bluuebunny/crossref_metadata_2025 huggingface dataset:
Reanalysis of Central Cervical Cord Injury Management
Authors: Bose Bikash , Northrup Bruce E. , Osterholm Jewell L. , Cotler Jerome M. , DiTunno John F.
Published: May 2010

Early investigators indicated that conservative management was superior to operative intervention in the treatment of central cord injuries. Their clinical data suggested that operative treatment, in fact, worsened the condition. Recent experience with this clinical entity, however, indicates that in selected patients operative intervention may be of value in improving the rate and degree of motor recovery. A retrospective study of all individuals admitted to our hospital (Delaware Valley Spinal Cord Injury Center) with central cervical spinal cord injury was done (28 patients). One-half had been treated with medical therapy alone (Group I); the others were treated both medically and surgically (Group II). Medical therapy consisted of intravenous mannitol, dexamethasone, and sodium bicarbonate given during the acute phase of the injury. Both groups were immobilized using either a halo or a Philadelphia collar. Criteria for entry into the surgical group were one or both of the following: (a) failure to improve progressively after an initial period of improvement, with persistent compression of neural tissue visualized on myelography and (b) unacceptable instability of the spinal bony elements. The patients were given neurological scores based on the motor power of the major muscle groups. The stability of the spine was scored using the Panjabi-White scale. The two groups were compared using Student's t-test and the two-factor analysis of variance. There was no significant difference in initial neurological scores between the groups. The surgical groups had a higher incidence of instability of the bony elements of the cervical spine, as judged by the Panjabi-White scale. At the time of discharge, Group II had significantly improved motor scores when compared with Group I. The results indicate that operative intervention did not produce neurological worsening and may be safely applied when patients with central cord injuries meet the criteria used in the study. Although the two groups are not comparable, operative intervention provided statistically better motor recovery than did conservative therapy (P < 0.05).
Postoperative Evaluation of Extracranial-Intracranial Arterial Bypass by Means of Ultrasonic Quantitative Flow Measurement and Computed Mapping of the Electroencephalogram
Authors: Hyodo Akio , Mizukami Masahiro , Kawase Takeshi , Nagata Ken , Yunoki Kazuta , Yamaguchi Katsuhiko
Published: May 2010

As an objective evaluation of extracranial-intracranial (EC/IC) bypass operation, we studied 10 patients with occlusive cerebrovascular disease after EC/IC bypass operation using ultrasonic quantitative flow measurement (UQFM) and the computed mapping of the electroencephalogram (CME). After the operation, to evaluate the efficacy of the bypass operation, we studied all patients by UQFM and CME before and during compression of the superficial temporal artery (STA). In a control series of cases, the change in common carotid blood flow during STA compression was not statistically significant, and the findings of CME were unchanged during STA compression. In the cases with bypass surgery, reduction of the common carotid blood flow during STA compression was obvious and statistically significant (P < 0.001). Additionally, in 5 of the 10 cases, the CME findings were aggravated during STA compression. Therefore, in these 5 cases the brain with bypass seems functionally dependent upon the bypass flow. It is suggested that the EC/IC bypass is effective at least in these 5 cases. The UQFM and the CME, which are noninvasive and simple, are very useful for postoperative evaluation of EC/IC bypass grafts from a hemodynamic and functional point of view.
Perichiasmal Tumors: Diagnostic and Prognostic Features
Authors: Trobe Jonathan D. , Tao Alvin H. , Schuster Jonathan J.
Published: May 2010

A review of 49 tumors compressing the intracranial optic nerve, optic chiasm, or optic tract revealed that the majority of patients had symptoms and signs of visual loss predominantly affecting one eye. Seventy-seven per cent of patients had a relative afferent pupillary defect (RAPD), and 96% had a hemianopic defect in at least one eye, All patients had either a RAPD or a hemianopic defect. The junctional pattern of visual field defects was nearly as common (39%) as the classic bitemporal pattern (46%). Many fields contained a mixture of nerve fiber bundle and hemianopic defects; the hemianopias tended to obscure the coexisting nerve fiber bundle defects. Poor preoperative acuity predicted a relatively poor postoperative acuity, but 95% of the patients had 20/40 or better acuity in at least one eye after operation.
High Dose Barbiturate Therapy in Neurosurgery and Intensive Care
Authors: Piatt Joseph H. , Schiff Steven J.
Published: May 2010

To assess the uses of high dose barbiturate therapy in neurosurgery and intensive care, the authors have undertaken a concise survey of relevant experimental investigations and a comprehensive review of published clinical experiences.
Treatment of Normal Pressure Hydrocephalus with Low versus Medium Pressure Cerebrospinal Fluid Shunts
Authors: McQuarrie Irvine G. , Saint-Louis Leslie , Scherer Priscilla B.
Published: May 2010

In a retrospective study, 39 patients received a low pressure (20 to 50 mm H2O) shunt and 33 received a medium pressure (55 to 85 mm H2O) shunt for the treatment of normal pressure hydrocephalus (NPH). Pre- and postoperative computed tomographic scans were obtained in 32 patients, permitting us to determine the influence of shunt pressure on ventricular size. A reduction in 3rd ventricle width was found to correlate with clinical improvement and was observed more frequently after the placement of a low pressure shunt than after the placement of a medium pressure shunt. When results were evaluated in patients who did not have advanced NPH or develop postoperative complications, gait was markedly improved in 60% of those receiving a low pressure shunt as opposed to 23% of those receiving a medium pressure shunt (P < 0.05).
Coexisting Cervical and Lumbar Spinal Stenosis: Diagnosis and Management
Authors: Epstein Nancy E. , Epstein Joseph A. , Carras Robert , Murthy Vishnubhakat S. , Hyman Roger A.
Published: May 2010

An attempt has been made to identify and manage patients symptomatic from both cervical and lumbar spinal stenosis. The order of operative intervention was related to the degree of myelopathy and radiculopathy. Patients requiring cervical surgery first had absolute stenosis with a spinal canal equal to or less than 10 mm in anteroposterior diameter. Those requiring lumbar surgery first presented with stenosis and a canal between 11 and 13 mm in depth. In the latter group, patients presented with radiculopathy in their upper and lower extremities. A significant portion (50%) had intermittent neurogenic claudication (INC). Motor and sensory changes were severe in those with absolute as compared to relative stenosis. After cervical laminectomy, myelopathy improved or stabilized, and the subsequent lumbar decompression could be completed with less risk. Cervical cord decompression often resulted in improvement in lumbar symptoms with resolution of pain, spasticity, and sensory deficits of myelopathic origin. However, latent symptoms of INC caused by lumbar stenosis were not affected by cervial decompression and increased in severity. Electrodiagnostic studies were helpful in that somatosensory evoked potentials showed conduction delays in the cervical cord in patients with significant disease. The identification of motor neuron disease and peripheral neuropathies was essential. The surgical management included extensive, multiple level laminectomy, unroofing of the lateral recesses, and foraminotomy. Neurolysis and untethering of the spinal cord was essential. Significant improvement was shown by 90% of these patients.
High Dose Glucocorticoids in the Management of Severe Head Injury
Authors: Giannotta Steven L. , Weiss Martin H. , Apuzzo Michael L.J. , Martin Evangeline
Published: May 2010

Eighty-eight patients with a Glasgow coma score of 8 or less 6 hours after nonpenetrating head trauma were given either high dose methylprednisolone sodium succinate (30 mg/kg q6h ×2, then 250 mg q6h ×6, then tapering over 8 days), low dose methylprednisolone (1.5 mg/kg q6h ×2, then 25 mg q6h ×6, then tapering over 8 days), or placebo. Standard care including the removal of traumatic hematomas, assisted ventilation, and intracranial pressure monitoring and control was carried out. Follow-up assessments were performed on all surviving patients at 6 months and were graded according to the Glascow outcome scale. No statistically significant difference in outcome was seen between the low dose group and the placebo group. The high dose group experienced a mortality of 39% as compared to a 52% mortality in the low dose and placebo groups (P < 0.05). Mortality differences were most marked in patients less than 40 years old, with the high dose group experiencing a mortality of 6% as compared to a 43% mortality for the low dose and placebo groups (P < 0.05). For patients under 50 years old, the incidence of recovery of speech was 62% compared to 36% in the low dose and placebo groups (P < 0.5). The increased survival in those treated with high dose corticoids, however, was associated with an increase in the poorer outcome categories.
Computed Tomographic Guidance Stereotaxis in the Management of Lesions of the Third Ventricular Region
Authors: Apuzzo Michael L. J. , Chandrasoma Parakrama T. , Zelman Vladimir , Giannotta Steven L. , Weiss Martin H.
Published: May 2010

The initial management strategies for lesions of the 3rd ventricular region are often controversial. Current techniques for computed tomographic guidance stereotaxis allow accurate access to any intracranial point. A Brown-Roberts-Wells stereotactic system was used as a technical adjunct in the initial management of 42 mass lesions of the 3rd ventricular region. Objectives included biopsy, culture, aspiration, visualization, and installment of drainage conduits. Forty-five point placements were accomplished, and 140 tissue specimens were retrieved without complication. The pathological diagnosis was substantiated in all cases and included lesions of developmental (1 case), neoplastic (31 cases), and infectious (10 cases) origins. Information based on stereotactic assessment provided a rational substrate for the initiation of management, which included craniotomy, cerebrospinal fluid diversion, radiotherapy, chemotherapy, and antibiotic or antiviral therapies. Based on this experience, it is apparent that these methods offer acceptably safe and accurate access to lesions of the entire 3rd ventricular region. Histological or microbiological diagnosis without the need for craniotomy may be readily realized and offers logical guidance for therapeutic strategies. Dependent on the pathological condition, definitive treatment may be achieved.
Clinical Use of a Portable Bedside Cerebral Blood Flow Machine in the Management of Aneurysmal Subarachnoid Hemorrhage
Authors: Rosenstein Jacob , Suzuki Mikio , Symon Lindsay , Redmond Sheila
Published: May 2010

Recent advances in electronics and microprocessors have enabled the development of a compact portable cerebral blood flow (CBF) machine capable of being transported to the patient's bedside. We have used such a device, the Novo Cerebrograph 2a, during the past 7 months on a regular basis in the day to day management of our patients with intracranial aneurysms. One hundred three studies were performed in 23 cases of suspected intracranial aneurysm. Twenty-two cases presented with acute subarachnoid hemorrhage. Patients were studied on admission, preoperatively, in the recovery room, on postoperative Days 1, 5, and 14, and whenever the clinical condition of the patient warranted. The preoperative admission grade was found to correlate well with the mean CBFisi (ISI: initial slope index). Grade III and IV patients had flows significantly lower than those of Grade I and II patients. Serial CBF measurements proved useful in the management of 18 of 22 cases admitted with acute subarachnoid hemorrhage. Delayed ischemic deficits secondary to vasospasm occurred in 6 cases, with a concomitant average fall in mean flow in the symptomatic hemispheres of 27.9%. After volume expansion, an average increase in flow of 29.7% was noted. Low preoperative flows influenced management decision-making in 8 cases. In a further 4 cases, serial CBF measurements were helpful in the differential diagnosis of new neurological signs.
A Prospective Study of Radiofrequency Rhizotomy in the Treatment of Posttraumatic Spasticity
Authors: Kasdon David L. , Lathi Ellen S.
Published: May 2010

Posttraumatic spasticity severely impedes rehabilitation potential and nursing care. Treatment of severe spasticity has included medical therapy, spinal cord ablative procedures, anterior and posterior root lesions and peripheral denervations, and tendon releases. Open rhizotomy and percutaneous radiofrequency rhizotomy have achieved good results. We prospectively studied 25 patients with severe spasticity to assess the efficacy of percutaneous radiofrequency rhizotomy. All or most of the prospectively identified goals were accomplished in 24 of the 25 patients, with improvement persisting during an average follow-up period of 12 months. The improvement due to decreased tone was much greater than the improvement due to increased range of motion.
Use of High Frequency Jet Ventilation during Mechanical Hyperventilation to Reduce Intracranial Pressure in Patients with Multiple Organ System Injury
Authors: Hurst James M. , Saul Thomas G. , DeHaven Bryan C. , Branson Rich
Published: May 2010

Eleven patients with multiple organ system injury, including significant closed head injury, all required positive end-expiratory pressure (PEEP) for treatment of their pulmonary pathological condition, Additionally, the need for intracranial pressure (ICP) monitoring had previously been established on clinical evaluation by the Neurosurgery Service. Seven of the 11 patients met the criteria for invasive hemodynamic monitoring. Hemodynamic monitoring data are supplied for these 7 patients. All patients, after the initial institution of conventional means of hyperventilation, were transitioned to high frequency jet ventilation (HFJV) to evaluate the effects of HFJV during mechanical hyperventilation, There was a statistically significant decrease in ICP (mean decrease of 7.2 mm Hg). There was also a statistically significant fall in PaO2 from 131 to 101 torr. This was not associated with an appreciable decrease in oxygen delivery. There was no change in cardiac output or intrapulmonary shunt fraction. It is concluded that successful control of ICP was possible in all cases without impairment of cardiac output, oxygen delivery, or cerebral perfusion pressure, even when the pulmonary abnormality required the use of PEEP.
Augmentation of Cerebral Blood Flow Induced by Hemodilution in Stroke Patients after Superficial Temporal-Middle Cerebral Arterial Bypass Operation
Authors: Wood James H. , Polyzoidis Konstantinos S. , Kee David B. , Prats Antonio R. , Gibby Gordon L. , Tindall George T.
Published: May 2010

Experimental hemodilutional therapy has been shown to raise collateral perfusion to acutely ischemic brain regions distal to occluded internal carotid (ICA) and middle cerebral (MCA) arteries and to reduce infarct size. Superficial temporal (STA)-MCA anastomosis surgically establishes additional regional collateralization, and this bypass angiographically enlarges over time. Despite bypass patency verification by Doppler recording made at the edge of the craniectomy, the microsurgical STA-MCA anastomosis in 11 stroke patients did not produce early changes in cerebral perfusion parameters in the MCA territory of either hemisphere as determined by 133xenon inhalation. Therefore, hemodilution was initiated in an effort to increase cerebral perfusion during this marginal period when the STA was beginning to dilate progressively. Incremental venesections with equal intravenous volume replacement with 5% human serum albumin caused a significant lowering of the hematocrit from 40 ± 1 to 33 ± 1%. This isovolemic hemodilutional therapy resulted in significant mean regional cerebral blood flow (rCBF) elevations of 23 ± 5% (SE) in the bypassed MCA territory and of 25 ± 6% in the opposite MCA region. The mean gray flow (F1) in the involved and homologous MCA regions significantly increased 27 ± 8% and 30 ± 11%, respectively. Similarly, the initial slope index (ISI2) significantly rose by 17 ± 5% in the bypassed MCA territory and by 18 ± 6% in the homologous region. These data objectively support the premise that reductions in hematocrit without intravascular volume expansion augment cerebral blood flow, probably by reducing blood viscosity. Moreover, inovolemic hemodilution, the effect of which lasts several weeks, may be useful adjunct therapy for the postoperative care of patients with marginal cerebral circulation who undergo cerebral revascularization.
Intramedullary Neurofibroma of the Cervical Spinal Cord: Case Report with Review of the Literature
Authors: Sharma Rajeev , Tandon Shiv C. , Mohanty Sureswar , Gupta Saroj
Published: May 2010

A case of cervical intramedullary neurofibroma diagnosed and surgically treated is reported. This patient, a 27-year-old man, had no evidence of von Recklinghausen's disease. The case is discussed, and a review of literature is presented.
Transverse Myelitis from Intraarterial Penicillin
Authors: Stafford Wesley W. , Mena Hernando , Piskun Walter S. , Weir Michael R.
Published: May 2010

A child was given intramuscular benzathine penicillin and experienced manifestations of sudden, irreversible transection of the spinal cord in the lower thoracic region. The biopsy supported an intravascular injection with occlusion of the spinal vasculature as the etiological mechanism. A review of similar cases reveals a recurring pattern-intramuscular injection with standard techniques and sites into a small muscle mass without evident blood return followed by rapid progression of paralysis. The problem seems to turn upon an inability to recognize the inadvertent intraarterial injection.
Nuclear Magnetic Resonance of the Spine: Clinical Potential and Limitation
Authors: Modic Michael T. , Hardy Russell W. , Weinstein Meredith A. , Duchesneau Paul M. , Paushter David M. , Boumphrey Francis
Published: May 2010

Magnetic resonance can visualize the vertebral bodies, discs, neural structures, cerebrospinal fluid (CSF), neural foramina, and extradural structures in the sagittal, axial, and coronal planes. The normal nucleus pulposus can be differentiated from the anulus and changes associated with degeneration. Infection, trauma, and neoplastic conditions can be identified. The signal intensity of the CSF relative to extradural and neural structures can be increased to provide evaluation of the size and configuration of the contents of the thecal sac without the use of an intrathecal contrast medium. Impingement by disc, tumors, fracture segments, and expansile masses can then be accurately evaluted, It is the most accurate modality for the evaluation of the foramen magnum, Chiari malformation, syringomyelia, infection, and degeneration of intervertebral discs. It can identify paravertebral soft tissue and bony changes when plain films and computed tomographic (CT) studies are negative or equivocal. Not only can lesions be localized, but significant information regarding the nature of the process can be obtained. Using variations of the spin-echo technique with appropriate T1 and T2-weighted images, magnetic resonance can produce tissue contrast distinctions not possible with CT scans or conventional angiography.
Surgical Management of the Frontal Sinus
Authors: Sataloff Robert Thayer , Sariego Joaquin , Myers Donald L. , Richter Harry J.
Published: May 2010

The management of frontal sinus injury from trauma or operation has been controversial. Case reports and extensive literature review emphasize the importance of careful treatment of the frontal sinus whenever it is violated. The principles of management are reviewed.
Traumatic Acute Epidural Hematoma: Unrecognized High Lethality in Comatose Patients
Authors: Seelig John M. , Marshall Lawrence F. , Toutant Steven M. , Toole Belinda M. , Klauber Melville R. , Bowers Sharon A. , Varnell James A.
Published: May 2010

A series of 51 comatose patients suffering traumatic epidural hematoma after closed head injury is reviewed. This prospective series was accumulated from the National Pilot Traumatic Coma Data Bank during a 2-year period and represents 9% of all patients entered into the Data Bank. The overall mortality was 41%, with 4% remaining in the vegetative state. Fifty per cent of these patients, all of whom were in coma, also had an associated intracerebral contusion. There was no difference in outcome with regard to sex, mode of injury, or the presence or absence of contusion or shift on the computed tomographic (CT) scan. The motor score immediately before operation was the most powerful preoperative predictor of outcome. Sixty-seven per cent or two-thirds of the patients with a motor score of 4, 5, or 6 on the Glasgow coma scale had a satisfactory outcome at last follow-up examination. In contrast, in patients with a motor score of 3 or less, two-thirds either died or remained in a vegetative state. The acute traumatic epidural hematoma is often lethal in the comatose patient. We recommend early evacuation of epidural hematomas, i.e., when they are first noted on the CT scan, rather than waiting for clinical motor deterioration.
Microsurgical Anatomy of the Deep Venous System of the Brain
Authors: Ono Michio , Rhoton Albert L. , Peace David , Rodriguez Roland J.
Published: May 2010

The microsurgical anatomy of the deep venous system of the brain was examined in 20 cerebral hemispheres. The deep venous system is composed of the internal cerebral, basal, and great veins and their tributaries. This system drains the deep white and gray matter surrounding the lateral and 3rd ventricles and the basal cisterns. The deep veins are divided into a ventricular group composed of the veins converging on the walls of the lateral ventricles and a cisternal group that includes the veins draining the walls of the basal cisterns. The internal cerebral vein is included in the ventricular group because it is predominantly related to the ventricles, and the basal and great veins are reviewed with the cisternal group because they course through the basal cisterns. The choroidal veins are included with the ventricle veins because they arise on the choroid plexus in the ventricles. The thalamic veins appear in both the ventricular and the cisternal groups because some course on the ventricular surfaces and others course in the basal cisterns. The operative approaches to the major trunks in this system are reviewed.
Natural History of Arteriovenous Malformations of the Brain: A Clinical Study
Authors: Fults Dan , Kelly David L.
Published: May 2010

The natural history of intracranial arteriovenous malformations (AVMs) was studied in 131 patients. The 83 patients managed nonsurgically and the 48 patients treated surgically were followed for an average of 8 years. Hemorrhage occurred in 61.8% of all patients. A second hemorrhage occurred in 67.4% of the survivors of the first hemorrhage. The mortality associated with recurrent hemorrhage did not increase significantly with successive episodes of hemorrhage. The rate of rebleeding was 17.9%/year initially, but declined to 3%/year after 5 years and then to 2%/year after 10 years. Among patients treated nonsurgically, the prognosis was more favorable for patients presenting with seizures than for patients presenting with hemorrhage. Patients in the seizure group had a 26.9% incidence of hemorrhage causing an 11.6% mortality; 40.5% of the patients in the hemorrhage group died. The prognosis was poor for patients with posterior fossa A V Ms; the mortality was 66.7% with the first hemorrhage. Recurrent posterior fossa hemorrhage was the rule in survivors, and most of those hemorrhages were fatal. The prognosis for children with AVMs was no different from that for adults.
Access to the Posterior Medial Temporal Lobe Structures in the Surgical Treatment of Temporal Lobe Epilepsy
Authors: Spencer Dennis D. , Spencer Susan S. , Mattson Richard H. , Williamson Peter D. , Novelly Robert A.
Published: May 2010

The authors describe a surgical technique that allows access to the posterior temporal horn of the lateral ventricle with preservation of the most functional lateral temporal cortex. Development of the technique was stimulated by the need to resect posteromedial temporal lobe structures in patients with intractable complex partial epilepsy and well-identified unilateral posterior hippocampal foci. This technique has also been of value in the resection of some lateral ventricular and posteromedial temporal lobe masses. The operation consists of three steps. No more than 4.5 cm of the anterolateral temporal lobe is removed en bloc such that the most anterior aspect of the temporal horn is entered. An incision is carried from the floor of the temporal horn through the inferior longitudinal fasciculus to the middle fossa dura mater and posteriorally into the lateral ventricular atrium. The lateral temporal cortex and white matter are then elevated with a self-retaining retractor. This exposes the posteromedial temporal horn or intraaxial mass for excision or allows en bloc resection of the entire hippocampus and medial temporal lobe structures while preserving the functional association areas of the lateral temporal cortex, including speech and visual spatial function.
Sacral Fractures
Authors: Schmidek Henry H. , Smith Donald A. , Kristiansen Thomas K.
Published: May 2010

The sacral spine has received relatively little attention in the orthopedic and neurosurgical literature, in part because of the infrequency of developmental, degenerative, or neoplastic conditions of the sacrum requiring surgical intervention. This neglect is unwarranted in trauma, however, because sacral fracture and its associated neural deficit are both common and often complex problems. The sacrum and pelvis behave as a single functional unit; an understanding of the principles of sacropelvic stability has obvious relevance in planning the occasional resection of a sacral tumor and in dealing with the common problem of massive pelvic trauma. A classification of sacral fractures is reviewed along with the usual patterns of neurological involvement. Through analysis of an institutional series of cases, a specific attempt is made to correlate varying types of vertical sacral fractures with differing types of pelvic injury. The radiographic and physiological investigation of sacral fractures is reviewed, as are the various options for achieving the reduction, decompression, and stabilization of sacral fractures.
Fifty Years of Experience with Chordomas in Southeast Scotland
Authors: O'Neill P. , Bell B.A. , Miller J.D. , Jacobson I. , Guthrie W.
Published: May 2010

We report the clinical presentation and management of 34 patients with a histologically proven chordoma, treated in the neurosurgical departments in Edinburgh and Dundee, over the past 50 years. Although these tumors are commonly regarded as being locally invasive with a variable, but generally slow growth rate, they can metastasize, and this may precede surgical intervention, as in one of our patients. Our cases are compared to those in previously published series, and a comprehensive review of the treatment modalities for tumors at various sites is presented. The optimal treatment to be recommended from our own experience, and that of others, is aggressive operation and radiotherapy. A combination of hyperthermia and chemotherapy has shown some promise, but remains untested, and highlights the need for a multicenter trial with long follow-up to allow the evaluation of new therapeutic approaches.
Rupture of Previously Unruptured Giant Carotid Aneurysm after Superficial Temporal-Middle Cerebral Artery Bypass and Internal Carotid Occlusion
Authors: Matsuda Masayuki , Shiino Akihiko , Handa Jyoji
Published: May 2010

A 51-year-old woman with an unruptured giant aneurysm of the internal carotid artery was treated by gradual occlusion of the internal carotid artery in the neck combined with a superficial temporal artery to middle cerebral artery bypass graft. Visual field defects improved after the operation, and thrombosis of the aneurysm was confirmed by angiography and computed tomography. Nevertheless, a fatal hemorrhage occurred 34 days after the final turn of the Selverstone clamp. The possible mechanism of rupture of the apparently thrombosed aneurysm is discussed. There is a risk of rupture of the aneurysm as long as the aneurysmal lumen remains after proximal ligation, no matter how small it may be.
Intraventricular Cavernous Hemangioma: Report of Three Cases and Review of the Literature
Authors: Chadduck William M. , Binet Eugene F. , Farrell Fank W. , Araoz Carlos A. , Reding David L.
Published: May 2010

The clinical and radiographic presentations of 3 patients with intraventricular cavernous hemangioma are described. The accumulated total of 19 cases from the literature are compared to determine whether there is a common clinical and radiographic presentation for this benign intraventricular lesion. The differential diagnosis of intraventricular cavernous hemangioma includes intraventricular meningioma, choroid plexus papilloma, arteriovenous malformation, low grade astrocytoma, and ependymoma.
Tentorial Cavernous Angioma with Calcification in a Neonate
Authors: Moritake Kouzo , Handa Hajime , Nozaki Kazuhiko , Tomiwa Kiyotaka
Published: May 2010

A cavernous angioma of the tentorium cerebelli, first disclosed by perinatal serial ultrasonographic studies, was extirpated totally without remarkable neurological deficit in a neonate. The tumor was accompanied by a calcified expansive hematoma in the posterior fossa. To our knowledge, this is the first case not only of cavernous angioma treated surgically and verified histologically in a neonate, but also of a calcified hematoma revealed on a conventional skull x-ray film at birth, This case suggests the possibility of hemorrhage from intracranial cavernous angioma early in life, even prenatally, and emphasizes the necessity for early diagnosis and early treatment of intracranial cavernous angiomas.
Hemorrhagic Complications after the Lumbar Injection of Chymopapain
Authors: Buchman Aron , Wright Robert B. , Wichter Melvin D. , Whisler Walter W. , Bosch Albert
Published: May 2010

There are few reports of hemorrhagic central nervous system complications after chymopapain injection in humans. Two patients are reported who developed hemorrhagic complications after the lumbar injection of chymopapain. The first developed a hemorrhagic encephalomyelopathy followed by clinically suspected acute arachnoiditis, which responded to high doses of dexamethasone. The second patient developed subarachnoid hemorrhage secondary to vertebral artery aneurysm rupture after the injection of chymopapain.
Postoperative Prophylactic Anticonvulsant Therapy in Cerebral Gliomas
Authors: Boarini David J. , Beck David W. , VanGilder John C.
Published: May 2010

A retrospective study was performed to evaluate the efficacy of prophylactic anticonvulsants in preventing seizures in 68 patients with supratentorial astrocytomas who had been treated with operation and irradiation and who had no previous history of convulsions. Thirty-three patients received prophylactic anticonvulsants and 38 patients did not. The incidence of all types of seizures (generalized convulsions or partial) was lower in patients receiving anticonvulsants. No seizures with an impairment of consciousness occurred in the patients with documented therapeutic anticonvulsant blood levels. The overall incidence of seizures was 39% in untreated patients and 21% in treated patients. The incidence of major seizures including tonic/clonic or partial complex seizures with impairment of consciousness was zero in patients with therapeutic anticonvulsant levels and 18% in untreated patients. Regarding the overall incidence of seizures in both groups, there tend to be fewer seizures in older patients, females, patients with a higher grade of malignancy, and patients who had a more radical resection of the tumor. This study suggests that seizures are a frequent occurrence after operation and irradiation for supratentorial glioma and that anticonvulsants may be effective in reducing the incidence of those seizures.
Resistance to Outflow of Cerebrospinal Fluid Determined by Bolus Injection Technique and Constant Rate Steady State Infusion in Humans
Authors: Kosteljanetz Michael
Published: May 2010

Two methods for the determination of resistance to the outflow of cerebrospinal fluid, the bolus injection technique and the constant rate steady state infusion technique, were compared. Thirty-two patients with a variety of intracranial diseases (usually communicating hydrocephalus) were studied. There was a high degree of correlation between the resistance values obtained with the two methods, but values based on the bolus injection technique were systematically and statistically significantly lower than those obtained with the constant rate infusion test. From a practical point of view. both methods were found to be applicable in a clinical setting.
Papilledema after Acute Head Injury
Authors: Selhorst John B. , Gudeman Steven K. , Butterworth John F. , Harbison John W. , Miller J. Douglas , Becker Donald P.
Published: May 2010

Low grade papilledema after acute, severe head injury was identified in 15 (3.5%) of 426 patients. Papilledema was recognized immediately after head injury in 1 patient, during the 1st week in 10 patients, and in the 2nd week or after in 4 patients. Initial computed tomographic scans showed evidence of brain injury in 11 of these patients. The intracranial pressure (ICP) was monitored continuously for 3 or more days in 9 patients; it was mildly elevated (20 to 40 mm Hg) in 7 patients and moderately elevated (40 to 60 mn Hg) in 2 patients. Intracranial hypertension was controllable in each patient. A sudden, severe, but transient increase in ICP best explained the immediate development of papilledema and survival of 1 patient. Sustained but mild to moderately elevated ICP accounted for papilledema appearing in the 1st week. Papilledema in the 2nd week or after occurred from impaired cerebrospinal fluid absorption and consequent communicating hydrocephalus or delayed focal or diffuse cerebral swelling. A lesser degree of head injury in patients with posttraumatic papilledema was suggested by a higher Glasgow coma score, milder and controllable elevations in ICP, and the absence of any fatality in this group. The favorable outcome was significant compared to the mortality of the more severely injured patients (chi square-4.327; p < 0.04). Papilledema did not occur in 6 patients with sustained, severely elevated ICP(>60 mm Hg) for 3 or more days. Each of these patients died. The Severity of the trauma apparently accounts for the failure of pailledema to develop, possibly by arresting exoplasmic production and transport in retinal nerve fibers.
Leiomyosarcoma Metastatic to the Brain: Case Report and Literature Review
Authors: Feeney John J. , Popek Edwina J. , Bergman William C.
Published: May 2010

An intracerebral hematoma (ICH) developed in a patient during diagnostic evaluation for hemoptysis and guaiac-positive stools. Tissue obtained from colonic polyps, a pregastric mass, and cerebrum had features of poorly differentiated leiomyosarcoma. Only three other cases of pathologically confirmed cerebral metastasis of leiomyosarcoma are reported in the literature. The presence of cerebral metastasis at the time of the initial diagnosis of leiomyosarcoma and the associated ICH are features unique to this case.
Thoracic Spinal Angiomyolipoma: Case Report and Literature Review
Authors: von Hanwehr Roger , Apuzzo Michael L. J. , Ahmadi Jamshid , Chandrasoma Parakrama
Published: May 2010

A rare case of thoracic spinal angiomyolipoma presenting with evidence of vertebral body infiltration and concurrent epidural spinal cord compression is described. Clinicopathological correlates, aspects of radiological diagnosis, considerations for surgical management, and histopathological features denoting possible unique attributes of biological behavior for this entity are discussed in conjunction with a review of the previous literature on angiolipomas in general.
Surgical Approaches to Intraventricular Meningiomas of the Trigone
Authors: Jun Cecil L. , Nutik Stephen L.
Published: May 2010

A case of a large intraventricular meningioma of the trigone is described. The tumor was removed by the transcallosal route. The neuropsychological sequelae of this approach are discussed. The value of other surgical approaches for meningiomas of the trigone is reviewed. The transcallosal approach originally described by Kempe and Blaylock is highly recommended.
Microdiscectomy versus Chemonucleolysis
Authors: Maroon Joseph C. , Abla Adnan
Published: May 2010

A retrospective analysis of 50 consecutive patients treated with chemonucleolysis and 50 treated with microlumbar discectomy was carried out. Similar clinical criteria for the diagnosis of “virgin” herniated lumbar discs were used. All patients had low back or radicular pain unrelieved by a minimum of 4 weeks of conservative therapy. Physical findings included a positive straight leg raising sign, weakness of the appropriate muscle groups, and a sensory loss or evidence of depressed reflexes. All had myelograms or computed tomographic scans demonstrating an extradural defect. Compensation cases were eliminated. Results demonstrated a 90% marked improvement in the microdiscectomy category and a 58% marked improvement in the chemonucleolysis group. Four per cent of the microdiscectomy patients were unimproved, and 18% of the chemonucleolysis group required a subsequent surgical procedure. The average postoperative hospital stay was 3 days for both groups. Because of the necessity for reoperations in the chemonucleolysis group, chemonucleolysis seemed less cost-effective than microdiscectomy.
Symptomatic Anterior Spinal Arachnoid Diverticulum
Authors: Chan Richard C. , Thompson Gordon B. , Bratty Paul J. A.
Published: May 2010

The authors report a case of symptomatic arachnoid diverticulum, which was located anterior to the spinal cord and covered the entire length of the spinal canal. The patient underwent cervical laminectomy and cystoperitoneal shunting with subsequent neurological improvement. The causes, clinical manifestations, diagnosis, and management of spinal arachnoid diverticulum are discussed.
Traumatic Aneurysm of the Posterior Inferior Cerebellar Artery Caused by Fracture of the Clivus
Authors: Meguro Kotoo , Rowed David W.
Published: May 2010

The authors present a case of traumatic aneurysm of the posterior inferior cerebellar artery produced by fracture of the clivus. Varieties of clival fractures reported in the literature are reviewed. Associated basilar or carotid arterial lesions have been reported, but traumatic aneurysm, so far as we are aware, has not. The authors emphasize the importance of a high index of suspicion of undetected traumatic intracranial aneurysm when an unusual amount of subarachnoid hemorrhage is noted on the initial computed tomographic scan, particularly if associated with displaced basal skull fracture.
Hemorrhage into a Spinal Ependymoma after Peridural Anesthesia
Authors: Antoniadis Grigorios , Richter Hans-Peter , Schachenmayr Walter
Published: May 2010

The authors present a case of the accidental puncture of a spinal ependymoma causing bleeding and an increase in the preexisting neurological deficits.
Intracerebral Hematoma Secondary to Lightning Stroke: Case Report and Review of the Literature
Authors: Stanley Lowell D. , Suss Richard A.
Published: May 2010

A young boy sustained a lightning stroke to his head. He was rendered immediately unconscious and hemiplegic. Computed tomography revealed three discrete basal ganglia hematomas. This patient's management is discussed, and a review of lightning injuries to the central nervous system is presented.
Malignant Teratoma of the Optic Nerve: Case Report
Authors: Samii Madjid , Ramina Ricardo , Koch Gesine , Reusche Erich
Published: May 2010

An unusual case of a malignant teratoma of the right optic nerve with extension into the chiasm is presented. The preoperative diagnosis was difficult to establish. Complete removal of the lesion with postoperative irradiation was carried out. Eight months after the operation, the patient developed subarachnoid metastases by the cerebrospinal fluid pathway as well as systemic metastases and died. No local recurrence of the tumor was seen at autopsy. The therapeutic possibilities for these lesions are discussed.
Complications of Use of the Neodymium:Yttrium-Aluminum-Garnet Laser in Neurosurgery
Authors: Jain K.K.
Published: May 2010

Review of the clinical records of 32 patients who underwent operation for brain tumors with the use of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser during a 4-month period revealed 5 cases of complications related to laser use. One death was presumed to be due to intratumor explosion (the popcorn effect) after excessive Nd:YAG laser application. The other death was due to heat necrosis of the brain stem after radiation of an ependymoma of the 4th ventricle. Two patients suffered neurological deficits. One had facial palsy after radiation of the site of attachment of a meningioma to the petrous bone. The other suffered aphasia and hemiparesis due to heat damage to the cerebral cortex after laser coagulation of the overlying dura mater. The fifth patient suffered postoperative hemorrhage in a residual necrotic chromophobe adenoma after a transsphenoidal approach using the Nd:YAG laser. These complications are preventable. Suggestions are made for the safe use of this laser.
Anatomical Study of the Superficial Temporal Artery
Authors: Marano Stephen R. , Fischer Donald W. , Gaines Casey , Sonntag Volker K.H.
Published: May 2010

Fifty consecutive human autopsy specimens were studied to determine the suitability of the superficial temporal artery (STA) for use in microvascular anastomoses. Ten variations of the STA were found. The STA at the zygoma averaged 2.2 mm in outside diameter. The STA averaged 31.7 mm from the zygoma to its bifurcation, where the average outside diameter was 1.9 mm. Eight per cent of the specimens had no bifurcation, and 92% had at least one branch in a frontal or parietal distribution that was ≥1 mm. A suitable frontal branch (i.e., ≥1 mm in diameter and ≥70 mm in length) was found in 90% of the specimens, and a suitable parietal branch was found in 71%. Six specimens (12%) had an additional branch, all of which were of suitable length and diameter. Eight per cent of the specimens lacked a vessel suitable for microvascular anastomosis.
Nonsurgical Management of Small and Intracanalicular Acoustic Tumors
Authors: Clark Craig W. , Moretz William H. , Acker James D. , Gardner Gale L. , Eggers Frank , Robertson Jon H.
Published: May 2010

Although surgical removal is generally regarded as the management strategy of choice for acoustic tumors, there remains a small group of patients usually with small or intracanalicular tumors in whom nonoperative management may be a desirable alternative to operation. The authors present a series of six such cases and discuss criteria that may aid in the selection of patients suitable for initial nonoperative management.
Intraventricular Primary Cerebral Neuroblastoma in Adults: Report of Three Cases
Authors: Pearl Gary S. , Takei Yoshio , Bakay Roy A.E. , Davis Patricia
Published: May 2010

Primary cerebral neuroblastoma most often occurs in the cerebral parenchyma in children. When it occurs in adults, it is also described as an intraparenchymal neoplasm. We report three cases of primary cerebral neuroblastoma in adults presenting as an intraventricular mass.
Stereotactic Surgery for Mass Lesions of the Midbrain and Pons
Authors: Coffey Robert J. , Lunsford Dade L.
Published: May 2010

Appropriate treatment for intracranial mass lesions depends upon accurate histological diagnosis. Although both advanced generation computed tomographic and magnetic resonance scanners can detect small lesions within the brain stem, only the combination of these advanced imaging tools with stereotactic instrumentation permits safe and accurate pathological diagnosis of such lesions. We present the results of 13 operations performed on 12 patients with mass lesions of the pons and mesencephalon. A definitive diagnosis was obtained in all patients. Aspiration of necrotic tumors (3 patients), neoplastic or benign cysts (2 patients), and chronic hematomas (2 patients) resulted in immediate neurological improvement in 7 of these 12 patients. No morbidity or mortality related to surgery occurred in this series. Both the preoperative clinical and radiographic diagnoses were erroneous in 6 patients so that accurate histological diagnosis indeed altered subsequent therapy. A transfrontal approach to the midbrain and a transcerebellar approach to the lateral pons are described. The importance of accurate diagnosis, the possibility of definitive therapy in selected patients, and the encouraging benefits and safety of stereotactic surgery indicate that empiric treatment of mass lesions of the midbrain and pons is no longer justified.
Hydromyelia Complicating Apert's Syndrome: A Case Report
Authors: Vollmer Dennis G. , Park T.S. , Cail Wayne S. , Jane John A.
Published: May 2010

A 7-year-old boy with Apert's syndrome and hydrocephalus presented with scoliosis and lower extremity weakness. Neuroradiological evaluation demonstrated bony abnormalities involving the foramen magnum and a markedly hydromyelic spinal cord. Clinical improvement followed posterior fossa decompression and a myelotomy on the caudal conus medullaris. A possible role of the craniofacial anomaly in the pathogenesis of the hydromyelia is discussed.
Primary Rhabdomyosarcoma of the Central Nervous System: Case Report
Authors: Bradford Robert , Crockard Alan H. , Isaacson Peter G.
Published: May 2010

A case of a primary rhabdom yosarcoma that appeared to be arising from the filum terminale in a 48-year-old man is reported. The histological diagnosis of rhabdomyosarcoma was supported using immunocytochemical methods. Twenty-two cases of primary rhabdomyosarcoma of the central nervous system previously reported in the literature are reviewed briefly. The possible origin of these tumors from neuroectoderm is discussed. (Neurosurgery 17:101-104, 1985)
Surgical Considerations in the Initial Repair of Meningomyelocele and the Introduction of a Technical Modification
Authors: Venes Joan L.
Published: May 2010

Tethering of the spinal cord has been increasingly recognized as a cause of late deterioration in the child with repaired meningomyelocele. Findings at reoperation include dense arachnoiditis, dermal inclusion cysts, fibrolipoma of the filum terminale, and, on occasion, foreign body granulomas. This article reviews four key steps in meningomyelocele repair and the guidelines for detection of surgically remediable lesions associated with this disorder. In addition, it proposes a modification of the standard dural closure that may reduce the incidence of contributory adhesive arachnoiditis by the creation of a capacious cerebrospinal fluid space about the neural plaque. (Neurosurgery 17:111-113, 1985)