bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiotherapy of Intracranial Astrocytomas
Authors: Scanlon Paul W. , Taylor William F.
Published: May 2010

In a review of 417 intracranial astrocytomas treated radiotherapeutically at the Mayo Clinic from 1960 through 1969, the well-known correlation of tumor grade with survival was verified. Totally unexpected was the finding that age was fully as important a discriminant as tumor grade. Another unexpected finding was that patients treated with biopsy only followed by radiation therapy did as well as or slightly better than those subjected to resection followed by postoperative radiotherapy. We could not verify the importance to survival of either large dose or large volume radiotherapy, which has been emphasized by some. Patients receiving less than 1400 rets did just as well as or slightly better than those receiving more than 1400 rets. With low grade astrocytomas, survival beyond 4 years was significantly worse (higher death rates) in the group receiving more than 1400 rets. This suggested the possibility of radiation damage with delayed manifestations. We also could not verify an increased effectiveness for the generally accepted use of total brain irradiation for high grade gliomas.
Abdominal Metastases of Primary Intracranial Yolk Sac Tumors through Ventriculoperitoneal Shunts
Authors: Wilson Edward R. , Takei Yoshio , Bikoff William T. , O'Brien Mark S. , Tindall George T. , Boehm Walter M.
Published: May 2010

Three cases of rare primary intracranial yolk sac tumor are reported. Two cases had a pineal location, whereas the third presented as a suprasellar mass. After the placement of ventriculoperitoneal shunts for relief of hydrocephalus, all of the patients developed metastases restricted to the peritoneum, as demonstrated by autopsy in one patient (Case 1) and clinical and radiographic evidence in two patients (Cases 2 and 3). The peritoneal metastases were directly associated with the death of one patient, but were successfully treated with chemotherapy in another patient, who is still alive more than 2.5 years after initial presentation. The value of ascitic fluid cytology and alpha-fetoprotein determination in the diagnosis of this complication was demonstrated in one patient. These cases emphasize the need for awareness of this mode of metastasis and its potentially lethal effect.
Ganglioglioma—Neurogliogenic Tumor Involving the Left Frontal Lobe
Authors: DiTullio Michael V. , Fried Herbert
Published: May 2010

A 5-year-old boy presented with a 7-month history of headache and projectile vomiting. Computerized axial tomography revealed a large, high density lesion involving the entire left frontal lobe. At operation a 330-g, apparently encapsulated, mildly cystic neoplasm was removed from the region of the left frontal operculum. Microscopic examination demonstrated moderately cellular astrocytic tissue interspersed with several large, bizarre, and occasionally binucleate ganglion cells. The pathological entity of ganglioglioma is briefly reviewed.
Gradual Carotid Artery Occlusion in the Treatment of Inaccessible Internal Carotid Artery Aneurysms
Authors: Giannotta Steven L. , McGillicuddy John E. , Kindt Glenn W.
Published: May 2010

The authors discuss 21 cases of large or surgically inaccessible internal carotid artery aneurysms treated with gradual occlusion of the cervical portion of the internal carotid artery. Eighty-five per cent of the patients experienced relief or marked improvement of their symptoms after treatment. Two early cases developed postligation ischemic deficits that partially resolved. After the introduction of expansion of circulating blood volume and induced hypertension as adjuncts to graded carotid occlusion, no ischemic complications occurred.
Suprascapular Entrapment Neuropathy: A Clinical, Anatomical, and Comparative Study
Authors: Rengachary Setti S. , Neff James P. , Singer Philip A. , Brackett Charles E. , Payne Nettleton S. , Tindall George T.
Published: May 2010

The clinical syndrome of suprascapular entrapment neuropathy is described and three illustrative cases are discussed. Diagnostic criteria for this entity are outlined.
Scalp Projection of Surgical Lesions in the Cerebral Hemispheres with the Use of Radioisotopes
Authors: Davis Ross , Smoak William
Published: May 2010

The extent of a brain tumor or abscess in the cerebral hemispheres can be easily projected onto the scalp by using small radioactive markers. A positive uptake by the lesion is seen on the persistence scope of the nuclear camera and can be delineated by scalp markers to define the limits of future craniotomy. This technique has been used for six tumor operations and has successfully reduced the size of the craniotomy and brain incision, as well as increasing the accuracy of localizing the tumor.
Nelson's Syndrome
Authors: Saleman Michael , Garcia Julio H. , Abbott Douglas J. , Martin Luis G.
Published: May 2010

We present a case of Nelson's syndrome in which the clinical, radiographic, and surgical findings are indicative of a discrete microadenoma rather than of diffuse pituitary hyperplasia. Ultrastructural analysis reveals this to be the first example of a sparsely granulated lesion in Nelson's syndrome and only the second such adrenocorticotropic hormonesecreting tumor reported. Unfortunately, there do not seem to be any firm ultrastructural features that differentiate between hyperplasia and discrete adenoma. Separation of the two entities may be important in delineating the pathogenesis and treatment of Nelson's syndrome; these are discussed.
Value of Tumor Markers in the Treatment of Endodermal Sinus Tumors and Choriocarcinomas in the Pineal Region
Authors: Haase Jens , Nielsen Kirsten
Published: May 2010

A case of embryonal carcinoma in the pineal region of a 17-year-old boy is presented. The tumor included elements of choriocarcinoma and endodermal sinus tumor, and the use of human chorionic gonadotropin and alpha-fetoprotein as tumor markers is discussed. The markers were demonstrated both within the tumor and in the cerebrospinal fluid (CSF) and blood. The patient was treated with a postoperative program of irradiation and cancer chemotherapy, and at follow-up examination 20 months after operation no signs of residual tumor were present. It is suggested that human chorionic gonadotropin and alpha-fetoprotein should be measured in the blood and CSF before the treatment of midline tumors.
>Checkerboard Visual Evoked Response in Evaluation and Management of Pituitary Tumors
Authors: Gott Peggy S. , Weiss Martin H. , Apuzzo Michael , Van Der Meulen Joseph P.
Published: May 2010

As a routine part of the evaluation of patients with pituitary tumor, visual evoked responses (VERs) to checkerboard pattern reversal were recorded from 83 patients with tomographically documented pituitary tumor. VER tests were correlated with examinations of visual acuity, color perception, and visual fields and with computerized tomographic scan evidence of suprasellar extension of the tumor. The purpose of the VER recording was to determine the presence of visual system compression by the tumor and thus contribute to the decision of whether surgery was necessary. Each of the patients who had suprasellar extension of the tumor sufficient to produce a visual field abnormality also had an abnormal VER. In addition, some patients with suprasellar extension had normal visual fields but abnormal visual evoked responses. Thus, the VER provided earlier evidence of suprasellar extension causing visual system compromise than did conventional visual tests.
Serum Cortisol Abnormalities after Craniocerebral Trauma
Authors: Steinbok Paul , Thompson Gordon
Published: May 2010

Serial estimations of serum cortisol were performed in 49 patients with craniocerebral trauma. Abnormalities of serum cortisol, including alterations in diurnal rhythm and elevations of serum cortisol level, occurred in 21 patients. The frequency and severity of the abnormalities correlated with the severity of the head injury, and there was a trend suggesting that middle fossa basal skull fractures predisposed to cortisol abnormalities. A further 6 patients were studied to assess the effects of exogenous dexamethasone, and in all patients there was suppression of elevated serum cortisol levels by the dexamethasone. The findings suggest that hypercortisolemia after head injury is related to an alteration rather than an abolition of the normal feedback mechanism.
Serial Computerized Tomographic Scanning and the Prognosis of Severe Head Injury
Authors: Cooper Paul R. , Maravilla Kenneth , Moody Sarah , Clark W. Kemp
Published: May 2010

Serial (two or three) computerized tomographic (CT) scans were performed on a series of 58 patients with severe head injury. The protocol called for scans to be done upon admission and on Days 3 and 7 after injury. New lesions (i.e., lesions not visualized on the initial CT scans but appearing on subsequent scans) were a frequent finding, occurring in over half of all patients. For the purposes of this study a new lesion was classified as edema involving two or more lobes, extra-axial hematoma, parenchymal hemorrhage, or infarction. Significant correlation was found between good outcome and the absence of new lesions and between bad outcome and the development of new lesions (p < 0.001). Several patients did well in spite of the development of new lesions, but these patients were unique in that most had small, unilateral parenchymal hematomas located at or near the frontal or temporal poles. In most cases, patients who did poorly in spite of not developing new lesions had severe injuries visualized on their initial scans (massive intracerebral hematoma, hemorrhage of the corpus callosum) or succumbed to medical complications. The pertinent literature is reviewed, and other CT findings associated with a poor prognosis are noted. The authors suggest that serial CT scanning may be used to make prognostic assessments in severely head-injured patients and may be of value in increasing the confidence in and accuracy of assessments made on clinical grounds alone.
Treatment of Subarachnoid Hemorrhage with Sodium Nitroprusside and Phenylephrine
Authors: Rothberg Charles S. , Weir Bryce , Overton Thomas R.
Published: May 2010

The effectiveness of simultaneous intravenous sodium nitroprusside and phenylephrine in improving the cerebrovascular disturbances and survival rate after induced subarachnoid hemorrhage (SAH) was studied in the cynomolgus monkey. We measured regional cerebral blood flow (rCBF) using the intra-arterial xenon-133 clearance technique. In our experimental animal model, SAH was associated with a persistent reduction in rCBF, elevation of cerebrovascular resistance (CVR), cerebral vasospasm for the duration of the study (150 minutes), and poor survival. For animals receiving the treatment regime (administered approximately 25 minutes after the induced SAH), rCBF remained low, CVR was high, and cerebral vasospasm was persistent. Survival in this group was the same as that observed for the untreated animals. Simultaneous administration of sodium nitroprusside and phenylephrine was ineffective in improving rCBF, CVR, cerebral vasospasm. or survival after SAH. In the control group (receiving only the treatment and not an intracranial insult), rCBF was below resting levels both during and after therapy, indicating impaired cerebral autoregulation.
Effect of Proximal Occlusion on Anastomosis Patency in Dogs
Authors: Levinthal Robert , Stern W.E.
Published: May 2010

This study compared the superficial temporal-middle cerebral artery (STA-MCA) anastomosis patency in animals with and without proximal embolic middle cerebral artery (MCA) occlusion. Sixteen dogs underwent STA-MCA bypass in association with silicone embolization of the MCA via an internal carotid injection. Animals re-explored 3 to 5 days postoperatively with evaluation of anastomosis patency by Evans blue injection and direct cutting of the STA demonstrated that 10 of 10 dogs with proximal MCA emboli had a patent STA-MCA anastomosis, whereas only 2 of 6 animals without an embolus lodged in the proximal middle cerebral artery had a patent connection. The likelihood of the anastomosis remaining open seems to be greatly influenced by the potential flow gradient between the extracranial and intracranial circulations.
Intravascular Use of Isobutyl 2-Cyanoacrylate: Part 1
Authors: Samson Duke , Ditmore Michael Q. , Beyer Chester W.
Published: May 2010

The intravascular use of the rapidly polymerizing acrylic compound, isobutyl 2-cyanoacrylate (IBC). in 10 patients with intracranial arteriovenous malformations (AVMs) is described. The monomer was introduced into each malformation at craniotomy using angiographic control and microvascular dissection technique to identify, isolate, and inject the major components of each vascular lesion while attempting to preserve normal arterial circulation. Postoperative angiography was used routinely to evaluate the results of IBC embolization. Four patients underwent the injection and immediate surgical excision of an intracranial AVM, and 6 underwent injection alone; 3 of the latter had residual malformation demonstrated on postoperative angiography, and 1 of these patients had the remnants of her malformation occluded by a second embolic procedure. There was no operative mortality nor permanent neurological morbidity. Three patients suffered transient neurological dysfunction in the immediate postoperative period.
Acromegaly
Authors: Balagura Saul , Derome Patrick , Guiot Gerard
Published: May 2010

The surgical treatment of 132 acromegalics is analyzed. There was an equal sex distribution among patients between the ages of 30 and 59. In the younger patients there was a preponderance of males, and the opposite situation occurred in patients older than 59 years. The overall cure rates were 58% (growth hormone (GH) < 5 ng/ml) and 78% (GH < 10 ng/ml). Endocrinological evidence of cure was observed most commonly in patients who exhibited preoperative GH values below 70 ng/ml.
Epidural Hematomas of the Posterior Cranial Fossa
Authors: Zuccarello M. , Pardatscher K. , Andrioli G. C. , Fiore D. L. , Iavicoli R. , Cervellini P.
Published: May 2010

We report eight cases of epidural hematoma of the posterior cranial fossa. The main symptoms and neurological signs are reviewed. The value of computed tomographic scanning in determining a definite diagnosis and in improving the morbidity and mortality rates of such a lesion is emphasized.
Significance of the So-Called Absorptive Reserve in Communicating Hydrocephalus
Authors: Sklar Frederick H. , Beyer Chester W. , Diehl Jan T. , Clark Kemp W.
Published: May 2010

Twelve patients with communicating hydrocephalus were studied with a servocontrolled lumbar infusion technique to measure net cerebrospinal fluid (CSF) absorptive capacity and resting pressure. Each patient showed a significant absorptive reserve; the rate of CSF absorption exceeded the rate of formation over a physiological range of pressure. The size of the ventricles did not correlate with either the absorptive capacity or the resting pressure parameter, or both. The data suggest that communicating hydrocephalus does not reflect a simple imbalance between the rates of CSF formation and absorption. Other factors must be of etiological importance and are considered in the discussion.
Traumatic Subdural Hygroma
Authors: Stone James L. , Lang Robert G. R. , Sugar Oscar , Moody Robert A.
Published: May 2010

The authors report a series of 80 cases of traumatic subdural hygroma and discuss the clinical and radiological features, management, surgical results, and pathogenesis. Changes in mental status without focal signs of brain damage were noted in over 50% of the cases. A clinical course marked by stabilization without complete recovery of neurological function was found in over 40% of the cases of “simple hygroma.” The lumbar cerebrospinal fluid often showed hemorrhage and elevation of the protein content. Skull fractures were found in 39% of the cases, and subdural hygromas were associated with cerebral atrophy, cortical contusions, subdural hematomas, and overlying epidural hematomas, and overlying epidural hematomas. The characteristic angiographic and computed tomographic scan findings are discussed, as are surgical pathology and outcome. Several theories of pathogenesis are presented. The authors advocate simple burr hole drainage as the treatment of choice. Significant reaccumulation may occur occasionally.
Emergency Twist Drill Trephination
Authors: Mahoney Brian D. , Rockswold Gaylan L. , Ruiz Ernest , Clinton Joseph E.
Published: May 2010

We have used the rapid progression of post-traumatic uncal herniation in spite of intensive medical therapy as the indication for twist drill trephination in the emergency department. During a 54-month period, 51 trephinations were performed on 41 patients. The trephine was placed through the temporal bone ipsilateral to the dilated pupil, and the dura mater was opened to allow partial evacuation of a hematoma. All patients subsequently underwent craniotomy, autopsy, and/or cerebral computed tomography (CT). The trephination was diagnostically accurate for the absence or presence of an extracerebral hematoma in 42 of 51 trephinations (82%). In 6 of these cases the dilated pupil responded to partial hematoma evacuation by decreasing in size. In 3 of the 6 there was a marked overall improvement in neurological status subsequent to trephination. These 3 patients later recovered to an independent functional state. Only 23 of these 41 patients (56%) with herniation profiles actually had significant extracerebral hematomas. This fact emphasizes the inadvisability of taking this type of patient directly to the operating room without a diagnostic study. A rapidly performed CT scan is the obvious first choice. However, if there is any delay in obtaining this study or when uncal herniation occurs rapidly, a twist drill trephination can be of value in diagnosing the absence or presence of a treatable extracerebral hematoma. There were no complications related to this procedure in this group.
Chromophobe Pituitary Adenoma
Authors: Chadduck William M.
Published: May 2010

Three patients with both diabetes mellitus and pituitary chromophobe adenomas are presented. All of the patients had quite fibrous tumors, a finding that may relate to the presence of diabetes mellitus and that may make trans-sphenoidal surgery more difficult.
Neurenteric Cyst
Authors: D'Almeida Antonio C. , Stewart Donald H.
Published: May 2010

An isolated, cervical intraspinal enteric cyst in a 40-year old man was treated successfully by laminectomy, intradural exploration, and excision. No bony anomalies were demonstrated. The pertinent literature is reviewed for embryogenic, anatomical, pathological, and clinical considerations.
Multiloculated Hydrocephalus in Infants
Authors: Albanese Vincenzo , Tomasello Francesco , Sampaolo Simone
Published: May 2010

abstract

The clinical features and the neuroradiological appearance of multiloculated hydrocephalus that followed meningitis and ventriculitis in five newborn infants are presented. Several factors probably involved in the pathogenesis are discussed. Computed tomography is particularly helpful in the recognition of this entity and in the evaluation of its course. However, ventriculograms are advised to document the communication of the septated cavities. Of four infants treated by ventriculoatrial shunting, two died and two are mentally and neurologically disabled. Another infant, who underwent craniotomy and fenestration of the ventricular membranes, died accidentally 3 months after operation. In light of similar cases reported in the literature, the prognosis seems very poor. Craniotomy with fenestration of the ventricular septa seems a promising procedure, although further supportive evidence is needed.
Pineal Tumors
Authors: Chang Cecil Guang-shiung , Kageyama Naoki , Mobayashi Tatsuya , Yoshida Jun , Negoro Makoto
Published: May 2010

abstract

The clinical presentations, findings of neuroradiological examinations, laboratory findings, pathological diagnoses, methods of treatment, and results of follow-up of 43 cases of pineal tumor collected at the Nagoya University Hospital from 1958 to 1979 are reviewed. The definitions of calcification of the pineal body and of pineal tumor are given. There is a significant difference in the incidence of calcification of the pineal body between pineal teratomas and pineal germinomas. Although there is a 100% rate of calcification of the pineal body in cases of pineal germinoma, the rate is very low in cases of pineal teratoma; calcification appears in only a small percentage of the cases of teratoma mixed with germinoma or embryonal carcinoma, or both. In male patients with susprasellar germinoma, there is a high frequency of an associated pineal calcification. No pineal calcification is seen in cases of basal ganglia germinoma. The computed tomographic (CT) findings of pineal teratoma and germinoma are characteristic. CT scanning is superior for early diagnosis of suprasellar and basal ganglia germinomas.
Dandy-Walker Syndrome in Consecutive Siblings
Authors: Lehman Richard M.
Published: May 2010

abstract

The author reports consecutive siblings with the Dandy-Walker syndrome. The second patient was a twin and her apparently normal twin now appears by computed tomographic scan to have hydrocephalus with a hindbrain malformation.
Widened Epidural Space after Spinal Fusion
Authors: Grossman Robert I. , Davis Kenneth R.
Published: May 2010

abstract

Two cases of widening of the L-5, S-1 anterior epidural space after lumbar laminectomy and bilateral transverse process fusion are reported. Metrizamide lumbar epidurography was valuable in assessing this apparent widening and demonstrating that this space was normal and free of disc material. Posterior traction on the dural sac is a possible explanation for this myelographic abnormality.
Epidermoid Tumors Involving the Fourth Ventricle
Authors: Rosario Marshal , Becker Dennis H. , Conley Frances K.
Published: May 2010

abstract

The case histories of three patients with epidermoid tumors of the 4th ventricle treated by surgical excision are presented. All three cases exhibited a prolonged latent period from the onset of symptoms to the final diagnosis. Despite the strategic location and enormous size of all three tumors, only one of the patients had significant hydrocephalus. The radiographic diagnosis and differential diagnosis of epidermoid tumors are discussed.
Post-traumatic Occlusion of the Supraclinoid Internal Carotid Artery
Authors: Ajir Farroukh , Tibbetts James C.
Published: May 2010

Intracranial occlusion of the internal carotid artery secondary to minor head or neck injury is uncommon. We report the case of an 18-year-old man who sustained a minor head and neck injury during a fist fight and developed a left hemiparesis resulting from thrombosis of the supraclinoid portion of the right internal carotid artery. Conservative inpatient treatment with low dose heparin and aspirin resulted in a gradual, steady improvement. Two months later, after an intensive program of physical therapy, the patient showed good progress; his facial weakness had lessened and his left hemiparesis was mild. Although there is no ideal treatment for internal carotid artery occlusion secondary to minor trauma, conservative treatment should be undertaken unless there are progressive or recurring ischemic symptoms, in which case an extracranial-intracranial bypass operation should be considered.
Galactorrhea after Prolonged Traumatic Coma
Authors: de Leo Roberto , Petruk Kenneth C. , Crockford Peter
Published: May 2010

A 17-year-old girl suffered a traumatic acute subdural hematoma and rib fractures after a motor vehicle accident. Prolonged coma resulted, and significant galactorrhea began 4 weeks after the accident. The galactorrhea was treated successfully by the administration of 2-bromoergocryptine. The pathophysiology of this condition is discussed.
Computed Tomographic Demonstration of Giant Aneurysms of the Vertebrobasilar System
Authors: Ganti S. Ramaiah , Steinberger Abe , McMurtry James G. , Hilal Sadak K.
Published: May 2010

Giant aneurysms of the vertebrobasilar system can easily mimic other mass lesions in the posterior fossa and 3rd ventricle. Recently, we treated eight cases of giant aneurysm in the vertebrobasilar circulation that were demonstrated by computed tomography with angiographic correlation. We describe the salient radiological features that help to distinguish giant aneurysms from neoplasms and discuss their clinical manifestations and surgical management.
Craniosynostosis
Authors: Carmel Peter W. , Luken Martin G. , Ascherl George F.
Published: May 2010

Computed tomography has proven useful in children with craniosynostosis for the evaluation of deformity of the skull base. calvarium. and parenchymal brain structures. A retrospective analysis of 24 children seen during a 4-year period who had adequate preoperative, postoperative. and follow-up scans was carried out. Bone windows were used. and both bone thinning adjacent to fused sutures and thickening of affected sutures were demonstrated. Changes in calvarial contour were easily followed. Current trends in craniofacial reconstructive surgery have placed emphasis on skull base abnormalities: these are readily measured on axial computed tomographic (CT) sections. and postoperative progress may be monitored by serial scanning. In addition, new data revealing distortion of brain structures and cerebrospinal fluid pathways in these children have been obtained with CT scans. These soft tissue abnormalities had not been appreciated before the CT era, and they add a new dimension to the evaluation of these disorders. We think that these abnormalities indicate a local pressure increase on the brain at the fusion site. The restoration of parenchymal changes toward normal during the postoperative period correlated well with cosmetic improvement.
Syndrome of Inappropriate Secretion of Antidiuretic Hormone after Subara chnoid Hemorrhage
Authors: Dóczi Thomas , Bende János , Huszka Endre , Kiss József
Published: May 2010

The authors report a review of 290 patients admitted for the treatment of subarachnoid hemorrhage. Twenty-seven (9.3%) patients developed the syndrome of inappropriate secretion of antidituetic hormone (SIADH). The diagnosis was established by means of daily laboratory investigations (serum electrolytes and osmolality; urine sodium and osmolality; and fluid balance). The patients were divided into two groups (severs and mild SIADH) on the basis of clinical symptoms and signs and laboratory findings. High values of urine osmolality and sodium concentration in patients with low values of serum osmolality and sodium concentration were demonstrated. Thirteen (4.5%) patients had severe and 14 (4.8%) patients had mild SIADH. The source of bleeding was not discovered in 14 patients (4.8%). Nearly 10% of the patients with an aneurysm on the anterior communicating artery developed SIADH. Fluid therapy for these patients is described, and the treatement of SIADH is discussed.
Malignant Hyperthermia:
Authors: Bursick Daniel M. , Waterman Peter M. , Jannetta Peter J.
Published: May 2010

A case of suspected malignant hyperthermia in a neurosurgical patient is presented. The syndrome complex. treatment. and complications are reviewed and discussed.
Neurogenic Claudication Due to Narrowing of the Lumbar Canal by Extradural Metastatic Tumor
Authors: Martin Neil A. , Gutin Philip H. , Newman Alan B. , Pickett Jackson B.
Published: May 2010

Neurogenic claudication has been described in association with bony constriction of the lumbar canal. but has not previously been reported in association with extradural metastasis. We report the case of a 69-year-old who developed neurogenic claudication due to narrowing of the lumbar canal by metastatic adenocarcinoma of the prostate, Radiation therapy resulted in tumor regression and resolution of the claudication.
Prediction of Cerebellopontine Angle Tumors Based on Discriminant Analysis of Brain Stem Auditory Evoked Responses
Authors: Zappulla Rosario A. , Karmel Bernard Z. , Greenblatt Edward
Published: May 2010

Multivariate discriminant analysis of brain stem auditory evoked response component latency intervals in patients with cerebellopontine angle tumors allowed accurate detection of 90% (35 of 39) of the tumor population with response data recordable from at least one ear. Eighty-five per cent (23 of 27) of these could be detected by using information from the unaffected ear. One of 21 normal subjects was miselassified. Tumors significantly increased the I—III and III—V intervals on the side of the tumor. Increases in III—V interval latency were also observed on the unaffected side. The size of the tumor was significantly correlated with both discriminant scores derived from the analysis of the unaffected ear and delays in the III—V intervals from either the affected or the unaffected ear. These results were attributed to physiological factors and mechanical distortions of the brain stem. Regression equations derived from linear discriminant analysis for cerebellopontine angle tumors are presented and discussed in terms of their predictive validity.
Ommaya Reservoir Insertion Guided by Computed Tomography
Authors: Levy Walter J. , Hahn Joseph F.
Published: May 2010

The placement of a ventricular catheter in patients with small ventricles carries the risks of catheter malfunction and bleeding. We report the use of computed tomography (CT) to place an Ommaya reservoir in two patients with acute myelogenous leukemia and one patient with lymphoma who had normal to small ventricles. The entire procedure was carried out in the scanner and demonstrates the feasibility of operations performed in the CT scanner.
Painful Neuroma
Authors: Battista Arthur F. , Cravioto Humberto M. , Budzilovich Gleb N.
Published: May 2010

Sixteen months after resection of a painful neuroma and fascicle ligation of the proximal nerve segments, the fascicleligated neural tissue was examined by light and electron microscopy. No significant neuroma formation was found in the fascicle-ligated regions. The distal portion consisted mainly of connective tissue fibroblasts with an absence of neural elements. Maintaining the perineurium intact by fascicle ligation seems to alter significantly axonal regeneration in humans, as is indicated by minimal neuroma formation. Similar findings after fascicle ligation in animals have also been reported. This lack of neuroma formation after resection of a painful neuroma and fascicle ligation may play a significant role in relieving pain in patients with painful neuromas.
Prevention of Cerebral Ischemic Symptoms in Cerebral Vasospasm with Trapidil, an Antagonist and Selective Synthesis Inhibitor of Thromboxane A2
Authors: Suzuki Shigeharu , Sobata Eiji , Iwabuchi Takashi
Published: May 2010

The results of our previous experimental and clinical studies led us to the hypothesis that, in the pathogenesis of cerebral vasospasm, subarachnoid focal acidosis resulting from anaerobic changes of subarachnoid clots may be a factor upsetting the balanced synthesis of both thromboxane A2 and prostaglandin I2 from prostaglandin endoperoxides on the inner surface of cerebral arteries. Thus, there is a higher concentration of thromboxane A2, a prostanoid that causes arterial contraction and platelet aggregation. We tested the administration of trapidil, an antagonist and selective synthesis inhibitor of thromboxane A2, in a series of 20 cases for the prevention of cerebral vasospasm and cerebral ischemia after aneurysmal rupture. Vasospasm was demonstrated by angiography in 9 of these cases, but only 2 of the 9 showed mild signs of cerebral ischemia. Of the 20 patients, 15 were discharged from the hospital as cured and 3 had a neurological deficit at discharge. Our findings suggest the significance in symptomatic vasospasm of thrombus formation by platelet aggregation and the effectiveness of trapidil as a preventive.
Simple Technique for Monitoring Intraoperative Spinal Cord Function
Authors: Hahn Joseph F. , Lesser Ronald , Klem George , Lueders Hans
Published: May 2010

Interference with normal spinal cord functioning is an important. although uncommon. complication of spinal surgery. Spinal evoked potentials have been advocated as a means of monitoring spinal cord transmission during operative procedures. We have developed a simple technique using electrodes inserted into the interspinal ligaments for monitoring purposes. This has produced stable and reproducible recordings with obvious clinical benefit in the first 50 cases in which it has been used.
Retinoblastoma as a Possible Primary Intracranial Tumor
Authors: Bullitt Elizabeth , Crain Barbara J.
Published: May 2010

A 10-month-old infant with a small. unilateral, peripheral retinal lesion also had a large. well-encapsulated. suprasellar retinoblastoma. The primary vs. the metastatic nature of the intracranial tumor is considered. It is postulated that primary intracranial tumors may arise within areas of the central nervous system embryologically related to the retina in patients with the genetic form of retinoblastoma.
Significance of Infundibular Dilatation in Unexplained Subarachnoid Hemorrhage
Authors: Yoshida Masafumi , Anegawa Shigetaka , Moritaka Kazuhiko
Published: May 2010

Angiographically equivocal aneurysmal dilatation at the junction of the internal carotid and the posterior communicating arteries was noted in a patient with documented subarachnoid hemorrhage. This was initially thought to be infundibular dilatation. A craniotomy revealed an actual aneurysm. which was obliterated successfully. Whether infundibular dilatation is a preaneurysmal state or a benign dilatation is controversial. The management of angiographically noted infundibular dilatation in cases of “essential” subarachnoid hemorrhage is discussed.
Theophylline Toxicity after the Use of Aminophylline in the Treatment of Cerebral Vasospasm
Authors: Bailey Robert T. , Young Byron , Rapp Robert P. , Blouin Robert A.
Published: May 2010

We are reporting a case of theophylline toxicity after the initiation of i.v. aminophylline and isoproterenol in the treatment of cerebral vasospasm. The dose of aminophylline (125 mg/hour) previously recommended results in a toxic serum theophylline concentration in a majority of patients if the infusion is continued for more than 24 to 48 hours. The rapid achievement of an optimal serum level is obtained with a standard loading dose of 8.0 mg/kg. The initial infusion rate should be based on calculated pharmacokinetic data. Maintenance dosing adjustments are then based on serum determinations and the presence of toxic effects.
Pulmonary Effects of Head Trauma
Authors: Baigelman Walter , O'Brien James C.
Published: May 2010

Knowledge of the interrelation of the central nervous system-respiratory axis is crucial to the management of patients with head injuries with or without concomitant pulmonary-thoracic problems. Damage to the central nervous system (CNS) can result in unexplained hypoxemia, noncardiac pulmonary edema, altered patterns of respiration, and an increased risk of aspiration. The damaged thorax and lung can contribute to brain ischemia and rises in intracranial pressure. The treatment of one end of the CNS-respiratory axis is not without effect on the other end of the continuum. Corticosteroids, diuretics, mannitol. iatrogenic hyperventilation, barbiturates, and vasopressors are used in the management of patients with head trauma, but may have an impact on oxygenation and ventilation. When positive end expiratory pressure is used in the management of a pulmonary process, it should be optimized and used with caution while monitoring for its effect on intrac. ial pressure. Pulmonary toilet, while remaining a necessity, must be performed in a manner so as to minimize potential negative effects on the brain. Hyperoxia and hypothermia should be avoided. Mechanical ventilation should be used as dictated by the desired PaCO2 and not as a mandatory adjunct to endotracheal intubation.
Bilateral Acoustic Neuromas
Authors: Martuza Robert L. , Ojemann Robert G.
Published: May 2010

Fifteen patients with bilateral acoustic neuromas are presented. Ten patients became symptomatic before age 21. and 9 of these patients developed additional central nervous system tumors. Cutaneous manifestations of neurofibromatosis and a positive family history of this disorder were absent in many of the patients. Most patients required multiple surgical procedures, and the timing, techniques, and results of these operations are reported. The pathogenesis of these tumors, the genetic aspects of this disorder, and potential treatment alternatives are discussed.
Cerebrospinal Fluid Drainage from a Subarachnoid Screw
Authors: Ropper Allan H.
Published: May 2010

Reduction of intracranial pressure by the removal of cerebrospinal fluid from a subarachnoid screw device was accomplished in several patients. Attempts at fluid removal by this technique may obviate more aggressive therapy for raised intracranial pressure.
Dental Considerations in the Sublabial Trans-sphenoidal Surgical Approach to the Pituitary Gland
Authors: Watson Stephen W. , Sinn Douglas P. , Neuwelt Edward A.
Published: May 2010

The sublabial trans-sphenoidal approach for the ablation of pituitary tumors can cause denervation or pulp death of some of the anterior teeth. The problem results from the bone removal necessary for placement of the nasal retractor. When bone is removed close to the apices of the anterior teeth, root injury may occur. This complication may be avoided through preoperative evaluation of skeletal and dental morphology. This evaluation revals the amount of bone between the tooth roots and the nasal floor and hence the ultimate access for the nasal retractor.
Superior Temporal Gyrus Approach to Middle Cerebral Artery Aneurysms
Authors: Heros Roberto C. , Ojemann Robert G. , Crowell Robert M.
Published: May 2010

Aneurysms of the bifurcation of the middle cerebral artery (MCA) can be approached through a small incision in the anterior portion of the superior temporal gyrus. The pterion and the lateral aspect of the lesser wing of the sphenoid bone are removed. The aneurysm is approached, using microsurgical techniques, by following the main divisions of the MCA to the parent trunk and the base of the aneurysm. Once the parent vessel and the origin of the major divisions are clearly identified, it is usually preferable to dissect and mobilize the entire aneurysmal complex to elucidate the anatomy and prepare the neck for clipping. This approach offers the advantages of minimal brain retraction and minimal manipulation of the main trunk and perforators of the MCA. In addition, it allows a more complete exposure of the aneurysmal complex and facilitates dissection behind the aneurysm, which is more difficult when the aneurysm is approached from the front by opening the sylvian fissure medially to laterally. A potential disadvantage of this method is that proximal control is not obtained until the base of the aneurysm is reached, but this has not been a problem in our experience. Other disadvantages are the need for a slightly larger bone flap and the potentially increased risk of epilepsy. This approach is not suitable when the main trunk of the MCA is short and the aneurysm is in front of the insula. It is also not recommended for the rare cases in which the aneurysm points back over the insula. During a 6-year period, this approach was used in 49 of 58 cases of MCA aneurysm. The only deaths in this group occurred in patients who were in deep coma before operation. Two patients were made worse by operative complications, and 2 more worsened as a result of postoperative vasospasm. There was a significant incidence of thrombophlebitis and pulmonary embolism in this series.
Interventional Radiology Polymer Update
Authors: Pevsner P. H. , George E. D. , Doppman J. L.
Published: May 2010

An overview of intravascular interventional embolic materials is presented. The physicochemical and biological properties of the monomer isobutyl 2-cyanoacrylate are discussed with specific details regarding therapeutic applications.
Comparison of Clinical Result between Microsurgical and Direct Visual Intracranial Aneurysm Surgery
Authors: Leibrock Lyal G. , Epstein Mel H. , Long Donlin
Published: May 2010

A retrospective study of 119 operative procedures for intracranial aneurysm was performed to compare the clinical result with microsurgical technique vs. that with standard instruments and without magnification; the operative technique was the major variable. The study demonstrated more normal patients, less intraoperative aneurysm rupture, and a greater capacity to isolate the aneurysm definitively with microsurgical technique. Anatomically and pathologically more difficult aneurysms had an even greater percentage of good clinical results when treated microsurgically. Familiarity and experience with microsurgical technique was associated with better clinical results, whereas the results with direct vision remained static.
Familial Gliomas
Authors: Chadduck William M. , Netsky Martin G.
Published: May 2010

Four families having multiple family members with cerebral gliomas are presented. Genetic studies were done in some, but no chromosomal abnormalities were found in this group of patients or their families. The authors recommend that careful attention be given to the family history of all glioma patients and that more extensive genetic studies be done. The formation of a registry to report cases of familial gliomas is also suggested.
Cystic Glioma of the Brain Stem with Prolonged Survival
Authors: Soffer Dov , Sahar Abraham
Published: May 2010

An unusual case of benign stem glioma with a 15-year survival is presented. In spite of 12 years of clinical quiescence, a focus of the tumor in the upper brain stem was found at necropsy. Morphologically, the tumor was a cystic pilocytic astrocytoma. The few previously reported similar cases in the same location were also associated with a favorable prognosis. It is suggested that, in analogy to the cystic cerebellar and cerebral astrocytomas, there is a group of cystic pilocytic astrocytomas of the brain stem with benign biological behavior.
Large Dose Thiopental Anesthesia for Intracranial Aneurysm Surgery
Authors: Sokoll Martin D. , Kassell Neal F. , Davies Loyd R.
Published: May 2010

Twenty patients undergoing intracranial aneurysm clipping were anesthetized with doses of thiopental sufficient to produce electroencephalographic burst suppression, nitrous oxide, oxygen, and morphine sulfate. Diuresis was induced with a combination of furosemide and mannitol. The cardiovascular effects of this anesthetic technique were studied. The central venous, pulmonary artery, pulmonary artery wedge, and systemic arterial blood pressures and the cardiac output were determined. The cardiac index and the systemic and pulmonary vascular resistance were calculated. The systemic blood pressure remained unchanged throughout the procedure except during the period of induced hypotension. The cardiac index decreased on the average from 3.3 during the control period to 2.15 litres/minute/m2 after the induction of anesthesia and diuresis (P < 0.05). During sodium nitroprusside-induced hypotension, there was a further decrease in the cardiac index to 1.81 litres/minute/m2 (P < 0.05). Changes in the cardiac index were associated with a significant decrease in the central venous and pulmonary artery wedge pressures (from 2.5 to 0.1 and 5.9 to 0.2 torr, respectively) and an increased systemic vascular resistance. Cardiovascular performance recovered quickly after termination of the induced hypotension and remained stable in the postoperative period. This anesthetic technique seems to be useful in the surgical repair of intracranial aneurysms.
Computed Tomography-directed Stereotaxy for Biopsy and Interstitial Irradiation of Brain Tumors: Technical Note
Authors: MacKay Alexander R. , Gutin Philip H. , Hosobuchi Yoshio , Norman David
Published: May 2010

A computed tomographic-stereotactic system based on the Leksell stereotactic frame has been used to implant radioactive 125I sources into (28 procedures) or to biopsy (2 procedures as biopsy only, 2 in conjunction with the implantation of a radioactive source) malignant brain tumors. In every instance, the selected target was reached precisely, allowing accurate diagnosis and treatment.
Monitoring of Cortical Somatosensory Evoked Potentials to Determine the Safety of Sacrificing the Anterior Cerebral Artery
Authors: Grundy Betty L. , Nelson Paul B. , Lina Agnes , Heros Roberto C.
Published: May 2010

Cortical somatosensory evoked potentials (SSEPs) reflect the functional integrity of somatosensory pathways from the site of stimulation to the primary somatosensory cortex. We used intraoperative monitoring of cortical SSEPs to determine whether the right anterior cerebral artery (RACA), the major feeding vessel of a large arteriovenous malformation (AVM), could be sacrificed without compromising sensorimotor function in the left lower extremity. The SSEPs recorded after test occlusion of the RACA showed preservation of the initial cortical positivity, and the RACA was divided. The AVM was excised completely, and the patient suffered no neurological deficit.
Overall Management of Vascular Lesions Considered Treatable with Extracranial-Intracranial Bypass: Part 1
Authors: Heilbrun Peter M.
Published: May 2010

From 1973 to 1979, 49 patients with internal carotid occlusion were evaluated and treated. Eighteen of 49 (37%) presented with transient ischemic attack/prolonged reversible ischemic neurological deficit, 14 of 49 (29%) presented with mild completed stroke, 13 of 49 (27%) presented with severe completed stroke, and 4 of 49 (8%) were asymptomatic. Surgical treatment consisting of extracranial-intracranial (EC-IC) bypass, internal carotid stump reconstruction and endarterectomy to open the occlusion, contralateral endarterectomy for carotid stenosis opposite the occlusion, and iatrogenic carotid occlusion with EC-IC bypass was carried out on 22 (45%) patients considered at risk for ischemia based on angiographic evidence of poor collateral circulation and potential sources of emboli. Medical treatment consisting of anticoagulants or anti-platelet aggregation agents was used in 27 (55%) patients with good collateral circulation. By 6 weeks after the initiation of treatment, 10 of 49 (20%) reached end points of new strokes and death. By an average of 3 years after treatment began, 30 of 49 (61%) reached the same end points. The results suggest that new ischemic events in the distribution of the occluded carotid artery occur infrequently if the angiographic study shows adequate collateral circulation to the ischemic territory at risk. Surgical revascularization should be reserved for patients with (a) recurrent ischemic events after the diagnosis of carotid occlusion or (b) poor collateral circulation.
Cutaneous Implantation Metastasis Complicating a Superficial Temporal-Middle Cerebral Artery Anastomosis
Authors: Salzman Richard S. , Bennett Richard G. , Fleischer Alan S.
Published: May 2010

A 52-year-old patient who underwent a superficial temporal-middle cerebral artery anastomosis subsequently developed an unusual squamous cell carcinoma in the skin overlying the anastomosis. The pathological picture and course of events suggest that this tumor was implanted into deeper tissues at the time of operation. Systematic microscopically controlled operation (Mohs' chemosurgical technique) was required to preserve the anastomosis while completely extirpating the tumor.
Giant Serpentine Aneurysm of the Posterior Cerebral Artery
Authors: Fukamachi Akira , Hirato Masabumi , Wakao Tetsuo , Kawafuchi Jun-ichi
Published: May 2010

We are reporting an unusual case of a giant serpentine aneurysm of the posterior cerebral artery (PCA). We were unable to find a report in the literature of a similar aneurysm. The microsurgical pterional approach was used for temporary clipping of the P-2 segment of the PCA, and the aneurysm was trapped successfully and excised. The discussion includes the operative approach to the giant serpentine aneurysm.