bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical approach to giant intracranial aneurysms
Authors: Sundt Thoralf M. , Piepgras David G.
Published: May 2009

✓ The authors report experience with the surgical management of 80 giant intracranial aneurysms (> 2.5cm in diameter) during a 10-year period in which they performed 594 operations for aneurysms. The overall incidence of giant aneurysms was 13% but varied according to location: 20% of aneurysms of the internal carotid artery (ICA); 13% of middle cerebral artery (MCA) aneurysms; 1% of anterior cerebral artery (ACA) aneurysms; 15% of aneurysms of the basilar artery caput (BAC); and 18% of vertebrobasilar trunk(VB) aneurysms. Twenty-five patients had a subarachnoid hemorrhage (SAH), 49 had mass effect from the aneurysm, and six had ischemic events. There was no apparent difference in results related to the presence or absence of an SAH. Poor results were attributable to the operation except in the two cases of ACA aneurysm in which preexisting dementia persisted. Mortality was 4% and morbidity was 14%, varying from a combined low morbidity-mortality of 8% for ICA lesions to a high of 50% for BAC aneurysms. During the period of the study, different techniques were developed in an attempt to lower the risks of surgery.Ultimately ICA aneurysms were monitored with cerebral blood flow measurements and electroencephalography before and after temporary ICA ligation, then approached following resection of the anterior clinoid or treated with bypass in combination with ICA ligation. Aneurysms of the MCA were either opened during temporary MCA occlusion or resected in combination with a bypass procedure. Bypass grafts and circulatory arrest with extracorporeal circulation may have a role in giant aneurysms of the posterior circulation.
Computerized tomography findings in arteriovenous malformations of the brain
Authors: Leblanc Richard , Ethier Roméo , Little John R.
Published: May 2009

✓ Computerized tomography (CT) scans of 54 patients with an arteriovenous malformation (AVM) of the brain were reviewed. The 31 males and 23 females (mean age: 33 years) were classified according to clinical presentation: 1) intracranial hemorrhage (30 patients); 2) seizure disorder (19 patients); and 3) other neurological disturbance (five patients). A brain hematoma was identified in all of the patients in the hemorrhage group having a CT scan within 1 week of the bleed. Extension of hemorrhage into the ventricular system as seen in eight cases was invariably accompanied by severe neurological dysfunction. A high-density lesion without associated mass effect was found in 48% of patients presenting with a seizure disorder. Dilatation of the ipsilateral lateral ventricle, a common finding in this group of patients, was thought to indicate an atrophic process. Evidence of discrete brain infarction was unusual. Intravenous infusion with Hypaque provided additional information in 31 of the 35 patients so studied. Demonstration of prominent or enlarged feeding arteries and/or draining veins occurred in 20% of patients with large malformations. Six cases of angiographically occult AVM's were found. A correlation of the CT scan with clinical, angiographic, and histological findings is presented.
Re-endothelialization of microvascular carotid end-to-side anastomosis in the rat
Authors: Gelderman Pim W. , Berendsen Wim
Published: May 2009

✓ A carotid end-to-side anastomosis was performed on 25 male and female Wistar rats (mean weight 197.8 gm). The animals were sacrificed at time intervals varying from 0 to 21 days after the operation. The anastomosis was exposed, the aorta cannulated, and the animals perfused with a 2.5% buffered glutaraldehyde solution at a constant pressure of 80 mm Hg. The anastomoses were removed for scanning electron microscopic (SEM) and light microscopic studies. The SEM results indicate that after the acute platelet-fibrin reaction in the first 48 hours, the suture line itself becomes re-endothelialized after 4 days. On the stitches, however, a cellular population consisting of leukocytes transforming into flattened cells was seen after 2 days. The morphology of these cells and their role in the regeneration of endothelium is discussed. This study presents evidence supporting a blood-borne genesis of endothelial cells in vivo.
Early neurosurgical repair in craniofacial dysmorphism
Authors: Hoffman Harold J. , Hendrick E. Bruce
Published: May 2009

✓ The authors describe the operative repair and results in 16 cases of craniofacial dysmorphism. The craniofacial dysmorphic states are presumably caused by premature closure of basal skull sutures in combination with the coronal sutures. Hydrocephalus is commonly associated with these conditions and contributes to the bizarre appearance as well as the abnormal mentation that some of these patients display. Early neurosurgical intervention using the procedure of lateral supraorbital ridge advancement yields excellent results in the majority of these infants.
Long-term analysis of cerebrospinal fluid shunt infections
Authors: George Randolph , Leibrock Lyal , Epstein Mel
Published: May 2009

✓ The authors have retrospectively analyzed 840 cerebrospinal fluid shunting procedures over a 25-year period to determine the relationships between infection rates and several possible influences on infection. Two-thirds of all shunt infections occurred within 1 month of surgery. The very young and very old had higher infection rates. Infections became less prevalent over the period of the study, and mortality from infection decreased from 35% to 6%. Successive shunts (revisions) were found to have progressively higher infection rates. Ventriculoatrial and ventriculoperitoneal silicone plastic shunts had similar infection rates (11.4% and 12.0%). The uncontrolled use of prophylactic antibiotics had no effect on shunt infections. Staphylococcus epidermidis became gradually more prevalent over the period of the study, and eventually caused one-half of all infections. Where infection occurred in the presence of prophylaxis, the infectious organism was usually sensitive to the antibiotic being used. The surgeon was found to be the largest single factor in the incidence of shunt infections. A 25-fold variance in infection rates among surgeons could be related to individual experience and technique.
Microsurgical anatomy of lumbosacral spinal roots
Authors: d'Avella Domenico , Mingrino Salvatore
Published: May 2009

✓ A dissecting microscope study of the microsurgical anatomy of the lumbosacral spinal roots, carried out on the spinal cords of 30 adult subjects, is reported. The longitudinal extent of the medullary segment of origin of each root, and the morphological features of the root-spinal cord junction are described. Observations regarding intrathecal anastomoses between anterior and posterior roots, and shape, position, and real incidence of anastomotic rami are reported. The authors emphasize the importance of anastomotic rami when performing a rhizotomy.
Excitability changes in peripheral nerve fibers after repetitive electrical stimulation
Authors: Ignelzi Ronald J. , Nyquist Judith K.
Published: May 2009

✓ The Melzack-Wall gate control theory has been invoked to explain the peripheral analgesia resulting from repetitive electrical stimulation of peripheral nerve. This model emphasizes presynaptic inhibitory interactions among afferent fiber terminals in the spinal cord. An alternative explanation, that of velocity change in peripheral nerve fiber conduction, has been suggested by compound action potential studies from our laboratory. The present study was designed to extend this work, and to investigate the single fiber changes subsequent to brief (5- to 20-minute) periods of repetitive, high frequency (180 to 200/sec) electrical stimulation through an implantable peripheral nerve cuff device of the type used clinically for pain relief. Most fibers, regardless of their diameter (estimated from conduction velocity), show one or more of the following characteristics: a transient slowing of conduction velocity, an increase in electrical threshold and/or a decrease in response probability following a period of repetitive electrical stimulation. This supports the hypothesis that there are changes in direct peripheral nerve fiber excitability occurring under conditions simulating clinical electroanalgesia.
Actinomycotic subdural empyema
Authors: Louie Jeff A. , Kusske John A. , Rush Jeffery L. , Pribram Henry W.
Published: May 2009

✓ The authors report a case of a subdural empyema caused by the organism Actinomyces israelii. The clinical course is outlined and the pathophysiological mechanism is discussed.
Delayed nonfatal pulmonary edema following subarachnoid hemorrhage
Authors: Fisher Anthony , Aboul-Nasr Hesham Tawfik
Published: May 2009

✓ A case of neurogenic pulmonary edema (NPE) is reported which is unusual in that it was delayed 4 days after the initial subarachnoid hemorrhage, and occurred at a time when the patient was improving clinically. After a favorable response to therapy, it recurred 48 hours later, again without neurological deterioration. The possible mechanisms in the production of NPE are discussed.
Familial communicating hydrocephalus, posterior cerebellar agenesis, mega cisterna magna, and port-wine nevi
Authors: Nova Harvey R.
Published: May 2009

✓ This report deals with a family in which the maternal grandmother, the mother, and all three male children have port-wine nevi and mega cisterna magna. Two of the three male children have, in addition, congenital communicating hydrocephalus associated with agenesis of the posterior cerebellar vermis. This case of familial communicating hydrocephalus, posterior cerebellar vermis agenesis, port-wine nevus, and mega cisterna magna represents a new neurocutaneous syndrome, possibly transmitted as an autosomal dominant.
Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra- to intracranial bypass
Authors: Gelber Benjamin R. , Sundt Thoralf M.
Published: May 2009

✓ Ten patients with intracranial internal carotid artery (ICA) aneurysms were managed by combining ICA ligation with an extracranial to intracranial bypass procedure. Nine of these grafts were proven patent by angiogram. One patient was unable to return for postoperative angiograms; his graft had appeared patent on physical examination. Seven aneurysms were intracavernous, two were giant carotid-ophthalmic aneurysms, and one aneurysm was at the intracranial bifurcation of the ICA. Despite occlusion cerebral blood flow (CBF) measurements of 20 ml/100 gm/min or less in six patients, only one patient was unable to tolerate ICA ligation. Three patients developed transient aphasia, but there were no permanent neurological deficits associated with the carotid occlusion. Seven patients had improvement in pre-existing extraocular palsies or visual field defects. Others remained stable.

The combination of an extracranial to intracranial microvascular bypass procedure with ICA ligation seems to be an effective method of treatment for aneurysms near the base of the skull that cannot be obliterated by a direct intracranial approach. The addition of the bypass procedure permits ICA ligation in patients who would not otherwise have tolerated occlusion of that vessel. Intraoperative xenon CBF measurements are an important adjunct to the operation.
Traumatic intracranial aneurysms
Authors: Parkinson Dwight , West Michael
Published: May 2009

✓ Eleven cases of traumatic intracranial aneurysms, six saccular and five arteriovenous, are presented with an operative mortality of 22.2%, which compares favorably with the few reports in the literature. These lesions are usually associated with serious head injuries. The diagnosis is often delayed or overlooked as the surgeon's attention is distracted by the presence of an accompanying intracranial hematoma. With increasing replacement of angiography by computerized tomography in aneurysm diagnosis, these aneurysms are even more likely to escape detection. They should be suspected in any patient who deteriorates within 2 weeks of the trauma. Conservative management carries a mortality rate of about 50%. Because of their superficial location, they are amenable to successful surgical extirpation. Improved mortality depends on early recognition and surgical obliteration.
Management of the unresectable cystic craniopharyngioma by aspiration through an Ommaya reservoir drainage system
Authors: Gutin Philip H. , Klemme William M. , Lagger Raymond L. , MacKay Alexander R. , Pitts Lawrence H. , Hosobuchi Yoshio
Published: May 2009

✓ Four patients with primary and recurrent craniopharyngiomas that were grossly cystic were managed by intermittent aspiration through an indwelling Ommaya reservoir apparatus. The technique is safe and provides a reasonable alternative for the amelioration of signs and symptoms when total extirpation of the tumor is impossible.
Spinal epidural neoplasia
Authors: Dunn Robert C. , Kelly William A. , Wohns Richard N. W. , Howe John F.
Published: May 2009

✓ The outcome following decompressive laminectomy and spinal irradiation has been evaluated in 104 consecutive patients with epidural metastatic neoplasia, using broad criteria for successful outcome. Of patients so treated, 33% were benefited, while 23% became worse. Both tumor histology and the preoperative neurological status were important factors in determining the response to this therapy. The authors review the surgical and radiotherapeutic literature in the treatment of this condition, and conclude that there is no clearly established superiority of laminectomy followed by irradiation over radiotherapy alone. Specific indications for surgery exist if prior histological confirmation of malignancy is lacking, if there is neurological deterioration during radiotherapy, or if there are recurrent symptoms referable to a previously irradiated metastasis. Surgery is also indicated if facilities for prompt administration of radiotherapy are unavailable.
The response of feline spinal pial arterioles to norepinephrine
Authors: Crawford Robert A. , Gregory Peter C. , Griffiths Ian R.
Published: May 2009

✓ The effect of norepinephrine on the diameter of feline spinal pial arteries and arterioles was studied by microapplication of the drug to the perivascular environment. Vascular diameter was determined by the television image-splitting method. Application of norepinephrine over the range of 5 × 10−8M to 5 × 10−3M to spinal pial arterioles resulted in constriction of the vessels. The dose-response curve showed a tendency to plateau at concentrations above 5 × 10−5M, with a maximal constriction of 28.8 ± 5.1% at 5 × 10−3M. The reduction in vessel diameter to microapplication of norepinephrine was prevented with the inclusion of an equimolar concentration of the α-adrenergic blocker, phentolamine, in the injectate. The data indicate the presence of α-adrenergic receptors on the smooth muscle of spinal pial arterioles, and it is suggested that the arguments pertaining to the sympathetic control of blood flow in the brain apply also to the spinal cord.
Migration of subdural atrial shunt catheter into the pulmonary arteries
Authors: Carbonin Giorgio
Published: May 2009

✓ A rare case of migration of a distal catheter from a subdural atrial shunt into the pulmonary arteries is presented. The indication for surgical treatment is briefly discussed.
Shunt catheter impacted in the vena cava
Authors: Foy Patrick M. , Shaw Malcolm D. , Mercer John L.
Published: May 2009

✓ A shunt-dependent patient had an atrial catheter firmly adherent in the superior vena cava. Thoracotomy was required for its removal.
Acute renal failure following cerebral angiography and infusion computerized tomography
Authors: Robinson Joe S. , Arzola Daniel D. , Moody Robert A.
Published: May 2009

✓ The authors report a case in which acute renal failure developed following angiography and computerized tomography with infusion of contrast material performed within the same day.
Carotid-cavernous sinus thrombosis caused by Aspergillus fumigatus
Authors: Sekhar Laligam N. , Dujovny Manuel , Rao Gutti R.
Published: May 2009

✓ A case is presented of Aspergillus fumigatus granuloma involving the sphenoid sinus, sella turcica, cavernous sinus, and the internal carotid artery. The diagnosis was established by a transsphenoidal biopsy. The infection proved difficult to treat and finally remitted after chemotherapy with a combination of amphotericin B, rifampin (rifampicin), and flucytosine (5-fluorocytosine). The spectrum of aspergillosis of the central nervous system is reviewed, and difficulties in treating this infection are considered.
Systemic Weber-Christian disease presenting as an intracranial mass lesion
Authors: Mangiardi John R. , Rappaport Z. Harry , Ransohoff Joseph
Published: May 2009

✓ A case is reported in which systemic Weber-Christian disease presented as a dural mass causing the signs and symptoms of increased intracranial pressure. The literature and possible pathogenesis of this entity are discussed.
Anterior communicating artery aneurysms with associated anomalies
Authors: Kwak Ryungchan , Niizuma Hiroshi , Hatanaka Mitsuaki , Suzuki Jiro
Published: May 2009

✓ In 296 cases with a single aneurysm of the anterior communicating artery (ACoA), fenestration or the presence of more than two ACoA's was observed in 17 cases (5.7%), and abnormal vessels of ACoA origin, such as a median artery of the corpus callosum, were observed in 13 cases (4.4%). As more than one anomaly was found in some of these cases, anomalies of the ACoA were found in a total of 26 cases (8.8%). This occurrence rate was no higher than that observed in other cerebral aneurysm cases and in the control cases, which were reported previously. There was no significant increase of hypoplasia of the A1 portion if the ACoA aneurysm was complicated by other arterial anomalies.
Edema and circulatory disturbance in the spinal cord compressed by epidural neoplasms in rabbits
Authors: Ikeda Hiroya , Ushio Yukitaka , Hayakawa Toru , Mogami Heitaro
Published: May 2009

✓ An experimental model of spinal cord compression by epidural neoplasms was produced in rabbits by injecting a VX2 tumor-cell suspension anterior to the T-13 vertebral body. With this experimental model, edema and circulatory disturbance of the spinal cord compressed by epidural tumors were studied. The characteristic histopathological findings in the compressed spinal cord were edema and axonal swelling in the white matter. Water content and uptake of intravenously injected 99mTc pertechnetate in the compressed spinal cord were significantly greater than in the spinal cord distant from the tumor, and increased in proportion to the degree of neurological loss. Microangiography and fluorescein angiography demonstrated stenosis or obstruction of the epidural venous plexus and impairment of venous drainage in the compressed spinal cord at the early stage of neurological symptoms. It is suggested that venous stasis and subsequent vasogenic edema in the spinal cord play an important role in the symptomatology of metastatic epidural spinal cord compression.
Translabyrinthine and transtentorial removal of acoustic nerve tumors
Authors: King T. T. , Morrison A. W.
Published: May 2009

✓ The translabyrinthine route or an extension of it was used to remove 150 acoustic nerve tumors. The mortality was 2% and the morbidity low. Preservation of the facial nerve was achieved in 100% of the small and 80% of the medium-sized tumors, but in only 20% of the large growths. The complications encountered are discussed.
Nonoperative treatment of brain abscesses in selected high-risk patients
Authors: Rosenblum Mark L. , Hoff Julian T. , Norman David , Edwards Michael S. , Berg Bruce O.
Published: May 2009

✓ In a series of eight high-risk patients, presumed intraparenchymal pyogenic brain abscesses resolved or decreased markedly in size with antibiotic therapy and without surgery. Cases were selected for antibiotic trial because of multiplicity or location of the abscesses and complicating medical conditions. Patients were alert or lethargic, with stable or improving early clinical courses. Diagnosis was made by computerized tomography (CT) brain scans and corroborative laboratory and diagnostic studies. Cases were closely monitored with serial CT scans. In six cases, bacteria were cultured from blood, cerebrospinal fluid, or fluid aspirated from one of multiple abscesses. Antibiotics were selected for specificity against the cultured organism, or consisted of high-dose penicillin plus chloramphenicol; therapy continued for a median of 7 weeks.

Serial CT scans showed decreased abscess size by a mean of 2.4 weeks (range, 1 to 4 weeks) and resolution of contrast-enhancement and mass effects by a mean of 9.8 weeks (range, 8 to 14 weeks). Abscesses followed to resolution were significantly smaller (mean, 1.7 cm diameter, p < 0.01) than those not responding to similar courses of antibiotic therapy (mean, 4.2 cm diameter). Two patients died of causes unrelated to their abscesses; surviving patients have no neurological deficit (mean follow-up period, 25 months; range, 15 to 37 months). Guidelines are recommended for a treatment protocol to be cautiously applied for high-risk patients with small abscesses. Surgery is recommended in all other cases of pyogenic brain abscesses.
Levels of astroprotein (an astrocyte-specific cerebroprotein) in cerebrospinal fluid of patients with brain tumors
Authors: Hayakawa Toru , Morimoto Kazuyoshi , Ushio Yukitaka , Mori Takesada , Yoshimine Toshiki , Myoga Akio , Mogami Heitaro
Published: May 2009

✓ Levels of astroprotein (an astrocyte-specific protein found in the cerebrum) were measured by radioimmunoassay in the cerebrospinal fluid (CSF) of 120 patients with intracranial diseases and eight control subjects. The astroprotein level was elevated (above 25 ng/ml) in 13 of 30 cases (43.3%) of glial tumors, nine of 57 cases (15.8%) of nongliomatous intracranial tumors, seven of 33 cases (21.2%) of non-neoplastic intracranial diseases, but in none of the eight control cases. In glioblastoma patients, CSF astroprotein was elevated in eight of 12 cases (66.7%), in three of them to a remarkable degree (above 500 ng/ml). The possible role of this test is briefly discussed, and the mechanism of increase of the astroprotein levels in the CSF considered.
Third ventricular choroid plexus arteriovenous malformation simulating a colloid cyst
Authors: Britt Richard H. , Silverberg Gerald D. , Enzmann Dieter R. , Hanbery John W.
Published: May 2009

✓ A case of a cystic encapsulated arteriovenous malformation arising from the tela choroidea of the third ventricle is reported. Although the appearance of this lesion on computerized tomography scan suggested a colloid cyst by its location, it was atypical because of the non-homogeneity both before and after contrast infusion. The increased density on the unenhanced scan was due to hemosiderin pigment in the capsule wall caused by old hemorrhage. The diagnosis in this case was made by histological examination.
Malignant choroid plexus papilloma with extraneural metastasis
Authors: Valladares Joao B. , Perry Robert H. , Kalbag Ramanand M.
Published: May 2009

✓ The authors describe and discuss a case of malignant choroid plexus papilloma originating in the lateral ventricle of an 11-month-old child. Unusual features include a long survival time of 9 years and the presence of an extraneural malignant deposit, probably metastatic in origin.
Disseminated intravascular coagulation following cranial trauma
Authors: Clark Jerrold A. , Finelli Robert E. , Netsky Martin G.
Published: May 2009

✓ Cranial and spinal trauma resulted in disseminated intravascular coagulation (DIC) in a 78-year-oldman, causing widespread bleeding and incoagulable blood. Traumatized brain tissue was found in the lumina of dural venous sinuses. The mechanisms of DIC are reviewed. It is suggested that intravascular release ofpotent cerebral thromboplastin contributed to the severity of DIC in this patient, by causing activation of the extrinsic clotting system. Intrasinus brain tissue in cases of human trauma has not previously been reported.
Mucormycosis presenting as positional nystagmus and hydrocephalus
Authors: Sweeney Patrick J. , Hahn Joseph F. , McHenry Martin C. , Mitsumoto Hiroshi
Published: May 2009

✓ A case of mucormycosis presenting with signs of positional nystagmus and obstructive hydrocephalus is described. The authors believe that this presentation of Mucor is unique.
Fifth ventricle with bitemporal hemianopsia
Authors: Kansu Tulay , Bertan Vural
Published: May 2009

✓ Symptomatic cysts of the septum pellucidum (fifth ventricle) are rare, and they are not usually considered among the causes of chiasmal compression. This report describes a case with a noncommunicating cyst of the septum pellucidum that presented with signs of chiasmal compression.
Cervical radiculomyelopathy caused by deposition of calcium pyrophosphate dihydrate crystals in the ligamenta flava
Authors: Kawano Nobuyuki , Yoshida Sanae , Ohwada Takashi , Yada Kenzoh , Sasaki Kenichi , Matsuno Takashi
Published: May 2009

✓ A case of cervical radiculomyelopathy caused by multiple calcified nodules in the ligamenta flava is presented. Roentgenological examination of the cervical spine showed radiopaque nodular lesions, 7 × 7 × 5 mm in size, located in the paramedian portion of the posterior spinal canal. The nodules were removed surgically and they were confirmed to be calcifications of ligamenta flava. Microscopic examination of the nodules with the polarized light revealed extensive deposition of crystals. By x-ray diffraction study, the crystal was determined as calcium pyrophosphate dihydrate (CPPD: Ca2P2O7 · 2H2O). Although CPPD deposition in the cartilage has been known as pseudo-gout syndrome, deposition in the ligament has been reported only in a few cases. This is the first case with radiopaque calcified nodules in the ligamenta flava causing spinal cord compression, the composition of which proved to be CPPD.
A modified drill guide for the anterior cervical fusion (Cloward) procedure
Authors: Berry Henry , Horsey William J.
Published: May 2009

✓ A modified drill guide for use in the anterior cervical fusion procedure is described. This device permits an inspection of the interbody hole during the drilling process, and incorporates the additional mechanical improvements of replacement fixation points and locking rings of different diameter. These modifications have been found to simplify and improve control over the drilling component of this surgical procedure.
Responses to experimental subarachnoid hemorrhage in the spontaneously breathing primate
Authors: Rothberg Charles , Weir Bryce , Overton Thomas , Grace Michael
Published: May 2009

✓ The pathophysiological responses to experimental subarachnoid hemorrhage (SAH) were investigated in 20 spontaneously breathing cynomolgus monkeys. Four different volumes of fresh autogenous blood were used: 1.0, 1.33, 1.67, and 2.0 cc/kg. Five other animals had injection of 1.67 cc/kg of mock cerebrospinal fluid. Cerebral blood flow (CBF) was measured using the xenon-133 clearance technique. Respiratory rate and tidal volume were monitored by way of a Vertek pneumotach. The reduction of CBF after the SAH became more pronounced with increasing volumes of subarachnoid blood. The CBF remained reduced despite a return to normal of the cerebral perfusion pressure. Increasing SAH volumes were associated with greater abnormalities in the respiratory pattern, consisting of apnea and hyperventilation. These larger volumes were also associated with hypoxemia. Morbidity and mortality increased with increasing volumes of SAH, and are believed to be the result of a combination of decreased CBF, respiratory center disturbances, and pulmonary diffusion defects.
Local cerebral blood volume in head-injured patients
Authors: Kuhl David E. , Alavi Abass , Hoffman Edward J. , Phelps Michael E. , Zimmerman Robert A. , Obrist Walter D. , Bruce Derek A. , Greenberg Joel H. , Uzzell Barbara
Published: May 2009

✓ Local cerebral blood volume (CBV) was mapped in 10 normal subjects and in 30 patients after head injury. In normal subjects, the mean CBV was 4.34 ml/100 gm. The coefficient of variation was 12% for the group mean, and 3% for values obtained in duplicate studies of individuals. Patients with head injuries were divided into three groups according to the stage of their illness: acute illness, early recovery, and later recovery. Averages of mean CBV were within one standard deviation of normal. In contrast, consistent changes were found in serial studies of the mean CBV in the same patient. Compared to recovery values, levels of mean CBV measured soon after injury were reduced, largely at the expense of the gray-matter compartment. In five adults with predominantly unilateral lesions, there was an average early reduction in mean CBV and cerebral blood flow of 15% and 36%, respectively. In three children with diffuse brain swelling, there was an average early mean CBV reduction of 12%; a single child had early increased mean CBV at a time when intracranial pressure was high. Greater changes were seen in local CBV on individual sections. There were mixed zones of hypervolemia and hypovolemia in regions of infarction and intracerebral hematoma. Subdural hematomas had consistent medial margins of increased local CBV, representing dilated blood vessels of the underlying cortex. The presence and displacement of this hypervolemic zone were sensitive indicators of persistent subdural collection and mass effect, even when the collection was lucent to x-ray computed tomography.
Some examples of balloon technology in neurosurgery
Authors: Mullan Sean , Duda Eugene E. , Patronas Nicholas J.
Published: May 2009

✓ Examples are presented of the use of a compression balloon to treat trigeminal neuralgia, of a dilating balloon to release a web obstruction of the internal carotid artery, of detachable balloons to seal carotid-cavernous and vertebral-venous fistulas, of a temporary occlusive balloon to aid in thrombogenic treatment of a giant aneurysm, and of a temporary occlusive balloon with double or triple-lumen capacity to assist in angiographic diagnosis and to provide reversible carotid occlusion.
Neurosurgical treatment of pathological fracture-dislocation of the spine
Authors: Perrin Richard G. , Livingston Kenneth E.
Published: May 2009

✓ The treatment of 20 patients with symptomatic pathological fracture-dislocation of the spine is reviewed. The single most common primary disease was carcinoma of the breast (12 cases). Pain was the presenting symptom in 19 patients. At the time of surgery, six patients were weak but ambulatory, seven were bedridden, and three were paraplegic. The cervical spine (10 cases) was most frequently involved, followed by the thoracic region in six, and the lumbar segments in four. Treatment aimed at improving or preserving neurological function involved decompression of the cord (or cauda) with reduction of bone deformity and stabilization of the spine. Laminectomy decompression was performed in 18 cases. Posterior rib graft fusion was used to stabilize the spine in all patients with cervical, and in three with upper thoracic, pathological fracture-dislocation; Harrington rod instrumentation was used for lower thoracic and lumbar levels. All patients were considered for radiotherapy and/or chemotherapy. Ten patients are living, an average of 20 months following surgery. Among the remainder, the average survival was 5 months. Fourteen patients were ambulatory after surgery, four were improved, and two were unchanged. Twelve patients have achieved a “satisfactory” result (walking and continent 6 months after treatment), including the three who were paraplegic at the time of surgery.

Spinal metastases presenting as pathological fracture-dislocation of the spine may produce potentially devastating cord compression. Critical neurological sequelae can be avoided, and a satisfactory result can be achieved by urgent decompression of the cord and stabilization of the spine.
Spinal Cord Blood Flow in Experimental Transient Traumatic Paraplegia
Authors: Lohse Dean C. , Senter Howard J. , Kauer John S. , Wohns Richard
Published: May 2009

✓ Blood flow in the lateral funiculus of the thoracic spinal cord was measured in 24 anesthetized cats using the hydrogen clearance method. In a control series of eight nontraumatized animals, blood flow measurements were taken from the T-5 and T-6 segments for 6 consecutive hours. The mean spinal cord blood flow (SCBF) in the control group was 12.8 ± 3.51 (SD) ml/min/100 gm on the basis of 107 measurements over 6 hours. In the experimental groups, 16 animals were similarly prepared. The spinal cords of these animals were then traumatized by dropping a 20-gm weight 5 cm (100 gm-cm trauma) or 13 cm (260 gm-cm trauma) onto the T-5 segment. Previous experiments have shown that these trauma levels lead to a transient paraplegia of less than 10 and 30 days' duration, respectively. Two hundred blood flow measurements from T-5 and T-6 were taken over the 6 hours following trauma. In the seven animals of the 100 gm-cm group, mean SCBF after trauma from the T-5 segment was 12.6 ± 3.45 (SD) ml/min/100 gm on the basis of 50 measurements taken over 6 hours; not significantly different from the controls (p > 0.70). In the 260 gm-cm group, mean SCBF from T-5 for 6 hours after trauma was 17.3 ± 6.60 (SD) ml/min/100 gm; significantly higher than controls (p < 0.001). Mean SCBF 3 to 6 hours after trauma was significantly elevated over controls (p < 0.05). The mean hyperemia in the 260 gm-cm group was found to be due to marked hyperemia in only four animals of the series, while five animals maintained blood flows in the normal range.

This experiment provides quantitative evidence that white matter ischemia does not occur in spinal cord injuries that can be expected to produce only transient paraplegia. The data support the concept that white matter ischemia in the acute phase of severe spinal cord trauma may be related to secondary injury and subsequent permanent paraplegia.
Acute intracranial hypertension and auditory brain-stem responses
Authors: Nagao Seigo , Roccaforte Peter , Moody Robert A.
Published: May 2009

✓ The auditory brain-stem responses (BER's), infratentorial intracranial pressure (ICP), systemic blood pressure (BP), and heart rate were recorded before, during and after expansion of an infratentorial epidural mass in anesthetized cats. Two types of BER's to increasing posterior fossa pressure were noted. In Type 1, there was predominantly suppression of the electrical activity of the auditory nuclei of the upper brain stem (Waves V and IV) and upward transtentorial herniation of the midbrain. In Type 2, the neural activity of the lower brain-stem nuclei (Waves III and II) was affected as well as that of the upper brain stem. There was upward and foraminal impaction of the brain stem and cerebellum which was confirmed by the postmortem brain sections. The change in the amplitudes of BER Waves V and III proved useful in detecting upward transtentorial herniation of the midbrain and foraminal herniation of the cerebellum in acute expanding lesions of the posterior fossa. Medullary paralysis was also detected by observing Wave III.
Failure to detect papovavirus-associated T antigens in human brain tumor cells by anticomplement immunofluorescence
Authors: Kosaka Hideyuki , Sano Yoshinori , Matsukado Yasuhiko , Sairenji Takeshi , Hinuma Yorio
Published: May 2009

✓ To probe the possible presence of papovavirus-related T antigen(s) in human brain tumors, the imprinted or cultured cells at various passage levels were examined by anticomplement immunofluorescence using antisera to T antigen of each BK virus, JC virus, and simian virus 40. No T antigen was demonstrated in any tests with cells derived from 69 patients with various brain tumors. Twenty-two tumor cell strains cultured in the presence of a tumor promoter, phorbol ester, also failed to show the T antigen.
Microvascular relations of the trigeminal nerve
Authors: Haines Stephen J. , Jannetta Peter J. , Zorub David S.
Published: May 2009

✓ The vascular relationships of the trigeminal nerve root entry zone were examined bilaterally in 20 cadavers of individuals known to be free of facial pain. Fourteen of 40 nerves made contact with an artery, but only four of these showed evidence of compression or distortion of the nerve. In addition, the vascular relationships of 40 trigeminal nerves exposed surgically for treatment of trigeminal neuralgia were studied, and 31 nerves showed compression by adjacent arteries. Venous compression was seen in four of the cadaver nerves and in eight nerves from patients with trigeminal neuralgia. These data support the hypothesis that arterial compression of the trigeminal nerve is associated with trigeminal neuralgia.
Spinal cord energy metabolism in normal and postlaminectomy cats
Authors: Anderson Douglas K. , Means Eugene D. , Waters Thomas R.
Published: May 2009

✓ The purpose of this study was to determine 1) normal concentrations of adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), phosphocreatine (P-creatine), glucose, lactate, and pyruvate in upper (L-2) and lower (L-5) feline lumbar spinal cord, and 2) whether previously reported laminectomy-induced reduction in spinal cord blood flow (SCBF) resulted in disturbance of spinal cord energy metabolism. Concentrations of ATP, P-creatine, pyruvate, and glucose were significantly higher at L-5 than at L-2, probably as the result of larger amounts of gray matter at L-5 than L-2. Significant increases in ADP and AMP levels were the only metabolite changes noted 15 minutes following laminectomy. The authors speculate that the increase in ADP and AMP is due to a laminectomy-induced stimulation of ATP utilization. However, lack of change in other metabolites implies an efficient energy homeostasis. These results indicate that although laminectomy can reduce SCBF, the degree of this reduction is insufficient to adversely affect spinal cord energy metabolism. Thus, tissue from beneath or near the laminectomy site is viable and essentially normal.
Fatal subdural bleeding following superficial temporal-middle cerebral artery anastomosis
Authors: Leclercq Toussaint A. , Ambler Mary W.
Published: May 2009

✓ This report describes a sudden death during convalescence from superficial temporal artery-middle cerebral artery bypass surgery. Artificial arterial anastomosis introduces the danger of a high-pressure subdural hemorrhage in an unnatural location.
Neurogenic pulmonary edema associated with a colloid cyst in the third ventricle
Authors: Findler Gideon , Cotev Shamay
Published: May 2009

✓ Neurogenic pulmonary edema (NPE) is usually the result of head trauma. The authors describe the case of a 13-year-old girl, in whom NPE was associated with a colloid cyst of the third ventricle causing acute hydrocephalus. The mechanisms involved in the development of NPE are briefly discussed. The possible role of the colloid cyst in the distortion of the anatomical relationships in the vicinity of the hypothalamic nuclei is considered.
Interhemispheric cyst of neuroepithelial origin in association with partial agenesis of the corpus callosum
Authors: Solt Lillian C. , Deck John H. N. , Baim Roger Scott , TerBrugge Karl
Published: May 2009

✓ The authors report an adult patient with a symptomatic interhemispheric cyst demonstrated by computerized tomography (CT), angiography, and at surgery. Choroid plexus epithelium was identified arising from the inner aspect of the cyst wall. Partial agenesis of the corpus callosum is postulated on the basis of the CT findings and the presence of choroid plexus in the interhemispheric cyst.
“Fibrous dysplasia” of the skull with complete unilateral cranial nerve involvement
Authors: Fernandez Eduardo , Colavita Nicola , Moschini Massimo , Fileni Adriano
Published: May 2009

✓ A 40-year-old man with a slowly progressive unilateral sclerotic process of the base of the skull developed complete involvement of all cranial nerves on the right. Roentgenograms of the skull are interpreted as fibrous dysplasia, but pathological confirmation is lacking.
The critical importance of PaCO2 during intracranial aneurysm surgery
Authors: Sullivan Humbert G. , Keenan Richard L. , Isrow Larry , Feria A. William
Published: May 2009

✓ In a patient undergoing craniotomy for clipping of an anterior communicating artery aneurysm, sodium nitroprusside was used to lower systemic arterial blood pressure to 80/35 mm Hg (mean arterial blood pressure (MABP) = 50 mm Hg), at which time the electroencephalogram (EEG) changed abruptly from normal to a burst suppression pattern. At the onset of burst suppression, PaCO2 was 18 mm Hg. After PaCO2 had been increased to 28 mm Hg, the patient tolerated a blood pressure of 45/25 mm Hg (MABP = 32 mm Hg) during aneurysm clipping without EEG change. The observations reported here support the conclusion that, with moderate hypotension, hypocarbia may cause brain ischemia and that the level of PaCO2 may influence the degree of hypotension that may be safely used during aneurysm surgery. The importance of repeated arterial blood gas measurements when induced hypotension is employed for berry aneurysm surgery is stressed. Intraoperative EEG monitoring may be employed to help judge safe levels of intraoperative hypotension during intracranial aneurysm surgery.
Focal histiocytosis X of the parietal lobe
Authors: Khan Arfa , Fulco John D. , Shende Ashok , Rosenthal Alan , Marc Joseph A.
Published: May 2009

✓ The authors describe a case of histiocytosis X of the parietal lobe presenting as a space-occupying lesion on a computerized tomography scan of the brain. The clinical, radiographic, and therapeutic aspects of the case are discussed. A brief review of the literature is presented.
Preoperative treatment of ruptured intracranial aneurysms with tranexamic acid and monitoring of fibrinolytic activity
Authors: Alvarez Garijo J. A. , Vilches J. J. , Aznar J. A.
Published: May 2009

✓ The fibrinolytic activity in cerebrospinal fluid has been monitored by determination of levels of fibrin split products (FSP) in 23 patients with ruptured intracranial aneurysms. In 20 of these 23, FSP was found in the cerebrospinal fluid (CSF), with levels ranging from 10 to 80 μg/ml. Eleven of the 23 patients were treated with 2 gm tranexamic acid daily. In these patients FSP was found in only two cases during the 2nd week, while in 12 untreated patients it was found in 10 cases. These results suggest that there exists a localized fibrinolytic activity, and monitoring the FSP levels in the CSF may be a simple and accurate method for controlling the efficiency of antifibrinolytic therapy. Thus, treatment could be begun with a lower dose, which could be increased later as deemed necessary from the results of careful monitoring.
The role of the sympathetic nervous system in pressor responses induced by spinal injury
Authors: Young Wise , DeCrescito Vincent , Tomasula John J. , Ho Victor
Published: May 2009

✓ Spinal cord injury consistently evokes a transient 3- to 4-minute rise in systemic pressure, followed by prolonged hypotension. Because the role of the sympathetic nervous system in these blood pressure changes is not clear, the pressure responses were studied using systematic ablation of the peripheral sympathetic nervous system. In total, 24 cats were subjected to bilateral thoracic sympathectomy, adrenalectomy, splanchnicectomy, combinations of the preceding, sham operation, or no treatment. Either 3 or 24 hours after the ablations, the blood pressure responses were evoked by 400 gm-cm contusions of the thoracic cord. Although neither thoracic sympathectomy nor adrenalectomy alone abolished the hypertensive phase, the combination of the two procedures did. This suggests that both the thoracic sympathetic ganglia and the adrenal glands participate in the pressor response. Thoracic sympathectomy affected primarily the early part, whereas adrenalectomy diminished the later part of the hypertensive response. This correlates with the function of the former being neurally and the latter being humorally mediated. None of the sympathetic lesions consistently affected the hypotensive phase. Spinal contusion injury produces widespread sympathetic activation, mediating the hypertensive changes.
Experimental intracranial aneurysms in rats
Authors: Suzuki Shigeharu , Robertson James T. , White Richard P. , Stadlan Emanuel M. , Popoff Nina
Published: May 2009

✓ Experimental cerebral aneurysms were induced in rats in which the left carotid artery was ligated. The rats were rendered hypertensive by the Goldblatt procedure, and fed a diet containing β-aminopropionitrile. These intracranial aneurysms have significant gross and microscopic similarities to human berry aneurysms. The procedures and microscopic observations indicate that this experimental model could be useful for studying the development, pathophysiology, and therapy of saccular aneurysms.
Familial intracranial aneurysms
Authors: Fox John L. , Ko Jehoon P.
Published: May 2009

✓ The authors present a family of 13 siblings: six are proven to have had intracranial aneurysms, five have had elective cerebral angiography with normal findings, and two have refused angiography. Of the six aneurysm cases, two had disabling and one had fatal subarachnoid hemorrhages; three underwent successful clipping of their aneurysms which were discovered by elective angiography. It is concluded that the two remaining patients who have refused angiography have a 50% statistical chance of harboring a potentially lethal aneurysm, for in this family the occurrences of six proven cases among 11 siblings studied is consistent with a dominant Mendelian inheritance.
Direct percutaneous cerebral angiography in neurosurgical practice
Authors: Bauer Jerry , Salazar Jose Luis , Sugar Oscar , Pawl Ronald P.
Published: May 2009

✓ A retrospective analysis of 1171 consecutive percutaneous retrograde brachial and carotid cerebral angiograms was performed on 635 patients, 50.7% of whom were in the sixth decade or older. Symptoms and signs of cerebrovascular disease were the most frequently investigated and diagnosed, accounting for 46.7% of all the angiograms. Despite this relatively high-risk population, we have found direct percutaneous cerebral angiography to have a very low risk. The pros and cons of direct percutaneous versus transfemoral cerebral angiography are discussed. The literature of the previous 10 years is reviewed, and the complication rate of these two techniques is compared.
Effect of surgery on BCNU chemotherapy in a rat brain tumor model
Authors: Tel Esref , Hoshino Takao , Barker Marvin , Wilson Charles B.
Published: May 2009

✓ In Fischer 344 rats, 9L tumors were implanted in the left cerebral hemisphere. Compared with control animals not operated on, rats treated with an LD10 dose of BCNU 1 hour before or 1 or 12 hours after surgery on Day 16 postimplant had an increased life span of over 200% (greater than a 6 log cell kill). Minimal effect on survival was found when BCNU was administered during surgery. On the other hand, BCNU administered 12 hours before or 24 or 72 hours after surgery did not show any additive effect of surgery on BCNU treatment. These results suggest that in a clinical setting, a bolus of BCNU administered to tumor patients within 12 hours of surgery might increase substantially the total tumor cell kill compared with surgical resection alone.