bluuebunny/crossref_metadata_2025 huggingface dataset:
Polyol content of cerebrospinal fluid in brain-tumor patients
Authors: Watanabe Satoru , Kamiyama Junko , Chigasaki Hiroo , Yoshioka Shigetake
Published: May 2009

✓ In order to investigate whether cerebrospinal fluid (CSF) polyols are consumed by brain tissue, the concentration of seven polyols in the CSF and the serum of 30 patients with intracranial tumor and 17 control individuals was measured by gas chromatography. The mean polyol content in the control samples showed that the fructose, inositol, and glucitol levels were significantly greater in CSF than in serum. A comparison of the lumbar CSF from control subjects and 11 patients with malignant tumors exposed to the CSF snowed the fructose and inositol levels to be significantly lower (54% and 45%, respectively) and the glucose content to be slightly higher (110%) in the tumor cases. These differences were markedly greater in the ventricular than in the lumbar CSF and greater in patients with tumors exposed to the CSF space than in those with tumors buried in the brain tissue. In ventricular CSF obtained from seven patients with malignant brain tumors before and after radio— and/or chemotherapy, significant increases in fructose (34%) and glucitol (48%) levels were found, but the other polyols did not change significantly. In culture, the human glioblastoma cell growth rate was higher in the medium containing fructose and glucose than in that containing glucose alone. A notable amount of fructose and glucose was consumed by cultured glioblastoma cells. The roles of polyols contained in CSF and the effects of fructose on the growth of cultured glioblastoma cells are discussed in light of these findings and of previous reports.
Administration of intravenous urea and normal saline for the treatment of hyponatremia in neurosurgical patients
Authors: Reeder Ralph F. , Harbaugh Robert E.
Published: May 2009

✓ Hyponatremia frequently complicates the care of neurosurgical patients and requires prompt effective therapy. These patients commonly fulfill the laboratory criteria of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) or cerebral salt wasting; the classification depends on the volume status of the patient. The authors have been dissatisfied with the standard therapy of fluid restriction for the critically ill neurosurgical patient because of 1) slow rates of sodium correction; 2) poor applicability in patients requiring multiple intravenous medications and/or nutritional support; and 3) possible dangers of inducing or enhancing cerebral ischemia in patients who already may be fluid-depleted.

Reported successes in the treatment of hyponatremia due to SIADH by administration of urea and normal saline led to the authors' routine use of this therapy for hyponatremic neurosurgical patients. A retrospective review of an 18-month period revealed 48 patients (3% of all neurosurgical inpatients) with hyponatremia from various causes who received 62 treatments of urea and normal saline. Treatment consisted of 40 gm urea dissolved in 100 to 150 ml normal saline as an intravenous drip every 8 hours and an intravenous infusion of normal saline at 60 to 100 ml/hr for 1 to 2 days. The mean pretreatment serum sodium level (± standard deviation) was 130 ± 3 mmol/liter (range from 119 to 134 mmol/liter). There was a significant mean posttreatment elevation to 138 ± 4 mmol/liter (range 129 to 148 mmol/liter) (p < 0.001, Student's t-test). Average daily fluid intake and output on treatment days were 2719 ± 912 and 2892 ± 1357 ml, respectively. There were no treatment complications in this group. It is concluded that urea and saline administration results in a rapid, safe, and effective correction of hyponatremia, making this method superior to fluid restriction in many neurosurgical patients.
Complications of intracranial bypass for vertebrobasilar insufficiency
Authors: Hopkins Leo N. , Budny James L.
Published: May 2009

✓ The authors' initial experience with intracranial revascularization of vertebrobasilar insufficiency, reported previously, fortunately yielded reasonably good results with high patency rates but in some cases there were significant, albeit temporary, complications. Since that time, major brain-stem strokes have occurred in two patients following superficial temporal to superior cerebellar artery bypass procedures. This occurrence has caused the authors to reassess their experience with this procedure and review the published literature with regard to complications. This review and the results of the international bypass study on anterior circulation ischemia suggest that a very cautious and conservative approach should be taken prior to considering intracranial bypass to the superior cerebellar or posterior cerebral artery.
Polytetrafluoroethylene interposition grafts in vertebral tocarotid artery transposition
Authors: Cavanaugh David A. , Story Jim L. , Brown Willis E. , Ansell Lee V. , Skerhut Holger E. I.
Published: May 2009

✓ Eight patients undergoing an end-to-side vertebral artery (VA) to common carotid artery transposition between August, 1979, and July, 1982, had a polytetrafluoroethylene (PTFE) interposition graft placed when a direct anastomosis was believed not to be satisfactory. Five of these patients are living; clinical and radiographic follow-up studies over periods ranging between 54 and 82 months show that their transpositions are patent. Two patients died perioperatively, one from an acute anterior myocardial infarction and the other from acute VA occlusion with a propagating thrombus. A third patient died of myocardial infarction 20 months after graft placement; the anastomosis had been found patent at 12 months. This report gives the clinical and radiographic follow-up results in a previously reported group of patients with PTFE interposition grafts. Some of these patients have been followed for over 6 years after surgery: the average radiographic follow-up period in the five survivors is 60 months, and all grafts are patent without evidence of progressive stenosis. Expanded PTFE appears to be an acceptable material for short interposition grafts in operations involving the VA; however, direct artery-to-artery anastomosis is preferred. The results of longer PTFE grafts in reconstructive cerebrovascular surgery have not been adequately studied.
Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients
Authors: Robertson Claudia S. , Narayan Raj K. , Gokaslan Ziya L. , Pahwa Rajesh , Grossman Robert G. , Caram Pedro , Allen Elizabeth
Published: May 2009

✓ The hypothesis that cerebral arteriovenous difference of oxygen content (AVDO2) can be used to predict cerebral blood flow (CBF) was tested in patients who were comatose due to head injury, subarachnoid hemorrhage, or cerebrovascular disease. In 51 patients CBF was measured daily for 3 to 5 days, and in 49 patients CBF was measured every 8 hours for 5 to 10 days after injury. In the latter group of patients, when a low CBF (≤ 0.2 ml/gm/min) or an increased level of cerebral lactate production (CMRL) (≤ −0.06 µmol/gm/min) was encountered, therapy was instituted to increase CBF, and measurements of CBF, AVDO2, and arteriovenous difference of lactate content (AVDL) were repeated. When data from all patients were analyzed, including those with cerebral ischemia and those without, AVDO2 had only a modest correlation with CBF (r = −0.24 in 578 measurements, p < 0.01). When patients with ischemia, indicated by an increased CMRL, were excluded from the analysis, CBF and AVDO2 had a much improved correlation (r = −0.74 in 313 measurements, p < 0.01). Most patients with a very low CBF would have been misclassified as having a normal or increased CBF based on the AVDO2 alone. However, when measurements of AVDO2 were supplemented with AVDL, four distinct CBF patterns could be distinguished. Patients with an ischemia/infarction pattern typically had a lactate-oxygen index (LOI = −AVDL/AVDO2) of 0.08 or greater and a variable AVDO2. The three nonischemic CBF patterns had an LOI of less than 0.08, and could be classified according to the AVDO2. Patients with a normal CBF (mean 0.42 ± 0.12 ml/gm/min) had an AVDO2 between 1.3 and 3.0 µmol/ml. A CBF pattern of hyperemia (mean 0.53 ± 0.18 ml/gm/min) was characterized by an AVDO2 of less than 1.3 µmol/ml. A compensated hypoperfusion CBF pattern (mean 0.23 ± 0.07 ml/gm/min) was identified by an AVDO2 of more than 3.0 µmol/min. These studies suggest that reliable estimates of CBF may be made from AVDO2 and AVDL measurements, which can be easily obtained in the intensive care unit.
Multiple subpial transection: a new approach to the surgical treatment of focal epilepsy
Authors: Morrell Frank , Whisler Walter W. , Bleck Thomas P.
Published: May 2009

✓ A new operative approach has been designed for the relief of medically intractable focal epilepsy. It is intended particularly to be used in those cases where the epileptogenic lesion lies in “unresectable” cortex; that is, those cerebral regions subserving speech, memory, and primary motor and sensory function. The procedure is based upon experimental evidence indicating 1) that epileptogenic discharge requires substantial side-to-side or horizontal interaction of cortical neurons, and 2) that the major functional properties of cortical tissue depend upon the vertical fiber connections of the columnar units. The technique requires severing of tangential intracortical fibers while preserving the vertical fiber connections of both incoming and outgoing nerve pathways and of the penetrating blood vessels which also have a vertical orientation.

In this study, the effect of multiple subpial transection was assessed on both function and seizure control. The effect on function was reviewed in 32 cases; only 20 cases were evaluated with respect to seizure control, since a follow-up period of 5 years or more (5 to 22 years) is required before conclusions can be drawn. Multiple subpial transection was applied to the precentral gyrus in 16 cases, the postcentral gyrus in six, Broca's area in five, and Wernicke's area in five. With respect to function, the major finding was that none of the 32 patients has suffered a clinically significant behavioral deficit (although subtle deficits could be detected by careful neurological examination). Complete control of seizures has been obtained in 11 (55%) of the 20 cases evaluated. Nine patients developed recurrent seizures consequent to progressive disease unsuspected before operation (Rasmussen's encephalitis in five, tumor in three, and subacute sclerosing panencephalitis in one). In none of these cases, however, did the recurrent seizures arise in the transected zone. Thus, the results indicate that multiple subpial transection is about as effective as standard excisional therapy, and can be successfully employed when epileptogenic lesions encroach upon cortical territories, the removal of which would be functionally incapacitating.
New long-wavelength Nd:YAG laser at 1.44 µm: effect on brain
Authors: Martiniuk Reginald , Bauer James A. , McKean John D. S. , Tulip John , Mielke Bruce W.
Published: May 2009

✓ A wavelength-shifted Nd:YAG laser, tuned to coincide with the infrared absorption peak of water at 1.44 µm, was used to make lesions in normal rabbit brain. A total of 48 lesions were made with power up to 20 W, with energy up to 40 joules, and with two different spot sizes. These lesions were compared to lesions made with 1.06 µm radiation from an Nd:YAG laser under identical operating conditions. Measurements of blood-brain barrier damage and width, depth, and volume of tissue affected were obtained 30 minutes after placement of the lesions. It was found that 1.44-µm lesions produced photoevaporative tissue loss at the highest intensities used. The layer of coagulated tissue remaining after photovaporization had a mean thickness of 0.6 mm irrespective of the volume of tissue removed. There was no photovaporization in the 1.06-µm lesions. In addition, the amount of peripheral edema per unit volume of tissue coagulated was approximately half at the 1.44-µm wavelength. These findings suggest that the 1.44-µm Nd:YAG laser may be a useful surgical instrument since it combines the photoevaporative effect of the CO2 laser while maintaining the advantages of the conventional Nd:YAG laser (quartz fiber delivery and effective hemostasis).
Effect of dorsal-column stimulation on gelatinosa and marginal neurons of cat spinal cord
Authors: Dubuisson David
Published: May 2009

✓ Single neuronal units with physiological characteristics of superficial dorsal-horn neurons were recorded extracellularly in laminae 1, 2, and 3 of cat spinal cord. When focal electrical stimulation was applied to the ipsilateral dorsal column, most of the units were excited transsynaptically at various latencies consistent with an effect mediated by large myelinated axons. Units recorded in laminae 2 and 3 had earlier latencies of activation than units in lamina 1. Units with cutaneous receptive fields only for noxious stimuli were activated at significantly longer latencies than units responsive to innocuous stimuli. The time course of these effects was consistent with the concept that many cells in laminae 1 to 3 receive direct excitatory synaptic input from collaterals of dorsal-column fibers, and some lamina 1 cells receive excitatory synaptic input from lamina 2 neurons. Previous reports have emphasized the inhibitory action of dorsal-column stimulation on nociceptive responses of cells in laminae 4 and 5 of the dorsal-horn, particularly those of the spinocervical tract in cats and the spinothalamic tract in primates. The present study suggests that some of this inhibition might be sustained by a network of interneurons in or near the substantia gelatinosa and marginal layer. The therapeutic efficiency of dorsal-column stimulation for pain relief in humans may depend in part on the activation of neurons in the superficial layers of the dorsal horn.
Intrasellar persistent trigeminal artery associated with a pituitary adenoma
Authors: Lee K. Stuart , Kelly David L.
Published: May 2009

✓ The case of a patient with Cushing's disease and a pituitary macroadenoma, who also had a persistent trigeminal artery coursing through the sella turcica on preoperative imaging studies, is presented. The patient was treated by transsphenoidal resection of the tumor.
Malignant optic glioma in adults
Authors: Taphoorn Martin J. B. , de Vries-Knoppert Willemien A. E. J. , Ponssen Hans , Wolbers John G.
Published: May 2009

✓ Malignant optic glioma in adulthood is a rare tumor that causes early loss of vision and nearly always leads to death within a year. A case history is presented illustrating the clinical and neuroradiological characteristics of the malignant optic glioma in adults. A review of the literature is given.
Retrieval of loose peritoneal shunts by laparoscopy
Authors: Davis Frank M. , Wah Tara L.
Published: May 2009

✓ Disconnected shunt catheters free in the peritoneal cavity can be easily removed by laparoscopy with minimal opening of the peritoneum. Experience with five such cases is summarized.
A new insulated caudalis nucleus DREZ electrode
Authors: Young Jacob N. , Nashold Blaine S. , Cosman Eric R.
Published: May 2009

✓ A new insulated radiofrequency electrode for making nucleus caudalis dorsal root entry zone lesions reduces the incidence of ataxia.
Vertebral body impactor for posterior lateral decompression of thoracic and lumbar fractures
Authors: Oro John , Watts Clark , Gaines Robert
Published: May 2009

✓ A hand-held impactor is described that allows secure impaction of retropulsed vertebral body bone fragments in burst fractures of the thoracic or lumbar spine.
The neurobiology of Alzheimer's disease
Authors: Henderson Victor W. , Finch Caleb E.
Published: May 2009

✓ The defining histological characteristics of Alzheimer's disease (AD) are neurofibrillary tangles and neuritic plaques, although neither is pathognomonic for this disorder. The distribution of AD histopathology suggests selective neuronal vulnerability, with specific cell populations affected within discrete regions of the cerebral hemispheres and within certain subcortical and brain-stem nuclear areas. At the ultrastructural level, tangles and plaque neurites contain paired helical filaments whose composition is unknown but may include altered cytoskeletal elements. Amyloid, deposited in plaque cores and often focally present within the cerebral vasculature, contains a polypeptide (“beta-protein,” or “beta-amyloid”) encoded by a chromosome 21 gene. At least in occasional families, AD has been linked to a separate chromosome 21 locus, but different underlying genetic factors may operate in other cases. Inorganic substances, including aluminum and silicon, are reported to co-localize within tangle-bearing neurons and plaque cores. Specific environmental agents have not been confirmed to be pathogenetically important, however, but may eventually prove to exert a permissive, facilitatory, or even causative role in many AD patients.
Reversible acute and subacute myelopathy in patients with dural arteriovenous fistulas
Authors: Criscuolo Gregory R. , Oldfield Edward H. , Doppman John L.
Published: May 2009

✓ Acute or subacute neurological deterioration without evidence of hemorrhage in a patient with a spinal arteriovenous (AV) malformation has been referred to as “Foix-Alajouanine syndrome.” This clinical entity has been considered to be the result of progressive vascular thrombosis resulting in a necrotic myelopathy; it has therefore been thought to be largely irreversible and hence untreatable. The authors report five patients with dural AV fistulas who presented in this manner, and who improved substantially after embolic and surgical therapy. The outcome of these patients indicates that acute and subacute progression of myelopathy in cases of spinal dural AV fistulas may be caused by venous congestion and not necessarily by thrombosis. Therefore, a clinical diagnosis of Foix-Alajouanine syndrome is of little practical use, as spinal cord dysfunction from venous congestion is a potentially reversible process whereas thrombotic infarction is not. This diagnosis may result in suboptimal management. The recognition of nonhemorrhagic acute or subacute myelopathy as a complication of a spinal dural AV fistula is important since what appears to be irreversible cord injury is often treatable by standard surgical techniques.
Hemodynamics of spinal dural arteriovenous fistulass
Authors: Hassler Werner , Thron Armin , Grote Ernst H.
Published: May 2009

✓ Local hemodynamics were investigated during nine operations for spinal dural arteriovenous (AV) fistulas. In eight cases, microvascular Doppler sonography was used to measure flow velocities and vasomotor reactivity to CO2 changes. Intravascular pressure recordings of the draining veins on the medullary surface were performed in nine cases. The flow velocities in dural AV fistula feeding vessels were not as high as has been shown in cerebral angioma feeders. The AV fistula feeders often showed low end-diastolic flow velocities as a sign of increased vascular resistance, even in the presence of a downstream AV fistula, thus proving disturbance of venous outflow from the spinal canal. After excision of the fistula, the circulation of the spinal cord vessels improved, with higher inflow and outflow velocities. In the veins formerly draining the fistula, no further flow could be recorded; however, they did not collapse, indicating that some pressure remained. The mean venous pressure in the dural AV fistulas was about 74% of the systemic arterial pressure. It increased concomitantly with the arterial pressure, which may explain the clinical deterioration that occurs during physical activity. Fistulas with a high shunt volume on angiography showed only moderately increased venous pressures and a more pronounced pressure drop compared to low-volume fistulas. The CO2 reactivity of vessels supplying the spinal cord could be demonstrated in all cases, and was normal before and after removal of the fistula.
Intracarotid cisplatin chemotherapy for recurrent gliomas
Authors: Mahaley M. Stephen , Hipp Stephen W. , Dropcho Edward J. , Bertsch Linda , Cush Sharon , Tirey Tammy , Gillespie G. Yancey
Published: May 2009

✓ Forty patients with recurrent gliomas were treated with monthly intra-arterial infusions of cisplatin. Of the 35 evaluable patients, 12 (34%) responded with computerized tomography (CT) evidence of a decrease in tumor size; in 14 (40%) the tumor stabilized on CT scans, and in nine (26%) the disease progressed. The median survival period was 35.0 weeks for the responders and 27.5 weeks for all 35 patients. The primary toxicities were renal (reversible alterations in creatinine clearance), otological (severe hearing loss in one patient), and likely neurotoxicity in one patient who had received bilateral infusions following contralateral tumor progression. The authors are now using this form of regional chemotherapy sequentially before and following radiotherapy in newly diagnosed cases.
Prognostic importance of DNA ploidy in medulloblastoma of childhood
Authors: Yasue Masaharu , Tomita Tadanori , Engelhard Herbert , Gonzalez-Crussi Frank , McLone David G. , Bauer Kenneth D.
Published: May 2009

✓ The deoxyribonucleic acid (DNA) content of 53 medulloblastomas was analyzed by means of flow cytometry and compared with the clinical and histological findings in the host patients. Analysis of DNA showed that about half of the tumors were diploid and the other half were aneuploid. More diploid tumors were found among patients of a young age, but the difference was without statistical significance. Cellular differentiation of the tumor did not correlate with DNA ploidy. No correlation was found between Chang's T staging system and the DNA ploidy, whereas the M staging correlated with the ploidy; diploid medulloblastomas had a greater tendency to metastasize than aneuploid medulloblastomas (p = 0.0003). Four-year survival was compared with the extent of resection and DNA ploidy. The patients with total resection and aneuploid medulloblastoma had a better prognosis than those with subtotal resection and diploid tumor (p = 0.001). There was only one survivor among eight patients with subtotally resected diploid medulloblastomas, while all of the seven patients with totally resected aneuploid medulloblastomas survived. Comparison of the G0/G1 phase fraction and S phase fraction in the surviving group and the deceased group offered no significant information.
A comparison of the Minerva and halo jackets for stabilization of the cervical spine
Authors: Benzel Edward C. , Hadden Theresa A. , Saulsbery Carla M.
Published: May 2009

✓ The motion at each intervertebral level permitted by the halo jacket and the thermoplastic Minerva body jacket was compared in 10 ambulatory patients with an unstable cervical spine. The thermoplastic Minerva body jacket is a new lightweight modification of a Minerva jacket which is fabricated from Polyform (a splinting material made of a polyester polycaprolactone) and Polycushion (a closed-cell foam for padding). Each patient served as his/her own control. The average movement from flexion to extension at each intervertebral level was significantly less in the thermoplastic Minerva body jacket (2.3° ± 1.7°) than in the halo jacket (3.7° ± 3.1°) (p < 0.0025). This difference is attributable to the “snaking phenomenon” encountered with halo jacket immobilization and should be taken into account when considering an external splint for an unstable cervical spine. The thermoplastic Minerva body jacket also offered a substantial improvement in comfort for the patient over that experienced in the halo jacket. The apparent advantage with respect to stability and comfort of the thermoplastic Minerva body jacket over the halo jacket suggests that the former device is the orthosis of choice for ambulatory stabilization of most patients with an unstable posttraumatic cervical spine injury.
Magnetic resonance imaging and aneurysm clips
Authors: Romner Bertil , Olsson Magnus , Ljunggren Bengt , Holtås Stig , Säveland Hans , Brandt Lennart , Persson Bertil
Published: May 2009

✓ The magnetic properties of 12 different types of aneurysm clip were investigated in order to identify which clips allow postoperative magnetic resonance (MR) imaging without risk. Clip-induced MR artifacts were also quantitatively studied using a geometrical phantom. Nonferromagnetic aneurysm clips like the Yaşargil Phynox, Sugita Elgiloy, and Vari-Angle McFadden clips do not appear to contraindicate MR studies performed with a FONAR β-3000M imager. There is no clip movement upon introduction of the phantom into the MR imager, and the image artifacts caused by the clips are so limited that patients harboring such clips may well be considered for MR imaging. This examination may reveal information not obtainable by any other radiological modality.
Proton magnetic resonance studies of triethyltin-induced edema during perinatal brain development in rabbits
Authors: Lorenzo Antonio V. , Jolesz Ferenc A. , Wallman James K. , Ruenzel Paul W.
Published: May 2009

✓ To better understand the role of myelin-associated water in the differentiation of white and gray matter in magnetic resonance (MR) imaging, changes in MR relaxation processes were studied in rabbits during myelination and after induction of cytotoxic edema with triethyltin (TET). Normal rabbits were killed at various age intervals ranging from premature (28 days' gestation) to adult, and changes in MR relaxation times (T1 and T2) and in water and electrolyte content were determined for various areas of brain and muscle. Similar measurements were made in rabbits of comparable age exposed to TET. Light and electron microscopy and MR imaging were used to follow myelin development and morphological changes induced by TET. During the first 30 postnatal days, both T1 and T2 declined by 50% in normal rabbits, a fall that paralleled the loss in brain water and sodium that occurred during the same period. Exposure to TET prolonged T1 and T2 in white but not gray matter, reflecting the accumulation of sodium and water (edema fluid) in white matter areas. Multiexponential analysis revealed a second, longer component in T2 magnetization decay of TET-exposed white matter, presumably attributable to accumulation of non-ordered water within intramyelinic vacuoles, a supposition consistent with electron microscopic and MR imaging findings. In contrast to reports by others, changes in T1 (but not T2) closely correlated with alterations in brain water (r = 0.93, df = 39). The absence of tissue disruption in the animals in the present study may account for these differences, but further studies will be required both to resolve this question and to fully understand MR images of white matter edema in mature and immature brain.
Implantation of dispersed cells into primate brain
Authors: Plunkett Robert J. , Saris Stephen C. , Bankiewicz Krzysztof S. , Ikejiri Barbara , Weber Richard J.
Published: May 2009

✓ Although several experimental therapies such as dopaminergic cell implantation in parkinsonian models and intratumoral placement of lymphokine-activated killer cells require intracerebral deposition of dispersed cell suspensions, a successful technique of needle implantation of cells into primate brain has not been demonstrated. The authors have sought to establish a stereotaxic technique to predictably deposit dispersed cells in primate brain. Human lymphocytes were cultured in recombinant interleukin-2, labeled with sodium 51 chromate (51Cr), and stereotaxically injected into the frontal white matter of six anesthetized rhesus monkeys. A 10-µl aliquot of cell suspension (2 × 107 cells/ml) was deposited 16 mm deep to the dura at 5 µl/min via Hamilton No. 22s or 26s needles. Five control aliquots were counted for each injection. Reflux out of the needle track was absorbed on gauze, and the recovered cells were counted. The animals were sacrificed 1 hour after implantation and the brain was removed and sectioned such that the cortex and white matter along the needle track were separate. The tissue sections were then counted. Recovery was expressed as the percentage of total injected radioactivity (cpm) that was present in each brain section. Two additional injected hemispheres were processed for autoradiography and histological study.

Cell recovery in the brain (mean ± standard deviation) was 87.2% ± 13.9% (3.3% ± 4.9% in cortex and 83.9% ± 15.9% in white matter). The autoradiograms and histological examination showed a dense accumulation of radioactivity (cells) at the target site and minimal radioactivity (cells) in the needle track. Accurate intracerebral deposition of dispersed cells in primates was achieved with the technique described. This knowledge permits reliable stereotaxic implantation of cells into the brains of nonhuman primates and humans for investigation and therapy.
Postradiation astrocytoma
Authors: Kitanaka Chifumi , Shitara Nobuyuki , Nakagomi Tadayoshi , Nakamura Hirohiko , Genka Shigeru , Nakagawa Keiichi , Akanuma Atsuo , Aoyama Hiromu , Takakura Kintomo
Published: May 2009

✓ The authors describe two cases of malignant astrocytomas associated with previous radiation therapy in childhood for intracranial germinoma and craniopharyngioma. In both patients, there was no recurrence at the primary tumor site. Because of a geometric coincidence between the tumor location and the radiation field, radiotherapy was strongly implicated as a cause of these two astrocytomas.
Papillary meningioma with pulmonary metastasis
Authors: Fukushima Takeo , Tsugu Hitoshi , Tomonaga Masamichi , Shirakusa Takayuki
Published: May 2009

✓ Successful surgical treatment by extirpation of remote metastases is extremely rare. A patient was admitted in whom multiple metastases to the lung occurred 8 years after extirpation of a papillary meningioma of the posterior fossa. The meningioma did not recur at the original site. The pulmonary metastases were surgically removed. The histological and electron microscopic findings of this case are presented.
Gas in a spinal extradural cyst
Authors: Kumar Rakesh , West Charles G. H. , Gillespie James E.
Published: May 2009

✓ This case report describes a patient with sciatica resulting from lumbar root compression by a gas-containing cyst in the extradural space. Removal of the cyst provided prompt relief. The origin and anatomic distribution of gas collections in the spine are considered based on a review of the literature.
Suprainguinal ligament approach for surgical treatment of meralgia paresthetica
Authors: Aldrich E. Francois , van den Heever C. Mauritz
Published: May 2009

✓ For relief of meralgia paresthetica the authors have developed a suprainguinal ligament approach for decompression of the lateral femoral cutaneous nerve of the thigh. This proximal approach offers an alternative to the standard infraligament methods. Its chief advantage is that identification of the nerve trunk is easy and accurate. This avoids the tedious dissection involved in looking for small distal branches with their variable location. Lysis is easily performed, and angulation of the nerve in the iliac fossa is avoided. With this method, poor operative results can usually be eliminated.
Neurosurgical intervention in penetrating spinal trauma with associated visceral injury
Authors: Venger Benjamin H. , Simpson Richard K. , Narayan Raj K.
Published: May 2009

✓ Associated injuries to the neck, chest, or abdomen are found in approximately one-quarter of all civilians with penetrating spinal cord or cauda equina injuries. While the value of and indications for general surgical exploration and repair of these injuries are fairly self-evident, the value of neurosurgical intervention in terms of neurological outcome and infection prophylaxis remains the subject of debate. To study this issue, 160 civilian patients with penetrating spinal injuries and neurological deficits were retrospectively reviewed. Associated injuries of the esophagus, trachea, bronchi, or bowel were seen in 107 individuals (67%); 33 (31%) of these patients had abdominal injuries, 25 (23%) had neck injuries, 23 (21%) had thoracic injuries, and 26 (24%) had injuries occurring at multiple sites. Of these 107 patients, 67 (63%) had complete neurological injuries and the remaining 40 (37%) demonstrated incomplete deficits. All 107 patients underwent surgical exploration and repair of their visceral injuries; in 19 of them a neurosurgical procedure was also performed for decompression of the neural elements and/or debridement of the wound. Regardless of the presence of associated visceral injuries, the mechanism of injury, and the extent of the neurological deficit, no statistically significant difference in neurological outcome was found in patients with or without neurosurgical intervention. Complications associated with neurological injury were reported in 17 (11%) of the total group of 160 patients. Four (21%) of the 19 patients who had neurosurgical intervention suffered a related complication, compared to only six (7%) of the 88 patients who were managed conservatively (p < 0.05). Within the limitations of a retrospective review, the results of this study do not clearly support the value of routine neurosurgical intervention as an adjunct to general surgical repair in cases of spinal injury associated with penetrating visceral trauma.
Spinal cord stimulation in management of chronic pain
Authors: Meglio Mario , Cioni Beatrice , Rossi Gian Franco
Published: May 2009

✓ Between 1978 and 1986, 109 patients with chronic pain underwent spinal cord stimulation (SCS) at the authors' institute as part of their pain treatment program. The results of SCS in these patients at the end of the test period and at the latest follow-up examination are analyzed in relation to the etiology of their pain. In 40 patients pain was associated with an obstructive peripheral vasculopathy, in 10 with a previous herpes zoster infection, in 15 with an incomplete traumatic spinal cord lesion, in nine with root and/or nerve damage, in 11 with cancer, and in 19 with previous back surgery. The etiology of the pain in five patients was uncertain. This experience supports the conclusion that the best indications for SCS are vasculopathic pain and post-herpetic neuralgia. No clinical usefulness was found for SCS in cancer pain or in central deafferentation types of pain.
Adult cerebellar medulloblastomas: the pathological, radiographic, and clinical disease spectrum
Authors: Hubbard Jerry L. , Scheithauer Bernd W. , Kispert David B. , Carpenter Sandra M. , Wick Mark R. , Laws Edward R.
Published: May 2009

✓ The records of 34 patients over 16 years of age with cerebellar medulloblastoma were retrospectively reviewed. All patients were treated by surgery, and all surviving patients were given radiation therapy. The imaging characteristics of this rare entity were evaluated with regard to the tumor location in the cerebellum, and the prognostic effects of histological characteristics such as neuronal or glial differentiation and the presence of desmoplasia were investigated. Neither histological parameters nor tumor location (median, paramedian, or lateral cerebellar) affected patient survival. The desmoplastic variant was encountered in 38% of these adult medulloblastomas and occurred in all three cerebellar locations. The degree of surgical resection did not have a major effect on long-term survival; long-term survival was possible even in patients who had received only a biopsy. The extent of initial radiation therapy was positively correlated with recurrence-free survival; full neuraxis irradiation was associated with a 13% incidence of delayed spinal metastases, whereas 75% of patients treated with irradiation of only the posterior fossa and/or the whole brain developed spinal deposits. A similar local recurrence rate (12.5%) was noted in both irradiation groups. Chemotherapy resulted in palliation in some patients with metastatic disease.
Cerebral aneurysms following radiotherapy for medulloblastoma
Authors: Benson Peter J. , Sung Joo Ho
Published: May 2009

✓ Three patients, two males and one female aged 21, 14, and 31 years, respectively, developed cerebral saccular aneurysms several years after undergoing radiotherapy for cerebellar medulloblastoma at 2, 5, and 14 years of age, respectively. Following surgery, all three received combined cobalt-60 irradiation and intrathecal colloidal radioactive gold (198Au) therapy, and died from rupture of the aneurysm 19, 9, and 17 years after the radiotherapy, respectively. Autopsy examination revealed no recurrence of the medulloblastoma, but widespread radiation-induced vasculopathy was found at the base of the brain and in the spinal cord, and saccular aneurysms arose from the posterior cerebral arteries at the basal cistern or choroidal fissure. The aneurysms differed from the ordinary saccular aneurysms of congenital type in their location and histological features. Their locations corresponded to the areas where intrathecally administered colloidal 198Au is likely to pool, and they originated directly from a segment of the artery rather than from a branching site as in congenital saccular aneurysms. It is, therefore, concluded that the aneurysms in these three patients were most likely radiation-induced.
Evaluation of selective transsphenoidal adenomectomy by endocrinological testing and somatomedin-C measurement in acromegaly
Authors: Losa Marco , Oeckler Reinhard , Schopohl Jochen , Müller O. Albrecht , Alba-Lopez Julia , von Werder Klaus
Published: May 2009

✓ A series of 29 previously untreated patients with acromegaly underwent transsphenoidal adenomectomy. Pre- and postoperative evaluation consisted of measuring growth hormone (GH) secretory dynamics during an oral glucose tolerance test (OGTT), the insulin hypoglycemia test, and the thyrotropin- and gonadotropin-releasing hormone (TRH/GnRH) test, and by obtaining the basal somatomedin-C level. After surgery, clinical and biochemical amelioration was achieved in all but two patients. In the whole group, basal GH and somatomedin-C levels decreased from a mean (± standard error of the mean) of 52.3 ± 12.7 to 11.1 ± 6.3 ng/ml and from 7.6 ± 0.7 to 2.5 ± 0.5 U/ml, respectively. Application of different criteria of cure revealed that 19 patients (66%) had basal GH levels below 5 ng/ml, 17 patients (59%) had normal somatomedin-C values, 16 patients (55%) had complete GH suppression (< 1 ng/ml) during OGTT, and 13 patients (45%) met the above-mentioned criteria with disappearance of the paradoxical GH response to TRH/GnRH test. Evaluation of GH secretion by insulin hypoglycemia testing was useless in assessing the outcome after neurosurgery. When only patients with a normal somatomedin-C level and complete GH suppressibility during OGTT were considered “cured,” the main favorable prognostic factor was intrasellar tumor localization, since 15 (75%) of 20 patients were “cured,” as opposed to only one (11%) of nine with extrasellar extension of the adenoma. During the follow-up period, no tumor recurrence was detected in any of the “cured” patients. In these subjects somatomedin-C levels remained stable in all except two patients, who showed a slow increase within the normal range of somatomedin-C concentration. These data confirm that transsphenoidal surgery is the most effective form of treatment in previously untreated acromegalic patients and that normalization of somatomedin-C levels reflects normal GH secretion. Measurement of somatomedin-C could replace more extensive endocrinological testing during monitoring of treated acromegalic patients.
Benign astrocytic and oligodendrocytic tumors of the cerebral hemispheres in children
Authors: Hirsch Jean-François , Sainte Rose Christian , Pierre-Kahn Alain , Pfister André , Hoppe-Hirsch Elizabeth
Published: May 2009

✓ The authors review 42 consecutive cases of benign astrocytic and oligodendrocytic tumors of the cerebral hemispheres in children undergoing surgery in the pediatric service of the Hôpital des Enfants Malades between 1975 and 1987. Epilepsy was the presenting sign in 76% of the children and remained the only clinical sign at diagnosis in 62%. Partial or complex partial seizures were observed in half of the cases, but other seizure types were also frequent. Diagnosis of the tumor as the etiological agent rested upon the results of computerized tomography or magnetic resonance imaging.

Postoperative mortality (5%) and morbidity (16%) rates were low. The postoperative intelligence quotient was above 80 in 71% of the patients, and 77% of the children had no major problem in school. Although only two of the 42 patients were given postoperative radiotherapy, there were no recurrences in 82% of the survivors. The actuarial probability of nonrecurrence of the tumor was 95% at 5 years. Three patients with recurrent tumor underwent further surgery and are, at the present time, recurrence-free. The incidence of epilepsy fell from 76% before surgery to 19% after removal of the tumor alone; therefore, intraoperative electrocorticography and resection of the electrically abnormal cortex at the time of the first surgical procedure do not appear necessary. It is possible that tumor removal restores a mechanism that limits the spread of seizures and, thus, the clinical manifestations of epilepsy. Benign astrocytic and oligodendrocytic tumors of the cerebral hemispheres in children should not be treated with adjuvant radiotherapy, at least initially.
Cerebral blood flow and the thermal properties of the brain: a preliminary analysis
Authors: Salcman Michael , Moriyama Eiji , Elsner Henry J. , Rossman Herman , Gettleman Robert A. , Neuberth Gordon , Corradino Gregory
Published: May 2009

✓ Safe and effective use of hyperthermia for the treatment of brain tumors requires precise control of the distribution of temperatures (that is, the thermal field) within the tumor and within the adjacent brain. Major influences upon the distribution of temperatures include the passive thermal properties of the brain, such as its specific heat (Cb), and the contribution of cerebral blood flow (CBF). Recently, an electrical-mechanical analog model of heat flow within the brain has been developed from which an expression for CBF has been derived: CBF = Cb/(τρc) where τ is the thermal decay constant, ρ is the density of blood, and c is its specific heat. To test this model a series of experiments was carried out in adult dogs in which stereotaxically implanted microwave antennas operating at 2450 MHz, fluoro-optical thermometry probes, and platinum electrodes were used to simultaneously measure CBF by thermal washout and hydrogen clearance techniques. The correlation coefficient for estimates of CBF derived by the two methods in 52 paired observations was 0.89. Measurements of CBF were more reliable at increased distances from the microwave antenna, since CBF is sensitive to the degree of temperature elevation (ΔT). The ratio of post-heating CBF to pre-heating CBF varies linearly with ΔT and has a correlation coefficient of 0.86. When values of CBF determined by the hydrogen clearance method were employed in the above equation, it was possible to derive Cb as 0.70 ± 0.08 cal/gm-°C. Use of this value for Cb in this equation produces estimates of CBF by thermal clearance that are within 10% of the values for CBF as measured by the hydrogen clearance method. It is concluded that this model of thermal flow within the brain may have heuristic value for treatment planning and that microwave antennas and fluoro-optical probes may represent a new methodology for the clinical estimation of CBF. These methods have recently been employed in patients undergoing combined hyperthermia and chemotherapy.
Effect of intracisternal antithrombin III on subarachnoid hemorrhage-induced arterial narrowing
Authors: Vollmer Dennis G. , Hongo Kazuhiro , Kassell Neal F. , Ogawa Hisayuki , Tsukahara Tetsuya , Lehman R. Michael
Published: May 2009

✓ The ability of antithrombin III, an endogenous plasma glycoprotein, to reverse the arterial narrowing in a rabbit model of cerebral vasospasm was evaluated. The vasodilator activity of antithrombin III on rabbit arteries was first assessed in vitro using a myograph-arterial ring preparation. Antithrombin III (10 IU/ml) induced a 55.4% ± 2.66% (mean ± standard error of the mean) relaxation in basilar artery precontracted with serotonin (5-HT) in five specimens as compared with a 9.8% ± 1.6% relaxation of common carotid artery in six specimens. For in vivo analysis, 21 New Zealand White male rabbits were separated into three groups: Group 1 served as normal controls; Group 2 received a subarachnoid blood injection (SAH) and were sacrificed on Day 3 thereafter; and Group 3 animals were subjected to SAH, then received a 2-hour intracisternal infusion of antithrombin III (100 IU) in saline prior to sacrifice on Day 3. Basilar artery caliber was determined using a morphometric method to analyze perfusion-fixed arterial segments. Control basilar artery diameter in Group 1 was 0.64 ± 0.02 mm. In Group 2 a 27% reduction in arterial caliber to 0.47 ± 0.03 mm was observed by Day 3 post SAH (p < 0.0001). Group 3 animals had a mean basilar artery diameter of 0.68 ± 0.02 mm. This was significantly larger than the untreated SAH rabbits in Group 2 (p < 0.0001), but not different from control artery diameters in Group 1. The findings demonstrate that antithrombin III in saline has a significant ability to reverse delayed narrowing of the rabbit basilar artery after SAH.
The effect of total parenteral nutrition on vasogenic edema development following cold injury in rats
Authors: Combs David J. , Ott Linda , McAninch Pamela S. , Dempsey Robert J. , Young Byron
Published: May 2009

✓ Total parenteral nutrition (TPN) has been shown to decrease mortality and to increase the rate of recovery in head-injured patients. However, a recent short-term animal experiment has raised concern over the potential enhancement of vasogenic edema by TPN. The experiment described here was undertaken to examine longer-term effects of TPN infusion on vasogenic edema development. Twenty-four rats received an infusion of a TPN solution (35% glucose) or 0.9% saline at 4 ml/kg/hr for 4 or 26 hours following cold injury. In the 4-hour experiment, TPN increased the serum glucose level to 772 ± 57 mg/dl compared to 160 ± 14 mg/dl in the saline-treated animals (p = 0.0001) and increased serum osmolality to 312 ± 3 mOsm/kg compared to 291 ± 3 mOsm/kg in the saline-treated group (p = 0.0006). In the 26-hour experiment, TPN-infused rats were also hyperglycemic and hyperosmotic by 4 hours postinjury and remained hyperglycemic at 26 hours postinjury (serum glucose level 374 ± 97 mg/dl compared to 141 ± 3 mg/dl in saline-treated animals; p = 0.0371). Although by 26 hours the TPN-infused rats appeared hyperosmotic compared to the saline-treated rats, high variability in the TPN group prevented statistical confirmation of this observation (serum osmolality 337 ± 35 mOsm/kg in the TPN group compared to 287 ± 6 mOsm/kg in the saline group).

A three-way analysis of variance with repeated measures was used to analyze the effect of infusion (saline vs. TPN), time (4 vs. 26 hours), and cold injury on the specific gravity of the five brain regions studied. Cold injury significantly increased edema development in the injured versus uninjured hemisphere for every region studied (p ≤ 0.0034, all five regions), and edema development increased significantly between 4 and 26 hours in three of the five regions (p ≤ 0.0207, all three regions). The infusion fluid was not a significant factor in any of the analyses. In conclusion, TPN infusion produced hyperglycemia and hyperosmolality in cold-injured rats but did not enhance vasogenic edema development in any brain region studied.
Inflammatory reaction to synthetic dural substitute
Authors: Cohen Alan R. , Aleksic Slobodan , Ransohoff Joseph
Published: May 2009

✓ The authors report an unusual complication related to a dural substitute. An inflammatory response to a Marlex mesh duraplasty simulated a recurrent convexity meningioma 20 years after the initial surgery.