bluuebunny/crossref_metadata_2025 huggingface dataset:
HBx Sensitizes Cells to Oxidative Stress-induced Apoptosis by Accelerating the Loss of Mcl-1 Protein via Caspase-3 Cascade
Authors: Hu Liang , Chen Lei , Yang GuangZhen , Li Liang , Sun HanYong , Chang YanXin , Tu QianQian , Wu MengChao , Wang HongYang
Published: April 2011

Background

Oxidative stress has been implicated in the pathogenesis of a wide spectrum of human diseases, including Hepatitis B virus (HBV)-related liver disease. Hepatitis B virus X protein (HBx) is a key regulator of HBV that exerts pleiotropic activity on cellular functions. Recent studies showed that HBx alters mitochondrial membrane potential, thereby sensitizing cells to pro-apoptotic signals. However, it remains largely unknown whether susceptibility of hepatocytes could be disturbed by HBx under oxidative stress conditions. The purpose of this study is to determine the apoptotic susceptibility of HBx-expressing hepatocytes upon exposure to pro-oxidant stimuli in vitro and in vivo and explore its underlying mechanism.

Results

Although expression of HBx itself did not activate apoptotic signaling, it significantly enhanced oxidative stress-induced cell death both in vitro and in vivo. Interestingly, this phenomenon was associated with a pronounced reduction of protein levels of Mcl-1, but not other anti-apoptotic Bcl-2 members. Importantly, enforced expression of Mcl-1 prevented HBx-triggered cell apoptosis; conversely, specific knockdown of Mcl-1 exacerbated HBx-induced apoptosis upon exposure to oxidative stress. Furthermore, inhibition of caspase-3 not only abrogated HBx-triggered apoptotic killing but also blocked HBx-induced Mcl-1 loss. Additionally, expression of HBx and Mcl-1 was found to be inversely correlated in HBV-related hepatocellular carcinogenesis (HCC) tissues.

Conclusions

Our findings indicate that HBx exerts pro-apoptotic effect upon exposure to oxidative stress probably through accelerating the loss of Mcl-1 protein via caspase-3 cascade, which may shed a new light on the molecular mechanism of HBV-related hepatocarcinogenesis.
Luxury Perfusion Syndrome Confirmed by Sequential Studies of Regional Cerebral Blood Flow and Volume after Extracranial to Intracranial Bypass Surgery: Case Report
Authors: Higashi Sotaro , Matsuda Hiroshi , Fujii Hiroyuki , Ito Haruhide , Yamashita Junkoh
Published: April 2011

We report a case of luxury perfusion syndrome with temporary neurological deterioration after extracranial to intracranial bypass surgery. A preoperative computed tomographic scan showed no detectable infarct, and the measurement of regional cerebral blood flow showed severe depression of ipsilateral hemispheric perfusion. The patient developed temporary neurological deterioration after bypass surgery, with no recognizable pathological signs on postoperative computed tomographic and angiographic studies. Regional cerebral blood flow and volume were more elevated during the period of neurological deterioration than after the subsequent recovery. This strongly suggests that excessive blood flow directed into chronically ischemic brain through a graft may induce a luxury perfusion syndrome resulting in neurological deterioration.
The Incidence of Unexpected Pathological Findings in an Image-Guided Biopsy Series: A Review of 100 Consecutive Cases
Authors: Friedman William A. , Sceats James D. , Nestok Blake R. , Ballinger William E.
Published: April 2011

Despite the widespread availability of image-guided stereotactic biopsy, the need for such procedures in patients with “clear-cut” clinical and radiographic diagnoses is still frequently discussed. In an attempt to ascertain the incidence of unexpected pathological findings, 100 consecutive stereotactic biopsies have been reviewed. Twelve patients were found to have diagnoses of pathological conditions that preoperatively were considered unlikely, or not considered at all. The details of these “diagnostically discordant” cases are discussed.
Cerebral Distribution of Immunoconjugate after Treatment for Neoplastic Meningitis Using an Intrathecal Radiolabeled Monoclonal Antibody
Authors: Benjamin Jonathan Charles , Moss Timothy , Mosely Robin Peter , Maxwell Ruth , Coakham Hugh Beresford
Published: April 2011

A detailed autopsy and autoradiographic study was performed after the death of a patient undergoing intrathecal, antibody-guided irradiation for carcinomatous meningitis. The results demonstrated tumor cells infiltrating the surface meninges and a severe astrocytic reaction associated with oedema in the periventricular and brain stem subpial white matter. This was not seen in cortical or other gray matter structures. Autoradiographic examination correlated well, demonstrating isotope within the oedematous areas of the white matter in addition to the expected concentration in the leptomeningeal layers. These findings are discussed in the context of antibody binding to tumor tissue and the possible benefits conferred in the treatment of infiltrating tumor cells.
Brown-Seéquard Syndrome Associated with Posttraumatic Cervical Epidural Hematoma: Case Report and Review of the Literature
Authors: Zupruk Gerald M. , Mehta Zoya
Published: April 2011

Post-traumatic cervical epidural hematoma is an uncommon entity. A case is presented in which such a lesion developed after chiropractic manipulation of the neck. The patient presented with a Brown-Séquard syndrome, which has only rarely been reported in association with cervical epidural hematoma. The correct diagnosis was obtained by computed tomographic scanning. Surgical evacuation of the hematoma was followed by full recovery.
Transcranial Doppler Monitoring of Cerebral Flow Velocities during Surgical Occlusion of the Carotid Artery
Authors: Powers Alexandros D. , Smith Robert R. , Graeber Michael C.
Published: April 2011

Transcranial Doppler (TCD) was used to assess collateral flow and to quantitate perfusion velocity changes in a group of 18 patients requiring temporary or permanent surgical occlusion of the internal carotid artery for treatment of their cerebrovascular lesions. Velocity measurements were correlated with times of occlusion and neurological outcome in order to assess safe vessel occlusion times and the need for an intraoperative shunt. These data were used to calculate a perfusion velocity index (PVi), which indicated that values >2 were well tolerated, and values of <1 were associated with ischemic signs. In addition, preoperative TCD examinations were combined with compressive maneuvers of the carotid artery in the neck to evaluate the feasibility of carotid clamp ligation for the treatment of giant intracranial aneurysms deemed unsuitable for direct clipping. When maintenance of neurological function and intracranial vessel flow velocities were found to be normal, with aneurysmal flow velocities of zero, ligation of the carotid artery could safely be undertaken. Finally, TCD allowed continuous surveillance of cerebral hemodynamics, which gave immediate assurance of postoperative ICA patency, as well as the ability to identify high velocity states associated with hyperperfusion syndromes, which occurred in two patients.
Late Magnetic Resonance Imaging Related to Neurobehavioral Functioning after Aneurysmal Subarachnoid Hemorrhage
Authors: Romner Bertil , Sonesson Bengt , Ljunggren Bengt , Brandt Lennart , Säveland Hans , Holtås Stig
Published: April 2011

Twenty patients who underwent early aneurysm surgery—that is, surgery within 72 hours after rupture—underwent further follow-up examination including magnetic resonance imaging (MRI) of the brain and a comprehensive neuropsychological assessment. Significant statistical correlation between tissue loss as seen on a late MRI scan and neurobehavioral deficits could not be established. Among 9 patients with no tissue loss seen on MRI, 3 exhibited substantial cognitive dysfunction and 6 had mild impairment. Three patients showed minor but corresponding tissue loss and deficits. In 3 patients with pronounced pathological indications on MRI, evidence of cognitive dysfunction was absent in 2, and 1 patient showed substantial impairment. The remaining 5 individuals displayed moderate pathological indications on MRI, with no obvious correspondence to cognitive functioning. In 7 patients, small white matter lesions, probably silent infarcts not seen on computed tomographic scan, were discovered on MRI. There was a clear relationship between arterial hypertension prior to aneurysm rupture and the extent of tissue loss seen on MRI. Absence of pathological findings on MRI scan did not exclude cognitive malfunctioning, and vice-versa.
Transluminal Angioplasty of Intracerebral Vessels for Cerebral Arterial Spasm: Reversal of Neurological Deficits after Delayed Treatment
Authors: Barnwell Stanley L. , Higashida Randall T. , Halbach Van V. , Dowd Christopher F. , Wilson Charles B. , Hieshima Grant B.
Published: April 2011

We used intracerebral transluminal angioplasty to treat two episodes of symptomatic vasospasm in a patient recovering from an aneurysmal subarachnoid hemorrhage. The procedures were performed after medical therapies, intravascular volume expansion, and induced arterial hypertension failed to alleviate the patient's neurological condition. The first angioplasty, confined to the right middle cerebral and distal internal carotid arteries, took place more than 30 hours after the onset of left hemiplegia. Despite the subsequent discovery of a small parietal lobe infarct, it brought about a marked improvement in left motor function and may have also limited the spread of necrotic damage. The second angioplasty was necessitated when stenotic segments of the basilar and posterior cerebral arteries caused a 24-hour decline in the patient's mental status. Although delayed in relation to the onset of symptoms, it successfully reversed the patient's comatose state. The use of transluminal angioplasty for vasospasm is generally limited to cases where it can be performed shortly after the onset of neurological symptoms; delaying the procedure increases the risk of hemorrhage from reperfused areas of infarction. Our experience with this patient demonstrates that delayed angioplasty can improve vascular flow to ischemic territory, even after infarction, without complications and with resultant improvement in neurological function.
Suprasellar Arachnoid Cysts: Management by Cyst Wall Resection
Authors: Jones Robert Francis Clifford , Warnock Timothy Hugh , Nayanar Vimala , Gupta Jagdish Mitter
Published: April 2011

Five children with ventricular dilatation (4 boys, 1 girl) had features seen on computer tomographic scan that were consistent with suprasellar arachnoid cysts. All children were investigated with a CT ventriculogram and/or CT cisternogram, and no communication with the cyst was demonstrated. Three children were seen in the 1st year of life and the remaining 2 children were between 1 and 5 years of age. Hydrocephalus and developmental delay were the most common presenting features, followed by visual disturbance, squint, or ataxia. Direct surgical decompression was performed in all 5 patients to avoid long-term placement of a ventriculoperitoneal shunt. A temporary shunt was placed in 2 children because of high intracranial pressure. Direct partial excision of the cyst wall to allow long-term drainage into the basal cisterns or ventricular system was successful in all children. The presence of subdural collections postoperatively required temporary shunting in 2 children. After follow-up for between 10 and 22 months no clinical endocrinological sequelae have been detected, but 2 children have raised serum prolactin levels. Three children are developmentally delayed; one of these has regained some skills since surgery. Direct surgical decompression of suprasellar arachnoid cysts to avoid long-term shunt placement is the preferred method of surgical treatment for this condition.
Efficacy of Single Intracisternal Bolus Injection of Recombinant Tissue Plasminogen Activator to Prevent Delayed Cerebral Vasospasm after Experimental Subarachnoid Hemorrhage
Authors: Seifert Volker , Eisert Wolfgang G. , Stolke Dietmar , Goetz Christoph
Published: April 2011

Premature lysis of subarachnoid blood clots by thrombolytic substances such as urokinase and plasmin has been shown to be efficacious in preventing cerebral vasospasm in clinical and experimental investigations. Recently, tissue plasminogen activator (rtPA) derived from recombinant deoxyribonucleic (DNA) technology has been introduced as a new thrombolytic substance. With its high affinity for fibrin-bound plasminogen and low affinity for circulating plasminogen by which a clot-selective fibrinolysis can be achieved without the danger of inducing systemic fibrinogenolysis, rtPA might be the ideal substance for the postoperative lysis of cisternal blood accumulations after subarachnoid hemorrhage. The efficacy of rtPA in preventing delayed cerebral vasospasm after experimental subarachnoid hemorrhage using a single intracisternal bolus injection of this agent was investigated. With a single injection of 25 Mg of rtPA into the cisterna magna 48 hours after the first and 6 hours after the second injection of blood in the two-hemorrhage model of cerebral vasospasm, angiographic spasm of the basilar artery was completely prevented in all animals so treated whereas in the control group severe vasospasm occurred. Autopsy studies of the experimental animals demonstrated that the subarachnoid blood clots were almost completely removed by intracisternal rtPA application. Additionally the pathomorphological signs of proliferative vasculopathy present in all animals of the control group were not demonstrable in the rtPA group. As intracisternal bolus injection of rtPA is highly efficacious in preventing angiographic as well as pathomorphological vasospasm, it is concluded that use of this thrombolytic substance might be a promising approach for pharmacological blood clot removal.
The Effects of Hyperventilation on Cerebral Blood Flow in the Rat with an Open and Closed Carotid-Jugular Fistula
Authors: Morgan Michael K. , Anderson Robert E. , Sundt Thoralf M.
Published: April 2011

Perturbations in cerebral hemodynamics at the time of ablation of an arteriovenous shunt have been regarded as important in the pathogenesis of swelling and hemorrhage complicating resection of arteriovenous malformations (AVMs). A carotid-jugular fistula model in the rat had previously been investigated and found to simulate in part the nonhemorrhagic pathophysiology of a large cerebral arteriovenous fistula. Utilizing this model and measuring cerebral blood flow in 14 regions with a [14C]iodoantipyrine autoradiographic technique, the effects of hypocapnea on the cerebral circulation in opened and closed fistulas were investigated. Regional cerebral blood flow (rCBF) in control animals ranged from a median of 53 to 64 ml/100 g/min at a partial arterial carbon dioxide pressure (PaCO2) of 28 ± 2 mm Hg and 85 to 112 ml/100 g/min at a PaCO2 of 40 ± 5 mm Hg. In animals with an open carotid-jugular fistula created 12 weeks before the study, these median rCBF values at comparable PaCO2 levels ranged, respectively, from 15 to 39 ml/100 g/min and 50 to 68 ml/100 g/min (the 25th percentile for the open fistula in the hypocapneic group was 15 ml/100 g/min in 5 of the 14 regions studied). In contrast, median rCBF in the closed fistula group ranged from 73 to 100 ml/100 g/min in hypocapneic animals and from 118 to 187 ml/100 g/min in normocapneic animals. These results demonstrate the preservation of CO2 reactivity; hypoperfusion in the presence of a carotid-jugular fistula, hyperemia on fistula occlusion, and the potential to induce cerebral ischemia with hyperventilation in this model of a cerebral arteriovenous fistula. These data caution against the use of hyperventilation during surgery in patients with cerebral arteriovenous malformations.
Transcranial Doppler Monitoring of Cerebral Blood Velocity During Craniotomy
Authors: Giller Cole A.
Published: April 2011

Transcranial Doppler techniques were used to monitor blood velocity in cerebral arteries continuously during 14 neurosurgical operations performed on 13 patients, including 12 craniotomies. Stable Doppler signals were obtained for prolonged periods of time, and they correlated with intraoperative events. Monitoring during spontaneous blood pressure and CO2 variations allowed assessment of autoregulatory capacity. In particular, 5 of the 7 patients receiving craniotomy for aneurysmal subarachnoid hemorrhage had impaired autoregulation. A 30 to 50% decrease in Doppler velocities was seen in 7 patients after etomidate administration. Early experience suggests that transcranial Doppler monitoring during craniotomy is feasible and can indicate the effects of operative events on blood flow as well as provide an assessment of cerebral autoregulation.
Sterile Abscesses in Glioma Patients Treated by Intraparenchymal Injection of Lymphokine-Activated Killer Cells and Recombinant Interleukin-2: Case Reports
Authors: Atkinson Lynn L. , Merchant Randall E. , Ghatak Nitya R. , Young Harold F.
Published: April 2011

Earlier, we conducted Phase I clinical trials to determine any acute toxicity of adoptive immunotherapy with intralesional injections of autologous lymphocytes expressing lymphokine-activated killer (LAK) activity and recombinant interleukin-2 (rIL-2) in patients with malignant glioma. Within six weeks of craniotomy and intralesional injection of autologous LAK cells plus rIL-2, 3 of 29 patients demonstrated a decline in clinical status and evidence on computed tomographic and magnetic resonance imaging scans of edema and mass of unknown character at the site of previous surgery and immunotherapy. Craniotomy was performed to remove the tissue and reduce intracranial pressure. Microscopic examination of the excised material indicated no new tumor growth within the resected mass, but rather that the tissue had the histological characteristics of a chronic sterile abscess including necrosis, fibrosis, and influx of inflammatory cells. Factors that may have contributed to this reaction in the 3 patients were age, Karnofsky score, the extent of tumor excision, and immune status. All 3 had also been treated with greater than average numbers of rIL-2 activated lymphocytes that demonstrated significant in vitro LAK activity. The results suggest that in patients whose clinical status is good and who are not immunosuppressed by corticosteroids, the dose-limiting toxicity of intraparenchymal immunotherapy with LAK cells plus rIL-2 for glioma may be related to the total, absolute number of activated cells injected, and this toxicity develops over time and is manifested by development of a sterile abscess.
Metastatic Small Cell Carcinoma to the Pineal Body: Case
Authors: Kashiwagi Shiro , Hatano Mitsunori , Yokoyama Tatsunori
Published: April 2011

A case of metastatic small cell carcinoma to the pineal body is reported and the clinical and radiological features of this rare tumor are discussed. A 66-year-old man presented with progressive dementia, gait disturbance, vertical gaze palsy. and convergence retraction nystagmus. Computed tomographic scan revealed a 2 × 3-cm high-density mass in the pineal region, which showed strong contrast enhancement. The tumor was resected through a right occipital transtentorial approach. The pathological diagnosis of the surgical specimens was small cell carcinoma. A systemic workup for the primary lesion subsequently revealed small cell carcinoma of the lung. Although occurring rarely, metastatic tumor should be considered in the differential diagnosis of pineal tumor in elderly patients.
A Modification of the Brown-Roberts-Wells Stereotactic Frame for Implantation of Ventricular Access Reservoirs
Authors: Frank Edmund , Kohler Erik , Hein Larry
Published: April 2011

A ventricular catheter and connected subcutaneous reservoir (ventricular access reservoir) allows easy, repeated access to the cerebrospinal fluid for a multitude of purposes. In situations in which the ventricles are small or displaced, insertion of a ventricular catheter may be difficult. Multiple passes to cannulate the ventricle may damage the brain and manipulation of the catheter and reservoir may cause migration of the catheter, possibly compromising its function. A stereotactic method for insertion of ventricular access reservoirs using a device that attaches to the Brown-Roberts-Wells stereotactic system has been developed. With this device the catheter and reservoir are guided into place as a single unit, utilizing a guide attached to the Brown-Roberts-Wells frame. This technique has been useful in inserting ventricular access reservoirs into patients with small ventricles or in whom there is some abnormality of the brain or skull that renders classical landmarks for ventricular cannulation useless.
Synchronous Vertebral Decompression and Posterior Stabilization in the Treatment of Spinal Malignancy
Authors: Johnston Francis G. , Uttley David , Marsh Henry T.
Published: April 2011

Thirty-four patients with metastatic tumors of the spinal column exhibiting vertebral collapse and posterior element disease were treated by a single-stage operation combining decompression of the vertebral body with posterior spinal instrumentation. Attention is drawn to the use of computed tomographic scanning in planning the operative approach. The indications for surgery were neurological deficit in 32 patients and pain in 2; 14 patients received preoperative radiotherapy. Of the 21 patients who were nonambulant preoperatively, 67% walked again, 21% regained sphincter control, and 68% had less pain. The surgical mortality was 12%; wound infection and dehiscence occurred in 15%. These results indicate that a single-stage decompression and posterior stabilization may improve neurological function dramatically in patients with malignant cord compression. The operative morbidity and mortality is comparable to that of laminectomy.
Reduced Size of a Hormonally Silent Pituitary Adenoma during Treatment with CV 205-502, a New Dopamine Agonist Mainly Stimulating D2 Receptors
Authors: Hedner Pavo , Valdemarsson Stig
Published: April 2011

A 39-year-old woman with secondary amenorrhea and visual field defects underwent craniotomy for a large pituitary tumor that was hormonally silent according to measurement of plasma hormone levels and immunohistochemical analysis. During the preoperative investigation, bromocriptine was administered for 1 month, but there was no change in the tumor size as seen on computed tomographic scans. One month after surgery, visual field defects recurred, and a tumor mass comparable to the preoperative state was found on computed tomographic scan. The tumor size gradually diminished during treatment with CV 205-502, a tricyclic benzoquinoline which stimulates mainly D2receptors and is better tolerated than bromocriptine. The visual fields were completely normalized after 3 months of treatment with the drug, and surgical management of the tumor mass was no longer considered to be necessary. Thus, as in many similar cases, the hormonally silent pituitary tumor in this patient proved unresponsive to bromocriptine treatment. In contrast. the tumor was reduced by therapy with CV 205-502, a drug that is better tolerated and might permit a more intense stimulation of D2receptors.
Transoral Stereotactic Biopsy of the Second Cervical Vertebral Body: Case Report with Technical Note
Authors: Patil Angelo A.
Published: April 2011

Although the transoral approach to the atlantoaxial region is generally an open surgical procedure, in patients in whom only tissue diagnosis is required, a needle biopsy can be done. In this paper a patient with a metastatic lesion in the second cervical vertebral body is presented, and the technique for needle biopsy of the second cervical body using stereotactic methods is described.
Craniocervical Stabilization Using Luque/Hartshill Rectangles
Authors: MacKenzie Alasdair I. , Uttley David , Marsh Henry T. , Bell B. A.
Published: April 2011

Unteated craniocervical instability is associated with a high morbidity and a significant mortality. Existing methods using bone grafts, interlaminar wires, or acrylic eventually produce stability but require prolonged periods of immobility and have a high failure rate. The ideal method of fixation should provide for permanent correction of deformity and relief of symptoms, with immediate stabilization, at a single procedure. Posterior fixation of the occiput to a stable part of the cervical spine with a molded metal rectangle held in place by interlaminar wires was used to accomplish this. We report 20 patients treated consecutively who have undergone craniocervical fusion by this method using Luque/Hartshill rectangles. Fourteen patients had preexisting atlantoaxial instability and 6 had cord compression, but would become unstable after decompression. All operations were performed under general anesthesia; 9 patients (40%) were awake for intubation/positioning, and 7 patients had a simultaneous decompression. Sixteen patients made an uncomplicated recovery and became mobile 3 days postoperatively. Symptomatic and neurological improvement occurred in 70% of all patients. Neurological complications occurred in 4 patients (20%), reflecting the serious nature of the condition; 2 patients (10%) showed no change. Scrutiny of their presentations and operations failed to identify avoidable risk factors, except faulty wiring techniques. In all patients, permanent stabilization was achieved immediately, facilitating early mobilization with a real chance of improvement, which indicates that the method merits wider application. (Neurosurgery 26:32-36, 1990)
Combined Use of Subdural and Intracerebral Electrodes in Preoperative Evaluation of Epilepsy
Authors: van Veelen C. W. M. , Debets R. M. Chr. , van Huffelen A. C. , van Emde Boas W. , Binnie C. D. , van Leeuwen Storm W. , Velis D. N. , van Dieren A.
Published: April 2011

For intracranial recording of partial seizures considered to originate from one of the temporal or frontal lobes, the team in the Utrecht Academic Hospital has used subdural, multicontact, flexible electrodes since 1972. These are introduced through bilateral, frontocentral trephine holes and are manipulated under fluoroscopy to cover most of the cerebral convexity. It became evident that in many patients, additional placements to record from intracerebral structures were indispensable. Therefore, using the same trephine holes, an additional 2 to 4 depth electrodes were stereotactically implanted in the mesial temporal and/or frontal structures, as appropriate. An extensive intra- and extracerebral spatial representation of the epileptogenic zone was thus obtained. We report here the methods for manufacturing and applying these electrodes and our clinical experience with 28 patients. The results obtained so far stress the value of combining subdural and depth electroencephalographic monitoring in the presurgical selection of patients suffering from medically refractory complex partial seizures. By miniaturizing the electrodes, extensive areas of the brain can be investigated without craniotomy or multiple burr holes. (Neurosurgery 26:93-101, 1990)
Intraventricular Neurocytoma: A Report of Two Cases
Authors: Patil Angelo A. , McComb R. D. , Gelber B. , McConnell J. , Sasse S.
Published: April 2011

Intraventricular neurocytoma is a rare clincopathological entity that has been recently recognized. Previous reports have not described the magnetic resonance imaging findings of this tumor. This paper describes two patients with neurocytoma in which serpiginous flow voids and isointensity with cortex were distinctive features on the magnetic resonance imaging scan. Immunohistochemical studies showed reactivity for neuron-specific enolase, Leu-7, and S-100 protein. (Neurosurgery 26:140-144, 1990)
Middle Fossa Arachnoid Cyst Eroding into the Middle Ear: Case Report
Authors: Haworth Charles S. , Pobereskin Louis H.
Published: April 2011

We describe an unusual presentation of a large middle fossa cyst which eroded through the anterior petrous ridge into the middle ear. The significance of this and considerations related to its treatment are discussed. (Neurosurgery 26:154-155, 1990)
A Study of the Reactivity of Feeding Vessels to Arteriovenous Malformations: Correlation with Clinical Outcome
Authors: Muraszko Karin , Wang Hsueh Hwa , Pelton Gregory , Stein Bennett M.
Published: April 2011

Isolated segments from the feeding arteries to arteriovenous malformations (AVMs) from 24 patients were studied in vitro. In a perfusion chamber, isometric contraction of these arterial rings to various vasoactive substances was recorded and correlated with the following: spontaneous activity, spasm as seen in the operating room; radiographic evidence of ectasia preoperatively and postoperatively; and postoperative course. Of the 24 patients studied, four patients had nonreactive AVM nutrient vessels upon in vitro testing. In addition, these vessel segments displayed no spontaneous activity although all of the other vessels tested developed spontaneous activity while in the perfusion chamber. The patients with “unreactive vessels” had an increased incidence of postoperative edema and hemorrhage in the surrounding brain, consistent with the symptoms of normal perfusion pressure breakthrough. Thus, our study utilizes an in vitro technique to evaluate a specific segment of the AVM complex, the feeding vessel, which permitted us to assess abnormalities of reactivity in these vessel segments. This method may be useful for future evaluations of the pathophysiology of AVMs.
Transcranial Doppler Ultrasound as a Guide to Graded Therapeutic Occlusion of the Carotid Artery
Authors: Giller Cole A. , Steig Phillip , Batjer Hunt H. , Samson Duke , Purdy Phillip
Published: April 2011

Although gradual carotid artery occlusion is an accepted and effective treatment for some surgically inaccessible intracranial aneurysms, there are no specific guidelines to determine the optimal amount of carotid artery narrowing at each adjustment. The technique of transcranial Doppler ultrasound, however, allows continuous measurement of blood velocity in the middle cerebral artery as the carotid artery is narrowed, so that hemodynamic effects and development of collateral flow can be immediately assessed at the bedside at each adjustment of the carotid artery diameter. This case report describes the use of transcranial Doppler to guide the rate of carotid occlusion in a patient with an unclippable giant aneurysm of the carotid artery. Sudden carotid occlusion and gradual occlusion at the usual rate were not tolerated by the patient. but repeatedly tightening the clamp until the first signs of attenuation of the Doppler signal allowed an expedient occlusion without complication. Transcranial Doppler ultrasound can provide a useful dynamic guide to gradual therapeutic carotid occlusion.
Ruptured Aneurysm at the Origin of the Accessory Middle Cerebral Artery: Case Report
Authors: Kuwabara Satoshi , Naitoh Hiroki
Published: April 2011

The accessory middle cerebral artery is a rare vascular anomaly of the brain. We describe a case of a ruptured aneurysm at the junction of the accessory middle cerebral artery and the horizontal portion of the anterior cerebral artery. The lesion was demonstrated by angiography and confirmed at surgery. No perforating arteries arising from this accessory artery were found. There have been only four previous reports of aneurysms located at the origin of the accessory middle cerebral artery. The relevant literature is briefly reviewed.
Arterial Graft Reconstruction in an Aneurysm of the Middle Cerebral Artery
Authors: Ramina Ricardo , Arruda Walter O. , Prestes Antonio C. F. , Parolin Monica K. F. , Teive Helio G. , Meneses Murilo S.
Published: April 2011

A case of a large aneurysm of the middle cerebral artery that was treated by resection of the aneurysm sac and reconstruction of the vessel is presented. The middle cerebral artery was reconstructed using a graft from the superficial temporal artery (STA). Cerebral vessel reconstructions are usually carried out with veins as grafts. This paper shows the possibility of using the STA as a graft. When a vessel reconstruction is contemplated, the skin flap should be planned in order to save the STA.
Adrenal Medulla Transplantation into the Putamen in Parkinson's Disease
Authors: Takeuchi Juji , Takebe Yoshihiro , Sakakura Tadashi , Hara Yasushi , Yasuda Takanari , Imai Terukuni
Published: April 2011

Autologous adrenal medulla was transplanted into the putamen of a patient with severe Parkinson's disease. After the operation, the patient's akinesia and rigidity decreased and the duration of action of L-dopa treatment was prolonged. The effect lasted for only 6 months, however, following which the patient's condition gradually began to deteriorate again, returning to the preoperative state by 12 months after surgery. This paper discusses possible reasons why the effect was only temporary.
Diffuse Idiopathic Skeletal Hyperostosis Causing Acute Thoracic Myelopathy: A Case Report and Discussion
Authors: Reisner Andrew , Stiles Richard G. , Tindall Suzie C.
Published: April 2011

A case of diffuse idiopathic skeletal hyperostosis presenting as acute thoracic myelopathy is reported. Diffuse idiopathic skeletal hyperostosis has long been regarded as a radiological entity with an innocuous clinical course. The manifestations of this disease are reviewed. There is mounting evidence that it is neither a clinically infrequent nor, as this case report illustrates, an exclusively benign condition.
Pseudopsychopathic Syndrome in Hydrocephalus: A Case Report and Review
Authors: Bowen Matthew , Verma Arun , Bajwa Saeed , Kusmirek Leslie
Published: April 2011

A 24-year-old man with a head injury developed a communicating hydrocephalus and underwent ventriculoperitoneal shunting. A revision was required, and the patient emerged from coma with severe behavior outbursts, which persisted for more than 1 year. Computed tomographic scans indicated a recurrence of low-pressure communicating hydrocephalus and a shunt revision was performed. The patient's severe behavior outbursts immediately decreased dramatically, The improvement continued long term and extended beyond the acute rehabilitation program.
Decompression of Lumbar Spinal Stenosis and Stabilization with Knodt Rods in the Elderly Patient
Authors: Conley Frances K. , Cady Carol T. , Lieberson Robert E.
Published: April 2011

We present a series of 25 elderly patients who exhibited signs and symptoms of neurogenic claudication and who were found to have one or two levels of spinal stenosis. At the time of decompressive surgery, excessive movement was found at the stenotic levels, so a simple stabilization procedure was performed using Knodt rods and a facet fusion. The expectation was that spine fixation would decrease the amount of postoperative back pain, which can be a result of continued abnormal mobility. All of the patients have been followed for 2 or more years. This elderly group of individuals tolerated surgery well, and long-term results were good.
Magnetic Resonance Imaging of a Fat Embolism of the Brain: Case Report
Authors: Saito Atsushi , Meguro Kotoo , Matsumura Akira , Komatsu Yoji , Oohashi Noriyoshi
Published: April 2011

A 22-year-old man developed fat embolism syndrome. Although a computed tomographic (CT) scan of the brain showed nothing abnormal, a magnetic resonance imaging scan detected scattered spotty areas of low intensity on T1-weighted images and of high intensity on T2-weighted images. Magnetic resonance imaging is thought to be more sensitive than computed tomography in detecting cerebral fat embolism syndrome and correlates well with the clinical course.
Treatment of Carotid-Cavernous Fistulas Associated with Ehlers-Danlos Syndrome
Authors: Halbach Van V. , Higashida Randall T. , Dowd Christopher F. , Barnwell Stanley L. , Hieshima Grant B.
Published: April 2011

Four patients with Ehlers-Danlos syndrome presented spontaneously with symptomatic direct carotid-cavernous fistulas. Two had previously (2 and 15 years, respectively) had contralateral carotid-cavernous fistulas that were treated with carotid occlusion procedures. The patients' ages at presentation ranged from 19 to 49 years, with a mean of 32 years. All four patients underwent attempted embolization procedures. Two patients had transarterial embolization, one with balloons and liquid adhesives, one with platinum coils and a balloon; the carotid artery was preserved in one and sacrificed in one other. In one patient, who underwent direct puncture of the carotid artery, a massive hematoma causing airway compromise required intubation and emergent surgical repair, The fistula spontaneously closed during this event. In the fourth patient, two transvenous embolizations resulted in markedly decreased flow, but diversion of residual flow to cortical veins produced a fatal pontine hemorrhage. The vascular fragility associated with Ehlers-Danlos syndrome can produce spontaneous direct carotid-cavernous fistulas and makes both diagnostic and therapeutic procedures more difficult.
Hydrostatic Dilatation of Autologous Vein Grafts: Technical Note
Authors: Puca Alfredo , Spetzler Robert F. , Zabramski Joseph M.
Published: April 2011

The authors describe a method for hydrostatic dilatation of venous bypass grafts that limits trauma to the vessel wall while assuring maximal vessel diameter.
Tumors of the Lateral Ventricular Wall, Especially the Septum Pellucidum: Clinical Presentation and Variations in Pathological Features
Authors: Nishio Shunji , Fujiwara Shigeru , Tashima Takatoshi , Takeshita Iwao , Fujii Kiyotaka , Fukui Masashi
Published: April 2011

The clinical and histopathological features of 19 patients with tumors involving the septum pellucidum are presented. These tumors predominantly affected young adults, and the clinical manifestations were usually the results of raised intracranial pressure related to obstructive hydrocephalus, mental abnormality, epileptic seizures, or a combination of these. Seventeen of the tumors grew mainly in the lateral and third ventricles, and the other 2 grew both into the lateral ventricle and the cerebral parenchyma. The direction of cellular differentiation of the tumor cells varied from patient to patient and consisted of 8 neurocytomas, 1 mature neuronal tumor with ganglionic and small round neuronal cells, 3 subependymomas, 3 subependymal giant cell astrocytomas, 2 pilocytic astrocytomas, 1 malignant astrocytoma, and 1 teratoma with embryonal carcinoma. These tumors were considered to have arisen from the multipotential cells in the subependymal plate or germ cell rests in the lateral ventricular wall, especially in the septum pellucidum. Because of the relatively inert biological behavior and histological features of most of these tumors, we favor the malformative theory of their origin. Either total or an extensive excision of the tumors in this series, which had developed mainly in the ventricular system, provided long-term survival in many cases.
Epidural Abscess after Spinal Anesthesia: A Favorable Outcome
Authors: Abdel-Magid Roshdy A. , Kotb Hassan I. M.
Published: April 2011

A case of lumbar epidural abscess after spinal anesthesia with sciatica and sphincteric disturbance is presented. The case was investigated by myelography and diagnosed after exploration, resulting in dramatic improvement.
Symptomatic Pineal Cyst: Case Report
Authors: Maurer Paul Kurt , Ecklund James , Parisi Joseph E. , Ondra Stephen
Published: April 2011

Pineal cysts are being described with increasing frequency since the advent of magnetic resonance imaging. Although pineal cysts are incidental findings in as many as 4% of magnetic resonance imaging studies, symptomatic pineal cysts are quite rare. We present a case of pineal cyst causing aqueductal obstruction with symptomatic hydrocephalus and resultant headache and syncope, which was treated by surgical resection. A review of the relevant literature and discussion follow.
Cranial Vault and Gigantic Intracranial Hydatid Cyst in a Young Woman
Authors: Negovetic Lucijan , Lupret Velimir , Smiljanic Danko , Arsenic Boris
Published: April 2011

The case of a young woman (20 years) with a gigantic intracranial hydatid cyst (110 × 90 × 65 mm) is presented. The first manifestation was a grand mal seizure followed by symptoms of raised intracranial pressure. The origin of the cyst was in the diploe of the right check frontal, temporal, and parietal bones. An osteoplastic craniotomy was performed, and more than 100 fertile daughter cysts were removed, together with the wall of the cyst. A modification in the standard operative procedure is proposed for gigantic cysts that emerge from the diploe of the cranial vault and extend intracranially. Therapy with dexamethasone and phenobarbital was instituted preoperatively and continued postoperatively. The 3-month follow-up showed no relapse.
Intradural Herniation of a Thoracic Disc Presenting as Flaccid Paraplegia: Case Report
Authors: Hamilton Mark G. , Thomas Harvey G.
Published: April 2011

A case of intradural herniation of a thoracic disc in a patient with a flaccid paraplegia is described. Intradural herniation of a thoracic disc is considered a rare event. A review of the relevant patient literature revealed 14 other reports involving 28 patients. No other report has described a patient with an intradural thoracic disc herniation who developed a flaccid paraplegia.
A Case of Dyschondroplasia Associated with Brain Stem Glioma: Diagnosis by Stereotactic Biopsy
Authors: Patt Stephan , Weigel Klaus , Mayer Heinz Michael
Published: April 2011

We present a 24-year-old patient with multiple chondromas of both hands, the pelvis, the left leg, and an associated brain stem glioma. There was no evidence of hemangioma or dyschromia. and the condition was diagnosed as Ollier's disease, a special type of dyschondroplasia like Maffucci's syndrome and Kast's disease. An increased overall risk for development of malignant skeletal and nonskeletal tumors is associated with Maffucci's syndrome. The risk of malignant degeneration is lower in Ollier's disease. A glioma in the pons and the right lobe of the cerebellum was found in this patient. The literature describes an association with gliomas in only 12 cases of dyschondroplasia and an infratentorial localization in just one case. Signs of malignancy were histologically confirmed in 7 cases without significant preponderance of any one type. Our patient had a low-grade brain stem astrocytoma with fibrillar and gemistocytic components. A stereotactic serial biopsy made it possible to rule out malignant degeneration. Stereotactic brain tumor biopsy as a routine neurosurgical procedure is particularly valuable for deep space-occupying processes and forms the basis for therapy. In the present case, irradiation was not recommended.
Epidermoid Tumors of the 4th Ventricle: Report of Seven Cases
Authors: Lunardi Pierpaolo , Missori Paolo , Gagliardi Franco Maria , Fortuna Aldo
Published: April 2011

Epidermoid tumors occur very rarely in the 4th ventricle. We discuss the history, clinical course, and the surgical results for seven patients. One patient had a remittal of symptoms, probably due to the emergence of the tumor from the 4th ventricle into the cisterna magna. Total removal of the capsule was possible only in the youngest patient. At present, four patients (mean follow-up, 6 years) enjoy good general and neurological health.
Infectious Intracranial Aneurysms: Comparison of Groups with and without Endocarditis
Authors: Barrow Daniel L. , Prats Antonio R.
Published: April 2011

A series of 12 patients with infectious intracranial aneurysms is presented, and a number of unusual features of the disorder are emphasized. A comparison of characteristics of the aneurysms and clinical course is made between patients with and without infective endocarditis. Most of the unusual characteristics of infectious aneurysms, including rare locations, causative organisms, and predisposing medical conditions, occurred in the group without endocarditis. The relationship of atypical features of infectious aneurysms to the etiology of aneurysm formation is discussed, and an approach to treatment is presented.
Hypertension as a Risk Factor for Epilepsy after Aneurysmal Subarachnoid Hemorrhage and Surgery
Authors: öhman Juha
Published: April 2011

A prospective, consecutive series of 307 patients with aneurysmal subarachnoid hemorrhage ranging from Grades I to V according to the classification of Hunt and Hess on admission were evaluated to determine the incidence of epilepsy 1 to 3 years (mean, 1.4 years) after aneurysmal subarachnoid hemorrhage (SAH) and surgery. Sixty-three patients had died and one patient was lost to follow-up. Twenty-nine patients developed epileptic seizures after the SAH and surgery. The mean time from the SAH to epileptic seizure varied from 0 days (day of the SAH) to 2 years (mean, 6.7 months). The seizures were classified as focal in 9 patients (31%) and as generalized in 20 patients (69%). All patients received anticonvulsant medication after more than one seizure. The risk factors for development of posthemorrhagic/postoperative epilepsy were, in order of importance: a history of hypertension; an infarct on late computed tomographic scan; and the duration of coma after the ictus. Of the 85 patients with histories of hypertension, 17 (20.0%) developed epilepsy. Only 12 (5.4%) of the 222 nonhypertensive patients developed epileptic seizures. The difference between the groups was significant (P =0.0001). Computed tomographic scans were undertaken in 237 patients 1 to 3 years (mean, 1.4 years) after the SAH and surgery. Postoperative epilepsy was significantly associated with infarcts visualized on computed tomographic scan (P = 0.0005).
Subdural Hematoma Associated with Metastatic Neoplasms
Authors: McKenzie Clark R. , Rengachary Setti S. , McGregor Douglas H. , Dixon Anita Y. , Suskind Dana L.
Published: April 2011

Two cases of subdural hematoma, one acute and the other chronic, associated with cancer metastatic to the dura are reported. Various mechanisms of the association of hematomas with cancer are reviewed.
Concurrent Intradural and Extradural Meningiomas of the Cervical Spine
Authors: Weil Stuart M. , Gewirtz Robert J. , Tew John M.
Published: April 2011

A case of an extradural spinal meningioma presenting with a separate intradural meningioma at the same cord level is reported. Review of the English literature on spinal epidural meningiomas reveals a high incidence of concurrent intradural tumors in patients with epidural meningiomas. This leads to the conclusion that the intradural space should be evaluated carefully when an epidural meningioma is encountered.
Myelopathy Presenting Decades after Surgery for Congenital Cervical Cutaneous Lesions
Authors: Wu Julian K. , Scott Michael R.
Published: April 2011

We report on two patients in whom cervical myelopathy developed decades after they had undergone surgery for congenital cervical cutaneous lesions. Preoperative magnetic resonance imaging demonstrated dorsal tethering and cavitation of the cervical cord in the area of the previous surgery and was helpful in decision making regarding surgical exploration and in planning for it. We stress the importance of long-term follow-up by both clinical examination and magnetic resonance imaging in children who have been operated on for cervical cutaneous masses that may have central connections.