bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative Embolization of Intracranial Meningiomas
Authors: Richter Hans-Peter , Schachenmayr Walter
Published: May 2010

The operative and histopathological findings in 31 cases of intracranial meningioma after preoperative embolization with Gelfoam and/or lyophilized dura mater are reported. Removal of the tumor after embolization was facilitated in those meningiomas fed exclusively or mainly by branches of the external carotid artery (29 of 31). Large areas of tumor necrosis were never seen on histopathological examination, even when suggested by large regions of decreased density on the postembolization computed tomographic scan. Preoperative embolization of the feeding vessels arising from the external carotid artery system has proven to be a useful adjunct before the resection of intracranial meningiomas.
Stereotactic Implantation of Deep Brain Electrodes Using Computed Tomography
Authors: Lunsford L. D. , Latchaw R. E. , Vries J. K.
Published: May 2010

The selection of intracranial targets for stereotactic functional neurosurgical procedures traditionally has relied on information derived from pooled brain atlases and supplemented by contrast encephalographic or angiographic data from the individual patient. The integration of stereotaxy with computed tomography (CT) has permitted direct identification of intracranial targets based on multiplanar reformatted CT images from each individual patient. Four patients underwent the CT stereotactic implantation of a single deep brain electrode for the control of chronic pain (two cases) or of multiple depth electrodes for long term electroencephalographic recordings in the management of seizure disorders (two cases). In all patients, accurate and precise electrode placement was achieved from CT images alone. The use of CT permitted detailed anatomical stereotactic study of each patient's brain, the preplotting of electrode trajectories before probe insertion, and the rapid confirmation of precise electrode placement. Intraoperative contrast encephalography was not necessary. Functional neurosurgery was performed successfully and advantageously using CT stereotactic technique alone
Comparison of High Resolution Real Time Ultrasonography and High Resolution Computed Tomography in an Infant with Spinal Dysraphism
Authors: James Hector E. , Scheible William , Kerber Charles , Hilton Saskia v. W.
Published: May 2010

An infant with a lumbosacral spinal subcutaneous and intraspinal lipoma involving the conus medullaris was studied with computed tomography and high resolution real time ultrasonography to determine the extent and location of the disease before operation. The high resolution ultrasonogram demonstrated the abnormality with good detail and the added advantage of real time display of the lack of pulsatile mobility of the neural elements, confirming spinal cord tethering. Spinal high resolution ultrasonography is a noninvasive diagnostic tool in infants with spinal abnormalities and should be an important part of a neurosurgeon's diagnostic support system.
Fibrosarcoma of the Heart Metastatic to the Brain
Authors: Saris Stephen , Vavoulis George , Linder James , Friedman Allan
Published: May 2010

A right parietal lobe metastasis of a fibrosarcoma originating in the left atrium of the heart was resected twice in a 33-year-old man. Light microscopy showed lightly packed, pleomorphic spindle cells with abundant collagen production and an alcian blue-positive matrix. Electron microscopy confirmed the fibroblastic character of these cells. Review of the literature reveals one other cardiac fibrosarcoma metastatic to the brain. The case presented is the first reported example of successful surgical resection of this unusual metastatic sarcoma. Although he succumbed to metastatic disease, the patient remained neurologically intact until the time of death.
Autogeneic Fat Transplants in the Epidural Space in Routine Lumbar Spine Surgery
Authors: Bryant Michael S. , Bremer Alfonso M. , Nguyen Tai Q.
Published: May 2010

This report presents our experience with the use of autogeneic fat patch grafts to protect the exposed dura mater during lumbar spine operations. A total of 44 consecutive surgical procedures was performed primarily for discogenic or spondylotic disease from 1979 to 1982. Prophylactic antibiotics were used in 21 (48%) cases. The autogeneic fat transplants were well accepted by all recipients during 10.4 (1 to 32) months of follow-up. Fat grafts, greater than 1 cm in thickness, were easily identified on subsequent computed tomographic (CT) scans. There were no postoperative wound infections. However, 1 patient developed a large subcutaneous sterile fluid accumulation at the fat donor site, which required surgical intervention. Our results, both short and long term, indicate that autogeneic fat transplants may be well tolerated in the lumbar spine area. The fat graft viability as demonstrated by CT scanning and histological examination supports the contention that autogeneic fat interposed between dura mater and overlying musculature may serve as a barrier limiting the growth of cicatrix into the spinal canal.
Indwelling Epidural Morphine for Control of Post-Lumbar Spinal Surgery Pain
Authors: Ray Charles D. , Bagley Russel
Published: May 2010

The epidural instillation of morphine for pain control has been utilized for some time, although primarily intraoperatively or for patients with chronic severe pain, as in terminal cancer. Long term indwelling catheter or subarachnoid administration of epidural morphine are both potentially hazardous. However, in relatively brief applications, up to a few days, the epidural administration of morphine sulfate is effective, safe, and well tolerated when used according to a carefully controlled plan. We report the use of this method as an improved means for the control of post-lumbar surgery pain in 25 cases. These patients were compared with 25 others receiving standard doses of parenteral and oral narcotics. The two groups were quite similar preoperatively. However, patients receiving epidural morphine were more comfortable, had fewer side effects such as nausea and lassitude, and exhibited no respiratory depression. Further, they ambulated sooner, showed no definitive orthostatic hypotension and less ileus, and remained much more alert and cooperative during the initial 48 hours after operation. Hospitalizations were usually shorter by 1 or 2 days. The administration of very small doses (1.0 to 2.5 mg) of morphine every 12 to 24 hours was usually adequate for good to excellent postoperative pain control. Hydroxyzine was sometimes used to potentiate the analgesia between doses. The epidural catheters were routinely removed within about 72 hours. The technique for the intraoperative placement of the epidural catheter and drug administration are detailed. Precautions for catheter placement were carefully followed to prevent dural penetration or intrathecal injection.
Vasospasm and Regional Cerebral Blood Flow (rCBF) in Patients with Ruptured Intracranial Aneurysm: Serial rCBF Studies with the Xenon-133 Inhalation Method
Authors: Yamakami Iwao , Isobe Katsumi , Yamaura Akira , Nakamura Takao , Makino Hiroyasu
Published: May 2010

To clarify the relationship of vasospasm to the reduction of cerebral blood flow (CBF) and the delayed ischemic neurological deficit, serial rCBF studies with the use of the xenon-133 inhalation method were conducted in 35 postoperative patients with ruptured intracranial aneurysms. The CBF was calculated as an initial slope index (ISI) derived from the desaturation curve of each head probe, and the hemispheric mean value of the ISI (mean ISI) was calculated in both hemispheres. The mean ISI in the hemisphere ipsilateral to the operation was low compared to that of the contralateral hemisphere. In relation to the presence of vasospasm, angiographic findings were classified into the following five types: diffuse, peripheral, proximal-severe, proximal-mild, and no spasm. Patients with vasospasm of the diffuse, peripheral, and proximal-severe types showed a markedly decreased mean ISI, and vasospasm of the diffuse type caused the greatest degree of reduction. The mean ISI of the patients who developed delayed ischemic neurological deficit (DIND) due to vasospasm was significantly decreased (37.4± 4.6) compared to that of the patients who did not develop DIND (52.2± 5.6). None of 3 cases of no spasm and only 1 of 14 cases of proximal-mild spasm developed DIND. On the other hand, all of 4 cases of diffuse, 2 of 3 cases of peripheral, and 2 of 6 cases of proximal-severe spasm developed DIND. Thus, if these three types of vasospasm are joined together as severe vasospasm, 8 of 13 cases with severe vasospasm developed DIND. These results suggest that severe vasospasm causes a reduction of CBF and that the reduced CBF brings about DIND.
Evaluation of the Histopathology of Brain Tumor Tissue Obtained by Ultrasonic Aspiration
Authors: Richmond Isabelle L. , Hawksley Carlene A.
Published: May 2010

Ultrasonic aspiration has been widely adopted in the resection of tumors of the central nervous system. In the past, the tumor tissue fragments obtained have been discarded. To evaluate these fragments as possible sources of material for histopathological study and tissue culture, we compared the microscopic features and viability in tissue culture of CUSA tissue fragments and biopsies obtained by conventional methods. Two cases (a meningioma and a subependymal astrocytoma) are presented to demonstrate that these tissue fragments retain good preservation of histological detail and tissue culture viability. Because the quantity of tumor tissue available from the CUSA tissue trap is consistently greater than that obtained by standard biopsy methods, utilization of this material may facilitate pathological interpretation by providing a more representative sample of tumor histology as well as providing an adequate and sterile source of material for tissue culture studies.
Intraarterial 1,3-Bis(2-chloroethyl)-1-nitrosourea (BCNU) and Systemic Chemotherapy for Malignant Gliomas: A Follow-up Study
Authors: West Charles R. , Avellanosa Anthony M. , Barua Nilou R. , Patel Arun , Hong Chung I.
Published: May 2010

Twenty-five adults who harbored malignant gliomas received 72 courses of intraarterial 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) (100 mg/m2) and 67 courses of systemic vincristine (1.0 mg/m2) and procarbazine (100 mg/m2) as induction therapy (BVP) followed by 106 courses of systemic 1-(2-chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea (methyl-CCNU) (130 mg/m2), vincristine, and procarbazine as maintenance therapy (MVP). With a 6-week interval between each treatment, the median and range for the number of courses of BVP were 3 and 1 to 4 and those for MVP were 3 and 0 to 14, respectively. Fifteen patients (60%) responded to both BVP and MVP, and 10 (40%) did not. The overall median survival time was 12.7 months (range, 1.8 to 48.5+ months). Two of 3 patients who had recurrent gliomas responded and survived for 37+ to 45+ months. Seven of 10 who had nonirradiated glioblastomas responded and survived for 9 to 22 months. Four who had nonirradiated anaplastic astrocytomas all responded and survived for 38+ to 48.5+ months. Two who also received radiotherapy (1 glioblastoma and 1 primitive neuroectodermal tumor) benefited and survived for 16.9 and 28.5+ months. All who did not respond favorably died within 8 months. During the infusion of BCNU, complications included transient orbital and head pain, periorbital and scleral erythema in all patients, and a focal seizure in 1 (4%). During the 6-month induction periods, leukopenia and thrombocytopenia occurred in 1 (4%), deep vein thrombosis occurred in 9 (36%), pulmonary emboli occurred in 8 (32%), upper respiratory infections occurred in 6 (24%), pneumonia occurred in 9 (36%), and herpes zoster occurred in 1 (4%). During maintenance therapy, seizures occurred in 4 (16%) and leukopenia and/or thrombocytopenia occurred by the fifth course in 6 of 9 who received 5 to 14 treatments.
Percutaneous Glossopharyngeal Thermocoagulation Complicated by Syncope and Seizures
Authors: Ori Carlo , Salar Giuseppe , Giron Giampiero
Published: May 2010

We describe the case of a patient who, during the percutaneous thermocoagulation of the petrous ganglion of Andersch, suffered a serious vagal response resulting in cardiac arrest, collapse, and generalized convulsions. Notwithstanding such major symptoms, the postoperative examination revealed no lesions of the vagus nerve and the glossopharyngeal lesion was shown to be isolated and selective.
Hormone Binding in Brain Tumors
Authors: Glick Roberta P. , Molteni Agostino , Fors Ellen M.
Published: May 2010

Brain tumors from 64 patients were studied for the presence of hormone binding. Estradiol binding was detected in 34 patients: 13 of 21 meningiomas, 4 of 8 schwannomas, 1 oligodendroglioma, 1 of 5 benign gliomas, 4 of 5 malignant gliomas, 5 of 11 metastatic tumors, and 6 of 11 pediatric tumors: 1 medulloblastoma, 2 malignant ependymomas, 1 benign astrocytoma, 1 malignant sarcoma, and 1 malignant teratoma, Eleven patients were studied for progesterone binding, which was measurable in 7: 1 schwannoma, 3 meningiomas, 1 malignant sarcoma (pediatric group), 1 astrocytoma—gemistocytic (pediatric group), and 1 metastatic adenocarcinoma. There were 41 females and 23 males in the study, Fifteen females were premenopausal, 18 were postmenopausal, and 8 were in the pediatric age group. Of the 34 tumors with measurable estradiol binding, 23 occurred in females. In the progesterone group, 4 of the 7 tumors with measurable binding activity were from female patients. In the pediatric group, estradiol binding was detected in 1 medulloblastoma, 2 malignant ependymomas, 1 malignant teratoma, 1 malignant sarcoma, and 1 astrocytoma. Five of the 6 pediatric tumors with estradiol binding were malignant, and both pediatric tumors with progesterone binding were also malignant. Of the 10 gliomas studied, 4 of the 5 malignant tumors had estradiol binding, whereas only 1 of the 5 benign tumors showed binding. Our studies with the pediatric tumors and the gliomas suggest that a relationship exists between the malignancy of the tumor and the presence of hormone binding. The ubiquitous nature of the presence of hormone binding is discussed, as is the possible correlation between age, sex, histological grade, and significance of hormone binding in brain tumors.
Three-Dimensional Reconstruction of Craniofacial Deformity Using Computed Tomography
Authors: Hemmy D.C. , David D.J. , Herman Gabor T.
Published: May 2010

The computed tomographic studies obtained routinely in the examination of patients with congenital or acquired defects of the skull and facial bones can be utilized as a substrate to provide an accurate three-dimensional representation of osseous abnormalities. The total dose of x-irradiation is reduced as other means of radiological examination are eliminated. Osseous structures are faithfully reproduced. Complete inspection of the reproduced structure can be made from any viewpoint, including internal inspection.
Degenerative Spondylolisthesis with an Intact Neural Arch: A Review of 60 Cases with an Analysis of Clinical Findings and the Development of Surgical Management
Authors: Epstein Nancy E. , Epstein Joseph A. , Carras Robert , Lavine Leroy S.
Published: May 2010

The treatment over the past 12 years of 60 patients with degenerative spondylolisthesis with an intact neural arch is reviewed. The patients averaged 65 years of age, with women outnumbering men by a ratio of 2:1. Symptoms in the lower extremities had been present for 3 months to 10 years, although varying back pain had existed for longer periods. Two-thirds showed signs of motor dysfunction. Sensory alterations and a positive Lasėgue's sign could be demonstrated in only one-half of the patients studied. Four of 5 patients developed intermittent neurogenic claudication, with varying evidence of painful radiculopathy. The marked disability caused by claudication contrasted sharply with the lesser neurological changes, and these patients required early surgical decompression. Diagnostic studies included electro-myography, plain x-ray films, tomography, computed tomographic scanning, and myelography. The latter outlined a relative stenosis caused by olisthesis as well as arthrotic and spondylotic changes that determined the extent of decompressive operation required. The L-4, L-5 interspace was involved in 56 patients, L-3, L-4 was involved in 2, and L-5, S-1 was involved in 2. The ideal operation with L-4, L-5 olisthesis included complete laminectomy of L-4 and L-5 with unroofing of the lateral recesses and foraminotomy. This more extensive procedure was justified because of the failures encountered in previous patients in whom inadequate decompression had been performed. Among failures, obesity, diabetes, hyperlordosis, and extensive long-standing dysfunction were prominent. The relief of symptoms of intermittent neurogenic claudication was the most gratifying response observed. There was no unusual morbidity.
Do We Need to Cross Match Blood for Elective Laminectomy?
Authors: Sarma Deba P.
Published: May 2010

Elective laminectomy cases do not need a routine order for typing and cross matching of blood. Data from the literature and from personal experience in the blood bank of a 580-bed general hospital are presented to support this conclusion. An ABO-Rh type and an antibody screen can safely substitute for routine cross matches for such cases. The use of type and screen rather than cross match allows the blood bank to distribute limited blood resources more efficiently without jeopardizing the patients.
Bilateral Parietal Arteriovenous Malformations: Report of a Case
Authors: Stone James L. , Crowell Robert M. , Lisner Blaine M. , Naseem Mohammad , Oldershaw John B.
Published: May 2010

A patient with bilateral parietal arteriovenous malformations (AVMs) is reported. The clinical presentation included seizures, coma, and signs of tentorial herniation. After the evacuation of a large left intraparietal hematoma, cerebral angiography identified a small left parietal AVM, which was excised. Mass effect and increased intracranial pressure were present at the time of the initial angiography, and the presence of a right parietal AVM was not appreciated. Postoperative cerebral angiography to document excision of the left parietal AVM then disclosed the small right parietal AVM, which was later excised. The patient has recovered very well. The natural history of AVMs and the occurrence of multiple AVMs are discussed.
Intracerebral Hemorrhage Remote from the Site of the Initial Neurosurgical Procedure
Authors: Waga Shiro , Shimosaka Shinichi , Sakakura Makoto
Published: May 2010

Four cases of intracerebral hemorrhage remote from the site of the initial neurosurgical procedure are presented. Two of the four patients had preoperative hypertension. Possible mechanisms are discussed, and labile hypertension and unstable blood pressure during the perisurgical period may be contributory. Clinical awareness of this rare but potential complication is essential to early diagnosis and treatment. Difficulty in awakening from anesthesia and the development of new neurological deficits not attributable to the operative site are the most important keys to early diagnosis. Computed tomography is the diagnostic method of choice.
Moderate Grade Astrocytoma Presenting in a 4-Month-Old Child with a Family History of von Recklinghausen's Neurofibromatosis Spanning Four Generations: A Case Report
Authors: Epstein Nancy E. , Rosenthal Alan D. , Selman Jay , Osipoff Michael , Hyman Roger A.
Published: May 2010

Intracranial gliomas are found in association with von Recklinghausen's neurofibromatosis. However, few truly neonatal lesions have been identified and studied. This case report concerns a 4-month-old child who was found to have a massive thalamic glioma of moderate grade. Four paternal generations had suffered from different manifestations of this transmissible autosomal-dominant (Ad) phakomatosis.
Current Status of Carotid Endarterectomy for Atheromatous Disease
Authors: Loftus Christopher M. , Quest Donald O.
Published: May 2010

The authors discuss the indications for both elective and emergency carotid endarterectomy. Reports on the surgical treatment of asymptomatic bruit and contralateral carotid stenosis are reviewed. The results of endarterectomy for symptomatic carotid disease, including transient ischemic attacks, acute neurological deficit, and complete carotid occlusion, are discussed. The complications and risks of carotid surgery are also presented.
Spontaneous Arterial Subdural Hematoma
Authors: McDermott Michael , Fleming Ross J. F. , Vanderlinden Graham R. , Tucker William S.
Published: May 2010

The occurrence of spontaneous arterial subdural hematomas is very rare. We report five patients who presented with sudden severe headache and who developed progressive neurological deficits, two becoming comatose. None had a history of trauma. A diagnosis of subarachnoid hemorrhage was suspected in all patients, but all proved to have subdural hematomas caused by “spontaneous” rupture of a cortical artery. Nineteen similar cases have been reported in the English literature. The source of bleeding was identified as a cortical artery located near the sylvian region in four of our five patients and in most of the reported cases. There are several possible anatomical situations that may predispose a cortical artery to “spontaneous” rupture: (a) spontaneous rupture of a cortical artery at the point of origin of a fragile arterial twig, especially a right-angled branch, a point of potential weakness; (b) rupture of a small artery traversing the subdural space and connecting a cortical artery to the dura mater (a “bridging” artery); (c) adhesions between a cortical artery and arachnoid or dura mater; (d) a knuckle of cortical artery protruding through the arachnoid and adherent to the dura mater. In each situation, the artery is probably torn by a sudden movement of the brain during a vigorous head movement, not severe enough to be considered trauma.
Iohexol versus Metrizamide for Lumbar Myelography: Preliminary Report of Double-Blind Trial
Authors: Gebarski Stephen S. , Gabrielsen Trygve O. , Knake James E. , Latack Joseph T. , Hoff Julian T.
Published: May 2010

Lumbar myelography was performed in 38 patients; 19 received iohexol (an investigational aqueous contrast agent) and 19 received metrizamide. Iohexol is stable in solution, which is not the case with metrizamide. There was no other significant difference in diagnostic utility or quality between the two media. However, there was considerable postmyelography morbidity in the metrizamide group, but no postmyelography morbidity in the iohexol group. Preliminary clinical evidence suggests that iohexol is significantly superior to metrizamide as a contrast agent for lumbar myelography.
Quantitative Determination of Plasma Fibrinolytic Activity in Patients with Ruptured Intracranial Aneurysms Who Are Receiving ϵ-Aminocaproic Acid: Relationship of Possible Complications of Therapy to the Degree of Fibrinolytic Inhibition
Authors: Burchiel Kim J. , Hoffman John M. , Bakay Roy A. E.
Published: May 2010

Fifty-two patients were each given a constant infusion of 1.5 g of ϵ-aminocaproic acid (EACA) per hour after subarachnoid hemorrhage (SAH) from an intracranial aneurysm. Each patient's available plasminogen activity (APA), a measure of plasma fibrinolytic activity, was determined by fluorometric assay before and during EACA treatment. Five categories of potential EACA complications were identified: rebleeding, cerebral vasospasm, hydrocephalus, thrombosis, and miscellaneous (bleeding time prolongation, thrombocytopenia). The APA of the 37 patients with complications was significantly higher than that of the 15 without complications. Four patients suffered rebleeding episodes and had significantly higher APA levels during EACA therapy when compared to all other patients, i.e., those with and without other complications. Patients with vasospasm, hydrocephalus, and thrombotic complications also had significantly higher APA levels during EACA therapy compared to patients without complications. The latter may be simply a reflection of the activation of fibrinolytic activity that occurs after SAH. It is apparent from these studies that, after the initiation of EACA treatment, a maximal steady state inhibition of fibrinolytic activity is not achieved for 2 days and, after the cessation of EACA therapy, normal fibrinolytic activity is not restored for a period of 3 to 4 days. In addition, patients with thrombotic events may show persistently low serum plasminogen activity after discontinuance of EACA therapy, probably due to continuing thrombosis and consumption of plasminogen. These results indicate that patients with recurrent preoperative aneurysmal hemorrhage while on EACA therapy may have inadequate fibrinolytic inactivation, and this may be an important factor contributing to rebleeding episodes. The authors conclude that further studies of patients with SAH from ruptured intracranial aneurysms who are receiving EACA should be done to correlate serum fibrinolytic activity, rebleeding episodes, and other putative complications of antifibrinolytic therapy.
Neurosurgical Treatment of Nonmalignant Intractable Rectal Pain: Microsurgical Commissural Myelotomy with the Carbon Dioxide Laser
Authors: Fink Robert A.
Published: May 2010

Spinal cord neuroablative procedures for intractable midline pain have been limited in application because of frequent side effects and disabilities caused by manipulation of adjacent normal structures during the operation. The carbon dioxide laser, with its ability to execute microneurosurgical procedures without such manipulation, presents an opportunity to minimize adverse effects while still interrupting the desired pain-conducting fibers. Commissural myelotomy with the carbon dioxide laser in a patient suffering from pain due to nonmalignant disease and with a preoperatively intact spinal cord is described.
“Conjoined” Nerve Roots: A Requirement for Computed Tomographic and Myelographic Correlation for Diagnosis
Authors: Gebarski Stephen S. , McGillicuddy John E.
Published: May 2010

In a case of “conjoined” nerve roots with herniated nucleus pulposus, the computed tomographic findings were inconclusive, if not misleading. Myelography alone was also not definitive. Correlation of these two studies allowed a successful surgical approach.
Unusual Fracture/Dislocation of the Lower Cervical Spine: Case Report
Authors: Byun Hang S. , Patel Pratap P.
Published: May 2010

An unusual fracture/dislocation of the lower cervical spine is described, and a possible mechanism of injury is postulated.
Defective Cerebrovascular Autoregulation in Regions Proximal to Arteriovenous Malformations of the Brain: A Case Report and Topic Review
Authors: Solomon Robert A. , Michelsen Jost W.
Published: May 2010

We report the case of a patient with a large left subfrontal arteriovenous malformation (AVM) that was supplied by the right internal carotid artery. The anomalous blood supply developed because of complete occlusion of the left internal carotid artery. When the AVM was removed, the patient experienced a hemorrhage into the right basal ganglia. The possibility that this hemorrhage was related to a defect of autoregulation in blood vessels that lie proximal to a large AVM is discussed. Even though this is a unique case, the pathophysiological events that are documented are relevent to the preoperative preparation and surgical management of all patients with AVMs.
Tuberous Sclerosis: A Review for the Neurosurgeon
Authors: Nagib Mahmoud G. , Haines Stephen J. , Erickson Donald L. , Mastri Angeline R.
Published: May 2010

The clinical. radiological, and pathological characteristics of tuberous sclerosis are reviewed. Neurosurgical intervention in the syndrome is discussed in light of two recently treated cases and a literature review.
Method of Computed Tomography-based Stereotactic Biopsy with Arteriographic Control
Authors: Kelly Patrick J. , Alker George J. , Kall Bruce A. , Goerss Stephan
Published: May 2010

A method for computed tomography (CT)-based stereotactic biopsy of intracranial neoplasms with arteriographic control is described. Stereotactic CT and digitized stereotactic arteriographic data are input to a three-dimensional computer matrix that corresponds to the coordinate system of a stereotactic frame located in the operating room. A site for biopsy is selected by cursor from the CT display screen. The computer calculates and outputs the mechanical adjustments of the stereotactic frame necessary to place the target point into the focal point of the frame. Horizontal and vertical approach angles are determined from the digitized arteriogram and are displayed as settings on the stereotactic frame that represent an avascular trajectory along which the lesion may be biopsied safely. This procedure has been used successfully in 86 patients, with no morbidity or mortality.
Clinical Utility of Allogeneic Skull Discs in Human Craniotomy
Authors: Prolo Donald J. , Gutierrez Robert V. , DeVine Jeffrey S. , Oklund Sally A.
Published: May 2010

One hundred fifteen burr hole defects were filled with sterilized human cadaver skull in 45 patients ranging in age between 10 and 88 years. One to 6 allogeneic skull discs per patient were placed in all areas of the calvaria. The length of postoperative observation ranges between 6 months and 5 years. No instances of infection, resorption, or rejection have occurred. Discs became incorporated and were osteoconductive, with new bone formed by “creeping substitution.” In contrast to frozen autogeneic skull, these allogeneic discs were not resorbed. Allogeneic skull may be used safely and effectively to fill small discontinuity defects in the human calvaria.
Myxopapillary Ependymoma of the Filum Terminale and Cauda Equina in Childhood: Report of Seven Cases and Review of the Literature
Authors: Chan Helen S. L. , Becker Laurence E. , Hoffman Harold J. , Humphreys Robin P. , Hendrick Bruce E. , Fitz Charles R. , Chuang Sylvester H.
Published: May 2010

Seven of fourteen children with spinal cord ependymoma had myxopapillary tumors of the filum terminale. These tumors made up 15.9% of all primary spinal neuroectodermal tumors in children (44 cases) seen during a 62-year period (1919 to 1981). Their clinical presentation, radiological features, pathological findings, treatment, and outcome are reported. Six of the seven patients were known to be alive at the time of writing. The seventh patient was lost to follow-up after 3 years without tumor recurrence. Of 5 patients whose primary mode of treatment was operation alone, 3 had intraspinal or intracranial recurrences. Despite tumor recurrences, 2 patients were long term survivors after further operation and irradiation, whereas the third patient recently received craniospinal irradiation for intracranial tumor recurrence. The 2 patients who did not have tumor recurrence after operation alone had been followed for 3 and 7 years, respectively. Two children with subtotal tumor resection and spinal irradiation had no recurrences at 1 and 17 years, respectively. Our data suggest that this unusual subtype of spinal ependymoma is not uncommon during childhood and has a good prognosis. All patients with this tumor require prolonged follow-up for tumor recurrence after operation and irradiation.
Cerebral Abscess: Loss of Computed Tomographic Enhancement with Steroids
Authors: Black Keith L. , Farhat Saeed M.
Published: May 2010

A case of cerebral abscess with decreased computed tomography enhancement and clinical improvement after steroid therapy alone is reported. When the steroids were discontinued, the computed tomography enhancement increased and the patient's clinical condition deteriorated. The abscess subsequently ruptured with the development of ventriculitis. The infection was not eradicated with penicillin or chloramphenicol, but was effectively treated with metronidazole.
Neurosyphilis Presenting as a Focal Mass Lesion: A Case Report
Authors: Kulla Lawrence , Russell James A. , Smith Thomas W. , Zito Joseph L. , Davidson Robin
Published: May 2010

A patient with subacute aphasia and hemiparesis was found to have a low density white matter lesion with mass effect on the computed tomographic (CT) scan. Serological examination and biopsy established the diagnosis of paretic neurosyphilis. This CT appearance has not previously been described in cases of neurosyphilis. Neurosyphilis should be considered as a potentially treatable cause of a cerebral mass lesion.
Extreme Lateral Disc Herniation: Diagnosis by Computed Tomographic Scanning
Authors: Godersky John C. , Erickson Donald L. , Seljeskog Edward L.
Published: May 2010

Extreme lateral disc herniation with compression of the nerve root as it exits through the foramen has been a recognized entity for a number of years. Until recently, this diagnosis was made infrequently except at the time of operation. Reported here are 12 cases of root compression from disc herniation at the level of the pedicle or farther laterally in the foramen (extreme lateral disc herniation). Diagnosis and localization of the root compression were determined preoperatively in 11 of 12 cases based on the computed tomographic (CT) scan appearance of the lesion. Myelography was performed in 9 cases and was interpreted as normal in 6 and abnormal in 3 instances. In each of the 3 abnormal studies, the actual abnormality was at a different level than that predicted by the myelogram. The clinical presentations in these patients were not distinct except that a positive straight leg raising test was present in only 7 of 12. Preoperative knowledge of the site of nerve root compression as delineated by CT scanning was essential in planning the operative procedure. It prevented unnecessary exploration of uninvolved levels and directed the surgeon to the far lateral site of the herniation. Illustrative examples are presented.
Connatal Brain Tumors in Patients with Tuberous Sclerosis
Authors: Painter Michael J. , Pang Dachling , Ahdab-Barmada Mamdouha , Bergman Ira
Published: May 2010

Two neonates with tuberous sclerosis and giant cell astrocytomas diagnosed soon after birth are described. During attempted surgical resection of their tumors, both infants developed refractory intraoperative cardiac arrhythmias and died. At autopsy, both patients had multiple cardiac rhabdomyomas. Subependymal giant cell astrocytomas rarely present in the neonate, but genetic implications and associated cardiac hamartomas warrant special consideration of these connatal tumors. Surgical considerations suggest that an operative approach to these tumors should be delayed beyond the neonatal period.
Low Grade Glioma Presenting as Subarachnoid Hemorrhage
Authors: Memon Muhammed Yacob , Neal A. , Imami R. , Villareal N.
Published: May 2010

During the last 2 years, we treated three cases of brain tumor that presented with intracranial hemorrhage. Two of the three tumors were metastatic. They presented with hemorrhage into the tumor, but no blood in the cerebrospinal fluid. One tumor was a low grade astrocytoma that presented as subarachnoid and intraventricular hemorrhage in a 15-year-old child. It was removed with no neurological sequelae.
Subdural Hemorrhage Secondary to Extramedullary Hematopoiesis in Postpolycythemic Myeloid Metaplasia
Authors: Brown Jeffrey A. , Gomez-Leon Guillermo
Published: May 2010

A 64-year-old woman with a 20-year history of polycythemia vera and a 2-month history of postpolycythemic myeloid metaplasia (PPMM) became comatose because of bilateral subdural hematomas. Biopsy of the dura mater at operation demonstrated extramedullary hematopoiesis (EMH). The subdural hemorrhage was secondary to dural invasion by hematopoietic tissue and vascular dilation with a predisposing element of thrombocytopenia. This is the second case of central nervous system (CNS) EMH in a case of polycythemia vera. Only 8 cases of symptomatic CNS EMH and 16 cases overall have been reported, and these were primarily due to agnogenic myeloid metaplasia. Symptoms were secondary to the mass effect of dural tumor-like hematopoietic tissue or to an elevated cerebrospinal fluid protein content. The survival after a diagnosis of PPMM with CNS EMH has been less than 6 months in all cases. CNS EMH is an unusual and a potentially critical complication of polycythemia vera that should be considered in the evaluation of the patient with polycythemia vera and myeloid metaplasia.
Penetrating Injury of the Tuberculum Sellae
Authors: Nath F. P. , Teasdale E. , Mendelow A.D.
Published: May 2010

An unusual case of perforation of the tuberculum sellae and right ethmoid bone by a 10-in, serrated bread knife is described. The patient survived with no neurological or endocrine deficit. The importance of preoperative angiography and control of the proximal and distal vasculature is stressed.
Squamous Cell Carcinoma and Meningomyelocele
Authors: Chadduck William M. , Uthman Edward O.
Published: May 2010

A case of invasive squamous cell carcinoma arising in the skin overlying a large lumbar meningomyelocele is reported. This case is unique in that a chronic neurocutaneous fistula was not present. It is proposed that chronic irritation of the meningomyelocele was the primary factor in the pathogenesis of the cancer.
Intramedullary Subependymoma of the Cervical Spinal Cord: Case Report
Authors: Salcman Michael , Mayer Richard
Published: May 2010

The third case of intramedullary subependymoma of the cervical spinal cord is reported. This is the first such case for which intraoperative views are available. It was possible to remove most of this lesion with the aid of the operating microscope, the carbon dioxide laser, and the use of somatosensory evoked potentials. The diagnosis was clouded by the coexistence of Holmes-Adie pupils and absent reflexes in the lower extremities. All three reported intramedullary subependymomas have been found in the cervical spinal cord of middle-aged patients. Tumors in this clinical setting should not be assumed to be unresectable astrocytomas without careful histopathological and intraoperative evaluation.
Dexamethasone-a Helpful Adjunct in Management after Lumbar Discectomy
Authors: King J. Stovall
Published: May 2010

This randomized prospective study was designated to test the hypothesis that intraoperative and postoperative administration of a potent antiinflammatory steroid (dexamethasone) would reduce patients' postoperative pain. The hypothesis is based on the concept that inflammation is associated with a lowering of the threshold for nociceptive sense organs and that the inflammatory process is responsible, at least in part, for postoperative pain. The quantity of narcotics requested by the patients during the first 72 hours of the postoperative period was used as the measure of their postoperative pain. Patients treated with steroid who underwent lumbar laminotomy and discectomy used considerably less narcotic during the postoperative period than those not treated with steroid (P value < 0.01). Less difference was noted in patients who underwent laminectomy, and no statistically significant difference was noted for those who underwent anterior discectomy. It is concluded that the use of an antiinflammatory steroid during and after operation significantly reduces the immediate postoperative pain after lumbar discectomy and may be useful in the postoperative management of other surgical procedures.
Intrasellar Cavernous Hemangioma
Authors: Buonaguidi Roberto , Canapicci Raffaelle , Mimassi Nagi , Ferdeghini Marco
Published: May 2010

We present a very rare case of an intrasellar cavernous hemangioma mimicking, clinically and neuroradiologically, the presence of a nonfunctioning pituitary adenoma. It was possible to diagnose this benign, congenital vascular malformation only through a histological examination.
Hemangioma Calcificans in the Fourth Ventricle
Authors: Hidenori Kobayashi , Hirokazu Kawano , Haruhide Ito , Minoru Hayashi , Shinjiro Yamamoto
Published: May 2010

A case of hemangioma calcificans in the 4th ventricle is reported. Skull x-ray films demonstrated a dense calcification in the posterior fossa. Computed tomography disclosed a hyperdense mass in the 4th ventricle. The clinical picture was of increased intracranial pressure due to obstructive hydrocephalus. An hemangioma calcificans in the 4th ventricle was removed successfully.
Anomalous Exit of the C-6 Nerve Root via the C-6, C-7 Foramen
Authors: Rosner Michael J. , Whaley Robert
Published: May 2010

We report a case of the anomalous exit of the C-6 nerve root at the C-6, C-7 foramen. This caused intense radicular and cervical pain in a 25-year-old woman. At myelography, the 5th and 6th cervical roots appeared conjoined, and at operation the C-6 root and ganglion were found to turn acutely downward, lateral to the pedicle of C-6, and then to exit with the C-7 nerve root through the C-6, C-7 foramen. The ganglion of C-6 was placed nearly parallel to the dural sac and tethered at its origin on the dural sac and at the exit foramen with the C-7 root. The pedicle of C-6 was interposed between the dural sac and the ganglion of C-6, Cervical hemilaminectomy and resection of the pedicle of C-6 defined the anatomy and resulted in a clinical cure. The radiological features are described and contrasted with those of other anomalies. To our knowledge, this is the first report of such an anomalous course of exit of a cervical root.
Criteria for Cure in Acromegaly: Report of a Case Apparently Cured in Which Persisting Tumor Was Found at Autopsy
Authors: Wrightson Philip , Holdaway Ian MacM. , Synek Beth J. L.
Published: May 2010

A 49-year-old man with acromegaly underwent the apparently complete removal of a pituitary microadenoma by the transsphenoidal route. There was complete remission of the biochemical abnormalities for 21/2 years, with basal plasma growth hormone (GH) levels of less than 1 ng/ml and normal somatomedin levels. The patient then died after the rupture of a cerebral aneurysm. Serial sections of the pituitary fossa showed persistent tumor with a volume of about 6% of the remaining normal gland. It is concluded that current endocrine tests are limited in their ability to detect residual GH-secreting tumor. Their sensitivity is likely to depend on the mass of the tumor and on the GH secretion rate. Predictions of long term cure based on these tests are only tentative.
Acute Operation and Preventive Nimodipine Improve Outcome in Patients with Ruptured Cerebral Aneurysms
Authors: Auer Ludwig M.
Published: May 2010

Sixty-five patients with ruptured aneurysms were operated upon within 48 to 72 hours after subarachnoid hemorrhage (SAH) and were treated with a regimen of intra- and postoperative nimodipine for the prevention of symptomatic vasospasm. The clinical grading (Hunt and Hess) was I to III in 49 patients and IV or V in 16. The SAH was mild in 15 patients, moderate in 27, and severe in 23; 12 patients harbored an intracerebral hematoma, and 6 had intraventricular bleeding. Acute hydrocephalus was observed on preoperative computed tomography (CT) in 19 patients. On CT 3 days postoperatively (i.e., Day 3-4 after SAH), 30 of 65 patients still had subarachnoid blood; however, severe symptomatic vasospasm as the deciding threatening event during the delayed postoperative period was not encountered in this series. Transient symptoms of ischemia were noted in 2 patients (3%) and were accompanied by angiographic spasm in 1. Irreversible neurological deficit occurred in 2 patients (3%); in 1 of these, it was a complication of postoperative control angiography. Of the patients preoperatively graded I or II, 96% had an excellent to fair outcome 6 months postoperatively, and 1 patient (4%) had died because of a surgical complication. Among patients preoperatively graded III or IV, 86% had an excellent to fair outcome, and the remaining 14% had a poor outcome. Shunt-dependent hydrocephalus developed in 7% of the patients. Acute surgical repair of ruptured cerebral aneurysms and preventive topical and intravenous administration of nimodipine reduce management complications and improve outcome; above all, ischemic lesions from symptomatic vasospasm are reduced to a minimum.
Lumbar Disc Hernia Secondary to Gunshot Injury
Authors: Mariottini A. , Delfini R. , Ciappetta P. , Paolella G.
Published: May 2010

The authors present a case of injury to the 4th lumbar root secondary to a gunshot wound. The lesion was not directly related to the traumatic action of the projectile, but was caused by the compressive action of disc material forced into the vertebral canal as a result of the destructive effects of a 7.65 caliber bullet.
Sarcoidosis Presenting as an Intramedullary Spinal Cord Mass
Authors: Hitchon Patrick W. , Haque Anwar Ul , Olson Jeffrey J. , Jacobs Steven K. , Olson Steven P.
Published: May 2010

A patient with sarcoidosis of the spinal cord showing cord enlargement upon myelography is presented. The literature regarding spinal cord involvement with sarcoidosis, the indications for operation, and treatment is reviewed.
Neuroepithelial Cysts of the Posterior Fossa: Pathogenesis and Report of Two Cases
Authors: Andrews Brian T. , Halks-Miller Meredith , Berger Mitchell S. , Rosenblum Mark L. , Wilson Charles B.
Published: May 2010

We present two cases of simple neuroepithelial cyst-one at the cerebellopontine angle and the other in the pontine brain stem-in which a basement membrane was detected. The pathogenesis of these cysts, their diagnosis using computed tomography-metrizamide cisternography and nuclear magnetic resonance imaging, and their surgical treatment by fenestration and drainage are discussed.
Primary Dural Melanomas: Report of Two Cases and Review of the Literature
Authors: Özden Beyhan , Barlas Orhan , Hacthanefioğlu Uğur
Published: May 2010

Two cases of primary melanoma of the central nervous system originating from the dura mater and without involvement of the leptomeninges are described. In one case, the tumor was located extradurally with firm attachment to the dura mater and dural melanosis. In the other case, the dura was involved diffusely with multiple discrete masses of 1 to 3 mm in diameter. A literature review revealed five other cases of primary dural melanoma. A discussion of the origin of primary dural melanoma is presented.
Lower Extremity Functional Neuromuscular Stimulation in Cases of Spinal Cord Injury
Authors: Cybulski George R. , Penn Richard D. , Jaeger Robert J.
Published: May 2010

Functional neuromuscular stimulation (FNS) provides a mechanism for the activation of muscles paralyzed by injury to the spinal cord. Although this technique was first used to treat patients with spinal cord injury over 20 years ago, only recent advances in electronics and biomechanics have made it a promising aid for the rehabilitation of these patients. Thus far, restoration of palmar prehension and lateral prehension in quadriplegics and of standing and biped gait in paraplegics has been achieved under carefully controlled laboratory conditions. This article reviews the current status of FNS and its potential as a practical tool to aid spinal cord-injured patients. Neurosurgeons who care for these patients might be expected to be involved in the future use of FNS if implantable systems are developed and tested.
A Quantitative Assessment of the Brain Stem Auditory Evoked Response during Intraoperative Monitoring
Authors: Zappulla Rosario , Greenblatt Edward , Kaye Steven , Malis Leonard
Published: May 2010

The brain stem auditory evoked response (BAER) was monitored intraoperatively in 11 patients with tumors of the posterior fossa. A technique for the objective quantitative assessment of the BAER based on the variance of the phase angle between small group averages is described. The resulting component synchrony measure corroborated standard peak latency and amplitude changes of the BAER during operative manipulation. A discussion of the replication and use of the objective measure is presented.