in 0.5-ml increments (0.07 ml/sec) at 15-minute intervals. The endpoint of balloon expansion was the onset of an isoelectric electroencephalogram, near-arrest of hemispheric cerebral blood flow (CBF) (measured by H2 clearance), and the appearance of a suprainfratentorial intracranial pressure gradient, which was held for 15 minutes. The in vivo development of brain edema was detected by measuring brain elastic response (BER) extradurally, and was correlated with postmortem measurement of brain water content (gravimetry); blood-brain barrier integrity was tested by Evans blue dye given after the insult. After decompression, the dogs were randomly assigned to one of four treatment groups: Group I received hyperventilation (PaCO2 28 ± 1 mm Hg, mean ± standard deviation); Group II received furosemide (2.4 mg/kg) and pentobarbital (10 mg/kg) every 8 hours; Group III received 20% mannitol in a 1.4-gm/kg bolus plus furosemide, 0.5 mg/kg; and Group IV received SOD, 15,000 U/kg every 15 minutes for 3 hours. At 4 hours of decompression Group IV had significantly greater recovery in local CBF and BER than Groups I, II, and III (p < 0.05). The 24-hour survival rate was 20% for Group I, 60% for Group II, 80% for Group III, and 100% for Group IV. The survival rate appeared to correlate with a variable degree of postmortem intraparenchymal hemorrhages, blood-brain barrier disruption, and moderate to severe brain edema for Groups I, II, and III. In contrast, Group IV had the least brain edema (p < 0.05) and Evans blue dye extravasation (p < 0.05) and the fewest intraparenchymal hemorrhages. These data support the hypothesis that, under the experimental conditions described here, the superoxide anion plays a major role in the pathophysiology of postdecompression ischemic edema.
Delayed postoperative neurological deterioration from prolonged sodium nitroprusside administration
Authors: Ram Zvi , Spiegelman Roberto , Findler Gideon , Hadani Moshe
Published: May 2009

✓ Sodium nitroprusside is commonly used for the induction of hypotension during neurosurgical procedures. Its toxicity stems from hemodynamic compromise as well as from its metabolites, especially the formation of cyanide. A patient is described who underwent craniotomy for hypertensive intracerebral hemorrhage. He gradually recovered following the operation, but needed continued administration of sodium nitroprusside for control of hypertension. On the 7th postoperative day, he deteriorated into coma with evidence of severe edema and herniation on the computerized tomography scan. Cessation of sodium nitroprusside and treatment for cyanide poisoning resulted in resolution of his symptoms within hours. The potential toxicity of sodium nitroprusside, measures to prevent toxicity, and therapeutic steps are discussed.
Delayed nonhemorrhagic encephalopathy following mild head trauma
Authors: Ram Zvi , Hadani Moshe , Spiegelman Roberto , Tadmor Rina , Shacked Itzchack
Published: May 2009

✓ Delayed nonhemorrhagic encephalopathy following mild head trauma is a rare condition with an unknown etiology. The few cases reported in the literature are in young adults, all of them in the era before computerized tomography (CT) became available, and all had a devastating clinical course with multifocal ischemia or necrotic lesions found at autopsy. A case is presented of a young man with this syndrome who survived the acute encephalopathic phase with severe residual neurological deficits. Repeat CT scans during and following the acute phase as well as magnetic resonance imaging showed diffuse multifocal lesions compatible with ischemic changes and demyelination in the “watershed” areas of the brain.
A hazard of craniotomy in the sitting position: the posterior compartment syndrome of the thigh
Authors: Poppi Massimo , Giuliani Giuliano , Gambari Paolo Ivan , Acciarri Nicola , Gaist Giulio , Calbucci Fabio
Published: May 2009

✓ A bilateral posterior compartment syndrome of the thigh with a sciatic neuropathy in a patient following a craniotomy in the sitting position is described. The pathophysiology of the sciatic nerve dysfunction is discussed and the diagnostic value of computerized tomography is emphasized. Prompt decompression of the nerve is suggested.
Transluminal angioplasty for treatment of intracranial arterial vasospasm
Authors: Higashida Randall T. , Halbach Van V. , Cahan Leslie D. , Brant-Zawadzki Michael , Barnwell Stanley , Dowd Christopher , Hieshima Grant B.
Published: May 2009

✓ Percutaneous transluminal angioplasty for treatment of intracerebral arterial vasospasm is now being performed in selected cases. Thirty-six vascular territories in 13 patients, ranging in age from 15 to 73 years, have been treated with a new silicone microballoon device. This balloon has allowed mechanical dilatation of segmental and diffuse areas of spastic intracerebral blood vessels less than 1 mm in diameter with return to normal luminal diameter. Follow-up angiography has documented improved cerebral perfusion without return of spasm.

In 10 patients (77%), vasospasm was due to subarachnoid hemorrhage following rupture of an intracranial aneurysm. In three patients (23%), spasm with resultant neurological decline occurred during detachable balloon embolization therapy for treatment of an aneurysm. In each case, the vessel caliber returned to normal size following balloon dilatation. In nine (69%) of the 13 cases, balloon dilatation resulted in improvement of neurological function within minutes to hours following the procedure.

Transluminal angioplasty techniques may offer an alternative form of therapy in the management of symptomatic arterial vasospasm.
Astrocytomas of the cerebellum in children
Authors: Garcia Delia M. , Latifi Hamid R. , Simpson Joseph R. , Picker Selwyn
Published: May 2009

✓ Between 1928 and 1980, 84 children (aged 19 years or younger) with an astrocytoma of the cerebellum were managed at Washington University Medical Center-Barnes Hospital. Fifty-eight children were treated with surgery only and 26 received surgery and postoperative irradiation. The 5-, 10-, and 25-year actuarial disease-free survival rates for the entire group were 92%, 88%, and 88%, respectively. Age at diagnosis and extent of surgery were prognostic factors, but no correlation with survival times was found for gross appearance of the tumor or postoperative irradiation. Posttreatment neurological function was excellent in the 58 patients alive at the end of the study; 92% were completely normal or had only a mild neurological deficit and 75% were employed or attending school.
Giant-cell granulomatous hypophysitis: a distinct clinicopathological entity
Authors: Scanarini Massimo , d'Avella Domenico , Rotilio Antonino , Kitromilis Nicolaos , Mingrino Salvatore
Published: May 2009

✓ Idiopathic giant-cell granulomatous hypophysitis is a chronic inflammatory disorder of the pituitary gland. It presents clinically as a sellar mass lesion with pituitary insufficiency and/or hyperprolactinemia, and is radiologically indistinguishable from a pituitary tumor. In most of the previously reported cases the documentation of the disorder has been limited to autopsy tissue. Only a few cases documented by biopsy have been recorded. Four cases are presented here with radiological, endocrinological, and surgical findings. The appropriately documented cases collected from the literature and the present series are reviewed and the incidence, patterns of clinical and radiological presentation, and operative management of this disorder are discussed. This entity should be considered when evaluating patients with a pituitary mass and evidence of hypopituitarism and hyperprolactinemia.
Correlation of intraoperative ultrasound tumor volumes and margins with preoperative computerized tomography scans
Authors: LeRoux Peter D. , Berger Mitchel S. , Ojemann George A. , Wang Keith , Mack Laurence A.
Published: May 2009

✓ Twenty-two patients with primary or metastatic brain tumors were evaluated with computerized tomography (CT) and intraoperative ultrasound. Tumor volume was estimated using a geometric formula based on CT and intraoperative ultrasound measurements. In most cases, tumor margins were marked with indigo carmine injected by ventricular cannula or with Silastic ventricular catheters placed under ultrasonographic control. Nine tumors had previously been operated on and irradiated (Group A). In this group, intraoperative ultrasound tended to overestimate the tumor volume compared to CT (intraoperative ultrasound findings 141.39% ± 37.73% of CT findings (mean ± standard deviation)). Sixteen patients were operated on for the first time (Group B), and in this group the volume estimates were comparable (intraoperative ultrasound findings 101.69% ± 24.65% of CT findings). The difference between the means was statistically significant (p < 0.01). Ultrasonography improved intraoperative delineation of tumor margins, as depicted by CT, thus maximizing the extent of resection; however, with recurrent tumors, intraoperative ultrasound tended to overestimate the tumor volume. Gliosis may account for this difference.
A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus
Authors: Hakuba Akira , Tanaka Kiyoaki , Suzuki Toshihisa , Nishimura Shuro
Published: May 2009

✓ The authors present four cases of vascular lesions and 10 cases of tumors involving the cavernous sinus. They were operated on via a combined orbitozygomatic infratemporal epidural and subdural approach. With this approach, multisided exposure of the cavernous sinus can be achieved via the shortest possible distance with minimal retraction of the neural structures in and around the cavernous sinus. In one patient the carotid artery had been occluded previously, but in the other 13 patients it was preserved. There was no mortality, and all patients except one returned to work within 6 months after surgery.
Immunological reaction against the aging human subarachnoid erythrocyte
Authors: Peterson John W. , Kwun Byung-Duk , Teramura Atsushi , Hackett John D. , Morgan Jeffrey A. , Nishizawa Shigeru , Bun Takao , Zervas Nicholas T.
Published: May 2009

✓ The role of the aging human erythrocyte in the mechanisms leading to cerebral vasospasm after subarachnoid hemorrhage was investigated using an in vitro model for the environment of the erythrocyte in a subarachnoid blood clot. It has long been suspected that, due to its potent vasoactivity, erythrocyte lysate provides the major vasoconstrictive input to cerebral arteries during vasospasm. Under the model conditions (incubation at 37°C in an artificial cerebrospinal fluid), however, the rate of spontaneous hemolysis was quite slow (about 1%/day), becoming only somewhat more rapid after 4 days' incubation. The rate of hemolysis of aging erythrocytes was dramatically increased (500- to 1000-fold) by the addition of plasma proteins, but only after the erythrocytes had aged 2 to 3 days, or more. The mechanism of age-dependent, plasma-induced hemolysis of originally autologous erythrocytes is shown to involve activation of the plasma complement protein pathway, analogous to the mechanisms of innate immunity which lead to lysis of nonautologous cell types and activate the inflammatory response.
S-100 protein and neuron-specific enolase in CSF after experimental traumatic or focal ischemic brain damage
Authors: Hårdemark Hans-Göran , Ericsson Nils , Kotwica Zbigniew , Rundström Gerd , Mendel-Hartvig Ib , Olsson Yngve , Påhlman Sven , Persson Lennart
Published: May 2009

✓ Cerebrospinal fluid (CSF) markers of brain damage are potentially capable of providing quantitative information about the extent of certain neurological injury. The presence of such markers in CSF after brain damage is transient and it is essential to understand their kinetics if they are to be used in clinical practice. In the present study, the CSF concentrations of two neurospecific proteins, S-100 protein and neuron-specific enolase (NSE), were determined in rats before and repeatedly after one of two types of experimental brain damage: traumatic cortical injury and focal cerebral ischemia induced by middle cerebral artery (MCA) occlusion.

The two types of experimental brain damage resulted in significant differences in the kinetics of S-100 and NSE concentrations in CSF. Cortical contusion was followed by a rapid increase in both S-100 and NSE and a peak occurred in both after about 7½ hours, at which time the values declined toward normal. A second, smaller peak was seen after about 1½ days. The increase and decrease in S-100 and NSE levels in CSF was slower after MCA occlusion; a peak was seen after 2 to 4 days. Furthermore, S-100 was generally higher than NSE after trauma, whereas after MCA occlusion the NSE concentration was slightly higher than the S-100 value. These results support the use of CSF markers for estimation of the extent of brain damage in experimental models and forms a basis for the understanding of their kinetics, which is important for their use in clinical practice.
Activated complement components C3a and C4a in cerebrospinal fluid and plasma following subarachnoid hemorrhage
Authors: Kasuya Hidetoshi , Shimizu Takashi
Published: May 2009

✓ The cerebrospinal fluid (CSF) and plasma levels of the complement components C3a and C4a in 40 patients suffering from subarachnoid hemorrhage (SAH) were quantitated by radioimmunoassay. Serial measurements of the lumbar CSF levels revealed that the C3a and C4a levels were significantly elevated in the initial stage of SAH, but decreased rapidly. Within 48 hours after SAH, the mean C3a and C4a levels in the cisternal, lumbar, and ventricular CSF were significantly higher in patients with delayed ischemic neurological deficits (DIND) than in those without DIND. The serially measured plasma levels of C3a and C4a in patients with DIND were elevated more than in those without DIND, but they did not show a significant change over time. Simultaneous levels of fibrinopeptide A (FPA), an indicator of thrombin activity in CSF, were also measured by radioimmunoassay. There was a significant correlation between CSF-activated complement components and CSF FPA. These results suggest that complement activation occurred in the subarachnoid space soon after SAH, chiefly due to activation of the coagulation system. The higher CSF levels of C3a and C4a in patients with DIND may indicate a relationship between these components and the pathogenesis of cerebral vasospasms.
Effect of regional spinal cord blood flow and central control in recovery from spinal cord injury
Authors: Chehrazi B. Barry , Scremin Oscar , Decima Emilio E.
Published: May 2009

✓ Forty-two cats were subjected to decerebration, thoracic and lumbar laminectomies, and isolation of the sciatic nerves. Spinal evoked potentials in response to bilateral sciatic nerve stimulation were recorded at L-3, and the spinal cord blood flow (SCBF) was measured by the hydrogen clearance technique. Thoracic cordotomy did not alter the lumbar SCBF or the central conduction time as determined by spinal evoked potentials. Thoracic cordotomy significantly lowered the lumbar spinal cord injury threshold. Continuous sciatic nerve stimulation increased the lumbar SCBF in normal and traumatized animals; however, it did not affect the spinal cord injury threshold as measured by recovery of the spinal evoked potentials. It appears that rostral spinal cord integrity is far more significant in recovery from spinal cord injury than the maintenance of regional SCBF.
Late paraophthalmic aneurysm rupture following endovascular treatment
Authors: Strother Charles M. , Lunde Sigurd , Graves Virgil , Toutant Steven , Hieshima Grant B.
Published: May 2009

✓ A fatal rupture of a large paraophthalmic aneurysm 11 months following treatment with detachable balloons is described. This case illustrates the potential consequences of incomplete aneurysm obliteration with endovascular techniques and emphasizes the need for adequate posttreatment evaluation when this method is used for aneurysm therapy.
Results of reoperation for failed epilepsy surgery
Authors: Wyler Allen R. , Hermann Bruce P. , Richey E. T.
Published: May 2009

✓ A total of 37 patients who failed epilepsy surgery were evaluated with magnetic resonance imaging and long-term scalp electroencephalographic monitoring before reoperation. Repeat surgery involved focal resections after initial focal resections (30 cases) or stereotactic lesions (one case), or focal resections following anterior corpus callosotomy (six cases). Patients with initial focal resections followed by enlargement of the original operative site had the most successful outcome, especially those with complex partial seizures of temporal lobe origin. The most common cause for poor outcome of the original operation in patients with temporal lobe epilepsy was insufficient hippocampal resection. Patients who were most likely to benefit from reoperation were: 1) those with initially incompletely resected structural lesions; 2) those who were initially evaluated with invasive ictal monitoring; and 3) those who underwent further resection of the initial operative site rather than resection of a different cortical region.
National survey of patterns of care for brain-tumor patients
Authors: Mahaley M. Stephen , Mettlin Curtis , Natarajan Nachimuthu , Laws Edward R. , Peace Barbara B.
Published: May 2009

✓ An excellent response by participating institutions was realized in this survey of patterns of care for patients with primary brain tumors. Since the histopathology of the tumor is such a strong predictor of outcome and influences care so greatly, most analyses were performed not only on the overall series of patients but also by World Health Organization histological classification. Several factors that influence outcome were identified: tumor type, patient age, patient Karnofsky rating, tumor location, and therapy. Very few cases were coded as regards the American Joint Committee on Cancer clinical stage, and few potentially eligible cases were placed in investigative protocols. It behooves those centers providing investigative protocol opportunities to develop liaisons with practicing physicians nearby as well as at some distance and to provide an organizational framework that will make participation in these protocols practical for a larger segment of our brain-tumor patient population.

Between 1980 and 1985, the increased use of magnetic resonance imaging in neuroradiology is apparent as well as the increased use of stereotactic biopsy and interstitial radiotherapy. Complications of therapy seem acceptably low. Five-year survival for benign brain tumor is high, while that for the most common primary tumor, glioblastoma multiforme, is only 5.5%.

Some of the findings in this survey confirm those from the literature while others, particularly the pattern of care, represent new data.
Traumatic carotid artery dissection: diagnosis and treatment
Authors: Watridge Clarence B. , Muhlbauer Michael S. , Lowery Robbie D.
Published: May 2009

✓ Early diagnosis and successful management of traumatic carotid artery dissections require a high index of clinical suspicion. The diagnostic study of choice is cerebral arteriography. In this paper, 24 cases of traumatic carotid artery dissection are described. Presenting signs and symptoms include Horner's syndrome, dysphasia, hemiparesis, obtundation, and monoparesis. Patients detected early with mild neurological deficits fared well with treatment, while those with profound neurological deficits and delayed diagnoses had poor outcomes. Aggressive nonsurgical treatment is advocated including anticoagulation therapy for prevention of progressive thrombosis and arterial occlusion and/or distal arterial embolization with resultant cerebral ischemia. Direct surgical thromboendarterectomy is considered to carry high morbidity and mortality rates.
Cerebral blood flow and glucose metabolism in experimental brain edema
Authors: Sutton Leslie N. , Barranco David , Greenberg Joel , Dante Stephen , Florin Sandra , Welsh Frank
Published: May 2009

✓ The relationship between cerebral blood flow (CBF) and cerebral metabolic rate of glucose (CMR gl) in the white matter was studied in a plasma infusion model of vasogenic edema in cats. Local CBF, as determined by iodoantipyrine testing, was found to be significantly decreased in edematous white matter (mean ± standard error of the mean: 17.3 ± 1.5 ml/100 gm/min) when compared with CBF in the contralateral control white matter (24.8 ± 1.8 ml/100 gm/min). When the values for edematous brain were corrected for dilution, however, the local CBF averaged 25.3 ± 1.7 ml/100 gm/min, which was similar to the control value.

Local CMRgl was found to be significantly increased in plasma-infused white matter (16.3 ± 2.2 µmol/100 gm/min) compared with that in control white matter (10.7 ± 1.3 µmol/100 gm/min). This difference remained, despite correction for dilution and recalculation of local CMRgl values based on altered kinetic constants found in edematous brain. A similar increase in local CMRgl was noted with saline-infusion edema. It is concluded that the increased tissue water level does not alter CBF, but does induce an increase in anaerobic metabolism.
Isolation and partial purification of growth factors with TGF-like activity from human malignant gliomas
Authors: Rutka James T. , Rosenblum Mark L. , Stern Robert , Ralston Henry J. , Dougherty Dolores , Giblin Jane , DeArmond Steve
Published: May 2009

✓ The effect of concentrated conditioned medium from each of eight human malignant glioma cell lines on the growth of indicator cells (normal rat kidney fibroblasts (NRK), clone 14) was determined in monolayer and in soft agar assay systems. The conditioned medium from all cell lines was mitogenic in the monolayer assay, but only SF-210, U-343 MG-A, and U-251 MG produced soluble factors that caused NRK cells to grow in soft agar. The soluble growth-promoting factors from these three cell lines were acid- and heat-stable (60°C for 30 minutes) but were inactivated by trypsin (100 µm/ml) and dithiothreitol (50 µM). The growth factors from SF-210 and U-343 MG-A were further purified by molecular-sieve chromatography. The partially purified growth factor from U-343 MG-A retained transforming growth factor (TGF)-like activity, had a molecular weight of 9 kD, was potentiated by TGF-β in the soft agar assay, competed effectively with 125I-epidermal growth factor (EGF) radiolabeled for the EGF receptor on A 431 epidermoid carcinoma cells, and was completely inhibited by monoclonal antibodies to TGF-α. The partially purified growth factor from SF-210 had a molecular weight of 17 kD, was not inhibited by monoclonal antibodies to platelet-derived growth factor (PDGF) or TGF-α, and did not bind to a heparin-Sepharose column. These results imply that U-343 MG-A secretes a growth factor with TGF-α-like activity, and SF-210 secretes a TGF with neither TGF-α nor TGF-β activity.