bluuebunny/crossref_metadata_2025 huggingface dataset:
Surface topography of normal and neoplastic human anterior pituitary cells maintained in vitro
Authors: Harris Robert D. , Seljeskog Edward L. , Murray Kenneth J. , Chou Shelley N. , Cunningham William P. , Douglas Steven D.
Published: May 2009

✓ Pituitary tissues were obtained from 25 patients who underwent surgery for excision of pituitary macroadenomas, selective excision of microadenomas, or removal of a normal gland for palliation of metastatic cancer. Cells thus obtained were maintained in vitro for varying intervals, fixed, and examined by light (phase contrast), microscopy, transmission electron microscopy (TEM), and scanning electron microscopy (SEM). Previous SEM reports indicate that surface topography of in vitro neoplastic cells displays features that may correlate with neoplastic behavior. Cultured normal and pituitary tumor cells did not display these surface differences, with one exception, a prolactin-secreting microadenoma. Characteristic patterns for the cell populations were identified. Certain cell types appeared in all the cultures: 1) large and small granule-containing cells; 2) flat and irregular agranular cells; 3) spindle-shaped cells; and 4) spherical, irregularly surfaced cells. In one case of an endocrine-inactive juvenile pituitary chromophobe adenoma, unique cells were observed. Surface topography did not appear to be of predictive value in determining the neoplastic character of pituitary tumors.
Cytochemical demonstration of adenylate and guanylate cyclases in vascular smooth muscle of circle of Willis
Authors: Tani Eiichi , Yamagata Shogo , Maeda Yukio , Ito Yuko
Published: May 2009

✓ The cytochemical localization of adenylate cyclase and guanylate cyclase was studied in the arteries of the circle of Willis in dogs. The reaction products of both adenylate and guanylate cyclases were similarly distributed and selectively localized predominantly adjacent to sarcoplasmic reticulum and sparsely to mitochondria and outer nuclear membranes of vascular smooth muscles. The observations could suggest a close association of the intracellular localizations of both cyclases and the intracellular calcium storage sites, and ultimately contribute to our complete understanding of regulation of cerebral blood flow and vasospasm.
Symptomatic pituitary tumor enlargement after induced pregnancy
Authors: Nelson Paul B. , Robinson Alan G. , Archer David F. , Maroon Joseph C.
Published: May 2009

✓ A case is presented and 11 others are reviewed in which symptomatic pituitary tumor enlargement occurred during pregnancies that resulted from induced ovulation. The syndrome is usually characterized by headache and visual disturbances with bitemporal visual field abnormalities, but may present with ocular muscle palsies. The cases are divided into two groups. The patients in one group had a shorter duration of amenorrhea (3.8 years), developed symptoms before the 14th week of pregnancy, and were usually treated by tumor removal. Patients in the second group had a longer period of amenorrhea (10.2 years), developed symptoms after the 24th week of pregnancy, and their symptoms regressed with delivery of the infant. Tumor removal or termination of the pregnancy both resulted in resolution of symptoms. All pregnancies resulted in normal infants. This series provides guidelines for management of future cases.
The fate of autogenous grafts to the spinal dura
Authors: Keller Jeffrey T. , Dunsker Stewart B. , McWhorter Joe M. , Ongkiko Carlos M. , Saunders Mary C. , Mayfield Frank H.
Published: May 2009

✓ An experimental study was designed to compare the efficacy of autogenous fat and Gelfoam in minimizing scar tissue attachment to the dura and nerve roots. A multiple level lumbar laminectomy was performed in 20 dogs, and Gelfoam and autogenous fat were placed in the epidural space at two laminectomy sites, over the dura, interposed between the overlying paraspinal muscles and the dura. A third lumbar laminectomy site in each dog served as a control. The animals were sacrificed after different time periods (3, 6, 12, 18, and 24 weeks), and the specimens were examined histologically and histochemically. The colloidal iron-periodic acid Schiff-Bismarck brown-picric acid (CI-PAS-BB-PA) and high iron diamine-Alcian blue 8Gx (HID-AB) techniques were used to demonstrate connective tissues and glycosaminoglycans.

The scar at the laminectomy sites where Gelfoam was placed and at the control sites was composed of dense irregular connective tissue. Examination of the laminectomy sites where autogenous fat was used revealed less scar tissue. In addition, there was a layer of fat with a slight increase in intercellular connective tissue fibers interposed between the overlying erector spinae musculature and the dura. Our results indicate that autogenous fat interposed between the dura and the overlying paraspinal musculature serves as a barrier limiting the growth of connective tissue into the spinal canal. We could find no evidence that Gelfoam prevented the ingrowth of scar tissue into the operated area.
Xeroradiography in evaluation of cervical spine injuries
Authors: Peters Norman D. , Ehni George
Published: May 2009

✓ Xeroradiography is a useful tool in the evaluation of fractures and dislocation of the lower cervical spine. It affords clear visualization with minimal manipulation or risk.
Hypothalamic hypothyroidism and hypogonadism in prolonged traumatic coma
Authors: Fleischer Alan S. , Rudman Daniel R. , Payne Nettleton S. , Tindall George T.
Published: May 2009

✓ Prolonged coma after head trauma is associated with depletion of 3′,5′cyclic adenosine monophosphate (cAMP) in the cerebrospinal fluid (CSF). Because cAMP has previously been implicated in neuroendocrine secretion, this study examines the pituitary-hypothalamic function in 15 adult male patients (to exclude the effects of puberty and menses) with traumatic coma lasting longer than 2 weeks. Ventricular CSF cAMP was measured at 2- to 4-day intervals for 10 to 25 days. Simultaneously, plasma hormone concentrations were also determined.

In all 15 cases, CSF cAMP and plasma levels of thyroid-stimulating hormone (TSH), thyroxine (T4), free T4, triiodothyronine (T3), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone became subnormal. In 11 patients whose level of consciousness fluctuated, the reduction in plasma T4 and testosterone were proportional to both severity of coma (r > 0.81, p < 0.05) and depletion of CSF cAMP (r > 0.81, p < 0.05). In four patients who remained deeply comatose for 17 to 25 days, the hypothyroidism and hypogonadism persisted. In six patients who regained consciousness, both endocrine defects improved partially or completely. Injection of 1) thyrotrophic-releasing hormone and 2) gonadotrophic-releasing hormone elicited normal or supernormal increases in plasma concentrations of 1) TSH, and 2) LH and FSH, reduced, respectively, suggesting a suprahypophyseal deficiency. These observations demonstrate that suprahypophyseal hypothyroidism and hypogonadism may occur regularly in patients with traumatic coma lasting longer than 2 weeks.
Surgical treatment of a mesencephalic tuberculoma
Authors: Dierssen Guillermo , Trigueros Felipe , Sanz Felipe , Coca Jose Maria , Orozco Miguel
Published: May 2009

✓ A case is reported of a mesencephalic tuberculoma which was suspected clinically and removed surgically with a relatively good functional recovery.
Superficial temporal-middle cerebral artery anastomoses in the treatment of a carotid-cavernous fistula
Authors: Shen Albert Ly-young
Published: May 2009

✓ The treatment of a patient with a carotid-cavernous fistula and complete occlusion of the contralateral internal carotid artery is reported. Bilateral superficial temporal-middle cerebral artery anastomoses were performed to create collateral circulation prior to trapping the fistula. The patient made an excellent recovery.
Extradural lumbar cryptococcosis
Authors: Litvinoff Jerome , Nelson Max
Published: May 2009

✓ An 85-year-old woman presented with back and leg pain. Plain films showed destruction of the posterior elements of L-5 and myelography demonstrated a large extradural mass at that level. Exploration revealed a huge gelatinous extradural mass with invasion of the paraspinal muscles. Fungal stains showed that the mass consisted of innumerable Cryptococci. There was no evidence of cryptococcal involvement elsewhere.
Collection of blood from the pituitary stalk and portal veins in monkeys, and from the pituitary sinusoidal system of monkey and man
Authors: Carmel Peter W. , Antunes J. Lobo , Ferin Michel
Published: May 2009

✓ A transorbital, transsphenoidal microsurgical approach to the pituitary stalk and gland was used to collect blood from the hypothalamo-hypophyseal portal system in monkeys. Specimens may be obtained from the entire pituitary stalk, individual long portal veins, or the pituitary sinusoidal bed, with little risk of mortality. Continuous stalk blood sampling was carried out for periods of up to 10 hours. Pituitary sinusoidal-system blood was also collected during transsphenoidal surgery in man. The uses of data concerning hypothalamic-hypophyseal regulation obtained by these methods are illustrated.
An analysis of follow-up results of 1000 intracranial saccular aneurysms with definitive surgical treatment
Authors: Yoshimoto Takashi , Uchida Keita , Kaneko Uichi , Kayama Takamasa , Suzuki Jiro
Published: May 2009

✓ The authors report a follow-up review of 1000 cases of intracranial definitive surgery for saccular aneurysms. The prognosis for such surgical cases is discussed. Postoperative results at least 6 months after discharge from the hospital were analyzed in 876 (93.3%) of the 939 surviving patients. The longest follow-up period was 14 years and 5 months, with an average of 3 years and 7 months. At the time of discharge, there were 543 excellent results, 186 good, 117 fair, 93 poor, and 61 deaths. The chief findings were as follows: 1) Most of the patients determined as “excellent” or “good” at discharge were able to return to normal life; most of the deaths or instances of worsened condition found in the follow-up study were due to new lesions. 2) Fully 62% of the cases determined as “fair” at discharge were found in an improved state at the follow-up study, having returned to normal life. 3) Only 19% of cases determined as “poor” at discharge had improved to the point where a return to normal life was possible, the majority having died or remaining in poor condition.
Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantile hydrocephalus
Authors: Keucher Thomas R. , Mealey John
Published: May 2009

✓ This series of 228 patients with infantile non-neoplastic hydrocephalus who received either a ventriculoatrial (VA) or a ventriculoperitoneal (VP) shunt before 2 years of age was followed for an average of 7 years, and the results with the two types of shunt were compared. Mortality and infection rates were similar for both groups of patients, but children with VP shunts required significantly fewer revisions and had a much greater likelihood of not having any revisions during the follow-up period. Late complications occurred more frequently with VA shunts and were more serious. It is concluded that VP shunts offer significant advantages over VA systems in this population.
Meningioma of the anterior part of the third ventricle
Authors: Markwalder Thomas M. , Markwalder Regula V. , Markwalder Hans M.
Published: May 2009

✓ The authors present a case of meningioma located in the anterior part of the third ventricle. The mass was successfully removed through a right-sided transventricular approach after stereotaxic biopsy. A review of the relevant literature is included.
Percutaneous restoration of a kinked shunt
Authors: Natelson Stephen E.
Published: May 2009

✓ A thin-walled atrial catheter used in shunting for hydrocephalus may become curled or kinked in the neck after it has been in normal position and functioning for years. The usual cause is a bout of severe coughing. Such a case is described together with a percutaneous method of restoration of the shunt by transfemoral catheterization utilizing a wire loop.
A new self-drilling skull traction device with flexion-extension modification
Authors: Caton William L. , Heifetz Milton D. , Small Richard B. , Kurze Theodore
Published: May 2009

✓ A new tong has been designed that can be attached to the skull using the three-prong principle. It may act as a rigid integral part of the skull, or may simply swivel in the same manner as all contemporary tongs. This ability to function as a rigid attachment allows for flexion or extension of the patient's neck if indicated. The need for incisions or extra drills has been eliminated.
Pipette suction for atraumatic extraction of intraventricular cysticercosis cysts
Authors: Madrazo N Ignacio , Sanchez Cabrera Jose M. , Maldonado Leon J. Antonio
Published: May 2009

✓ The authors use a slender Pasteur pipette for the atraumatic extraction of Cysticercus cysts from the deep ventricular cavities. Their technique is described and illustrated.
Studies of experimental cervical spinal cord transection
Authors: Tibbs Phillip A. , Young Byron , Ziegler Michael G. , McAllister R. G.
Published: May 2009

✓ Plasma concentrations of norepinephrine (NE) were measured by a radioenzymatic assay technique before and serially after laminectomy at the C-6 level in 14 anesthetized dogs. In half the animals, no further procedures were carried out (control group); in the other dogs, cervical cord transection was performed in addition to laminectomy (experimental group). Mean plasma NE levels were similar in both groups after laminectomy and before cord interruption. In the control group, NE levels increased gradually for 2 hours after the procedure. In the group with cord transection, however, NE rose immediately after transection to 267% of the baseline value, then fell to 25% of the plasma NE level in the control group at 30 minutes, 29% at 60 minutes, and 15% at 120 minutes. Cervical spinal cord transection, therefore, results in an abrupt but short-lived increase in plasma NE concentrations. These changes in plasma NE levels may explain, at least in part, the hemodynamic alterations and the acute central hemorrhagic necrosis that occur after high spinal cord trauma.
Results of urinary diversion in patients with myelomeningocele
Authors: Smith Harold P. , Russell John M. , Boyce William H. , Alexander Eben
Published: May 2009

✓ Among 481 children with myelomeningocele seen at the North Carolina Baptist Hospital since 1949, 46 have undergone a urinary diversion procedure, as follows: ileal loop in 43; sigmoid loop in two; and transverse colon conduit in one. The indications for diversion were incontinence in 28, urinary infection or pyelonephritis in 27, and hydronephrosis, pyelocaliectasis, and reflux in 12 patients. No deaths resulted from the diversionary procedures. One patient required early surgical revision and seven patients required late surgical revision. Two patients have since died, 44 have been followed for an average of 7.9 years, 15 for more than 10 years. Overall, of 26 patients with normal prediversionary intravenous pyelograms (IVP's), 88% now have normal or nearly normal IVP's; of 14 patients with abnormal prediversionary IVP's, 79% now have normal, improved, or unaltered IVP's. Renal function has remained normal in all 44 patients, and renal calculi have developed in 10 patients.

Ileal loop diversion appears to convert a high-pressure system into a low-pressure system, thereby helping to prevent further renal damage. This procedure tends to stabilize, rather than improve, urinary-tract function. For these children already so incapacitated by their basic disease, this goal is acceptable, particularly since it also provides continence and independence from parental nursing.
Chronic extradural hematoma and extradural aerocele
Authors: Hanieh Ahmad
Published: May 2009

✓ A case is presented of the successful surgical management of a patient with head injury complicated by a chronic extradural hematoma and extradural aerocele.
Primary epidural Ewing's sarcoma presenting as a lumbar disc protrusion
Authors: Fink Lawrence H. , Meriwether Michael W.
Published: May 2009

✓ Primary neoplasms of the spinal epidural space are uncommon. One of the rarest of these is a soft tissue sarcoma indistinguishable from Ewing's sarcoma of the bone. Only 39 such cases have been reported previously, of which only three arose within the epidural space. The authors report an additional case, which presented in an atypical manner, and review the pertinent literature.
Double-contrast ventriculography with oxygen and water-soluble positive contrast medium, metrizamide (Amipaque)
Authors: Servo Antti , Halonen Viljo
Published: May 2009

✓ A technique for ventriculography using both gas and a positive contrast medium metrizamide (Amipaque) is presented. This ventriculographic method proved superior to computerized tomography (CT) scanning in revealing the cause of obstructive hydrocephalus. Small central tumors and intraventricular cysts, often missed with CT, were also well demonstrated. This technique has been used since 1975, and is simple an$ safe.
Neurosurgery at the crossroads: leadership role of the American Association of Neurological Surgeons
Authors: Dohn Donald F.
Published: May 2009

✓ The President of the American Association of Neurological Surgeons (AANS) reviews the formative history of the major neurosurgical societies, together with their agreement to consolidate their efforts in the joint AANS. As a united group, the Association has been effective in carrying out relations with other professional organizations and with government. Long-range planning is being pursued steadily to increase the role of organized neurosurgery in maintenance of, and improvement in, patient care, education, and research.
Spontaneous regression of posterior fossa dural arteriovenous malformation
Authors: Endo Shunro , Koshu Keiji , Suzuki Jiro
Published: May 2009

✓ The authors report a case of infratentorial arteriovenous malformation that regressed spontaneously within 25 months without bleeding episodes or surgical intervention. The patient's clinical symptoms, left-sided tinnitus, cranial bruit, and right homonymous hemianopsia, disappeared completely over the same period.
Sensitivity of the short-range spinal interneurons of the cat to experimental spinal cord trauma
Authors: Benoist György , Kausz Mária , Réthelyi Miklós , Pásztor Emil
Published: May 2009

✓ The technique of retrograde axoplasmic transport was used to demonstrate the effect of experimental spinal cord injury on the spinal interneurons in the upper lumbar and lower thoracic segments of cats. Force of varied intensity was applied to the dorsal surface of the spinal cord and horseradish peroxidase (HRP) was injected into the next caudal segment. A large impact (250 to 350 gm-cm) inducing permanent paraplegia of the hind legs blocked the axoplasmic transport instantaneously in both cranial and caudal directions. If 1 week elapsed between the trauma and injection, neurons cranial to the trauma did not show any evidence for retrograde axoplasmic transport, while few neurons in the caudal direction were labeled with HRP. A moderate impact (150 gm-cm) which rendered the animals only transiently paraplegic spared the axoplasmic transport in some neurons both cranially and caudally to the injection. No obvious recovery or additional loss in the number of HRP-labeled neurons could be found in the cats if the injection followed the trauma by 1 week. The loss of spinal cord neurons following the injury seems to be the immediate mechanical consequence of the trauma.
Vestibulospinal monitoring in experimental spinal trauma
Authors: Young Wise , Tomasula John , DeCrescito Vincent , Flamm Eugene S. , Ransohoff Joseph
Published: May 2009

✓ Vestibulospinal tract function was monitored in experimental contusion of the spinal cord in cats, and compared with somatosensory cortical evoked potentials. Both white and gray matter portions of the vestibular and somatosensory pathways were evaluated in cord injuries at T-7 and L-4. Severe contusions of 20 gm–20 cm force impact resulted in a rapid (less than 1 second) abolition of thoracic white matter conductivity, but a somewhat slower (4 to 5 minutes) loss of lumbar gray matter responses. A paradoxical transient recovery of white matter conductivity occurred 1 to 2 hours after injury, despite eventual progression to central hemorrhagic necrosis at the contusion site. In contrast, mild contusions (20 gm–10 cm force impact) produced only a temporary loss of neuronal activity: white matter for 1 to 2 hours, and gray matter for 30 to 40 minutes. In general, vestibular and somatosensory potentials showed similar sensitivity to contusion, although the former tended to recover earlier. We conclude that contusion injury causes two types of neuronal dysfunction in spinal cord: 1) a low-threshold concussion-related loss of activity lasting 30 to 120 minutes; and 2) a higher threshold necrotic process, requiring 1 to 2 hours to develop, which apparently spreads from gray to white matter.
Cerebral cyst infection with Micrococcus sedentarius
Authors: Greene Gerald R. , Mc Ninch Catherine , Foltz Eldon L.
Published: May 2009

✓ A 7-year-old boy with congenital hydrocephalus and a left septate cerebral cyst presented with a shunt infection due to Micrococcus sedentarius, resistant to all penicillins. The shunt infection was persistent despite several courses of parenteral, intraventricular, and intracyst antibiotics. Evaluation of the ventricular fluid revealed adequate “killing power” against the patient's microorganism. No extracranial focus of infection could be found. Computerized tomographic scanning, along with air ventriculography, identified a noncommunicating area of the cerebral cyst. Only when communication between this location and the rest of the cyst was established were the antibiotics efficacious. Undercirculated areas of cerebrospinal fluid should be sought when shunt infections and ventriculitis persist in spite of adequate parenteral and local therapy in patients with brain cysts.
Cerebral vasospasm following aneurysm rupture
Authors: Fleischer Alan S. , Tindall George T.
Published: May 2009

✓ A retrospective study was made of 195 patients who had ruptured intracranial aneurysms without significant intracerebral hematomas and who recovered to at least Grade III by Hunt and Hess' classification. The first 121 patients underwent aneurysm surgery 10 days to 2 weeks after subarachnoid hemorrhage (SAH) without repeat preoperative angiography and without special attention to volume replacement or avoidance of hypotension. Vasospasm resulted in cerebral ischemia in 15% of this group, more than half of these postoperatively, and was treated successfully in half the patients with a combination of aminophylline and isoproterenol. The later 74 patients were managed with aggressive maintenance of normal circulating blood volume and preoperative angiography at 2 weeks following SAH. If significant vasospasm persisted on angiography, surgery was delayed an additional week and, if spasm was still present then, aminophylline and isoproterenol were added prophylactically to aggressive volume replacement before surgery. In this second group of patients, the incidence of clinical vasospasm was essentially unchanged; however, it was almost completely limited to the preoperative period, and was more effectively treated with aminophylline and isoproterenol. Postoperative vasospasm was almost completely eliminated from the second group of patients.
Cranial asymmetry secondary to unilateral hemispheric damage during late childhood
Authors: Wyler Allen R. , Ward Arthur A.
Published: May 2009

✓ Skull abnormalities such as unilateral hypertrophy of skull thickness, enlarged sinuses, and elevated petrous ridge with contralateral body hemiatrophy are commonly associated with hemispheric damage that occurs during infancy. The present case emphasizes that such changes may be associated with cortical damage during late childhood.
Thalamic stimulation for neuropathic pain
Authors: Turnbull Ian M. , Shulman Ralph , Woodhurst W. Barrie
Published: May 2009

✓ Eighteen patients with neuropathic pain underwent thalamic electrode implantation. Satisfactory initial pain relief ensued in 14, and their electrode systems were internalized for long-term use. Twelve of the 14 continue to obtain either complete or partial pain relief by regular stimulation. One of the other two patients has had a complete remission of pain, apparently spontaneously, and the other had to have the electrode removed after it retracted from his thalamus on two occasions. The electrodes have been placed in the sensory nucleus of the thalamus where stimulation evokes paresthesias in the painful part of the body. Technical problems consisting of our inability to locate the target in two patients and our failure to fix the electrode adequately in one prevented us from employing the treatment in three patients. The fourth patient had temperature dysesthesia which was not altered during 2 weeks of stimulation.
Microsurgical anatomy of the choroidal arteries Fourth ventricle and cerebellopontine angles
Authors: Fujii Kiyotaka , Lenkey Carla , Rhoton Albert L.
Published: May 2009

✓ The microsurgical anatomy of the arteries supplying the choroid plexus in the fourth ventricle and cerebellopontine angles was examined under × 3 to × 20 magnification in brains from 25 adult cadavers. In the most common pattern, the branches of the anterior inferior cerebellar artery (AICA) supplied the portion of the choroid plexus in the cerebellopontine angle and adjacent part of the lateral recess of the fourth ventricle, and the posterior inferior cerebellar artery (PICA) supplied the choroid plexus in the roof and medial part of the lateral recess of the fourth ventricle. The superior cerebellar artery (SCA) gave rise to a choroidal branch in only one brain. The choroid plexus on each side of the midline was divided into a medial and a lateral segment. Each segment was considered two parts to facilitate the description of its blood supply. The medial segment, located in the roof of the fourth ventricle, was divided into a rostral or nodular part, and a caudal or tonsillar part. The lateral segment, located in the lateral recess of the fourth ventricle and cerebellopontine angle, was separated into a medial or peduncular part, and a lateral or floccular part. The AICA most commonly supplied all the floccular part and the lateral portion of the peduncular part, and the PICA most commonly supplied all of the tonsillar and nodular parts, and the medial portion of the peduncular part.
An evaluation of nerve repair with nerve allografts in normal and immunologically tolerant rats
Authors: Zalewski Andrew A. , Silvers Willys K.
Published: May 2009

✓ Schwann cells survive longer in allografts of ganglia that contain minor, rather than major and minor, transplantation antigens. The authors have investigated whether a nerve allograft with minor antigens would be superior to one with major and minor incompatibilities in aiding in the repair of injured nerve. A segment of host peroneal nerve was removed from rats and replaced with a peroneal nerve allograft that contained either minor or major and minor antigens. The results showed that in normal rats, host nerve fibers could functionally regenerate through (that is, grow through and reinnervate muscle) nerve allografts 2 cm but not 4 cm in length, irrespective of the antigens the allografts contained. Host nerve fibers could, however, regenerate through 4-cm nerve allografts if the hosts were rendered immunologically tolerant of the transplantation antigens of the nerve donors. Furthermore, when sensitized lymphoid cells were injected into tolerant rats bearing functional nerve allografts, Schwann cell rejection and demyelination occurred in the graft but host nerve fibers remained. It is concluded that minor antigens alone are as potent as major and minor antigens together in evoking an immune response that prevents functional regeneration through long lengths of nerve allografts. Host nerve fibers can, however, regenerate through such nerve allografts if the hosts are immunosuppressed.
Sparganosis of the brain
Authors: Mineura Katsuyoshi , Mori Teruaki
Published: May 2009

✓ A patient is reported with sparganosis of the brain involving Sparganum mansoni. This 33-year-old Korean woman had complained of generalized tonic-clonic convulsions during the 5 years before operation. Right frontotemporal craniotomy was performed, and a live Sparganum mansoni was removed from the subdural space. To date, this tapeworm has been reported in only two autopsied human brains. This is the first case in which a live Sparganum mansoni was successfully removed from the intracranial region.
Experimental model for maxillary artery to middle cerebral artery anastomosis in dogs
Authors: Asari Syoji , Ohara Susumu , Fujisawa Hiroyuki , Kageyama Toshiaki , Matsumoto Keizo
Published: May 2009

✓ End-to-side anastomoses between the maxillary artery and a branch of the middle cerebral artery were performed as an experimental model for extracranial-intracranial shunt in dogs. Anastomoses were carried out after occlusion of the middle cerebral artery. Eighteen of 21 shunts were patent (86%) 2 weeks after the procedure.
Recent diagnostic experience with subdural empyema
Authors: Luken Martin G. , Whelan Margaret A.
Published: May 2009

✓ The authors review the Neurological Institute experience of six cases of subdural empyema in the 4 years since the introduction there of computerized tomography (CT) scanning. Four patients had no known prior neurological disease, and presented with the classical clinical syndrome of fever, depressed sensorium, and focal seizures; three of these patients had histories or radiographic evidence of sinus disease. The two remaining patients had undergone earlier drainage procedures for chronic subdural hematomas, and presented without neurological symptoms but with low-grade fever and signs of local wound infection. All of the patients of the former (primary) empyema group had technically satisfactory contrasted CT scans at a time when the clinical syndrome was fully developed, and none revealed the subdural collection. Angiograms were performed in three of these cases and were uniformly successful in demonstrating the collections and suggesting their inflammatory natures. Both secondary empyemas were readily visualized by CT, and showed characteristic brightly enhancing membranes.

It is concluded that primary and secondary subdural empyemas differ both in clinical presentation and in accuracy of CT diagnosis. In the former group, evidence of sinus disease is suggestive but does not by its absence exclude a purulent subdural collection. In patients with the typical clinical syndrome, reliance on CT is hazardous, and angiography is the diagnostic procedure of choice.
Atheromatous pseudo-occlusion of the internal carotid artery
Authors: Sekhar Laligam N. , Heros Roberto C. , Lotz Preston R. , Rosenbaum Arthur E.
Published: May 2009

✓ In the past year, three patients were referred for microvascular bypass surgery for relief of symptoms secondary to an apparently occluded internal carotid artery (ICA). Careful review of the late films of their initial arteriographic series or repeat arteriography with a specialized technique revealed a thin trickle of contrast medium flowing antegrade through a region of extreme stenosis. This thin line of contrast material ascended slowly to meet the column of contrast medium in the cavernous carotid segment that was filling by collateral circulation. Surgical exploration of the neck in these patients revealed a patent but collapsed ICA distal to a localized atheromatous plaque. These patients have been asymptomatic following carotid endarterectomy. This distinctive angiographic appearance may be described as “atheromatous pseudo-occlusion.” Once recognized, carotid endarterectomy is the logical treatment of choice.
Recovery of vasomotor response in human spinal cord transection
Authors: Tsai Shin-Han , Shih Chun-Jen , Shyy Thung-Tai , Liu Jiang-Chuan
Published: May 2009

✓ Vasomotor responses of the skin of the thumb and the big toe were measured in normal subjects and patients with spinal transection at a neutral ambient temperature of 22.0 ± 0.5°C, and in a cool (12.0 ± 0.5°C) and warm (32.0 ± 0.5°C) environment. The vasomotor response of the hand and foot to the cooling and warming of part of the opposite upper or lower extremity was also recorded. Spinal transection at T5–11 abolishes acutely all vasomotor responses in the paraplegic lower extremities, but does not alter the responses in the upper extremities. By 4 months, the vasomotor tone in the lower extremities at a neutral ambient temperature returned to normal values as did the response to a cool and warm environment. The crossed vasomotor reflex to cooling and warming one lower extremity recovers more slowly, requiring a period of 18 months for complete recovery. The slower recovery of the vasomotor reflex in spinally transected man than in similarly treated dogs is thought to be due to the greater spinal shock in the former. The recovery of vasomotor responses in the paraplegic limbs to cooling and warming after thoracic transections suggests that these responses are primitive and powerful thermoregulatory mechanisms.
Cystic meningioma in a 10-month-old infant
Authors: Amano Keiichi , Miura Naohisa , Tajika Yasuhiko , Matsumori Kuniaki , Kubo Osami , Kobayashi Naotoshi , Kitamura Koiti
Published: May 2009

✓ The authors report a case of cystic meningioma in a 10-month-old boy diagnosed by metrizamide ventriculography and computerized tomography. Intracranial meningioma in infants under 1 year old is extremely rare. This case is only the 16th case reported in the world literature; the other 15 cases are reviewed.
Plasmacytoma of the clivus presenting with an unusual combination of symptoms
Authors: Vera Cristian L. , Kempe Ludwig G. , Powers James M.
Published: May 2009

✓ A case of plasmacytoma of the clivus is presented. The patient was asymptomatic until a coincidental traumatic lesion produced manifestations of vagus nerve dysfunction. Conduction was blocked in some fibers of the vagus nerve while, at the same time, episodes of activity were triggered in fibers of the same nerve trunk, resulting in an unusual combination of symptoms. The symptomatology of the case is discussed.
Percutaneous sacral rhizotomy for neurogenic detrusor hyperreflexia
Authors: Young Byron , Mulcahy John J.
Published: May 2009

✓ Ten patients with neurogenic detrusor hyperreflexia were treated by percutaneous radiofrequency sacral rhizotomy. All had low-threshold involuntary micturition. The bladder capacity of seven patients was increased to over 290 cc during a follow-up interval of 3 to 18 months. This convenient percutaneous procedure is particularly suited for controlling detrusor hyperreflexia, which has frequent failures of initial treatment and late recurrence of symptoms.
Primary pineal endodermal sinus tumor with elevated serum and CSF alphafetoprotein levels
Authors: Arita Norio , Bitoh Shoji , Ushio Yukitaka , Hayakawa Toru , Hasegawa Hiroshi , Fujiwara Masaaki , Ozaki Koji , Par-khen Lee , Mori Takesada
Published: May 2009

✓ A 12-year-old girl with an alphafetoprotein-producing brain tumor in the pineal region is presented. The marker was detected in both serum and cerebrospinal fluid. The amount of the marker decreased after irradiation of the tumor and systemic chemotherapy and increased prior to tumor recurrence. At autopsy, the tumor was histopathologically diagnosed as an endodermal sinus tumor, and alphafetoprotein was demonstrated in the tumor cells by the immunofluorescence method. Alphafetoprotein may represent a specific and sensitive marker for predicting tumor histopathology and for monitoring the therapeutic response in patients with primary intracranial germ-cell tumors.
Is the dream of a voluntary society still possible?
Authors: Brewster Kingman
Published: May 2009

✓ The United States Ambassador to the Court of St. James reviews the historic search for a society which is as voluntary as possible for the greatest number of citizens. Under the rule of law, there must continue to exist freedom of choice, freshness of start and opportunity, and the promise of mobility. The citizenry should not become dependent upon public administrators or political masters. Growth and expansion should not be constrained beyond reasonable limits, and openness of opportunity must be given high priority. The variety of State and private educational resources should be tapped for the design of educational communication programs.
Effect of transient ischemia on free fatty acids and phospholipids in the gerbil brain
Authors: Yoshida Shinichi , Inoh Satoshi , Asano Takao , Sano Keiji , Kubota Masaru , Shimazaki Hiroyuki , Ueta Nobuo
Published: May 2009

✓ The effect of transient bilateral carotid occlusion on levels of free fatty acids, phospholipids, and lipid peroxides in the brain was studied in gerbils. During occlusion, both saturated and polyunsaturated free fatty acids increased strikingly to approximately 11-fold in total by 30 minutes. During recirculation, however, a selectively rapid decrement occurred in arachidonic acid, while saturated fatty acids gradually decreased to their basal levels in 180 minutes. The peroxide level, estimated by a thiobarbituric acid test, did not change during occlusion, but was elevated on reperfusion. Phosphatidylethanolamine content decreased throughout the periods examined. These results do not support a hypothesis that lipid peroxidation is initiated during ischemia by the lack of oxygen at the terminus of the mitochondrial respiratory chain. Instead, it is suggested that severe cerebral ischemia disintegrates membrane phospholipids, probably through activation of hydrolytic enzymes, and that overt peroxidative processes take place during reflow by means of restoration of oxygen supply. The peroxidative reactions may, indeed, cause additional damage during the postischemic phase.
Cerebrovascular reactivity to noradrenaline and serotonin following experimental subarachnoid hemorrhage
Authors: Lobato Ramiro D. , Marín Jesús , Salaices Mercedes , Rivilla Fernando , Burgos Javier
Published: May 2009

✓ This study analyzes the time course of the changes induced by subarachnoid hemorrhage (SAH) in the sensitivity of cat cerebral arteries to noradrenaline and serotonin. Cerebral arteries displayed a supersensitivity to these amines, which was most marked 3 days after the experiment and then gradually disappeared. The supersensitivity to serotonin was greater and longer than the response to noradrenaline. The increased in the vascular contractile response induced by SAH was similar to that seen after superior cervical ganglionectomy or intracisternal injections of 6-hydroxydopamine. It is suggested that supersensitivity to noradrenaline and serotonin induced by SAH may be involved in the production of chronic cerebral vasospasm.
Cranial epidermoid tumor associated with subacute extradural hematoma
Authors: Abou-Samra Moustapha , Marlin Arthur E. , Story Jim L. , Brown Willis E.
Published: May 2009

✓ The authors present a case of cranial epidermoid tumor that caused a subacute epidural hematoma after minor trauma. The radiological, operative, and pathological findings are described, and indications for elective excision of cranial epidermoid tumor are discussed.
Localization of stereotaxic centers by computerized tomographic scanning
Authors: Burchiel Kim J. , Ojemann George A. , Bolender Nicole
Published: May 2009

✓ A method is described for determining stereotaxic coordinates using computerized tomographic scanning and intraoperative ventriculography of the third ventricle.
Long-term follow up of patients surgically treated by the far-lateral approach for foraminal and extraforaminal lumbar disc herniations
Authors: Porchet François , Chollet-Bornand Anne , de Tribolet Nicolas
Published: May 2009

Object. This study was undertaken to evaluate the long-term benefit in 202 patients who were surgically treated via a microsurgical far-lateral approach for foraminal or extraforaminal lumbar disc herniations.

Methods. All patients underwent surgery at the authors' institute since 1987 and represented 6.5% of all lumbar spinal disc surgeries. There were 67 women and 135 men who ranged in age from 19 to 78 years (mean age 58 years). All patients had unilateral leg pain due to lumbar disc herniations into or lateral to the lateral interpedicular compartment. One patient underwent surgery at the L1–2 level, nine at L2–3, 48 at L3–4, 86 at L4–5, and 58 at the L5—S1 level. The mean follow-up period was 50 months (range 12–120 months). Outcome was defined as excellent (no pain), good (some back pain), fair (moderate radiculopathy), and poor (unchanged or worse) based on Macnab classification. Overall, excellent and good results were achieved in 62 (31%) and 85 (42%) patients, respectively, and fair and poor results in 40 (20%) and 15 (7%) patients, respectively. Of 11 recurrent disc herniations, four presented in an extreme-lateral position, five in a paramedian location, and two on the contralateral side. There were three minor complications related to surgery, seven general complications, and no case of spinal instability.

Conclusions. The far-lateral approach is a safe, effective procedure that avoids the risk of secondary spinal instability.
Percutaneous spinal fusion using bone morphogenetic protein-2 gene therapy
Authors: Alden Tord D. , Pittman Debra D. , Beres Elisa J. , Hankins Gerald R. , Kallmes David F. , Wisotsky Benjamin M. , Kerns Kelvin M. , Helm Gregory A.
Published: May 2009

Object. Gene therapy has many potential applications in neurosurgery. One application involves bone morphogenetic protein-2 (BMP-2), a low-molecular-weight glycoprotein that induces bone formation in vivo. Numerous studies have demonstrated that the BMP-2 protein can enhance spinal fusion. This study was undertaken to determine whether direct injection of an adenoviral construct containing the BMP-2 gene can be used for spinal fusion.

Methods. Twelve athymic nude rats were used in this study. Recombinant, replication-defective type 5 adenovirus with the cytomegalovirus (CMV) promoter and BMP-2 gene (Ad-BMP-2) was used. A second adenovirus constructed with the CMV promoter and β-galactosidase (β-gal) gene (Ad-β-gal) was used as a control. In three groups (four rats each) 7.5 µl of virus (5 × 108 particles/µl) was injected percutaneously and paraspinally at the lumbosacral junction: Group 1 received Ad-BMP-2 bilaterally; Group 2 received Ad-BMP-2 on the right, Ad-β-gal on the left; and Group 3 received Ad-β-gal bilaterally. Computerized tomography (CT) scans of the lumbosacral spine were obtained at 3, 5, 8, and 12 weeks. At 12 weeks, the animals were killed and underwent histological inspection. Ectopic bone formation was observed both on three-dimensionally reconstructed CT scans and histological examination in all rats at sites treated with Ad-BMP-2. Histological analysis demonstrated bone at different stages of maturity adjacent to the spinous processes, laminae, and transverse processes.

Conclusions. Results of this study clearly demonstrated that it is possible to produce in vivo endochondral bone formation by using direct adenoviral construct injection into the paraspinal musculature, which suggests that gene therapy may be useful for spinal fusion in the future.
Subdural hematoma from a Type I spinal arteriovenous malformation
Authors: Han Patrick P. , Theodore Nicholas , Porter Randall W. , Detwiler Paul W. , Lawton MichaeL T. , Spetzler Robert F.
Published: May 2009

✓ The authors report a patient in whom a subdural hematoma developed from a Type I spinal arteriovenous malformation (AVM). The patient became symptomatic with back pain, and magnetic resonance imaging revealed a spinal subdural hematoma. Selective spinal angiography, however, failed to demonstrate a pathological process. The patient underwent exploratory laminoplasty that revealed a subdural extraarachnoid hematoma with an underlying Type I spinal AVM, which was surgically obliterated. The patient recovered completely. Subdural hematomas that affect the spine are rare. Although a negative result was obtained using selective spinal angiography, exploratory surgery should be considered for the evacuation of a subdural hematoma and possibly for the definitive treatment of a spinal AVM.
Anterior sacral meningocele in pregnancy
Authors: Hanna Amgad Saddik , Morandi Xavier
Published: May 2009

✓ Anterior sacral meningocele was first described in 1837. Most reported cases were associated with complications, including meningitis and death, because of misdiagnosis or inappropriate surgical approach. The authors present a case of anterior sacral meningocele accidentally discovered during pregnancy and provide unique magnetic resonance imaging documentation. The pathogenesis, management, and surgical technique are discussed.
Simultaneous anterior—posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization
Authors: Fourney Daryl R. , Abi-Said Dima , Rhines Laurence D. , Walsh Garrett L. , Lang Frederick F. , McCutcheon Ian E. , Gokaslan Ziya L.
Published: May 2009

Object. Thoracic or lumbar spine malignant tumors involving both the anterior and posterior columns represent a complex surgical problem. The authors review the results of treating patients with these lesions in whom surgery was performed via a simultaneous anterior—posterior approach.

Methods. The hospital records of 26 patients who underwent surgery via simultaneous combined approach for thoracic and lumbar spinal tumors at our institution from July 1994 to March 2000 were reviewed. Surgery was performed with the patients in the lateral decubitus position for the procedure. The technical details are reported.

The mean survival determined by Kaplan—Meier analysis was 43.4 months for the 15 patients with primary malignant tumors and 22.5 months for the 11 patients with metastatic spinal disease. At 1 month after surgery, 23 (96%) of 24 patients who complained of pain preoperatively reported improvements (p < 0.001, Wilcoxon signed-rank test), and eight (62%) of 13 patients with preoperative neurological deficits were functionally improved (p = 0.01). There were nine major complications, five minor complications, and no deaths within 30 days of surgery. Two patients (8%) later underwent surgery for recurrent tumor.

Conclusions. The simultaneous anterior—posterior approach is a safe and feasible alternative for the exposure tumors of the thoracic and lumbar spine that involve both the anterior and posterior columns. Advantages of the approach include direct visualization of adjacent neurovascular structures, the ability to achieve complete resection of lesions involving all three columns simultaneously (optimizing hemostasis), and the ability to perform excellent dorsal and ventral stabilization in one operative session.
Amyloidoma of the thoracic spine
Authors: Suri Vaishali S. , Tatke Medha , Kumar Sushil , Gupta Vikas
Published: May 2009

✓ The authors report the case of a patient with amyloidoma of the thoracic spine. A 34-year-old man presented with a 2-month history of upper-back pain, bilateral lower-extremity weakness, and numbness below the nipple.

A computerized tomography study revealed an extradural mass with destruction of the T-2 lamina and pedicle. Intraoperatively, there was a pinkish, partially suctionable mass infiltrating the muscle plane and causing destruction of the T-2 lamina. Histological examination showed typical amyloid masses that demonstrated apple-green double refraction on examination of the Congo red—stained section under polarized light.

Amyloidomas are rare benign lesions that, unlike other forms of amyloidosis, have an excellent prognosis. A cure is possible with complete resection of the mass.