bluuebunny/crossref_metadata_2025 huggingface dataset:
Intracranial pressure monitoring after elective intracranial surgery
Authors: Constantini Shlomi , Cotev Shamay , Rappaport Z. Harry , Pomeranz Shlomo , Shalit Mordechai N.
Published: May 2009

✓ A retrospective study of 514 consecutive patients whose intracranial pressure (ICP) was monitored after elective supratentorial or infratentorial surgery is reported. Of the 412 patients operated on in the supratentorial region, 76 (18.4%) had a postoperative sustained ICP elevation exceeding 20 torr. Abnormally high ICP occurred after 13 (12.7%) of the 102 infratentorial operations. Risk factors for postoperative ICP elevation were: resection of glioblastoma in 27.2% of cases, repeat surgery in 42.9% of cases, and protracted surgery (> 6 hours) in 41.7% of cases. Of the 89 patients with elevated ICP, 47 (52.8%) had an associated clinical deterioration. In 19 of these, the rise in ICP occurred before this deterioration was noticed, leading as a rule to quick diagnostic and management response. In eight patients clinical deterioration was noticed before the rise in ICP, and in 20 it happened simultaneously. The higher the level of ICP elevation, the greater were the chances of associated deterioration.

The most common findings on computerized tomography scanning in 35 of the 89 patients with elevated ICP were brain edema (19 cases) and bleeding in the tumor bed (15 cases). Mannitol, thiopental, additional hyperventilation, and reintubation (in patients who were previously extubated) were used to reduce ICP, in addition to surgical decompression whenever indicated. Thirteen patients with raised ICP and clinical deterioration underwent reoperation.

The postoperative infection rate was 1.2% (six cases). In only one patient could infection be attributed to ICP monitoring. It was concluded that ICP monitoring is advantageous in the immediate postoperative management after elective intracranial surgery and is almost risk-free. It should therefore be used liberally, especially when risk factors for ICP elevation can be identified prior to the end of surgery.
Pharmacological comparison of endothelium-dependent relaxation in isolated cerebral and extracerebral arteries
Authors: Nakagomi Tadayoshi , Hongo Kazuhiro , Kassell Neal F. , Sasaki Tomio , Lehman R. Michael , Ogawa Hisayuki , Vollmer Dennis G. , Torner James C.
Published: May 2009

✓ Endothelium-dependent relaxation was induced by acetylcholine (ACh), adenosine triphosphate (ATP), and thrombin in isolated cerebral and extracerebral arteries obtained from rabbits and dogs. Using an isometric tension-recording method, the authors then examined the difference in the extent of relaxation between the cerebral and extracerebral arteries. In rabbits, the dose-response curve of the basilar artery for ACh was significantly different (p < 0.05) from curves of the femoral and common carotid arteries. The IC50value (the concentration inducing a one-half inhibition of the initial contractile tone) for the basilar artery in ACh-induced relaxation was significantly higher (p < 0.05) than for the common carotid artery, although the mean maximum relaxation of the basilar artery to ACh was not significantly different from that seen in extracerebral arteries. The relaxing effect of ACh in dogs was much less in the middle cerebral and basilar arteries than in the common carotid, vertebral, and femoral arteries. On the other hand, both ATP (in rabbits and dogs) and thrombin (in dogs) induced significantly more (p < 0.05) relaxation in the cerebral arteries than in the extracerebral arteries.

Endothelium-dependent relaxation induced by ACh or ATP has been demonstrated in a wide range of arteries from a variety of animals. The present results suggest that ATP has a more important role than ACh in the regulation of the vascular tone of the major cerebral arteries in these two species.
Recurrent Lhermitte-Duclos disease in a child
Authors: Marano Stephen R. , Johnson Peter C. , Spetzler Robert F.
Published: May 2009

✓ A case of recurrent Lhermitte-Duclos disease (dysplastic gangliocytoma of the cerebellum) in a child is described with a summary of the clinical presentation and associated malformations, and a review of other cases reported in the literature. The histological examination and electron microscopic findings, with special reference to the cytological changes found during evaluation of the recurrence, are presented. Theories regarding the pathogenesis of Lhermitte-Duclos disease are reviewed.
Congenital anaplastic astrocytoma with favorable prognosis
Authors: Roosen Norbert , Deckert Martina , Nicola Nikolaus , Wechsler Wolfgang , Schober Ralf , von Voss Hubertus , Mayer Peter , Werner Christoph
Published: May 2009

✓ A large intracranial tumor that caused macrocrania leading to dystocia was demonstrated by prenatal ultrasound examination. After birth, computerized tomography (CT) confirmed the presence of a giant supratentorial tumor with a large cyst. When the infant was 20 days old, the tumor was radically extirpated. Neuropathological examination revealed an astrocytoma with focal signs of anaplasia showing a macrocyst as well as multiple microcysts resulting from hemorrhages into the tumor. Although no adjuvant radio- or chemotherapy was administered, the child had nearly normal psychomotor development without clinical or CT evidence of tumor recurrence, and is now 3 years old.
Leptomeningeal and orbital benign lymphophagocytic histiocytosis
Authors: Asai Akio , Matsutani Masao , Kohno Takeshi , Fujimaki Takamitsu , Tanaka Hideki , Kawaguchi Kenji , Koike Morio , Takakura Kintomo
Published: May 2009

✓ An extremely rare case of isolated histioproliferative lesions arising from the subarachnoid space of the left occipital convexity and the orbit is presented. The presence of histiocytes showing lymphophagocytosis and positivity for S-100 protein staining confirmed that the lesions represented extranodal forms of sinus histiocytosis with massive lymphadenopathy.
Epidural hibernoma as a complication of corticosteroid treatment
Authors: Perling Lance H. , Laurent John P. , Cheek William R.
Published: May 2009

✓ Centripetal fat deposition is a well-recognized consequence of excessive use of corticosteroids, either endogenous or exogenous. Recently, several patients receiving large doses of corticosteroids have suffered compressive myelopathies due to excessive epidural fat collections, labeled “epidural lipomatosis.” Two of these have been children, and a third child is reported here. This child was receiving chronic steroids for juvenile rheumatoid arthritis when he presented with such a myelopathy, which was confirmed by metrizamide computerized tomography myelography as well as by surgical exploration. Histological examination revealed that the epidural tissue was a brown-fat tumor or “hibernoma.” An epidural hibernoma has not been described previously. The histological and endocrine features of fat in Cushing's syndrome are discussed, and the literature concerning hibernoma and epidural lipomatosis is reviewed.
Postendarterectomy heparin-induced thrombocytopenia
Authors: Rogers Larry A.
Published: May 2009

✓ Two episodes of massive bleeding from a sutured arteriotomy were observed within 30 hours after carotid endarterectomy. The patient had received anticoagulation therapy with heparin for 72 hours prior to surgery. A platelet count of 93,000/cu mm was demonstrated following the second hemorrhage. The potential problem of drug-induced thrombocytopenia following vascular surgery is discussed.
Changes in radicular function following low-back surgery
Authors: Blaauw Gerhard , Braakman Reinder , Gelpke Geert Jan , Singh Ram
Published: May 2009

✓ Results of neurological assessment 1 year following surgical treatment of herniated lumbar intervertebral discs and lumbar stenosis are reported in 443 patients. The data were collected using separate series of questionnaires to be completed by the patient and the surgeon. Preoperatively, motor loss was reported by 12% of patients, while surgeons found motor weakness in 28%. Postoperative motor loss was still present in 24% and 25% of these cases, respectively; the operation had caused or aggravated motor loss in 5% and 3% of cases, respectively. Sensory phenomena were reported by 53% of the patients, while surgeons found sensory loss in 45%. Sensation was reported as abnormal 1 year after surgery both by patients and by surgeons in one-third of these cases. Sensory loss, considered by the patient to be caused or aggravated by operation, occurred in 15% of cases and in 12% of cases the surgeons agreed. Preoperatively, unilaterally diminished knee and Achilles tendon reflexes were found in 9% and 42%, respectively; at 1 year after surgery, these had recovered in 65% and 57% of cases, respectively. Surgery caused or aggravated unilaterally diminished knee or ankle jerks in 3% and 10% of cases, respectively.
Detection of mRNA of prolactin and ACTH in clinically nonfunctioning pituitary adenomas
Authors: Sakurai Tsuyoshi , Seo Hisao , Yamamoto Naohito , Nagaya Takashi , Nakane Toshichi , Kuwayama Akio , Kageyama Naoki , Matsui Nobuo
Published: May 2009

✓ Clinically nonfunctioning pituitary adenomas have been thought to synthesize some pituitary hormones as shown by studies involving cell culture, immunocytochemistry, or measurement of hormone levels in tumor homogenates. Nevertheless, they are not associated with hypersecretion of pituitary hormones. To further clarify hormone synthesis in such pituitary adenomas, the presence of messenger ribonucleic acid (mRNA) of prolactin (PRL) growth hormone, and adrenocorticotropic hormone (ACTH) in the cytoplasm of 16 nonfunctioning adenomas was determined by means of a hybridization technique, and compared to the immunocytochemical findings. In three adenomas (19%) PRL mRNA was detected and in one case (6%) ACTH mRNA was detected. The hybridization technique appears to be more sensitive than immunohistochemistry for detection of specific mRNA's in assigning the hormone synthesis potential to clinically nonfunctioning tumors. The results suggest that PRL and ACTH are synthesized in some cases of clinically nonfunctioning pituitary adenomas and that hybridization techniques are useful to investigate hormone synthesis in pituitary adenomas. The ability to demonstrate PRL mRNA in tumor tissues allowed differentiation between hyperprolactinemia caused by synthesis of PRL in the tumor and that due to hypersecretion from the adjacent normal pituitary.
MR imaging of CSF pulsatory flow and its relation to intracranial pressure
Authors: Ohara Shigeki , Nagai Hajime , Matsumoto Takashi , Banno Tatsuo
Published: May 2009

✓ In a retrospective study of magnetic resonance (MR) images obtained in 289 neurosurgical patients, loss of signal intensity (signal-void phenomenon, SVP) of the cerebrospinal fluid (CSF) in the mesencephalic aqueduct was observed in 77 patients. This SVP was noted in the MR studies of 12 of 14 patients with communicating hydrocephalus who showed a normal mean intracranial pressure (ICP) and normal pulse pressure, but in only seven of 50 patients with high mean ICP and high pulse pressure (such as those with a supratentorial tumor). The difference in the incidence of SVP between these two disease groups was statistically significant by Fisher's direct probability test. Based on MR images triggered by electrocardiography (EKG) waves, graphs were plotted to show the signal intensity of ventricular CSF versus time after the EKG R-wave. These graphs showed six distinct patterns which changed after the ICP was lowered by the withdrawal of CSF via a lumbar puncture.

It is known that CSF in the cranial cavity flows toward the spinal space in a to-and-fro manner in response to the pulsations of the brain. The SVP reflects the capacity of the craniospinal cavity to buffer pressure changes within it. It may be possible to differentiate normal from increased ICP by the MR signal intensity of the CSF in the ventricular system.
Effect of nimodipine on the outcome of patients after aneurysmal subarachnoid hemorrhage and surgery
Authors: Öhman Juha , Heiskanen Olli
Published: May 2009

✓ The effect of intravenous nimodipine on the incidence of mortality and delayed ischemic neurological deficits of patients after aneurysmal subarachnoid hemorrhage (SAH) and surgery was studied in a prospective double-blind placebo-controlled trial. Upon admission, all of the patients were in Grades I to III according to the classification of Hunt and Hess. Of the 213 patients enrolled in the study, 58 underwent early surgery (within 72 hours after the bleed: Days 0 to 3), 69 were operated on subacutely (between Days 4 and 7), and 74 had late surgery (on Day 8 or later). Eleven patients died before surgery was undertaken and one was not scheduled for operation. Administration of the drug was started immediately after the radiological diagnosis of a ruptured aneurysm had been made. The dose of nimodipine or matching placebo was 0.5 µg/kg/min via continuous intravenous infusion for 7 to 10 days after the SAH and, if the patient was operated on late, for 2 to 3 days after the operation as well. After intravenous treatment, oral administration of nimodipine or placebo was continued for up to 21 days after SAH in a dose of 60 mg every 4 hours. Nimodipine treatment was associated with a significant decrease in mortality rate (p = 0.03) in the early and subacute surgery groups. In the total series the number of deaths due to delayed ischemic deterioration was significantly lower in the nimodipine group than in the placebo group (p = 0.01).
A double-blind placebo-controlled trial of perioperative prophylactic antibiotics for elective neurosurgery
Authors: Bullock Ross , van Dellen James R. , Ketelbey William , Reinach S. Gustav
Published: May 2009

✓ In this study, 417 patients undergoing “clean” elective neurosurgical operative procedures were randomized to receive a broad-spectrum antibiotic (piperacillin) or placebo given as three perioperative doses, each 6 hours apart. Randomization was carried out by hospital pharmacists, and the investigators remained blinded until the end of the study. Twenty cases were excluded from analysis because either an unforeseen second operation was performed or antibiotic therapy was initiated within 30 days after surgery to treat infection or the risk of infection. Twelve of the 205 patients treated with placebo developed postoperative wound sepsis, and four of the 192 piperacillin-treated patients developed wound sepsis — a statistically significant difference (p < 0.05, Fisher's exact test). Piperacillin thus appeared to reduce the incidence of neurosurgical wound infection in this study.
A comparison of the Glasgow Coma Scale and the Reaction Level Scale (RLS85)
Authors: Starmark Jan-Erik , Stålhammar Daniel , Holmgren Eddy , Rosander Björn
Published: May 2009

✓ The Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS85) were compared for rating neurosurgical patients in regard to ranking order of deficit severity, interobserver variability, and coverage for relevant factors. Four physicians, four registered nurses, and four assistant nurses performed 72 pairwise ratings on 47 neurosurgical patients. The rank correlation between the GCS sum score and the RLS85 was −0.94, suggesting the same ranking order of severity and indicating that the underlying concepts of somnolence, delirium, and motor responses in coma are evaluated in the same way.

By the sign test, the RLS85 was shown to have better interobserver agreement than the GCS sum score and the eye-motor-verbal (EMV) profile. The interobserver grading disagreements in both scales were distributed over the entire range of responsiveness, and for the GCS sum score they were slanted to combined segments 9 to 15. The RLS85 showed full coverage of relevant factors, while 43 (60%) of the 72 test occasions in the GCS sum score and the EMV profiles showed untestable features, most often because of patient intubation. The pseudoscore (that is, the choice of value given to untestable features) affects interobserver agreement as well as the estimated overall patient responsiveness in the GCS sum score. Assessment by the order of applying the scales showed a significant effect on the GCS eye-opening scale (p = 0.01) and the GCS sum score (p = 0.03), indicating a sensitivity to environmental stimuli unrelated to the patient's status. This study demonstrates that basically the same information as that found in the separate eye, motor, and verbal scales of the GCS can be combined directly into the RLS85, which has better interobserver agreement and better coverage than the GCS sum score.
Study and clinical application of a porcine biomembrane for the repair of dural defects
Authors: Bang-Zong Xu , Hong-Xue Pan , Ke-Ming Li , Xi-Jin Chen , Ying-Dei Tian , Yong-Lin Li , Jian Liu
Published: May 2009

✓ A biomembrane was developed from pig peritoneum treated with 0.65% glutaraldehyde. This was evaluated for use as a dural substitute in an animal model and in a patient population. After being treated with the glutaraldehyde solution, the biomembrane lost its antigenicity while its collagen underwent an irreversible cross-linking reaction, causing it to become a stable nonviable polymer resistant to absorption by the host. The biomembrane was used experimentally in 43 procedures on 20 dogs and was applied clinically in 614 patients. The results demonstrated that it is an acceptable material for the repair of dural defects, with the following advantages: 1) it is nontoxic to the body and brain tissues, with minimal tissue reaction; 2) its biophysical properties facilitate watertight closure with sutures; 3) its distensibility makes it suitable for decompressive surgical dural repair; and 4) its visceral surface is extremely smooth, causing virtually no adhesions with the brain tissue while the outer surface readily heals with the subcutaneous tissue.
Effect of intrathecal thrombolytic therapy on subarachnoid clot and chronic vasospasm in a primate model of SAH
Authors: Findlay Jay Max , Weir Bryce K. A. , Steinke David , Tanabe Takamura , Gordon Philip , Grace Michael
Published: May 2009

✓ The safety and efficacy of the thrombolytic agent tissue-type plasminogen activator (tPA) in the elimination of subarachnoid clot and prevention of chronic vasospasm were evaluated in a blind randomized placebo-controlled trial. Twenty-four monkeys were randomly assigned to one of two groups of 12. Each group underwent baseline cerebral angiography and coagulation analysis followed by right-sided craniectomy and experimental subarachnoid hemorrhage (SAH). An Ommaya reservoir was inserted with its catheter placed into the subarachnoid space. Twenty-four hours later one group (the tPA group) received 0.5 mg of tPA in 0.5 ml of buffer injected into the reservoir every 8 hours for three doses, while the second group (the placebo group) received the same volume of normal saline. On Day 7, angiography was repeated and the animals were sacrificed. One animal from the placebo group developed a delayed ischemic neurological deficit on Day 5 after SAH. Moderate to severe vasospasm (> 30% reduction in vessel caliber) was present on Day 7 in the internal carotid and middle cerebral arteries of the animals in the placebo group (p < 0.01), while in the tPA group only mild narrowing of the anterior cerebral artery was seen. No significant change in coagulation status occurred in either group. All animals in the placebo group had a large amount of subarachnoid clot remaining at the time of sacrifice, but 11 of the 12 animals in the tPA group were completely free of clot. The results of electron microscopic studies of the cerebral arteries correlated with angiography, and there was no histological evidence of brain inflammation associated with the intrathecal use of tPA.
Production and clearance of lactate from brain tissue, cerebrospinal fluid, and serum following experimental brain injury
Authors: Inao Suguru , Marmarou Anthony , Clarke Geoff D. , Andersen Bruce J. , Fatouros Panos P. , Young Harold F.
Published: May 2009

✓ Lactate dynamics in the brain, cerebrospinal fluid (CSF), and serum were studied in 20 chloralose-anesthetized cats following fluid-percussion trauma. Brain lactate and brain tissue pH were measured by hydrogen-1 and phophorus-31 magnetic resonance spectroscopy. The CSF, arterial, and cerebrovenous serum lactate levels as well as serum glucose concentration were quantified. In the six sham-operated control animals, brain, CSF, cerebrovenous, and arterial lactate levels as well as brain pH remained at normal values. In the five animals in the mild-trauma group (1.6 atm), brain and CSF lactate levels were moderately elevated, although the brain pH and serum lactate content remained at control values.

Severe trauma (3.1 atm) in nine cats produced an 82% increase in the brain lactate index and a reduction in brain tissue pH (7.02 ± 0.02 to 6.95 ± 0.02; mean ± standard error of the mean), indicating brain tissue acidosis caused by excessive lactate accumulation. Brain lactate levels reached a peak 1½ hours after severe trauma, then steadily decreased to normal levels by 8 hours posttrauma. Maximum increases of CSF and arterial lactate levels (from 1.4 ± 0.2 to 4.1 ± 0.4 and from 1.6 ± 0.2 to 4.1 to 0.6 mmol/liter, respectively) were observed 15 minutes after trauma, and the values decreased during the next 2 hours. The response was biphasic, with a secondary rise observed in both CSF and serum lactate levels during the remaining 4 hours of the experiment. The difference between the arterial and venous lactate levels (A-Vlact) gradually increased and reached a peak 2 hours postinjury (from −0.05 ± 0.10 to −0.41 ± 0.09 mmol/liter).

The results of this study show that the production of lactate in brain tissue, CSF, and blood increased in proportion to the severity of the injury. The observation that lactate levels in blood and CSF are maximum immediately following impact while brain lactate and A-Vlact are gradually increasing suggests that the brain-tissue production of lactate fails to account for the rapid appearance of lactate in CSF and blood. It is speculated that the initial elevation of CSF lactate values reflects the systemic response of trauma, and the secondary rise of CSF lactate levels following severe trauma is due to slow seepage of lactate produced by brain tissue into the CSF space. These studies are the first to describe the temporal profile of brain lactate production and eventual clearance by CSF and blood in fluid-percussion injury. The results emphasize the need for caution in interpreting elevated CSF lactate levels following head injury.
Isolation and in vitro growth of glioma-infiltrating lymphocytes, and an analysis of their surface phenotypes
Authors: Sawamura Yutaka , Abe Hiroshi , Aida Toshimitsu , Hosokawa Masuo , Kobayashi Hiroshi
Published: May 2009

✓ The present investigation was conducted in order to examine the feasibility of isolating and growing gliomainfiltrating lymphocytesin vitroas possible effector cells for use in new adoptive immunotherapy. Eight surgical specimens obtained from patients with malignant astrocytomas were treated by enzyme dispersion; the cells were separated on a density gradient and grown in the presence of human recombinant interleukin-2. The cultured lymphocytes were tested for cell-surface markers by using monoclonal antibodies in a flow cytometric analysis. In all cases the glioma-derived lymphocytes were grown in culture for several weeks with substantial increases in cell numbers (at least 5 × 108cells). The mature T cell population (CD3, 89%) was found to have an increased proportion of the cytotoxic/suppressor phenotype CD8 (55%) as compared to peripheral blood lymphocytes (PBL's). Eighty-six percent of the cultivated lymphocytes expressed HLA-DR. The IL-2 receptor was predominantly expressed on the helper subset (CD4-positive). Otherwise, anti-CD16, which specifically reacts with natural killer (NK) cells, did not stain significantly more of the cultured glioma-derived lymphocytes compared with lymphocyte-activated PBL's. These results corroborate the observations made with conventional immunohistochemical examination. It has been demonstrated that T lymphocytes isolated from human cancers are enriched for specific reactivity to their autochthonous tumor cells. These experiments support the possible use of glioma-infiltrating lymphocytes as a new treatment for patients with malignant glioma.
Specific cytotoxic activity of T lymphocyte clones derived from a patient with gliosarcoma
Authors: Miyatake Shin-Ichi , Kikuchi Haruhiko , Iwasaki Kohichi , Yamashita Junkoh , Zu-You-Li  , Namba Yuzirou , Hanaoka Masao
Published: May 2009

✓ Eleven lymphocyte clones were established from the peripheral blood lymphocytes of a patient with gliosarcoma by means of autologous tumor stimulation and the limiting-dilution technique with recombinant interleukin-2. Ten of the 11 clones were cytotoxic against the autologous tumor cell line GI-1. Seven of the 10 clones were also cytotoxic against allogeneic brain-tumor lines and HeLa cells, one clone was cytotoxic against several target cells, and two clones were specifically cytotoxic against GI-1 and allogeneic brain-tumor cells. One of the 11 clones was not cytotoxic against any target cells tested. Lymphokine-activated killer cells induced by recombinant interleukin-2 alone exhibited cytotoxic activity against all target tumor cells tested. Surface phenotypic analysis revealed that all lymphocyte clones expressed CD3 antigen, some expressed CD4 antigen, and others expressed CD8 antigen. These clones seemed to be antigen-specific cytotoxic T lymphocyte clones. Analysis with these antigen-specific cytotoxic T lymphocyte clones may be useful in the elucidation of tumor-specific or tumor-associated antigens on autologous tumor cells.
Bilateral proptosis from a subgaleal hematoma
Authors: Lee Kyeong Seok , Bae Hack Gun , Yun Il Gyu
Published: May 2009

✓ A case of bilateral proptosis due to orbital extension of a subgaleal hematoma is reported. It was produced by a compressive dressing applied for treatment of the hematoma. Orbital entry seemed to be via the lateral canthal region.
Systemic gamma-interferon therapy for recurrent gliomas
Authors: Mahaley M. Stephen , Bertsch Linda , Cush Sharon , Gillespie G. Yancey
Published: May 2009

✓ Recombinant gamma-interferon (2 mg/sq m) was administered intravenously twice weekly in 8-week courses to 14 patients with recurrent gliomas. Computerized tomography (CT) evidence of response was seen in only one patient, and stabilization for 12 to 86 weeks was recorded in three. This was a disappointing result, particularly in a series of patients with relatively small initial tumor volumes (less than 50 cu mm on enhanced CT) and Karnofsky functional ratings of 70 or higher. In addition, several instances of toxicity potentially attributable to gamma-interferon were observed.
Trigeminal schwannoma
Authors: McCormick Paul C. , Bello Jacqueline A. , Post Kalmon D.
Published: May 2009

✓ A consecutive series of 14 patients with trigeminal schwannoma managed surgically at the Neurological Institute of New York since 1970 is reported. Nine women and five men (mean age 40 years) were diagnosed following a mean symptom duration of 33 months. Abnormalities of trigeminal nerve function were present in 11 patients on admission examination. Facial pain was a prominent feature in eight patients. Two patients, both with schwannomas arising from the trigeminal root, presented initially with typical trigeminal neuralgia. Additional cranial nerve palsies or cerebellar or pyramidal tract signs were noted in eight patients.

The surgical approach to these tumors depends on their anatomical location. Four patients had tumors confined to the middle fossa, three patients had tumors limited to the posterior fossa, and seven patients had both supratentorial and infratentorial components of their tumors. Twenty operative procedures were performed on these patients, resulting in complete extirpation in six patients, nearly complete removal in seven patients, and partial removal in one patient. Adherence of the tumor to the lateral wall of the cavernous sinus or the brain stem precluded total removal. There was one postoperative death. In the immediate postoperative period, abnormalities of cranial nerves controlling the extraocular muscles were common. In general, these deficits were transient; however, some permanent loss of trigeminal nerve function occurred in nine patients. Two patients required tarsorrhaphy for neurotropic keratitis, and two patients underwent cerebrospinal fluid (CSF) shunting procedures for hydrocephalus or for a persistent CSF leak. The follow-up period ranged from 4 to 177 months (mean 47 months).

The clinical features, anatomical considerations, and surgical approach to these rare tumors are discussed. A clinical review of 106 additional cases of trigeminal schwannoma, reported in the English literature since 1935, is also presented.
Relationship of depth of brain lesions to consciousness and outcome after closed head injury
Authors: Levin Harvey S. , Williams David , Crofford Marsha J. , High Walter M. , Eisenberg Howard M. , Amparo Eugenio G. , Guinto Faustino C. , Kalisky Zvi , Handel Stanley F. , Goldman Arnold M.
Published: May 2009

✓ Magnetic resonance (MR) imaging was performed in 94 patients who sustained closed head injury of varying severity. Results of MR studies obtained after the intensive care phase of treatment disclosed that intracranial lesions were present in about 88% of the patients. Consistent with the centripetal model of progressive brain injury proposed in 1974 by Ommaya and Gennarelli, the depth of brain lesion was positively related to the degree and duration of impaired consciousness. Further analysis indicated that the relationship between depth of brain lesion and impaired consciousness could not be attributed to secondary effects of raised intracranial pressure or to the size of intracranial lesion(s).
Function of parietal and frontal shunts in childhood hydrocephalus
Authors: Albright A. Leland , Haines Stephen J. , Taylor Floyd H.
Published: May 2009

✓ This study was performed to determine if cerebrospinal fluid (CSF) shunts inserted via the frontal and parietal regions function for similar lengths of time. The medical records of 114 children with CSF shunts were reviewed. In 83 of these cases computerized tomography scans were also available. Ninety percent of the operations were to insert the child's first shunt. The site of insertion, cause of hydrocephalus, patient's age, surgeon, duration of function (time from insertion to malfunction or to latest follow-up evaluation), presence of infection, catheter location within the ventricle, and duration of function of the subsequent shunt were recorded. Data were analyzed by the chi-square, logistic regression, and life-table methods. Shunts had been inserted via the frontal route in 62 children and via the parietal route in 52. The children's ages, causes of hydrocephalus, and infection rates were similar in both groups. Duration of shunt function was predicted by the site of shunt insertion and the catheter position within the ventricles: shunts inserted via the frontal region functioned significantly longer than parietally inserted shunts, both as the initial shunt (Wilcoxon, p = 0.0008) and after a malfunction, and catheters positioned within the ipsilateral frontal horn functioned significantly longer than those in other ventricular locations (Wilcoxon, p = 0.03).
Heterotransplantation of malignant human gliomas in neonatal rats
Authors: Tamargo Rafael J. , Epstein Jonathan I. , Brem Henry
Published: May 2009

✓ Three human glioma cell lines (TE-671 medulloblastoma, U-87 MG glioblastoma, and U-373 MG glioblastoma) were transplanted to the quadrigeminal cistern of the brain in 37 newborn Sprague-Dawley rats and to the subcutaneous space in 30 of their siblings. Two of the three gliomas (the TE-671 medulloblastoma and the U-87 MG glioblastoma) grew both intracranially and subcutaneously. The U-373 MG glioblastoma did not grow in either site. The resulting tumors expressed unique morphological features characteristic of their tissue of origin. The newborn rat represents a model for the heterologous transplantation of human gliomas, providing a biological window for the study of these lesions.
Fatal intracranial hemorrhage after balloon occlusion of an extracranial vertebral arteriovenous fistula
Authors: Kondoh Takeshi , Tamaki Norihiko , Takeda Naoya , Suyama Touru , Oi Shizuo , Matsumoto Satoshi
Published: May 2009

✓ A patient is presented who developed a fatal hemorrhage immediately after balloon occlusion of an extracranial vertebral arteriovenous fistula. The fistula was associated with marked retrograde flow not only from the contralateral vertebral artery but also from the carotid artery system through the posterior communicating artery and the basilar artery. The bleeding appeared to be caused by acute hemodynamic effects following abrupt occlusion of the long-standing fistula. A gradual staged occlusion or trapping procedure should be considered for the treatment of such vertebral arteriovenous fistulae.
Control of epilepsy partialis continuans with intravenous nimodipine
Authors: Brandt Lennart , Säveland Hans , Ljunggren Bengt , Andersson Karl-Erik
Published: May 2009

✓ The authors present two patients with continuous focal epileptic seizures intractable to conventional antiepileptic therapy. Both cases were successfully treated with intravenous nimodipine.
Microvascular compression: an alternative view and hypothesis
Authors: Adams C. B. T.
Published: May 2009

✓ The concept of microvascular compression (MVC) is discussed critically. The root entry or exit zone is defined: it is much shorter than generally realized. The anatomy of the intracranial vessels is considered, as well as known facts concerning trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia relating to MVC. The results of microvascular decompression (MVD) are analyzed; one-third of patients do not obtain an optimum result.

The evidence used to support the hypothesis of MVC, including neurophysiology, is discussed and it is believed to be insufficient and unconvincing. The basis of MVD could be trauma of the nerve during operative dissection and “decompression.” The concept of MVC might be more convincing if MVD can be shown to cure a condition such as spasmodic torticollis, which cannot be remedied by damage to or section of the same cranial nerve or nerves.
Fractionated proton radiation therapy of chordoma and low-grade chondrosarcoma of the base of the skull
Authors: Austin-Seymour Mary , Munzenrider John , Goitein Michael , Verhey Lynn , Urie Marcia , Gentry Richard , Birnbaum Steven , Ruotolo Donna , McManus Patricia , Skates Steven , Ojemann Robert G. , Rosenberg Andrew , Schiller Alan , Koehler Andreas , Suit Herman D.
Published: May 2009

✓ Sixty-eight patients with chordoma or low-grade chondrosarcoma at the base of the skull received fractionated high-dose postoperative radiation delivered with a 160-MeV proton beam. Protons have favorable physical characteristics which allow the delivery of high doses of radiation to these critically located tumors. The methods employed for these treatments are described. These patients have been followed for at least 17 months and for a median of 34 months. The median tumor dose was 69 CGE (cobalt Gy equivalent): CGE is the dose in proton Gy multiplied by 1.1, which is the relative biological effectiveness for protons compared to cobalt-60. The daily dose was 1.8 to 2.1 CGE. For this group the 5-year actuarial local control rate is 82% and disease-free survival rate is 76%. The incidence of treatment-related morbidity has been acceptable.
Lack of histopathological correlation of malignant ependymomas with postoperative survival
Authors: Ross Gary W. , Rubinstein Lucien J.
Published: May 2009

✓ It is widely believed that an important determinant of clinical behavior and prognosis in patients harboring an ependymoma is the histological grade of malignancy of the tumor. Excluding from the present analysis examples of ependymoblastoma (a highly cellular, embryonal tumor occurring in children, with a notably poor prognosis and a tendency to subarachnoid spread), an attempt was made to correlate 15 cases of histologically malignant ependymoma with clinical recurrence and postoperative patient survival times. Ten patients (67%) were alive from 15 months to 14 years after surgery (median survival time 8.8 years); one patient had a histologically benign recurrence 11 years after surgical resection. Five patients (33%) died from a local recurrence of their tumor; their postoperative survival times ranged from 13 months to 6 years (median 2.5 years).

The prognosis of malignant ependymomas is therefore highly variable. No correlation was possible between the tumor's histological features, site, or likelihood of recurrence. This lack of clinicohistopathological concordance contrasts with the known correlations that exist in astrocytomas.
Nonhyperemic blood flow restoration and brain edema in experimental focal cerebral ischemia
Authors: Kuroiwa Toshihiko , Shibutani Makoto , Okeda Riki
Published: May 2009

✓ The effect of suppression of postischemic reactive hyperemia on the blood-brain barrier (BBB) and ischemic brain edema after temporary focal cerebral ischemia was studied in cats under ketamine and alpha-chloralose anesthesia. Regional cerebral blood flow (rCBF) was measured by a thermal diffusion method and a hydrogen clearance method. The animals were separated into three groups. In Group A, the left middle cerebral artery (MCA) was occluded for 6 hours. In Group B, the MCA was occluded for 3 hours and then reperfused for 3 hours; postischemic hyperemia was suppressed to the preischemic level by regulating the degree of MCA constriction. In Group C, the MCA was occluded for 3 hours and reperfused for 3 hours without suppressing the postischemic reactive hyperemia. The brain was removed and cut coronally at the site of rCBF measurement. The degree of ischemic edema was assessed by gravimetry in samples taken from the coronal section and correlated with the degree of BBB disruption at the corresponding sites, evaluated by densitometric determination of Evans blue discoloration.

The findings showed that 1) ischemic edema was significantly exacerbated by postischemic hyperemia during reperfusion in parallel with the degree of BBB opening to serum proteins, and 2) suppression of postischemic hyperemia significantly reduced the exacerbation of ischemic edema and BBB opening. These findings indicate that blood flow may be restored without significant exacerbation of postischemic edema by the suppression of postischemic hyperemia in focal cerebral ischemia.
DNA synthesis, blood flow, and glucose utilization in experimental rat brain tumors
Authors: Watanabe Akira , Tanaka Ryuichi , Takeda Norio , Washiyama Kazuo
Published: May 2009

✓ The relationships between distribution of deoxyribonucleic acid (DNA)-synthesizing cells (S-phase cells) and blood flow and glucose utilization were investigated in rat brain tumors using an autoradiographic technique and immunoperoxidase staining for bromodeoxyuridine (BUdR). Two strains of rat brain tumor were used: strain A and B, both induced by the Rous sarcoma virus. Strain A was biologically more malignant than strain B. The blood flow was unevenly distributed in the tumor; compared with the contralateral cortex, the average blood flow in the tumor was about 50% in strain A and 60% in strain B. The distribution of blood flow did not correlate with the distribution of S-phase cells or with the distribution of vessels in the tumor in either strain A or B. The average glucose utilization in strain A was about 250% and in strain B about 170% of that of the contralateral cortex. The high glucose utilization area correlated well with the distribution of BUdR-positive nuclei in strain B. These findings suggest that the biological malignancy of a tumor correlates with glucose utilization rather than with blood flow, and that malignant brain tumors show a marked increase in glucose utilization for nucleic acid synthesis.
Effect of lidocaine after experimental cerebral ischemia induced by air embolism
Authors: Evans Delbert E. , Catron Philip W. , McDermott James J. , Thomas Linda B. , Kobrine Arthur I. , Flynn Edward T.
Published: May 2009

✓ To investigate possible approaches to the treatment of neural damage induced by air embolism and other forms of acute cerebral ischemia, somatosensory evoked potentials (SEP's) were measured after cerebral air embolism in the anesthetized cat. Air was introduced into the carotid artery in increments of 0.08 ml until the SEP amplitude was reduced to approximately 10% or less of baseline values. Either a saline or lidocaine infusion was begun 5 minutes after inducing cerebral ischemia. In the saline-treated group, SEP amplitude was reduced to 6.7% ± 1.6% (mean ± standard error of the mean) of baseline, with a return to 32.6% ± 4.7% of baseline over a 2-hour period. In the lidocaine-treated group, SEP amplitude was reduced to 5.9% ± 1.5%, with a return to 77.3% ± 6.2% over a 2-hour period. The results suggest that lidocaine administration facilitates the return of neural function after acute cerebral ischemia induced by air embolism.
Degradation of neurofilament protein in cerebral ischemia
Authors: Ogata Nobuyoshi , Yonekawa Yasuhiro , Taki Waro , Kannagi Reiji , Murachi Takashi , Hamakubo Takao , Kikuchi Haruhiko
Published: May 2009

✓ Degradation of neurofilament (NF) triplet proteins: NF200 (molecular weight (MW) 200,000), NF150 (MW 150,000), and NF68 (MW 68,000) as well as of other cytoskeletal proteins in the rat brain during ischemia was investigated. Sodium dodecyl sulfate-gel electrophoresis and immunoblot methods with anti-NF200 antibody were used for the study. Selective degradation of NF200 and NF150 was observed during the initial 10 to 15 minutes of ischemia. The degradation was demonstrated both in permanent ischemia caused by decapitation and in transient ischemia induced by four-vessel occlusion followed by reperfusion after 30 minutes of occlusion (modified Pulsinelli method). The degradation suggests that the activation of a protease occurs in the first 15 minutes of cerebral ischemia, which is the earliest irreversible neuronal change ever to be reported.
Release of endothelium-derived relaxing factor after subarachnoid hemorrhage
Authors: Kim Phyo , Lorenz Robert R. , Sundt Thoralf M. , Vanhoutte Paul M.
Published: May 2009

✓ The purpose of this study was to determine the cause of the loss of endothelium-dependent relaxation observed in chronic cerebral vasospasm. A bioassay system was developed to measure the release of endothelium-derived relaxing factor (EDRF) from canine basilar arteries. Subarachnoid hemorrhage (SAH) was induced in dogs by two injections of autologous blood into the cisterna magna. Angiograms were performed on the 7th day after SAH to check the presence of chronic vasospasm. The animals were sacrificed on the 8th day, and in vitro experiments were performed on rings harvested from the basilar artery. These confirmed loss of endothelium-dependent relaxation in response to bradykinin and arginine vasopressin in the group with SAH. The basilar arteries were perfused with modified Krebs-Ringer solution. The perfusate was bioassayed with a ring of coronary artery without endothelium (bioassay ring). The release of the EDRF was detected by relaxation of the bioassay ring contracted with prostaglandin F2α. Arginine vasopressin and bradykinin added to the perfusate upstream of the basilar artery caused concentration-dependent release of the EDRF. The direct effect of these peptides on the smooth muscle of the bioassay ring was to cause contraction. The release of the EDRF was identical in basilar arteries from the control and the SAH groups. These results indicate that the release of the EDRF is not impaired during chronic vasospasm, and thus that the loss of the endothelium-dependent relaxation is due to a decreased transfer of the EDRF or a reduced responsiveness of the smooth muscle to the factor.
Thoracic dorsal ramus entrapment
Authors: González-Darder José M.
Published: May 2009

✓ Entrapment of the dorsal ramus of a thoracic spinal nerve is described in a patient with chronic back pain and sensory disturbance in the cutaneous territory served by the T3–5 dorsal rami. The dorsal ramus of the T-4 nerve was found to be compressed by a bone spur involving the inferior T-4 apophyseal facet. The point of entrapment was a tunnel bounded by the transverse process, apophyseal joint, rib, and superior costotransverse ligament.
Atlanto-axial rotational limitation secondary to osteoid osteoma of the axis
Authors: Bucci Michael N. , Feldenzer John A. , Phillips William A. , Gebarski Stephen S. , Dauser Robert C.
Published: May 2009

✓ An unusual case of atlanto-axial rotational limitation secondary to an osteoid osteoma of the axis is presented. Transoral microsurgical resection followed by physical therapy improved the clinical symptoms. This case illustrates several unique problems within the cervical spine as well as the efficacy of the transoral approach to the axis.
Magnetic resonance imaging of vascular compression in trigeminal neuralgia
Authors: Wong Bowen Y. , Steinberg Gary K. , Rosen Larry
Published: May 2009

✓ A case of trigeminal neuralgia is reported in which preoperative high-resolution magnetic resonance imaging demonstrated vascular compression of the trigeminal nerve. Surgery confirmed compression and indentation of the fifth nerve by a large branch of the superior cerebellar artery. Following microvascular decompression, the patient experienced no further pain. Magnetic resonance imaging may be useful in the evaluation of trigeminal neuralgia to identify a subgroup of patients who could benefit most from decompression.
Carotid transluminal angioplasty with evidence of distal embolization
Authors: DeMonte Franco , Peerless Sydney J. , Rankin Richard N.
Published: May 2009

✓ A 57-year-old woman presented with symptomatic triple tandem stenosis of the left carotid artery. Transluminal angioplasty of an atherosclerotic stenosis at the origin of the common carotid artery was performed retrogradely through a distal arteriotomy after endarterectomy. The postangioplasty effluent was collected and analyzed. Cholesterol crystals and amorphous plaque debris were identified, indicating a source for distal embolization. The clinical significance of this small amount of debris embolizing to the intracranial circulation is uncertain, but should be of concern when considering angioplasty of the cerebral circulation.
Hemostatic control of scalp incisions
Authors: Sakhai Hossein
Published: May 2009

✓ A method is described to control bleeding from scalp incisions made for cranial surgery. The technique is simple and shortens the total length of time required for the procedure.
Thermosensitive determination of patency in lumboperitoneal shunts
Authors: Ishiwata Yusuke , Chiba Yasuhiro , Yamashita Toshinori , Gondo Gakuji , Ide Kaoru , Kuwabara Takeo
Published: May 2009

✓ Surface cooling and thermistor recording over shunt tubing was used in 23 studies of cerebrospinal fluid shunt patency in 19 patients with lumboperitoneal shunts and normal-pressure hydrocephalus. Shunt patency was shown by downward reflection of the recording trace similar to that obtained for ventriculoperitoneal shunts. Obstruction was demonstrated by a flat-line recording or an upward deflection.