bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Mannitol on Increased Intracranial Pressure
Authors: McGraw C. Patrick , Howard George
Published: May 2010

We studied 61 patients with a closed head injury and increased intracranial pressure (ICP). The ICP was monitored continuously, concomitant with the administration of 20% mannitol. If the ICP remained higher than 25 mm Hg for 10 minutes or more, the patient was included in the study. Analysis of monitoring records delineated four variables that were related to the response of ICP to mannitol: (a) the level of ICP 1 hour before mannitol was administered, (b) the level of ICP when mannitol was administered, (c) the amount of mannitol that was administered immediately before the resulting changes in ICP were measured, and (d) the cumulative amount of mannitol given over the 6 hours before the most recent mannitol dosage was administered. The level of the ICP measurements and the cumulative amount of preceding doses of mannitol influenced the response of ICP to mannitol more than did the size of the dose of mannitol. These findings imply that: (a) the initial administration of more mannitol than is absolutely needed may lead to larger doses being required to control ICP and (b) for that reason, mannitol given on a gram/kilogram, an hourly, or a serum osmolarity basis to control increased ICP has negative long term effects because more mannitol may be required to decrease ICP when an excessive amount of it has been given previously.
Computerized Electroencephalogram Monitoring and Carotid Artery Shunting
Authors: Rampil Ira J. , Correll James W. , Rosenbaum Stanley H. , Quest Donald O. , Holzer John A.
Published: May 2010

During carotid artery surgery, ischemic electroencephalogram (EEG) changes were detected by computerized analysis in 27 of 225 carotid clamping intervals. All but 7 of these changes resolved spontaneously before the restoration of blood flow, Restored flow was associated, after variable delay, with an improved EEG pattern in 6 of 7 cases. Of 27 EEG episodes, there were 5 cases in which the EEG event persisted for 10 minutes or longer. All 5 patients developed new neurological deficits; none of the other patients did. It is suggested that all patients undergoing carotid artery surgery be monitored with EEG and that a shunt be placed if a persistent EEG change is noted.
Palinopsia: Rare but Ominous Symptom of Cerebral Dysfunction
Authors: Lazaro R. P.
Published: May 2010

A 66-year-old man experienced palinopsia (visual perseveration) that lasted for several minutes. A malignant glioma of the right occipital lobe was demonstrated radiologically and histologically. The lesions that can give rise to this phenomenon are usually neoplasms and vascular disorders. This symptom can be confused with hysteria or psychosis, especially when no objective clinical findings are demonstrable. The mechanism of this symptom is still obscure.
Adult Arnold-Chiari Malformation and Intrinsic Brain Stem Neoplasm: A Difficult Differential Diagnosis
Authors: Phillips Timothy W. , McGillicuddy John E. , Hoff Julian T. , Latack Joseph
Published: May 2010

The occurrence of a brain stem neoplasm in three adults previously treated for an adult Arnold-Chiari malformation is reported. The diagnosis of adult Arnold-Chiari malformation had been confirmed by angiography and computed tomographic scanning. All patients were treated with a combination of ventricular shunts and posterior fossa decompression. The diagnosis of brain stem neoplasm was not made until late in the clinical course, and all patients died within 2 years of the onset of symptoms.
Postoperative Intervertebral Disc Space Infection
Authors: Rawlings Charles E. , Wilkins Robert H. , Gallis Harry A. , Goldner Leonard J. , Francis Robert
Published: May 2010

Intervertebral disc space infection is an uncommon, but serious, complication of disc surgery. By a retrospective chart review, we identified 27 patients at our institution who had a postoperative disc space infection; 14 were diagnosed and treated within the last 5 years. The characteristic symptoms were severe spinal pain and limited spinal mobility beginning 7 to 30 days postoperatively. The key physical findings were paravertebral muscle spasm and marked mechanical signs. The key laboratory findings were an elevated erythrocyte sedimentation rate and a mildly elevated white blood cell count. The diagnosis was based on the clinical presentation and early radiographic changes in the vertebral bodies adjacent to the involved disc, especially irregularities of the cortical margins seen best by tomography. Definitive bacteriological diagnosis by Craig needle biopsy was attempted in 14 patients; 7 had positive cultures and all yielded a Staphylococcus species. The usual treatment consisted of the administration of antistaphylococcal antibiotics and immobilization of the spine with a spica cast, a plastic body jacket, or complete bedrest. The final radiographic findings showed bony fusion or bridging in 19 patients, and 25 patients had a pain-free recovery after 1 to 9 months. There was 1 recurrent infection, and 3 patients eventually required an anterior discectomy and fusion. Based on a review of our own cases and those reported in the literature, we stress the importance of spinal tomography in establishing the diagnosis of postoperative disc space infection at a relatively early stage in a patient who is suspected of having this condition on the basis of typical symptoms and signs combined with an elevated sedimentation rate. We recommend treatment with both immobilization of the spine and the administration of appropriate antibiotics, first by the intravenous route and then orally.
Subarachnoid Hemorrhage with Normal Cerebral Panangiography
Authors: Béguelin Claude , Seiler Rolf
Published: May 2010

Forty-two nonhypertensive patients with a proven subarachnoid hemorrhage but normal cerebral panangiography were investigated. The follow-up period was 1 to 5 years, with a mean of 39.1 months. Treatment consisted of 2 weeks of bedrest and sedation, followed by progressive mobilization on the 3rd week. Thirteen patients (Group A) were treated with tranexamic acid, whereas 29 patients (Group B) received no antifibrinolytic therapy. Five patients of Group A died of ischemia caused by cerebral vasospasm. No patient of Group B died, and there was no early rebleeding in either group. Therefore, antifibrinolytic therapy is not indicated in these patients. Only 1 of 42 patients (2.4%) experienced late rebleeding, and he again had normal cerebral panangiography. Reangiography several weeks or months after the first hemorrhage seems not to be indicated. The overall prognosis of the surviving patients was good; almost all were able to return to their previous occupations within 6 months after the hemorrhage.
Treatment of Massive Intraoperative Brain Swelling
Authors: Marshall Lawrence F. , Hoi Sang U
Published: May 2010

Massive intraoperative brain swelling is an infrequent but catastrophic occurrence. In this report, we describe the use of very large doses of thiopental as a means of treating such swelling. In our initial 11 cases (5 arteriovenous malformations, 4 hematomas, and 2 penetrating injuries), this approach produced the following outcomes: 6 patients made a good recovery, 2 are moderately disabled, 1 is severely disabled, and 2 are dead. These results indicate that this condition, which once was considered unmanageable, can indeed be managed and that treatment often results in an acceptable outcome. More recent experience in an additional 6 patients suggests that the use of planned deep thiopental anesthesia, with induced cerebral silence, during intracranial surgery may even prevent the occurrence of this phenomenon.
Postsurgical Arachnoid Cyst: Report of Two Cases
Authors: Luerssen Thomas G. , Kalsbeck John E.
Published: May 2010

We present two cases that demonstrate the occurrence of symptomatic arachnoid cysts after craniotomy. Both patients presented 1 year postoperatively with generalized seizures as the only symptom. Focal or localizing neurological signs were not present. Both patients responded well to shunting procedures.
Posterior Fossa Hemorrhage in the Term Neonate
Authors: Menezes Arnold H. , Smith Douglas E. , Bell William E.
Published: May 2010

Posterior fossa hemorrhage (PFH) in the newborn term infant has been infrequently reported, and before computed tomographic (CT) scanning most were identified at postmortem examination. The origin and causes of PFH in the term neonate differ from those in adults. The main possible causes are: (a) tentorial and falx disruption with avulsion of bridging veins due to mechanical compression and distortion of the head during the birth process, resulting in posterior fossa subdural collections and vermis hematoma, and (b) occipital osteodiastasis associated with cerebellar hemisphere laceration, with intracerebellar hematoma and subdural collections. Three full-term neonates with PFH were operated on with good outcome. Both of the possible causes contributed to the hemorrhage. Review of the literature to date has led to the following conclusions: (a) PFH in the term infant is frequently associated with breech delivery, forceps instrumentation, and prolonged labor with cranial molding. (b) Massive PFH is associated with dural sinus laceration, rupture of the vein of Galen, or rupture of hematoma into the subdural space. Symptoms may be delayed up to 96 hours in cases where there is a small continuing hemorrhage. (c) CT scanning with reconstructions is essential to provide precise localization of the hemorrhage and thus avoid errors in interpretation. (d) Prompt removal of PFH improves survival and decreases sequelae. (e) Shunting procedures are necessary in 36% of the cases.
Aneurysmal Rebleeding: A Preliminary Report from the Cooperative Aneurysm Study
Authors: Kassell Neal F. , Torner James C.
Published: May 2010

It is generally considered that the peak incidence of rebleeding after aneurysmal subarachnoid hemorrhage is at the end of the 1st or the beginning of the 2nd week after the initial rupture. However, in a series of 2265 patients admitted within 3 days of their first subarachnoid hemorrhage, the peak of rebleeding occurred on the same day as the initial hemorrhage and there was no later peak. These data suggest that new management strategies for minimizing rebleeding must be considered for patients admitted soon after aneurysm rupture.
Role of Radiation Therapy in the Treatment of Cerebral Oligodendroglioma: An Analysis of 57 Cases and a Literature Review
Authors: Reedy Peter D. , Bay Janet W. , Hahn Joseph F.
Published: May 2010

Fifty-seven cases of histologically confirmed cerebral oligodendroglioma treated at the Cleveland Clinic between 1950 and 1980 were reviewed. No difference in the 5-year survival rate was seen in patients treated with postoperative radiation therapy vs. operation alone. These data are compared to previously published series with special emphasis on the role of radiation therapy.
Intraluminal Dilatation of the Innominate Artery before Extracranial-Intracranial Bypass: Case Report
Authors: Garrido Eddy , Garofola John H.
Published: May 2010

We are reporting a successful dilatation of the innominate artery with the Grüntzig balloon catheter before an extracranial-intracranial bypass procedure.
Triple Fossa Metastasis of Prostate Cancer
Authors: Kwee Ingrid L. , Nakada Tsutomu , St. John James N.
Published: May 2010

The radiological appearance of prostate cancer metastasis to the central nervous system often mimics meningioma. The bony change of prostate cancer metastasis resembles the hyperostosis of meningioma because of its blastic rather than lytic nature. On computed tomographic (CT) scan, like meningioma, prostate cancer metastasis enhances homogeneously after the infusion of contrast material. Triple fossa (middle, temporal, and orbital fossae) involvement by a solitary mass without bony destruction is thought to be highly specific for meningiomas. We report a case demonstrating the CT findings typical for a triple fossa meningioma caused by prostate cancer metastasis.
Intraoperative Use of Real Time Ultrasonography Applied to Aneurysm Surgery
Authors: Hyodo Akio , Mizukami Masahiro , Tazawa Toshiaki , Togashi Osamu
Published: May 2010

The intraoperative application of real time ultrasonography during 13 neurosurgical operations for intracranial aneurysms is reported. In 2 cases, the aneurysms themselves could be detected clearly by real time ultrasonic imaging. In the case of a large aneurysm, information about the nature of the aneurysmal wall was obtained. Other lesions coexisting with the aneurysm (namely, intracerebral hematoma, massive subarachnoid hemorrhage, and hydrocephalus) could be recognized clearly. Real time intraoperative ultrasonography is considered to be useful in aneurysm surgery.
Microvascular Anastomosis for the Treatment of Seizures in Patients with Cerebrovascular Ischemia: A Report of Five Cases
Authors: Ramos Morales F. , Albert P. , de Leon A. Ponce , Yagüe L.
Published: May 2010

The authors report five patients who had either generalized or focal seizures in association with occlusion of the internal carotid artery. Two of them developed a motor deficit after having had several seizures. The other three did not develop a fixed neurological deficit, but their seizures had continued in spite of anticonvulsant treatment. After an extracranial to intracranial (EC-IC) bypass, the seizures either stopped or became less frequent. Based on our experience with these patients and our review of the literature, we think that seizures may be the initial or at least an early manifestation of cerebrovascular insufficiency in some patients. An EC-IC bypass may be of help when angiographic evidence of cerebrovascular occlusive disease is found.
Evaluation of Level of Consciousness by the Glasgow Coma Scale in Children with Reye's Syndrome
Authors: Duncan Charles C. , Ment Laura R. , Shaywitz Bennett A.
Published: May 2010

The Glasgow Coma Scale, which was designed to evaluate level of consciousness after head trauma, has been compared to the Lovejoy scale in 21 patients with Reye's syndrome. Like other investigators, we have noted a poorer prognosis in those patients with higher peak NH3 levels and rapid progression of disease. However, we have also noted that the Glasgow coma scale provides a better, earlier indicator of progressive central nervous system disease than the Lovejoy scale and, therefore, helps physicians caring for such patients to institute intracranial pressure (ICP) monitoring and vigorous measures for the control of elevated ICP earlier than they might otherwise.
Surgical Exposure of the High Cervical Carotid Artery: Experimental Study and Review
Authors: Batzdorf Ulrich , Gregorius Karl F.
Published: May 2010

Difficulty in gaining access to the high cervical internal carotid artery (ICA) has thus far prevented effective operation for intimal repair and treatment of aneurysms at this level. Mobilization of the angle of the mandible by means of mandibular osteotomies considerably improves exposure to the high cervical ICA. This procedure has been performed in rhesus monkeys and in human cadavers. In monkeys, retromandibular external carotid artery-ICA anastomoses were carried out with no problems (neurological, wound healing, or other). This new technique should be considered for the management of some high cervical ICA lesions, particularly those occurring after closed cervical trauma.
Value of Computed Tomographic Myelography in Neurofibromatosis
Authors: Angtuaco Edgardo J. C. , Binet Eugene F. , Flanigan Stevenson
Published: May 2010

Computed tomographic myelography (CTM) is the procedure of choice in patients exhibiting spinal manifestations of neurofibromatosis. Due to the lack of specificity of several of the more important plain spine radiographic findings in this disease. CTM may be necessary to distinguish between surgical and nonsurgical entities. CTM will determine the size, shape, and intraspinal extension of posterior mediastinal neural tumors and separate them from the more common thoracic meningoceles. CTM will likewise elucidate the causes of posterior vertebral body scalloping, distinguishing between dural ectasia and neural tumor. CTM will also frequently demonstrate additional asymptomatic lesions at other levels.
Giant Basilar Artery Aneurysm Presenting as a Third Ventricular Tumor
Authors: Bose Bikash , Northrup Bruce , Osterholm Jewell
Published: May 2010

Giant aneurysm of the basilar artery presenting as a 3rd ventricular tumor is an unusual phenomenon. We are reporting a case in which a patient with a giant aneurysm of the basilar artery presented with symptoms of headaches and gait disturbance secondary to obstructive hydrocephalus. Although giant aneurysms presenting as mass lesions have been reported, the computed axial tomographic findings in our case were unique. Giant aneurysms of the basilar artery may be considered in the differential diagnosis of 3rd ventricular tumors.
Occipital Encephalocele—a Case of Conjoined Twinning?
Authors: Antunes Lobo J. , Sharer Leroy R. , Pellock John M.
Published: May 2010

A case of an occipital encephalocele is described. Morphological analysis of the surgical specimen suggests that the case represents an instance of incomplete conjoined twinning.
Hyperekplexia Relieved by Surgical Decompression of the Cervicomedullary Region
Authors: Winston Ken
Published: May 2010

Hyperekplexia in an 8-year-old boy with myelodysplasia was greatly improved by surgical decompression of the cervicomedullary region. The possible implications for treatment and for understanding the cause of this syndrome are discussed.
Delayed Traumatic Intracerebral Hematoma: Report of 15 Cases Operatively Treated
Authors: Young Henry A. , Gleave John R. W. , Schmidek Henry H. , Gregory Susan
Published: May 2010

Fifteen cases of delayed traumatic intracerebral hematoma (DTICH) operatively treated are reported. Patients who are awake or only drowsy on admission (Coma Grades 1 and 2, Grady scale) often undergo dramatic sudden neurological deterioration 48 to 72 hours after admission. Emergency computed tomographic scanning and prompt craniotomy for hematoma evacuation yield excellent clinical results in the majority of cases. Patients presenting in deeper grades of coma (Grades 3 to 5. Grady scale) who develop DTICH do quite poorly, often because the diagnosis is difficult to make and consequently is delayed. The development of DTICH is in our experience highly unpredictable, and often no clear secondary cause (hypercapnia, hypoxia, bleeding diathesis) can be demonstrated.
Intrasellar Schwannoma: Case Report
Authors: Perone Thomas P. , Robinson Bernard , Holmes Stephen M.
Published: May 2010

An unusual case of an intrasellar schwannoma radiographically simulating a pituitary tumor is reported. The literature on unusual intracranial locations of schwannomas and their possible origin is discussed.
Interhemispheric and Percallosal (Transcallosal) Approach to the Cingulate Gyri, Intraventricular Shunt Tubes, and Certain Deeply Placed Brain Lesions
Authors: Ehni George
Published: May 2010

The author reports 52 interhemispheric and percallosal operations carried out by himself and certain of his associated trainees upon 50 patients presenting 19 different pathological entities over a period of 38 years (1944 through 1982). The still too little appreciated advantages of this approach over transcortical avenues to the anterior ventricular system are described, together with specific indications, contraindications, and reliable and proven surgical techniques. The long term results are examined for four different outcomes: (a) recovery without deficit or with a deficit wholly chargeable to the lesion before its extirpation; (b) recovery, but with a deficit produced by or increased by the surgical procedure: (c) failure to benefit: and (d) death due to the operation. Eleven patients had invasive tumors that were not totally removable, and 6 died postoperatively, Five survived with disease-produced deficits that failed to disappear. Two had permanent deficits due to intraoperative misfortunes. Twenty-six made full recoveries. with return to work or school. Only 1 patient had a postoperative seizure problem.
Role of Computed Tomography in the Radiological Evaluation of Painful Radiculopathy after Negative Myelography: Foraminal Neural Entrapment
Authors: Osborne Dennis R. , Heinz Ralph E. , Bullard D. , Friedman A.
Published: May 2010

Thirty-five patients with an unremarkable or a negative water-soluble contrast myelogram and a diagnosis of foraminal neural entrapment made or more firmly established by computed tomography (CT) were detected in evaluating 950 patients presenting for myelography. The CT criterion of forminal neural entrapment was the presence of a mass displacing epidural fat and encroaching on the neural intervertebral foramen or lateral recess so as to compromise an emerging nerve root. The entrapment (confirmed operatively) was due to a laterally prolapsed disc (16 cases), superior articular hypertrophy (4 cases), lateral recess stenosis (3 cases), posterolateral vertebral bone lipping (2 cases), tumors (6 cases), postoperative scarring (2 cases), spondylolisthesis (1 case), and synovial cysts that encroached on the neural foramina (1 case). CT is an important additional investigation in patients with a painful radiculopathy and a negative or equivocal water-soluble contrast myelogram.
Computed Tomography-guided Percutaneous Biopsy: A Combined Approach to the Retroperitoneum
Authors: Messersmith Richard N. , Cronan John , Esparza Alfredo R.
Published: May 2010

When computed tomography (CT) is used to evaluate the lumbar spine in patients with low back pain, it is important to look at the adjacent retroperitoneum. CT is ideally suited to visualize the retroperitoneum and provide access for percutaneous needle biopsy.
Subdural Tapping and Irrigation for the Treatment of Chronic Subdural Hematoma in Adults
Authors: Aoki Nobuhiko
Published: May 2010

A new technique for the treatment of chronic subdural hematoma by tapping and irrigation was shown by computed tomography to be safe and reliable in 39 patients. The basis for such treatment is discussed in light of the current theories of the pathogenesis of chronic subdural hematoma.
Caloric Stimulation-induced Augmentation of H-Reflexes in Normal Subjects, but Not in Spinal Cord-injured Patients
Authors: Raffensperger Maureen , York Donald H.
Published: May 2010

This study examined the effects of ice water caloric stimulation on H-reflex amplitude in normal subjects and three complete spinal cord-injured patients. H-reflexes were obtained by stimulating the tibial nerve at the popliteal fossa and recording the H-response from the gastrocnemius muscle. All normal subjects who experienced nystagmus or vertigo demonstrated significant augmentation in H-reflex amplitude with ice water irrigation of the ear canal. In the three spinal cord-injured patients, there was no significant change of H-reflex with the ice water stimulus. The results suggest that descending tracts in the anterior spinal cord must be functional to demonstrate caloric augmentation of H-reflexes. In patients with spinal cord injury, it may be possible to predict the recovery of motor function using this test together with other clinical signs of neurological function.
Chronic Encapsulated Intracerebellar Hematoma in Infancy: Case Report
Authors: Aoki Nobuhiko , Mizuguchi Kunio
Published: May 2010

A case of intracerebellar hematoma in infancy is reported. Although the clinical course and computed tomographic appearances suggested a cerebellar tumor, intraoperative and microscopic investigations demonstrated a chronic expanding hematoma enlarging with repeated hemorrhages inside the capsule. The differential diagnosis of this entity is discussed.
5-Fluorouracil and 1-(2-Chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) Followed by Hydroxyurea, Misonidazole, and Irradiation for Brain Stem Gliomas: A Pilot Study of the Brain Tumor Research Center and the Childrens Cancer Group
Authors: Levin Victor A. , Edwards Michael S. , Wara William M. , Allen Jeffrey , Ortega Jorge , Vestnys Pamela
Published: May 2010

Twenty-eight evaluable children with the diagnosis of brain stem glioma were treated with 5-fluorouracil and CCNU before posterior fossa irradiation (5500 rads); during irradiation, the children received hydroxyurea and misonidazole, The treatment was well tolerated, and minimal toxicity was produced. The median relapse-free survival was 32 weeks, and the median survival was 44 weeks. Analysis of covariates showed that, in patients between the ages of 2 and 19 years, survival was longest in the older children (P < 0.02). Tumor histology, sex, extent of operation (if any), Karnofsky score, and radiation dose did not correlate with survival.
Contralateral Pterional Approach for Carotid-Ophthalmic Aneurysm: Usefulness of High Resolution Metrizamide or Blood Computed Tomographic Cisternography
Authors: Yamada Kazuo , Hayakawa Toru , Oku Yuzuru , Ushio Yasutaka , Yoshimine Toshiki , Kawai Ryuji
Published: May 2010

Four carotid-ophthalmic aneurysms were treated through a contralateral pterional approach. Three of these aneurysms were clipped successfully. Because awareness of the size and shape of the optic chiasm is crucial for the success of this approach, we used metrizamide or blood cisternography with a high resolution computed tomographic scanner. With this technique, the shape of the optic chiasm was delineated before operation to make certain that the prechiasmatic space was large enough for the aneurysm to be approached.
Somatosensory Evoked Potentials and Cortical Blood Flow During Craniotomy for Vascular Disease
Authors: Carter Philip L. , Raudzens Peter A. , Gaines Casey , Crowell Robert M.
Published: May 2010

It has been demonstrated that central conduction time (CCT) is slowed and that attenuation of cortical potentials occurs with reduced cerebral perfusion. During 11 craniotomies for aneurysm, arteriovenous malformation (AVM), or extracranial-intracranial (EC-IC) bypass, we continuously monitored somatosensory evoked potentials (SSEPs) and regional cortical blood flow (rCBF) as determined by a thermal flow probe. The CCT was calculated and correlated with the rCBF. In 8 of the 11 cases, the rCBF values varied within 1 SD of normal values derived from 25 measurements of nonischemic cerebral cortex. All initial CCT values were within 1 SD of normal, but 4 of 11 patients had a prolonged CCT intraoperatively. Three of these were associated with a low rCBF (14 to 31 m1/100 g/minute). One patient had postoperative confusion at the time of discharge. One patient who underwent AVM embolization had a permanent loss of SSEPs postoperatively, and his preexisting hemiparesis was more profound after operation. Finally, 1 patient's CCT improved after EC-IC bypass. This is a preliminary study that demonstrates the feasibility of monitoring CCT and rCBF during craniotomy. When rCBF values fall and the CCT slows, neurological deficit will probably occur.
Hemangioblastoma of the Third Ventricle
Authors: Loftus Christopher M. , Marquardt Merlin D. , Stein Bennett M.
Published: May 2010

A case of intraventricular hemangioblastoma not associated with von Hippel-Lindau disease is presented. Only one other case of intraventricular hemangioblastoma has been reported. The literature on supratentorial hemangioblastomas is reviewed, and the problems of histological identification of such lesions are discussed.
Curved Biopsy Needle for Stereotactic Surgery: A Technical Note
Authors: Levy Walter J. , Oro John J.
Published: May 2010

Needle brain biopsy and aspiration is an important technique for the diagnosis of tumors and for the evacuation of fluid collections. Current biopsy methods use a straight needle, which has the disadvantage of requiring multiple passes through the overlying brain to obtain multiple biopsies. Furthermore, a straight needle does not give optimal samples of tumor for diagnosis because the needle passes through the viable rim of the tumor instead of along it. We are reporting a curved plastic biopsy needle suitable for computed tomography-guided biopsy. It remains inside an outer guide catheter that holds it straight until it reaches the edge of the tissue to be biopsied. At this point, the needle is advanced beyond the guide catheter and obtains the biopsy sample by passing around the edge of a tumor. This can in principle produce an improvement in diagnostic yield. Furthermore, multiple biopsies of the tumor from a single guide catheter position are possible. The surgeon rotates the curved needle within its guide catheter to redirect it before the needle emerges. and a different biopsy is then obtained without reinsertion. This avoids multiple punctures of the overlying uninvolved tissue. We are reporting the technique and beginning an evaluation of it.
Fracture of the Occipital Condyle
Authors: Spencer Jose A. , Yeakley Joel W. , Kaufman Howard H.
Published: May 2010

Fracture of the occipital condyle is a rare problem. Diagnosis requires a high index of suspicion in a patient with a head injury and abnormalities of function of the lower cranial nerves. The diagnosis is best made by high resolution computed tomographic scanning with sagittal and coronal reconstructions. Although transoral and lateral surgical approaches for decompression and stabilization are possible, these are difficult and frought with danger. We report a case of occipital condyle fracture in which operation was deferred and spontaneous recovery occurred, as has happened in previous cases.
Brain Tumor and Achondroplasia: A Case Report and Review of the Literature
Authors: McArdle David Q. , Sawaya Raymond , Khodadad Ghahreman
Published: May 2010

This is the first reported case of a meningioma occurring in an achondroplastic dwarf. The patient had been treated for lumbar stenosis 7 years previously and later developed mental status change and visual loss due to a large tuberculum sella meningioma. Statistical analysis of the prevalence of both diseases in the United States shows insufficient evidence for a pathogenetic link between the two diseases.
Constant Ventricular Drainage: Pitfalls and Variables Technical Note
Authors: Rosner Michael J. , Hayes Dorothee , Clark Marcia
Published: May 2010

After observing the erratic performance of a commercially available ventricular drainage system, we examined the hydrostatic pressure exerted by the system as a function of the volume of fluid within the drainage bag (at a constant height). Initially, 3 to 4 cm more than the expected 27 cm of height was required to achieve a drainage pressure of 20 mm Hg. As the volume of fluid increased, there was an initial precipitous fall from the 20 mm Hg preset pressure to 14 to 16 mm Hg; this pressure differential increased as the volume of drained fluid increased. Removal of air from the drainage bag resulted in an additional decrement in the observed hydrostatic pressure. These decrements in pressure were not apparent with another commercially available bag used commonly for ventricular drainage. We therefore recommend that, if ventricular drainage is to be accomplished against a constant hydrostatic pressure head, the system should be configured so that the actual hydrostatic pressure against which drainage occurs can be measured quickly and easily. The system should be checked at frequent intervals as the ventricular drainage bag fills. We note additional pitfalls in use of constant ventricular drainage and suggest solutions.
Reflow into a Thrombosed Giant Middle Cerebral Artery Aneurysm after Extracranial-Intracranial Bypass
Authors: Robbins J. , Fein J. M. , Lantos G. , Hooshangi N.
Published: May 2010

This report graphically illustrates the consequences of flow augmentation through extracranial-intracranial bypass grafts. Propagation of clot from a thrombosed middle cerebral artery aneurysm into the middle cerebral artery produced transient ischemic attacks. Superficial temporal artery-middle cerebral artery bypass was performed to augment cerebral blood flow. Postoperative angiography demonstrated filling of the aneurysm through improved collateral channels. The role of bypass operation in the presence of an aneurysm and its contribution to collateral blood flow and clot lysis are discussed.
Solitary Eosinophilic Granuloma of the Skull
Authors: Rawlings Charles E. , Wilkins Robert H.
Published: May 2010

Solitary eosinophilic granuloma of the skull is a rare lesion, the natural history of which has not been defined completely, By a retrospective chart review, 26 patients were identified as having a solitary eosinophilic granuloma of the skull at first presentation to our institution between 1946 and 1982. Characteristically, the patient noted an enlarging, tender skull mass during the several weeks to several months before the initial assessment. Laboratory findings were normal except for 1 case of eosinophilia. Radiographically, the abnormality consisted of a punched-out, well defined, lytic lesion most commonly seen in the parietal or frontal bone. Whole body bone scans or bone surveys were used to rule out further lesions. The definitive diagnosis was made by histological examination, which showed the characteristic histiocytes, eosinophils, and multinucleated cells of eosinophilic granuloma. The usual treatment consisted of a craniectomy or curettage perhaps followed by local, moderate dose radiation therapy. The follow-up period ranged from 1 month to 25 years and averaged 8 years; in that time. 8 patients (31%) developed additional lesions. Of these 8 patients, only 3 were older than 3 years at the time of the first recurrence. Based on a review of our own patients and those reported in the literature, we stress that a solitary eosinophilic granuloma of the skull may foreshadow future disease elsewhere and is not an easily dimissed local disease, especially in children. After the initial treatment, we recommend careful long term follow-up and treatment of additional lesions with radiation therapy.
Posttraumatic Hydrocephalus
Authors: Beyerl Brian , Black Peter McL.
Published: May 2010

Posttraumatic hydrocephalus is a treatable complication of head injury and can present with several different clinical syndromes. These include obtundation; simple failure to improve; a tetrad of psychomotor retardation, memory loss, gait trouble. and incontinence; and unusual symptoms including emotional disorder. Posttraumatic hydrocephalus seems to result from a blockage of cerebrospinal fluid (CSF) flow around the cerebral convexities. When the lumbar CSF pressure is consistently above 180 mm H2O. the hydrocephalus should be treated unless a contraindication to operation exists. Underlying brain injury from the trauma itself, however, may prevent recovery. When the typical symptoms of normal pressure hydrocephalus (NPH) are present, a shunt is also indicated. Decision-making is difficult when the patient has normal pressure. but is too injured to display the symptoms of NPH or has atypical symptoms. Overnight pressure recording, lumboventricular infusion testing, or cisternography may clarify whether a shunt is needed in this situation. but there is still considerable uncertainty about shunt prediction in this setting.
Prognosis of the So-Called “Diffuse” Cerebellar Astrocytoma
Authors: Palma Lucio , Russo Antonio , Celli Paolo
Published: May 2010

The term “diffuse cerebellar astrocytoma” was originally introduced by Russell and Rubinstein to describe that minority of cerebellar tumors microscopically similar to the cerebral hemispheric astrocytoma. The aim of this study was to verify some recent reports warning against the less favorable long term prognosis of the “diffuse” form of the cerebellar astrocytoma. We reviewed our series of cerebellar astrocytomas in children and collected 49 cases operated on before 1966 (i.e., with a follow-up ranging from a minimum of 15 years to 29 years). In addition, we reexamined all recurrent cerebellar astrocytomas observed during a 30-year period, looking for the eventual occurrence of the “diffuse” form. In the first group, 10 cases (20%) were classified as “diffuse” and 39 cases (80%) were classifed as “classic”. However, in 3 cases largely featuring a diffuse pattern, we also noted some areas of the classic type. These two subgroups showed no significant differences in patient sex and age, the incidence of macrocysts, the surgical technique used, the eventual x-ray therapy, and the long term functional results (P > 0.05). When we studied recurrent tumors that were reoperated on, we did not find any case showing histologically the “diffuse” pattern. To conclude, we cannot agree with the pessimism about the ominous long term prognosis of the diffuse cerebellar astrocytoma. In our opinion, the so-called diffuse cerebellar astrocytoma does not exist as a separate clinicopathological entity.
Primary Intrasellar Germinoma in a Woman Presenting with Secondary Amenorrhea and Hyperprolactinemia
Authors: Shen Dwight Y. , Guay André T. , Silverman Mark L. , Hybels Roger L. , Freidberg Stephen R.
Published: May 2010

A 32-year-old woman with secondary amenorrhea was found to have an elevated level of serum prolactin, partial diabetes insipidus, and a subtle visual field defect. A primary intrasellar tumor was noted on the computed tomographic scan. Although the tumor had some characteristics of a prolactinoma, transsphenoidal exploration revealed a primary germinoma. The tissue diagnosis led to appropriate treatment with radiotherapy. The tumor regressed, and the patient had a spontaneous pregnancy. Had dopamine agonists been used initially, amelioration of the hyperprolactinemia and delay in the proper diagnosis and treatment would have occurred.
Giant Intracranial Aneurysms Presenting with Massive Cerebral Edema
Authors: Heros Roberto C. , Kolluri Sastry
Published: May 2010

Two cases of giant left middle cerebral artery aneurysm presenting with rapidly progressing hemiparesis and aphasia are presented. In both, the computed tomographic scan showed recent intraaneurysmal thrombosis and massive edema and swelling of the cerebral hemisphere. There was no evidence of recent hemorrhage in either case. In both patients, surgical resection of the aneurysm was accomplished, but the outcome was disastrous. The literature is reviewed and the possible mechanisms responsible for brain swelling in these cases are discussed.
Spontaneous Intracerebral Hematomas: A New Proposal about the Usefulness and Limits of Surgical Treatment
Authors: Volpin Lorenzo , Cervellini Patrizio , Colombo Federico , Zanusso Mariano , Benedetti Antonio
Published: May 2010

We analyzed the volume of 132 spontaneous supratentorial intracerebral hematomas calculated with computed tomographic (CT) scans and related it to the clinical condition of the patients on admission and to the outcome at their discharge from the hospital (1 to 3 months after the ictus). Fifty patients were operated on, and 82 received only medical treatment. In evaluating outcome, we were more interested in survival than its quality. The main problem is the evaluation and treatment of the many patients who are comatose upon admission (about half of the patients). We concluded that surgical treatment by evacuation of the hematoma increases the percentage of survival of comatose patients with a hematoma volume between 26 and 85 ml.
Craniostenosis Secondary to Calcified Subperiosteal Hematoma: Case Report
Authors: Martinez-Lage Juan F. , Esteban Juan A. , Perez Miguel Martinez , Poza Máximo
Published: May 2010

The case of a 5-month-old boy with sagittal synostosis secondary to a calcified cephalohematoma of the cranial vault is reported. Although birth trauma has been suggested as a cause of craniosynostosis, a review of the current literature failed to show a similar case. Surgical treatment to remove the calcified hematoma produced good cosmetic and functional results.
Usefulness of the Orbitofrontomalar Approach Associated with Bone Reconstruction for Frontotemporosphenoid Meningiomas
Authors: Pellerin P. , Lesoin F. , Dhellemmes P. , Donazzan M. , Jomin M.
Published: May 2010

Seven cases of frontotemporosphenoid meningioma are reported. The principles of the orbitofrontomalar approach and of reconstruction of the orbital cone and of the frontomalar region with an orbitotemporal prop are discussed.
Head Injury from Firework Explosion
Authors: Tsementzis S. A. , Hitchcock E. R.
Published: May 2010

The extent of complications and the management of a patient with head injury due to a firework explosion are presented.
Nimodipine and Chronic Vasospasm in Monkeys: Part 1 Clinical and Radiological Findings
Authors: Nosko Michael , Weir Bryce , Krueger Christel , Cook David , Norris Susan , Overton Thomas , Boisvert Donald
Published: May 2010

The efficacy of the calcium channel blocker nimodipine in the prevention of chronic cerebral vasospasm (VSP) and delayed ischemia after subarachnoid hemorrhage (SAH) in monkeys was examined in a blind, randomized, placebocontrolled trial. The primate model developed in this laboratory reliably induces chronic cerebral vasospasm and can induce pathologically proven delayed ischemic neurological deficits (DINDs). With standard microsurgical procedures, an average 6.4-ml autologous hematoma was placed directly against the major anterior cerebral vessels in the right basal subarachnoid spaces of 24 monkeys. The monkeys were randomized to one of four groups and were treated orally q8h for 7 days with nimodipine (3, 6, or 12mg/kg) or placebo. An additional 2 monkeys underwent the surgical procedure without clot placement. Drug administration began between 14 and 20 hours after clot placement. Indices monitored before and after SAH included neurological status, angiographic cerebral vessel caliber, and cerebral blood flow. Significant VSP (25 to 100% reduction in vessel caliber) was present on Day 7 on the clot side in 83% of the animals (P ≤ 0.001). There was no significant difference (P > 0.05) in the incidence of VSP among the four groups. Similarly, there was no significant difference (P > 0.05) in the mean vessel caliber reduction after SAH among the four treatment groups. There was no VSP present on Day 7 in the sham-operated animals. One animal receiving high dose nimodipine (12 mg/kg p.o. q8h) developed a DIND on Day 5 after SAH. A second animal in the 12-mg/kg group developed a transient neurological deficit between Days 4 and 7.
Percutaneous Discectomy: An Anatomical Study
Authors: Kanter Steven L. , Friedman William A.
Published: May 2010

Percutaneous discectomy is a viable alternative in the treatment of herniated intervertebral discs of the lumbar spine. Anatomical analysis of the retroperitoneal surgical path utilizing computed tomography suggests that the risk of vascular injury is negligible at the L-4, L-5 level, but substantial at the L-5, S-1 level. In addition, one-third of patients otherwise suitable for percutaneous discectomy have segments of bowel obstructing the surgical path. Obtaining an abdominal computed tomographic scan with the patient in the surgical position seems to be a valuable screening technique in the evaluation of candidates for this procedure.
Hypothalamic Hamartoma: Report of Two Cases
Authors: Sato Masaharu , Ushio Yukitaka , Arita Norio , Mogami Heitaro
Published: May 2010

Two histologically confirmed hypothalamic hamartomas, one in a 7-year-old boy and another in a 10-year-old boy, are reported. One patient had precocious puberty, epileptic laughter, and abnormal behavior; the other had cerebral seizures. Partial removal of the tumors had no effect on precocious puberty; however, behavior improved in the first patient, and seizure control improved in the second patient.
Modified Prone Position for Cranial Remodeling Procedures in Children with Craniofacial Dysmorphism: A Technical Note
Authors: Park T.S. , Haworth Charles S. , Jane John A. , Bedford Robert B. , Persing John A.
Published: May 2010

A new head position for use during operation on young children with cranial deformities is described. The position allows exposure of the entire calvarium from the supraorbital ridges to the posterior rim of the foramen magnum. It is a modification of the conventional prone position involving hyperextension of the neck. The authors have safely used this position to perform one-stage radical cranial remodeling procedures that previously required two stages. The advantages of this position and the methods for achieving it are discussed.
Stereotactic Removal of a Migrating Ventricular Catheter
Authors: Blacklock Bob J. , Maxwell Robert E.
Published: May 2010

Retained ventricular catheters are usually well tolerated but, when infection is present, their removal becomes imperative because such catheters serve as a nidus for persistent infection. Minimally invasive methods for the removal of retained catheters are desirable. The removal of an infected, retained, subcortical ventricular catheter using stereotactic techniques is descrided. The authors think that this method is a safe and effective first step in dealing with this difficult problem.
Spontaneous Intratumoral Hemorrhage after Ventriculoperitoneal Shunting
Authors: Zuccarello Mario , Dollo Carmen , Carollo Carla
Published: May 2010

We report a 1/12-year-old child with an ependymoma in the posterior cranial fossa. As the computed tomographic scan showed evidence of marked triventricular hydrocephalus, the patient underwent ventriculoperitoneal shunting. Two hours after operation, he developed a fatal intratumoral hemorrhage. The indications and contraindications of ventricular external or internal drainage before posterior cranial fossa tumor removal are briefly discussed.
Spontaneous Cerebrospinal Fluid Rhinorrhea: Evolving Concepts in Diagnosis and Surgical Management Based on the Mayo Clinic Experience from 1970 through 1981
Authors: Hubbard Jerry L. , McDonald Thomas J. , Pearson Bruce W. , Laws Edward R.
Published: May 2010

Spontaneous cerebrospinal fluid (CSF) rhinorrhea, occurring in the absence of recent trauma, is a distinct clinical entity that can be difficult to diagnose and treat. The case records of 28 patients with this entity were reviewed retrospectively. Pertinent historical data and the results of radiographic evaluation are discussed. The patients were classified into one of three major etiological categories: congenital anomaly, delayed posttraumatic, and tumor groups. The fistulas causing the rhinorrhea were approached extracranially or intracranially, depending on the suspected cause and location. A cure was obtained in 22 of the 27 patients surgically treated (81%). Seventeen patients were cured by a single operation, 5 were cured after multiple operations, and 5 continued to leak despite surgical treatment. Three of the 5 patients who were surgical failures had intracranial tumors, and 2 of them died from complications of persistent fistulas. With the use of a multidisciplinary team approach, an extracranial operation (transethmoidal or transsphenoidal) to repair a spontaneous CSF leak offers a high success rate and is associated with minimal morbidity in appropriately selected patients.