bluuebunny/crossref_metadata_2025 huggingface dataset:
“Subacute” postoperative subdural empyema
Authors: Post Elisabeth M. , Modesti Luciano M.
Published: May 2009

✓ Although subdural empyema (SDE) has long been a recognized postoperative complication, little has been written to suggest that SDE's following operative procedures are different from those occurring in patients who have not had previous surgery. Four cases of postoperative SDE are reported which seem to have several distinguishing features and are grouped under the title of “subacute” subdural empyemas. These include: occurrence in a previous craniotomy site, a prolonged course, the insidious onset of symptoms, and the absence of signs of constitutional illness. The presence of an inner subdural membrane which limits the size of the empyema and separates it from the underlying brain is thought to be the reason for the relatively benign nature of the presenting symptoms and the extremely good prognosis. Computerized tomography scanning was not able to provide a preoperative diagnosis of empyema in any case.
Evaluation of prostaglandin biosynthetic activity in canine basilar artery following subarachnoid injection of blood
Authors: Sasaki Tomio , Murota Sei-itsu , Wakai Susumu , Asano Takao , Sano Keiji
Published: May 2009

✓ Transformation of arachidonic acid into prostaglandins was investigated in the basilar artery by incubating sections of artery with carbon-14-labeled arachidonic acid. Thin-layer radiochromatography revealed that, in normal canine basilar arteries, 14C-arachidonic acid was transformed mainly to 6-ketoprostaglandin (PG)F1α, a spontaneous metabolite of prostacyclin (PGI2). Among other prostaglandins, only a small amount of PGF2α was detected, whereas PGD2, PGE2, and thromboxane B2 were not. Arteries removed on Days 3 and 8 after subarachnoid blood injection showed a prostaglandin synthesis profile similar to that in the normal cerebral artery.

In borate-buffered saline (0.1M borate buffer, pH 9.0/0.15M NaCl = 1:9, vol/vol), canine basilar artery produced a PGI2-like substance that inhibited adenosine diphosphate (ADP)-induced platelet aggregation. Its anti-aggregatory activity was completely abolished by acidification. Aspirin likewise inhibited production of the anti-aggregatory substance. From these results, it was concluded that the anti-aggregatory activity was due solely to the production of PGI2 by the arterial specimen. Based on the above results, PGI2 biosynthetic activity in the cerebral artery exposed to subarachnoid blood injection was bioassayed by measuring the inhibitory activity of the incubation product upon ADP-induced platelet aggregation following incubation of the arteries in borate-buffered saline for 5 to 30 minutes at 20°C, using synthetic PGI2-Na as a standard.

The synthetic activity of PGI2 in the artery exposed to subarachnoid blood injection had diminished remarkably by Days 3 and 8. This diminution of PGI2 synthesis in the cerebral artery may be involved in the pathogenesis of cerebral vasospasm.
Giant traumatic false aneurysm of the internal carotid artery associated with a carotid-cavernous fistula
Authors: Reddy S. V. Ramana , Sundt Thoralf M.
Published: May 2009

✓ A case of giant traumatic false aneurysm of the intracranial internal carotid artery (ICA) with a concomitant carotid-cavernous fistula is reported. The fistula and the aneurysm persisted after ipsilateral cervical ICA ligation was performed elsewhere. Successful obliteration of the aneurysm and the fistula, with preservation of cross filling of the ipsilateral middle cerebral artery system, was accomplished by ligation of the intracranial ICA proximal to the origin of the posterior communicating artery with a 7–0 prolene suture, followed by transaneurysmal packing of the fistula.
Pathology of arteriovenous malformations embolized with isobutyl-2-cyanoacrylate (bucrylate)
Authors: Vinters Harry V. , Debrun Gérard , Kaufmann John C. E. , Drake Charles G.
Published: May 2009

✓ There is controversy as to the possible toxic effects of isobutyl-2-cyanoacrylate (bucrylate) when this substance is used for purposes of therapeutic embolization. Two cases are presented in which cerebral arteriovenous malformations were resected, one 42 days and the other a year after bucrylate embolization. In both, pathological examination revealed a brisk intimal foreign-body giant-cell reaction wherever bucrylate was present in a vessel, along with chronic inflammation in the vessel walls and adjacent brain parenchyma. The findings are discussed in the light of other observations on the histotoxicity of bucrylate.
Fibrous ankylosis of the mandible following frontotemporal craniotomy
Authors: Hendler Barry H. , Kreger Thomas M. , Goldman H. Warren
Published: May 2009

✓ A case of fibrous ankylosis of the mandible secondary to frontotemporal craniotomy is reported. The pathogenic, clinical, and therapeutic aspects of the case are discussed.
Symptomatic subependymoma of the fourth ventricle
Authors: Gandolfi Angelo , Brizzi Riccardo E. , Tedeschi Filomeno , Paini Paolo , Bassi Pellegrino
Published: May 2009

✓ Symptomatic subependymomas of the fourth ventricle are rare and usually not included in the preoperative differential diagnosis of tumors in this region. The case of a 63-year-old man with fourth ventricle subependymoma is described. For several years he had suffered with nausea and vomiting, and now presented signs of direct involvement of the posterior fossa. He was investigated preoperatively with computerized tomography, but the ultimate diagnosis was not suspected at that time. The tumor was diagnosed as an subependymoma at operation and was totally excised. This tumor type can easily be recognized on intraoperative frozen section, and its diagnosis should always lead to an attempt at complete surgical removal.
Recurrent osteoma overlying cranioplasty
Authors: Vonofakos Dimitrios A. , Karakoulakis Eustratios
Published: May 2009

✓ An osteoma of the skull was removed from this patient and the bone defect was covered with a cranioplastic plate. Two years later, a recurrent osteoma developed, overlying the plastic plate. There was no connection with the borders of the craniectomy.
Effects of profound hypotension on cerebral blood flow during surgery for intracranial aneurysms
Authors: Keith Farrar J. , Gamache Francis W. , Ferguson Gary G. , Barker John , Varkey George P. , Drake Charles G.
Published: May 2009

✓ The progression of changes in cerebral blood flow (CBF) and neurological status were measured in 12 patients in whom profound hypotension (mean arterial blood pressure (MABP): 30 to 40 mm Hg) was used during intracranial aneurysm surgery. Nine patients (Group I) showed autoregulation of CBF to an MABP of 40 to 50 mm Hg during surgery. None of these patients had arterial spasm preoperatively. Postoperatively, mild flow disturbances were noted at the site of retraction. Three Group I patients developed arterial spasm postoperatively, but there was no associated neurological deterioration. The remaining three patients (Group II) had impaired autoregulation during surgery, and CBF decreased by 35% to 65% at an MABP of 50 mm Hg. Two of these patients had angiography immediately before surgery, and both showed moderate to severe arterial spasm. Relatively severe flow disturbances were noted postoperatively at the site of retraction, and two patients developed ischemic deficits of late onset. Brain retractor pressure and the degree and duration of hypotension were equivalent in the two patient groups. There was no correlation between intraoperative reductions in CBF (to as low as 20 ml/100 gm/min in the unretracted hemisphere) and immediate postoperative neurological deficits. The use of halothane and mannitol and the relatively short duration of the flow reductions were suggested as factors contributing to the protection from ischemia that was observed. Arterial spasm was found to produce hemodynamic instability and reduced CBF, although neurological status was unaffected in the majority of patients. Patients with impaired autoregulation during surgery were at increased risk of delayed ischemic complications postoperatively, and showed characteristic flow disturbances at all three stages of their clinical course.
Subarachnoid hemorrhage and cerebrovascular spasm
Authors: Petter Eldevik O. , Kristiansen Kristian , Torvik Ansgar
Published: May 2009

✓ Artificial subarachnoid hemorrhage (SAH) produced by injection of autologous blood into the cisterna magna in dogs gave rise to considerable narrowing or spasm of the basilar artery and its branches, including the posterior cerebral arteries, as demonstrated by cerebral angiography. Repeated cisternal injections of blood at various intervals produced more severe spasm than a single injection. After perfusion-fixation of the brain, the cerebral arteries were examined by light and electron microscopy. None of the animals showed abnormalities in the intima or media of the vessel walls. Previously reported findings of morphological changes due to spasm could not be confirmed.

Postmortem examination of brain vessels from nine patients with SAH and arterial spasm showed no specific changes that could be ascribed to spasm.
Pineal tumors in children and adolescents
Authors: Abay Eustaquio O. , Laws Edward R. , Grado Gordon L. , Bruckman James E. , Forbes Glenn S. , Gomez Manuel R. , Scott Mark
Published: May 2009

✓ Tumors of the pineal region account for 3% to 8% of pediatric intracranial tumors. The treatment of such tumors has been in a state of flux between conservative therapy (cerebrospinal fluid shunting and radiotherapy) and direct surgical removal. A brief history and review of the literature with analysis of both approaches is given, and the Mayo Clinic's experience with conservative treatment of tumors in the pineal region in patients 20 years old and younger (27 cases) is studied and analyzed. The series comprises 21 boys and six girls, with an age range of 1 to 20 years (mean 13.7 years). Follow-up examinations are complete and range from 1 to 24 years, with a mean follow-up period of 7.8 years. The median survival time for these patients treated with shunt and radiotherapy is 17.7 years. There was no mortality from treatment and complications were rare. The details of the clinical presentation, diagnostic findings, pathology, therapy, recurrence, and survival are presented.

All patients under 6 years of age (six cases) had recurrences, 50% in other areas in the brain and 50% in the spinal cord, perhaps pointing to the need for whole-brain and spinal-axis irradiation in patients in this age group. The results of this study of the conservative approach form a standard against which results of any other type of therapy may be compared.
Internal irradiation for cystic craniopharyngioma
Authors: Kobayashi Tatsuya , Kageyama Naoki , Ohara Ken
Published: May 2009

✓ The authors report the results of internal irradiation with labeled chromic phosphate (32P) and gold-198 (198Au) colloid in eight cases of cystic craniopharyngiomas. They used a newly developed dosimetric formula, by which the radiation dose at the cyst wall and at any point far from the radioactive source can be calculated. Ten courses of irradiation in eight patients were carried out by injection of either 32P or 198Au colloid into the cyst through an Ommaya drainage system that had been placed at craniotomy. Follow-up studies ranging from 13 to 156 months revealed that all cysts were effectively treated, with elimination of fluid or collapse of the cyst. This was confirmed by Conray cystography and/or computerized tomography.

Not only the dose delivered to the wall but also the thickness of the cyst wall and the location of the cyst are important factors in planning internal irradiation. A safe and adequate dose to the cyst wall could range between 9000 to 30,000 rads for craniopharyngioma. This treatment is suitable for large cysts that are thought to be difficult to remove radically, recurrent cysts resistant to previous treatment, or multiple cysts. Internal irradiation may also be applicable in other cystic intracranial tumors if dosimetry is calculated accurately.
Reoperation for glioblastoma
Authors: Young Byron , Oldfield Edward H. , Markesbery William R. , Haack Dennis , Tibbs Phillip A. , McCombs Paul , Chin Hong W. , Maruyama Yosh , Meacham William F.
Published: May 2009

✓ The results of a second operation for tumor removal in 24 adult patients with supratentorial glioblastoma multiforme or anaplastic astrocytoma were analyzed. The median survival time after reoperation was 14 weeks. Five of the 24 patients lived 6 months or longer after reoperation. Only three of these patients maintained a Karnofsky rating (KR) of at least 60 for 6 months or longer after reoperation.

Preoperative neurological status (KR) is the most significant determinant of survival after reoperation (p = 0.02). When the KR is at least 60, median survival after reoperation is 22 weeks. When the KR prior to reoperation is less than 60, median survival is 9 weeks. Only one of 13 patients with a KR of less than 60 prior to reoperation survived longer than 6 months after the second operation. The interval between first and second operation is significantly related to survival (p = 0.03), but when adjustment is made for the KR the interoperative interval is no longer significantly related to survival after the second operation (p = 0.39). Age, sex, and location of tumor were not significantly related to duration of survival.

This study suggests that reoperation is most likely to produce the best result when the KR is at least 60 and the interval between operations is longer than 6 months. Using these criteria, one-third of the patients could be expected to survive with a KR of at least 60 for 6 months. The study indicates that reoperation should not be carried out when the KR is less than 60.
Regional blood flow and capillary permeability in the ethylnitrosourea-induced rat glioma
Authors: Yamada Kazuo , Hayakawa Toru , Ushio Yukitaka , Arita Norio , Kato Amami , Mogami Heitaro
Published: May 2009

✓ Regional cerebral blood flow and capillary permeability of rat brains bearing ethylnitrosourea-induced gliomas of various size were investigated with 14C-antipyrine autoradiography and Evans blue staining. In the small tumors (<2 mm in diameter), blood flow was uniformly reduced when compared to the adjacent brain. Even in tiny tumors (0.3 to 0.4 mm in diameter), reduction in blood flow was evident. In the medium (2 to 4 mm in diameter) and large (> 4 mm in diameter) tumors, the blood flow increased or decreased depending on the part of the tumor examined. The necrotic center and peripheral edge had low blood flows, whereas the viable portion adjacent to the necrotic center had high blood flows. Blood flow in the brain tissue adjacent to medium and large tumors was lower than control brain tissue, probably due to local edema. Leakage of intravenous Evans blue in the tissue was only evident in the large tumors with central necrosis. The present findings suggest that neovascularization of the tumor may occur when the tumor reaches a certain size, and leaky new vessels may be the cause of brain edema associated with tumor.
Malignant meningioma: clinical and pathological features
Authors: Thomas Harvey G. , Dolman Clarisse L. , Berry Kenneth
Published: May 2009

✓ The records of 15 patients with a diagnosis of malignant meningioma were reviewed. In one of these patients, in whom invasion of the brain and pituitary gland was the only unusual feature, the tumor was reclassified as benign. Seven tumors, four hemangiopericytomas and two transitional and one syncytial meningioma, were considered to be only borderline-malignant despite necrosis and invasion of the brain, because of few mitoses and regular architecture. Of this group of patients, four men and three women, two are alive and well, three died after incomplete resections, and two succumbed to recurrent tumor that had become inoperable. The other seven patients, six men and one woman, had lesions classified as histologically frankly malignant, on the basis of marked anaplasia and numerous mitoses. These comprised three hemangiopericytomas and three syncytial and one fibrous meningioma. One of these patients is alive and well and the others are dead, three as a result of metastases. The initial clinical course of malignant meningiomas tends to be short but is otherwise indistinguishable from that of benign meningiomas. The chances of recurrence and eventual death are high, and extracranial metastases are not rare. The tumors are most often hemangiopericytomas, but not exclusively so, and men are particularly at risk.
Intracranial ceruminous gland adenocarcinoma
Authors: Cilluffo John M. , Harner Stephen G. , Miller Ross H.
Published: May 2009

✓ Patients with adenocarcinoma of the ceruminous gland arising in the middle ear have a typical syndrome consisting of unilateral hearing loss, otalgia, facial paresis, and a middle-ear mass. Adjacent cranial nerves also may be affected. Some patients may have an ipsilateral cerebellar ataxia if the lesion extends into the cerebellopontine angle and compresses the cerebellar hemisphere. Obstructive hydrocephalus may occur secondary to obstruction of the aqueduct or fourth ventricle. The initial clinical findings may be those of a jugular foramen syndrome. These lesions are usually slow-growing and may be associated with a very prolonged clinical course. Although the tumors are rare, the physician should be aware of their existence if proper care is to be given.
Evidence for orbital deformation that may contribute to monocular blindness following minor frontal head trauma
Authors: Gross Cordell E. , DeKock James R. , Panje William R. , Hershkowitz Noah , Newman John
Published: May 2009

✓ Traction injury to the optic nerve and vasa nervorum is the suggested etiology for monocular blindness following trivial frontal trauma. Holographic interferometry was used on human skulls to demonstrate orbital deformation in response to nondestructive frontal loading. The findings suggest an additional mechanism for energy dissipation and therefore for optic nerve injury following frontal impact.
Transpositions and anastomoses between the posterior cerebral and superior cerebellar arteries
Authors: Sundt Thoralf M. , Campbell J. Keith , Houser Otis W.
Published: May 2009

✓ Two cases are reported in which anastomotic procedures between the posterior cerebral and superior cerebellar arteries were useful for the management of occlusive and aneurysmal disease of the posterior circulation. Operative procedures such as these may play a role in the future management of vascular problems in this system.
The association of intracranial aneurysms and arteriovenous malformation of the brain
Authors: Hayashi Seiji , Arimoto Taira , Itakura Toru , Fujii Toru , Nishiguchi Takashi , Komai Norihiko
Published: May 2009

✓ A case of intracranial multiple aneurysms associated with an arteriovenous malformation (AVM) is described. Three aneurysms were found arising from an enlarged anterior cerebral artery feeding an AVM. In spite of the fact that two of these aneurysms received no surgical treatment, they disappeared almost completely several months after excision of the AVM. Seventy-three previously reported cases of cerebral aneurysms associated with AVM's are reviewed, and the effect of hemodynamic stresses on the development of these aneurysms is summarized.
Delayed myelopathy secondary to retained intraspinal metallic fragment
Authors: Jones F. Douglas , Woosley Ronald E.
Published: May 2009

✓ The authors present a case of delayed myelopathy arising 8 years after a stab wound to the thoracic spine, with intradural retention of the knife tip. Following removal of the knife tip, the patient had a good recovery. A review of the literature documents eight additional cases of delayed myelopathy secondary to retained fragments from spinal stab wounds.
Spinal cord herniation into a congenital extradural arachnoid cyst causing Brown-Séquard syndrome
Authors: Masuzawa Hideaki , Nakayama Hitoshi , Shitara Nobuyuki , Suzuki Takeyo
Published: May 2009

✓ This is a report of a patient who developed sharp intercostal pain and Brown-Séquard syndrome. Displacement of the spinal cord toward an extradural mass was noted at the T4–5 vertebral level on iophendylate myelography and metrizamide computerized tomography myelography. Multiple meningeal diverticular lesions of congenital origin were also found. Surgical correction of the spinal cord, which had herniated into a laterally located extradural arachnoid cyst and become incarcerated, resulted in a complete neurological recovery.
Isolated hypertrophic interstitial neuropathy of the trigeminal nerve associated with trigeminal neuralgia
Authors: Baskin David S. , Townsend Jeannette J. , Wilson Charles B.
Published: May 2009

✓ Hypertrophic interstitial neuropathy (HIN) of the trigeminal nerve was observed in a patient with trigeminal neuralgia who had no other neurological abnormalities. Pathological documentation confirmed focal HIN. No similar histologically documented case of isolated trigeminal nerve involvement by HIN has been reported previously.
Superficial peroneal nerve entrapment
Authors: Banerjee Timir , Koons Dexter D.
Published: May 2009

✓ Two cases of entrapment of the superficial peroneal nerve are presented. This is an unusual cause for leg discomfort and should be considered in the differential diagnosis of leg pain.
Cranial chondromyxoid fibroma
Authors: Miyamoto Etsuo , Kuriyama Tsuyoshi , Iwamoto Munehisa , Tsuji Naoki , Shizuki Kohzo
Published: May 2009

✓ A case of chondromyxoid fibroma of the frontal bone in a 15-year-old girl is presented. This is a benign tumor, but should be excised widely enough to include a rim of normal bone, otherwise it may recur or even undergo malignant transformation.
Evoked potentials in the clinical neurosciences
Authors: Greenberg Richard P. , Ducker Thomas B.
Published: May 2009

✓ The use of evoked potentials for the evaluation of disorders of the nervous system has become a most valuable aid to the neurosurgeon and neurologist, often providing information of critical value without recourse to invasive techniques. In order to employ these techniques, it is helpful to understand the principles of evoked potential electrogenesis and the methodology used for analysis of evoked potential clinical data. This article is aimed at providing the clinical neurosurgeon with this type of information and with a review of current clinical applications in this rapidly developing field.
Can the outcome from head injury be improved?
Authors: Langfitt Thomas W. , Gennarelli Thomas A.
Published: May 2009

✓ In the past few years, considerable progress has been made in describing patients with head injuries in such a manner that comparisons in morbidity and mortality can be made among neurosurgical centers according to the seriousness of the injury. Less progress has been made in classifying the type of pathology, especially by computerized tomography. The authors have introduced a classification that includes both the type and the seriousness of the injury. There appear to be two principal causes of the brain damage produced by head injury: 1) mechanical damage to neurons and their processes, especially axons, and 2) ischemia. Mechanical damage produces axonal degeneration. Although central regeneration generally is quite limited, perhaps many of the axons damaged by head injury degenerate in continuity, a circumstance in which functional regeneration by axoplasmic outgrowth is much more likely to occur than in most experimental situations where the axons are physically divided. The ischemic brain damage that is so common in head injury appears to be due to mass lesions and brain swelling that both cause intracranial hypertension. The more the brain swells, and the higher the intracranial pressure, the more difficult it is to control the swelling and the pressure. In patients with acute subdural hematoma in particular, the brain swelling and the high mortality appear to be due to ischemic brain damage. There is recent evidence that the mortality rate in patients with acute subdural hematoma is a function of the time from injury to evacuation of the hematoma. Therefore, outcome from head injury can be improved by the earliest possible removal of space-occupying hematomas and by early, vigorous management of intracranial hypertension.
Immunological, biochemical, ultrastructural, and electrophysiological characteristics of a human glioblastoma-derived cell culture line
Authors: Black Peter McL. , Kornblith Paul L. , Davison Peter F. , Liszczak Theodore M. , Merk Linda P. , Smith Barry H. , McKeever Paul E. , Quindlen Eugene A.
Published: May 2009

✓ This report presents the results of a study using multiple techniques of the established human cell line, LM, which has been developed in culture medium from a patient with a right temporoparietal glioblastoma. This cell line has human subtetraploid karyotype and has several features of a transformed line in culture. These include continuous propagation for 10 years, ability to form tumor nodules when transplanted into immunologically suppressed hamsters, and pleomorphic appearance. Ultrastructurally, it is characterized by multiple nuclei, few actin cables, and numerous surface-membrane microvilli, as well as abundant 9- to 10-nm cystoplasmic filaments. By its immunological reactivity, the line can be shown to contain glial fibrillary acidic protein at low levels, consistent with its glial origin and continued nature. Dibutyryl cyclic adenosine monophosphate (db-cAMP) induces formation of long astrocytic-like processes as well. Its membrane electrical characteristics include a low resting membrane potential and short time constant. Used in a microtiter antiglioma antibody cytotoxicity assay, LM yields a positive reaction to antibodies in the sera of 80% of patients with astrocytomas and only 9% of normal blood-bank donors, suggesting that it shares common antigens with other astrocytic tumor lines.

The varied characteristics of this glioblastoma-derived line emphasize the “multiforme” nature of the neoplasm and suggest that for characterization of any such line, multiple parameters are necessary to allow comparison with other long-term glioblastoma lines in the literature. The usefulness of the LM line in in vitro cell biological, immunological, chemotherapeutic, and radiobiological studies of gliomas makes such efforts very worthwhile.
Antibiotic prophylaxis of postoperative neurosurgical wound infection
Authors: Haines Stephen J. , Goodman Michael L.
Published: May 2009

✓ In an effort to reduce the incidence of postoperative wound infection, the recently proposed regimen of intravenous vancomycin and tobramycin and streptomycin irrigating solution was used in 878 neurosurgical operations. There were eight infections, for an infection rate of 0.9%. This infection rate was compared to the rate in the previously reported series using a sequential statistical analysis. The infection rate was found to be signficantly greater than that previously reported. Controlled clinical trials will be required before the efficacy of antibiotic prophylaxis in clean neurosurgical procedures can be considered proven.
Microvascular perfusion and metabolism in injured spinal cord after methylprednisolone treatment
Authors: Anderson Douglas K. , Means Eugene D. , Waters Thomas R. , Green Evangelyn S.
Published: May 2009

✓ The purpose of this study was to determine the effect of treatment with the synthetic glucocorticoid, methylprednisolone, on the microvasculature and metabolism of the traumatized spinal cord. Spinal cords of cats were compressed with a 170-gm weight for 5 minutes and were treated with either high-dose methylprednisolone (HDMP, 15 mg/kg/24 hrs) or megadose methylprednisolone (MDMP, 60 mg/kg/24 hrs). Animals were sacrificed at 2, 8, or 24 hours following injury. Treatment with HDMP resulted in substantial preservation of injured spinal cord microvascular perfusion at 8 hours as compared with injured untreated cats. Compression trauma caused a partial derangement of energy metabolism and a shift toward anaerobic glycolysis in both treated and untreated groups for the entire 24-hour postinjury period. Tissue levels of adenosine triphosphate, phosphocreatine, and total adenylates in the HDMP-treated cats sacrificed at 8 hours after trauma were significantly elevated over untreated controls, but those in the 2- and 24-hour groups were not. Concentrations of energy intermediates in MDMP-treated cats were either equal to or below those of injured untreated animals at all three postinjury time periods. The postinjury metabolite pattern and concentrations seen in this study possibly result from differing levels of blood flow and neuronal activity in the injured untreated, HDMP-, and MDMP-treated spinal cords. Better tissue perfusion in the HDMP-treated cats might be expected to result in an improved tissue energy state in these animals. However, intensive high-dose glucocorticoid treatment has been demonstrated to augment spinal cord monosynaptic and polysynaptic reflex transmission and primary afferent excitability. Furthermore, acute single intravenous dose studies have shown this direct neuronal action to be dose-related. Thus, additional high-energy phosphate molecules that may be reformed as a result of HDMP treatment were perhaps used as the energy source for any increased neuronal activity caused by steroid administration. The beneficial effects of glucocorticoid treatment in experimental spinal cord trauma might derive from preserved cellular structural integrity. This could result in increased levels of neuronal activity, energy utilization, and production in treated as compared with untreated tissue.
Spontaneous spinal epidural hematoma in a 22-month-old girl
Authors: Vallée Bernard , Besson Gérard , Gaudin Jean , Person Hervé , Le Fur Jean-Marie , Le Guyader Jacques
Published: May 2009

✓ The authors report the case of a 22-month-old girl who developed cervical pain, neck stiffness, and quadriparesis over 12 days. An epidural hematoma was removed, with complete recovery after 6 months. There was no history of trauma. A search of the literature revealed eight previous cases of spontaneous spinal epidural hematomas in children under the age of 10 years.
Treatment of nontraumatic atlantoaxial dislocation and fibrous fusion
Authors: Lucas John T. , Hungerford Gordon D. , Perot Phanor L.
Published: May 2009

✓ The authors describe a case of nontraumatic atlantoaxial dislocation secondary to acute rheumatic fever, in which there appeared to be fibrous fusion between the axis and the atlas in the subluxed position. The dislocation was reduced by means of combined traction and steroid therapy. Fibrous fusion occurred in the realigned position after immobilization.
Acromegaly and spinal stenosis
Authors: Epstein Nancy , Whelan Margaret , Benjamin Vallo
Published: May 2009

✓ Spinal stenosis is a well defined clinical entity that is occasionally encountered in patients with acromegaly. Persistent elevation of growth hormone promotes hypertrophy of the bones and ligaments, resulting in widening of the thoracolumbar vertebral bodies, and developmental narrowing of the spinal canal. This report describes the case of a 54-year-old acromegalic man with a 30-year history of low-back pain, who developed symptoms of spinal stenosis. This case and two similar cases from the literature are discussed, and the appropriate therapeutic approaches reviewed.
Frontal lobe perivascular schwannoma
Authors: Auer Roland N. , Budny James , Drake Charles G. , Ball Melvyn J.
Published: May 2009

✓ A 15-year-old youth presented with a history and computerized tomography picture of subarachnoid hemorrhage. Conservative management was undertaken after failure to demonstrate an aneurysm. Reevaluation and operation 15 months later disclosed a firm leathery schwannoma intimately related to the frontal lobe and extending into the cortex in the Virchow-Robin spaces.
Removal of retained ventricular shunt catheters without craniotomy
Authors: Chehrazi Bahram , Duncan Charles C.
Published: May 2009

✓ A technique is described in which insulated suction is used to extract infected retained ventricular catheters in cases of shunt infection. This procedure allows safe removal without craniotomy. Retained catheters are pulled through an insulated No. 11F or 13F suction tube attached to an electrocoagulation unit used for resection and coagulation of adhesions. The technique has been successful in two cases with retained catheters.
Stabilizing hemostatic clamp for arterial anastomosis in microneurosurgery
Authors: Mrówka Ryszard , Frydrych Andrzej
Published: May 2009

✓ The authors describe a “stabilizing hemostatic clamp” of their own design for use in end-to-side anastomosis. Its application facilitates simultaneous stabilization and hemostatis of the cortical artery at the site where anastomosis is to be performed. Using this instrument, the authors have performed anastomosis of the superficial temporal artery with a branch of the middle cerebral artery in 60 patients. On evaluation of the clinical effects of the treatment and results of control angiography, and taking into account the authors' relatively small experience with this type of surgical treatment, they conclude that their new clamp facilitates this form of surgery.
Digital video subtraction angiography of the cervical and cerebral vasculature
Authors: Seeger Joachim F. , Weinstein Philip R. , Carmody Raymond F. , Ovitt Theron W. , Fisher H. Donald , Capp M. Paul
Published: May 2009

✓ A digital video subtraction angiography unit developed at the University of Arizona is described. The system allows the angiographic evaluation of the cervical and cerebral vasculature by means of intravenous injection of contrast material. The procedure is performed on outpatients and is reliable, safe, and economical. The authors have evaluated suspected arterial and venous occlusive disease, certain aneurysms and tumors, and postoperative results of vascular bypass procedures and aneurysm clipping. The clinical application of the technique is shown with appropriate case presentations.
Intracranial pressure changes following aneurysm rupture
Authors: Voldby Bo , Enevoldsen Erna M.
Published: May 2009

✓ Intraventricular pressure (IVP) was measured continuously by the method of Lundberg for an average period of 8 days in 52 patients with recent rupture of an intracranial saccular aneurysm. The patients were graded as follows according to the system of Hunt and Hess: 13 patients were Grades I–II, 19 patients Grades II–III, and 20 patients Grades III–V. The degree of cerebral arterial spasm was measured on angiograms taken on admission and approximately 7 days later. Drainage of ventricular cerebrospinal fluid was performed intermittently when IVP exceeded 25 mm Hg.

The results showed a close correlation between changes in clinical grade and in mean IVP. Drainage improved the condition in uncomplicated cases, but was less effective or ineffective when severe vasospasm or rebleeding occurred. Lowering the IVP by drainage did not appear to increase the risk of rebleeding. In contrast to patients with no or slight spasm, patients with severe spasm had a permanently elevated IVP, even before spasm was demonstrable angiographically. A mean IVP exceeding 25 mm Hg for the whole period of monitoring was associated with a poor prognosis. Finally, indications for continuous monitoring of IVP and ventricular drainage in aneurysm patients are suggested.
Intracranial pressure changes following aneurysm rupture
Authors: Voldby Bo , Enevoldsen Erna M.
Published: May 2009

✓ Lactate concentrations and pH were measured serially in the cerebrospinal fluid (CSF) of 52 patients with ruptured intracranial aneurysms. Measurements were made during continuous monitoring of the intraventricular pressure (IVP) in the first 12 days after the initial subarachnoid hemorrhage. A total of 226 samples of CSF were analyzed. The clinical condition of the patients was graded according to the Hunt and Hess system. The degree of cerebral arterial spasm was measured on angiograms taken on admission and again approximately 7 days later. Results showed that the lactate concentrations in hemorrhagic and xanthochromic CSF were significantly higher than in clear CSF, indicating lactate production from shed blood cells. However, regardless of the degree of blood admixture to CSF, lactate increased with deteriorating clinical condition. Patients with a moderately increased IVP (20 to 40 mm Hg) had lactate levels of about 3 mmol/liter. A rising IVP or the development of severe spasm was accompanied by a persistent elevation or an increase in lactate. These results suggest that increased CSF concentrations of lactate reflected an increased production of lactate by partially ischemic cerebral tissue. A CSF lactate value above 3.5 mmol/liter was associated with a poor prognosis.
Interposition saphenous vein grafts for advanced occlusive disease and large aneurysms in the posterior circulation
Authors: Sundt Thoralf M. , Piepgras David G. , Houser O. Wayne , Campbell J. Keith
Published: May 2009

✓ The authors report their initial experience with the use of interposition saphenous vein grafts between the external carotid artery and the proximal posterior cerebral artery. The indications, results, and technical aspects of the operation are reviewed. All patients accepted for surgery were at high risk for a posterior circulation infarct, and all patients with ischemic symptomatology had continued to progress while on anticoagulant drugs or anti-platelet agents. Thus, all patients were at high risk, and 11 of the 14 patients operated on were confined to bed before surgery. Intraoperative graft flows varied from 35 to 170 ml/min, and postoperative graft flows ranged from 75 to 311 ml/min in the patent grafts. There were three early graft occlusions and two late graft occlusions; these all occurred in patients with relatively low flows at the time of surgery (40 ml/min or lower). Subdural hygroma was the next most frequent complication to graft occlusion. It was thought to be caused by the pulsating graft anastomosed to a major vessel through a small opening in the basal arachnoid, which provided a new path for cerebrospinal fluid flow in patients with a degree of preexisting atrophy. One patient with a large aneurysm in the posterior circulation underwent proximal intracranial clipping of the vertebral artery and bypass grafting simultaneously. There were seven excellent results and two good results in nine patients in whom the graft remained patent. In the five patients with graft occlusion, there were two minor strokes, two major strokes, and one death.
Effect of subarachnoid hemorrhage on the extracellular microenvironment
Authors: Hubschmann Otakar R. , Kornhauser David
Published: May 2009

✓ Local experimental subarachnoid hemorrhage (SAH) was produced over the cerebral cortex in 15 cats. The cellular response was monitored using ion-specific electrodes for extracellular potassium (K+) and calcium (Ca++) activity, DC cortical potential, and electrocorticogram. The response was characterized by a profound cellular depolarization and extracellular calcium (Ca++) depletion which accompanied extracellular potassium (K+) accumulation. The prehemorrhage baseline calcium levels measured 1.14 ± 0.11 mM, and were lowered to 0.4 to 0.7 mM/liter in different experiments. The K+ accumulation reached levels between 16 and 31 mM from a baseline of 3.17 ± 0.52 mM and were cleared to normal or nearly normal within 5 minutes. The Ca++ levels also returned to normal within 5 minutes, but remained depressed for the duration of the experiment in two animals. These results confirm that blood extravasated into the subarachnoid space has a direct effect on parenchymal elements. The combination of transient K+ elevations and calcium depression may play an important role in the development of vascular spasm by inducing or facilitating a contraction in the muscular layer in the wall of major intracranial vessels.
Brain-stem hematoma
Authors: O'Laoire Seán A. , Crockard H. Alan , Thomas David G. T. , Gordon Derek S.
Published: May 2009

✓ Six cases of brain-stem hematoma are described. The clinical presentation in these cases was extremely variable. Operative evacuation of the hematoma resulted in immediate improvement in all cases, and a full or nearly full recovery in five. Untreated brain-stem hematoma is probably always fatal, whereas surgical evacuation is effective and safe. The diagnosis of brain-stem hematoma should be considered in any case of brain-stem lesion.
The lateral wall of the cavernous sinus
Authors: Umansky Felix , Nathan Hilel
Published: May 2009

✓ In a study of the cavernous sinus in 70 specimens, the lateral wall of the sinus was found to be formed by two layers: a superficial, dural layer and a deep layer. The latter was formed by the sheaths of nerves III, IV, and V1,2 plus a reticular membrane extending between the sheaths. This membrane was often incomplete, particularly beween the sheaths of nerves III and IV above, and V1 below. These findings do not conform with the descriptions of a single dural layer of the lateral wall, with nerves III, IV, and V1,2 embedded in it, nor to other descriptions showing the cavity of the sinus divided into two compartments by a septum close to the lateral wall, with nerves III, IV, and V1 located within the septum. In the present study, the superficial and the deep layers of the lateral wall were found to be loosely attached to each other and easy to separate. In no case was a superficial compartment of the sinus found to be present between the two layers, and the nerves were never found to be running embedded in the superficial layer.
Evaluation of periventricular hypodensity in experimental hydrocephalus by metrizamide CT ventriculography
Authors: Hiratsuka Hideo , Tabata Hitoshi , Tsuruoka Shin , Aoyagi Masaru , Okada Kodai , Inaba Yutaka
Published: May 2009

✓ Hydrocephalus was induced in 13 dogs by injecting kaolin into the cisterna magna and was evaluated by computerized tomography (CT) scans. Modification of periventricular hypodensity was observed by metrizamide-enhanced CT ventriculography. Periventricular hypodensity was seen as early as 12 hours after kaolin injection. On CT ventriculography, metrizamide stayed longer in the ventricles of hydrocephalic dogs than in those of normal dogs, and migrated into the areas of periventricular hypodensity; the changes became significant within 12 to 24 hours. Four of the dogs were killed immediately after CT ventriculography, and the iodine concentration was measured. Iodine concentration was highest in the periventricular white matter, followed by the basal ganglia, and it was low in the cerebral and cerebellar cortex. When the change in Hounsfield units found by CT ventriculography at the regions of interest was compared to the actual iodine concentrations, the figures were quite compatible. Similarly, the specific gravity was measured in tissue from various parts of the brain of two hydrocephalic dogs, and compared against the value of that from five normal dogs. The specific gravity values were particularly low in the periventricular white matter of the hydrocephalic brains, suggesting a higher water content in that region. Since the increased migration of metrizamide occurred at the same region, it is suggested that development of periventricular hypodensity is due to increased transit of cerebrospinal fluid from the ventricles to the white matter.
Intrathecal and intraventricular morphine for pain in cancer patients: initial study
Authors: Leavens Milam E. , Hill C. Stratton , Cech David A. , Weyland Jane B. , Weston Jaye S.
Published: May 2009

✓ Intractable pain in six cancer patients was treated with lumbar intrathecal morphine (two patients) and intraventricular morphine (four patients). Daily percutaneous injections of morphine through Ommaya reservoirs were made. Initially, 1 mg of lumbar intrathecal morphine resulted in pain relief for 10 to 14 hours, and 2.5 to 4.0 mg of intraventricular morphine gave relief for 12 to 24 hours. This treatment was continued for 3 to 7 months in three of the adults. Morphine requirements gradually increased. Side effects were minimal, and there were no complications.
Radical orbital decompression for severe dysthyroid exophthalmos
Authors: Maroon Joseph C. , Kennerdell John S.
Published: May 2009

✓ A surgical technique is described for radical decompression of the orbit for dysthyroid exophthalmopathy. The operation should be considered in a patient with proptosis greater than 30 mm bilaterally or one with unilateral proptosis of 10 mm or more greater than the opposite eye. Such exophthalmos is frequently associated with corneal exposure and ulceration, extreme cosmetic disfigurement, and optic neuropathy. The surgical procedure is performed through a 35-mm lateral skin incision and a lateral canthotomy with subconjunctival dissection. All four walls of the orbit are partially removed. This panorbital decompression procedure has been performed on five patients, with reduction of preoperative proptosis by as much as 17 mm. Complications were minimal. A review of the effectiveness of other orbital decompressive procedures is presented. It appears that the four-wall decompressive procedure offers the maximum degree of orbital reduction.
Intramedullary enterogenous cyst of the spinal cord
Authors: Kwok David M. F. , Jeffreys Richard V.
Published: May 2009

✓ The authors describe a case of intramedullary enterogenous cyst of the spinal cord, and review the clinical aspects of this entity together with the histological classification. Discussions on the embryogenesis and pathogenesis of this rare lesion are reviewed and summarized.
Postirradiation sarcomatous transformation of a pituitary adenoma: a combined pituitary tumor
Authors: Pieterse Steve , Dinning Trevor A. R. , Blumbergs Peter C.
Published: May 2009

✓ A case is reported in which a fibrosarcoma developed 20 years after irradiation of a pituitary chromophobe adenoma. This rare lesion, like most of the other documented postirradiation pituitary sarcomas, was a combination of fibrosarcoma and pituitary adenoma. These lesions tend to behave in a characteristic fashion, with onset after a long latent interval following irradiation, growth to a large size, and failure to metastasize.
Symptomatic Rathke's cleft cysts
Authors: Steinberg Gary K. , Koenig George H. , Golden James B.
Published: May 2009

✓ Two unusual cases of symptomatic Rathke's cleft cysts are described. The first patient was a 47-year-old man who presented with recurrent aseptic meningitis in addition to visual symptoms, panhypopituitarism, and hydrocephalus. The second patient was a 41-year-old man presenting with increasing headache, and a large, nonenhancing sellar cyst showing suprasellar extension on computerized tomography. The similarities between Rathke's cleft cysts and craniopharyngiomas are discussed.
Norepinephrine in cerebrospinal fluid of patients with cerebral vasospasm
Authors: Shigeno Taku
Published: May 2009

✓ The content of norepinephrine (NE) in the ventricular, basal cisternal, and lumbar cerebrospinal fluid (CSF) was determined in 19 patients with ruptured cerebral aneurysms at different intervals according to the presence or absence of vasospasm. Twelve were operated on within 3 days after subarachnoid hemorrhage (SAH), prior to the occurrence of vasospasm. Postoperatively, CSF was continuously drained from a basal cistern or lateral ventricle. Norepinephrine was assayed by the highly sensitive automated fluorometric method. The concentration of NE increased in all sites of CSF sampling along with the appearance of vasospasm. Above all, the cisternal CSF of patients with vasospasm contained significantly higher NE (0.246 ± 0.049 ng/ml, mean ± SEM) compared to those without vasospasm (0.075 ± 0.001 ng/ml) (p < 0.001). However, since this increase cannot be considered to be high enough locally to constrict cerebral arteries, this might be only a secondary phenomenon due to release of NE into CSF from various sources in the brain.