bluuebunny/crossref_metadata_2025 huggingface dataset:
ATPase in human brain tumors
Authors: Laws Edward R. , O'Connor John S.
Published: May 2009

✓ The energy-dependent membrane transport ATPases have been quantitatively determined in 59 human brain tumors and control cerebral cortex. The values for total ATPase were significantly decreased in the 11 types of brain tumors tested, while in the glioma group there was a consistent further decrease in ATPase with increasingly malignant types. The findings suggest that a deficiency in ATPase is a characteristic of neoplasia in the central nervous system.
Cerebral abscesses in early infancy
Authors: Hoffman Harold J. , Hendrick E. Bruce , Hiscox James L.
Published: May 2009

✓ Experience with large cerebral abscesses in six newborn or very young infants is the basis for this report and discussion. Hydrocephalus, an afebrile state, and an elevated white blood cell count were characteristic. Diagnosis by aspiration was usually fortuitous in the process of subdural tap or ventriculography. Treatment by multiple aspirations was reasonably successful, but ultimate excision of the shrunken abscess may be wise. In only one case was the source of infection obvious.
The effect of cervical carotid ligation on giant intracranial aneurysms
Authors: Tytus John S. , Ward Arthur A.
Published: May 2009

✓ Two patients with giant aneurysms of the internal carotid artery showed progressive visual field deficits, and one, endocrine dysfunction. Neither patient had ever had symptoms suggesting subarachnoid hemorrhage. Both patients benefitted from common carotid ligation. Comparable reports are reviewed, and the application of a previously reported technique for monitoring gradual occlusion of the common carotid artery is emphasized.
Axial ventriculography
Authors: Picaza Jorge A. , Hunter Sam E. , Cannon Bland W.
Published: May 2009

✓ A technique for visualization of the axial ventricular structures has proved to be useful in stereotaxic surgery. The method incorporates a surgical approach through a coronal burr hole, a Seletz rubber ventricular cannula for catheterization, Conray as the contrast medium, and an x-ray technique in which the tube and not the patient's head is mobile. The side effects have been mild and transitory, and no major complications have occurred.
Vascular insufficiency and differential distortion of brain and cord caused by cervicomedullary football injuries
Authors: Schneider Richard C. , Gosch Hank H. , Norrell Horace , Jerva Michael , Combs Loyal W. , Smith Richard A.
Published: May 2009

✓ The problem of serious and fatal football injuries involving the cervicomedullary junction is presented. The mechanisms of such injuries (“stick blocking,” “spearing”) have been analyzed with the help of motion pictures of the action. The second cervical segment of the spinal cord was the commonest site of pathological change. A poor collateral vascular supply to the vertebrobasilar region, compression of the venous sinus, and the great disparity between the distortion of the freely mobile brain and the relatively fixed cervical spinal cord were implicated as the most likely background for the damage, which in turn may lead to acute cerebral edema and tentorial or tonsilar herniation.
Paralysis of both arms from injury of the upper portion of the pyramidal decussation: “cruciate paralysis”
Authors: Bell Herbert S.
Published: May 2009

✓ A new clinical entity, “cruciate paralysis,” manifested by paralysis in both arms without weakness in the legs, is described. The mechanism that produces this rare condition is discussed and the possibility of differential injury to the pyramidal decussation emphasized.
Effects of local pressure on cortical electrical activity and cortical vessels in the dog
Authors: Numoto Mitsuo , Donaghy R. M. Peardon
Published: May 2009

✓ Suppression of the cortical electrical activity and resistance of cortical vessels to collapse were investigated under various pressures applied locally by an inflatable balloon over the cerebral cortex of dogs. The locally applied pressure and the transmitted general intracranial pressure were measured by a special pressure switch. To produce a 50% suppression of the electrical activity required an average of 45.4 mm Hg local pressure; for 100% suppression, an average of 164 mm Hg. Thus, suppression of the cortical electrical activity is proportional to the pressure applied. In separate experiments with transparent cranial windows, collapse of the cortical veins was produced by an average local pressure of 48.5 mm Hg and collapse of the cortical arteries by an average of 188 mm Hg. It is concluded that the cortical electrical activity is suppressed as a result of changes in local blood flow which are in turn a result of local compression and tissue distortion.
Experimental relationship of radiofrequency electrical current and lesion size for application to percutaneous cordotomy
Authors: Fox John L.
Published: May 2009

✓ Using the brains of anesthetized dogs, a study was carried out to evaluate the role played by differences in electrode size and inaccuracies in electrode placement during percutaneous cordotomy. It was determined that if the bare, active-electrode actually is entirely inside neural tissue, an effective lesion can be created with a minimum of current. For example, by using an electrode 3 mm in length and 0.4 mm in diameter, a radiofrequency current level of 50 mA (1.3 W) for 60 sec will create a lesion 5.5 mm long and 5 mm wide. If this electrode is properly positioned within neural tissue, it is impossible to achieve current levels of 75 mA or more, for the power density becomes so high that the local tissue is boiled and fried, which creates a gaseous and/or organic insulation around the electrode causing the current to drop to zero. The same phenomenon occurs at lower current levels if a smaller electrode is used due to the higher power density caused by putting the current through a smaller electrode-tissue interface. If all or any part of the bare, active electrode is outside neural tissue and in contact with cerebrospinal fluid, up to 100 to 300 mA of current may be needed to effect an adequate lesion since most of the current supplied is then shunted proportionately away from the high impedance neural tissue and into the lower impedance CSF. The heat spreading to the leptomeninges probably accounts for the severe neck pain experienced.
Ependymomas
Authors: Barone Bartolo M. , Elvidge Arthur R.
Published: May 2009

✓ A clinical and pathological survey of 74 histologically verified ependymomas (47 intracranial, 27 spinal) was derived from a total series of 2186 gliomas. Patient ages ranged from 7 months to 64 years. The malignant tumors above the tentorium tended to occur in patients over 22 years. The greatest frequency occurred with 24 tumors in the fourth ventricle and 20 in the region of the cauda equina. The location, symptomatology, objective findings, surgical and x-ray therapy, and vital statistics have been evaluated. There was no correlation between tumor characteristics and preoperative symptomatology. Supplementary x-ray therapy appeared to be beneficial. Seventeen of the 36 patients with benign intracranial tumors and five of the 11 patients with malignant intracranial tumors survive. Fourteen of the 27 patients with spinal ependymomas survive. There was one instance of generalized metastasis in the spinal series and none in the intracranial group.
Electrical recording with micro- and macroelectrodes from the cerebellum of man
Authors: Slaughter D. Graham , Nashold Blaine S. , Somjen George G.
Published: May 2009

✓ Recordings of electrical activity in the cerebellar cortex and deep nuclei were obtained from three patients with congenital athetosis, prior to therapeutic ablation of the dentate nucleus. Recordings from microelectrodes were carried out during the stereotaxic procedure with the patient under light fluthane anesthesia. Macroelectrodes were also implanted within the cerebellar nuclear and cortical regions; records from these electrodes were obtained with the patient fully awake during a 2-week evaluation period. Two major areas of electrical activity were defined in the cortical gray and nuclear gray, separated by an area of relative electrical silence corresponding to the cerebellar white matter. The electrical activity from the nuclear gray was characteristically of a higher frequency and voltage; thus, the limits of the nuclear region can be defined by contrast with the relatively silent white matter. The recorded electrical activity was not influenced by either sleep or active movement of the extremities.
The clinical significance of junctional dilatation of the posterior communicating artery
Authors: Epstein Fred , Ransohoff Joseph , Budzilovich Gleb N.
Published: May 2009

✓ Junctional dilatation of the origin of the posterior communicating artery presents a characteristic angiographic picture that occasionally may be difficult to differentiate from that of an aneurysm. Some investigators believe that such dilatations are in fact aneurysmal. This paper reports and assesses the gross and histological findings in seven junctional dilatations discovered at autopsy, including one aneurysm mistakenly diagnosed angiographically. There were no significant histological abnormalities in any case. It is concluded that a junctional dilatation is neither aneurysmal nor preaneurysmal and is probably not even a pathological entity.
Nonsurgical treatment of chronic subdural hematoma
Authors: Suzuki Jiro , Takaku Akira
Published: May 2009

✓ A nonsurgical treatment consisting of osmotherapy with 20% Mannitol was performed on a consecutive series of 23 male patients with chronic subdural hematoma, ranging from 21 to 71 years in age, including seven serious cases. Disappearance or marked reduction of the hematoma content and complete clinical recovery were obtained in 22 patients. The duration of the treatment was 12 to 106 days. Follow-up study from 8 months to 3½ years showed no sequelae, recurrence, or complications.
Intracranial removal of pituitary adenomas
Authors: Stern W. Eugene , Batzdorf Ulrich
Published: May 2009

✓ The effects of varying degrees of completeness of intracranial excision of benign pituitary adenomas among 64 patients operated on by members of the UCLA neurosurgical faculty and resident staff were assessed as to their influence upon tumor recurrences and operative mortality and morbidity. The recurrence “rate” was 9.4%. The operative mortality was 5.9%. There were lower mortality and recurrence rates among those patients treated by radical “total” excision techniques. It is not possible to predict in advance which patient will suffer a recurrence. Recurrence cannot be selectively predicted when tumor is left in place at the time of the first definitive operation. The authors believe that most benign pituitary adenomas can be radically excised and that neurosurgeons should not be content with decompressive procedures or partial removals.
The changing role of the institution in health care
Authors: Crosby Edwin L.
Published: May 2009

✓ The dramatic changes in institutional health care since Harvey Cushing's era are reviewed by the director of the American Hospital Association, and predictions made concerning the even greater changes in the years ahead. The author sees the hospital's role in health care as growing rather than diminishing and urges the medical profession to actively shape its future. He calls outmoded the concept of the hospital as a set of walls but believes its influence must spread into all segments of heath care. Its role as the guarantor of the quality of care must likewise be spread, and he believes that the traditional fee-for-service solo practice will not be acceptable to the large purchasers of health care except in those instances where there is a close physical and organizational tie to the central institution, the hospital. He asks in view of the importance of the hospital, that those who work in it and for it should look to see if the traditional organizational pattern of our voluntary hospital can meet the demands to be placed upon it by such sophisticated purchasers as Blue Cross, insurance, and government. He foresees increasing adoption of the straight-line organization in the hospital rather than the orthodox triad of governing board, medical staff, and administration.
The spinal manometric examination (Queckenstedt's test)
Authors: Ehni George , McNeel Day
Published: May 2009

✓ Queckenstedt's dynamic manometry has been studied in a model constructed of clinical manometers, spinal needles, and commonly available items. Experiments with the model were made with the system unblocked, partially blocked, and totally blocked in ways to simulate clinical conditions. In clinical manometry what one observes is flow of fluid and its actual pressure. Poiseuille's law is predictive. Impedance to flow is governed by that segment of the system having the smallest cross section, whether it is the pathological block or the spinal needle chosen. If a blocking lesion contains fluid which the rising cerebrospinal fluid pressure can displace (as venous blood), a block may exist on myelography but not on manometry. When, in the presence of partial block, the manometer indication does not fall to the initial pressure but holds up at a new resting pressure, this new pressure probably represents the pressure of the lesion upon the cord and dura. When fluid cannot be displaced from a blocking lesion, as when it is totally solid, no amount of CSF pressure rise produced by jugular compression will overcome the block.
Dermoid tumors of the spinal cord
Authors: Bailey Ian C.
Published: May 2009

✓ This is an analysis of 10 cases of dermoid tumor occurring in the spinal canal (8 lumbar and 2 thoracic). Low-back pain was the commonest presenting symptom, especially if the tumor was adherent to the conus medullaris. Other complaints included urinary dysfunction and motor and sensory disturbances of the legs. Clinical and radiological evidence of spina bifida was found in about half of the cases and suggested the diagnosis of a developmental type of tumor when patients presented with progressive spinal cord compression.

At operation, the tumors were often found embedded in the conus medullaris or firmly adherent to the cauda equina, thus precluding complete removal. Evacuation of the cystic contents, however, gave lasting relief of the low-back pain and did not cause any deterioration in neurological function. In a follow-up study, ranging from 1 to 15 years, virtually no improvement in the neurological signs was observed. On the other hand, only one case has deteriorated due to recurrence of tumor growth.
Attempted infanticide by insertion of sewing needles through fontanels
Authors: Ameli N. O. , Alimohammadi A.
Published: May 2009

✓ The insertion of sewing needles through the fontanels of an unwanted baby is apparently an ancient practice of which there are still instances. In this paper two such cases are described, one a man of 32 and the other a woman aged 31 with needles in a vertical position near the midline of the convexity of the brain. The first patient had had epileptic attacks for 8 years, and the other headache and hemiparesis for 7 months. Removal of the needles resulted in amelioration of the symptoms. The needles obviously had been introduced when the anterior fontanels were still open. The long interval before the onset of symptoms has been observed in the two other cases reported in the literature.
Brain energetics and neurosurgery
Authors: Woodhall Barnes , Kramer Richard S. , Currie William D. , Sanders Aaron P.
Published: May 2009

✓ Consecutive studies of brain energetics undertaken at Duke University during a period of 5 years are described. Various forms of stress such as hypoxia, hyperbaric oxygenation, and selected drugs were used to depict quantitative adverse effects upon the brain's basic energy system, and protectant measures evaluated including hypothermia and appropriate substrates. A systematic survey of substrate protectants was carried out in laboratory animals, and the theory and practice of preserving brain energy levels explored. A foundation for clinical application has been established.
Neurogenic bladder in parkinsonism: effect of thalamotomy
Authors: Porter Robert W. , Bors Ernest
Published: May 2009

✓ In a group of 62 patients with Parkinsonism, 44 had significant bladder dysfunction, although only one had acute urinary retention. Twenty-five showed a hyperactive type of detrusor function with decreased capacity and an increased volume/pressure response on cystometrography. Of these 25 patients, 23 had marked somatic rigidity with or without tremor. In contrast, 19 patients had hypoactive function manifested by an increased bladder capacity and a decreased volume/pressure response shown in the cystometrogram; of this group 11 had marked tremor with very little rigidity. Forty-nine patients underwent one or more stereotaxic thalamotomies. The effect of surgical therapy on both types of bladder dysfunction was generally favorable in 40 of these patients whose somatic manifestations were satisfactorily controlled.
Bilateral traumatic abducens palsy
Authors: Schneider Richard C. , Johnson Frank D.
Published: May 2009

✓ Two patients with bilateral abducens palsy are presented. A study of the associated injury to the cervical spine suggests that a severe blow to the head in an upward and posterior direction may produce contusion or avulsion of the abducens nerve by the rigid petrosphenoidal ligament under which it passes.
Vein of Galen ligation in the primate
Authors: Hammock Mary K. , Milhorat Thomas H. , Earle Kenneth , Di Chiro Giovanni
Published: May 2009

✓ The vein of Galen was ligated in 16 Rhesus monkeys and six mongrel dogs, and the animals followed for periods up to six months. Ventricular size was determined preoperatively by pneumoencephalography. Angiography was performed prior to surgery and at intervals from the immediate postoperative period to 6 months following vein ligation. After sacrifice, all brains were serially sectioned and examined by light microscopy. In no case was hydrocephalus found to follow vein of Galen ligation. Consequences were limited to angiographic dilatation of major draining sinuses and cortical veins and microscopic dilatation of diencephalic and choroidal vessels. These changes were evident in the immediate postoperative period and persisted for as long as the animals were followed.
Multiple arteriovenous malformations involving the scalp, dura, retina, cerebrum, and posterior fossa
Authors: Tamaki N. , Fujita K. , Yamashita H.
Published: May 2009

✓ A case is presented of multiple arteriovenous malformations involving the scalp, dura, retina, cerebrum, and posterior fossa in one patient who also had an internal carotid aneurysm. Cobalt irradiation was followed by symptomatic improvement.
Limited exposure in cerebral surgery
Authors: Wilson Donald H.
Published: May 2009

✓ A limited exposure is possible, and perhaps preferable, for most cerebral surgery. For some years we have performed all craniotomies with a 2-in. trephine, through a linear incision. The exposure is simple, swift and bloodless. It preserves the integrity of normal tissue as much as possible. Thus, healing is rapid and brain edema is minimal. The technique allows the surgeon to spend most of his time at the target, a particular advantage in microsurgery.
Common carotid to intracranial internal carotid bypass venous graft
Authors: Lougheed William M. , Marshall Brian M. , Hunter Michael , Michel Ernest R. , Sandwith-Smyth Harley
Published: May 2009

✓ A 54-year-old woman was admitted with a complete occlusion of the right internal carotid artery and a 25% stenosis of the left internal carotid artery. Intracranial circulation on the right side was restored by taking a vein from the leg and anastomosing the vein of the intracranial carotid artery just distal to the anterior clinoid process. Prior to insertion the vein was turned inside out, the valves removed and then reinverted allowing the distal end of the vein to be anastomosed to the intracranial internal carotid artery. The blood flow was therefore reversed in the vein. The proximal end of the vein was anastomosed to the common carotid artery. Upon completion there was excellent circulation in the bypass graft and internal carotid artery.
Early complications following penetrating wounds of the brain
Authors: Hagan Ralph E.
Published: May 2009

✓ The experience of an evacuation hospital in Japan in treating 506 consecutive patients from Vietnam with penetrating wounds of the brain is reported with particular reference to early complications. Sixty-eight patients were operated on for still retained intracranial foreign bodies. Thirty-five of the 62 patients with retained intracranial bone fragments had positive microbial cultures of the fragment, which in 63% showed Staphylococcus epidermis. All of the metallic fragments cultured revealed microbial growth. Superficial infections were noted in 32 patients. Superficial plus deep infections were found in eight patients with no retained bone fragments. Eighteen patients had meningitis proven by culture, while an additional 12 patients with CSF sugars of less than 40 mg% were assumed to have meningitis. Twelve patients developed CSF leaks requiring surgery. Twenty-three patients (4.54%) died as a result of their wounds. The neurosurgical treatment recommended for these patients is described.
Retained intracranial bone fragments: analysis of 42 patients
Authors: Hammon William M.
Published: May 2009

✓ Forty-two patients with retained intracranial bone fragments from Vietnam war wounds were evaluated and treated at the Walter Reed General Hospital. Forty required further debridement, 16 had positive wound cultures while they were on antibiotic therapy, 23 had gross evidence of infection, and the remainder also had debris and necrosis at the retained bone fragment sites. There were eight in-hospital deaths. All surviving patients available to follow-up have been free of infection. Retained intracranial fragments of bone should be removed as early as is possible.
A bacteriological study of craniocerebral missile wounds from Vietnam
Authors: Carey Michael E. , Young Harold , Mathis Jacob L. , Forsythe James
Published: May 2009

✓ Bacteriological studies were performed on 45 craniocerebral missile wounds incurred in Vietnam within 2 to 4 hours of occurrence. All missiles had penetrated into the brain. Aerobic and anaerobic cultures were taken of the skin wound, brain, and indriven bone fragments. Forty-four of the skin wounds were contaminated, predominantly with staphylococcus. Only five brain wounds showed bacterial contamination 2 to 4 hours after wounding, indicating that many missile tracks within the brain are initially sterile. Of the patients who had early debridement, 45% had contaminated bone within the brain; possibly up to 75% of all indriven bone chips were sterile.

The authors draw the following conclusions. Complete brain debridement with removal of all indriven bone is ideal. Accessible retained bone should be removed by reoperation. Multiple reoperations for an inaccessible retained fragment are inadvisable, however, as fatalities or severe neurologic residua may result. An individual indriven bone chip has a small likelihood of bacterial contamination provided initial debridement was done early. This knowledge may justify an expectant policy in certain individuals harboring an inaccessible retained bone fragment. The retained fragment would be removed only if untoward difficulties develop.
Lhermitte's phenomenon after high velocity missile injuries of the brain
Authors: Leaver Robert C. , Loeser John D.
Published: May 2009

✓ High velocity wounds of the brain have been associated with the development of Lhermitte's phenomenon in 26 of 56 consecutive cases from Vietnam studied from 1 month to 1 year after injury. No antecedent factors could be identified. Civilian trauma and elective neurosurgical procedures have not, to our knowledge, been reported to cause this sign. Subarachnoid or subdural adhesions are suggested as the cause of Lhermitte's phenomenon in these patients.
Hemodynamic responses to acute quadriplegia with or without chest trauma
Authors: Meyer Glenn A. , Berman Irwin R. , Doty Donald B. , Moseley Roger V. , Gutierrez Victor S.
Published: May 2009

✓ This report describes the pathophysiology, as manifested by hemodynamic and blood volume determinations, in nine acutely quadriplegic patients studied in Vietnam. Four of the nine patients developed fulminating pulmonary edema while in the hospital and showed marked differences in the hemodynamic and blood volume data when compared with five patients who did not develop pulmonary edema. The unique hazard of excessive intravascular volume replacement in quadriplegic patients is documented, and effective diagnostic and therapeutic procedures are suggested. Related reports and physiological studies are discussed.
Intramural neural elements in components of the carotid bifurcation
Authors: Meyerson Sheldon B. , Hall James L. , Hunt William E.
Published: May 2009

✓ The histology of the specialized region of the carotid bifurcation in man was studied with Orcein stain for elastic tissue, Masson's trichrome for muscle and connective tissue, and Bodian's silver method for neural elements. Four distinct regions exist: the common carotid, which appears to be solely a conduit; the carotid sinus, which is thin and very elastic with its baroreceptors in the medial wall; the external carotid, which is highly muscular and presumably active; and the internal carotid, also highly muscular and presumably active. The transition between zones is abrupt. Prominent clusters of up to 30 or 40 multipolar nerve cells, 15 to 25 µ in diameter, were found in the subintimal region of the internal carotid artery, some in the common, and a few in the external carotid. Occasional rounder cells of similar size with only one process were seen, possibly of sensory type. No cell bodies were seen in the adventitia of any vessel. No relation to the perivascular plexus was established. It is speculated that the neurons may be related to the reported local differential response to environment by the internal and external carotid systems.
Arteriovenous anomaly of the brain associated with cerebral aneurysm
Authors: Shenkin Henry A. , Jenkins Felix , Kim Kwang
Published: May 2009

✓ The removal of an arteriovenous anomaly of the brain resulted in a distinct reduction in the size of a large aneurysm located upon its principal feeding vessel. This confirms previous inferences that the development of aneurysms is related to the amount of blood flow in the parent vessel.
Hematoma from arteriovenous malformation producing hydrocephalus and simulating a thalamic tumor
Authors: Ng Larry K. T. , Schwarz Gabriel , Mishkin Mark M.
Published: May 2009

✓ Two patients with a history of progressive unilateral neurological symptoms and signs, and evidence of obstructive hydrocephalus from a mass lesion adjacent to the third ventricle as demonstrated by pneumography, were each found to have an intracerebral hematoma secondary to remote hemorrhage from a small vascular malformation. One patient died shortly after surgical exploration and the other after ventriculography. The pathophysiology of hydrocephalus associated with a vascular malformation is discussed and the need for considering a benign cause for obstructive hydrocephalus from a mass deep in the brain substance is emphasized.
Ankylosing spondylitis: cauda equina syndrome with multiple spinal arachnoid cysts
Authors: Rosenkranz Wolf
Published: May 2009

✓ A case of ankylosing spondylitis in a patient with a cauda equina syndrome is reported. A lumbar myelogram revealed erosions of the bones of the neural canal with enclosed multiple intraspinal cysts.
Effects of dexamethasone and methylprednisolone on cell cultures of human glioblastomas
Authors: Mealey John , Chen Tsu T. , Schanz George P.
Published: May 2009

✓ Eight biopsied glioblastomas were propagated in vitro through multiple, serial cell cultures which were exposed to dexamethasone and methylprednisolone in concentrations ranging from 0.25 to 400 µg/ml. The higher concentrations of both steroids produced inhibition of culture growth and cytotoxic damage which appeared relatively nonspecific. Although the responses observed were dose-dependent, the sensitivity among glioma cultures of different origins varied. Of the two steroids, Methylprednisolone was more injurious to glioma cells in vitro and was cytolytic in doses of 400 µg/ml. Growth inhibition was demonstrated after a 1-day exposure to this corticoid, but this effect was usually transient at lower doses. Thereafter, surviving resistant cells resumed their natural rate of growth in the continued presence of the steroid as well as under standard conditions of culture. Potential clinical applications of the antineoplastic properties of corticosteroids against the gliomas are discussed, emphasizing the need to investigate additional, possibly more efficacious compounds.
Morphological studies of rat brain tumors induced by N-nitrosomethylurea
Authors: Schmidek Henry H. , Nielsen Surl L. , Schiller Alan L. , Messer Janette
Published: May 2009

✓ Experimental glial tumors were induced by weekly intravenous injections of N-nitrosomethylurea (NNMU) in rats. The tumors included low- and high-grade gliomas of the astrocytic series and mixed gliomas. The histology of the tumors did not vary significantly with serial passage through tissue culture, subcutaneous implantation, or freezing. These neoplasms provide reliable animal models of brain tumors common to man.
Lipomas of the spinal cord and cauda equina
Authors: Rogers Harry M. , Long Don M. , Chou Shelley N. , French Lyle A.
Published: May 2009

✓ This report presents 18 cases of lipoma of the spinal cord or cauda equina, four of which were unassociated with congenital anomalies of the spine and 14 with such anomalies. Review of the literature shows that unassociated cases are rare, with only 100 cases reported, while those associated with congenital anomalies are more common. The patients ranged in age from 2 months to 5 years. Fourteen patients had external evidence of an abnormality in the form of a mass or dimple over the vertebral column. Plain x-ray films showed evidence of an intraspinal lesion in all cases except one. The treatment was surgical in all cases, with nine good results, eight satisfactory, and one unsatisfactory. The exact pathogenesis of spinal cord lipomas is unclear, although the high incidence of associated congenital defects, age of onset, and location of the tumors suggest a developmental origin. The tumors occupy a juxtamedullary-subpial location and are composed of firm, lobulated adult fat. Early surgery consisting of generous laminectomy, incision of the pia, and subtotal removal of the tumor is felt to be the treatment of choice.
A study of intracranial aneurysms with ultrasoft x-rays
Authors: Hassler Ove
Published: May 2009

✓ Ten saccular aneurysms obtained postmortem from large cerebral arteries were examined with ultrasoft x-rays. At the border toward the aneurysms the elastic lamella generally showed duplication, thickening, and fragmentation, with irregular variations in the absorption of ultrasoft x-rays. Calcification could only be discovered in the intimal collagenous tissue several millimeters from the aneurysm mouth. Eosinophilic substance was found in one case to be markedly radiopaque. The observations support the hypothesis that at the site of a media defect there is a compensatory hypertrophy of the elastic lamella, resulting in degeneration and decay. Fluorescent microscopy of the elastic lamella gave similar results.
Conray ventriculography in the diagnosis of brain tumors and congenital malformations in children
Authors: Weiss Sanford R. , Raskind Robert
Published: May 2009

✓ In view of the technical complexity of gas ventriculography and the physiologic hazards of water insoluble contrast media, methylglucamine iothalamate 60% (Conray) was used in the diagnosis of brain tumor or congenital malformation in 15 children 1 mos to 10 yrs of age. The method proved simple, reliable, and radiographically satisfactory. General or local anesthesia was used. It was not necessary to change the position of the head during study. The medium left the ventricular system within 5 to 10 min and was excreted in the urine within 24 hrs. No complications occurred.
“Gangliorhabdomyosarcoma”: a tumor of ectomesenchyme
Authors: Holimon James L. , Rosenblum William I.
Published: May 2009

✓ A case is reported in which a tumor mass in the cerebellopontine angle contained elements of a ganglioneuroma and a rhabdomyosarcoma. The mass was continuous with highly malignant tissue eroding the middle ear and the face. The latter tissue and pulmonary metastases were histologically identical to rhabdomyosarcoma. This and eight other comparable cases are considered examples of single tumors containing both neoplastic ganglion cells and rhabdomyoblasts. These elements might be expected in tumors arising from ectomesenchyme.
Spontaneous disappearance of cerebral arteriovenous angioma
Authors: Conforti Paolo
Published: May 2009

✓ The author reports a case in which a cerebral arteriovenous malformation disappeared completely and spontaneously within 3 years. Comparable cases from the literature are cited. The disappearance of the malformation may have been due to hemorrhagic episodes and the resulting thromboses.
Recurrence of vascular malformation of the scalp 18 years following excision
Authors: Wilkinson Harold A.
Published: May 2009

✓ A vascular malformation (“cirsoid aneurysm”) of the frontal scalp was excised from an 8-year-old girl. Eighteen years later, during her second pregnancy, the malformation recurred. Despite the presence of an underlying bone defect, arteriography excluded an intracranial extension. The frequency of association of vascular malformations of the scalp with cerebral vascular malformations is reviewed, and the need for careful arteriography reiterated.
The effects of glucosteroids on experimental cold-induced brain edema.
Authors: Maxwell Robert E. , Long Don M. , French Lyle A.
Published: May 2009

✓ Although the beneficial effects of glucosteroids on brain edema are well documented and generally accepted clinically, investigations into their effects on experimental brain edema have been somewhat contradictory. In this study brain edema was produced by local cortical freezing in animals pretreated with glucosteroids and in untreated animals. Gross estimation of edema, wet weight-dry weight determination, and mechanical planimetry of areas of extravasated dye indicated a statistically significant reduction in edema of both white and gray matter at 24, 48, and 72 hours. Gross estimation of edema indicated a persisting effect with resolution of edema at 5 days in treated animals and from 7 to 12 days in untreated animals. These studies substantiate initial investigations and indicate a primary reduction in brain edema by glucosteroids. At least one of the effects of the glucosteroids appears to be reduction of the abnormal vascular permeability causing brain edema.
Bifrontal decompressive craniotomy for massive cerebral edema
Authors: Kjellberg Raymond N. , Prieto Alberto
Published: May 2009

✓ A large bifrontal craniotomy was used in selected patients judged to carry an unusually high mortality risk due to brain swelling secondary to brain trauma. The procedure enabled exploration of both hemisphere convexities, evacuation of accumulated blood and necrotic brain, and decompression of swollen brain. This report reviews 73 cases operated on at the Massachusetts General Hospital since March, 1962; 18% of these patients survived. The largest experience was with post-traumatic cerebral edema, although intractable edema secondary to mass lesions, hemorrhage, toxic encephalopathy, and pseudotumor cerebri was also treated.
Experimental lingual-basilar arterial microanastomosis
Authors: Reichman O. Howard
Published: May 2009

✓ A lingual-basilar artery microanastomosis was performed in 33 dogs; in 24, the cerebral arterial inflow was isolated to the lingual-basilar system. This experimental model demonstrated several factors influencing the use of extracranial vessels to enhance cerebral perfusion. The new lingual-basilar system increased in size to meet flow requirements formerly served by the normal vessels. Arterial spasm was present in the early postoperative period. Arteriography was detrimental if performed at the time of anastomosis or in the healing phase.
The osmolality of subdural hematoma fluid
Authors: Weir Bryce
Published: May 2009

✓ In 23 patients with subdural hematomas the osmolality of the hematoma fluid was compared with that of venous blood and in 11 of these cases with lumbar cerebrospinal fluid. There was no significant difference in the osmolalities of these fluids. The electrophoretic pattern of the subdural hematoma fluid resembles that of serum in that it usually does not contain prealbumins. The hemoglobin breakdown products migrate with the alpha II and beta globulins and include methemoglobin, oxyhemoglobin, and bilirubin. It is suggested that the late onset of symptoms, which often occurs, is due to either progressive bleeding from the neovascular outer membrane, effusion through it of albumin and fluid, or recurrent bleeding from a venous stump. It is also possible that very little expansion in the size of the subdural hematoma occurs following the initial formation and that late decompensation results from dynamic changes in the compressed brain. This work provides no evidence either to support or refute the concept of an osmotic mechanism for hematoma expansion.
Carotid-ophthalmic aneurysms
Authors: Kothandaram Ponneri , Dawson Benjamin H. , Kruyt Rudolph C.
Published: May 2009

✓ The symptoms, signs, and treatment of 19 patients with carotid-ophthalmic aneurysms are reviewed and the related surgical anatomy discussed. The importance of good oblique angiograms and the hazards of craniotomy are emphasized. Common carotid ligation is recommended as the treatment of choice.
Multiple melanotic meningiomas of the cervical cord
Authors: Scott Michael , Ferrara Vincent L. , Peale Augustin R.
Published: May 2009

✓ The clinical course and pathological findings are described in a patient who survived 17 years following her first operation for multiple encapsulated extradural and intradural melanotic meningiomas of the cervical meninges. Although the recurrence of these tumors suggested a malignant histological component, the long history of survival, the restricted location, and absence of melanotic tumors elsewhere, and the basic histological background all favored an uncommon variant of meningioma.
Alcohol block of the celiac plexus for control of upper abdominal pain caused by cancer and pancreatitis
Authors: Gorbitz Carlos , Leavens Milam E.
Published: May 2009

✓ A modified technique for alcohol block of the celiac plexus in cases of upper abdominal visceral pain is described. The hazards and complications of the procedure are discussed. The results in 11 patients are reported.
The pathological findings in fatal craniospinal injuries
Authors: Davis Donald , Bohlman Henry , Walker A. Earl , Fisher Russell , Robinson Robert
Published: May 2009

✓ A series of 50 fatal cases of craniospinal injury were reviewed with particular attention to the pathological findings at the craniospinal junction. There was marked tendency for the spinal cord to be damaged in the upper cervical segments, whereas disc injuries predominated in lower cervical segments. The vertebral artery was rarely involved. The lateral ligamentous structures were often damaged, while the transverse ligaments of the odontoid were spared. Rupture of muscles was rare, although hemorrhage into muscles was common.
Ischemia in primate spinal cord injury
Authors: Locke George E. , Yashon David , Feldman Robert A. , Hunt William E.
Published: May 2009

✓ Lactate accumulation in spinal cord tissue following trauma was determined to ascertain the role and magnitude of ischemia. High thoracic and low thoracic laminectomies were performed on each of nine rhesus monkeys. The lower exposed cord was traumatized with a calibrated blow of 300 gm cm. The upper exposed cord served as a nontraumatized control. At time intervals of 1.5 min to 48 hrs after trauma, both cord segments were removed and assayed for lactic acid. Lactate in nontraumatized segments averaged 3.64 mM/kg tissue, with a range of 2.20 to 4.95. Lactate in traumatized segments removed in from 1.5 min to 12 hrs from six monkeys averaged 5.50 mM/kg tissue, with a range of 4.32 to 6.46. Lactate in traumatized segments from three monkeys 18 to 40 hrs after trauma averaged 4.07 mM/kg, with a range of 3.20 to 5.18. This finding supports the concept that ischemia plays a role early in the traumatic process in spinal cord injury.
Lactate accumulation inprimate spinal cord during circulatory arrest
Authors: Feldman Robert A. , Yashon David , Locke George E. , Hunt William E.
Published: May 2009

✓ In rhesus monkeys subjected to circulatory arrest, studies were made of the relationship of lactate production in the spinal cord to the duration of circulatory arrest and magnitude of lactate accumulation, and the results were compared to the magnitude of rise in cerebral tissue lactate. Both high and low thoracic laminectomies were performed on each of eight rhesus monkeys. Spinal cord tissue was excised for lactate assay at the upper laminectomy as a control, and a second tissue specimen was excised at the lower laminectomy site at time increments of 30 sec to 30 min after circulatory arrest. Tissue was excised from each site without circulatory arrest in one monkey and showed negligible increase in lactate production, indicating that excision of tissue itself does not result in increased lactate. Nonanoxic samples from seven monkeys averaged 4.60 millimoles (mM)/lactate/kg tissue, with a range of 2.22 to 6.49. Postcirculatory arrest samples from these monkeys averaged 11.10 mM lactate/kg tissue, with a range of 3.62 (at 30 sec) to 14.33 (at 10 min). Anoxic spinal tissue lactate was elevated above controls in each instance, and tissue lactate peaked between 5 to 10 min after circulatory arrest and remained stable with mild fluctuations beyond that time. Thus, the spinal cord responds to circulatory arrest much as cerebral tissue, but with some delay in the accumulation of lactic acid.
Nerve cells in the intracranial part of the trigeminal nerve of man and dog
Authors: Mira Kamal Mousa , Elnaga Ibrahiem Abou , El-Sherif Hassanein
Published: May 2009

✓ Nerve cells histologically similar to the ganglionic cells of the trigeminal nerve were observed in the proximal part of the sensory root and in the motor root of the human trigeminal nerve. They were also seen in the sensory root of the trigeminal nerve of the dog. Counting of the nerve fibers showed doubling of the number of nerve fibers in the three divisions compared with the fibers in the sensory root adjacent to the trigeminal ganglion. There was also an increase in the number of fibers within the sensory root as it courses centrally, while a decrease was seen in the number of fibers in the proximal part of the motor root. Intermediate nerve bundles were seen leaving the motor root near the pons and joining the sensory root centrally. The fibers of the sensory root corresponding to each peripheral division maintained their specific location in the sensory root during the whole course centrally.
Fibromuscular hyperplasia of the extracranial internal carotid artery
Authors: Galligioni Francesco , Iraci Giorgio , Marin Gino
Published: May 2009

✓ Fibromuscular hyperplasia is an alteration of the arterial wall, affecting mostly middle-aged women. When localized to the internal carotid arteries, it can give symptoms of intermittent or permanent cerebral ischemia, but is usually asymptomatic. Three cases, all of them accidental angiographic findings, are used as a basis for discussion of the angiographic features, differential diagnosis, and surgical treatment.
Long-term neurological residua in patients surviving brain abscess with surgery
Authors: Carey Michael E. , Chou Shelley N. , French Lyle A.
Published: May 2009

✓ Long-term neurological sequelae were analyzed in 40 patients (24 adults and 16 children) who survived a brain abscess with surgery. Median follow-up was 6 years. The brain abscesses were secondary to hematogenous spread, sinus and mastoid infections, and trauma. Hemiparesis, seizures, visual defects, and learning problems (in children) were the most common sequelae observed. Abscess location played a significant role in determining sequelae. Only two of 16 patients with frontal polar and temporal lobe abscesses had unsatisfactory long-term results, while eight of 16 individuals with abscesses near the sensorimotor strip were left with permanent unsatisfactory neurological sequelae.

Nineteen of 24 adults (80%) had a satisfactory long-term neurological status, but only 10 of 16 children (63%) had a similar outcome. In adult survivors, hemiparesis and seizures were mild, and emotional changes rare. Children were often severely paretic, had poorly controlled seizures, suffered from personality impairment, and were occasionally totally disabled. If the postoperative neurological condition is used to evaluate various types of surgical therapy for the treatment of brain abscess, then the therapies under study must be matched for patient age and abscess location before treatment comparisons can be made.
The adrenocortical response to craniotomy for brain tumor
Authors: Shenkin Henry A. , Gutterman Paul , Bouzarth William F.
Published: May 2009

✓ The diurnal plasma cortisol content was determined in 32 patients with supratentorial brain tumors preoperatively and over a period of 9 days postoperatively. Craniotomy caused an elevation of plasma cortisol at least 25% above that achieved after other types of surgery. This high level of circulating cortisol was maintained on the first postoperative day and then gradually descended to preoperative levels by the 9th postoperative day. The usual diurnal pattern was reversed in 15% of postoperative observations. While in the majority of instances this reversal accompanied a distinct aberration from the normal postoperative course, 40% of the time no abnormality in the postoperative course could be detected to account for this reversal. It is concluded that substitution corticosteroid therapy when needed by a patient undergoing craniotomy should be maintained at high levels for at least 5 days postoperatively and then decreased slowly to maintenance levels by the 8th to 10th postoperative day. The progressive decline in circulating plasma cortisol from the 1st to 5th postoperative days, the same period during which postoperative cerebral edema is developing to its maximum, suggests that cerebral edema of itself does not evoke an adrenocortical response.
Increase in regional cerebral blood flow following experimental arterial air embolism
Authors: Simms Norval M. , Kush George S. , Long Don M. , Loken Merle K. , French Lyle A.
Published: May 2009

✓ Acute intracranial hemodynamic alterations consequent to arterial air embolism were studied in the dog using the radioxenon clearance technique. In eight dogs, the mean pre-embolic (control) hemispheric flow was 28.3 ml/100 gm/min. Following the injection of varying amounts of air into the right vertebral artery, there was an augmentation in the measured cerebral blood flow in all animals. Statistical analysis revealed the flow response to be independent of the amounts of air used in these experiments. The mean post-embolic cerebral blood flow was 39.3 ml/100 gm/min, representing a statistically significant increase of 11.0 ml/100 gm/min. Although the post-embolic supernormal flow may be due to the interaction of multiple pathophysiologic factors, air-induced traumatic vasodilatation is advocated as the most important pathogenetic mechanism. Prolonged vasodilatation with loss of autoregulation results in physiological shunting of blood through the affected capillary beds. Alterations in the intracerebral vasculature due to arterial air embolism are compared with studies by other investigators who have observed the effects in extracerebral vessels.