bluuebunny/crossref_metadata_2025 huggingface dataset:
Ecchordosis physaliphora
Authors: Wyatt Richard B. , Schochet Sydney S. , McCormick William F.
Published: May 2009

✓ Ecchordosis physaliphora, an asymptomatic gelatinous excrescence arising from the clivus, is occasionally encountered at autopsy. Morphologically, ecchordosis closely resembles notochord and chordoma. All three consist of vacuolated cells that contain acid mucopolysaccharides. Under the electron microscope, the intracellular vacuoles have a smooth limiting membrane whereas the extracellular vacuoles are lined by microvilli and pinocytotic vesicles. No ultrastructural features accounting for the biological difference between ecchordosis and chordoma are observed in this study.
Familial intracranial aneurysms
Authors: Brisman Ronald , Abbassioun Kazem
Published: May 2009

✓ Six cases of intracranial aneurysms are described in three families: two sisters, identical twins, and a mother and daughter. The cases suggest a hereditary basis for some intracranial aneurysms.
Cerebral angiography during operation for intracranial aneurysms and arteriovenous malformations
Authors: Lazar Martin L. , Watts Clark C. , Kilgore Bassett , Clark Kemp
Published: May 2009

✓ Angiography during the operative procedure is desirable, but is often difficult because of the problem of maintaining a needle or cannula in an artery for long periods of time. Cannulation of the superficial temporal artery avoids this technical problem. The artery is easily found, cannulation is simple, and obliteration of the artery is of no consequence. Cerebral angiography then provides a means for prompt evaluation of the surgical procedure at any time during the actual operation.
Surgical treatment of brain stem gliomas
Authors: Lassiter Kenneth R. L. , Alexander Eben , Davis Courtland H. , Kelly David L.
Published: May 2009

✓ A long-term study has been made of a consecutive series of 37 patients with brain stem gliomas, 22 of whom were children and 15 adults. Surgical exploration was carried out in 34 of the 37 cases and only very rarely was a diagnosis made on clinical grounds or air study alone. In 10 cases a histological diagnosis was made at operation. In five patients a significantly large neoplastic cyst was found and evacuated, and four of these have had long-term useful survivals. There were nine postoperative deaths, most of them in the pre-Decadron era; 17 cases died during follow-up, with a mean survival of 33 months; and eight patients are living, with a mean survival of 3 months to 9 years. A plea is made for surgical exploration of these lesions in the hope of finding a surgically approachable cyst, and for the use of radiation therapy at a later time.
Human growth hormone in cultures of human pituitary tumors
Authors: Batzdorf Ulrich , Gold Vivian , Matthews Nancy , Brown Josiah
Published: May 2009

✓ Tissue culture medium of 14 human pituitary adenomas removed from acromegalic and hypopituitary patients was analyzed for human growth hormone (HGH). High HGH levels were detected in the culture medium of all adenomas removed from acromegalic patients. HGH was undetectable in the tissue culture medium of six of eight adenomas removed from hypopituitary patients. Elevated HGH levels were also found in the culture medium of pituitary tissue obtained from a juvenile diabetic patient.
Modification in the activity of some enzymes of the cerebrospinal fluid in patients with intracranial tumors
Authors: Vara-Lopez Rafael , Vara-Thorbeck Rafael
Published: May 2009

✓ Investigations of enzymatic activity in the human cerebrospinal fluid have shown a general and pathological increase in patients with intracranial tumors. The variation in components suggests the value of a diagnostic study of enzymes whenever brain tumors are presumed to exist.
Kyphoscoliosis following lumbar subarachnoid shunts
Authors: Kushner Jack , Alexander Eben , Davis Courtland H. , Kelly David L.
Published: May 2009

✓ In a follow-up of 80 lumbar subarachnoid shunts for hydrocephalus, scoliosis with limitation of back flexion was found to have developed in approximately 50% of the surviving children, some of whom showed a disparity in the length and size of their legs. There was no correlation between the direction of the convexity of the scoliosis and the side of the shortened leg, or between the number of shunt revisions and the ultimate development of kyphoscoliosis, or between removal of laminae and the subsequent development of scoliosis. Three case histories are presented to illustrate the still unproven but possible relationship between arachnoiditis due to polyethylene tubes and the ensuing scoliosis. Removal of the lumbar shunts, decompression, and laminectomy seemed to have no beneficial effect in the reversal of the scoliosis in any of the cases reviewed.
A method for revision of ventriculocardiac shunts
Authors: Anderson Frank M.
Published: May 2009

✓ In 21 hydrocephalic children with ventriculocardiac shunts, revision of the cardiac portion has been done through a lower neck incision and the new shunt tube introduced at the junction of the right internal jugular and brachiocephalic veins. This method of replacing a nonfunctional shunt is useful when scarring or occlusion of the jugular vein prohibits advance of the tube. The procedure is direct, is not unduly difficult, and permits secondary revision if required.
Brain tumor of mixed mesenchymal and neuroepithelial origin
Authors: Shuangshoti Samruay , Netsky Martin G.
Published: May 2009

✓ A case is reported in which the intracerebral tumor was a mixed mesenchymal and neuroepithelial (glial) neoplasm. The mesenchymal part contained both lymphoma and dedifferentiated meningioma; the neuroepithelial portion was glioblastoma multiforme. The combined tumor had both gross and microscopic features of a “giant cell sarcoma” and “giant-celled glioblastoma.” The findings in this case and a review of the literature indicate the mixed mesenchymal and neuroepithelial origin of these tumors.
Documented enlargement and rupture of a small arterial sacculation
Authors: Young Byron , Meacham William F. , Allen Joseph H.
Published: May 2009

✓ Small aneurysms may sometimes be considered junctional dilatations but may also progressively enlarge and cause spontaneous subarachnoid hemorrhage, as in the case reported. These small aneurysms should be treated precisely as an aneurysm directly responsible for bleeding. When found in conjunction with other aneurysms, they should either be treated simultaneously or followed until clinical developments indicate the need for such surgery.
Cerebrovascular malformation in childhood presenting with cardiomegaly
Authors: Taylor John R. , Bell William E. , Graf Carl J.
Published: May 2009

✓ Cardiomegaly secondary to a cerebrovascular malformation is described in a 4-year-old child, including resolution of the cardiomegaly following successful removal of the malformation. The pathophysiological mechanisms are discussed, as well as the care of such patients during and immediately after surgery. All patients with large vascular malformations should have careful assessment of their cardiac status, and, conversely, the evaluation of patients with unexplained cardiomegaly or heart failure should include a search for vascular malformations.
Calvarial hemangioma with blood supply from branches of the internal carotid artery
Authors: Atallah Naim K. , Nassar Sami I.
Published: May 2009

✓ The sources of blood supply of calvarial hemangiomas are not well established angiographically but have been reported to derive from the middle meningeal artery. A case is presented in which both the external and the internal carotid arteries supplied the hemangioma. The protean arteriographic picture is explained in terms of the various tissues the tumor involves (galea, calvarium, or meninges).
Intracranial midline anterior fossae ossifying fibroma invading orbits, paranasal sinuses, and right maxillary antrum
Authors: Scott Michael , Peale Augustin R. , Croissant Paul D.
Published: May 2009

✓ The clinical course, roentgenological findings, and operative management of a patient with an ossifying fibroma (benign osteoblastoma) of the anterior cranial fossae are described. The tumor invaded the orbits, the ethmoids, the upper nasal cavity, and the right maxillary antrum. The differential roentgenological diagnosis is discussed.
The subarachnoid space in congenital obstructive hydrocephalus
Authors: Milhorat Thomas H. , Hammock Mary K. , Chandra Roma S.
Published: May 2009

✓ The leptomeninges of 52 patients who died with a diagnosis of congenital or early acquired obstructive hydrocephalus were examined microscopically. In each case a well-developed subarachnoid space was present and in no cases were the leptomeninges congenitally absent. Thus, the commonly held belief that the subarachnoid space may fail to develop in congenital obstructive hydrocephalus was not supported by this study. Pathological findings in the leptomeninges were common, however, and were generally related to the following factors: the severity of the hydrocephalus, the duration of the hydrocephalus, the success or failure of surgical management, past infection (both intrauterine and postnatal), and subarachnoid hemorrhage. The type of ventricular obstruction did not seem to be a significant factor. Certain embryological considerations raised by the current findings are discussed.
Results of a controlled trial of late surgical versus conservative treatment of intracranial arterial aneurysms
Authors: Troupp Henry , Björkesten Gunnar af
Published: May 2009

✓ A controlled trial involving 178 subarachnoid hemorrhage patients in good condition (Grade 1) and with single intracranial arterial aneurysms is reported. The decision to treat with stalk ligature or conservatively was made at a comparatively late stage, on an average of 51 days after the initial hemorrhage. After a follow-up time of ½ to over 5 years (average 3½ years), there was no statistical difference between the results in the operated and unoperated groups. The majority of the nine fatal recurrences among the 92 unoperated patients occurred within the first months after initial hemorrhage; only one death occurred later than 4 months after hemorrhage. There was one operative death in the hospital among the 86 operated patients; all the four late deaths from reasons related to the aneurysm occurred in patients who had had operations other than aneurysmal stalk ligatures performed. It is concluded that Grade 1 aneurysm patients have such a good natural prognosis that the value of late surgery seems limited, even if performed without mortality or increased morbidity, and in the form of stalk ligature.
Ultrasonic diagnosis of carotid artery disease
Authors: Kristensen Jørgen Kvist , Eiken Mogens , von Wowern Fritz
Published: May 2009

✓ Ultrasonic echoes from an artery, registered on an oscilloscope screen as vertical deflections from a horizontal baseline, exhibit pulse-synchronous displacements on the x-axis as well as variations in amplitude. The visualization of these echo movements can constitute the basis for an evaluation of arterial conditions comparable to palpation of the pulse but has the advantage of being applicable to arteries that cannot be palpated. The method has been applied to the internal carotid artery in 325 patients, and an evaluation of the method is given on the basis of a comparison with 166 angiograms of the artery. The method has proven to be a valuable diagnostic aid in studying patients suspected of having carotid artery disease.
Potassium and the pathogenesis of cerebral arterial spasm in dog and man
Authors: Wilkins Robert H. , Levitt Philip
Published: May 2009

✓ This study investigates the possibility that the intracranial arterial spasm occurring in patients with subarachnoid hemorrhage might be due to potassium released from blood clots surrounding the involved cerebral arteries. Although cerebral arterial spasm could be induced in the dog by the injection of potassium into the chiasmatic cistern, it only occurred with potassium concentrations higher than those expected to result from hemolysis of subarachnoid clots. Furthermore, the potassium concentrations were not elevated in the cerebrospinal fluid of human patients with subarachnoid hemorrhage, and the individual potassium values could not be correlated with the presence or degree of spasm encountered in these patients.
A true mycotic (Aspergillus) aneurysm leading to fatal subarachnoid hemorrhage in a patient with hereditary hemorrhagic telangiectasia
Authors: Davidson Peter , Robertson David M.
Published: May 2009

✓ A mycotic basilar artery aneurysm, in which Aspergillus was identified histologically, was found to be the cause of a massive subarachnoid hemorrhage in a 75-year-old man who suffered from hereditary hemorrhagic telangiectasia; there was no evidence of intracranial involvement by the latter disorder.
Intracerebral fibroma in an 11-month-old infant
Authors: Koos Wolfgang T. , Jellinger Kurt , Sunder-Plassmann Max
Published: May 2009

✓ The authors report the successful surgical treatment of a primary intracerebral fibroma (fibroblastoma) in an 11-month-old boy. Related cases are also discussed.
Granular cell myoblastoma of the neurohypophysis
Authors: Symon Lindsay , Ganz J. C. , Burston John
Published: May 2009

✓ Two cases are described in which a granular cell myoblastoma of the pituitary gland presented as a space-occupying lesion, and was successfully removed. Reports of comparable cases are discussed. Important diagnostic criteria include the angiographic demonstration of abnormal circulation and the absence of calcification.
Acrylic prosthesis of the fifth cervical vertebra in multiple myeloma
Authors: Cross Glen O. , White Hugh L. , White Laurens P.
Published: May 2009

✓ A simple method of vertebral body replacement by acrylic plastic as originally advocated by Scoville and associates was successfully used in a case of multiple myeloma of C-5. The patient was able to walk early without external braces, and returned to his usual activity 1 month later.
Remarks on incomplete hypotheses for the control of cerebral circulation
Authors: Penfield Wilder
Published: May 2009

✓ The role of focal ischemia and the altered circulation in a brain scar in relation to focal cerebral seizures has provided one of the continuing problems in the experimental approach to the mechanism of epilepsy. The brain of the epileptic patient as observed during craniotomy appears to show more vasomotor lability than the normal brain. This lability seems uninfluenced by sympathectomy or carotid artery sinus denervation. Epileptic lesions of all types show cytological evidence of ischemia. It seems likely that some undiscovered secret of cerebral circulation is the ultimate cause of epilepsy.
X-ray microscopy and histochemistry of the human cerebral blood vessels
Authors: de C. H. Saunders Richard L. , Bell Mary A.
Published: May 2009

Differential injection with radiopaque materials followed by projection x-ray microscopy has demonstrated the microangiographic pattern of epicerebral, transcerebral, and cortical blood vessels in the human brain. The authors report that alkaline phosphatase activity provides a means of showing the capillary bed more completely and differentiating cortical arteries from cortical veins. The vertical and horizontal organization of the cortical vessels is related to the cortical columns and lamination. Pairing and spiraling of arterioles of the penetrating cortical vessels are described. Lead staining for neuronal acid phosphatase activity in combination with alkaline phosphatase stain for blood vessels makes it possible to examine the neurons and microvascular pattern by both optical and projection x-ray microscopy.
Microvasculature of the human spinal cord
Authors: Turnbull Ian M.
Published: May 2009

✓ The regional differences in spinal microvasculature are outlined from microangiographic examination of the human spinal cord. Five to eight central arteries arise from each centimeter length of the anterior spinal artery in the cervical region, two to five in the thoracic region, and five to twelve in the lumbosacral region. The central arteries in the cervical and lumbar cord in addition to being more numerous are of larger caliber than those in the thoracic cord. Terminal arterioles do not interconnect within the spinal cord but give rise to interlocking capillary networks, which are more numerous in the gray than in the white matter. Arteries in the lateral columns are elongated with flattening of the spinal cord due to a space-occupying lesion. Correlation of the distortion of the small vessels with various types of spinal cord displacement is described.
Red cerebral veins and the cerebral steal syndrome
Authors: Feindel William , Yamamoto Y. Lucas , Hodge Charles P.
Published: May 2009

✓ The circulation through an arteriovenous malformation and the microcirculation of the surrounding brain were examined during craniotomy by fluorescein angiography and by microregional blood flow measurements using xenon133 and Neohydrin-Hg197. The evidence indicates that occluding the arterial supply to the angioma obliterated the cerebral steal by reducing the shunt or non-nutritional flow and improving the perfusion flow through the cortical microcirculation. The features characterizing the cerebral steal syndrome are described.
The infratentorial supracerebellar approach to pineal lesions
Authors: Stein Bennett M.
Published: May 2009

✓ In six patients with pineal tumors, a posterior fossa approach was used to explore the pineal region. This approach avoided the deep venous system and led to no mortality and minimal morbidity. Because a certain percentage of pineal lesions are benign and amenable to resection, it is recommended that all pineal tumors be explored prior to a decision regarding radiotherapy.
Brain death
Authors: Mohandas A. , Chou Shelley N.
Published: May 2009

✓ “Brain death” was analyzed in 25 moribund patients with regard to the clinical evaluation of the patients and the significance of segmental reflexes and electroencephalographic recordings. It is concluded that a state of brain death in a patient with known irreparable pathology can be established solely on clinical grounds.
Cerebral chromoblastomycosis
Authors: Musella Rosario A. , Collins George H.
Published: May 2009

✓ This report describes the fifth known case of cerebral chromoblastomycosis occurring in the United States. Because of the prior occurrence of a nocardial brain abscess and the demonstration of immunologic deficiency, it is assumed that some defect of the immune response may have been contributory.
Arterial vascularization of the spinal cord
Authors: Lazorthes Guy , Gouaze Andrè , Zadeh Jean O. , Jacques Santini Jean , Lazorthes Yves , Burdin Phillipe
Published: May 2009

✓ This study of the arterial blood of the spinal cord indicates that, of the 62 radicular branches (rami radiculares), at the most seven or eight truly participate in the vascularization of the spinal cord. The authors have observed that the situation and distribution of these branches enable the distinction of three large arterial areas: cervicothoracic, midthoracic, and thoracolumbar. The fixed nature of the intramedullary arterial distribution contrasts with the variability of the afferent arterial supplies. No demarcation permits separation of the vascularization of the spinal cord into anterior and posterior parts. The anastomotic systems situated on the arterial pathways are potentially valuable, but their functioning is problematical. The anterior spinal artery is not continuous, for in the midthoracic region there exists a critical narrow zone. The perimedullary anastomotic system appears insufficient while intramedullary anastomoses are without functional value.
Microangiographic study of experimental spinal cord injuries
Authors: Fairholm David J. , Turnbull Ian M.
Published: May 2009

✓ The pathology of spinal cord injury has been studied in 34 rabbits and 5 dogs with attention focused on the condition of the microvasculature during the evolution of neuronal and axonal degeneration and necrosis. The animals were killed and perfused arterially with colloidal barium from 10 min to 14 days after a controlled spinal injury. Microradiographs of the injured tissues were obtained and compared with corresponding histological sections. Microangiography at 7 to 14 days defines two zones in the injured spinal cord. Zone 1 is located in the posterocentral part of the cord. Capillaries in this region progressively lose their ability to conduct blood and perfusate over the first 4 hours. Degenerative changes in neurons are visible by 1 hour after injury. Necrosis of all elements including capillaries ensues. Zone 2 surrounds Zone 1. Microvascular patterns are normal in Zone 2 although neuronal and axonal degeneration is severe. Pericapillary hemorrhages which occur as early as 10 min after injury in Zone 1 and become progressively larger over the first 4 hours seldom are seen in Zone 2. The evidence indicates that at all times in the pathogenesis of spinal cord injury the microvasculature in Zone 2 is capable of perfusion. Degeneration of neural structures either precedes microvascular breakdown (Zone 1) or occurs in the absence of microvascular disruption (Zone 2). Recovery of damaged neurons and axons depends upon a preserved microcirculation.
Angiographic demonstration of brain injury without significant mass lesion
Authors: Kindt Glenn W. , Gabrielsen Trygve O.
Published: May 2009

✓ Evidence of brain damage was demonstrated in two patients without significant mass lesions by the presence of early venous filling and abnormal contrast staining. The vascular changes were most prominent on subtraction films. It is likely that these angiograms demonstrated the “luxury perfusion” phenomenon described previously in areas of damaged brain.
The deposition of Hg203-chlormerodrin in experimental brain tumors
Authors: Kobayashi Tatsuya , Bakay Louis , Lee Joseph C.
Published: May 2009

✓ The deposition of Hg203-chlormerodrin was studied in intracranial tumors in mice induced by implantation of 20-methyl cholanthrene by tissue assay, as well as light microscopic and electron microscopic autoradiography. The investigations were carried out in astrocytomas, glioblastomas, and meningeal tumors. The chlormerodrin content of the tumors exceeded that of normal brain with a significant tumor/brain ratio ranging from 5.8 to 22.5. It was found that the chlormerodrin molecule becomes rapidly incorporated in the tumor cells, with a preference for that portion of the cytoplasm associated with the vacuolar system.
Pre- and postoperative electromyographic evaluations in the carpal tunnel syndrome
Authors: Schlagenhauff Reinhold E. , Glasauer Franz E.
Published: May 2009

✓ Twenty-five cases of carpal tunnel syndrome in 20 patients were evaluated preoperatively and postoperatively by electromyography. Clinical improvement resulted in all cases following decompression of the median nerve, and only in a few instances did mild symptoms persist. Distal motor conduction time improved postoperatively in 24 cases studied, 19 of which returned to normal range. Most of the obvious improvement occurred within the first 3 months, and further improvement could be observed as late as 36 months. Although no definite correlation could be established between the preoperative severity of the carpal tunnel syndrome and the postoperative clinical and electrical improvement, there was a definite evidence of better recovery in the younger age group. There was a greater range of improvement and a return closer to normal postoperatively in cases with severe preoperative distal latency. All cases examined after 24 months had reached normal values.
Dysphagia secondary to anterior cervical osteophytes
Authors: Tanabe Calvin T. , Hill Curtis L.
Published: May 2009

✓ Two cases of dysphagia secondary to anterior cervical osteophytes were successfully treated at the University of Oregon Medical School by surgical excision of the osteophytes. In both cases the cervical osteophytes caused mechanical obstruction to deglutition by esophageal compression. Postoperative x-ray examination confirmed relief of obstruction. Related cases, clinical features, diagnostic steps, and possible mechanisms are discussed.
An internal shunt for use in the reconstruction of dural venous sinuses
Authors: Kapp John P. , Gielchinsky Isaac , Petty Clayton , McClure Claude
Published: May 2009

✓ A technique is described for construction and use of an internal shunt which provides hemostasis and permits blood flow through the injured sinus during the period of repair. An illustrative case is presented.
A soluble internal splint for experimental vascular anastomosis
Authors: Suzuki Jiro , Onuma Takehide
Published: May 2009

✓ The authors have developed, in dogs, a nonsuture vascular anastomosis utilizing plastic adhesive and a water-soluble spindle tube composed of 80% saccharose, 16% glucose, and 4% dextrin. The patency rate of end-to-end arterial anastomosis was 70% in arteries with an external diameter of 2.5 to 4.0 mm. The device is easily applied, saves time, and does not require any special instruments.
Multiple supratentorial hemangioblastomas
Authors: Ishwar Shakuntla , Taniguchi Raymond M. , Vogel F. Stephen
Published: May 2009

✓ Multiple hemangioblastomas were found above the tentorium in a 62-year-old woman who first had a discrete 2.5 cm tumor removed from the superior aspect of the tentorium adjacent to the falx, and 2 years later developed two more intracranial mass lesions, one in the right parietal area, the other attached to the dura of the right frontal fossa. Histological examination of all three tumors showed precisely the same well-differentiated morphology of hemangioblastoma. Foci of extramedullary hematopoiesis were present within them. Electron microscopic examination of the last two lesions disclosed secretory granules within the tumor cells, indicative of erythropoietin production, as described previously in a hemangioblastoma. Collagen and endothelial cells were not present in quantities consistent with an angioblastic meningioma. The genesis of hemangioblastomas is discussed.
Surgical treatment of cerebral metastases from lung cancer
Authors: MacGee Edwin E.
Published: May 2009

✓ Results in 27 cases of intracranial surgery for metastatic lung cancer are evaluated with regard to both the quality and duration of survival; 56% of the patients lived more than 1 year, with the longest survivor still living 32 months after operation. The operative mortality was 26%. These data suggest that intracranial surgery is worthwhile in patients with lung cancer when the cerebral metastasis is either solitary or single.
Communicating hydrocephalus associated with deficient dysplastic parasagittal arachnoidal granulations
Authors: Gilles Floyd H. , Davidson Robin I.
Published: May 2009

✓ Marked diminution of arachnoidal granulations with abnormality of those remaining is presented as a cause of communicating hydrocephalus in two children. Although this underlying abnormality has been alluded to in the past, it has not been adequately documented. The authors believe their observations constitute sufficient evidence to warrant consideration of this entity as one of the causes of communicating hydrocephalus.
Lumboperitoneal shunts
Authors: Eisenberg Howard M. , Davidson Robin I. , Shillito John
Published: May 2009

✓ A series of 34 lumboperitoneal shunts performed at Children's Hospital Medical Center, Boston, for communicating hydrocephalus is reviewed. The ease of placement and revision of this shunt, the relatively benign complications that occurred, and the fact that 21 of these 34 patients are still using lumboperitoneal shunts with good control of the hydrocephalus have justified continuing use of this method as the initial bypass procedure in the treatment of communicating hydrocephalus.
Experimental extravascular surface-cooling of the brain stem, fourth ventricle, and high cervical spinal cord
Authors: Selker Robert G.
Published: May 2009

✓ Fifteen dogs were subjected to suboccipital craniectomy and cervical laminectomy for the purpose of irrigating the spinal cord and floor of the fourth ventricle with iced saline solution. No significant respiratory or cardiovascular dysfunction was noted. It is believed that this technique may be of value in reversing traumatic edema in higher centers of the central nervous system, and that well-maintained levels of oxygen tension as measured peripherally are beneficial to any insult of the central nervous system.
Prognosis for patients with nonsurgically-treated aneurysms
Authors: Graf Carl J.
Published: May 2009

✓ The clinical review of this large series of patients with aneurysmal subarachnoid hemorrhage has revealed that the prognosis, with surgical or nonsurgical treatment, is related to several factors, but most significantly to the condition of the patient 1 day after hemorrhage. Autopsy study indicates that the prognosis for patients with unsuspected or “incidental” unruptured aneurysms is better than could be expected with surgical treatment.
A computerized echoencephalograph
Authors: Galicich Joseph H. , Williams John B.
Published: May 2009

✓ A new echoencephalograph is described which automates the measurement of midline shifts. A built-in digital computer identifies echo patterns, performs all calculations, and indicates midline shift directly in millimeters, allowing a graphic record to be made of many, rapid, individual echo determinations.
Neonatal intracranial choriocarcinoma
Authors: Kelly David L. , Kushner Jack , McLean William T.
Published: May 2009

✓ A case is reported of a newborn child whose predominant lesion was a metastatic choriocarcinoma of the brain. The outstanding features of the clinical course were repeated episodes of intracranial and subgaleal hemorrhage. Angiograms revealed large areas of pooling of contrast medium without neovascularization or rapid venous drainage. A review of the literature demonstrated the infrequency with which this lesion has been encountered.
Massive cerebral Aspergillus abscess in a leukemic child
Authors: Amromin George D. , Gildenhorn Vivian B.
Published: May 2009

✓ A case of a massive destructive intracerebral Aspergillus abscess in a leukemic child, treated with immunorepressive drugs, is described.
Coup and contre-coup injury: observations on the mechanics of visible brain injuries in the rhesus monkey
Authors: Ommaya Ayub K. , Grubb Robert L. , Naumann Ronald A.
Published: May 2009

✓ The distribution of coup and contre-coup contusions and subdural hematomas after frontal and occipital impacts has been studied in the rhesus monkey. The effect of skull fracture on these lesions is noted, and the data compared to known postmortem observations in man. The translation/cavitation theory for brain injury as presently conceived is not supported by these data. The skull distortion and head rotation hypothesis offers opportunities for developing a better theory for brain injury by direct as well as indirect impact. The significance of these observations for design of protective devices is briefly discussed.
Relative susceptibility of elements of the cerebral cortex to mechanical trauma in the rat
Authors: Epstein Melvin H.
Published: May 2009

✓ A model system for the study of trauma to elements of the central nervous system is described. It consists of floating samples of cortex (1 mm3) in nutrient medium. After variable amounts of trauma the cortical samples are allowed to grow in tissue culture, or their individual cytoarchitectonic layers are studied metabolically in the Cartesian diver. The results indicate that neurons are the most labile cellular elements when the cerebral cortex is exposed to mechanical trauma. The glia are the next most vulnerable to damage while the fibroblastic series are highly resistant to concussive forces.
Acetylcholine and experimental brain injury
Authors: Metz Bernard
Published: May 2009

✓ Anesthetized dogs were subjected to a blow directly on the cerebral cortical surface. As measured by perfusion studies via push-pull cannulae, at the site of trauma within 20 min there was a significant increase in acetylcholine (ACh) released from the cerebral cortical cells, which rose progressively until a plateau was reached in about 1 hour. Concomitantly, ACh appeared within the cerebrospinal fluid (CSF) within 40 min after the injury. In addition, as monitored by the ACh liberation, the injured cells were apparently unable to respond functionally to a subcortical stimulus for several hours after the trauma. These studies support the hypothesis that ACh is released from the mechanically damaged cells, and then subsequently leaks into the CSF. The evidence suggests that a cholinergic factor may be significant in brain injury.
Supratentorial epidural pressure recorded during posterior fossa surgery
Authors: Nornes Helge , Magnæs Björn
Published: May 2009

✓ Supratentorial epidural pressure (EDP) was recorded during posterior fossa surgery in 14 patients. It was found that the operative position had great influence on the supratentorial EDP and that a correct position, especially of the head, was important in the control of the intracranial pressure. Rapid and extensive ventricular drainage may set up a secondary rise in pressure and must be avoided. Craniectomy alone did not have any definite decompressive effect as judged from the EDP. Splitting of the dura or resection of a tumor usually resulted in a fall in the EDP in patients with previously increased pressure. Inadequate ventilation as well as hyperventilation was rapidly manifested through variations in the EDP. EDP monitoring combined with single determinations of PaCO2 was a valuable guide in securing adequate ventilation.
Excision of pineal tumors
Authors: Jamieson Kenneth G.
Published: May 2009

✓ The successful excision of six pineal tumors is reported. A modification of the technique recommended by Poppen was used and is described.
Ruptured intracranial aneurysms in the first two decades of life
Authors: Patel Aneel N. , Richardson Alan E.
Published: May 2009

✓ An analysis of 3000 ruptured intracranial aneurysms revealed 58 cases in patients under the age of 19 years. There was a striking incidence of aneurysms of the carotid termination and anterior cerebral complex, accounting for 43 of 58 cases, and of these 20 involved the terminal portion of the carotid artery. Vasospasm occurred slightly less often than in adults and infarction was only seen in one postmortem examination. The surgical mortality in alert patients was 7% whereas in a comparable bedrest group it was 38%. This good tolerance to surgery was evident whether intracranial operation or carotid ligation was used, but the surgical method was not randomly allocated.
Neurological involvement in the nevoid basal cell carcinoma syndrome
Authors: Neblett Charles R. , Waltz Thomas A. , Anderson David E.
Published: May 2009

✓ Four patients who had medulloblastomas in association with the nevoid basal cell carcinoma syndrome are reported, for a total of six known cases. Involvement of the central nervous system appears to be an integral component of this syndrome. The medulloblastoma appear earlier in life (50% of the patients are less than 2 years old), and the prognosis appears to be better (five of the six are still living). Possible reasons for these features are considered, and other associated abnormalities are discussed.
Intracranial aneurysm on a persistent primitive trigeminal artery
Authors: George Ajax E. , Lin Joseph P. , Morantz Robert A.
Published: May 2009

✓ The angiographic demonstration of a rare case of persistent trigeminal artery aneurysm is reported. The incidence of persistent trigeminal artery in the authors' series is 0.6%. Approximately 14% of patients with a persistent trigeminal artery also have an intracranial aneurysm. The embryology involved and related cases are reviewed.
Chondroblastoma of the skull
Authors: Cares Herbert L. , Terplan Kornel
Published: May 2009

✓ A case of benign chondroblastoma of the skull is described with respect to its clinical presentation, roentgenographic appearance, gross and microscopic characteristics, surgical treatment, and therapeutic result. Theories of pathogenesis and the relationship of chondroblastoma to ordinary giant cell tumors are discussed.
Past personalities and present problems
Authors: MacCarty Collin S.
Published: May 2009

✓ The president of the AANS relates anecdotes based on the friendship between Harvey Cushing and the Mayo brothers. He discusses and reproduces unfamiliar letters from Dr. Cushing to Dr. William C. MacCarty, the president's father. He also discusses selected contemporary neurosurgical problems such as malpractice suits and fragmentation within the specialty.
Experimental epsilon-aminocaproic acid (EACA) administration in the presence of subarachnoid blood
Authors: Ewald Tom , Mahaley Steve , Goodrich Jack , Wilkinson Robert , Silver Don
Published: May 2009

✓ Epsilon-aminocaproic acid (EACA) was administered to dogs intrathecally, orally, or intravenously with blood present in the subarachnoid space. These animals were compared with appropriate controls with regard to the subsequent transport of intrathecally injected radioactive albumin from cerebrospinal fluid (CSF) to the blood and the presence of hydrocephalus or adhesive arachnoiditis at the various times of sacrifice. An adhesive arachnoiditis sufficient to produce hydrocephalus or a delay in CSF protein effluence was not observed. The administration of EACA to dogs in the presence of subarachnoid blood did not appear to be associated with any deleterious effects.
Effects of subarachnoid hemorrhage from puncture of the middle cerebral artery on blood flow and vasculature of the cerebral cortex in the cat
Authors: Yamaguchi Takenori , Waltz Arthur G.
Published: May 2009

✓ Bilateral measurements of regional cortical blood flow (CBF) and the diameter of superficial cortical arteries were made before and after puncture of the right middle cerebral arteries (MCA) of 11 cats with bilateral craniectomies. The CBF was decreased in the right cerebral hemispheres before puncture, probably because of manipulation and exposure of the MCA. Decreases of CBF occurred after MCA puncture in the contralateral cerebral hemispheres of five of seven animals without subarachnoid blood over the convexities of the hemispheres. The mean CBF value for the contralateral hemispheres was significantly lower after puncture than before. There was no consistent relationship between CBF and the calibers of surface cortical arteries. Thus, basal subarachnoid bleeding can cause decreases of CBF of the cerebral hemispheres, probably because of basal arterial spasm associated, at times, with vasomotor paralysis and failure of autoregulatory responses. If combined with increases of intracranial pressure, such decreases of CBF may be adequate to produce cerebral ischemia.
Two types of curves for transfer of RIHSA from cerebrospinal fluid to plasma in patients with normal pressure hydrocephalus
Authors: Behrman Simon , Cast Ian , O'Gorman P.
Published: May 2009

✓ Adult patients suffering from progressive dementia and showing enlargement of cerebral ventricles without elevation of cerebrospinal fluid (CSF) pressure received intrathecal injections of radioisotopes. By plotting subsequent blood radioactivity at intervals, two types of curves were obtained. Group A showed a rapid rise of activity followed by a high plateau; Group B showed a slow but continuous rise of activity. In patients in whom intrathecal radioisotope scans were also performed, the concentration of radioactivity was mainly sagittal in Group A, whereas ventricular radioactivity persisted in Group B. It is proposed that the diminished rate of transfer in Group B is due to either diminished rate of absorption or of formation of CSF, or both. The estimation of the rate of transfer of isotope from CSF to plasma provides a supplementary aid in the diagnosis of normal-pressure hydrocephalus.
Ventriculoauriculostomy-associated infection
Authors: Shurtleff David B. , Christie Dennis , Foltz Eldon L.
Published: May 2009

✓ A series of 102 newly referred and uninfected patients on whom 299 operative procedures to insert ventriculoauricular cerebrospinal fluid shunts were performed over a 12-year period were studied for the rate and cause of associated sepsis. It was found that 15.7% of the shunt insertions were followed by infection, and 1.3% of the revisions, for an overall infection rate of 14%. There were two clinical groups, those who developed acute postoperative infections (9%) and those with delayed infections developing 1 month to 6 years after operation (5%). The causes of the infections are discussed. It is suggested that careful follow-up with frequent blood cultures will reveal more infected cases in the delayed group, and that bacteriocidal agents selected for the specific organism should be maintained in cerebrospinal fluid and blood for long periods.
Pericardial tamponade by Holter ventriculoatrial shunts
Authors: Tsingoglou Stavros , Eckstein Herbert B.
Published: May 2009

✓ Ten cases of cardiac tamponade caused by pericardial perforation by a Holter catheter in the treatment of hydrocephalus by ventriculoatrial drainage are reported. These 10 cases occurred in an 8-year practice of two surgeons in a period during which approximately 1800 Holter shunts were inserted and an approximately equal number of operations for lengthening of the distal catheter were performed. The etiological factors, the clinical picture, and the diagnosis are discussed. Cardiac perforation is caused either by forceful introduction of the distal catheter during a shunt revision procedure or by too long a distal catheter that ulcerates through the cardiac wall. Enlargement of cardiac silhouette after shunt insertion is virtually diagnostic of a pericardial effusion. If undiagnosed, this condition was invariably fatal, but if diagnosed in time, immediate treatment was always curative. The distal catheter should be shortened, but suture of the cardiac perforation itself is not necessary.
Pathological findings in acute experimental spinal cord trauma
Authors: Ducker Thomas B. , Kindt Glenn W. , Kempe Ludwig G.
Published: May 2009

✓ This study shows that spinal cord pathology secondary to acute trauma in monkeys evolves with stepwise sequential changes. The acute damage is more central than peripheral. Depending on the amount of trauma, the subacute damage may be limited to central gray necrosis or may progress or evolve to include the neighboring white matter. These pathological changes may be taking place even in the presence of clinical improvement.
Galactorrhea in males with tumors in the region of the pituitary gland
Authors: Finn James E. , Mount Lester A.
Published: May 2009

✓ The pathophysiology of galactorrhea in males with pituitary tumors is discussed, two cases are presented, and previously-reported cases are reviewed. Hypersecretion of prolactin is probably the basis for the galactorrhea. Prolactin may be secreted by the tumor itself, or the remaining normal pituitary tissue may oversecrete if the hypothalamus or the pituitary stalk is compressed.
Treatment of multiple intracranial aneurysms
Authors: Mount Lester A. , Brisman Ronald
Published: May 2009

✓ The authors report a series of 70 patients with 161 multiple intracranial aneurysms. There was no mortality in 23 patients in whom all aneurysms were treated intracranially. Unoperated aneurysms later caused morbidity or mortality in eight of 33 patients. The authors believe that patients who have had a subarachnoid hemorrhage should have four-vessel arteriography to identify all aneurysms, and that all surgically accessible aneurysms should be treated, preferably intracranially in good-risk patients who have no disabling neurological deficit.
Ectopic pinealoma in the region of the optic chiasm
Authors: Kageyama Naoki
Published: May 2009

✓ Five cases of ectopic pinealoma in the chiasmal region are reported and the clinical characteristics emphasized. These include diabetes insipidus, hypopituitarism, visual defects, plus normal skull films and intracranial pressure. Microscopic studies of autopsy and surgical specimens show that visual disturbance is caused by destruction of the optic nerve or chiasm by tumor infiltration. Four patients received cobalt-60 radiotherapy and are healthy 6 to 10 years later.
Experience with brain abscesses
Authors: Carey Michael E. , Chou Shelley N. , French Lyle A.
Published: May 2009

✓ Eighty-six patients with brain abscesses were seen at the University of Minnesota Hospitals from 1946–1965, and 46 died, a 53% mortality. Multiple and brain stem abscesses accounted for several fatalities, while delayed and missed diagnosis accounted for one third of the deaths. Evidence of infection was often minimal in patients with brain abscess. Lumbar puncture as a diagnostic tool was inaccurate and occasionally fatal. Brain scan, electroencephalography, and angiography were the best diagnostic tests. Drainage and excision were each associated with approximately a 20% mortality. The most pertinent correlation regarding treatment, however, was that of increasing mortality with deteriorating preoperative neurological status. Postoperative deaths were due to failure in locating the abscess at surgery or untoward events such as cerebritis, edema, or excessive bleeding at the operative site.
Acute spinal cord compression paralysis
Authors: Tarlov Isadore M.
Published: May 2009

✓ The author believes that mechanical deformation rather than anoxia causes spinal cord compression paralysis. The outlook for recovery of function is therefore better than it would be if anoxia were the cause. Recovery from immediate complete sensorimotor paralysis with spinal subarachnoid block may occur if laminectomy is prompt. Patients suffering from incomplete compressive sensorimotor paralysis may recover without laminectomy, which should be done only if there is no improvement or progressive loss of function in spite of conservative treatment. The preservation of pain sensation in patients with motor paralysis following acute cord compression is a favorable prognostic sign.
The effects of prostaglandins E1, A1, and F2a on the cerebral circulation of dogs and monkeys
Authors: Denton Ira C. , White Richard P. , Robertson James T.
Published: May 2009

✓ Alterations in cerebrovascular tone caused by the intracarotid administration of prostaglandin E1, A1, and F2a were evaluated by means of a standard perfusion technique in dogs and monkeys. Only PGF2a evoked a selective increase in cerebrovascular tone. This effect was observed in both species and resembled the action of serotonin. On the other hand, prostaglandin E1 selectively reduced cerebrovascular tone in dogs, but had no such specific action in the monkey. Prostaglandin A1 lacked a specific influence on the cerebral circulation of either species. Since different prostaglandins produced specific and diametrically opposite effects on cerebral circulation, these substances may be useful in experimental studies of vasospasm, and may normally influence cerebrovascular tone.
Craniocerebral missile injuries in the monkey: an experimental physiological model
Authors: Gerber Arthur M. , Moody Robert A.
Published: May 2009

✓ Experiments were carried out on rhesus monkeys to determine what physiological parameters were most closely correlated with death due to craniocerebral missile injuries. Observations of intracranial pressure, blood pressure, carotid flow, blood gases, respiratory rate, depth and volume, and electroencephalograms were made. These parameters were compared in survivors and nonsurvivors as were the pathological injuries. The most important single parameter that correlated with death was the drop in carotid flow. As this same correlation has been observed in epidural compression experiments in the monkey, there is a strong suspicion that reduced blood flow to the brain as measured by carotid flow is a common factor in craniocerebral missile injuries and epidural compression injuries.