bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermography in the management of carotid-cavernous fistulas
Authors: Galera Rafael G. , Martinez Alberto C.
Published: May 2009

✓ The authors report their experiences with thermography as a new tool to assess the diagnosis and postoperative control of patients with carotid-cavernous fistulas (CCF). A zone of increased temperature on the homolateral orbital region is described in cases of CCF. A supraorbital “cool” area, as seen in patients with carotid stenosis or occlusion, is observed when surgery with the Jaeger-Hamby technique has been successful. Thermograms obtained in five patients are presented and the pathophysiology of these findings is discussed.
Treatment of vertebrojugular fistula by balloon occlusion
Authors: Goodman Stanley J. , Hasso Anton , Kirkpatrick Douglas
Published: May 2009

✓ The authors report the successful treatment of a posttraumatic vertebrojugular fistula by a combination of vascular trapping and intraluminal balloon occlusion.
Intracranial pressure, blood pressure, and pulse rate after occlusion of a middle cerebral artery in cats
Authors: Hayakawa Toru , Waltz Arthur G.
Published: May 2009

✓ The left middle cerebral artery was occluded in 12 tranquilized but unanesthetized cats with use of a device implanted transorbitally 5 to 7 days earlier. Bilateral epidural pressures, mean aortic blood pressure, and pulse rate were measured at intervals for up to 48 hours after occlusion. The relationships of these measurements to each other and to the extent and severity of cerebral infarcts is described.
Proximal occlusion of the anterior cerebral artery for anterior communicating aneurysm
Authors: Hockley Anthony D.
Published: May 2009

✓ Results of proximal anterior cerebral artery occlusion are described in 68 patients with anterior communicating artery aneurysms. The procedure is found useful in the treatment of these aneurysms because of its technical simplicity and the low rates of mortality and morbidity achieved.
Tuberculous brain abscess
Authors: Rab Syed M. , Bhatti Iqtidar H. , Ghani Abdul , Khan Anjum
Published: May 2009

✓ The authors describe a case of tuberculous cerebral abscess of the frontal lobe that developed 1 year after an episode of acute miliary tuberculosis. The development of such a lesion indicates a persistence of infection and an immunological breakdown which may partly have been due to protein malnutrition.
Giant suprasellar aneurysm associated with optic stalk agenesis and unilateral anophthalmos
Authors: Hoff Julian , Winestock David , Hoyt William F.
Published: May 2009

✓ The authors report a patient with unilateral anophthalmos who had a large suprasellar aneurysm associated with aplasia of an optic nerve and the chiasmal commissure. The anatomical findings at craniotomy are described.
Collagen sponge for surface brain protection
Authors: Kurze Theodore , Apuzzo Michael L. J. , Weiss Martin H. , Heiden James S.
Published: May 2009

✓ The authors discuss the properties, use, and advantages of collagen sponge as a microneurosurgical adjunct. Experience with the material in over 300 operative cases has demonstrated its value for protecting the surface of the brain during exposure and retraction in neurosurgical procedures.
Clindamycin concentrations in the central nervous system of primates before and after head trauma
Authors: Picardi James L. , Lewis H. Paul , Tan James S. , Phair John P.
Published: May 2009

✓ The authors measured levels of clindamycin, a drug well established as useful in the treatment of various soft-tissue and parenchymal bacterial infections, in serum, cerebrospinal fluid, and brain tissue of 14 rhesus monkeys. Penetration into brain tissue was erratic and concentrations detected were not significant. Cerebrospinal fluid levels, however, averaged 20.5% of paired serum concentrations and were higher than concentrations needed to inhibit most Gram-positive bacteria. Further studies in humans are indicated before this antibiotic may be used routinely.
Ependymal cyst of the spinal cord
Authors: Mosso James A. , Verity M. Anthony
Published: May 2009

✓ A case with extramedullary ependymal cyst of the spinal cord is presented. The clinical, operative, and pathological findings are discussed and a review of previous cases and a nosologic classification of ependymal lined cysts given.
Enlargement of an arteriovenous malformation documented by angiography
Authors: Spetzler Robert F. , Wilson Charles B.
Published: May 2009

✓ The authors present a case in which an enlarging arteriovenous malformation was documented angiographically. Enlargement of the malformation concurrent with the appearance of basilar artery insufficiency was ascribed to a sump effect (steal) by the arteriovenous shunt.
Role of histamine in posttraumatic spinal cord hyperemia and the luxury perfusion syndrome
Authors: Kobrine Arthur I. , Doyle Thomas F.
Published: May 2009

✓ The authors studied the effect of pretreatment of monkeys with antihistamines on hyperemia observed in the lateral funiculus of the spinal cord after severe experimental spinal cord trauma. After administration of Chlorpheniramine and Metiamide, the spinal cords were traumatized with a 600 gm-cm injury. Blood flow in the lateral funiculus at the injury site was then determined hourly for 6 hours. The blood flow at this site remained in the normal range at all times in all animals. Neither a hyperemia nor an ischemia could be demonstrated. This finding reaffirms the authors' previous observation that ischemia does not exist in the lateral funiculus after severe experimental spinal cord trauma, and explains the previous observation of hyperemia as a histamine-related phenomenon, easily blocked by the administration of Chlorpheniramine and Metiamide, potent antihistamines which together block both the H1 and H2 receptor sites.
Retained intracranial metallic foreign bodies
Authors: Ott Kenneth , Tarlov Edward , Crowell Robert , Papadakis Nikolas
Published: May 2009

✓ The authors discuss two examples of extensive migration of retained metallic foreign bodies. The potential for further neurological injury from migration, formation of neurotoxic breakdown products, and the danger of infection are factors to be assessed when considering the removal of retained intracranial metallic foreign bodies.
Aneurysm of the inferior gluteal artery causing sciatic pain
Authors: Rinaldi Italo , Fitzer Peter M. , Whitley Donald F. , Peach William F. , Umstott Charles E. , Graham Walter H. , Winfrey Elisha W.
Published: May 2009

✓ The authors describe a case with sciatic pain caused by a large extrapelvic aneurysm of the inferior gluteal artery. Differential diagnosis and treatment are discussed.
Endothelial growth factor present in tissue culture of CNS tumors
Authors: Kelly Patrick J. , Suddith Robert L. , Hutchison Harold T. , Werrbach Karen , Haber Bernard
Published: May 2009

✓ Human endothelial cells obtained from postpartum umbilical veins and placed in primary tissue cultures were treated with media from cultures of human and experimental central nervous system tumors. Endothelial proliferation was determined by the uptake of 3H thymidine with autoradiography and represented as the thymidine labeling index (TI), which is the proportion of 3H thymidine-labeled endothelial cells to total number of cells counted. There was a marked increase in the TI when tumor-conditioned medium was added to endothelial cultures (range 28.7% to 98.3%) when compared to controls (2.1%) and endothelium with conditioned media from fibroblasts (4.5%). This study demonstrates the presence of a chemical substance produced by tumor cells which results in endothelial proliferation. The system described provides a useful assay technique for the further characterization of this endothelial growth factor.
Effects of hyperventilation, CO2, and CSF pressure on internal carotid blood flow in the baboon
Authors: Rudenberg F. Hermann , McGraw C. Patrick , Tindall George T.
Published: May 2009

✓ The combined effect upon cerebral blood flow (CBF) of an elevation of cerebrospinal fluid pressure (CSFP) and changes in respiratory CO2 was studied in nine baboons under chloralose anesthesia. The animals were mildly hyperventilated and provided with increasing amounts of CO2 in O2-air. Arterial CO2 tensions (PaCO2) increased from 17 to 58 mm Hg. Internal carotid blood flow (ICBF) was measured at normal CSFP and at hydrostatically maintained 50 mm Hg CSFP. It was found that: 1) end-tidal CO2 may be used as a substitute for arterial PaCO2 determinations; 2) this elevation of CSFP has little effect on ICBF during hypercapnia and normocapnia; however, 3) during hypocapnia the ICBF is reduced an additional 20% when CSFP is elevated; that is, ICBF is reduced 50% from normal when end-tidal CO2 is reduced to 2% at this elevated level of CSFP.

Caution should be exercised during hyperventilation therapy particularly if the elevated CSFP or intracranial pressure (ICP) is not reduced to approach normal levels; in these conditions, the combination of decreasing PaCO2 and elevated ICP may reduce CBF below critical levels and thus lead to cerebral hypoxia.
Calcification in a chromophobe adenoma
Authors: Chambers A. Alan , Lukin Robert , Tsunekawa Nakoto
Published: May 2009

✓ A patient with a densely calcified chromophobe adenoma is reported. Considerable hemorrhage and fibrosis were present in the tumor and may have been responsible for the extensive calcification.
Delayed cervical myelopathy caused by bomb shell fragment
Authors: Amitani Katsumasa , Tsuyuguchi Yuichi , Hukuda Sinsuke
Published: May 2009

✓ A rare case of delayed cervical myelopathy caused by a bomb shell fragment is reported. The fragment lay intradurally with minimum foreign body reaction. Symptoms did not begin to occur until 17 years after injury.
Persisting embryonal arterial communication between vertebral artery and subclavian vein
Authors: Kunc Zdeněk , Bret Jiří
Published: May 2009

✓ The authors report a case with an arteriovenous communication between the vertebral artery and the subclavian vein. The anomalous vessel was classified as a persistent lateral branch of the fifth cervical intersegmental artery. It was successfully closed at surgery.
Gardner's syndrome involving the skull, dura, and brain
Authors: Terao Hideo , Sato Seitaro , Kim Shiin
Published: May 2009

✓ An isolated case of Gardner's syndrome with characteristic multiple osteomas in the skull is presented. Neurosurgical intervention was required for an intracerebral metastasis from colonic carcinoma. Postoperatively, abnormal hyperplasia of the dura developed.
Carbamazepine in the treatment of the flashing pain syndrome
Authors: Dunsker Stewart B. , Mayfield Frank H.
Published: May 2009

✓ Five patients were seen who described similar rapid shot-like pains that we have called “flashing pain syndrome” and whose pain was relieved by carbamazepine. The pathology of these conditions is not uniform, but the clinical description appears to be specific for an unpleasant condition that will respond dramatically to carbamazepine.
Some characteristic findings of isotope cisternograms in children
Authors: Maki Yutaka , Kokubo Yoshihiko , Nose Tadao , Yoshii Yoshihiko
Published: May 2009

✓ The authors describe the characteristic pattern in the isotope cisternograms of normal children and emphasize that, in interpreting isotope cisternograms, the age of the patient must be taken into account.
Microsurgical ganglionectomy for chronic pain syndromes
Authors: Osgood Carroll P. , Dujovny Manuel , Faille Ronald , Abassy Munir
Published: May 2009

✓ An improved microsurgical technique for lumbosacral ganglionectomy is described.
Effect of dexamethasone on experimental brain edema in cats
Authors: Dick Arthur R. , McCallum Mary E. , Maxwell John A. , Nelson Stanley R.
Published: May 2009

✓ The authors studied the effects of dexamethasone, 0.3 mg/kg/hr administered intravenously beginning 1 hour before injury, in adult cats with brain edema secondary to cold-induced cortical lesions. Edema was quantitatively measured in cortex, gyral white matter, and central (deep) white matter at 3, 24, 48, and 72 hours, with and without dexamethasone, by determining specific gravity (density) of samples in a continuous gradient column. Cold-induced lesions resulted in edema, which was greatest in the white matter of the injured hemisphere but also present in the contralateral hemisphere. Except for a slight but significant increase in density (decreased edema) of cortex at 24 hours, dexamethasone therapy resulted in no reduction of cold-induced edema, and in some cases increased the edema.
Posterior cervical fusion in children
Authors: McWhorter Joe M. , Alexander Eben , Davis Courtland H. , Kelly David L.
Published: May 2009

✓ Six cases of posterior cervical fusion with rib grafts in children are reported. Four of the children had sustained cervical spine injuries in accidents, and two had congenital absence of the odontoid. Three-level fusions (C1–3) were done in four children, and four-level fusions (C1–4) in two. One child died of unrelated causes 3 months after the operation. The other five children have been followed for 5 to 13 years. All are doing well and each has a remarkably supple, stable neck and no neurological deficit.
Multifocal glioma of the brain
Authors: Borovich Bernardo , Mayer Marcel , Gellei Baruch , Peyser Eli , Yahel Mordechai
Published: May 2009

✓ A case is presented in which two separate concurrent astrocytomas of the brain in the same patient were successfully operated on. The patient has been followed for 3 years and remains well. The authors believe that the diagnosis of multifocal tumors can be established on clinical grounds when the tumors are remote from each other, and when there has been no recurrence of neoplasm between the lesions after a long follow-up period. It is felt that a more optimistic approach to the treatment of multifocal tumors may yield good results.
Trans-unco-discal approach
Authors: Hakuba Akira
Published: May 2009

✓ A series of 40 patients with degenerative discopathy was effectively treated by means of a trans-unco-discal approach, which is a combined anterior and lateral approach to cervical discs. Interbody fusion is not performed except for special cases such as significant kyphosis and unstable cervical spine. Twenty patients who had this approach without interbody bone graft have been followed clinically and radiographically for 9 to 36 months. The author describes the surgical technique, complications, and results.
Mesencephalic spur (beaking deformity of the tectum) in Arnold-Chiari malformation
Authors: Adeloye Adelola
Published: May 2009

✓ The beaking deformity of the tectum, referred to in this paper as the mesencephalic spur, is regularly present in the Type II variety of the Arnold-Chiari malformation in varying degrees of severity. When the mesencephalic spur is related to associated myelomeningocele, it was found that the more extensive the myelomeningocele, and the older the affected children, the more prominent was the mesencephalic spur.
Primary osteogenic sarcoma of the calvaria
Authors: Hendee Robert W.
Published: May 2009

✓ The author presents a case of skull neoplasm identified as osteogenic sarcoma. En bloc extirpation was performed. No other primary location of this rare tumor was found, and no metastasis has occurred nearly 2 years postoperatively.
Medicine through untinted glasses
Authors: Egeberg Roger O.
Published: May 2009

✓ The 1976 Cushing orator takes a critical look at federal medical programs today, and at the health desires and needs of the public. He outlines the possible future roles of federal and state government and of the medical profession itself.
Lymphatic fistula following myelomeningocele repair
Authors: Dempsey Lawrence C. , Pevehouse Byron C.
Published: May 2009

✓ The authors report a lymphatic fistula as a complication of myelomeningocele repair and discuss its pathophysiology and successful treatment.
Combined isotope ventriculography and lumbar myelocisternography in the diagnosis of communicating syringomyelia
Authors: Peserico Luigi , Angiari Paolo , Merli Gian Antonio , Sonnino Vittorio , Faglioni Pietro , Canossi Gian Carlo
Published: May 2009

✓ Several investigative procedures are currently used to diagnose communicating syringomyelia. The combination of isotope ventriculography and lumbar myelocisternography has never been proposed nor carried out to verify this condition. We feel that this is a safe and valuable procedure to identify a patent central canal communicating with the fourth ventricle and is worth considering when diagnosing communicating syringomyelia.
Cardiac arrhythmias resulting from experimental head injury
Authors: Evans Delbert E. , Alter William A. , Shatsky Stanley A. , Gunby E. Neal
Published: May 2009

✓ The cardiovascular events resulting from experimental head injury were studied to determine the incidence of cardiac arrhythmias and to define the autonomic mechanisms responsible for these changes. Electrocardiograms and arterial blood pressure were recorded in anesthetized monkeys before and after the animals were subjected to temporoparietal head impact. Cardiac arrhythmias and hypotension occurred immediately following impact in every animal studied. Various atrioventricular nodal and ventricular arrhythmias were seen. Cholinergic blockade was found to prevent arrhythmias induced by head injury whereas adrenergic blockade was found to be ineffective.
Double-blind evaluation of intradiscal chymopapain for herniated lumbar discs
Authors: Schwetschenau P. Robert , Ramirez Archimedes , Johnston James , Barnes Elnora , Martins Albert N.
Published: May 2009

✓ The authors report 66 patients with signs, symptoms, and a myelographic abnormality of herniated lumbar disc, who were not responsive to conservative treatment. The discs were injected at random with either chymopapain or a placebo. Neither patient nor surgeon knew which agent was used until after the results had been tabulated. Unless early laminectomy was necessary for intractable pain, all patients were followed for 2 months or more. There was no statistically significant difference in incidence or quality of improvement between the two groups: chymopapain was successful in 58% while placebo was successful in 49% (p = 0.15). Early results from this study indicate that most, if not all, of the putative effectiveness of chemonucleolysis probably derives from a placebo effect.
Primary Burkitt's lymphoma of the frontal bone
Authors: Gawish Hassan H. A.
Published: May 2009

✓ The author reports a case of recurrent Burkitt's lymphoma in the left frontal region with extradural extension. Craniotomy was performed to relieve rapidly progressive intracranial compression. The patient received cytotoxic treatment postoperatively, with remarkable regression of the tumor.
Efficacy of cryohypophysectomy in the treatment of acromegaly
Authors: DiTullio Michael V. , Rand Robert W.
Published: May 2009

✓ Between 1963 and 1974, 54 patients with acromegaly (28 men and 26 women) ranging in age from 23 to 61 years were evaluated. Each patient underwent thorough preoperative neurological, roentgenographic, and endocrinological surveys; most demonstrated mild-to-severe abnormalities in growth hormone immunoassay and oral glucose tolerance. Of those who underwent stereotaxic cryohypophysectomy, approximately 80% were considered to have a beneficial result. The efficacy of this form of therapy was judged on the basis of: 1) significant overall clinical improvement and regression of acromegalic features; 2) improvement in the glucose tolerance curve; and 3) a fall of serum growth hormone below 10 ng/ml. Complications including rhinorrhea, meningitis, and hemorrhage occurred in only a small number of cases. A comparison is made between this technique and others, including craniotomy, radiotherapy, and transnasal transsphenoidal hypophysectomy. The efficacy, low morbidity, and the ease with which the procedure may be performed make this our treatment of choice when dealing with growth-hormone-producing pituitary adenomas with no suprasellar extension.
Experimental intraoperative localization of retained intracerebral bone fragments using transdural ultrasound
Authors: Wood James H. , Parver Mitchell , Doppman John L. , Ommaya Ayub K.
Published: May 2009

✓ Precise intraoperative localization of retained bone fragments and foreign bodies avoids extensive brain dissection, cerebral edema, damage to vital structures, incomplete debridement, and prolonged surgical procedures. Such localization after head trauma is often hampered by cerebral distortion, previous incomplete debridement, fragment migration, and surgical draping. Our intraoperative technique of transdural A-scanning using aspiration-biopsy transducers precisely localized 3.5-mm fragments without damage to underlying cortical tissue and vessels. Transdural Amode echoencephalography was found to be more reliable for intracerebral depth estimations but epidural B-mode sonography was more useful for determining the size of fragments. Transdural ultrasound offered an intraoperative alternative to stereotaxic localization of retained bone fragments in experimental head trauma.
Fate of small diameter cervical veins grafted into the common carotid arteries of growing rabbits
Authors: Bannister Carys M. , Mundy Lesley A. , Mundy Janice E.
Published: May 2009

✓ Autogenous cervical veins were grafted into the common carotid arteries of rabbits during their active growing period. A patency rate of 58.8% was achieved but the thin-walled vein grafts underwent massive dilatation. This dilatation is likely to severely limit the usefulness of these veins as a source of bridging grafts in clinical practice, particularly for use within the intracranial cavity.
Cavernous sinus syndrome produced by communication between the external carotid artery and cavernous sinus
Authors: Edwards Michael S. , Connolly Edward S.
Published: May 2009

✓ The authors present two cases of cavernous sinus syndrome with spontaneous onset secondary to arteriovenous malformations and review the cases reported previously. These malformations enlarge slowly and produce symptoms only in adult life. Diagnosis may be difficult when there is no associated bruit. Adequate evaluation necessitates selective angiography of both the internal and external carotid artery circulation and the vertebral circulation. Conservative treatment is recommended unless symptoms worsen or there is progressive loss of vision.
Neurophysiological and neurochemical alterations during electrical stimulation of human caudate nucleus
Authors: Wood James H. , Lake C. Raymond , Ziegler Michael G. , Van Buren John M.
Published: May 2009

✓ Lumbar cerebrospinal fluid (CSF) norepinephrine (NE) concentrations were preoperatively determined in five patients using a radioenzymatic assay technique. Stereotaxic thalamotomy was performed using depth coagulating electrodes with stimulating points at 5.0-mm intervals along the shaft. No significant alterations in prestimulation lumbar CSF NE levels were noted 12 days after electrode installation. Stimulating points within the caudate nucleus were anatomically localized using ventricular landmarks and stimulation-induced neurophysiological responses were recorded. Twelve hours after intermittent electrical stimulation of the caudate nucleus, lumbar CSF NE concentrations were significantly decreased. Our data suggest the presence of noradrenergic pathways in man that are inhibited by caudate nucleus stimulation.
Effects of cyclic AMP and dibutyryl cyclic AMP on cerebral hemodynamics and metabolism in the baboon
Authors: Tagashira Yukio , Matsuda Masayuki , Welch Kenneth M. A. , Chabi Eva , Meyer John S.
Published: May 2009

✓ Adenosine 3′,5′-cyclic monophosphate (cyclic AMP) (0.5 mg/kg) was infused into the carotid artery of baboons anesthesized with sodium pentobarbital, causing a biphasic increase in cerebral blood flow (CBF) and reduction in cerebrovascular resistance (CVR) associated in each phase with stimulation of cerebral metabolism evidenced by increased cerebral oxygen consumption (CMRO2) and cerebral glucose consumption (CMRGI). Intracarotid dibutyryl cyclic AMP (0.5 mg/kg) caused a monophasic increase in CBF and reduction of CVR but failed to alter cerebral metabolism. This may be due to its rapid removal from the circulation with ineffective passage across the blood-brain barrier since intracisternal infusion of dibutyryl cyclic AMP caused sustained increase in CBF, CMRO2 and CMRGl and reduction in CVR. Intracarotid AMP (0.4 mg/kg) and adenosine (0.3 mg/kg) caused an immediate and more marked increase in CBF and decrease in CVR unassociated with cerebral metabolic change making it unlikely that the observed effects of cyclic AMP can be attributed to its breakdown products. Cyclic AMP or its dibutyryl derivative may alter cerebral metabolism secondary to neuronal activation but increase in glucose/oxygen utilization ratio after intracarotid cyclic AMP and intracisternal dibutyryl cyclic AMP also suggests an influence on enzymatic regulation of glucose metabolism.
Excision of multiple intracranial metastatic hypernephroma
Authors: Dayes Lloyd A. , Rouhe Stanley A. , Barnes Roger W.
Published: May 2009

✓ The authors report a case of cerebral and cerebellar metastatic renal carcinoma with 7-year survival without present evidence of recurrence following excision of both intracranial lesions and the primary lesion (by radical nephrectomy).
The effect of cerebellar stimulation on focal seizure activity and spasticity in monkeys
Authors: Hemmy David C. , Larson Sanford J. , Sances Anthony , Millar Edward A.
Published: May 2009

✓ Experiments were carried out in awake, unmedicated monkeys to determine the effect of application of current to the cerebellar hemispheres on electrically induced focal motor seizures and surgically induced spasticity. Application of current at various frequencies and pulse amplitudes did not significantly alter focal motor seizures but did significantly reduce spasticity. Analysis of evoked potential recordings carried out during various experimental procedures suggests that application of current to the cerebellar hemispheres may reduce cortical neuronal responsiveness.
The effects of beta adrenergic blockade on spinal cord autoregulation in the monkey
Authors: Kobrine Arthur I. , Evans Delbert E. , Rizzoli Hugo V.
Published: May 2009

✓ Blood flow in the spinal cord was measured in a group of monkeys over a wide range of artificially varied blood pressures after the administration of propranolol, a beta adrenergic blocker. Spinal cord blood flow was found to be constant and in the normal range between a mean system arterial blood pressure of 50 to 150 mm Hg. From 150 to 180 mm Hg spinal cord blood flow decreased. There was no breakthrough of autoregulation, previously seen in the untreated animal. It is suggested, therefore, that the previously observed breakthrough of autoregulation is a beta adrenergic-mediated phenomenon.
Multiple meningeal diverticula and cysts associated with duplications of the sheaths of spinal nerve posterior roots
Authors: Nathan Hilel , Rosner Samuel
Published: May 2009

✓ Multiple diverticula and cysts of the meninges were found during an anatomical dissection. They were associated with duplications of sheaths of the posterior roots of the spinal nerves. The diverticula and cysts appeared as simple flaccid corrugated dilatations of the sheaths, as ampullary expansions, as pediculated cysts, or as saccular dilatations of different sizes and locations. The duplication of the sheaths affected posterior roots of the thoracic nerves only. Some variations of the sheaths described in the literature are discussed. The possibility is considered that both conditions result from the same pathological factors in the embryo.
Ventriculography with non-ionic water-soluble contrast medium, Amipaque (metrizamide)
Authors: Suzuki Shigeharu , Ito Kenjiro , Iwabuchi Takashi
Published: May 2009

✓ A non-ionic water-soluble contrast medium, Amipaque (metrizamide), was studied for use in ventriculography both experimentally and clinically, and identified as having markedly low toxicity. Twenty adult mongrel dogs were injected intraventricularly or intracisternally with 2.0 to 5.0 ml of Amipaque. It was found that Amipaque is safe compared with other water-soluble contrast media, especially relative to epileptogenic effect. The authors also carried out 17 clinical trials of ventriculography using 4.0 to 15.0 ml of Amipaque in 13 neurosurgical patients. There were no troublesome symptoms except for a mild headache as a side-effect in one patient, and Amipaque proved to be a satisfactory diagnostic contrast medium.
Delayed radiation necrosis of the brain
Authors: Martins Albert N. , Johnston James S. , Henry James M. , Stoffel Thomas J. , Chiro Giovanni Di
Published: May 2009

✓ The cases of six patients are presented to delineate the clinical profile of delayed radiation necrosis of the brain. In five the diagnosis was verified histologically. Symptoms most often begin 9 months to 2 years after radiotherapy. Progressive visual impairment and dementia are common following perisellar irradiation, while hemispheric signs predominate following irradiation of the cerebrum. Cerebrospinal fluid protein may be elevated. Focal delta slowing is usually present on electroencephalography. The necrotic brain may appear on radionuclide brain scan as an area of abnormal uptake and also act as an avascular space-occupying lesion. With computerized tomography, radiation necrosis appears as an intracerebral area with diminished absorption coefficient that is often enhanced with intravenous contrast medium. The syndrome may be sufficiently characteristic to eliminate the need for surgical exploration and biopsy in some cases. Cumulative experience suggests that the risk-to-benefit ratio of radiotherapy becomes increasingly unfavorable for most patients with benign intracranial neoplasms when the standard brain tumor dose of 5000 to 7000 rads is fractionated at greater than 200 rads per day.
Brown-Séquard syndrome and cervical spondylosis
Authors: Jabbari Bahman , Pierce James F. , Boston Susan , Echols Dean M.
Published: May 2009

✓ Six patients with a rapidly progressive myelopathy of the Brown-Séquard type are presented (two in detail). Their clinical history, results of laboratory investigations, and surgical exploration revealed cervical spondylosis as the sole cause of this syndrome. We believe that a rapidly progressive myelopathy of Brown-Séquard type, even in younger individuals, is often a presenting clinical feature of cervical spondylosis.
Indications for nonoperative treatment of spinal cord compression due to breast cancer
Authors: Cobb Cully A. , Leavens Milam E. , Eckles Nylene
Published: May 2009

✓ A retrospective series of 12,478 patients with breast cancer included 2467 patients with spinal metastases. Local treatment was not necessary in 688 patients. Neurological deficit did not develop in 1735 patients who underwent radiotherapy. Forty-four patients developed myelopathy due to spinal cord compression as demonstrated by neurological examination and myelography. Twenty-six of these patients were initially treated by laminectomy and 18 were initially treated with radiotherapy. The two groups did not significantly differ in their outcome with respect to motor power, pain relief, or ability to walk. Six patients who underwent radiotherapy deteriorated during 2 months of treatment. Four of these patients were not operative candidates because of poor general condition (three patients) or long duration of paraplegia (one patient). Of two patients who underwent emergency laminectomy, one became paraplegic; however, the other patient was significantly improved. For this reason it is essential that patients undergoing radiotherapy for spinal cord compression be followed closely by a neurosurgeon. The authors believe that in appropriate cases radiotherapy alone can yield results as good as laminectomy combined with radiotherapy.
Cerebral arterial blood flow and aneurysm surgery
Authors: Nornes Helge , Wikeby Per
Published: May 2009

✓ Cerebral arterial blood flow was monitored in 22 patients undergoing surgery for intracranial saccular aneurysms. An electromagnetic flow probe was used to record the internal carotid artery (ICA) flow in the neck or intracranially in seven patients. The ICA flow ranged between 100 and 175 ml/min (average 144 ml/min). Intracranial flow measurements with specially designed probes were made in 17 patients. The middle cerebral artery (MCA) showed flow values between 75 and 120 ml/min (average 97 ml/min). Flow figures recorded from the proximal anterior cerebral artery (ACA) were lower (average 65 ml/min), and had a wider range from 30 to 110 ml/min.

Test occlusion of the terminal ICA showed a retrograde flow in the proximal ACA to the MCA ranging from 15 to 125 ml/min (average 78 ml/min). This test was used to investigate the collateral potential of the anterior portion of the circle of Willis, which is essential to the decision of whether to undertake trap ligation procedures in this location. Flow monitoring in the parent vessel was also of use in some patients to assess flow conditions after the clipping of the aneurysm neck.
Computerized tomographic demonstration of a retroperitoneal hematoma causing femoral neuropathy
Authors: Simeone Joseph F. , Robinson Franklin , Rothman Stephen L. G. , Jaffe C. Carl
Published: May 2009

✓ To the previously reported 28 cases of femoral neuropathy caused by a retroperitoneal hematoma in patients on anticoagulant drugs are added two cases in which the diagnosis was made by direct visualization of hematoma of the iliacus muscle by computerized tomography of the abdomen.
Effects of stimulating the cerebellar surface on the activity in penicillin foci
Authors: Bantli Heinrich , Bloedel James R. , Anderson Gary , McRoberts Ronald , Sandberg Eric
Published: May 2009

✓ The effect of stimulating the cerebellar surface on the activity of acute penicillin foci (20,000 units) was investigated in a statistically designed study. All animals were randomly assigned either to an experimental group in which the dura over the posterior lobe was opened and a bipolar surface electrode placed over the vermis of the anterior lobe, or else to a control group in which only the dura was opened. After surgery, the animals in the experimental group were randomly assigned to a stimulated or an unstimulated group. The cerebellar surface was stimulated at a frequency of 10/sec using capacitatively coupled pulses with peak current densities of 26.0 mA/sq cm and a duration of 0.1 msec. The effectiveness of the stimuli for activating neuronal elements in the cerebellum was evaluated 1) by recording the cerebellar evoked response from the sensorimotor cortex, and 2) by measuring the effect of a conditioning cerebellar stimulus on the percent change in the amplitude of the cortical response evoked by stimulating the receptive fields of the trigeminal nerve. A statistical comparison of the mean number of seizures for successive 10-minute intervals between control and experimental groups indicated that any difference in the means of these parameters occurred by chance with a high probability and did not result from any treatment. The duration of the seizures, however, was significantly affected by stimulation of the cerebellar surface. Further, the total number of seizures and the amplitude of the cerebellar evoked response in the same animal were inversely correlated. Thus, stimuli that evoked large-amplitude responses over the sensorimotor cortex may have produced a decrease in the number of seizures, whereas stimuli that evoked small-amplitude responses may have produced an increase in the total number of seizures with respect to the control group.
Pathological changes from acute to chronic in experimental spinal cord trauma
Authors: Wagner Franklin C. , VanGilder John C. , Dohrmann George J.
Published: May 2009

✓ The pathological changes occurring in the thoracic spinal cords of 41 cats were studied by light microscopy at 4 hours, 4 weeks, and 4 months after graded transdural trauma. Alterations characteristic of a vascular injury proportionate to the magnitude of the original trauma which results in tissue hypoxia, destruction, and reparation were identified at each interval studied. In more severely injured animals these changes consisted of an initial hemorrhagic infarction followed by the removal of necrotic parenchyma and the development of an adhesive arachnoiditis and intramedullary cavitation. A comparison of the findings in the present investigation with what has been described in postmortem studies of spinal cord injured patients indicates that the response of the spinal cord to non-disruptive trauma is similar in both cases.
Sacral rootlet rhizotomy at the conus medullaris for hypertonic neurogenic bladder
Authors: Toczek Stanislaw K. , McCullough David C. , Boggs John S.
Published: May 2009

✓ Three patients with spastic neurogenic bladder underwent sacral root stimulation and appropriate section of motor rootlets to the detrusor at the level of the conus medullaris. Compared to the results obtained with rhizotomies at the sacral levels in a previous series of patients, urinary frequency and infection were inhibited for longer periods of time, but some uninhibited bladder activity recurred in all three patients. Analysis of anatomical and electrophysiological data serves to emphasize the complexity and asymmetry of efferent supply to detrusor muscle. The authors conclude that the role of selective rhizotomy for inhibition of the spastic bladder is inconclusive, and perhaps a combination of surgery and medications that inhibit smooth-muscle contraction may be required for long-term protection of urinary collection systems.
Progressive neurological dysfunction secondary to postoperative cervical pseudomeningocele in a C-4 quadriplegic
Authors: Burres Kenneth P. , Conley Frances K.
Published: May 2009

✓ A case is detailed of a patient who developed progressive neurological deficit above a fixed quadriplegic level at C-4 18 years after posterior cervical decompression for trauma. Diagnostic evaluation revealed a pseudomeningocele at the site of his previous surgery. Subsequent operative closure resulted in reversal of his neurological symptoms.
The angiographically occult cerebrovascular malformation
Authors: Golden James B. , Kramer Richard A.
Published: May 2009

✓ Three cases presenting with hemiparesis, headache, or seizures gave no history suggestive of subarachnoid or intracerebral hemorrhage. Carotid arteriograms were performed, and in each case failed to demonstrate a vascular malformation. In all three cases cerebral lesions were shown by either computerized tomographic (CT) scan, radionuclide scan, or both. Surgical exploration and biopsy revealed a vascular malformation in each case. The CT scans in two of the cases showed dense lesions that could suggest vascular malformation as a diagnostic possibility.
Cervical myelopathy due to spondylosis
Authors: Hawkins John C. , Yaghmai F. , Gindin R. Arthur
Published: May 2009

✓ The authors report the case of a patient with cervical myelopathy who was examined at autopsy 2 years after a second anterior cervical fusion by Cloward's technique. The clinical course and pre- and postoperative myelograms are presented. Theories as to the etiology of myelopathy are discussed. This case demonstrates chronic changes that seem to implicate a vascular theory but not the specific vessel or vessels. The mechanism of improvement following the Cloward procedure is not explained by the pathological slides.
Surgical treatment of bronchogenic carcinoma with a brain metastasis
Authors: Salerno Tomas A. , Munro Darrell D. , Little John R.
Published: May 2009

✓ Twenty-three patients with bronchogenic carcinoma and a brain metastasis had their primary and secondary tumors treated surgically. The 10 men and 13 women had an average age of 52 years. Fifteen patients presented with a lesion of the lung and eight patients presented initially with neurological findings of an intracranial mass lesion. The most common histological type of tumor was adenocarcinoma (48%), followed by squamous cell carcinoma, undifferentiated small cell carcinoma, and bronchoalveolar carcinoma. Twelve patients (52%) had a poor result and died during the first 6 months. Surgery appeared to improve short-term survival in six patients (26%). Five patients (22%) had a good result and lived longer than 2 years without significant neurological deficit. Three patients (13%) are alive 10 or more years following surgery.
Ipsilateral cerebral atrophy with thalamic tumor of childhood
Authors: Kwak Ryungchan , Saso Shun-Ichi , Suzuki Jiro
Published: May 2009

✓ A case of cerebral tumor with ipsilateral cerebral hemiatrophy is presented and five previously reported cases are reviewed. The etiology of this entity is discussed on the basis of the symptomatological and clinicopathological findings noted in these six cases. It is suggested that ipsilateral cerebral hemiatrophy is due to thinning of the cerebral cortex with degeneration and disappearance of ganglion cells, demyelination in the subcortex, and destruction of axons. The mechanism proposed for ipsilateral cerebral hemiatrophy due to thalamic tumor is that thalamic tumor causes degeneration and disappearance of thalamic ganglion cells and nerve fibers, with consequent secondary Wallerian degeneration of afferent and projecting fibers from the thalamus as well as retrograde degeneration of efferent fibers, thus resulting in extensive atrophy of the cerebral cortex and subcortical tissue.
Sequential angiographic studies demonstrating delayed development of an acute epidural hematoma
Authors: Goodkin Robert , Zahniser John
Published: May 2009

✓ A case is presented in which the delayed development of an acute epidural hematoma within 12 hours of a head injury was documented by serial cerebral angiography. A possible mechanism for the delayed evolution of the epidural hematoma is discussed.
Microsurgical anatomy of the posterior cerebral artery
Authors: Zeal Arnold A. , Rhoton Albert L.
Published: May 2009

✓ In order to define the microsurgical anatomy, 50 posterior cerebral arteries (PCA's) were examined using × 3 to × 40 magnification. The PC A was divided into four segments: Pt was the segment proximal to the posterior communicating artery (PCoA); P2 extended from the PCoA to the posterior margin of the midbrain and was subdivided into an equal anterior (P2A) and posterior (P2P) half; P3 began at the posterior midbrain, ran within the quadrigeminal cistern, and ended at the anterior limit of the calcarine fissure. The PCA had three types of branches: 1) cortical branches to the cerebrum; 2) central branches to the brain stem; and 3) ventricular branches to the choroid plexus. The largest branches reaching the lateral surface of the cerebrum were located immediately anterior to the preoccipital notch, and in most cases were branches of the posterior temporal artery. This area offers a greater than 75% chance of finding a vessel large enough to perform a microvascular anastomosis. The central branches were of two types: 1) direct perforating, and 2) circumferential. The direct perforating branches arising on P1 were the posterior thalamoperforating arteries. The “thalamogeniculate artery,” the vessel said to be occluded in the “thalamic syndrome,” was also of the direct perforating type, but it was a series of small arteries arising from P2A and P2P rather than being a single vessel. The circumferential arteries usually arose from P1 and encircled the midbrain providing branches as far posteriorly as the colliculi. The branches to the choroid plexus were the medial and lateral posterior choroidal arteries; the former usually arose from P2A and entered the roof of the third ventricle, and the latter arose as a series of arteries from P2P and passed over the pulvinar to enter the lateral ventricle.
Vertebrobasilar spasm: A significant cause of neurological deficit in head injury
Authors: Marshall Lawrence F. , Bruce Derek A. , Bruno Leonard , Langfitt Thomas W.
Published: May 2009

✓ Cerebral vasospasm in the anterior circulation has been recognized as a significant factor in the sequelae of head injury; however, vertebrobasilar spasm resulting from trauma has received much less attention. In the past year we have observed six patients where spasm in the major vessels of the posterior circulation was primarily or in part responsible for the neurological deficit. In such cases, the neurological examination may suggest a supratentorial mass with herniation and, in three of our cases, burr holes or carotid angiography were performed first. However, in every instance neurological signs present on admission indicated primary brain-stem dysfunction. In each of the six cases vertebral angiography demonstrated significant spasm in either the vertebral or basilar arteries. Intracranial pressure was monitored in each of the six patients and did not exceed 25 mm Hg in any. In cases of head injury where the neurological examination indicates brain-stem dysfunction inconsistent with or after a supratentorial mass has been excluded, vertebral angiography may aid in the diagnosis and subsequent management of such patients.
Autoregulation and CO2 responses of cerebral blood flow in patients with acute severe head injury
Authors: Enevoldsen Erna M. , Jensen Finn T.
Published: May 2009

✓ Regional cerebral blood flow (rCBF), cerebral intraventricular pressure (IVP), systemic arterial blood pressure, and cerebral ventricular fluid (CSF) lactate and pH were studied repeatedly in 23 patients during the acute phase of severe brain injury lasting from 3 to 21 days after the trauma. Cerebrovascular autoregulation was tested repeatedly by means of angiotensin infusion in 21 of the patients, and CO2 response in 14 by means of passive hyperventilation. The pressure in the brain ventricles was measured continuously in all patients and kept below 45 mm Hg during the study. If the IVP increased more than 10 mm Hg during the angiotensin infusion (as in one case), the autoregulation test was considered contraindicated and the angiotensin infusion was discontinued.

Dissociation between cerebrovascular autoregulation and CO2 response was a common phenomenon. Typically, autoregulation appeared preserved in the most severely injured areas of the cerebral cortex when the patient was deeply comatose, but deteriorated concomitantly with recovery; by the time the patient became alert, the autoregulation was always impaired. The CO2 response was impaired only in patients who were deeply comatose and had attacks of decerebrate rigidity; during recovery the CO2 response became normal. Thus, preserved autoregulation associated with impaired CO2 response indicated very severe brain damage, whereas impaired autoregulation associated with preserved CO2 response suggested moderate or severe brain damage in recovery. These paradoxical observations raise the question whether the preserved autoregulation seen in severely injured brain tissue is a true autoregulation caused by an active vasoconstrictor response to an increase in blood pressure.
Inversion of the cerebral mantle as a complication of ventricular shunting
Authors: Steinbok Paul , Berry Kenneth
Published: May 2009

✓ The authors report a case of inversion of part of the cerebral mantle into the frontal horn of the lateral ventricle following ventriculoperitoneal shunting for noncommunicating hydrocephalus. The abnormally positioned cerebral mantle continued to grow and caused no detectable neurological dysfunction.
A device for intracranial pressure regulation
Authors: Wright Ballard D. , Young Byron
Published: May 2009

✓ The authors describe a device that monitors and automatically regulates intracranial pressure.