bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine
Authors: Harrington Kevin D.
Published: May 2009

✓ Metastatic lesions involving the spine may cause vertebral body collapse, resulting in either spinal instability or neural compression, or both. Progressive destruction of the vertebral body by the tumor may cause increasing spinal instability, leading to a kyphotic deformity and further neural deficit. Anterior decompression allows direct excision of the tumor focus and direct neural decompression. Because of postoperative irradiation, conventional bone grafts are rarely incorporated.

Over an 8-year period, 52 patients with spinal instability secondary to metastatic pathological fractures of one or more vertebrae underwent anterior decompression and stabilization by replacement of the affected vertebral bodies with methyl methacrylate, polymerizing in situ. No postoperative external support was required, and the acrylic fixation achieved by this method was not affected adversely by subsequent irradiation to a mean of 4020 rads. Forty patients had major neurological impairment preoperatively and required anterior spinal cord and/or nerve root decompression prior to fixation. Of these, 21 had complete neurological recovery postoperatively, 13 others were improved significantly, five remain unchanged, and one patient deteriorated neurologically. There were three cases with failure of fixation. Seven other patients did not benefit from the procedure because of specific complications or the advanced state of their disease. The remaining 42 patients had good relief of pain and restoration of spinal stability, which did not deteriorate during the follow-up period, ranging from 6 to 100 months postoperatively.
Effect of acute spinal cord injury on axonal counts in the pyramidal tract of rats
Authors: Tator Charles H. , Rivlin Alex S. , Lewis Anthony J. , Schmoll Beatrice
Published: May 2009

✓ The concentration of axons in the pyramidal tract of normal and spinal cord-injured rats was determined by counting axons in sections of spinal cord stained by the Holmes technique. In the normal rat the axon concentration was uniform in the cervical, thoracic, and lumbar regions, although the size of the tract diminished progressively with its descent in the cord. After acute cord transection or compression injury, the axon concentration distal to the injury site diminished markedly. However, an appreciable number of distal axons persisted after injury, due to either delayed degeneration or to the presence of an admixture of afferent fibers. The axonal counting technique developed in this study should be helpful in experiments on spinal cord injury and regeneration.
Effects of a single large dose of methylprednisolone sodium succinate on experimental posttraumatic spinal cord ischemia
Authors: Hall Edward D. , Wolf Daniel L. , Braughler J. Mark
Published: May 2009

✓ The ability of a single large intravenous dose of methylprednisolone sodium succinate (MPSS: 15, 30, or 60 mg/kg) to modify the evolution of lumbar spinal cord ischemia in cats undergoing a contusion injury of 500 gm-cm is examined. Repeated measurements of spinal cord blood flow (SCBF) in the dorsolateral funiculus were made via the hydrogen clearance technique before and for 4 to 5 hours after injury. The mean preinjury SCBF for all animals was 12.29 ± 0.77 ml/100 gm/min. Following injury, SCBF began to decrease progressively in vehicle-treated animals to a level of 7.71 ml/100 gm/min, a fall of 37.3%. In contrast, cats that received a 30-mg/kg intravenous dose of MPSS at 30 minutes after injury maintained SCBF within normal limits (p < 0.05 at 3 and 4 hours after contusion). A 15-mg/kg MPSS dose was less effective at preventing posttraumatic white matter ischemia, and a 60-mg/kg dose was essentially ineffective.

It was determined that the 30-mg/kg MPSS dose was optimal for supporting SCBF when the drug was given at 30 minutes after spinal trauma, and a second series of experiments was carried out to examine the ability of this dose, when given at longer latencies, to improve decreased flow. Methylprednisolone given at 1½ hours after injury in four cats produced a slight (12.7%) but transient improvement in SCBF, and when administered at 4½ hours in another three animals was totally ineffective. These results show that MPSS in a 30-mg/kg dose can prevent posttraumatic spinal cord ischemia. However, it would appear that the ability of the steroid to reverse the ischemia once it has developed is limited, and probably lost, within a few hours of onset. This further suggests that the ischemic process is irreversible and underscores the need for early treatment with a large MPSS dose in order to prevent full development of ischemia and to promote neurological recovery.
Benign tumors of the foramen magnum
Authors: Meyer Fredric B. , Ebersold Michael J. , Reese David F.
Published: May 2009

✓ The authors reviewed 102 documented cases of benign extramedullary tumors of the foramen magnum treated at their institution between 1924 and 1982. There was 78 meningiomas, 23 neurofibromas, and one teratoma. Approximately 40% of the patients had a normal neurological examination upon first evaluation. The most frequent presenting complaints were suboccipital neck pain, dysesthesias, gait disturbances, weakness, and hand clumsiness. The average time from initial symptoms to diagnosis was 2¼ years. The most common findings included hyperreflexia, arm or hand weakness, Babinski sign, spastic gait, sensory loss, and 11th cranial nerve involvement. Based on these cases, an attempt is made to distinguish foramen magnum tumors from other disease entities by a grouping of signs and symptoms. There is no clinical finding that is pathognomonic. Metrizamide computerized tomography scanning and Pantopaque myelography have been the radiographic tests most commonly used to evaluate the foramen magnum. Recent experience suggests that nuclear magnetic resonance scanning will be a very useful noninvasive means of evaluating the foramen magnum region.
Spontaneous cervical epidural hematoma
Authors: Beatty Robert M. , Winston Ken R.
Published: May 2009

✓ The medical literature relating to spontaneous cervical epidural hematoma has been reviewed, and two new cases have been added. In total, 43 cases have been analyzed in detail, and the authors present some new hypotheses as to the pathophysiology of this disorder.
Multiple cerebral hemorrhages following chymopapain chemonucleolysis
Authors: Davis Reginald J. , North Richard B. , Campbell James N. , Suss Richard A.
Published: May 2009

✓ A case of multiple cerebral hemorrhages following chymopapain chemonucleolysis is reported. The authors believe the probable etiology was intrathecal extravasation of chymopapain after injection of the drug into a lumbar disc space.
Subhyaloid hemorrhage in Haemophilus meningitis
Authors: Campbell Donald A. , Roberts Paul , Shaw Malcolm D. M.
Published: May 2009

✓ A very rare case of subhyaloid hemorrhage, caused by Haemophilus meningitis, is presented and discussed.
Cerebrospinal fluid ascites complicating ventriculoperitoneal shunting
Authors: Yount Robert A. , Glazier Mark C. , Mealey John , Kalsbeck John E.
Published: May 2009

✓ Four cases of cerebrospinal fluid (CSF) ascites secondary to ventriculoperitoneal shunting are described. It is possible to differentiate CSF ascites from a CSF-filled pseudocyst by the characteristic bowel gas pattern on films of the abdomen and by the presence of shifting dullness. Two of the patients had active shunt infections, and had ascitic fluid with a protein level greater than 3 gm% and a white blood cell (WBC) count greater than 1000/cu mm. Both were treated successfully with antibiotics and removal of the shunt from the peritoneum. Two other patients had no evidence of infection, protein levels of less than 2 gm%, and WBC count less than 100 cu mm. These disorders resolved spontaneously. A review of 18 cases reported in the literature shows thatthe etiology of CSF ascites in the absence of shunt infection is multifactorial, and no features are consistently present in all cases. Ascites without infection may resolve spontaneously without surgical intervention.
Anterior sacral meningocele contiguous with a pelvic hamartoma
Authors: Leibowitz Eugene , Barton William , Sadighi Parvis , Ross Jeffrey S.
Published: May 2009

✓ A patient with an anterior sacral meningocele combined with a hamartoma was diagnosed with x-ray films, myelography, and computerized tomography. She was successfully operated on by a transabdominal approach.
Cerebral blood flow and metabolism in comatose patients with acute head injury
Authors: Obrist Walter D. , Langfitt Thomas W. , Jaggi Jurg L. , Cruz Julio , Gennarelli Thomas A.
Published: May 2009

✓ Cerebral blood flow (CBF) measurements were made in 75 adult patients with closed head injuries (mean Glasgow Coma Scale score 6.2), using the xenon-133 intravenous injection method with eight detectors over each hemisphere. All patients were studied acutely within 96 hours of trauma, and repeatedly observed until death or recovery (total of 361 examinations). Arteriojugular venous oxygen differences (AVDO2) were obtained in 55 of the patients, which permitted assessment of the balance between metabolism and blood flow, and provided estimates of cerebral metabolic rate for oxygen (CMRO2).

Based on mean regional CBF, the patients were classified into two groups: those who exhibited hyperemia on one or more examinations, and those who had a consistently reduced flow during their acute illness. “Hyperemia” was defined as a normal or supernormal CBF in the presence of coma, a definition that was independently confirmed by narrow AVDO2's indicative of “luxury perfusion.” During coma, all patients showed a significant depression in CMRO2.

Forty-one patients (55%) developed an acute hyperemia with an average duration of 3 days, while 34 patients (45%) consistently had subnormal flows. Although more prevalent in younger patients, hyperemia was found at all age levels (15 to 85 years). There was a highly significant association between hyperemia and the occurrence of intracranial hypertension, defined as an intracranial pressure above 20 mm Hg. Patients with reduced flow showed little or no evidence of global cerebral ischemia, but instead revealed the expected coupling of CBF and metabolism. The CBF responses to hyperventilation were generally preserved, with the hyperemic patients being slightly more reactive. In 10 patients with reduced flow, hyperventilation resulted in wide AVDO2's suggestive of ischemia.
Assessing the influence of non-treatment variables in a study of outcome from severe head injuries
Authors: Lokkeberg A. Russell , Grimes Richard M.
Published: May 2009

✓ An evaluation was made of the impact of non-treatment variables on severely injured head trauma patients. The principal findings were: 1) severity of injury was the best predictor of outcome; 2) patient's age had a statistically significant but marginally useful impact on outcome; 3) a regression analysis showed that duration of transport, up to 4 hours, had no impact on outcome; 4) time from accident to intubation had a marginal impact on outcome; and 5) one-way analysis of variance showed that mode of transportation, whether helicopter, ambulance, or other means had no impact on outcome.
Effects of multi-dose methylprednisolone sodium succinate administration on injured cat spinal cord neurofilament degradation and energy metabolism
Authors: Braughler J. Mark , Hall Edward D.
Published: May 2009

✓ Thirty minutes after experimental spinal cord contusion (500 gm-cm) injury, cats were treated with an initial intravenous dose of either vehicle (V) or 30 mg/kg of Solu-Medrol sterile powder (methylprednisolone sodium succinate; MPSS). Two hours later, cats received a second intravenous injection of either V or 15 mg/kg MPSS, giving three treatment groups: V/V; MPSS/V; MPSS/MPSS. At 4½ hours following injury of the cat lumbar spinal cord, the gray and white matter neurofilament protein content was reduced by over 70% within the injured segment of V/V-treated animals. The three major cat spinal cord neurofilament protein subunits of 200,000, 152,000, and 76,000 daltons were reduced in parallel by the injury. Treatment of cats with a single 30-mg/kg dose of MPSS (MPSS/V) provided a clear, although not significant, protection against neurofilament degradation compared with V/V-treated cats when measured at 4½ hours after injury. The lactic acid content of the injured spinal cord segment at 4½ hours after injury was significantly elevated in both V/V- and MPSS/V-treated cats, while the adenosine triphosphate (ATP) content, total adenylates, and energy charge were significantly reduced. The administration of a second intravenous 15-mg/kg dose of MPSS 2 hours after the initial 30-mg/kg dose (MPSS/MPSS) provided complete (p < 0.01) preservation of neurofilaments within the injured spinal cord segment measured at 4½ hours after injury. The levels of lactate, ATP, total adenylates, and tissue energy charge in MPSS/MPSS-treated cats were not different from those of uninjured spinal cords following laminectomy. The (Na+ + K+)-ATPase activity in the injured spinal segment was enhanced, although highly variable, in MPSS/V-treated animals. On the other hand, spinal cord enzyme activity was significantly and consistently elevated in the MPSS/MPSS-treated group. The results demonstrate that a 30-mg/kg dose of MPSS followed at 2 hours by a 15-mg/kg dose provides significantly better protection against injury-induced ischemia and Ca++-dependent neurofilament degradation than a single 30-mg/kg dose. These findings are in agreement with the spinal cord tissue pharmacokinetics and time-action characteristics of methylprednisolone observed in earlier studies.
Cancer pain relief using chronic morphine infusion
Authors: Penn Richard D. , Paice Judith A. , Gottschalk William , Ivankovich Anthony D.
Published: May 2009

✓ Fourteen patients were implanted with drug pumps to provide chronic epidural or intrathecal morphine to relieve pain due to cancer. A new programmable pump was used in seven of the patients and a constant infusion device was used in the other seven patients. Results, judged by subjective pain reports (on a 0 to 10 scale), decrease in oral narcotics, and change in activity level, were excellent in eight patients, good in five patients, and poor in one patient. The programmable device has the obvious advantage of being able to vary dose according to patient need and requires less frequent refilling. Four programmable pump failures occurred, two requiring replacement.
Decreased carotid arterial resistance in cats in response to trigeminal stimulation
Authors: Lambert Geoffrey A. , Bogduk Nikolai , Goadsby Peter J. , Duckworth John W. , Lance James W.
Published: May 2009

✓ Stimulation of the trigeminal nerve or ganglion in the cat caused a frequency-dependent reduction in carotid vascular resistance. Systemic arterial blood pressure (SABP) decreased at low frequencies (0.2 to 5 sec−1) and increased at higher frequencies, thus increasing carotid blood flow at the higher frequencies. The effect on resistance was predominantly ipsilateral and was unaltered by cervical sympathectomy, but was abolished or substantially reduced by section of the trigeminal root proximal to the ganglion. Diminution of carotid vascular resistance was replicated by stimulation of the greater superficial petrosal (GSP) nerve without any change in SABP. Section of the seventh cranial nerve reduced or abolished the response to stimulation of the trigeminal nerve but not that from the GSP nerve. The trigeminal response was prevented by ganglion-blocking drugs in seven out of eight cats. The resistance response was unaffected by noradrenergic, cholinergic, serotonergic, and histamine-2 blocking agents. No neural connection could be demonstrated between the GSP and the trigeminal ganglion, and the vascular response to GSP stimulation persisted after trigeminal section. It is concluded that activation of the trigeminal system increases carotid blood flow by a pathway involving the seventh cranial nerve, the GSP and Vidian nerves, and a parasympathetic synapse employing an unconventional transmitter. A varying proportion of the response (greatest in the third division) may be mediated by antidromic activation of trigeminal nerves. These findings may have clinical implications for the vascular changes of migraine and other facial pain.
Stereotaxic thalamotomy for treatment of posttraumatic movement disorders
Authors: Bullard Dennis E. , Nashold Blaine S.
Published: May 2009

✓ Stereotaxic ventrolateral thalamotomies have been successful in treating a wide spectrum of involuntary movement disorders, but very little has been reported concerning their use in posttraumatic movement disorders (MD's). This procedure has been used to treat 11 patients who developed persistent MD following severe closed head injuries. Among these, seven had action tremors, nine hemiballismic movements, two choreoathetoid movements, and two truncal ataxia. In two patients the MD was significant bilaterally, and in eight patients more than one type of MD was present. Standard thermal lesions based on the middle anterior commissure-posterior commissure line, 10 to 15 mm lateral to the midline, were performed following stimulation. Within the immediate postoperative period, all 11 patients had some degree of improvement in their MD; five showed marked improvement, four moderate improvement, and two minor improvement. One patient had recurrence of the MD 24 hours postoperatively requiring a second procedure, with marked improvement subsequently. In five of the six patients who underwent a left-sided procedure, a transient increase in preoperative dysarthria was noted. Nine patients had follow-up examinations 2 months to 3 years following surgery. Some persistent improvement in the MD was noted in all. Of three patients whose dysarthria was worse at 3 to 4 months, subsequent improvement was noted at 9 to 12 months in two. Stereotaxic thalamotomy appears to be an effective form of treatment for persistent posttraumatic MD. The major limitation is increased postoperative dysarthria. Further studies to evaluate risk factors associated with dysarthria and further refinement to prevent its occurrence are needed.
Experimental normal-pressure hydrocephalus is accompanied by increased transmantle pressure
Authors: Conner E. Scott , Foley Lorraine , Black Peter McL.
Published: May 2009

✓ This research was directed at the pathophysiology of normal-pressure hydrocephalus. The experimental method consisted of accurate and simultaneous measurement of the pressure within the ventricle and over the cerebral convexity in cats with hydrocephalus but normal ventricular pressure. Hydrocephalus was induced by the intracisternal injection of kaolin. Prior to the induction of hydrocephalus, the difference between the ventricular pressure and the pressure over the convexity (the transmantle pressure) was small (0.27 ± 0.31 cm saline, mean ± standard deviation). After the induction of normal-pressure hydrocephalus in seven animals, there was a statistically significant elevation of the transmantle pressure to 3.4 ± 3.9 cm saline (p < 0.05, Student's paired t-test). There was no similar increase in animals injected with lactated Ringer's solution. This finding supports the theory that it is the transmantle pressure, and not the ventricular pressure, that is the physiological determinant of ventricular dilatation. The theory explains why hydrocephalus can develop and persist despite normal ventricular pressure.
Use of porcine dermis as a dural substitute in 72 patients
Authors: O'Neill Padraic , Booth Anthony E.
Published: May 2009

✓ Experience over a 2-year period with the use of porcine dermis as a dural substitute is reported. In this series, porcine dermis was used for dural repair in a total of 72 patients. In a further 28 patients, one of the authors (A.E.B.) used porcine dermis to wrap lumbar nerve roots at the time of surgery for either prolapsed intervertebral disc or extradural lumbar nerve root adhesions. The authors report the advantages of this material which include ready availability and low cost. It is extremely pliable, easy to handle, and can be applied to relatively inaccessible areas. It appears to become rapidly adherent so that suture fixation is frequently not required. No evidence of a foreign-body inflammatory response has been found. No untoward result has been encountered in the 28 patients in whom porcine dermis was used to wrap lumbar nerve roots but it remains too early to show whether this will reduce the incidence of postoperative extradural adhesions.
Experimental transcerebral fistula
Authors: Foltz Eldon , Blanks Jeffrey , Morton Mortimer E.
Published: May 2009

✓ Cerebrospinal fluid dynamics were studied in eight dogs during normal, hydrocephalic, and postoperative phases. Radionuclide-labeled substances introduced into the normal ventricular system flow out of the exits from the fourth ventricle to the convexity subarachnoid spaces superiorly to be absorbed in the sagittal sinus, and basorostrally to the exits from the perineural olfactory sheath into the nose to produce physiological cerebrospinal fluid (CSF) rhinorrhea. Serial radionuclide ventriculography of the head following intraventricular isotope injection of labeled proteins and chelate into the kaolin-induced hydrocephalic system shows a high degree of ventricular stasis with no perineural olfactory nerve flow (rhinorrhea). An operative transcerebral fistula, fashioned from a dilated lateral ventricle to the convexity subarachnoid space, reestablishes perineural olfactory flow of CSF into the nose, as demonstrated by the radionuclide ventriculography studies. This suggests a potential method for treatment of hydrocephalus. Serial imaging studies in this surgically modified system clearly demonstrate radionuclide flow through the patent fistula to distal absorption sites, thereby bypassing the basal obstruction. Moreover, augmented CSF pressures associated with obstructive hydrocephalus can be controlled by such treatment. The application of this method in treating clinical hydrocephalus is discussed with emphasis on fistula arachnoid closure to assure fistula patency.
Melanosis and hydrocephalus
Authors: Humes Richard A. , Roskamp Jacqueline , Eisenbrey Arthur B.
Published: May 2009

✓ Four cases are presented in which hydrocephalus and extensive pigmented lesions of the body coexisted. A related developmental defect is suggested.
Surgical treatment for spontaneous carotid dissection with impending stroke
Authors: Miyamoto Susumu , Kikuchi Haruhiko , Karasawa Jun , Kuriyama Yoshihiro
Published: May 2009

✓ A case of spontaneous carotid artery dissection is presented. In the case described, superficial temporal artery-middle cerebral artery anastomosis was performed because of impending stroke. Surgical revascularization is indicated in a case that shows such a rapid evolution of stroke that spontaneous resolution of the dissection cannot be awaited.
Cavernous sinus fistula caused by intracavernous rupture of a persistent primitive trigeminal artery
Authors: Berger Mitchel S. , Hosobuchi Yoshio
Published: May 2009

✓ A persistent carotid-basilar anastomosis (primitive trigeminal artery), identified by four-vessel vertebral angiography, was shown to be the cause of a cavernous sinus fistula in a 51-year-old woman. The fistula, but not the primitive artery, was identified on a carotid arteriogram. Because of the flow contribution from the posterior circulation, balloon embolization via the carotid system failed, and the fistula was repaired through a direct surgical approach. The operative technique is described and the hemodynamic aspects of a cavernous sinus fistula that is related to this primitive anastomosis are reviewed.
Intracranial solitary chondroma
Authors: Özgen Tunçalp , Pamir M. Necmettin , Akalan Nejat , Bertan Vural , Önol Behsan
Published: May 2009

✓ A patient is described who had a solitary left frontal intracranial chondroma originating from the falx cerebri. The tumor was totally removed. The diagnostic value of computerized tomography and the surgical findings in this rare pathological condition are discussed.
Alternative to tarsorrhaphy in peripheral facial nerve palsy with expectation of functional recovery
Authors: Fernandez Eduardo , Pallini Roberto , Maira Giulio
Published: May 2009

✓ A simple technique is described for protecting the cornea in patients with peripheral facial nerve palsy while waiting for recovery of nerve function. The application of an adhesive strip to the superior eyelid permits opening and closing of the eye, and provides good protection of the cornea.
Microsurgical anatomy of the proximal segments of the middle cerebral artery
Authors: Umansky Felix , Juarez Salvador Montoya , Dujovny Manuel , Ausman James I. , Diaz Fernando G. , Gomes Francisco , Mirchandani Haresh G. , Ray William J.
Published: May 2009

✓ The microvascular anatomy of the proximal segments (M1 and M2) of the middle cerebral artery (MCA) was studied in 70 unfixed brain hemispheres from 35 cadavers. The arteries were injected with a tinted polyester resin and dissected under magnification by microsurgical techniques. The authors studied the outer diameter (OD), length, site of origin, and pattern of branching of the main trunk, secondary trunks, and the initial insular portion of the cortical branches of the MCA. The degree of mobilization of the arteries lying over the insular cortex was also assessed. The main trunk of the MCA, which had an OD of 3 ± 0.1 mm bilaterally and a length of 15 ± 1.1 mm in the right hemisphere and 15.7 ± 1.3 mm in the left hemisphere, could be divided into four groups: Group I: absence of a main division (that is, a single-trunk type of MCA) (in 6% of cases); Group II: bifurcation (64%); Group III: trifurcation (29%); and Group IV: quadrifurcation (1%). The secondary trunks resulting from the division of the main trunk of the MCA had a mean OD ranging from 1.4 to 2.3 mm and a mean length that varied from 12.1 to 14.9 mm. The mean OD of the cortical branches measured near their origin in the main and secondary trunks indicated that the angular artery was the largest vessel, with a mean OD of 1.5 mm on both sides of the brain. The temporopolar artery was the smallest, with a mean OD of 0.8 mm in the right hemisphere and 0.9 mm in the left hemisphere. The authors also describe the patterns of origin of the cortical vessels from the main trunk (early branches) and from the secondary trunks, as well as their branching pattern at the site of origin (single vessels and common stems). These anatomical data indicate that it is possible to perform microvascular reconstructive procedures, such as anastomosis, grafting, and reimplantation of branches in the insular area. The advantages of using unfixed specimens, intravascular injections, and magnification to reproduce in vivo conditions as closely as possible are also discussed.
Microsurgical anatomy of the anterior perforating arteries
Authors: Rosner Saran S. , Rhoton Albert L. , Ono Michio , Barry Margaret
Published: May 2009

✓ The anterior perforating arteries, the group of arteries that enter the brain through the anterior perforated substance (APS), were examined using × 3 to × 40 magnification in 50 cerebral hemispheres obtained from 25 adult cadavers. These arteries arose from the internal carotid, middle and anterior cerebral, and the anterior choroidal arteries. The carotid branches to the APS arose distal to the origin of the anterior choroidal artery. The anterior choroidal artery branches arose from the main or superior branch of the artery. The middle cerebral artery branches to the APS (the lenticulostriate arteries) arose from the M1 and M2 segments and were divided into medial, intermediate, and lateral groups, each of which had a characteristic configuration. The anterior cerebral artery branches arose from the A1 segment and from the recurrent artery. The internal carotid and anterior choroidal artery branches entered the posterior half of the central portion of the APS. The lenticulostriate branches entered the middle and posterior portions of the lateral half of the APS. The A1 segment gave rise to branches which entered the medial half of the APS above the optic nerve and chiasm. The recurrent artery sent branches into the anterior two-thirds of the full mediolateral extent of the APS. The relationship of these branches to the cerebral structures above the APS and to the common aneurysm sites is reviewed.
Morphological changes of the basilar artery, ventricles, and choroid plexus after experimental SAH
Authors: Liszczak Theodore M. , Black Peter McL. , Tzouras Argyris , Foley Lorraine , Zervas Nicholas T.
Published: May 2009

✓ Experimental subarachnoid hemorrhage (SAH) was induced in adult rabbits by three repeated cisterna magna injections of autologous nonheparinized blood. One week after the last blood injection the animals were sacrificed and examined for morphological change.

No vasculopathy was noted in the basilar arteries and no periarterial thrombus was seen around the majority of these arteries. Gross and microscopic changes were observed in both the ventricles and choroid plexus. Ventricular changes included dilation of the lateral ventricles, destruction of ciliated ependymal cells, and deposition of small amounts of blood throughout the ventricular system. These ventricular changes are similar to the pathological sequelae of SAH in patients. Choroid plexus changes included electron-dense cytoplasmic inclusions and dilation of the lateral and subcellular spaces. The ventricular surface and the choroid plexus are both affected by the intracisternal injection of blood. The hydrocephalus that follows SAH may be potentiated by ependymal disruption and loss of ciliated activity in the ventricles. Changes in choroid plexus function may also occur.
Intimal proliferation of cerebral arteries after subarachnoid blood injection in pigs
Authors: Takemae Toshiki , Branson P. Josephine , Alksne John F.
Published: May 2009

✓ A model of experimental subarachnoid hemorrhage in young pigs has been created using two subarachnoid blood injections. Cerebral arteries of the pig demonstrate intimal proliferation and medial necrosis 10 days after experimental blood injection; this appears to be a reaction to arterial injury. The similarity between the arterial reaction to subarachnoid blood and the general process of atherosclerosis is noted, and steps have been taken to insure that the vasculopathy described is truly a response to the injected blood. The authors conclude that the intimal proliferation observed between 1 and 2 weeks after experimental subarachnoid blood injection is an indicator of arterial injury and is, therefore, a good end point for further studies.
The syndrome of normal-pressure hydrocephalus
Authors: Vassilouthis John
Published: May 2009

✓ A series of 40 patients with the syndrome of normal-pressure hydrocephalus is presented. Diagnosis was based on clinical and computerized tomography (CT) scan criteria and was followed by the insertion of a ventriculoperitoneal shunt in every instance. All patients responded favorably to treatment (four of them had a fair outcome), and this response was maintained. There was one postoperative death, but no other serious complications. This study demonstrates that it is possible to diagnose the syndrome of normal-pressure hydrocephalus on the basis of clinical and CT scan criteria without any other invasive investigations. Such patients should respond favorably to an adequately functioning shunting system.
Cerebral hemodynamics in normal-pressure hydrocephalus
Authors: Tamaki Norihiko , Kusunoki Tadaki , Wakabayashi Toshimitsu , Matsumoto Satoshi
Published: May 2009

✓ Cerebral hemodynamics in 31 patients with suspected normal-pressure hydrocephalus were studied by means of the xenon-133 (133Xe) inhalation method and on dynamic computerized tomography (CT) scanning. Cerebral blood flow (CBF) is reduced in all patients with dementia. Hypoperfusion was noted in a frontal distribution in these patients compared with normal individuals. There was no difference in CBF patterns between patients with good and those with poor outcome. The CBF was increased following cerebrospinal fluid (CSF) shunting in patients who responded to that procedure: increase in flow correlated with clinical improvement, frontal and temporal lobe CBF was most markedly increased, and the CBF pattern became normal. In contrast, CBF was decreased after shunt placement in patients who were considered to have suffered from degenerative dementia, as evidenced by non-response to shunting.

Dynamic computerized tomography studies demonstrated that patients with a good outcome showed a postoperative reduction in mean transit time of contrast material, most prominent in the frontal and temporal gray matter, and slight in the deep frontal structures, but not in the major cerebral vessels. Patients with poor outcome after shunting, however, had an increase in transit time in all regions. This corresponded well with the results as determined by the 133Xe inhalation method.
Identification and management of high-risk patients with Klippel-Feil syndrome
Authors: Nagib Mahmoud G. , Maxwell Robert E. , Chou Shelley N.
Published: May 2009

✓ Patients with Klippel-Feil syndrome are often at high risk for neurological injury. The cervicomedullary junction and cervical spinal cord are especially vulnerable. Twenty-one patients examined and treated over a 20-year period are reviewed. The salient features of the syndrome are identified, and an approach to management is proposed.
Ultrastructural alterations in blood vessels of the white matter after experimental spinal cord trauma
Authors: Kapadia Shanta E.
Published: May 2009

✓ The ultrastructure of the microvasculature of the white matter of the spinal cord was studied after experimentally induced trauma in the cat. Immediately after the induction of trauma, disruption of endothelial cell junctions, increased pinocytotic activity in endothelial cells, and perivascular edema were seen in the blood vessels at the site of injury, but not in those of adjacent segments. However, within 2 hours of injury, the blood vessels of the white matter of the rostral and caudal segments also showed evidence of increased endothelial cell pinocytotic activity and perivascular edema, but disruption of endothelial junctions was not seen. It is therefore concluded that vasogenic edema occurs in the white matter at the site of injury soon after trauma and is due both to leakage from vessels with damaged endothelial cell junctions and also to increased transvesicular transport. By contrast, vasogenic edema develops only after a lapse of time in segments rostral and caudal to the site of injury, and probably results from increased transvesicular transport. A possible role for neurogenic chemical mediators in the genesis of the perivascular edema is discussed.
Effect of laminectomy and anesthesia upon spinal cord blood flow
Authors: Hitchon Patrick W. , Lobosky Jeffrey M. , Yamada Thoru , Torner James C.
Published: May 2009

✓ Spinal cord blood flow (SCBF) in 10 sheep subjected to laminectomy at L6–7, T6–7, and C7–T1 was compared to that of 10 control sheep subjected to anesthesia alone. Blood flow was measured using the radioactive microsphere technique, with the PaCO2 maintained at 40 ± 2 mm Hg. Both laminectomy and control animals showed a decrease in SCBF at a rate of 7% to 16%/hr for the 3 hours following the first blood flow determination. When prelaminectomy and postlaminectomy SCBF values were compared to their counterparts in the control animals, there were no significant differences. Laminectomy does not appear to alter SCBF from control values. Spinal evoked potentials (SEP's) were elicited in the laminectomy group by direct cord stimulation at C-7 and L-7. No changes were noted in amplitude or latency of SEP's over time in either caudal or rostral conduction.
Variants of sagittal synostosis: strategies for surgical correction
Authors: Vollmer Dennis G. , Jane John A. , Park T. S. , Persing John A.
Published: May 2009

✓ Sagittal synostosis is discussed with respect to the variations seen with the deformity. The morphological spectrum ranging from marked frontal bossing to prominent occipital bulging is described. Surgical techniques have been specifically designed for these variants. These techniques provide an immediate correction of scaphocephaly, and achieve a reduction of the specific deformity with morbidity comparable to that associated with conventional operations. The lack of large areas of craniectomy and the avoidance of synthetic materials are cited as additional advantages of these techniques. The importance of altering the surgical approach to the specific clinical problem is underscored. Two illustrative cases of sagittal synostosis variants are described, and recent experience with the modified operative techniques in treating these and similar cases is discussed.
On the origin of synkinesis in hemifacial spasm: results of intracranial recordings
Authors: Møller Aage R. , Jannetta Peter J.
Published: May 2009

✓ Recordings were made from facial muscles and the facial nerve near its entrance into the brain stem in patients with hemifacial spasm (HFS). The purpose of this study was to determine if the synkinesis commonly seen in patients with HFS could be linked to ephaptic transmission at the presumed site of the lesion (at the root entry zone (REZ) of the facial nerve). When the mandibular branch of the facial nerve was electrically stimulated, a response could be recorded from the orbicularis oculi muscles during the operation. The latency of the earliest response was 11.03 ± 0.66 msec (mean response of seven patients ± standard deviation (SD)). With equivalent stimulation a response could also be recorded from the facial nerve near the REZ; the latency of this response was 3.87 ± 0.36 msec. Stimulation of the facial nerve at the same location yielded a response from the orbicularis oculi muscle, with a latency of 4.65 ± 0.25 msec. The latency of the earliest response from the orbicularis oculi muscle to stimulation of the marginal mandibular branch of the facial nerve (11.3 msec) is thus larger than the sum of the conduction times from the points of stimulation of the marginal mandibular branch to the REZ of the facial nerve and from the REZ of the facial nerve to the orbicularis oculi muscle (8.52 ± 0.38 msec). It is therefore regarded as unlikely that the earliest response of the orbicularis oculi muscle to stimulation of the mandibular branch of the facial nerve is a result of “crosstalk” in the facial nerve at a location near the REZ, and it seems more likely that HFS caused by injury of the facial nerve is a result of reverberant activity in the facial motonucleus, possibly caused by mechanisms that are similar to kindling.
Residual anterior pituitary function following transsphenoidal resection of pituitary macroadenomas
Authors: Nelson Alfred T. , Tucker H. St. George , Becker Donald P.
Published: May 2009

✓ A series of 84 patients with pituitary adenomas greater than 1 cm in diameter is presented. Full preoperative and postoperative endocrine evaluations were carried out, and the effects of transsphenoidal surgery on remaining anterior pituitary function were analyzed. Of the patients who had normal anterior pituitary function before surgery, 78% retained normal function after surgery. Thirty-three percent of those patients with pituitary deficits who did not have panhypopituitarism before surgery had improved function after surgery; 33% had worsened function after surgery. None of the patients with panhypopituitarism before surgery regained function after surgery. Transsphenoidal surgery carries an acceptable risk for sacrificing anterior pituitary function, but the risk is greater in patients with larger tumors and preoperatively compromised pituitary function.
Predicting outcome from closed head injury by early assessment of trauma severity
Authors: Williams J. Michael , Gomes Francisco , Drudge Owen W. , Kessler Marc
Published: May 2009

✓ The relationship between severity of head injury and outcome was studied in 96 patients. Severity was assessed based on the level of coma and presence of mass lesion, hemiparesis, skull fracture, and pupil abnormality. Outcome was assessed using the Wechsler Adult Intelligence Scale, the Halstead-Reitan neuropsychological battery, and the Glasgow Outcome Scale. The relationship between assessment of severity of trauma and the outcome measurements was calculated by multiple regression analysis. Results indicate that coma grade and estimates of premorbid intelligence quotient (IQ) served best to predict IQ as assessed after the injury. The combination of coma grade, mass lesion, and skull fracture were important predictors of the Halstead Impairment Index. Coma grade and pupil abnormality predicted the Glasgow Outcome Scale. Low to moderate relationships were found between the predictor variables and the measurement of IQ and the Glasgow Outcome Scale; multiple regression coefficients were 0.63 and 0.61, respectively. The relationship between measurement of trauma severity and the Halstead Impairment Index was also low (R = 0.37).
Pituitary apoplexy associated with a triple bolus test
Authors: Bernstein Mark , Hegele Robert A. , Gentili Fred , Brothers Michael , Holgate Richard , Sturtridge William C. , Deck John
Published: May 2009

✓ The authors report a case of pituitary apoplexy resulting in bilateral internal carotid artery occlusion, with marked depression of consciousness and hemiplegia. After transsphenoidal tumor decompression, restoration of flow in both carotid arteries was documented angiographically and the patient made an excellent clinical recovery. The unique aspect of this case is that the pituitary apoplexy was apparently precipitated by neuroendocrine manipulation, performed as a preoperative test of pituitary function.
Selective peripancreatic sarcoma metastases from primary gliosarcoma
Authors: Weaver David , Vandenberg Scott , Park T. S. , Jane John A.
Published: May 2009

✓ Two phenomena associated with malignant gliomas are: 1) the ability to metastasize systemically, and 2) the capacity to induce sarcomatous transformation within the supportive mesenchyma. An unusual case is presented of selective metastases of the sarcomatous elements of a mixed gliosarcoma. Immunohistochemical cell staining with glial fibrillary acidic protein was used to confirm the presence of abnormal glial elements in the primary brain tumor as well as the absence of such glial elements in the abdominal metastases.
An improved subarachnoid screw for intracranial pressure monitoring
Authors: Landy Howard J. , Villanueva Philip A.
Published: May 2009

✓ A new subarachnoid screw for monitoring intracranial pressure has been developed incorporating a lock-nut and multiple subarachnoid ports in a low-profile design. This device offers enhanced stability and flexibility.
Thalamic tumors in children
Authors: Bernstein Mark , Hoffman Harold J. , Halliday William C. , Hendrick E. Bruce , Humphreys Robin P.
Published: May 2009

✓ The authors review the cases of 60 children (aged 5 months to 18 years) with thalamic tumors who were seen at The Hospital for Sick Children between 1951 and 1983. The diagnosis of thalamic tumor was based on neuroradiological studies; 33 children were first seen in the pre-computerized tomography (CT) era and 27 since the advent of CT scanning. Histological diagnosis was obtained in 37 patients at the time of operation. A further four tumors were verified histologically at autopsy. Thirty-six patients required cerebrospinal fluid shunt placement. Sixteen patients had no surgery on their tumor, three underwent needle biopsy, 20 underwent open biopsy, and 21 had partial resection. Forty-four patients were irradiated. All 20 patients with malignant tumors died, with a mean survival time of 1.1 years. Of 19 patients with benign tumors, 11 died, with a mean survival time of 5.3 years, and eight are still alive after a mean period of 7.2 years since diagnosis. Based on this series, the authors recommend open biopsy of thalamic tumors (and resection if deemed safe), followed by radiation in selected cases.
Medulloblastoma in childhood: an epidemiological study
Authors: Farwell Jacqueline R. , Dohrmann George J. , Flannery John T.
Published: May 2009

✓ The authors have reviewed 143 cases of medulloblastoma in children aged 19 years or younger who were treated in a 42-year period and reported in the Connecticut Tumor Registry. About 20 cases have occurred in each 5-year period since 1950, but 31 were seen between 1955 and 1959. Correspondingly, an excessive number of children born in the period 1954 to 1958 have developed medulloblastomas. A relationship to polio vaccine contaminated with SV40 virus may exist. Children with medulloblastomas had an increased number of immediate family members with brain tumors, leukemia, and childhood cancer when compared to controls. In this series, the male to female ratio was 1.33:1. Average age at diagnosis was 6½ years, with most children being diagnosed at 3 years old and fewer cases appearing in each successive hemidecade from birth to 20 years of age.

Probability of survival at 6 months was 0.687; at 1 year, 0.444; at 2 years, 0.314; and at 5 years, 0.222. Survival probability was statistically significantly better in the years 1968 to 1977 than in previous decades, in part due to fewer autopsy diagnoses and lowered operative mortality, but also due to a decreased mortality rate in children several years after diagnosis. Fifty-one percent were treated with operation and irradiation, 17% with operation alone, 12% with irradiation alone, and 5% with operation, irradiation, and chemotherapy. Fifteen percent were not treated. One- and 5-year survival rates in patients with operation and irradiation were, respectively, 0.615 and 0.307; with operation, 0.125 and 0.042; with irradiation, 0.688 and 0.277; and with operation, irradiation, and chemotherapy, 0.857 and 0.643. All seven children who received chemotherapy were diagnosed after 1968, and five are still alive. Perhaps due to short follow-up time, the course and mortality rate of children treated with all three modalities were not statistically significantly different from those of children treated since 1968 with operation and radiation therapy.
Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres
Authors: Laws Edward R. , Taylor William F. , Clifton Marvin B. , Okazaki Haruo
Published: May 2009

✓ The authors conducted a retrospective review of surgically treated, histologically proven cases of low-grade (Grade 1 or 2) astrocytomas. Follow-up analysis, with survival time as the end-point, was completed using multivariant statistical analysis. In the 461 cases of supratentorial low-grade astrocytoma in this study, age of the patient at the time of surgery was by far the most important variable in predicting length of survival. Other variables correlating with increasing survival times were: gross total surgical removal, lack of major preoperative neurological deficit, long duration of symptoms prior to surgery, seizures as a presenting symptom, lack of major postoperative neurological deficit, and surgery performed in recent decades. The multi-variant regression analysis showed that radiation therapy was of clear benefit, primarily in older patients with incompletely removed tumors.

For purposes of establishing prognosis and testing the results, a “score” was developed to predict survival times, based on the most important variables. The data in this study provide a basis for the analysis of future modes of management of low-grade gliomas.