bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of bullet removal on subsequent pain in persons with spinal cord injury secondary to gunshot wound
Authors: Richards J. Scott , Stover Samuel L. , Jaworski Theresa
Published: May 2009

✓ The prevention or minimization of future pain is often cited as a reason for removal of the bullet from patients who have incurred a spinal cord injury secondary to a gunshot wound. In an attempt to examine this assumption, multimodal pain ratings were recorded for 14 patients with spinal cord injury due to a gunshot wound in whom the bullet was still present, 14 neurologically matched patients with spinal cord injury due to a gunshot wound in whom the bullet was removed, and 28 control patients with spinal cord injury unrelated to a gunshot wound who were neurologically matched to the first two groups. The results suggest that persons who sustain a spinal cord injury secondary to gunshot wounds report more pain than those injured in other ways. In addition, there was no indication that surgical removal of the bullet was helpful in reducing subsequent pain either early in the rehabilitation process or at 1 year postinjury. The location of the bullet and the type of pain that subsequently developed were not correlated with the initial decision to surgically remove the bullet. Implications for further study and clinical practice are discussed.
Constant infusion of morphine for intractable cancer pain using an implanted pump
Authors: Hassenbusch Samuel J. , Pillay Prem K. , Magdinec Michelle , Currie Kathleen , Bay Janet W. , Covington Edward C. , Tomaszewski Marian Z.
Published: May 2009

✓ In the past, pain control for chronic pain syndromes using narcotic infusion has been carried out primarily via the intrathecal (subarachnoid) route. This report presents one of the first large series of terminally ill cancer patients with intractable pain treated with continuous epidural morphine infusions by means of implanted pumps and epidural spinal catheters. The purpose of the study was to demonstrate that the epidural route is effective with minimal complications, and that screening with temporary epidural catheter infusions results in a high rate of subsequent pain relief. A multidisciplinary team (neurosurgeon, anesthesiologists, psychiatrists, oncologists, and nurse clinicians) evaluated and treated all of the patients studied. Percutaneous placement of temporary epidural catheters for a trial assessment was performed by the anesthesiologists. Pain evaluations were conducted independently by psychiatrists using both verbal and visual analog scales. From 1982 to 1988, 41 (59.4%) of 69 patients evaluated for eligibility experienced good pain control during trial assessment and were subsequently implanted with Infusaid infusion pumps. Preinfusion pain analog values were 8.6 ± 0.3 and postimplantation values at 1 month were 3.8 ± 0.4 (p < 0.001). Over this same 1-month period, requirements of systemic morphine equivalents decreased by 79.3% with epidural infusions as compared to preinfusion requirements (p < 0.001 ). There were no instances of epidural scarring, respiratory depression, epidural infections, meningitis, or catheter blockage. One patient developed apparent drug tolerance and three patients required further catheter manipulations. This series strongly suggests that significant reductions in cancer pain can be obtained with few complications and a low morphine tolerance rate using chronic epidural morphine infusion. Anesthesiology and psychiatry input, along with temporary catheter infusion screening and quantitative pain evaluations using analog scales, are essential.
Cauda equina syndrome of long-standing ankylosing spondylitis
Authors: Tullous Micam W. , Skerhut Holger E. I. , Story Jim L. , Brown Willis E. , Eidelberg Eduardo , Dadsetan Mohammad R. , Jinkins John R.
Published: May 2009

✓ Cauda equina syndrome as a neurological complication of long-standing ankylosing spondylitis was first reported in 1961. The syndrome is relatively uncommon and its pathophysiology is still poorly understood. Based on their experience with such a case, the authors review the clinical, electrographic, histological, and radiographic features of the syndrome, including the findings of magnetic resonance (MR) imaging. The addition of MR imaging to the evaluation of patients with ankylosing spondylitis and the cauda equina syndrome not only aids in the diagnosis of the syndrome but may also provide valuable insight into the pathophysiology of this condition.
Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm
Authors: Ausman James I. , Diaz Fernando G. , Mullan Sean , Gehring Randy , Sadasivan Balaji , Dujovny Manuel
Published: May 2009

✓ A case is presented in which a giant intracranial vertebral artery aneurysm gave rise to an associated ipsilateral posterior inferior cerebellar artery (PICA) from its waist. Proximal vertebral artery ligation at C-1 was achieved. The aneurysm filled from the opposite vertebrobasilar junction. Direct intracranial trapping of the right vertebral aneurysm was followed by successful anastomosis of the proximally sectioned right PICA to the adjacent left PICA in an end-to-end fashion.
Occipitocervical fusion for reduction of traumatic periodontoid hypertrophic cicatrix
Authors: Lansen Thomas A. , Kasoff Samuel S. , Tenner Michael S.
Published: May 2009

✓ Periodontoid hypertrophic cicatrix resulting from trauma, as demonstrated by magnetic resonance (MR) imaging, is essentially the same as that seen in rheumatoid arthritis. Recent reports suggest that, in rheumatoid arthritis, occipitocervical fusion without transoral decompression of the pannus is adequate for resolution of this anterior lesion. A case of traumatic periodontoid cicatrix is presented in which posterior fusion resulted in reduction of the anterior mass lesion, clearly demonstrated by MR imaging. The etiology of periodontoid hypertrophic scarring, both traumatic and rheumatoid, is discussed in light of MR findings, and treatment implications are considered.
Transsphenoidal approach to infrasellar tumors involving the cavernous sinus
Authors: Hashimoto Nobuo , Kikuchi Haruhiko
Published: May 2009

✓ The authors review their 2-year experience with a rhinoseptal transsphenoidal approach to skull-base tumors of various pathologies involving both the sphenoid and cavernous sinuses. Eight patients with cranial nerve palsies attributable to compression of the contents of the cavernous sinus and/or optic canal are included in this report. Among these patients, a total of 17 cranial nerves were affected. Postoperative normalization was achieved in eight nerves, significant improvement in seven nerves, and no improvement in two nerves. There were no operative complications of aggravation of cranial nerve palsies in this series. In spite of the limited operating field, the results demonstrate the effectiveness and safety of this approach. The authors recommend that this approach be considered before more aggressive surgery is undertaken.
Craniopharyngiomas in children
Authors: Fischer Edwin G. , Welch Keasley , Shillito John , Winston Ken R. , Tarbell Nancy J.
Published: May 2009

✓ Thirty-seven patients with craniopharyngioma were treated at Children's Hospital, Boston, between 1972 and 1981, the mean follow-up period now being 10.5 years. Twenty of these patients are old enough to have finished high school and have been queried about their college or job activity. None of the four patients who had undergone radical excision of their tumor and who had reached the age of finishing high school was able to work independently. Among the 16 patients who reached this age and who were treated by more conservative operations and irradiation or irradiation alone, job performance or college attendance varied considerably, indicating that psychosocial impairment occurred in this group, but suggesting that the risk was less. The rate of tumor recurrence or of failure to respond to treatment was 57% (four of a total of seven survivors) following radical surgery and 7% (two of 27 survivors) after conservative operations and irradiation. The overall mortality rate was 8%; the causes of the three deaths were: “hypothalamic crisis” 1 year after radical resection; progressive tumor growth despite two attempts at resection and irradiation; and a brain-stem glioma in the field of irradiation 8 years after treatment.
Treatment of spinal metastases from kidney cancer by presurgical embolization and resection
Authors: Sundaresan Narayan , Choi In Sup , Hughes James E. O. , Sachdev Ved Prakash , Berenstein Alex
Published: May 2009

✓ Surgical treatment of bone metastases from kidney cancer is often complicated by profuse blood loss. The authors report the results of a retrospective review of 30 consecutive patients who underwent surgery for spinal metastases from kidney cancer. Seventeen patients (57%) were operated on after failing radiation therapy. Prior to operation, selective spinal angiography and embolization were performed in 17 patients with no permanent neurological deficits resulting. Gross total resection of the tumor and stabilization of the spine were then accomplished with acceptable blood loss. Twenty-seven (90%) of the 30 patients improved neurologically following surgery. There was a median survival time of 16 months, a 2-year survival rate of 33%, and a 5-year survival rate of 15%. Major surgical complications in this series were related to excessive blood loss in patients without embolization. These data suggest that patients with spinal metastases from kidney cancer should undergo spinal angiography and embolization prior to resection of the tumor. To improve upon current results, such treatment should be carried out prior to external radiation therapy.
Cerebral venous malformations
Authors: Rigamonti Daniele , Spetzler Robert F. , Medina Marjorie , Rigamonti Karen , Geckle David S. , Pappas Conrad
Published: May 2009

✓ Although cerebral venous malformations have been reported to cause epilepsy, progressive neurological deficits, and hemorrhage, their clinical significance remains controversial. In an attempt to clarify the natural history of the lesion and suggest an appropriate management strategy, the authors review their experience with 30 patients. In four patients with cerebellar venous angioma, an acute episode of ataxia was documented. The coexistence of a cavernous malformation was pathologically confirmed in the two patients who underwent surgery for bleeding presumed caused by the venous angioma. Infarction was shown in two patients and a tumor in two others. Follow-up periods ranged between 18 and 104 months, with only five patients symptomatic at the time of this report. Rebleeding had not occurred, nor had acute episodes of neurological dysfunction been documented.

This clinical experience suggests that a venous malformation is frequently associated with other, more symptomatic conditions and is often erroneously identified as the source of the symptoms. Because the nature of the relationship between the venous malformation and the allied conditions remains ambiguous, it is recommended that patients harboring a “symptomatic” venous malformation undergo high-field magnetic resonance imaging to rule out underlying pathology, and that any such pathology be treated independently of the venous malformation.
A comparative study on ventriculographic and computerized tomography-guided determinations of brain targets in functional stereotaxis
Authors: Hariz Marwan I. , Bergenheim A. Tommy
Published: May 2009

✓ Thalamic, pallidal, and hypothalamic targets were determined in 16 patients by a stereotactic computerized tomography (CT) study using a noninvasive technique with Laitinen's Stereoadapter. At surgery, the Stereoadapter was remounted to the head and the stereotactic CT coordinates were transferred to the Stereoguide without radiography. Air ventriculography was then carried out. The positions of the anterior and posterior commissures (AC and PC), the length of the intercommissural (IC) line, the width of the third ventricle, and the stereotactic coordinates of the target were measured on the ventriculograms and compared to the stereotactic CT measurements. The study showed that the width of the third ventricle was significantly larger on the ventriculograms than on the stereotactic CT scans, whereas the length of the IC line was not significantly different. The differences in the coordinates of the target and of the AC and PC were statistically significant only for the anteroposterior (y) coordinate. Both commissures as well as the surgical target lay, on average, 1.0 mm more anteriorly on the ventriculograms than on the stereotactic CT study.

It is concluded that air ventriculography may cause slight anterior displacement of the midbrain structures. The surgical coordinates of the targets based on the stereotactic CT study with the Stereoadapter were on average as accurate as those obtained with ventriculography; therefore, ventriculography may become superfluous in functional stereotaxis.
Transcranial Doppler ultrasound studies of cerebral autoregulation and subarachnoid hemorrhage in the rabbit
Authors: Nelson Richard J. , Perry Sheila , Hames Tony K. , Pickard John D.
Published: May 2009

✓ The authors describe a method for Doppler ultrasound recording of flow velocity in the basilar artery of normal rabbits and rabbits with experimental subarachnoid hemorrhage (SAH). With this transcranial Doppler (TCD) model, clinical assumptions regarding flow velocity/cerebral blood flow (CBF) relationships, autoregulatory responses, and Doppler spectral waveform analysis can be tested under controlled conditions and compared with established methods of CBF measurement (hydrogen clearance).

The time course of changes in flow velocity following SAH (cerebral vasospasm) is successfully demonstrated using the experimental TCD method. There are significant differences in the flow velocity and CBF responses to hypercapnia, hypocapnia, and trimethaphan-induced hypotension which indicate that TCD cannot be considered a simple alternative to CBF measurement for the study of cerebrovascular reactivity and cerebral autoregulation.
Cavernous angiomas of the cranial nerves
Authors: Matias-Guiu Xavier , Alejo Maria , Sole Teresa , Ferrer Isidre , Noboa Roberto , Bartumeus Federico
Published: May 2009

✓ Two cavernous hemangiomas arising in the third and eighth cranial nerves, respectively, and presenting as space-occupying lesions are reported. The tumors posed problems in the preoperative differential diagnosis. The main clinicopathological features of these tumors are discussed.
Whipple's disease presenting with isolated neurological symptoms
Authors: Brown Adam P. , Lane Judy C. , Murayama Shigeo , Vollmer Dennis G.
Published: May 2009

✓ Whipple's disease is infrequently considered in the differential diagnosis of patients presenting with progressive neurological deterioration. This is in part a result of the relative rarity of this entity and in part due to the more frequent initial presentation of the disease with gastrointestinal, musculoskeletal, or cardiovascular symptoms. A case is described in which the neurological symptoms of progressive dementia and weakness were seen in the relative absence of non-neurological symptomatology. The diagnosis of Whipple's disease was made from a brain biopsy. The neuropathology of Whipple's disease of the central nervous system is described and the importance of considering it as a treatable entity in the differential diagnosis of progressive neurological deterioration, despite the absence of systemic symptomatology, is stressed.
Meningioma with hypergammaglobulinemia
Authors: Gi Hidefuku , Nagao Seiichi , Yoshizumi Hideyuki , Nishioka Tatsuya , Uno Junji , Shingu Tadashi , Fujita Yuzo
Published: May 2009

✓ The case of a 14-year-old boy presenting with hypergammaglobulinemia (immunoglobulin (Ig)G and IgA) and a cerebellopontine angle tumor is reported. The tumor was histologically confirmed as meningioma infiltrated with plasma cells, lymphocytes, and histiocytes. Immunohistochemical studies showed that the infiltrating plasma cells were stained by antibodies to IgG and IgA. After total tumor removal, the hypergammaglobulinemia immediately resolved. A plausible interpretation of this sequence of events is that the inflammatory cell reaction to the meningioma caused the immunological response followed by an unusual hypergammaglobulinemia.
A new intracranial Silastic encircling clip for hemostasis
Authors: Ishiwata Yusuke , Inomori Shigeo , Fujitsu Kazuhiko , Nishimura Satoshi , Hirata Kazuhiro , Gondo Gakuji , Yamashita Toshinori , Fujino Hideyo , Kuwabara Takeo
Published: May 2009

✓ A new encircling clip made of a silicone tube has been designed for treating accidentally injured cerebral vessels. No special holders are necessary. This clip can be tailored depending on the shape of the injured vessel. The clip is a simple and effective tool for achieving complete hemostasis.
A surgeon's risk of AIDS
Authors: Schiff Steven J.
Published: May 2009

✓ A probabilistic model is used to estimate the cumulative risk to surgeons from human immunodeficiency virus (HIV). Recent data suggest that the probability of infection following percutaneous inoculation is about 1 in 250 cases. Several studies suggest that the frequency of percutaneous injury in surgery is at least 1 in 40 cases, for some as high as 1 in 20 cases. Assuming that on the average a surgeon will perform 350 operations per year and will practice for 30 years, the cumulative risk of HIV infection will depend on the prevalence of HIV infection in the surgical population. For HIV prevalences of 1 in 100 to 1 in 10, the cumulative risk per surgeon ranges from 1 in 100 to 1 in 5, respectively. Based on these risk estimates, it is crucial to decrease the frequency of percutaneous injury. The case is made for substantial improvements in barrier protection and modification of surgical technique.
Neurobehavioral outcome 1 year after severe head injury
Authors: Levin Harvey S. , Gary Howard E. , Eisenberg Howard M. , Ruff Ronald M. , Barth Jeffrey T. , Kreutzer Jeffrey , High Walter M. , Portman Sandra , Foulkes Mary A. , Jane John A. , Marmarou Anthony , Marshall Lawrence F.
Published: May 2009

✓ The outcome 1 year after they had sustained a severe head injury was investigated in patients who were admitted to the neurosurgery service at one of four centers participating in the Traumatic Coma Data Bank (TCDB). Of 300 eligible survivors, the quality of recovery 1 year after injury was assessed by at least the Glasgow Outcome Scale (GOS) in 263 patients (87%), whereas complete neuropsychological assessment was performed in 127 (42%) of the eligible survivors. The capacity of the patients to undergo neuropsychological testing 1 year after injury was a criterion of recovery as reflected by a significant relationship to neurological indices of acute injury and the GOS score at the time of hospital discharge. The neurobehavioral data at 1 year after injury were generally comparable across the four samples of patients and characterized by impairment of memory and slowed information processing. In contrast, language and visuospatial ability recovered to within the normal range. The lowest postresuscitation Glasgow Coma Scale (GCS) score and pupillary reactivity were predictive of the 1-year GOS score and neuropsychological performance. The lowest GCS score was especially predictive of neuropsychological performance 1 year postinjury in patients who had at least one nonreactive pupil following resuscitation. Notwithstanding limitations related to the scope of the TCDB and attrition in follow-up material, the results indicate a characteristic pattern of neurobehavioral recovery from severe head injury and encourage the use of neurobehavioral outcome measurements in clinical trials to evaluate interventions for head-injured patients.
Monosomy 22 in rhabdoid or atypical tumors of the brain
Authors: Biegel Jaclyn A. , Rorke Lucy B. , Packer Roger J. , Emanuel Beverly S.
Published: May 2009

✓ Cytogenetic studies of three rare childhood brain tumors were performed. Two children presented with pure rhabdoid tumors. The third child had a tumor composed of a mixture of rhabdoid elements with neuroepithelial, epithelial, and mesenchymal tissue — an atypical teratoid tumor. All three tumors demonstrated monosomy 22 as the only cytogenetic abnormality. The cytogenetic findings suggest that loss of a gene or genes on chromosome 22 may be involved in the initiation or progression of these malignant tumors. Further studies on additional fresh tumor specimens are warranted; however, it is possible that cytogenetic studies may be used as an additional means of diagnosing rhabdoid or atypical teratoid tumors of the brain.
Use of CT and MR imaging to distinguish intracranial lesions and to define the need for biopsy in AIDS patients
Authors: Ciricillo Samuel F. , Rosenblum Mark L.
Published: May 2009

✓ To explore the potential usefulness of imaging studies in the diagnosis of focal central nervous system (CNS) lesions associated with acquired immunodeficiency syndrome (AIDS), the authors retrospectively examined the radiographic studies of 149 AIDS patients who presented with signs and symptoms of the three most common focal CNS lesions. Of these patients, 74 (50%) had Toxoplasma abscesses, 45 (30%) had primary CNS lymphoma, and 30 patients (20%) had progressive multifocal leukoencephalopathy (PML). Magnetic resonance (MR) imaging was more sensitive than computerized tomography (CT) in detecting lesions, especially in cases of PML. Whereas CT was unable to distinguish mass lesions caused by toxoplasmosis from those caused by lymphoma, 71% of the solitary lesions seen on MR images were lymphomas. These results indicate that empirical treatment for toxoplasmosis, the most common initial treatment for AIDS patients with neurological symptoms stemming from mass lesions, is not likely to be successful for patients with solitary lesions on MR images. Rather, early biopsy is advisable. If the presence of lymphoma is confirmed, the rapid initiation of treatment can allow prolonged high-quality survival.
Characteristics and biological role of steroid hormone receptors in neuroepithelial tumors
Authors: Paoletti Pietro , Butti Giorgio , Zibera Carlo , Scerrati Massimo , Gibelli Nadia , Roselli Romeo , Magrassi Lorenzo , Sica Gigliola , Rossi Gianfranco , della Cuna Gioacchino Robustelli
Published: May 2009

✓ Tissue samples from 57 patients with neuroepithelial tumors (25 glioblastomas, 18 anaplastic astrocytomas, and 14 astrocytomas) were analyzed in order to evaluate the presence of estrogen, progesterone, glucocorticoid, and androgen receptors. Glucocorticoid- and androgen-specific binding proteins were present in 38.6% and 21.6% of the cases, respectively. Only a few tumors showed estrogen or progesterone receptors. A correlation was found between grade of anaplasia, patient's sex and age, and presence of glucocorticoid and androgen receptors. The biological role of these two receptors was investigated in 10 primary cell cultures derived from neuroepithelial tumors. For this purpose, dexamethasone and testosterone were added to culture medium at different concentrations (from 50 to 0.016 µg/ml). A significant stimulation of the cell growth was observed in four of five glucocorticoid receptor-positive cultures when dexamethasone in doses ranging from 2 to 0.016 µg/ml was added to the culture. No modulation of the growth was observed in glucocorticoid receptor-negative cultures at the same doses. Higher dexamethasone doses induced a significant decrease of the growth index independently from the glucocorticoid receptor status. All of the cultures tested for testosterone activity were negative for androgen receptors. This hormone induced an inhibition of the growth index at doses ranging from 50 to 0.4 µg/ml. The data suggest that neuroepithelial tumors contain specific glucocorticoid and androgen binding proteins. Glucocorticoid receptors modulate the growth of cultured neuroepithelial tumors in the presence of different concentrations of dexamethasone.
Hormonal dependency of cerebral meningiomas
Authors: Adams Eric F. , Schrell Uwe M. H. , Fahlbusch Rudolf , Thierauf Paul
Published: May 2009

✓ Cell culture and biochemical techniques have been employed to examine the effects of steroids, bromocriptine, and epidermal growth factor (EGF) on the growth and proliferative potential of meningiomas. In cell culture, the growth of meningiomas was not altered by progestogens, antiprogestogens, or 17β-estradiol. The progestogen, norethisterone, had no effect on the uptake by meningioma cell cultures of 3H-thymidine. Furthermore, cytosolic deoxyribonucleic acid (DNA) polymerase activity of meningiomas did not correlate with the progesterone receptor status of the same tumors. In contrast, the androgen antagonists, cyproterone acetate and 11-α-hydroxyprogesterone, and the dopamine agonist, bromocriptine, all inhibited the in vitro growth of meningioma cells. The growth of meningioma cell cultures was stimulated by EGF, and there was a positive correlation between the EGF content and DNA polymerase activity in meningioma cytosols. These results demonstrate that female sex steroids do not influence growth of meningiomas in vitro, whereas antiandrogens and bromocriptine have an antiproliferative effect. Consequently, bromocriptine and antiandrogens may have a role in the medical treatment of meningiomas. In addition, these results suggest that EGF may be involved in the genesis and/or progression of meningiomas.
Intracarotid hydroxyethyl methacrylate solution causing stroke in dogs
Authors: Purdy Phillip , White Charles L. , Batjer Hunt , Brewer Kirk , Hodges Kurt , Samson Duke
Published: May 2009

✓ Hydroxyethyl methacrylate (HEMA) has been advocated as a polymerizing solution with which to prevent deflation of detachable balloons in interventional neuroradiology. It is pertinent to know if unpolymerized HEMA would have untoward effects if accidentally released into the carotid artery by balloon rupture or deflation. Seven mongrel dogs underwent transfemoral catheterization of the common carotid artery and subsequent injection of HEMA solution in volumes of 1 cc in five dogs, 2 cc in one, and 4 cc in one. Angiography performed at the time of injection revealed evidence of intravascular thrombosis as well as possible spasm. Three surviving animals were sacrificed at 48 hours; the brains were fixed and examined histopathologically. One brain was normal and one was autolyzed and could not be examined. Five of the seven animals had histopathologically documented cerebral infarctions of varying size. No foreign substance was seen within the blood vessels to suggest intravascular polymerization. The animals injected with 2 or 4 cc HEMA solution did not survive 48 hours. Literature review reveals little documentation of the toxicology of intravascular HEMA. With its increasing popularity as a compound for polymerization in detachable balloons introduced into the brain, further investigations are warranted to understand the physical properties of the compound and potential risks of its use.
Magnetic resonance imaging contrast agents: theory and application to the central nervous system
Authors: Bronen Richard A. , Sze Gordon
Published: May 2009

✓ The theoretical aspects of magnetic resonance (MR) imaging contrast agents are reviewed, and their current applications to the central nervous system (CNS) and their future applications are discussed. Profound differences exist between contrast agents used for MR imaging and computerized tomography (CT). In MR imaging, the contrast agents are not imaged directly but rather act on adjacent protons to shorten T1 and T2 relaxation times. This in turn results in signal intensity changes. The lanthanide metal, gadolinium, in the form of gadopentetate dimeglumine, has been found to be both safe and efficacious as the only currently approved contrast agent for MR imaging.

Magnetic resonance imaging revolutionized the detection and treatment of disease affecting the brain and spine. Initially, it was thought that signal characteristics on MR imaging would allow differentiation of specific pathology. It was soon found that MR studies were able to detect more abnormalities but were less able to characterize them. The recent development of contrast agents for MR imaging has allowed this modality to surpass CT for the evaluation of most CNS lesions.

At present, contrast-enhanced MR imaging is generally accepted as the study of choice for evaluating acoustic neurinomas, pituitary lesions, meningeal disease, primary and secondary brain tumors, active multiple sclerosis, intradural spinal neoplasms, intramedullary spinal disease, and postoperative states in both the spine and brain. Even when contrast-enhanced CT can detect the same abnormalities, evaluation of the lesions in multiple planes on MR imaging can sometimes yield invaluable information, especially prior to surgery. Future developments of contrast material for MR imaging include non-gadolinium compounds, intrathecal contrast media, cerebral blood flow and volume evaluation, and, possibly, antibody-labeled contrast agents.
Clinoidal meningiomas
Authors: Al-Mefty Ossama
Published: May 2009

✓ Anterior clinoidal meningiomas are frequently grouped with suprasellar or sphenoid ridge meningiomas, masking their notorious association with a high mortality and morbidity rate, failure of total removal, and recurrence. To avoid injury to encased cerebral vessels, most surgeons are content with subtotal removal. Without total removal, however, recurrence is expected. Recent advances in cranial-base exposure and cavernous sinus surgery have facilitated radical total removal.

The author reports 24 cases operated on with vigorous attempts at total removal of the tumor with involved dura and bone. This experience has distinguished three groups (I, II, and III) which influence surgical difficulties, the success of total removal, and outcome. These subgroups relate to the presence of interfacing arachnoid membranes between the tumor and cerebral vessels. The presence or absence of arachnoid membranes depends on the origin of the tumor and its relation to the naked segment of carotid artery lying outside the carotid cistern. Total removal was impossible in the three patients in Group I, with postoperative death occurring in one patient and hemiplegia in another. Total removal was achieved in 18 of the 19 patients in Group II, with one death from pulmonary embolism. In the two patients in Group III, total removal without complications was easily achieved.
Unruptured intracranial aneurysms and arteriovenous malformations: frequency of intracranial hemorrhage and relationship of lesions
Authors: Brown Robert D. , Wiebers David O. , Forbes Glenn S.
Published: May 2009

✓ Among 91 patients with unruptured intracranial arteriovenous malformations (AVM's), 16 patients had 26 unruptured intracranial saccular aneurysms. An actuarial analysis showed the risk of intracranial hemorrhage among patients with coexisting aneurysm and AVM to be 7% per year at 5 years following diagnosis compared to 1.7% for patients with AVM alone. The difference in length of survival free of hemorrhage was significant (log-rank, p < 0.0007). Several angiographic and clinical parameters were investigated to better understand the relationship of these lesions. The aneurysms occurred in similar percentages in patients with small, medium, and large AVM's. Twenty-five aneurysms were on arteries feeding the malformation system, almost equally distributed proximally and distally. Eleven aneurysms were atypical in location, and all arose from primary or secondary branch feeders to the malformation; 24 were on enlarged feeding arteries. Eleven (16%) of the 67 patients with high-flow AVM's had associated aneurysms, compared with five (21%) of the 24 patients with low-flow AVM's. Four (16%) of 25 low-shunt malformations and 12 (18%) of 65 high-shunt malformations had associated aneurysms. All five aneurysms associated with low-shunt malformations were on a direct arterial feeder of the malformation. These data suggest that the intracranial AVM's predispose to aneurysm formation within AVM feeding systems and that the mechanism is not simply based upon the high blood flow or high arteriovenous shunt in these systems.
Motility factor produced by malignant glioma cells: role in tumor invasion
Authors: Ohnishi Takanori , Arita Norio , Hayakawa Toru , Izumoto Shuichi , Taki Takuyu , Yamamoto Hiroshi
Published: May 2009

✓ To better understand the cellular mechanism of tumor invasion, the production of a cell motility-stimulating factor by malignant glioma cells was studied in vitro. Serum-free conditioned media from cultures of rat C6 and human T98G cell lines contained a factor that stimulated the locomotion of the producer cells. This factor was termed the “glioma-derived motility factor.” The glioma-derived motility factor is a heat-labile protein with a molecular weight greater than 10 kD and has relative stability to acid. The factor showed not only chemotactic activity but also chemokinetic (stimulated random locomotion) activity in the two types of glioma cells studied. Although glioma-derived motility factors in conditioned media obtained from two different cell origins are likely to be the same, chemokinetic migration of T98G cells to their conditioned medium was much stronger than that of C6 cells to theirs.

Coincubation of cells with cytochalasin B, which disrupts the assembly of cellular actin microfilaments, almost completely inhibited the cell migration stimulated by glioma-derived motility factor. Cytochalasin B also induced marked alterations in cell morphology, including cell retraction and arborization, while the drug did not affect cell attachment to culture dishes. These results indicate that glioma cells produce a motility factor which may play a role particularly when tumor cells are detached and migrate away from the original tumor mass, thus promoting tumor invasion. Also, glioma cell migration stimulated by the motility factor requires the normal organization of cytoskeletons such as actin microfilaments.
Massive increases in extracellular potassium and the indiscriminate release of glutamate following concussive brain injury
Authors: Katayama Yoichi , Becker Donald P. , Tamura Toru , Hovda David A.
Published: May 2009

✓ An increase in extracellular K+ concentration ([K+]e) of the rat hippocampus following fluid-percussion concussive brain injury was demonstrated with microdialysis. The role of neuronal discharge was examined with in situ administration of 0.1 mM tetrodotoxin, a potent depressant of neuronal discharges, and of 0.5 to 20 mM cobalt, a blocker of Ca++ channels. While a small short-lasting [K+]e increase (1.40- to 2.15-fold) was observed after a mild insult, a more pronounced longer-lasting increase (4.28- to 5.90-fold) was induced without overt morphological damage as the severity of injury rose above a certain threshold (unconscious for 200 to 250 seconds). The small short-lasting increase was reduced with prior administration of tetrodotoxin but not with cobalt, indicating that neuronal discharges are the source of this increase. In contrast, the larger longer-lasting increase was resistant to tetrodotoxin and partially dependent on Ca++, suggesting that neurotransmitter release is involved. In order to test the hypothesis that the release of the excitatory amino acid neurotransmitter glutamate mediates this increase in [K+]e, the extracellular concentration of glutamate ([Glu]e) was measured along with [K+]e. The results indicate that a relatively specific increase in [Glu]e (as compared with other amino acids) was induced concomitantly with the increase in [K+]e. Furthermore, the in situ administration of 1 to 25 mM kynurenic acid, an excitatory amino acid antagonist, effectively attenuated the increase in [K+]e. A dose-response curve suggested that a maximum effect of kynurenic acid is obtained at a concentration that substantially blocks all receptor subtypes of excitatory amino acids. These data suggest that concussive brain injury causes a massive K+ flux which is likely to be related to an indiscriminate release of excitatory amino acids occurring immediately after brain injury.
Cerebrovascular and metabolic effects on the rat brain of focal Nd:YAG laser irradiation
Authors: Kiessling Marika , Herchenhan Eberhard , Eggert Hans R.
Published: May 2009

✓ To investigate the effects of focal neodymium:yttrium-aluminum-garnet (Nd:YAG) laser irradiation (λ = 1060 nm) on regional cerebral blood flow, cerebral protein synthesis, and blood-brain barrier permeability, the parietal brain surface of 44 rats was irradiated with a focused laser beam at a constant output energy of 30 J. Survival times ranged from 5 minutes to 48 hours. Laser irradiation immediately caused well-defined cortical coagulation necrosis. Within 5 minutes after unilateral irradiation, 14C-iodoantipyrine autoradiographs demonstrated severely reduced blood flow to the irradiation site and perilesional neocortex, but a distinct reactive hyperemia in all other areas of the forebrain. Apart from a persistent ischemic focus in the vicinity of the cortical coagulation necrosis, blood flow alterations in remote areas of the brain subsided within 3 hours after irradiation. Autoradiographic assessment of 3H-tyrosine incorporation into brain proteins revealed rapid onset and prolonged duration of protein synthesis inhibition in perifocal morphologically intact cortical and subcortical structures. Impairment of amino acid incorporation proved to be completely reversible within 48 hours. Immunoautoradiographic visualization of extravasated plasma proteins using 3H-labeled rabbit anti-rat immunoglobulins showed that, up to 1 hour after irradiation, immunoreactive proteins were confined to the neocortex at the irradiation site. At 4 hours, vasogenic edema was present in the vicinity of the irradiation site and the subcortical white matter, and, at later stages (16 to 36 hours), also extended into the contralateral hemisphere. Although this was followed by a gradual decrease in labeling intensity, resolution of edema was still not complete after 48 hours.

Analysis of sequential functional changes in conjunction with morphological alterations indicates that the evolution of morphological damage after laser irradiation does not correlate with the time course and spatial distribution of protein synthesis inhibition or vasogenic edema. Although the central coagulation necrosis represents a direct effect of radiation, the final size of the laser-induced lesion is determined by a delayed colliquation necrosis due to persistent perifocal ischemia. Extent and severity of ischemia in a zone with initial preservation of neuroglial cells can be explained by the optical properties of the Nd:YAG laser; extensive scattering of light within brain parenchyma associated with a high blood-to-brain absorption ratio selectively affects blood vessels outside the irradiation focus.
Cerebral venous oxygen content as a measure of brain energy metabolism with increased intracranial pressure and hyperventilation
Authors: Sutton Leslie N. , McLaughlin Alan C. , Dante Stephen , Kotapka Mark , Sinwell Teresa , Mills Elizabeth
Published: May 2009

✓ In order to test the hypothesis that the cerebral arteriovenous oxygen difference (AVDO2) and venous oxygen content (VO2) could be used to monitor brain energy metabolism in the setting of increased intracranial pressure (ICP), 12 cats were studied with 31P-magnetic resonance spectroscopy. Six cats were subjected to intracranial hypertension by cisternal infusion of saline. Energy failure occurred at an average AVDO2 of 8.4 ± 3.2 vol% (± standard deviation) (range 4.7 to 14.7 vol%). The VO2 at the point of metabolic failure averaged 1.45 ± 0.6 vol% and extended over a narrower range (1.0 to 2.9 vol%). In an additional six cats, ICP was raised to the threshold of metabolic failure and hyperventilation was then instituted (pCO2 10 to 18 torr). Five of the six cats experienced a drop in VO2 with hyperventilation. In two of these animals, hyperventilation resulted in a VO2 of 1.1 vol% or less and in metabolic failure as evidenced by a fall in phosphocreatine. It is concluded that a VO2 of less than 2 vol% is correlated with brain ischemia and that the safety of hyperventilation in the setting of increased ICP can be monitored by the use of VO2.
Recurrence of acoustic neurilemoma as a malignant spindle-cell neoplasm
Authors: McLean Catriona A. , Laidlaw John D. , Brownbill David S. B. , Gonzales Michael F.
Published: May 2009

✓ A 75-year-old man presented with a right cerebellopontine angle tumor 11 months after complete macroscopic resection of a right acoustic neurilemoma. Histological examination of the recurrent tumor showed a malignant spindle-cell neoplasm with positive staining for S-100 protein. The patient had no stigmata of von Recklinghausen's disease. It is proposed that this recurrence represents progression from a benign to a malignant acoustic nerve-sheath tumor, an event that is extremely rare outside the clinicopathological context of neurofibromatosis.
Angiographic demonstration of acute phase of intracranial arterial spasm following aneurysm rupture
Authors: Taneda Mamoru , Otsuki Hideo , Kumura Eiji , Sakaguchi Tateo
Published: May 2009

✓ A case documenting the acute phase of intracranial arterial spasm following rupture of an aneurysm arising from the left internal carotid artery is reported. The patient deteriorated due to recurrent hemorrhage while undergoing angiography 12 hours after the initial aneurysm rupture. The acute deterioration was accompanied by dilatation of the ipsilateral pupil and occurred during injection of contrast material. There was delayed filling of the middle cerebral artery complex along with this narrowing. The arterial narrowing was confirmed to have completely disappeared on an angiographic series performed 14 minutes after the first series of films. The etiology of the acute vasospasm is discussed.
Subarachnoid hemorrhage caused by a fungal aneurysm of the vertebral artery as a complication of intracranial aneurysm clipping
Authors: Piotrowski Wolfgang Peter , Pilz Peter , Chuang I-Hsing
Published: May 2009

✓ Intracranial aneurysms are an uncommon manifestation of fungal infection. A case is described in which the formation of an aneurysm followed an intracranial intraoperative Aspergillus infection attributable to a long period of preoperative antibiotic medication and immunosuppressive therapy with steroids.
New technique of side-to-end hypoglossal—facial nerve attachment with translocation of the infratemporal facial nerve
Authors: Darrouzet Vincent , Guerin Jean , Bébéar Jean-Pierre
Published: May 2009

Object. The goal of this study was to assess the clinical results of hypoglossal-facial nerve attachment (HFA), which was primarily performed in patients following excision of tumors of the cerebellopontine angle. In six of the patients a new side-to-end procedure was used.

Methods. The authors have performed a retrospective study of 33 patients who underwent HFA, including 24 classic end-to-end, three May, and six side-to-end procedures. For the latter procedure, a hemihypoglossal—facial nerve attachment was performed by rerouting the intratemporal facial nerve; this avoided the jump-cable graft used in May's technique. The goal of the new procedure is to reduce the incidence of morbidity due to hemilingual paralysis (difficulty in chewing, speaking, and swallowing). The incidence of hemilingual paralysis was evaluated based on the findings of a questionnaire that was completed by the patients. The patient's facial mobility was assessed using the House and Brackmann grading system and the author's analytic scoring system.

Conclusions. The HFA offers good functional results. Of the 28 cases evaluated, nine had House and Brackmann Grade III, 17 Grade IV, and only two Grade V at 18 months. When the new technique of side-to-end hemihypoglossal—facial nerve attachment was used, there was considerable reduction, if not complete disappearance, of lingual morbidity and the facial functional results were constant and satisfactory: there were five patients with House and Brackmann Grade III and one with Grade IV, and their mean percentage of facial mobility was 43.3%.
Resumption of work after aneurysmal subarachnoid hemorrhage in middle-aged Japanese patients
Authors: Nishino Akiko , Sakurai Yoshiharu , Tsuji Ichiro , Arai Hiroaki , Uenohara Hiroshi , Suzuki Shinsuke , Li Jing-Hua
Published: May 2009

Object. Previous reports on the results of treatment for aneurysmal subarachnoid hemorrhage (SAH) have been based only on activities of daily living after discharge, whereas resumption of work has received insufficient attention. Most Japanese work under a lifetime employment system, and it is best for those who have recovered from SAH to return to work for their previous employer. The present study was conducted to determine the extent to which discharged patients who have suffered an SAH resume their former occupations in Japan, focusing on those between 40 and 49 years of age, who usually have a strong desire to return to work.

Methods. The participants consisted of 193 patients with SAH. Based on the results of telephone interviews or written questionnaires, their work status at 1 year after onset was analyzed.

The work resumption rates for patients with Hunt and Kosnik neurological Grades 1 or 2 on admission were higher than for those with Grades 3 or 4 (p = 0.015) and lower for patients with basilar artery aneurysms than for those with aneurysms at other sites (p = 0.028). With regard to premorbid occupation, the work resumption rates were high (80%) for professionals and engineers, many of whom were public servants, or teachers at junior or senior high schools. The resumption rates were also high for primary industry workers (80%), but lowest (20%) for professional drivers (p = 0.04–0.001). The work resumption rate was lower for women than for men (p = 0.01).

Conclusions. These findings indicate that resumption of work is determined not only by medical factors, but also by social factors including gender, type of occupation, employment system, and socioeconomic background.
Magnetoencephalographic mapping of the language-specific cortex
Authors: Papanicolaou Andrew C. , Simos Panagiotis G. , Breier Joshua I. , Zouridakis George , Willmore L. James , Wheless James W. , Constantinou Jules E. C. , Maggio William W. , Gormley William B.
Published: May 2009

Object. In this paper the authors introduce a novel use of magnetoencephalography (MEG) for noninvasive mapping of language-specific cortex in individual patients and in healthy volunteers.

Methods. The authors describe a series of six experiments in which normative MEG data were collected and the reliability, validity, and topographical accuracy of the data were assessed in patients who had also undergone the Wada procedure or language mapping through intraoperative cortical stimulation.

Conclusions. Findings include: 1) receptive language—specific areas can be reliably activated by simple language tasks and this activation can be readily recorded in short MEG sessions; 2) MEG-derived maps of each individual are reliable because they remain stable over time and are independent of whether auditory or visual stimuli are used to activate the brain; and 3) these maps are also valid because they concur with results of the Wada procedure in assessing hemispheric dominance for language and with the results of cortical stimulation in identifying the precise topography of receptive language regions within the dominant hemisphere.

Although the MEG mapping technique should be further refined, it has been shown to be efficacious by correctly identifying the language-dominant hemisphere and specific language-related regions within this hemisphere. Further development of the technique may render it a valuable adjunct for routine presurgical planning in many patients who harbor tumors or have epilepsy.