bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapy of an experimental glioma with systemic or intraneoplastic methotrexate or radiation
Authors: Tator Charles H. , Wassenaar Willem , Day Anna , So Wei Sum
Published: May 2009

✓ An intracranial mouse glioma model was used to study the effectiveness of chemotherapy with methotrexate (MTX) or radiotherapy. Maximum tolerable doses of MTX were established by toxicity studies in nontumor-bearing mice for the intraperitoneal and intracerebral routes of drug administration with and without leucovorin as an antidote. These maximum tolerable doses were then given either by the intraperitoneal route or directly into the tumor to mice bearing intracerebral tumors. The glioma model proved to be extremely useful for assessing the modalities studied, including repeated intraneoplastic injection of MTX. Dosage schedules were successfully developed for administering large amounts of MTX and for preventing systemic toxicity by the administration of the antidote. Radiotherapy in single doses of 800 rads delayed the median day of death and produced several long-term survivors. Higher doses were toxic. Intraperitoneal or intraneoplastic MTX was completely ineffective as a chemotherapeutic agent for this tumor, even though very large amounts could be delivered due to the protection from systemic toxicity afforded by leucovorin. It is concluded that MTX is a poor chemotherapeutic agent for this experimental brain tumor, but that the technique of intraneoplastic administration of chemotherapeutic agents is feasible with this model system and should be studied further.
Measurement of CBF and carotid artery pressure compared with cerebral angiography in assessing collateral blood supply after carotid ligation
Authors: Jawad Khalil , Miller J. Douglas , Wyper David J. , Rowan John O.
Published: May 2009

✓ Angiographic assessment of collateral circulation to the brain at the circle of Willis was compared with measurements of cerebral blood flow (CBF) and internal carotid artery pressure during temporary carotid clamping in the prediction of tolerance of unilateral carotid ligation as treatment for intracranial carotid aneurysms in 92 patients. From CBF studies it was predicted that a substantial number of patients (27%) would suffer severe cerebral ischemia if carotid ligation were carried out. No single angiographic feature provided this predictive information. Bilateral fetal type of posterior communicating arteries were associated with significantly lower carotid artery back pressure on temporary carotid occlusion, and unilateral absence of posterior communicating arteries was related to lower CBF, but neither feature was associated with a significant reduction in the rate of successful carotid ligation. We believe that preliminary percutaneous digital carotid compression with electroencephalographic monitoring, followed by intraoperative measurement of the change in regional CBF and internal carotid artery pressure during temporary carotid clamping provides a safe method of selecting patients for carotid ligation. Carotid angiography with or without contralateral carotid compression is of little value in this respect.
The mechanism of spinal cord cavitation following spinal cord transection
Authors: Kao Chun C. , Chang Louis W.
Published: May 2009

✓ Transection of a spinal cord is followed by massive accumulation of lysosomes and release of lysosomal hydrolases within both the rostral and the caudal spinal cord stumps. The lysosomal activity begins at 3 hours after cord transection, maintains its peak for 3 to 7 days, and declines at 14 days after transection. The process is associated with autolysis of the cord stumps and subsequent cavitation. Lysosomal accumulation is greatly diminished, and, paradoxically, superior wound healing is the result at the stumps of a 5-mm segment of isolated spinal cord produced by double cord transection.
A physiological sealant for cerebrospinal fluid leaks
Authors: Silverberg Gerald D. , Harbury Christina B. , Rubenstein Edward
Published: May 2009

✓ A combination of concentrated platelets, thrombin, and fibrinogen was used to adhere a pericranial graft to surgically produced cerebrospinal fluid (CSF) fistulas in dogs. This sealant successfully stopped leakage of CSF in all fistulas produced in both acute and chronic preparations. All control animals leaked CSF acutely. In chronic control animals the CSF leaks sealed spontaneously but the grafts were not well incorporated. Histological examination of the grafts and underlying brain showed no injury to the brain or meningeal vessel from exposure to the platelet glue. Good fibrous union of the grafts to the dura was confirmed.
Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage
Authors: Tabaddor Kamran , Shulman Kenneth
Published: May 2009

✓ A simple method of bedside twist-drill craniostomy and closed-system drainage for evacuation of chronic and subacute subdural hematoma is introduced. The principles and theoretical considerations that form the basis for this technique are discussed. The technique was used in 21 patients with chronic or subacute subdural hematoma; it has produced results superior to those of the conventional methods used in our patient population. Possible mechanisms responsible for the better results with the simple twist-drill closed-system drainage are described.
Effect of positive end expiratory pressure ventilation on intracranial pressure in man
Authors: Apuzzo Michael L. J. , Weiss Martin H. , Petersons Viesturs , Small R. Baldwin , Kurze Theodore , Heiden James S.
Published: May 2009

✓ This study was designed to define the effect of positive end expiratory pressure (PEEP) ventilation on intracranial pressure (ICP). In 25 patients with severe head trauma with and without associated pulmonary injury the following parameters were simultaneously monitored under mechanical ventilation with and without PEEP: ICP, arterial blood pressure, central venous pressure, arterial blood gases, and cardiac rate. In addition, the volume-pressure response (VPR) was evaluated in each patient to assess cerebral elastance. The results indicate a significant increase in ICP with the application of PEEP only in the 12 patients who manifested increased cerebral elastance by VPR. Half of this latter group manifested impairment of cerebral perfusion pressure to levels less than 60 mm Hg. Return to baseline ICP levels was observed with termination of PEEP. No significantly consistent changes in other parameters were noted.
Calcified cervical intervertebral discs in children
Authors: Smith Richard A. , Vohman M. Darius , Dimon Joseph H. , Averett James E. , Milsap James H.
Published: May 2009

✓ Calcified cervical intervertebral discs in children are manifestations of an uncommon, distinct disease of unknown cause. Acute symptoms are usually followed by a benign course of spontaneous recovery, frequently culminating in resorption of the calcium. Rarely herniation of the disc may cause neurological complications. Two cases are presented as examples of the typical syndrome. A third case was operated on because of herniation with radiculopathy; the clinical, radiographic, and pathological findings are reported in detail.
Occipital mesenchymal tumors of infancy
Authors: Hockley Anthony D. , Hoffman Harold J. , Hendrick E. Bruce
Published: May 2009

✓ Mesenchymal tumors arising from the dura in three newborn babies are described, with discussion of their clinical and pathological significance.
Cortical vein thrombosis in Wegener's granulomatosis
Authors: Mickle J. Parker , McLennan James E. , Chi Je G. , Lidden Craig W.
Published: May 2009

✓ A patient with Wegener's granulomatosis is reported in whom a life-threatening cortical vein thrombosis was identified as the process causing acute neurological deterioration. The literature dealing with the neurological and neuropathological manifestations in Wegener's granulomatosis is reviewed.
Entrapment of median nerve by supracondylar process of the humerus
Authors: Laha Ranjit K. , Dujovny Manuel , DeCastro Samuel C.
Published: May 2009

✓ The supracondylar process of the humerus has been described by anatomists and anthropologists in man and lower animals. Infrequently this process may cause compression of the median nerve. We are presenting such a case along with a brief review of the literature. Excision of the bone process led to immediate disappearance of symptoms.
Demonstration of massive traumatic brain swelling within 20 minutes after injury
Authors: Kobrine Arthur I. , Timmins Eugene , Rajjoub Rodwan K. , Rizzoli Hugo V. , Davis David O.
Published: May 2009

✓ The authors documented by computerized axial tomography a case of massive brain swelling occurring within 20 minutes of a closed head injury. It is suggested that the cause of the brain swelling is acute vascular dilatation.
Wave-form characteristics and spatial distribution of evoked spinal electrogram in man
Authors: Shimoji Koki , Matsuki Michiko , Shimizu Hiroyuki
Published: May 2009

✓ The evoked spinal electrogram (SEG) in man was recorded from the epidural space, applying the technique of continuous epidural block, and compared with cord dorsum potential (CDP) in wakeful rabbits. Wave-form characteristics of the evoked SEG's activated by the segmental nerves were almost the same in both cervical and lumbar regions. Somatosensory evoked response from the scalp was clearly demonstrated by stimulation of both the tibial nerve and fifth toe skin, whereas the evoked SEG was produced only by stimulation of the former. This finding might indicate that large nerve fibers are more responsible for producing the evoked SEG. Central latencies to the peaks of the second components of the P2 wave were 29 to 33 and 42 to 48 msec, in cervical and lumbar enlargements, respectively. This probably indicates the presence of a long feedback loop producing the second components. The amplitude of the N1 wave showed a steeper decline along the spinal cord than that of the P2 deflection, indicating the different origins of these two components. Polarity of both the N1 and P2 waves became reversed when the recording electrode was situated in the anterior epidural space. The wave-form characteristics of the evoked SEG in man were very similar to those of the CDP in wakeful rabbits.
Immunoproteins in human brain tumor cyst fluids
Authors: Murray Kenneth J. , Ausman James I. , Chou Shelley N. , Douglas Steven D.
Published: May 2009

✓ Quantitation of the concentration of immunoproteins in serum, and cystic fluids from six patients (three with cerebral astrocytoma and three with cerebellar hemangioblastoma) has been determined. The values for total protein, albumin, immunoproteins IgG, IgA, and IgM, and C3c (complement) in cyst fluid more closely correspond to serum than to cerebrospinal fluid values. Values for cyst fluid, cerebrospinal fluid, and serum were determined using albumin ratios in order to compare relative differences between fluids from these three compartments. Our data suggest that: 1) the major protein content of brain tumor cyst fluid is consequential to a transudative process from serum, and 2) that immunoglobulins IgG and IgA are present in higher concentrations in human brain tumor cyst fluids in comparison to IgM concentrations. These studies further question the concept of the brain as an “immunologically privileged site,” and may be of direct relevance to the investigation of the use of immunotherapeutic modalities as an adjunct after surgical tumor removal.
Chemotherapeutic trials on human malignant astrocytomas in organ culture
Authors: Saez Ruben J. , Campbell R. Jean , Laws Edward R.
Published: May 2009

✓ A technique of organ culture based on a three-dimensional porous matrix was employed for chemotherapeutic trials on human malignant astrocytomas. This method allows neoplasms to retain the morphological identity and the histological characteristics they possess in vivo. Success in culture was greatest with high-grade astrocytomas, the majority of which showed definite infiltration of the matrix. Lowgrade tumors, if viable, did not display active penetration. Drug trials on eight malignant astrocytomas included BCNU, methyl CCNU, VP 16–213, and Solu-Medrol. Cyanide and luciferase were used as experimental metabolic toxins. Evidence of cytotoxicity was assessed qualitatively by histological changes on microscopic preparations of treated and control cultures. Microfluorometric determinations of reduced nicotinamide adenine dinucleotide (NADH) were applied to these trials in an effort to detect a quantitative biochemical index of drug effects. A variable rise in mean NADH levels above controls was recorded from the majority of treated cultures although correlation with microscopic changes was inconsistent. Because of its potential merits, organ culture may be a valuable tool for further work on pharmacological management of malignant gliomas.
Ethanol potentiation of central nervous system trauma
Authors: Flamm Eugene S. , Demopoulos Harry B. , Seligman Myron L. , Tomasula John J. , DeCrescito Vincent , Ransohoff Joseph
Published: May 2009

✓ Two models have been used to study the effects of ethanol on injuries of the central nervous system. The spinal cords of cats were injured by delivering a 200 gm-cm impact to the exposed dura mater. A second group of animals received a similar injury to the exposed dura mater overlying the cerebral hemispheres. The animals were divided into two groups, those that received an infusion of ethanol before injury, and control animals that received no ethanol. The parameters of injury used in this model produced small and insignificant lesions in those animals that received no ethanol; however, when the animals were pretreated with ethanol, a considerable increase in the extent of the injury was noted. The mechanisms by which this potentiation is produced are briefly discussed. These include alterations in membrane-bound enzymes and clotting mechanisms, and alteration of cell membranes through abnormal free radical reactions.
The effect of alpha adrenergic blockade on spinal cord autoregulation in the monkey
Authors: Kobrine Arthur I. , Evans Delbert E. , Rizzoli Hugo V.
Published: May 2009

✓ Spinal cord blood flow (SCBF) was measured over a wide range of artificially varied mean systemic arterial blood pressures (MAP) in a group of monkeys with alpha adrenergic receptors blocked by the intravenous administration of phenoxybenzamine (Dibenzyline). The SCBF was found to vary linearly with changes in MAP. Autoregulation appeared to have been abolished. These data are cited as evidence for a dominant role of the sympathetic nervous system in control of the spinal circulation.
Norepinephrine levels in experimental spinal cord trauma
Authors: Rawe Stephen E. , Roth Robert H. , Boadle-Biber Margaret , Collins William F.
Published: May 2009

✓ Levels of norepinephrine (NE) in the spinal cord tissue of nontraumatized cats are highest in the cervical and lumbar enlargements. A rather uniform but slightly increasing concentration gradient from cephalad to caudad is observed in the thoracic segments. A 500 gm-cm trauma at the T-5 or C-7 spinal cord segment did not demonstrate any significant increase in NE levels measured sequentially over a 4-hour period after trauma. Dopamine levels could not be detected in the nontraumatized or traumatized cat spinal cords. Four traumatized cats treated with alpha methyl tyrosine, a tyrosine hydroxylase inhibitor, and followed clinically for 5 months showed no improvement in neurological function when compared to untreated traumatized cats. This study does not support the norepinephrine hypothesis of experimental spinal cord trauma.
Norepinephrine levels in experimental spinal cord trauma
Authors: Rawe Stephen E. , Roth Robert H. , Collins William F.
Published: May 2009

✓ Alpha methyl tyrosine (AMT) or reserpine administered intravenously 24 hours before sacrifice in the nontraumatized cat resulted in significant reduction in tissue levels of norepinephrine (NE) tested at the T-5 spinal cord level. Phenoxybenzamine given 2 hours before sacrifice did not alter NE levels at T-5. Histological sections of spinal cord examined 1 hour after a 500 gm-cm trauma at the T-5 level in cats, pretreated 24 hours before trauma by a single dose of AMT or reserpine, demonstrated no reduction of gray or white matter hemorrhages when compared to controls. In cats pretreated with phenoxybenzamine 2 hours before trauma there was a marked reduction of hemorrhages at 1 hour posttrauma when compared to controls. The animals treated with phenoxybenzamine had a 32% reduction of systemic blood pressure before trauma, demonstrated no pressor response to spinal cord trauma, and were severely hypotensive posttrauma. It is concluded that posttraumatic blood pressure has greater etiological significance in the pathogenesis of experimental spinal cord hemorrhages than tissue levels of NE.
Posterior compartment syndrome of the thigh with a sciatic palsy
Authors: Zimmerman J. Eric , Afshar Farhad , Friedman William , Miller Carole A.
Published: May 2009

✓ The authors describe a posterior compartment syndrome of the thigh and sciatic nerve palsy following a traumatic hematoma, and discuss its treatment.
Carotid-cavernous sinus fistula caused by rupture of a primitive trigeminal artery aneurysm
Authors: Enomoto Takao , Sato Akira , Maki Yutaka
Published: May 2009

✓ A case is reported in which an aneurysm arising at the junction of the right internal carotid artery and a persistent primitive trigeminal artery ruptured to form a carotid-cavernous fistula. The internal carotid artery was ligated without any signs of brainstem ischemia due to inverted blood flow through the primitive trigeminal artery.
Traumatic false aneurysm of the superior cerebellar artery simulating posterior fossa tumor
Authors: Cockrill H. Howard , Jimenez John P. , Goree John A.
Published: May 2009

✓ An example of traumatic false aneurysm of the right superior cerebellar artery is described. The chronicity of the clinical picture and a positive brain scan strongly suggested a posterior fossa neoplasm; however, the angiographic findings permitted a specific diagnosis to be made.
Malignant hyperthermia
Authors: Rush Jeffery L. , Foltz Eldon L.
Published: May 2009

✓ The authors report the case of an infant with noncommunicating hydrocephalus, Arnold-Chiari malformation, and a lumbar myelomeningocele, in whom malignant hyperthermia occurred. The genetics and presumed etiology of this unusual problem are reviewed. The management is directed toward establishing effective cooling measures, reversing tissue hypoxia, and correcting respiratory and metabolic acidosis.
Pantopaque pulmonary embolism during myelography
Authors: Kwan Wong Wai , Kwi Ng King , Chye Lim Eng
Published: May 2009

✓ A case of Pantopaque pulmonary embolism during myelography is presented. All reported cases of venous intravasation of Pantopaque have been associated with traumatic lumbar tap, and a mechanism whereby a bloody lumbar tap causes venous intravasation and hence Pantopaque pulmonary embolism during myelography is postulated.
Changing venous pattern in a hemangioblastoma resembling an arteriovenous malformation
Authors: Thaggard Alvin , Handel Stanley , Leavens Milam E. , Isaacs George
Published: May 2009

✓ A patient with cerebellar hemangioblastoma underwent two successive cerebral arteriograms within a 48-hour period. The first arteriogram suggested an arteriovenous malformation. The second angiogram showed a dramatic change with nearly total absence of the earlier dilated draining veins. This change was found on examination of the surgical specimen to be caused by venous thrombosis.
Pathogenetic role of no-reflow phenomenon in experimental subarachnoid hemorrhage in dogs
Authors: Asano Takao , Sano Keiji
Published: May 2009

✓ The real pathogenetic role of no-reflow phenomenon in clinical situations such as the acute stage of subarachnoid hemorrhage (SAH) is not yet known. To study this problem, we carried out the following experiment in dogs: SAH was induced by withdrawing a needle previously inserted into the internal carotid artery through a small craniectomy in the lateral base of the skull. Complete dural repair and cranioplasty was done to avoid cerebrospinal fluid leakage. Cortical cerebral blood flow (CBF) changes, measured by a double-needle type thermocouple, intracranial pressure (ICP), electroencephalogram (EEG), and sensory evoked response were monitored under controlled ventilation for 3 hours after SAH. At the end of the experiment, the brain was perfused with carbon black solution at a pressure of 120 mm Hg. The 32 episodes of SAH thus induced yielded two basic patterns of ICP changes which simulated those previously reported with human SAH. In the first pattern, reactive hyperemia was always observed, followed by complete or incomplete recovery of cerebral function. Perfusion defects were frequently seen in the thalamus, basal ganglia, and parietooccipital cortex symmetrically. In the second pattern, prolonged elevation of ICP resulted in failure of recovery of both CBF and EEG. Carbon black filled only the pial arteries and the rest of the brain was totally unperfused. From the results, the pathogenetic role of the no-reflow phenomenon in the acute stage of SAH as influencing the prognosis is strongly suspected.
Immunobiology of primary intracranial tumors
Authors: Mahaley M. Stephen , Brooks William H. , Roszman Thomas L. , Bigner Darell D. , Dudka Lynn , Richardson Sheila
Published: May 2009

✓ Cellular and humoral immune parameters were evaluated in a series of braintumor patients, 42 with glioblastoma multiforme, 17 with other anaplastic gliomas, and 17 with meningiomas. A degree of anergy was found, which seems in the group as a whole to be proportional to the degree of anaplasia. In addition, serial bimonthly testing in individual cases revealed further reduction in certain immune responses coincident with clinical decline.
Cyclic AMP and adenyl cyclase in brain tumors
Authors: Furman Mathilda A. , Shulman Kenneth
Published: May 2009

✓ Some of the regulatory mechanisms of cyclic adenosine monophosphate (AMP) production in human brain tumors were investigated by assessing both cyclic AMP levels and adenyl cyclase activity. A large disparity was found between the levels of cyclic AMP of normal brain and brain-tumor tissue. Cyclic AMP levels were much lower in brain tumors (25.8 pmoles (picomoles)/mg protein) than in normal brain (98.8 pmoles/mg protein). These studies also show that the abnormally low levels of cyclic AMP in tumors parallel those of adenyl cyclase. The mean adenyl cyclase activity of brain tissue was found to be 111.0 pmoles of cyclic AMP/min/mg protein, while that of the tumor was only 23.0 pmoles/min/mg protein. Levels of cyclic AMP and adenyl cyclase activity were inversely related to the degree of malignancy. Attempts to stimulate adenyl cyclase in homogenates of human brain and brain tumors resulted in a similar response in both tissues. Norepinephrine was the most effective stimulant and produced a two- to threefold increase in cyclic AMP production, while histamine had no effect. It is concluded that one of the factors governing tumor growth may be a defect in the adenyl cyclase system.
Hospital-acquired bacterial meningitis in neurosurgical patients
Authors: Buckwold Frederick J. , Hand Roger , Hansebout Robert R.
Published: May 2009

✓ The authors review 23 cases of hospital-acquired meningitis occurring over a 15-year period in neurosurgical patients. Factors associated with the development of meningitis include recent craniotomy, cerebrospinal fluid leak, the presence of ventricular or lumbar drainage tubes, and skull fracture. Four cases were caused by Staphylococcus epidermidis; one of these patients died. In 19 cases, Gram-negative enteric bacteria were the etiologic agents, most commonly members of the Klebsiella-Enterobacter-Serratia group. Eleven of these patients died. The particular antibiotic or group of antibiotics used and the route of administration made no difference in the outcome of Gram-negative bacillary meningitis.
Use of microfibrillar collagen as a topical hemostatic agent in brain tissue
Authors: Rybock John D. , Long Don M.
Published: May 2009

✓ Microfibrillar collagen, a recently introduced topical hemostatic agent, was used to obtain hemostasis in suction-evacuation lesions of canine cortex. Gelatin foam was used as a control in identical lesions on the opposite side. Microfibrillar collagen was found to be faster acting and more effective than gelatin foam. Histological evaluation of the lesions at 2, 4, and 6 months postoperatively showed no significant difference in the amount or type of tissue reaction to the two agents.
Chronic cerebellar stimulation and developmental reflexes
Authors: Penn Richard D. , Etzel Mary Liz
Published: May 2009

✓ The changes in motor function in cerebral palsy patients produced by chronic anterior lobe cerebellar stimulation were documented with the Milani-Comparetti developmental scale, which allows comparison between functional gains and reflex patterns. Two patients with marked motor retardation and primitive reflexes were followed serially over several months of stimulation. Using these measures, the efficiency of chronic stimulation can be assessed, although many years will be needed to evaluate its role in treating motor disabilities.
Delayed paralysis after cervical fracture-dislocation
Authors: White James C. , Kneisley Lawrence W. , Rossier Alain B.
Published: May 2009

✓ The authors describe the late development of ascending damage to the spinal cord after a cervicothoracic fracture-dislocation that produced no evidence of cord or nerve injury other than transient mild paresthesia in the arms. After 16 years, progressive quadriplegia developed with subsequent ascending dissociated sensory loss in the upper cervical dermatomes. The presence of a central syrinx was verified at operation 18 years after the injury.
Visual loss from optochiasmatic arachnoiditis after tuberculous meningitis
Authors: Scott R. Michael , Sonntag Volker K. H. , Wilcox Lloyd M. , Adelman Lester S. , Rockel Thomas H.
Published: May 2009

✓ While recovering from tuberculous meningitis, a 5-year-old boy developed a profound visual deficit because of optochiasmatic arachnoiditis. Following micro-neurosurgical decompression of the optic nerves and chiasm, prompt visual recovery occurred.
Traumatic lumbosacral meningocele
Authors: Barberá José , Broseta Jaime , Argüelles Francisco , Barcia-Salorio Juan L.
Published: May 2009

✓ A case of traumatic avulsion of the L-5 and S-1 nerve roots is described. Surgical intervention was undertaken and long-term functional recovery obtained.
Posttraumatic hematoma beneath the epineurium of a branch of the median nerve
Authors: Polis Lech , Brzezinski Jerzy
Published: May 2009

✓ A very rare case of a posttraumatic hematoma, localized beneath the epineurium of a branch of the median nerve, is described and a probable mechanism of its development is given. Full recovery of nerve function followed surgery.
Reticulum stain for frozen-section diagnosis of pituitary adenomas
Authors: Velasco Manuel E. , Sindely Stephen D. , Roessmann Uros
Published: May 2009

✓ The authors describe a simple, quick, and reliable stain for use on frozen-section diagnosis of anterior pituitary microadenomas.
Microsurgical technique in the treatment of intracranial aneurysms
Authors: Zlotnik Ephraim I. , Oleshkevich Fedor V. , Stolkarts Joseph Z.
Published: May 2009

✓ A consecutive series of 137 patients with cerebral aneurysms operated on with microsurgical techniques is presented. Occlusion of the aneurysm was performed in 133 patients. Good results were obtained in 85.5% of the entire series and in 92.6% of the patients who were in satisfactory condition preoperatively. The overall mortality rate was 5.8%, and 3.7% for the patients in satisfactory condition. The preoperative and operative factors that influenced the results are discussed.
Terminal ventriculostomy for syringomyelia
Authors: Gardner W. James , Bell Herbert S. , Poolos Pete N. , Dohn Donald F. , Steinberg Marta
Published: May 2009

✓ The clinical course of 12 patients who underwent terminal ventriculostomy for syringomyelia is presented. Opening the central canal at the tip of the conus medullaris is a relatively benign procedure that improves the symptoms of syringomyelia and syringobulbia. This canal normally terminates at the tip of the conus, but in each of the 12 surgical specimens it continued into the filum terminale for distances up to 8 cm. In most cases the tip of the conus was located more caudally than normal, indicating some degree of tethering in fetal life. This belief is supported by the fact that the newborn, whose conus is tethered to a lipoma at the sacral level, may develop syringomyelia in adult life.
Transsphenoidal decompression of the optic nerve and chiasm
Authors: Laws Edward R. , Trautmann James C. , Hollenhorst Robert W.
Published: May 2009

✓ A review of recent experience with transsphenoidal surgery for lesions in and about the sella turcica establishes the value of this approach for the management of patients with visual loss. The lesions encountered consisted of pituitary adenoma in 45 cases, craniopharyngioma in 10 cases, and miscellaneous tumors involving the sella in the remaining seven cases. Sixty of the 62 patients in this series had quantitative determination of preoperative and postoperative visual status; after surgery, vision was improved in 81%, unchanged in 11%, and worse in 5%. Two patients (3%) died during the immediate postoperative period before their visual status could be evaluated.
Role of the posterior hypothalamus in the development of acute brain swelling
Authors: Nakagawa Yoku , Motomiya Mineo , Tsuru Mitsuo , Bando Mitsue , Tabata Makiko
Published: May 2009

✓ Destructive stereotaxic lesions were made in the posterior hypothalamus, unilaterally or bilaterally, in 26 dogs. In 21 dogs the intracranial pressure (ICP) was maintained in normal range, and in five dogs the ICP was artificially elevated to 300 to 400 mm H2O, preceding the procedures to the hypothalamus. Arterial oxygen and carbon dioxide pressure (PaO2 and PaCO2) were maintained in the normal range. Before and after each procedure, systemic arterial pressure (SAP) was elevated by intravenous injection of norepinephrine (5 × 10−3 mg/kg) to determine whether the ICP increases coincidentally with elevation of the systemic arterial pressure. The intracranial pressure/mean arterial pressure ratio of elevation by injection of norepinephrine was not significant regardless of the level of the ICP, or of uni- or bilateral lesions of the hypothalamus. The authors conclude that dysfunction of posterior hypothalamus does not play a specific role in the development of vasomotor paralysis leading to acute brain swelling, under conditions of normal or moderately raised ICP with normal PaCO2 and PaO2 levels.
Surgical management of unruptured asymptomatic aneurysms
Authors: Samson Duke S. , Hodosh Richard M. , Clark W. Kemp
Published: May 2009

✓ The natural history of unruptured asymptomatic aneurysms is unclear. Because of this uncertainty regarding risk of ultimate enlargement and/or hemorrhage, and in view of the significant mortality and morbidity traditionally involved in aneurysm surgery, clinicians have varied in their advocacy of surgical management of such lesions. Forty-nine consecutive patients harboring 52 such aneurysms were treated surgically over a 57-month period. There were no surgical deaths and morbidity was within acceptable limits. Patient population characteristics and surgical technique are discussed.
Intracranial biopsy assisted by computerized tomography
Authors: Maroon Joseph C. , Bank William O. , Drayer Burton P. , Rosenbaum Arthur E.
Published: May 2009

✓ A technique is described for biopsying intracranial tumors and aspirating cysts or abscesses using flexible non-metallic needle guides and computerized tomography as a guidance system. Three cases are described in which this technique was used.
An experimental cerebral missile injury model in primates
Authors: Crockard H. Alan , Brown Frederick D. , Johns Lydia M. , Mullan Sean
Published: May 2009

✓ An experimental model of cerebral missile injury in rhesus monkeys is described. The main objective was to create a “clean” wound devoid of bleeding from major vessels and complications due to bone fragments. There was a correlation between the wounding energy and the physiological signs, although we underestimated the actual energy level. After the right parietooccipital to right frontal injury, there was bradycardia, changes in blood pressure, and, in high-energy wounds, a marked alteration in respiration. This suggests that the missile's energy produces direct brain-stem damage, the extent of which can be related to the wounding energy.
Traumatic aneurysm of peripheral cerebral arteries
Authors: Asari Syoji , Nakamura Shigeo , Yamada Osamu , Beck Hiroichi , Sugatani Hiroshi , Higashi Toru
Published: May 2009

✓ The authors describe two cases of traumatic aneurysm of peripheral cerebral arteries. Surgical treatment as soon as possible after the diagnosis has been made is advised to avoid the high risk of delayed hemorrhage.
Dural posterior fossa AVM producing raised sagittal sinus pressure
Authors: Lamas Eduardo , Lobato Ramiro D. , Esparza Javier , Escudero Luis
Published: May 2009

✓ A patient with raised intracranial pressure secondary to a dural arteriovenous malformation (AVM) of the posterior fossa is presented. Direct shunting of arterial blood into the transverse sigmoid sinus caused a considerable increase of the sagittal sinus pressure (SSP) and elevation of intracranial pressure (ICP). Both ICP and SSP returned to normal values following obliteration of the dural AVM by selective embolization.
Spontaneous disappearance of a cerebral arteriovenous malformation in infancy
Authors: Mabe Hideo , Furuse Masahiro
Published: May 2009

✓ The authors report a case of the disappearance of an arteriovenous malformation in infancy, demonstrated by follow-up angiography performed 7 months after the original angiograms. Some possible mechanisms whereby a cerebral arteriovenous anomaly is thrombosed are discussed.
Lead encephalopathy simulating a cerebral neoplasm in an adult
Authors: Powers James M. , Rawe Stephen E. , Earlywine Garnett R.
Published: May 2009

✓ The clinical and pathological findings in an adult with lead encephalopathy due to moonshine consumption are presented. The remarkable focality of the edema led both the clinicians and radiologists to consider this a cerebral glioma.
Neuroepithelial cyst of the fourth ventricle
Authors: Sharpe James A. , Deck John H. N.
Published: May 2009

✓ Developmental cysts lined by neuroepithelium are a distinctive form of neural tube dysgenesis. Neuropathological study of a fourth ventricular cyst that caused symptomatic hydrocephalus indicated its neuroepithelial origin. The cyst arose from the ventral surface of the cerebellar vermis. Evagination of the rhombencephalic roof and entrapment of a ventricular diverticulum beneath the cerebellar anlagen is proposed as a mechanism responsible for the extraordinary occurrence of neuroepithelial cysts within the fourth ventricle.
Lumbar spinal abscess managed conservatively
Authors: Messer Henry D. , Lenchner Gregory S. , Brust John C. M. , Resor Stanley
Published: May 2009

✓ The authors report the case of a patient with spinal abscess in whom operation was withheld because of severe concomitant medical problems. Conservative management resulted in apparent cure.
Commissural myelotomy
Authors: Cook Albert W. , Kawakami Yasuto
Published: May 2009

✓ The effect of commissural myelotomy in 24 cases with intractable pain is described. The operative technique employed with the operating microscope or magnifying glasses and a special myelotome is outlined. The results suggest an outstanding advantage in patients with bilateral metastases from malignancies except intrapelvic metastases. Patients with lumbar arachnoiditis showed a total failure of pain relief after 2 to 5 years, in spite of good relief temporarily.
Epidermoid and dermoid cysts
Authors: Guidetti Beniamino , Gagliardi Franco M.
Published: May 2009

✓ The authors report on the clinical data, operating technique, postoperative complications, and late results in a series of 31 epidermoid and 21 dermoid cysts of the central nervous system.
Safety of mini-dose heparin administration for neurosurgical patients
Authors: Barnett Hugh G. , Clifford John R. , Llewellyn Raeburn C.
Published: May 2009

✓ A course of small doses of heparin given subcutaneously before and after elective operations has been reported to reduce the incidence of deep venous thrombosis and pulmonary embolism in general surgical patients. To test the safety of mini-dose heparin for neurosurgical patients, mini-dose heparin was used for 150 adult patients undergoing elective neurosurgical procedures. No operative complications were thought to be related to heparin administration. Postoperatively, there were four wound seromas, two hematomas, and one non-fatal pulmonary embolus. Seven patients died postoperatively, of whom five had no evidence of pulmonary embolus. Although no conclusions were drawn as to the effectiveness of mini-dose heparin in preventing deep venous thrombosis or pulmonary emboli, it was believed that the method could be used safely and without fear of increased intracranial or intraspinal bleeding for neurosurgical patients.
Arteriovenous malformations in the posterior fossa
Authors: Matsumura Hiroshi , Makita Yasumasa , Someda Kuniyuki , Kondo Akinori
Published: May 2009

✓ We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.
Syringomyelia following lumboureteral shunting for communicating hydrocephalus
Authors: Fischer Edwin G. , Welch Keasley , Shillito John
Published: May 2009

✓ Three patients are described in whom syringomyelia was identified long after the treatment of communicating hydrocephalus by a lumboureteral shunt. The reason for syrinx formation in these cases could not be determined. In two there was either autopsy-proven or presumed evidence for arachnoiditis, and in the third patient the symptoms of syringomyelia were acutely aggravated by temporary obstruction of the shunt. The development of a pressure drop from the intracranial compartment to the spinal compartment with crowding at the foramen magnum is also a suggested mechanism.
Preoperative diagnosis of brain-stem abscess by computerized tomography with survival
Authors: Messina Albert V. , Guido Laurence J. , Liebeskind Arie L.
Published: May 2009

✓ A case is reported in which the diagnosis of brain-stem abscess was made preoperatively by computerized tomography. Surgical therapy resulted in relatively good functional recovery.
An unusual atlanto-axial dislocation
Authors: Fox John L. , Jerez Alvaro
Published: May 2009

✓ A case is presented in which the patient sustained a complete dislocation of the odontoid process in front of the anterior arch of the first cervical vertebra. There was no fracture of the arch of C-1 vertebra. The patient was treated successfully by transoral excision of the odontoid process and the anterior arch of C-1. Twenty days later the patient's spine was stabilized posteriorly at C-1 through C-3 with wire and methylmethacrylate.
Intraparenchymal embolization for obliteration of an intramedullary AVM of the spinal cord
Authors: Ausman James I. , Gold Lawrence H. , Tadavarthy S. Murthy , Amplatz Kurt , Chou Shelley N.
Published: May 2009

✓ A new technique is presented in which expandable compressed Ivalon sponge emboli were used to obliterate an intramedullary arteriovenous malformation of the spinal cord by intraparenchymal embolization. A case is described in which this method was used.
The use of intravenous fluorescein in the repair of large myelomeningoceles
Authors: Venes Joan L.
Published: May 2009

✓ Intravenous fluorescein has been found a valuable guide in the identification of necrotic skin, which can then be debrided before wound closure. Fluorescein was used in four infants undergoing repair of large myelomeningoceles with no deleterious effects.
Evaluation of brain function in severe human head trauma with multimodality evoked potentials
Authors: Greenberg Richard P. , Mayer David J. , Becker Donald P. , Miller J. Douglas
Published: May 2009

✓ Methods for obtaining multimodality evoked potentials, somatosensory, visual, auditory, and auditory brain-stem potentials in patients with severe head trauma are described. A method of analyzing abnormal multimodality evoked potentials (graded evoked brain-injury potentials) is proposed that defines the degree of abnormality of the electrophysiological data and expresses it simply in four grades per modality. Data from 20 normal subjects are given for comparison with the abnormal data obtained from 51 patients with head trauma.
Pain reduction by electrical brain stimulation in man
Authors: Richardson Donald E. , Akil Huda
Published: May 2009

✓ Electrical stimulation of the periventricular gray matter is an effective means of relieving several types of pain without destruction of neural tissue. The effects are long lasting, often bilateral, and with judicious use do not appear subject to adaptation. However, sustained uninterrupted stimulation for several hours does lead to a reversible decrease in effectiveness. Side effects from stimulation are minimal and cause little or no untoward emotional changes. The results are discussed in terms of activation of an endogenous pain inhibitory mechanism that involves naturally occurring opiate-like factors such as the enkephalins and endorphins.
Non-pneumococcal Gram-positive coccal meningitis related to neurosurgery
Authors: Weinstein Melvin P. , Marc LaForce F. , Mangi Richard J. , Quintiliani Richard
Published: May 2009

✓ Thirty-eight of 154 cases (25%) of bacterial meningitis seen by the authors during a 7-year period were due to non-pneumococcal Gram-positive cocci. Thirty cases (80%) resulted from neurosurgical manipulation; half of these were shunt infections and half were early postoperative complications. Only three cases (8%) occurred de novo in patients with presumably normal host defenses. Signs, symptoms, and laboratory data related more to predisposing factors than to infecting microorganisms. Fever, peripheral leukocytosis, abnormal cerebrospinal fluid (CSF), and positive Gram stain were the most reliable indicators of infection. Prognosis was good with antibiotic therapy and removal of CSF shunt equipment when present.
Experimental head injury in the rat
Authors: Nilsson Bengt , Pontén Urban
Published: May 2009

✓ A standardized model of acceleration concussion in the rat was used for the study of cerebral energy metabolism during the acute concussive reaction. Impact velocities of 7 and 9 m/sec were used, and the cerebral metabolic state was determined 1, 4, and 15 minutes after the impact. A concussive response could be sustained with a normal energy state in the tissue, but with the more intense reaction to a 9 m/sec impact, energy depletion usually occurred. At 1 minute these changes were most pronounced in the brain-stem regions. At 4 minutes the reactions were more varied but a progression usually occurred during this time, while at 15 minutes restitution was indicated. Hypoxia due to neurogenic pulmonary edema aggravated the state. The findings are compatible with a high metabolic rate during concussion, but progressive changes indicate the rapid appearance of complicating factors, including hypoxemia and probably also ischemia.
Experimental head injury in the rat
Authors: Nilsson Bengt , Nordström Carl-Henrik
Published: May 2009

✓ Cerebral blood flow (CBF) and oxygen consumption (CMRO2) were determined during the immediate posttraumatic period in rats subjected to concussive impact acceleration. According to previous studies an impact of 9 m/sec velocity elicited typical and marked symptoms of experimental concussion and often a prolonged comatose state, accompanied by cerebral metabolic signs of energy failure. During the immediate concussive response there was an increase of the CBF, followed within the next few minutes by a decrease to about one-third of normal flow, and then by a tendency toward normalization of flow 20 to 40 minutes posttrauma. Simultaneous measurements of cerebral oxygen extraction indicated an increase of the CMRO2 during the first minute. During the ischemic phase oxygen extraction increased, but the lowest CBF values were only partially compensated for, and normal oxygen availability could not be maintained. The combined data, including cerebrospinal fluid pressure measurements, indicated primary cerebrovascular effects of the concussive trauma. These vasomotor effects may induce critical cerebral ischemia and thus profoundly influence posttraumatic cerebral function, and cause irreversible damage.
Rate of cerebral energy consumption in concussive head injury in the rat
Authors: Nilsson Bengt , Nordström Carl-Henrik
Published: May 2009

✓ The metabolic rate was determined in the rat brain during the immediate concussive response to standardized impact accelerations of 7 and 9 m/sec velocity. In one series, the metabolic state was determined in freeze-clamped cortical and brain-stem tissue 20 seconds after the impact. The metabolic rate was calculated from the rate of energy depletion in the adjacent unclamped tissue during 10 seconds of total ischemia. The freeze-clamping procedure per se was shown to enhance the metabolic rate probably by inducing mechanical excitation. In another series, in situ freezing was used for tissue sampling in the same situation. A 10-second period of heart standstill induced a standardized period of ischemia. During the acute concussive response to impact acceleration at 7 m/sec velocity, there was an increase of the metabolic rate in the brain stem. A more intense concussive impact at 9 m/sec velocity further enhanced this reaction and also involved the cortex. It is concluded that the basis of the immediate concussive response is a mechanically elicited neuronal excitation. This may lead to energy depletion unless the increased metabolic demands are met.
Pneumocephalus secondary to cerebrobronchial fistula formed by a ventriculoatrial shunt
Authors: Stuntz James T. , Shuman Robert M.
Published: May 2009

✓ A case is presented in which the atrial tip of a ventriculoatrial shunt formed a fistulous connection with the bronchial tree in a child. This resulted in acute bronchopneumonia, pneumocephalus, and ventriculitis. Pneumocephalus was created by an artificial respirator forcing air along the shunt tract during treatment of bronchopneumonia. Sudden death was related to transtentorial herniation. The diagnosis of a cerebrobronchial fistula should be entertained in shunt patients with respiratory distress and radiographic pulmonary densities unresponsive to antibiotics.
Elephantiasis of eyelids following repeated craniotomy
Authors: Amine Abdul R. C. , Sugar Oscar , Patterson Virginia , Crouch Earl R.
Published: May 2009

✓ A case is reported in which craniectomy for removal of right frontal meningioma was complicated by porencephaly. A peculiar granulomatous area was found over the brain at reoperation for cranioplasty. Iodine solution was used to paint the reactive material under the scalp flap. Giant swelling of the ipsilateral eyelids gradually developed, ascribed to interference with lymphatic drainage from the eyelids. There was no communication between eyelids and cerebrospinal fluid spaces. The enlarged eyelids were removed by ophthalmic plastic surgery.