bluuebunny/crossref_metadata_2025 huggingface dataset:
Arteriovenous malformation and glioma: coexistent or sequential?
Authors: Goodkin Robert , Zaias Barbara , Michelsen W. Jost
Published: May 2009

✓ A 9-year-old girl was evaluated for behavioral changes and seizures. Initial computerized tomography and cerebral angiography revealed a left cerebral vascular mass, diagnosed as an arteriovenous malformation. An embolization procedure was attempted but was terminated before completion because the patient developed a right hemiparesis. Her right-sided neurological deficit subsequently increased with enlargement of the mass lesion. On follow-up cerebral angiography approximately 2 years later the vascular malformation was no longer demonstrated. Biopsy of the mass lesion revealed it to be an anaplastic astrocytoma. This case is reported with a review of the literature on the coexistence of a brain tumor and a vascular malformation, the difficulties in diagnosis, and possible etiologies.
Delayed traumatic intracerebral hematomas: “Spät-Apoplexie”
Authors: Elsner Henry , Rigamonti Daniele , Corradino Gregory , Schlegel Robert , Joslyn John
Published: May 2009

✓ Two patients who suffered a head trauma experienced sudden clinical deterioration more than 1 week after their injury. The initial computerized tomography (CT) scan demonstrated a small hematoma underlying a depressed skull fracture in one patient and a small interhemispheric subdural hematoma in the other. Both patients had made a complete recovery and follow-up CT scans were normal when clinical deterioration suddenly occurred. Both patients developed a large intracerebral hematoma and underwent emergency evacuation of the mass. The first patient recovered with the exception of a moderate hemiparesis and dysphasia, but the second patient died.

Delayed traumatic intracerebral hematomas have been described in the literature. Since the advent of CT scanning, the incidence of this phenomenon has been estimated as between 1.7% and 7.4% of closed head injuries. In 1891, Otto Bollinger described four patients who suffered head injury, followed days to weeks later by death from an apoplectic event. His criteria for diagnosis of “traumatische Spät-Apoplexie” included the absence of preexisting vascular disease, a definite history of trauma, an asymptomatic interval of at least several days, and an apoplectic episode. These two cases reemphasize the existence of Spät-Apoplexie as a rare clinical condition. In the presence of CT findings of even small traumatic intracerebral or extracerebral hematomas, the possibility of this late complication should be kept in mind.
Anosmia following operation for cerebral aneurysms in the anterior circulation
Authors: Eriksen Kjeld Dons , Bøge-Rasmussen Torben , Kruse-Larsen Christian
Published: May 2009

✓ Damage to the olfactory nerve during frontotemporal approach to the basal cisternal region has not previously been investigated in a quantified manner. In this retrospective study of 25 patients operated on for ruptured intracranial aneurysms via the frontotemporal route, 22 patients suffered postoperatively from anosmia ipsilateral to the side of surgery. This complication most often goes unrecognized by the patient as well as the physician, and attention should be drawn to it because of its widespread occurrence. This investigation demonstrates a high incidence of anosmia (24 (88.9%) of 27 surgical sides) occurring ipsilateral to the frontotemporal approach in aneurysm surgery. Recovery after traumatic anosmia has been recorded up to 5 years after injury.1 Nevertheless, the authors believe that the damage is permanent when lasting 35 months or longer.
Normal and radiculopathic cutaneous pain tolerance levels evaluated by heat-beam dolorimetry
Authors: Lipman Jonathan J. , Blumenkopf Bennett , Lawrence Patricia L.
Published: May 2009

✓ The heat-beam dolorimeter has previously been used to obtain cutaneous pain tolerance measures in normal volunteers and patients with chronic pain. In the present study, normal reference data were collected at two stimulus intensities for 24 volunteers, and the stimulus-effect relationship (decreasing tolerance latency with increasing stimulus intensity) was found significant (p < 0.001) for all body sites tested. No overall sex differences were found; males behaved slightly more stoically than females, with differences significant only at the T3 site over the breasts. At the second evaluation at the higher stimulus intensity, females exhibited lower pain tolerance (greater pain sensitivity) at the right breast than males (p < 0.05). No significant lateral asymmetry was found in cutaneous pain tolerance except at the dorsum of the hand: the right hand evinced elevated pain tolerance compared with the left hand in both right- and left-handed subjects. Eight radiculopathic pain patients with clinically involved left L5 nerve roots were evaluated and their responses were compared with the volunteer normal reference data. The radiculopathic group evinced elevated tolerance levels in both the radiculopathic dermatome and noninvolved sites compared with normal individuals (p < 0.05).
Neurological injury and patterns of sacral fractures
Authors: Gibbons Kevin J. , Soloniuk Donald S. , Razack Nizam
Published: May 2009

✓ To evaluate the morphological and neurological findings in sacral spine injuries, a retrospective study was conducted of all patients admitted to Erie County Medical Center over a 2-year period with the diagnosis of pelvic or sacral injury. Of these 253 patients, 44 were found to have sacral fractures and form the basis of this study. The type of fracture, neurological deficit, treatment, and outcome in these patients were analyzed. The patient population consisted of 25 males and 19 females, with a mean age of 34 years (range 15 to 80 years). The fractures were classified by the degree of involvement of the foramina and central canal. Fractures through the ala sacralis only (Zone I, 25 cases) or involving the foramina but not the central canal (Zone II, seven cases) were less likely to cause nerve injury (24% and 29%, respectively). Fractures involving the central canal (Zone III), both vertical (five cases) and transverse (seven cases), were more likely to cause neurological injury (60% and 57%, respectively). Neurological deficits in Zone I and II injuries were usually unilateral lumbar and sacral radiculopathies. Zone III deficits were usually bilateral and severe; bowel and/or bladder incontinence was present in six of the 12 patients in this group. Deficits generally improved with time; however, operative reduction and internal fixation may have been useful, particularly in patients with unilateral root symptoms. The treatment options are discussed, and previously published series of sacral fractures are reviewed. The authors conclude that the classification of sacral fractures described is useful in predicting the incidence and severity of neurological deficit.
Selective opening of the blood-tumor barrier by intracarotid infusion of leukotriene C4
Authors: Black Keith L. , King Wesley A. , Ikezaki Kiyonobu
Published: May 2009

✓ Intracarotid infusions of leukotriene C4 (LTC4) were used to selectively open the blood-tumor barrier in rats with RG-2 gliomas. Blood-brain and blood-tumor permeability was determined by quantitative autoradiography using 14C aminoisobutyric acid. Leukotriene C4 (4 µg total dose) infused into the carotid artery ipsilateral to the tumor increased twofold the unidirectional transfer constant for permeability within the tumor while no effect on permeability was seen in normal brain. No gamma glutamyl transpeptidase (γ-GTP) activity was seen in tumor capillaries in contrast to high γ-GTP in normal brain capillaries. These findings suggest that normal brain capillaries may resist the vasogenic effects of LTC4, while LTC4 will increase permeability in tumor capillaries. This could relate to the ability of γ-GTP to act as an enzymatic barrier and inactivate leukotrienes in normal brain capillaries. Intracarotid LTC4 infusion may be a useful tool to selectively open the blood-tumor barrier for delivery of antineoplastic compounds.
Diphtheria toxin effects on brain-tumor xenografts
Authors: Wrobel Charles J. , Wright Donald C. , Dedrick Robert L. , Youle Richard J.
Published: May 2009

✓ A model was developed to determine whether protein-based chemotherapeutic agents can cross the blood-brain barrier and successfully treat brain tumors. The human small-cell lung carcinoma N417D was grown as a solid tumor in the nude rat brain, and diphtheria toxin (DT) was administered intravenously as therapy. Because rat cells lack functional DT receptors and are 1000 to 10,000 times less sensitive to DT than human cells, a therapeutic window exists between the implanted human tumor and the nude rat host. The pharmacokinetic and pharmacodynamic characteristics of DT were defined. Within 6 hours, more than 90% of the initial DT concentration was removed from the blood. The blood-to-tumor transfer constant Ki for DT in small N417D tumors was 0.49 µl/gm-min, one-fourth to one-fifth the reported values for permeability to proteins in other experimental tumor models. Despite the toxin's short plasma half-life and the relatively intact blood-tumor barrier, DT administered intravenously as a single dose significantly extended animal survival. Untreated nude rats developed solid parenchymal tumors and died in 11 to 16 days (median 15 days). When administered at 0.1 µg/animal, DT increased the median survival time to 19 days (p < 0.0016) while 1.0-µg doses extended median survival times to 26.5 days (p < 0.0002). A higher dose of DT (3.0 µg) had no further beneficial effect on survival (26.1 days).

Blood-brain barrier constraints to successful monoclonal antibody-based therapies of brain tumors may have been overestimated since antibody conjugates have plasma half-lives longer than DT, and the permeability of N417D tumors to DT is equal to or less than the permeability of other experimental tumors to large proteins. Recently developed immunotoxins that have the higher potency of DT and a therapeutic window as wide as DT has in this nude rat/human tumor paradigm may be effective in treating brain tumors despite limited blood-tumor permeability.
Mutism after posterior fossa surgery in children
Authors: Ferrante Luigi , Mastronardi Luciano , Acqui Michele , Fortuna Aldo
Published: May 2009

✓ Three patients aged 5½ to 9 years old with mutism after posterior fossa surgery are presented. The entity is discussed with a review of 15 additional previously reported cases in children aged 2 to 11 years. In all 18 patients, a large midline tumor of the posterior fossa (medulloblastoma in nine cases, astrocytoma in five, and ependymoma in four), often attached to one or both lateral recesses of the fourth ventricle, was removed. Mutism developed 18 to 72 hours after the operation (mean 41.5 hours) in patients with no disturbance of consciousness and no deficits of the lower cranial nerves or of the organs of phonation. All of these children had spoken in the first hours after surgery. The disorder lasted from 3 to 16 weeks (mean 7.9 weeks). Speech was regained after a period of dysarthria in six of the 10 cases for whom this information was available. The various hypotheses advanced to explain the pathogenesis of this speech disorder are analyzed.
Magnetic resonance demonstration of vertebral artery dissection
Authors: Quint Douglas J. , Spickler Eric M.
Published: May 2009

✓ Vertebral artery dissection may be spontaneous or related to some traumatic event. Diagnosis has usually been made by angiography, an invasive procedure with certain well-known risks. The authors describe the magnetic resonance (MR) appearance (both on conventional spin-echo and on gradient refocused “flow” sequences) in two patients with vertebral artery dissection confirmed by angiography. It is proposed that the less invasive MR imaging might be the imaging modality of choice for initial evaluation of suspected vertebral artery dissection.
Cystic angiomatosis of the skull presenting with extradural pneumocephalus
Authors: Morshed Aliakbar , Mohit Parviz
Published: May 2009

✓ The case is reported of a 40-year-old militiaman who presented 4 days after a blast injury with a huge swelling of the scalp. The bulge was determined to be an air mass collected extradurally via lysis of the air cells of the mastoid bone. Pathological study of the resected bones revealed cystic angiomatosis. The unusual clinical presentation, as well as the rarity of the pathological findings, prompted this report.
Mineralization of the falx cerebri simulating interhemispheric vascular anomalies on MR imaging
Authors: Ruge John R. , Russell Eric J. , Levy Robert M.
Published: May 2009

✓ Three cases of ossification of the falx cerebri initially mistaken for vascular lesions based on their magnetic resonance (MR) appearance are reviewed. The MR imaging and computerized tomography characteristics of mineralization of the falx cerebri and their differentiation from interhemispheric vascular lesions are discussed.
Hyperthermia catheter implantation and therapy in the brain
Authors: Marchosky J. Alexander , Moran Christopher J. , Fearnot Neal E. , Babbs Charles F.
Published: May 2009

✓ For the treatment of malignant gliomas, a technique for implanting hyperthermia catheters was developed that utilized a stereotactic template and head-stabilization frame mounted on a computerized tomography (CT) scanner. Computerized tomography scans were used to measure tumor dimensions and to determine the number, implantation depths, and active heating lengths of the catheters, which were implanted through twist-drill holes while the patient was in the CT room. Heat was subsequently delivered via implanted catheters using a computer-controlled hyperthermia system, which partially compensates for heterogeneous and time-varying tumor blood flow.
The Decade of the Brain: an era of promise for neurosurgery and a call to action
Authors: Goldstein Murray
Published: May 2009

✓ On July 25, 1989, President Bush signed a bill declaring the 1990's to be the Decade of the Brain. This offers the clinical and basic neuroscience communities an opportunity to join with the National Institute of Neurological Disorders and Stroke in moving ahead vigorously with research aimed at preventing and treating neurological disease. Neurosurgery must be an active participant in this national endeavor; its influence, skills, and contributions are needed.
The International Cooperative Studyon the Timing of Aneurysm Surgery
Authors: Kassell Neal F. , Torner James C. , Haley E. Clarke , Jane John A. , Adams Harold P. , Kongable Gail L. , _ _
Published: May 2009

✓ The International Cooperative Study on the Timing of Aneurysm Surgery evaluated the results of surgical and medical management in 3521 patients between December, 1980, and July, 1983. At admission, 75% of patients were in good neurological condition and surgery was performed in 83%. At the 6-month evaluation, 26% of the patients had died and 58% exhibited a complete recovery. Vasospasm and rebleeding were the leading causes of morbidity and mortality in addition to the initial bleed. Predictors for mortality included the patient's decreased level of consciousness and increased age, thickness of the subarachnoid hemorrhage clot on computerized tomography, elevated blood pressure, preexisting medical illnesses, and basilar aneurysms. The results presented here document the status of management in the 1980's.
Management and long-term follow-up review of children with lipomyelomeningocele, 1952–1987
Authors: Kanev Paul M. , Lemire Ronald J. , Loeser John D. , Berger Mitchel S.
Published: May 2009

✓ The medical records of patients at Children's Hospital and Medical Center treated for lipomyelomeningocele repair were reviewed to assess the long-term outcome of surgery. In total, 108 children were cared for between 1952 and 1987, and long-term data are available for 80 of 96 children who underwent surgery. Cutaneous manifestations and associated malformations were common. Surgical repair was performed at ages 1 week to 17 years; there was no operative mortality. Thirty-five of 38 children with normal preoperative examination were without deficits on long-term follow-up review. Bowel and bladder paralysis was present in 42 children and did not recover after release of cord tethering. Eleven children had return of symptoms and were reexplored 3 to 8 years after initial surgery. Surgical repair with release of cord tethering at the time of diagnosis is advocated, regardless of patient age.
An anterior approach for decompression of the suprascapular nerve
Authors: Shupeck Malcolm , Onofrio Burton M.
Published: May 2009

✓ In an effort to increase the beneficial results from decompressive surgery for suprascapular nerve entrapment, an anterior approach has been developed which minimizes manipulation of the suprascapular nerve and maximizes visualization while the decompression is being carried out. The technique and results in three patients are described.
Management of giant intracranial ICA aneurysms with combined extracranial-intracranial anastomosis and endovascular occlusion
Authors: Serbinenko Fjodor A. , Filatov Jury M. , Spallone Aldo , Tchurilov Mikhail V. , Lazarev Valery A.
Published: May 2009

✓Nine patients with giant internal carotid artery (ICA) aneurysms (> 2.5 cm in diameter) were subjected to a combined extracranial-intracranial (EC-IC) bypass procedure and endovascular ICA occlusion during 1987 and 1988. The procedures were performed under one anesthetic. In all cases the collateral circulation had been judged insufficient on the basis of a strict preoperative testing protocol including: cerebral panangiography, electroencephalography, somatosensory potential recording, and cerebral blood flow monitoring during manual compression of the ICA in the neck. There were four intracavernous ICA aneurysms, four carotid-ophthalmic artery aneurysms, and one supraclinoid ICA aneurysm. All patients showed symptoms and signs of compression of the surrounding nervous structures. In the five cases of intradural lesions, the artery was occluded at the level of the aneurysm neck, so the ophthalmic artery had to be occluded. There was, nevertheless, no case of worsening of vision following surgery, and all nine patients showed significant improvement following the combined procedure. A combined EC-IC bypass procedure and endovascular ICA occlusion allows for immediate verification of the surgical results and appears to be a worthwhile method for treating giant intracranial aneurysms.
Correlation of transcranial Doppler sonography findings with timing of aneurysm surgery
Authors: Romner Bertil , Ljunggren Bengt , Brandt Lennart , Saveland Hans
Published: May 2009

✓ Thirty-six patients with a proven first subarachnoid hemorrhage (SAH) from a ruptured supratentorial aneurysm were subjected to repeated transcranial Doppler sonography assessments. Eighteen individuals (Group A) were operated on within 48 hours, while the other 18 (Group B) had surgery between 49 and 96 hours after SAH. The patients represented two clinically comparable groups. In the first 72 hours post-SAH, no increased flow velocities suggestive of arterial narrowing or vasospasm were recorded. There was no significant difference in preoperative flow velocities between the groups. Postoperative flow velocities were significantly lower in patients operated on within 48 hours (p < 0.001). Two patients, who had surgery on Day 4 post-SAH and who showed the highest recorded postoperative flow velocities, died from cerebral vasospasm and infarction. The results favor a referral system which enables early surgical intervention not only to prevent rebleeds but also aimed at reducing delayed ischemic dysfunction.
Cytoarchitecture of the smooth muscles and pericytes of rat cerebral blood vessels
Authors: Ushiwata Issei , Ushiki Tatsuo
Published: May 2009

✓ The three-dimensional cytoarchitecture of the smooth muscles and pericytes of rat cerebral blood vessels was studied by scanning electron microscopy after removing extracellular connective tissue matrices with the KOH-collagenase digestion method. The tunica media of major intracranial arteries such as the internal carotid, vertebral, basilar, and other cerebral arteries measuring more than 100 µm in outer diameter consisted of spindle-shaped smooth-muscle cells arranged circularly to the long axis of the vessel. Muscle cells at the branching points, however, showed a variety of shapes, sizes, and arrangements. As the vessel size decreased, smooth-muscle cells showed bi- or trifurcations at the cell poles. In the precapillary arterioles, smooth-muscle cells which had helically surrounded the endothelial tubes had bulging cell bodies with various cytoplasmic processes extending from the cell poles. Distinct specializations presumed to be sphincters were not found on the arteries or arterioles. Pericytes of the capillary had become extended along the vessel axis, having fusiform cell bodies with longitudinally oriented long cytoplasmic processes. Cells located periendothelially in the venules and veins were stellate in shape with many cytoplasmic processes which were interwoven to form complicated cellular networks around the endothelial tube.
Silver colloid staining technique for analysis of glioma malignancy
Authors: Kajiwara Koji , Nishizaki Takafumi , Orita Tetsuji , Nakayama Hisato , Aoki Hideo , Ito Haruhide
Published: May 2009

✓ A silver colloid staining technique for identifying nucleolar organizer region-associated proteins (Ag-NOR's) was applied to 51 human gliomas. These comprised 20 glioblastomas multiforme, 15 anaplastic astrocytomas, and 16 astrocytomas, in which the mean numbers of Ag-NOR's per cell (± standard error of the mean) were 2.51 ± 0.12, 2.01 ± 0.10, and 1.76 ± 0.06, respectively. Significant differences among these were recognized, and the mean number of Ag-NOR's paralleled the degree of histopathological malignancy. In 16 cases, studies were performed of the number of Ag-NOR's and the S-phase fraction by in vitro labeling using anti-bromodeoxyuridine monoclonal antibody. A linear relationship was demonstrated between these two factors (r = 0.857, p < 0.001), although some scatter was seen. In 32 adult patients, the correlation between the number of Ag-NOR's and the prognosis was estimated. The results demonstrated that the group containing patients with less than 1.80 Ag-NOR's per cell had a better prognosis than the group with 1.80 Ag-NOR's or more. Thus, the number of Ag-NOR's reflected the degree of histopathological malignancy, S-phase fraction, and prognosis. Silver colloid staining for Ag-NOR's is a simple, rapid, and reproducible method for estimating the proliferative potential of human gliomas without requiring a complicated technique.
Neurological protection by dichloroacetate depending on the severity of injury in the paraplegic rat
Authors: LeMay Daniel R. , Zelenock Gerald B. , D'Alecy Louis G.
Published: May 2009

✓ Hyperglycemia has been shown to exacerbate neurological deficit associated with central nervous system ischemia. Iodoacetate or dichloroacetate was administered intraperitoneally to rats in a study to examine the role of glycolysis in hyperglycemic exacerbation of neurological deficit. Sprague-Dawley rats were injected with saline, iodoacetate, or dichloroacetate and then made paraplegic by temporary occlusion for 10, 12, 13, or 15 minutes of the right and left subclavian arteries and the aorta distal to the left subclavian artery. Glycolytic blockage by iodoacetate was lethal in doses of 15 mg/kg or more, whereas rats receiving 10 mg/kg survived but showed no significant neurological improvement compared to the saline-treated control group. Dichloroacetate, 500 mg/kg, protected neurological function, which suggests a possible detrimental role for lactate accumulation and the benefit of maintaining tricarboxylic acid cycle activity by stimulating pyruvate dehydrogenase. The protection seen with dichloroacetate depended on the severity of ischemic injury. Dichloroacetate administration had a minimal effect on neurological outcome with occlusion periods of 13 and 15 minutes, mild improvement with 12 minutes of occlusion, and a significant protective effect with a 10-minute occlusion period. The dose-response nature of ischemic injury and neurological outcome in this rat model of paraplegia therefore appears to play an important role in determining the effect observed with a specific intervention.
Precocious puberty following head injury
Authors: Maxwell Marius , Karacostas Dimitris , Ellenbogen Richard G. , Brzezinski Amnon , Zervas Nicholas T. , Black Peter McL.
Published: May 2009

✓ A 6-year-old girl developed secondary sexual characteristics 5 months after severe closed head injury. Endocrinological tests confirmed a pubertal sexual condition; there was also diminution of serum melatonin and disruption of the diurnal pattern. Magnetic resonance imaging demonstrated focal hypothalamic injury; this is believed to be the first time such a posttraumatic lesion has been demonstrated by imaging techniques. The pathophysiology of this condition is discussed.
Papillary pineocytoma
Authors: Vaquero Jesús , Coca Santiago , Martínez Roberto , Escandón Jorge
Published: May 2009

✓ A case of papillary pineocytoma is presented. It is necessary to be aware of this unusual histological type of pineocytoma in order to make a differential diagnosis among other types of papillary tumors that arise in the pineal region.
Hydrocephalus in an achondroplastic child treated by venous decompression at the jugular foramen
Authors: Lundar Tryggve , Jacob Bakke Søren , Nornes Helge
Published: May 2009

✓ A 10-month-old child with achondroplasia with progressive head enlargement, ventriculomegaly, and wide subarachnoid spaces over the hemispheres was referred for evaluation. A steady-state lumbar infusion test revealed increased cerebrospinal fluid (CSF) outflow resistance (14 mm Hg/ml/min), and intra-arterial digital subtraction angiography (DSA) demonstrated bilateral venous outflow obstruction due to stenosis of the jugular foramen. Surgical decompression by opening the right jugular foramen relieved the clinical signs of intracranial hypertension. During the following year, the patient's head enlargement was moderate with relative normalization of size. Repeat DSA demonstrated improved venous runoff on the right side, and a steady-state lumbar infusion test demonstrated reduced CSF outflow resistance (10 mm Hg/ml/min). Venous decompression is causal therapy and may prove to be preferable to shunting in children with hydrocephalus and bilateral stenosis of the jugular foramen.
Resection of high-cervical paraganglioma with cervical-to-petrous internal carotid artery saphenous vein bypass
Authors: Miyazaki Shinichiro , Fukushima Takanori , Fujimaki Takamitsu
Published: May 2009

✓ Two patients with large high-cervical paragangliomas were treated with radical resection and placement of a cervical-to-petrous internal carotid artery saphenous vein bypass. The high-cervical and infratemporal segments of the internal carotid artery engulfed within the tumor were resected and successfully replaced with a saphenous vein interposition graft. The postoperative course was uneventful in both cases and follow-up angiography revealed satisfactory reconstruction of the high-cervical and infratemporal skull base carotid artery. The operative technique, indications, and potential future applications of this newly developed skull base bypass procedure are discussed.
Risk of late stroke and survival following carotid endarterectomy procedures for symptomatic patients
Authors: Turner Dennis A. , Tracy Jay , Haines Stephen J.
Published: May 2009

✓ The long-term outcome following carotid endarterectomy for neurological symptoms was analyzed using a retrospective life-table approach in 212 patients who had undergone 243 endarterectomy procedures. The postoperative follow-up period averaged 38.9 ± 2.1 months (mean ± standard error of the mean). The endpoints of stroke and death were evaluated in these patients. Patient groups with the preoperative symptoms of amaurosis fugax, transient ischemic attack, and prior recovered stroke were similar in terms of life-table outcome over the follow-up period. Sixty-two percent of symptomatic patients were alive and free of stroke at 5 years. The late risk of stroke (after 30 days postoperatively) averaged 1.7% per year based on a linear approximation to the hazard at each life-table interval (1.3% per year for ipsilateral stroke). The trend of late stroke risk was clearly downward, however, and could be fitted more accurately by an exponential decay function with a half-life of 33 months. Thus, the risk of stroke following carotid endarterectomy for neurological symptoms was highest in the perioperative period, slowly declined with time, and occurred predominantly ipsilateral to the procedure.

The definition of a prospective medical control group remains crucial for a critical analysis of treatment modalities following the onset of premonitory neurological symptoms. In the absence of an adequate control group for this series, the calculated perioperative and postoperative stroke risk from this study was compared to data obtained from the literature on stroke risk in medically treated symptomatic patients. This uncontrolled comparison of treatment modalities suggests the combined perioperative and postoperative stroke risk associated with carotid endarterectomy to be modestly improved over medical treatment alone.
Chronic subdural hematoma in infancy
Authors: Aoki Nobuhiko
Published: May 2009

✓ The cases of 30 infants with chronic subdural hematoma treated surgically between 1978 and 1987 (after the introduction of computerized tomography) were reviewed. This series was limited to infants presenting with increased intracranial pressure, neurological deficits, or developmental retardation. Nineteen patients were male and 11 were female, ranging in age from 1 to 14 months (average 6.1 months). The surgical treatment was initiated with percutaneous subdural tapping which was repeated periodically, if indicated, for 2 weeks. If the patients failed to respond to subdural tapping, subdural-peritoneal shunting was installed. The follow-up periods were from 3 months to 9 years 8 months (average 4 years 10 months). Computerized tomography at that time disclosed disappearance or minimal collection of subdural fluid in 28 cases (93%) and a significant collection (> 5 mm) in two (7%). Neurological examination revealed that the patients were “normal” in 17 cases (57%), “mildly or moderately disabled” in nine (30%), and “severely disabled” in four (13%). The majority of disabled patients had lesions secondary to infantile acute subdural hematoma, child abuse, or hemorrhagic diathesis.

These results indicate that the treatment protocol in the present series is acceptable for the elimination of subdural hematoma. Together, early diagnosis and treatment of the etiological conditions causing the lesion are indispensable for obtaining a satisfactory neurological outcome.
Platelet-activating factor and progressive brain damage following focal brain injury
Authors: Frerichs Kai U. , Lindsberg Perttu J. , Hallenbeck John M. , Feuerstein Giora Z.
Published: May 2009

✓ The effects of a platelet-activating factor (PAF) antagonist on brain edema, cortical microcirculation, blood-brain barrier (BBB) disruption, and neuronal death following focal brain injury are reported. A neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was used to induce highly reproducible focal cortical lesions in anesthetized rats. Secondary brain damage in this model was characterized by progressive cortical hypoperfusion, edema, and BBB disruption in the vicinity of the hemispheroid lesion occurring acutely after injury. The histopathological evolution was followed for up to 4 days. Neuronal damage in the cortex and the hippocampus (CA-1) was assessed quantitatively, revealing secondary and progressive loss of neuronal tissue within the first 24 hours following injury.

Pretreatment with the PAF antagonist BN 50739 ameliorated the severe hypoperfusion in 12 rats (increasing local cerebral blood flow from a mean ± standard error of the mean of 40.5% ± 8.3% to 80.2% ± 7.8%, p < 0.01) and reduced edema by 70% in 10 rats (p < 0.05) acutely after injury. The PAF antagonist also reduced the progression of neuronal damage in the cortex and the CA-1 hippocampal neurons (decrease of neuronal death from 88.0% ± 3.9% to 49.8% ± 4.2% at 24 hours in the cortex and from 40.2 ± 5.0% to 13.2% ± 2.1% in the hippocampus in 30 rats; p < 0.05).

This study provides evidence to support progressive brain damage following focal brain injury, associated with secondary loss of neuronal cells. In this latter process, PAF antagonists may provide significant therapeutic protection in arresting secondary brain damage following cerebral ischemia and neurological trauma.
Effects of blood coagulation Factor XIII on the development of experimental cerebral aneurysms in rats
Authors: Kang Yoo , Hashimoto Nobuo , Kikuchi Haruhiko , Yamazoe Naohiro , Hazama Fumitada
Published: May 2009

✓ Pathological and experimental studies have shown that cerebral aneurysms develop in part as a result of injury to the blood vessel wall. One of the peculiar aspects of aneurysm development is a defective proliferative or healing response to such injury. To examine this phenomenon, blood coagulation Factor XIII, which is known to enhance the healing process of wounds in general, was given to rats to induce experimental cerebral aneurysms. The rats were subjected to ligation of one common carotid artery and induction of hypertension, and were fed beta-aminoproprionitrile. Two weeks thereafter, Factor XIII was injected intravenously daily for 5 days (10 U/100 gm body weight/day). Twelve days after the start of Factor XIII injections, the rats were sacrificed and examined under light and electron microscopy. In seven of 12 bifurcations which developed small aneurysms, prominent intimal thickening was observed in the aneurysm lumen. In the most advanced cases, the aneurysm lumen was completely filled with proliferated smooth-muscle cells and collagen. In five of nine bifurcations that showed no aneurysm development, apparent intimal thickening was found at the site where aneurysms might be expected to grow. In the group of rats studied for induction of cerebral aneurysms but not given Factor XIII, none of 11 bifurcations with or without aneurysms showed such intimal thickening. The results indicated that the proliferative response at the sites of aneurysm development was modified by exogenous Factor XIII.
Use of verapamil to enhance the antiproliferative activity of BCNU in human glioma cells: an in vitro and in vivo study
Authors: Bowles Alfred P. , Pantazis Cooley G. , Wansley William
Published: May 2009

✓ The authors have evaluated the antiproliferative activity of verapamil, alone or in combination with 1, 3-bis(2-chloroethyl)-1-nitrosourea (BCNU) in brain-tumor cells. These effects were studied in vitro using four human glioma cell lines and in vivo using glioblastoma multiforme cells transplanted to athymic nude mice. The results showed that verapamil when used alone produced inhibition of tumor growth; however, when verapamil was used in combination with BCNU (in vitro), significant dose-dependent suppression of proliferation occurred in all four cell lines. The in vivo results were far more dramatic. Mice treated with BCNU (25 mg/kg) plus verapamil (50 mg/kg) achieved a 200-fold decrease in tumor growth with a greater than 80% regression in tumor size. Complete cures were achieved in 80% of the mice observed for at least 50 days following the completion of therapy. These findings support the use of verapamil in overcoming drug resistance in malignant brain tumors.
Cell kinetics of rat 9L brain tumors determined by double labeling with iodo- and bromodeoxyuridine
Authors: Asai Akio , Shibui Soichiro , Barker Marvin , Vanderlaan Martin , Gray Joe W. , Hoshino Takao
Published: May 2009

✓ Rats with 9L brain tumors received intraperitoneal injections of iododeoxyuridine (IUdR) and bromodeoxyuridine (BUdR) to estimate the duration of the deoxyribonucleic acid (DNA) synthesis phase (Ts) and the potential doubling time (Tp) of individual tumors. Different sequences and intervals (2 or 3 hours) of IUdR and BUdR administration were evaluated. After denaturation, tumor sections were reacted with Br-3, a monoclonal antibody that identifies only BUdR, and then were stained immunohistochemically by the avidinbiotin complex method. An antibody that recognizes both IUdR and BUdR, IU-4, was applied to the sections and identified by the alkaline phosphatase-antialkaline phosphatase method. Nuclei labeled only with IUdR stained blue, while those labeled with BUdR or with BUdR and IUdR stained brown. The fraction of cells that either left or entered the S-phase during the time between administration of IUdR and BUdR was measured to calculate Ts and Tp, assuming that the labeled cohort completed the DNA synthesis at a constant rate. The Ts was 8.8 hours (coefficient of variation (cv) = 0.05) and the Tp was 64.2 hours (cv = 0.08). The sequence and interval of administration of IUdR and BUdR had a minimal effect on Ts and Tp. In studies of 9L cells in monolayer culture, the Ts was 9.6 hours (cv = 0.08) and the Tp was 30.6 hours (cv = 0.06). Double labeling with BUdR and IUdR allows the duration of the S-phase and potential doubling time of individual brain tumors to be estimated in situ from a single biopsy specimen.
Perforating branches of the basilar bifurcation
Authors: Caruso Giuseppe , Vincentelli François , Giudicelli Gérard , Grisoli François , Xu Tao , Gouaze André
Published: May 2009

✓ The perforating branches of the upper basilar artery and of the first (P1) segment of the posterior cerebral artery were studied in 50 fixed brains obtained from human cadavers. No vertical branches arose from the basilar bifurcation. The upper basilar artery gave rise to horizontal branches, which were studied with reference to their angle of origin. Perforating arteries arising from P1 segments were found in all specimens. Rare branches were found to come from the inferior and anterior surfaces of P1 segments. The anatomical patterns of these branches are discussed in the light of previous reports. Preoperative knowledge of some anatomical aspects (the position of the basilar apex, the angle between the right P1 and left P1 segments, and relationships to the dorsum sellae and the mammillary bodies) can help in the selection of a neurosurgical approach and may improve the operative results in the surgical treatment of basilar apex aneurysms.
Intrasellar mass with hypopituitarism as a manifestation of sarcoidosis
Authors: Capellan J. I. Lara , Olmedo L. Cuellar , Martin J. Martinez , Marin Ma del Mar , Villanueva M. Garcia , Zarza F. Marin , Blasco H. De La Calle
Published: May 2009

✓ A 45-year-old woman was admitted suffering from headache, weight loss, asthenia, pedal edema, and amenorrhea. Morphological and functional studies revealed an intrasellar mass causing hypopituitarism without diabetes insipidus. Histological examination of the tissue obtained at transsphenoidal surgery was compatible with a diagnosis of sarcoidosis. The clinical and histological features, together with the presence of cutaneous anergy and ocular lesions, led to the diagnosis of sarcoidosis. The presentation of sarcoidosis in this patient was very unusual because it was not accompanied by characteristic intrathoracic findings or by diabetes insipidus.
Orbital varix with a pearly phlebolith
Authors: Kubota Toshihiko , Kuroda Eiichi , Fujii Toshiharu , Kawano Hirokazu , Kabuto Masanori , Hayashi Minoru
Published: May 2009

✓ A patient is described with an orbital varix arising from the right superior ophthalmic vein, associated with ophthalmoplegia and severe pain, and without proptosis. The varix was detected using computerized tomography and orbital phlebography, and at surgery was verified as a venous aneurysm. During the operation, a pearly phlebolith was found. Histological examination of the varix revealed multiple ectatic venous channels. The etiology of this unusual clinical manifestation and the treatment of the patient are briefly discussed.
Subarachnoid hemorrhage possibly caused by a saccular carotid artery aneurysm within the cavernous sinus
Authors: Nishioka Tatsuya , Kondo Akinori , Aoyama Ikuhiro , Nin Kiyoshi , Takahashi Jun
Published: May 2009

✓ Aneurysms arising from the intracavernous portion of the internal carotid artery very rarely rupture. A patient is presented in whom rupture of an aneurysm wholly within the cavernous sinus caused a subarachnoid hemorrhage. The aneurysm was successfully clipped via a direct surgical approach. The possible mechanism by which subarachnoid hemorrhage occurred is briefly discussed.
Retrograde suction decompression of giant paraclinoidal aneurysms
Authors: Batjer H. Hunt , Samson Duke S.
Published: May 2009

✓ Giant paraclinoidal carotid artery aneurysms frequently require temporary interruption of local circulation to facilitate safe occlusion. Due to brisk retrograde flow through the ophthalmic artery and cavernous branches, simple trapping of the aneurysm by cervical internal carotid artery clamping and intracranial distal clipping may not adequately soften the lesion. The authors describe a retrograde suction method of aspiration of this collateral supply which they have used in over 40 cases. After temporary trapping, a No. 18 angiocatheter is inserted into the cervical internal carotid artery. This catheter is then connected to a wall suction point allowing rapid aneurysm deflation. This technique, accomplished by the surgical assistant, permits the surgeon the freedom to use both hands in dealing quickly with the aneurysm.
The subtemporal and preauricular infratemporal approach to intradural structures ventral to the brain stem
Authors: Sen Chandra Nath , Sekhar Laligam N.
Published: May 2009

✓ The subtemporal and preauricular infratemporal operative technique is an approach to the skull base through the anterior portion of the petrous temporal bone and is used for the removal of predominantly extradural tumors in this region. The present study, based on dissection of human cadavers, describes the use of this approach for the management of intradural lesions in the region of the clivus. Its main advantages include avoidance of brain retraction, the use of an extrapharyngeal route, and exposure of the ventral aspect of the pons and medulla and related structures caudal to the trigeminal root. This approach can easily be combined with an intradural subtemporal approach to provide additional exposure of the superior clivus rostral to the trigeminal root. Combining the two approaches provides direct access to the ventral surface of the entire brain stem from the dorsum sellae to the hypoglossal foramina. Five patients with lesions in the clivus and petrous apex have been operated on via this approach. Details of the anatomical aspects of the approach and its applications are presented.
Craniocervical decompression for cervicomedullary compression in pediatric patients with achondroplasia
Authors: Aryanpur John , Hurko Orest , Francomano Clair , Wang Henry , Carson Benjamin
Published: May 2009

✓ The congenital osseous abnormalities associated with achondroplasia include stenosis of the foramen magnum and the upper cervical spinal canal. In the pediatric achondroplastic patient, such stenosis may lead to cervicomedullary compression with serious sequelae, including paresis, hypertonia, delayed motor milestones, and respiratory compromise. Using a standardized protocol the authors have treated 15 young achondroplastic patients with documented cervicomedullary compression by craniocervical decompression and duroplasty. Following this procedure, significant improvement in presenting neurological or respiratory complaints was noted in all patients. The mortality rate in this series was zero. The major cause of morbidity associated with this procedure was perioperative cerebrospinal fluid (CSF) leakage from the surgical wound, presumably related to coexisting abnormalities of CSF dynamics. This problem was successfully managed by temporary or, when necessary, permanent CSF diversion procedures. It is concluded that craniocervical decompression is an effective and safe treatment for young achondroplastic patients with cervicomedullary compression.
Postoperative CT contrast enhancement following lobectomy for epilepsy
Authors: Laohaprasit Varun , Silbergeld Daniel L. , Ojemann George A. , Eskridge Joseph M. , Winn H. Richard
Published: May 2009

✓ Contrast-enhanced computerized tomography (CT) is frequently utilized immediately after surgery to determine the presence of residual tumor, but the response of nontumor brain tissue is unclear. Consequently, the authors investigated the postoperative CT contrast enhancement in six patients undergoing lobectomy for epilepsy. Preoperative CT scans were obtained in all cases and revealed no enhancing lesions. All patients underwent craniotomy with electrocorticography while awake, followed by lobectomy. Computerized tomography scans with and without administration of contrast material were obtained on postoperative Days 3, 7, and 30. Edema, artifact, and enhancement of the resection margins were seen on postoperative Days 3 and 7, but had resolved in all patients by Day 30. It is concluded that postoperative CT scans for assessment of residual tumor are best obtained at 30 days or thereafter, when normal brain does not enhance and edema and artifact have diminished.
NGF-like trophic support from peripheral nerve for grafted rhesus adrenal chromaffin cells
Authors: Kordower Jeffrey H. , Fiandaca Massimo S. , Notter Mary F. D. , Hansen John T. , Gash Don M.
Published: May 2009

✓ Autopsy results on patients and corresponding studies in nonhuman primates have revealed that autografts of adrenal medulla into the striatum, used as a treatment for Parkinson's disease, do not survive well. Because adrenal chromaffin cell viability may be limited by the low levels of available nerve growth factor (NGF) in the striatum, the present study was conducted to determine if transected peripheral nerve segments could provide sufficient levels of NGF to enhance chromaffin cell survival in vitro and in vivo.

Aged female rhesus monkeys, rendered hemiparkinsonian by the drug MPTP (n-methyl-4-phenyl-1,2,3,6 tetrahydropyridine), received autografts into the striatum using a stereotactic approach, of either sural nerve or adrenal medulla, or cografts of adrenal medulla and sural nerve (three animals in each group). Cell cultures were established from tissue not used in the grafts. Adrenal chromaffin cells either cocultured with sural nerve segments or exposed to exogenous NGF differentiated into a neuronal phenotype. Chromaffin cell survival, when cografted with sural nerve into the striatum, was enhanced four- to eightfold from between 8000 and 18,000 surviving cells in grafts of adrenal tissue only up to 67,000 surviving chromaffin cells in cografts. In grafts of adrenal tissue only, the implant site consisted of an inflammatory focus. Surviving chromaffin cells, which could be identified by both chromogranin A and tyrosine hydroxylase staining, retained their endocrine phenotype.

Cografted chromaffin cells exhibited multipolar neuritic processes and numerous chromaffin granules, and were also immunoreactive for tyrosine hydroxylase and chromogranin A. Blood vessels within the graft were fenestrated, indicating that the blood-brain barrier was not intact. Additionally, cografted chromaffin cells were observed in a postsynaptic relationship with axon terminals from an undetermined but presumably a host origin.