bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association of Hydrocephalus with Intramedullary Spinal Cord Tumors: A Series of 25 Patients
Authors: Rifkinson-Mann Stephanie , Wisoff Jeffrey H. , Epstein Fred
Published: April 2011

171 patients with intramedullary spinal cord tumors were operated on, of which 25 patients (15%), mostly children, developed symptomatic hydrocephalus. Twenty patients (12%) had malignant tumors, with 13 of the 20 cases (63%) complicated by increased intracranial pressure and ventriculomegaly. Of the remaining 151 patients with benign tumors (89%), only 12 (8%) developed symptomatic hydrocephalus. In an effort to understand the relationship between hydrocephalus and intramedullary spinal cord tumor, the authors analyze the level and histology of the neoplasm, as well as its association with spinal cysts. A review of the neurosurgical literature reveals that 34 similar cases of hydrocephalus associated with intramedullary spinal cord tumors have been reported to date. The authors note that the presence of hydrocephalus in patients with malignant intramedullary astrocytomas is associated with a shorter rate of survival than in those patients with high-grade lesions but without hydrocephalus, apparently due to rapid tumor progression. The ventriculomegaly seen with benign spinal cord gliomas has no statistically significant effect upon longterm prognosis.
Preoperative Superselective Arteriolar Embolization: A New Approach to Enhance Resectability of Spinal Tumors
Authors: Broaddus W. C. , Grady M. S. , Delashaw J. B. , Wisoff R. D. G. , Jane J. A.
Published: April 2011

The extent of surgical resection of spinal tumors is frequently limited by blood loss and technical difficulty associated with the vascularity of the tumors. We report here the use of superselective percutaneous arterial embolization to reduce the rate of blood loss at the time of surgical resection and enhance resectability. The types of tumors treated were metastatic renal carcinoma, metastatic thyroid carcinoma, metastatic melanoma, and giant cell tumor of the sacrum. Two of the patients required repeated embolization and surgery for recurrent symptoms. The estimated blood loss in seven of nine procedures performed on the six patients ranged from 300 to 800 ml, after which no transfusion was required. In two procedures, extensive resection of very large tumors resulted in larger losses of blood, and postoperative transfusion was necessary. No significant complications of embolization or surgery occurred. A key factor in our embolization technique is the use of microfibrillar collagen, which allows occlusion of tumor vessels as small as 20 µm and may prevent reconstitution of the embolized vessels by collateral flow. We conclude that preoperative arterial embolization enhances the resectability of a variety of spinal tumors by reducing intraoperative blood loss. This may provide an additional benefit by reducing the risk related to postoperative transfusion. By permitting a more aggressive surgical approach, the use of preoperative embolization also has the potential to improve outcome in patients with spinal tumors.
Fine Surface Structure of an Intraspinal Neurenteric Cyst: A Scanning and Transmission Electron Microscopy Study
Authors: Morita Yoshihiro , Kinoshita Kazuo , Wakisaka Shinichiro , Makihara Shinji
Published: April 2011

The case of an 11-year-old boy with an intraspinal neurenteric cyst, which recurred 8 years and 3 months after surgery, is presented. Scanning and transmission electron microscopy of the cyst epithelium revealed marked resemblance to that of the respiratory tract, despite the presence of numerous goblet cells mimicking intestine on light microscopy study. Detailed ultrastructural findings are described.
Computer-Aided Intelligence: Application of an Expert System to Brachial Plexus Injuries
Authors: Fisher Wink S.
Published: April 2011

When confronted with a patient with a brachial plexus injury, how often as neurosurgeons do we consult and atlas to confirm the anatomy of the brachial plexus and then attempt to establish the location of the lesion? Similar difficulties are encountered with lumbar and sacral plexus lesions. In a project organized to assist the neurosurgeon in this time-consuming task, a computer program that can rapidly determine the site of a lesion in a brachial, lumbar, or sacral plexus injury was created. Using known anatomical pathways (37 clinically relevant upper and 20 lower extremity muscle innervations), and relying solely upon the neurological motor examination, rapid computer-assisted diagnosis is possible. When more than one final common pathway lesion occurs (for example, multiple root avulsions of the brachial plexus), possible lesion sites can be obtained. An interactive dialogue between the user and the program helps to determine the location of the lesion. The program can be run on any IBM-compatible personal computer and is presented as an instrument that provides assistance in cases of complex peripheral nerve injuries, when expert consultants are unavailable. In addition, it can be used as an aid to learning and as a review of basic neuroanatomy.
Brain Retractor Edema during Induced Hypotension: The Effect of the Rate of Return of Blood Pressure
Authors: Lownie S. , Wu X. , Karlik S. , Gelb A.W.
Published: April 2011

This study evaluated the hypothesis that the postoperative formation of cerebral edema may be influenced by the rate of blood pressure return after induced hypotension in a graded brain retractor injury. Nineteen cats underwent unilateral craniotomy, isoflurane-induced hypotension to a mean of 50 mm Hg, and application of a brain retractor at 20 mm Hg of pressure for 1 hour. Blood pressure was returned to normal either within 3 minutes or over 20 minutes. The degree of cerebral edema formation was determined by Evans blue dye and coronal magnetic resonance imaging. All animals showed extravasation of Evans blue dye in the retracted hemisphere that was most marked at the periphery of the retractor. T1 relaxation times were significantly prolonged in the retracted hemispheres of both the fast return and slow return groups (18.8% and 17.8%, respectively) and more so at the Evans blue sites (42.8% and 40.8%), although not so strikingly beneath the retractor itself (6.3% and 7.8%). T2 relaxation times were similarly prolonged but to approximately half the degree of the T1 times. In the nonretracted hemisphere, drug-induced hypotension alone did not result in significant acute cerebral edema or blood-brain barrier alteration. There was no significant difference between the fast and slow groups in Evans blue extravasation or magnetic resonance changes. Thus, in a retractor-induced brain injury, restoration of arterial pressure to normal either gradually or rapidly did not influence the degree or extent of edema formation.
Long-Term Follow-up of Patients with Recurrent Malignant Gliomas Treated with Adjuvant Adoptive Immunotherapy
Authors: Lillehei Kevin O. , Mitchell Dawn H. , Johnson Stephen D. , McCleary Larry E. , Kruse Carol A.
Published: April 2011

Between August 1986 and October 1987, the Denver Brain Tumor Research Group conducted a clinical trial using autologous human recombinant interleukin-2 (rIL-2)-activated lymphocytes to treat 20 patients with recurrent high-grade gliomas. The trial involved surgical resection and/or decompression followed by intracavitary implantation of lymphokine-activated killer (LAK) cells and autologous stimulated lymphocytes (ASL) along with rIL-2 in a plasma clot. One month later, stimulated lymphocytes and rIL-2 were infused through a Rickham reservoir attached to a catheter directed into the tumor bed. The LAK cells were rIL-2-activated peripheral blood lymphocytes cultured for 4 days; the ASL were lectin- and rIL-2-activated peripheral blood lymphocytes cultured for 10 days. Of the 20 patients treated, 11 were evaluated as a group (mean age, 44 years, range, 15-61 years; mean Karnofsky rating, 69, range, 50-100; mean Decadron dose at entry, 14 mg/d. range, 0-32). The average number of lymphocytes implanted was 7.6 × 109 (range, 1.9-27.5 × 109), together with 1 to 4 × 106 U of rIL-2. To date, 10 of the 11 patients died, all from recurrent tumor growth. The median overall survival time was 63 weeks (range, 36-201; mean, 86). The median survival time after immunotherapy was 18 weeks (range, 11-151; mean, 39). No significant difference in survival after immunotherapy was found between those patients who had received previous chemotherapy and those who had not. The use of steroids or prior chemotherapy did not influence the in vitro generation of ASL or LAK cells. Prior chemotherapy did correlate, however, with diminished in vitro cytotoxicity against the natural killer-sensitive (K562) target cell by LAK cells (P < 0.05) but not that by ASL. There were no major adverse side effects. Although adoptive immunotherapy was safe and well tolerated, its therapeutic potential remains in question.
The Effect of Continuous Drainage of Cerebrospinal Fluid in Patients with Subarachnoid Hemorrhage: A Retrospective Analysis of 108 Patients
Authors: Kasuya Hidetoshi , Shimizu Takashi , Kagawa Mizuo
Published: April 2011

The effects of continuous drainage of cerebrospinal fluid (CSF) on vasospasm and hydrocephalus were analyzed retrospectively in 108 patients with subarachnoid hemorrhage (SAH) who were operated on for ruptured aneurysms within 48 hours of their onset. Ninety-two of these patients underwent a procedure for CSF drainage (cisternal drainage, ventricular drainage, lumbar drainage, or a combination of these). The duration, the total volume, and the average daily volume of CSF drainage were 10.4 ± 7.0 days (mean ± SD), 2034 ± 1566 ml, and 190 ± 65.3 ml, respectively. Patients with a greater drainage volume at a lower height of drainage in the early period after SAH developed more cerebral infarctions later (P < 0.025). The relationship between the total volume of CSF removed and shunt-dependent hydrocephalus was determined to be statistically significant (P < 0.005). Cerebral infarction and hydrocephalus after SAH were also found to be statistically associated (P < 0.001). Thus, continuous cerebrospinal fluid drainage should not be performed too readily in patients with SAH, because the removal of a large amount of CSF can induce cerebral vasospasm as well as hydrocephalus.
Symptomatic Diverticulum of the 4th Ventricle
Authors: Vaquero Jesus , Martinez Roberto , Coca Santiago , Saucedo Gertrudis
Published: April 2011

A case of symptomatic diverticulum of the 4th ventricle in a 57-year-old man is presented. This clinicopathological observation supports a relationship between ventricular diverticula and ependyma-lined paraventricular cysts.
Localization of Stereotactic Targets by Microrecording of Thalamic Somatosensory Evoked Potentials
Authors: Shima Fumio , Morioka Takato , Tobimatsu Shozo , Kavaklis Omiros , Kato Motohiro , Fukui Masashi
Published: April 2011

To improve the localization of stereotactic targets, somatosensory evoked potentials (SEPs) were recorded from the thalamus and subthalamic area using a specially designed semimicroelectrode in 61 patients and a conventional “macroclectrode” in 17 patients. By means of the semimicroelectrode, median nerve stimulation evoked two distinct SEPs, consisting of a diphasic wave with a huge positivity restricted to the nucleus ventrocaudalis (Vc) and a triphasic wave of lower amplitude with a major negativity in the ventral part of the nucleus ventrointermedius (Vim) and nucleus ventrooralis posterior (Vop) as well as the subthalamic lemniscal pathway. The Vim-Vc junction could thus be clearly delineated by an abrupt transition of SEPs from one type to the other with a precision of 1 mm. The parvicellular part of the Vc (Vcpc). situated in its basal region, was distinguishable from the Vc proper by a significant reduction of the positivity elicited by stimulation of the median nerve and by a rapid growth of a diphasic SEPs to stimulation of the posterior tibial nerve. In the other thalamic nuclei, stimulation of the median nerve elicited triphasic SEPs of a very small amplitude, suggesting a volume conduction current from the lemniscal pathway. With the macroclectrode, the positivity in the Vc was sensitive to electrode manipulation and the thalamic nuclei could not be distinctly outlined. SEP monitoring using the semimicroelectrode significantly improved the precision of target localization, which allowed minimizing of the volume of the therapeutic lesion without losing surgical effectiveness, while avoiding complications associated with increased penetration of the coagulating electrode. It is suggested that recording serial thalamic SEPs with the semimicroelectrode is a practical method to refine stereotactic targets in the thalamus.
Postoperative Computed Tomographic Evaluation of Patients with Large Pituitary Tumors Treated with Operative Decompression and Radiation Therapy
Authors: Nelson Paul B. , Robinson Alan G. , Hirsch William
Published: April 2011

Thirty consecutive patients who underwent operative decompression and radiation therapy for large sellar and suprasellar pituitary tumors (⩾2 cm) were studied in terms of the serial computed tomographic (CT) changes. There were 23 men and 7 women. The mean age was 49.6 ± 2.5 years, and the mean follow-up was 45.3 ± 3.9 months. Twenty-eight of the 30 patients had transsphenoidal surgery, and 27 had hormonally inactive tumors. Radiation therapy was begun within 1 month of surgery with a mean dose of 4855 ± 70 cGy. Postoperative CT scans were obtained within 1 month of surgery and at 6- to 12-month intervals thereafter. Fourteen patients (45%) had no suprasellar tumor visualized in either the early postoperative CT scans or on subsequent scans. Eleven patients (35%) had a persistent suprasellar mass during the early postoperative period that resolved on serial CT evaluation. The mean time for resolution was 10.4 ± 1.2 months. Six patients (20%) had a persistent suprasellar mass on serial CT evaluation. A persistent postoperative mass that subsequently resolved in many of the patients was thought to be caused by the gradual retraction of the postoperative packing and hematoma, as well as the effect of radiation on any residual tumor.
Neuropathy Caused by Spontaneous Intraneural Hemorrhage: Case Report
Authors: Poppi Massimo , Staffa Guido , Martinelli Paolo , Fabrizi Antonio P. , Giuliani Giuliano
Published: April 2011

A case of ulnar neuropathy at the elbow produced by spontaneous intraneural hemorrhage in a patient with acquired immunodeficiency syndrome and thrombocytopenia is reported. Intraneural hemorrhage in patients with bleeding disorders occurs infrequently. It consists of acute intrafascicular bleeding, presumably producing very high elevations of endoneurial fluid pressure. The clinical features and treatment of this condition are considered, the pertinent literature is reviewed, and the involved pathophysiological mechanisms are discussed.
Spinal Man after Declaration of Brain Death
Authors: André Turmel , Roux Alain , Bojanowski Michel W.
Published: April 2011

Complex spinal automatism in a patient who was declared brain dead is described. These movements tend to appear once cerebrospinal shock has abated. We postulate that these manifestations are a reflection of the physiological potential of the isolated spinal cord. These spinal movements should be included in the revised guidelines for the determination of cerebral death.
Spinal Cord Compression from a Thoracic Paraganglioma: Case Report
Authors: Cybulski George R. , Nijensohn Eduardo , Brody Betty A. , Meyer Paul R. , Cohen Bruce
Published: April 2011

A 34-year-old man with a 4-month history of midthoracic back pain sought treatment for a recent onset of lower extremity paresthesia and stiffness. A myelogram and computed tomographic myelogram disclosed an extradural block at the level of the 8th thoracic vertebral body with involvement of the pedicles, lamina, and spinous process. A posterior decompression of the spinal cord with subtotal resection of a highly vascular tumor was performed. The tumor was identified as a paraganglioma. In a second stage, the remainder of the tumor was embolized preoperatively, and gross total excision and sequential stabilization of the spine with a Luque rectangle and sublaminar wires were performed. The patient has been symptom free and without signs of a recurrence in the spine for over 13 months. A large abdominal paraganglioma was recently resected from its probable origin from the adventitia of the abdominal aorta.
Adult Peripheral Neuroepithelioma in Meckel's Cave
Authors: Midroni Gyl , Dhanani Al-Noor , Gray Trevor , Tucker William S. , Bilbao Juan M.
Published: April 2011

A case of peripheral neuroepithelioma arising from the trigeminal nerve in Meckel's cave is presented. The discussion emphasizes the pathological criteria for the diagnosis of a peripheral neuroepithelioma and the current controversy about the classification of this and related tumors.
Endoscopic Coagulation of the Choroid Plexus using the Nd:YAG Laser: Initial Experience and Proposal for Management
Authors: Bucholz Richard D. , Pittman Thomas
Published: April 2011

Although most patients with hydrocephalus are treated effectively with ventriculoperitoneal shunts, a small group fails to respond to diversion procedures. In some patients within this group, hydrocephalus may be caused in part by the overproduction of the cerebrospinal fluid (CSF). In other patients, previous shunt infections may limit the ability of the peritoneum to absorb fluid, and patient response to a ventriculoperitoneal shunt may be improved by reducing CSF production. We discuss a case of a 29-month-old hydrocephalic infant with a ventriculoperitoneal shunt who had ascites. Computed tomography showed bilateral symmetrical enlargement of the choroid plexus. Repeated cultures of the CSF and shunt tubing were sterile, and the daily production of the CSF exceeded 1000 ml. Therapy with acetazolamide decreased the CSF output temporarily, but it was discontinued after serious electrolyte abnormalities occurred. The endoscopic coagulation of the choroid plexus with a neodymium:YAG laser transmitted through a flexible quartz fiber decreased CSF production effectively. This procedure may be useful in a variety of clinical conditions associated with hydrocephalus or with other intraventricular lesions.
A Huge Intracranial Xanthogranuloma in the Middle Cranial Fossa: Case Report
Authors: Koyama Seigo , Tsubokawa Takashi , Katayama Yoichi , Hirota Hitoshi
Published: April 2011

Xanthogranulomas of the dura presenting with clinical symptoms are rare. We report here a case of a huge dural xanthogranuloma in the middle cranial fossa. which caused hemiparesis through marked displacement and stenosis of the middle cerebral artery. Although such tumors usually arise in association with histiocytosis X or familial hyperlipoproteinemia, the present case was not associated with these diseases.
Malignant Fibrous Histiocytoma in a Recurrent Thoracic Chordoma: Case Report and Literature Review
Authors: Nanda Anil , Hirsh Leonard F. , Antoiniades Kristina
Published: April 2011

Malignant transformation in a recurrent chordoma in the thoracic region is extremely uncommon. One new case, as well as a review of spinal chordomas that have undergone malignant transformation, is reported. Such cases emphasize the importance of the aggressive initial surgical treatment of spinal tumors.
Aneurysmal Bone Cyst of the Odontoid Process: Case Report
Authors: Andersen Bruce J. , Paul Goldhagen , Cahill David W.
Published: April 2011

Aneurysmal bone cysts (ABCs); are relatively uncommon, benign lesions. Fully 50% occur in long bones and 20% in the vertebral column, mostly in patients under 20 years of age. We report a case of an ABC in the odontoid process of a 74-year-old who sought treatment for pain and myelopathy. This is the first case reported of an ABC of the odontoid process.
C6 Glioma-Astrocytoma Cell and Fetal Astrocyte Migration into Artificial Basement Membrane: A Permissive Substrate for Neural Tumors but Not Fetal Astrocytes
Authors: Bernstein Jerald J. , Laws Edward R. , Levine Kirstiaan V. , Wood Lawrence R. , Tadvalkar Gauri , Goldberg William J.
Published: April 2011

Cortically homografted C6 glioma-astrocytoma cells both invade the rat host brain as a mass and migrate as individual cells. In contrast, fetal astrocytes derived from homografted whole pieces of fetal cortex migrate only as individual cells throughout the brain of the rat but are not capable of invasion. Our experiments explored the migratory capacity (over 7 days) of cultured purified fetal astrocytes and C6 cells after seeding 106 cells on a hydrated artificial basement membrane wafer (Matrigel). The artificial basement membrane wafer was not a suitable substrate for the growth of cultured fetal astrocytes. In contrast, C6 cells migrated as individual cells from the surface of the wafer into the substrate. Individual C6 cells migrated 1.8 mm in the first 4 days and then ceased migration. The C6 cells were observed at the base of a digestion tube that extended from and was open to the surface of the wafer. At 3 days, micropockets were observed to form around each C6 cell at the base of each tube. By 7 days, the majority of pockets observed were large and contained several C6 cells. These multiple cell groups appeared to be progenitors of tumor masses. These data indicate that C6 glioma-astrocytoma cells, which in vivo appear to be a model for glioblastoma multiforme, primarily migrate as individual cells through artificial basement membrane and secondarily form tumor masses. Progenitor tumor masses form by coalescence of individual C6 cell micropockets or the division of a single cell in an individual micropocket.
Occipital Meningoceles in Patients with the Dandy-Walker Syndrome
Authors: Bindal Ajay K. , Storrs Bruce B. , McLone David G.
Published: April 2011

Occipital cephaloceles in the Dandy-Walker syndrome are not rare. To date, 28 cases have been reported. We report on 8 cases of associated occipital meningocele, totalling 16% of all patients with the Dandy-Walker syndrome in our series. In all patients, communication existed between the posterior fossa cyst and the occipital meningocele. In 2 patients, the occipital meningocele disappeared after cerebrospinal fluid shunting and never required surgical repair. It appears that the cranial defect had ossified and resulted in self-closure. Poor intellectual development in persons with the Dandy-Walker syndrome is associated with the presence of other central nervous system and systemic abnormalities and not with occipital meningoceles alone.
Cranial Fasciitis: Case Report
Authors: Inamura Takanori , Takeshita Iwao , Nishio Shunji , Fujiwara Shigeru , Fukui Masashi
Published: April 2011

A 2-year-old boy with cranial fasciitis is described. He had a rapidly growing subcutaneous right occipital mass, which was associated with a dimple in the overlying skin. It appeared similar to a malignant subcutaneous tumor with skin invasion. Total resection of the tumor was performed, and the histological diagnosis, cranial fasciitis, was confirmed.
Intracranial Metastasis from Carcinoma of the Paranasal Sinus
Authors: Murphy Michael A. , Kaye Andrew H. , Hayes Ian P.
Published: April 2011

Carcinomas of the paranasal sinuses are locally invasive tumors that only occasionally metastasize. The tumor may spread intracranially by local invasion through the dura into the frontal lobes and extension along the vidian nerve. We describe two cases of cerebellar metastasis in patients with local recurrence and discuss the mechanism of spreading. It is possible that more aggressive treatment of these tumors, which results in longer survival, may be associated with an increased incidence of intracranial metastasis.
Acoustic Schwannomas in Children
Authors: Allcutt David A. , Hoffman Harold J. , Isla Alberta , Becker Laurence E. , Humphreys Robin P.
Published: April 2011

The clinical presentation and treatment of three cases of acoustic schwannoma occurring in children are described. All the tumors were detected late, when they had attained a large size and were extremely vascular. The use of preoperative tumor embolization as an adjunct to surgical excision is discussed. (Neurosurgery 29:14-18, 1991)
Large Cysts of the Pineal Gland: Report of Two Cases
Authors: Todo Tomoki , Kondo Tatsuya , Shinoura Nobusada , Yamada Ryozo
Published: April 2011

Two cases of large, nontumorous cysts of the pineal gland are reported, the histopathology of which was confirmed using surgically resected specimens. Both patients were middle-aged, and the pineal cysts were found incidentally. The histopathological findings in the two cases were strikingly similar to each other and were characterized by the following points: 1) the cyst wall typically consisted of three layers, namely, collagenous fibers, glia-like cells, and normal pineal cells; 2) the cyst wall was relatively thin, approximately 100 to 300 μm in thickness; and 3) deposits of caleification almost always existed on the side of the layer of collagenous fiber. Because these findings are clearly different from those previously reported. large benign cysts of the pineal gland. or at least some of them, may constitute a new pathological entity. It is important to consider this possible pathological diagnosis when dealing with pineal cysts. (Neurosurgery 29:101-106, 1991)
Arteriovenous Malformation in Meningothelial Meningioma: Case Report
Authors: Sawamura Yutaka , Janzer Robert C. , Fankhauser Heinz , de Tribolet Nicolas
Published: April 2011

An unusual association of a meningioma and an arteriovenous malformation is reported. A 68-year-old man developed left homonymous hemianopsia. left hemiparesis. and gaze palsy. Magnetic resonance imaging showed a right occipital mass lesion containing multiple signal-void areas with tubular and honeycomb appearance, suggesting a marked vascular component. An angiogram showed abnormal vasculature in the mass supplied by the posterior cerebral artery and a dural arteriovenous malformation on the tentorium. Neuropathological examination after total removal of the mass revealed a meningothelial meningioma including major portions of an arteriovenous malformation that extended from the dura and leptomeninges. through the meningioma, and into the occipital lobe, where the tumor was located. (Neurosurgery 29:109-113, 1991)
Development of Human Neural Transplantation
Authors: Madrazo Ignacio , Franco-Bourland Rebecca , Aguilera Maricarmen , Ostrosky-Solis Feggy , Cuevas Carlos , Castrejón Hugo , Magalloón Eduardo , Madrazo Mario
Published: April 2011

The possibility of altering the course of Parkinson's disease by brain grafting is slowly becoming a reality through the efforts of many research groups worldwide. It has been shown that this procedure, as performed in high-level medical research centers, usually produces no permanent adverse effects and can effectively ameliorate parkinsonian signs in certain patients. This progress has served to reinforce our commitment to develop neural transplantation into an effective therapy to treat such a devastating neurodegenerative disease. We have summarized the most important events that have shaped the initial phase of this research. In the course of the last 4 years, considerable knowledge has been gained in the clinical neurosciences regarding the real potential of various brain grafting procedures in treating Parkinson's disease, their shortcomings, and their usefulness in carefully selected patients. There is still no consensus regarding the various fundamental aspects of human brain grafting in Parkinson's disease. Questions concerning surgical technique, candidate selection, the optimal brain regions for implantation, the optimal tissue for implantation, and the real usefulness of brain grafting must be addressed. The importance of the quality of adrenal medulla fragments for grafting, the requirement for immunosuppressors in fetal brain grafting, and the optimal fetal age and the amount of donor tissue for effective grafting are additional areas of concern. The potential of xenografting, preserved tissues, and genetically engineered cells for human brain grafting remain unanswered. The development of human neural transplantation is the responsibility and privilege of neurosurgery.
Functional Recovery after Traumatic Transtentorial Herniation
Authors: Andrews Brian T. , Pitts Lawrence H.
Published: April 2011

To elucidate the factors associated with functional recovery after traumatic transtentorial herniation, we reviewed the records of 153 consecutive patients admitted with clinical signs of transtentorial herniation (altered level of consciousness, anisocoria or pupillary unresponsiveness, and abnormal motor findings). Overall, 28 patients (18%) had a functional outcome: 14 patients (9%) made a good recovery and 14 were moderately disabled. Sixteen patients (10.5%) were severely disabled or vegetative, and 104 (60%) died. Compared with patients who died or were left severely disabled or vegetative, patients who had a good recovery were younger (21 versus 38 years), were significantly more likely to be children (≤17 years old) and have anisocoria and a deteriorating Glasgow Coma Score (GCS), and were significantly less likely to be flaccid or have bilaterally fixed pupils; moderately disabled patients also had a lower median age and a higher frequency of anisocoria. There was no difference in the incidence of significant intracranial hematomas between patients with a functional outcome and those with a nonfunctional outcome. Twenty-seven percent of the 95 patients with anisocoria had a good outcome or moderate disability, whereas only 3.5% of the 58 patients with bilaterally fixed and dilated pupils at admission had a functional recovery (P < 0.05). Age, level of consciousness, and the degree of residual upper brain stem function at admission appear to be the most important determinants of functional outcome after traumatic transtentorial herniation.
Progression of Experimental Infantile Hydrocephalus and Effects of Ventriculoperitoneal Shunts: An Analysis Correlating Magnetic Resonance Imaging with Gross Morphology
Authors: McAllister James P. , Cohen Mitchell I. , O'Mara Kathleen A. , Johnson Michele H.
Published: April 2011

Although previous ultrasonographic studies did monitor ventricular enlargement successfully in experimentally-induced models of feline hydrocephalus, the resolution of neuroanatomic detail was relatively poor after placement of a ventriculoperitoneal (VP) shunt because the skull had ossified over the coronal sutures. Therefore, the present study employed magnetic resonance imaging to follow the progression of ventriculomegaly more accurately, as well as to evaluate the compensatory effects of VP shunting. Hydrocephalus was induced in kittens between 7 and 10 days old by injection of kaolin into the cisterna magna. Age-matched controls received similar injections of saline. At 9 to 14 days after the kaolin injection, the hydrocephalic animals received VP shunts. Anesthetized kittens were scanned at various intervals before and after shunt placement and were killed for morphological correlation. The features observed on the magnetic resonance imaging scans were consistent with the gross morphological changes that accompanied ventricular enlargement. The lateral ventricle began to enlarge as early as 1 day after the kaolin injection, and within 3 days, both the occipital and temporal horns, along with the 4th ventricle, showed signs of moderate dilatation. By 5 days, a bilateral communication had been established through the septum pellucidum. Continued expansion of the ventricular system occurred from 6 to 20 days after injection, to the point where the cerebral cortex was reduced to less than 25% of its original thickness. The internal capsule was stretched and edematous, the caudate nucleus was compressed ventrolaterally, and the cerebellar hemispheres were eroded and/or compressed. Animals in which shunts were successfully placed demonstrated a dramatic improvement in behavior, and a reduction of about 50% in the size of the lateral ventricles within 2 days. In some cases, the lateral ventricles became slit-like within 1 week. When they were killed, about half of the animals that received shunts exhibited mild to moderate ventriculomegaly. These results indicate that magnetic resonance imaging is an excellent method for visualizing the morphological changes associated with this animal model, that these alterations occur soon after the onset of hydrocephalus, and that VP shunting can successfully reduce ventriculomegaly.
Craniopharyngioma of the Posterior Fossa
Authors: Gokalp Hamit Z. , Egemen Nihat , Ildan Faruk , Bacaci Kadri
Published: April 2011

A case of craniopharyngioma originating in the very unusual location of the posterior fossa is presented. The patient, a 23-year-old man, was operated on at another hospital when he was 3 years old for craniopharyngioma in the suprasellar area. There was no complaint for several years after this initial operation. Three months before he was admitted to our hospital, he had complaints of headache, vomiting, nausea, and ataxia. A computed tomographic scan revealed a mass with a cyst and calcifications in the posterior fossa. The tumor was removed totally.
Multiple Growths of Primary Calvarial Meningiomas
Authors: Nakao Naoyuki , Kubo Kenji , Moriwaki Hiroshi
Published: April 2011

The authors present the case of a 68-year-old woman with multiple growths of primary calvarial meningiomas. Histological examination revealed one tumor arising in the left parietal bone that showed some malignant aspects, including hypercellularity, cellular pleomorphism, necrotic foci, and some mitoses; the tumor partially had a meningotheliomatous pattern. Two other tumors in the right parietal bone were meningotheliomatous meningiomas without any malignant features. With a review of the literature, the pathogenesis of the multiplicity is discussed.
Cerebral Hydatidosis in Childhood: A Retrospective Survey with Emphasis on Long-term Follow-up
Authors: Lunardi Pierpaolo , Missori Paolo , Di Lorenzo Nicola , Fortuna Aldo
Published: April 2011

We report the long-term outcome of surgery for cerebral hydatid cyst in 12 children. In only one child, who had been operated on for cardiac hydatidosis a year earlier, was the brain cyst known to be secondary. Of the 12 children. 10 had a single cyst and 2 had multiple cysts. Five single cysts were removed intact by “hydatid birth,” two cysts—one single and one multiple—were removed after puncture and aspiration of the cyst fluid, and the other five—four single and one multiple—were accidentally ruptured in the course of the operation. One patient died of infection of the residual space. 2 died of intracranial recurrence of the parasite (7 and 22 months later, respectively), and one. the child with secondary cerebral echinococcosis, died 6 years later of systemic echinococcosis. Eight patients who had a mean follow-up of 28 years are still living and enjoy very good health, both general and neurological. This long-term follow-up with such good results confirms the usually primary character of cerebral hydatid disease, at least in children. The combination of patent ductus arteriosus and ingestion of unboiled animals' milk might well explain how primarv cerebral hvdatid disease develops in children.
Modified Thermal Diffusion Flow Probe for the Continuous Monitoring of Cortical Blood Flow
Authors: Kuwayama Naoya , Takaku Akira , Harada Jun , Fukuda Osamu , Endo Shunro , Saito Tateo
Published: April 2011

A small thermal diffusion flow probe has been developed to monitor the dynamic changes in cerebral blood flow in small animals. Constantan wire was used as a heat source to make a miniature probe. The pair of thermocouples used to detect the heat gradient between two gold plates was elongated to avoid heat conduction between them, and this improvement allowed us to make quantitative measurements. After several basic experiments, local cerebral blood flow was measured simultaneously, using both the modified thermal probe and the hydrogen clearance method in four rabbits. A close relationship was obtained between the local cerebral blood flow values measured by hydrogen clearance (F, ml/100g/min) and the reciprocal of the thermocouple voltage (1/V;1/mV). The regression line was F = 29111(1/V- 1/226), (r = 0.92, P<0.001). We suggest that the modified thermal probe is a reliable and quantitative means of measuring flow. In addition, another probe modified for clinical use was evaluated. Continuous monitoring of local cerebral blood flow in postoperative patients was performed, and some illustrative cases are described.
Aphasia in Polyglots: Report of Two Cases and Analysis of the Literature
Authors: Mastronardi Luciano , Ferrante Luigi , Celli Paolo , Acqui Michele , Fortuna Aldo
Published: April 2011

Two cases of aphasia in polyglot patients who experienced different symptoms in each of the languages they knew are reported. The authors discuss the problem and analyze the available literature in an attempt to formulate a pathogenetic hypothesis of the different involvement of the known idioms sometimes observed in aphasic polyglots. In particular, when time has elapsed between the learning of the mother tongue and other languages, and all the known languages are. consequently, functionally independent, it is possible that the two or more known idioms have distinct anatomical representations, probably localized separately in the two hemispheres. This could explain why. in some polyglots, aphasia affects one of the known languages preferentially. In subjects in whom the different known idioms were learned during early childhood, the anatomical representation of the languages is similar, which explains why, in this kind of polyglot, all the known languages can be equally affected by cerebral damage that causes aphasia.
Recurrent Acoustic Tumor after a Suboccipital Removal
Authors: Thedinger Bradley S. , Keith C. Whittaker , Charles M. Luetje
Published: April 2011

Surgery for acoustic tumors has several priorities. First and foremost is the preservation of life with the total removal of the tumor; second is the preservation of the facial nerve; and last, when applicable, is the preservation of hearing. During the suboccipital (retrosigmoid) removal of a tumor, the surgeon unknowingly may leave tumor remnants leading to regrowth. We present five cases of recurrent acoustic tumors after a suboccipital removal. Inadequate drilling exposure of the internal auditory canal was the probable direct cause for tumor recurrence. A translabyrinthine removal is the best approach for total exposure of the entire internal auditory canal. The consequences of small tumor remnants will be discussed as well as their clinical relevance. Current radiological imaging and surgical techniques that avoid residual tumor will be presented.
Bedside Monitoring of Regionald Cortical Blood Flow in Comatose Patients Using Laser Doppler Flowmetry
Authors: Meyerson B. A. , Gunasekera L. , Linderoth B. , Gazelius B.
Published: April 2011

Continuous bedside monitoring of regional cerebrocortical blood flow was carried out using laser Doppler flowmetry (LDF) in four comatose patients. Newly designed thin and flexible optical probes that were easily implanted into the cortex were employed. When the patients were in a deep comatose state, the recordings revealed a conspicuous relationship to intracranial pressure. As the patients improved, the flux values gradually increased, and the recordings showed characteristic changes in the wave pattern, presumably related to the restoration of an impaired cerebral autoregulation. Changes in regional cerebrocortical blood flow were also observed during routine nursing procedures, the use of medications, and voluntary activities, as demonstrated by one patient after a complete recovery. Although the volume of tissue scanned with LDF was limited, and the flux values did not directly express regionalf cerebrocortical blood flow in terms of milliliters per unit volume, changes in cerebral circulation were portrayed clearly in the flow recordings. Thus. LDF, which is simple to use. permits continuous bedside monitoring of the cerebral microcirculation. Its use should improve the management of comatose patients and also open avenues for a better understanding of the cerebral circulation in pathological states.
Cervical Vertebral Artery Aneurysms and Arteriovenous Fistulae in Neurofibromatosis Type 1: Case Reports
Authors: Schievink Wouter I. , Piepgras David G.
Published: April 2011

Neurofibromatosis is of particular interest to neurosurgeons because of the various central and peripheral nervous system tumors and, more rarely, cervicocerebral arterial lesions associated with the disease. In the present paper, we report two patients with neurofibromatosis Type 1 (von Recklinghausen's disease) who had anomalies of the extracranial vertebral arteries. A large extracranial vertebral artery' aneurysm was incidentally discovered in the first patient, a 43-year-old woman, after rupture of a subclavian artery aneurysm. The second patient, a 28-year-old woman, had an enlarging neck mass and was found to have an extensive extracranial vertebral artery arteriovenous fistula. The vascular lesions associated with neurofibromatosis Type 1 in general and those arising from the extracranial vertebral artery in particular are reviewed.
Esophageal Perforation during Surgery on the Cervical Spine
Authors: van Berge Henegouwen D. P. , Roukema J. A. , de Nie J. C. , vd Werken C.
Published: April 2011

Esophageal perforation during surgery for cervical disc herniation is a rare complication. Differences in the time of diagnosis of this complication in three patients-no delay and delays of 6 hours and 4 days, respectively-resulted in different symptoms and outcomes. Early detection of the perforation allows prompt treatment. In the early stage, primary suture and, if necessary, interposition of vital tissue are sufficient to complete healing. In later stages, only drainage procedures, sometimes with a diversion of the salivary leakage, are indicated. In the reported patients, the outcome was favorable. On the other hand as an ongoing infection may cause mediastinitis, awareness of this complication and urgent surgical treatment may be lifesaving.
Cerebral Arteriovenous Malformations: Factors Influencing the Surgical Difficulty and Outcome
Authors: Tamaki Norihiko , Ehara Kazumasa , Lin Tin-Kai , Kuwamura Keiichi , Obora Yoshiro , Kanazawa Yasuhisa , Yamashita Hideyuki , Matsumoto Satoshi
Published: April 2011

The outcomes of 151 patients with arteriovenous malformations (AVMs) treated either surgically or conservatively are presented. In terms of long-term survival rate and follow-up results, the patients who underwent total excision had more favorable results than did those treated conservatively. Patient age was the most important clinical factors, with the preoperative level of consciousness being the second most important. A grading system was formulated on the basis of the angiographical factors by using multiregression analysis; the size of the AVM influenced the surgical outcome twice as much as did the location and the pattern of arterial feeding. Thus, a large AVM (≥4 cm) was given 2 points; a small AVM (<4 cm) was given 0 points; a deep AVM was given 1 point; a superficial AVM was given 0 points; an AVM supplied by three of more artery systems was given 1 point; and an AVM supplied by one or two artery systems was given 0 points. AVMs were categorized into 5 grades from Grade 0 to 4 by the summation of these points. Predicted Karnofsky scale after surgery was calculated by this grading system and the following equation: predicted Karnofsky scale = 87.2 - 5.6 × Grade. Grade 0 and 1 AVMs showed high rates of total excision (Grade 0, 94%; Grade 1, 82%) and of satisfactory outcome (Grade 0, 90%; Grade 1, 82%) and were classified as “easy” lesions. Grade 2 AVMs are lesions classified as “moderate” and had a total excision rate of 76% and a satisfactory outcome rate of 71%. Grade 3 and 4 lesions should be considered to be AVMs classified as “difficult” and showed total excision rates of 64 and 67%, respectively, and satisfactory outcome rates of 64 and 33%, respectively. This gradient system is useful for predicting both the degree of surgical difficulty and the operative morbidity of AVMs and, hence, for deciding the surgical indications.
Extramedullary Subdural Meningioma after Trauma
Authors: Kasantikul Vira , Charuchaikul Sirichan , Shuangshoti Samruay
Published: April 2011

A 61-year-old man had an extramedullary subdural meningioma occurring close to the site of an old vertebral traumatic fracture and spinal cord injury. The tumor was discovered 3 years after the spinal trauma. This finding supports the existence of a causal relationship between trauma and subsequent tumor development. A review of the literature disclosed only one other case of intraspinal meningioma after the traumatic fracture of the spine with spinal cord compression.
The Brain Tumor Cooperative Group NIH Trial 87-01: A Randomized Comparison of Surgery, External Radiotherapy, and Carmustine versus Surgery, Interstitial Radiotherapy Boost, External Radiation Therapy, and Carmustine
Authors:   Brain Tumor Cooperative Group, Selker Robert G. , Shapiro William R. , Burger Peter , Blackwood Margaret S. , Deutsch Melvin , Arena Vincent C. , Van Gilder John C. , Wu Julian , Malkin Mark G. , Mealey John , Neal John H. , Olson Jeffrey , Robertson James T. , Barnett Gene H. , Bloomfield Stephen , Albright Robert , Hochberg Fred H. , Hiesiger Emile , Green Sylvan
Published: April 2011

OBJECTIVE

The objective of the Brain Tumor Cooperative Group NIH Trial 87-01 trial was to investigate the effect of additional implanted radiation therapy in newly diagnosed patients with pathologically confirmed malignant gliomas.

METHODS

The study involved a randomized comparison of surgery, external beam radiotherapy, and carmustine (BCNU) versus surgery, external beam therapy, interstitial radiotherapy boost, and BCNU in newly diagnosed malignant gliomas. 125I was chosen as best suited for this effort because it allowed preimplantation planning and postimplantation quality assurance review. Two hundred ninety-nine patients met the eligibility criteria and were randomized into the two arms of the study between December 1987 and April 1994. Follow-up continued for an additional 3 years. Twenty-nine patients were identified as having committed protocol violations and were excluded, resulting in 270 subjects in the Valid Study Group. One hundred thirty-seven patients received external beam radiation and BCNU, and 133 underwent the 125I implantation plus external beam radiation and BCNU therapy.

RESULTS

The overall median survival for the Valid Study Group was 64.3 weeks. The median survival for patients receiving additional therapy of 125I was 68.1 weeks, and median survival for those receiving only external beam radiation and BCNU was 58.8 weeks. The cumulative proportion surviving between the two treatment groups was not statistically significantly different (log-rank test, P = 0.101). As in other studies in the literature, age, Karnofsky score, and pathology were predictors of mortality. Additional analyses incorporating an adjustment for these prognostic variables, either in a stratified analysis or Cox proportional hazards model, did not result in statistically significant differences in the cumulative proportion of patients surviving between the two treatment groups.

CONCLUSION

We conclude that there is no long-term survival advantage of increased radiation dose with 125I seeds in newly diagnosed glioma patients.