bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental brain injury: successful therapy with the weak base, tromethamine
Authors: Rosner Michael J. , Becker Donald P.
Published: May 2009

✓ The presence of lactic acidosis in the cerebrospinal fluid of patients suffering brain injury as the result of trauma, subarachnoid hemorrhage, neoplasia, or ischemia has been well documented. The authors theorized that this acidosis becomes harmful in itself, and that treatment with an alkalinizing agent (tris(hydroxymethyl)aminomethane: tromethamine) capable of penetrating the blood-brain barrier would be efficacious. Fifteen pairs of mongrel cats were subjected to a 2.85-atmosphere fluid-percussion injury (LD80), and were supported by respirators for up to 72 hours prior to being placed in cages for an additional 4 days of observation. Experimental cats underwent continuous infusion of tromethamine (begun 10 minutes after injury); control animals were infused with an equal volume of lactated Ringer's solution. Twenty percent of the control group survived until sacrificed on Day 7 post-injury. Survival in the tromethamine group was 60% (p < 0.05), and morbidity also appeared to be reduced in the treated cats. Intracranial pressure (ICP) in treated cats was 60% (p < 0.05) of that in the control cats after respirator support for 3 days. Tromethamine infusion was associated with improved survival, decreased morbidity, and decreased ICP when compared with results in control animals. The literature with regard to central nervous system acidosis has been reviewed in an attempt to clarify and define this problem.
Establishment of experimental malignant glioma-specific cytotoxic T lymphocyte clone by T cell growth factor
Authors: Yamasaki Toshiki , Handa Hajime , Yamashita Junkoh , Namba Yuziro , Watanabe Yoshihiko , Kuwata Shigeki , Hanaoka Masao
Published: May 2009

✓ In an attempt to facilitate the long-term proliferative growth and subsequent cloning of cytotoxic T lymphocytes (CTL's) against syngeneic murine 203-glioma (20-methylcholanthrene-induced ependymoblastoma of C57BL/6 mouse origin), sensitized T lymphocytes from tumor-bearing mice were cultured in the presence of T cell growth factor (TCGF). Of five clones established by a limiting dilution technique, two clones (G-CTLL 1 and 2) exhibited tumor-specific cytotoxicity. G-CTLL 1 cells, which possessed much higher cytotoxic activity than G-CTLL 2 cells, were further analyzed. G-CTLL 1 cells were maintained in a TCGF-dependent exponential proliferative culture for over 18 months and continued to mediate an extremely high cytotoxic activity with the target specificity (50- to 100-fold increases over the peak cytotoxic activity of sensitized T lymphocytes in tumor-bearing mice). Their phenotypes of surface antigens were Thy-1+ (weak positive), Lyt-1.−2.+3+, and asialo-GM1−, and their cytotoxicity was blocked by adding only anti-Lyt-2 monoclonal antibodies. These results indicated that the cloned cells originated from CTL's. The cloned cells were characterized by the production of immune interferon with the glioma antigen-stimulation, suggesting that the immune interferon could enhance the cytotoxic activity of the CTL clone at the site of a clone-target cell recognition event.
Jugular foramen schwannomas
Authors: Kaye Andrew H. , Hahn Joseph F. , Kinney Sam E. , Hardy Russell W. , Bay Janet W.
Published: May 2009

✓ Thirteen patients with schwannomas of the jugular foramen were operated on at the Cleveland Clinic between 1974 and 1983. The authors' experience in managing these rare tumors is presented. Three major growth patterns of jugular foramen schwannoma were seen, and it is postulated that the position of the tumor depends on its point of origin from the nerves as they pass through the pars nervosa of the jugular foramen. The more distal lesions will expand inferiorly out of the base of the skull, and the more proximal lesions will enlarge into the posterior fossa. Tumors in the mid region will tend to expand primarily into bone. The schwannoma was primarily intracranial in six patients. In five patients the tumor expanded the bone at the base of the skull, with only a small intracranial component, and in two patients the tumor was primarily extracranial, with a small extension into the bone or posterior fossa. The presentation of the patients varied according to the tumor growth pattern. Deafness, vertigo, and ataxia were present in all patients with a major intracranial component, and in most of these there were only minimal deficits of the jugular foramen nerves. By contrast, lower cranial nerve involvement, including hoarseness and weakness of the trapezius and sternocleidomastoid muscles, occurred in patients in whom the tumor was primarily within the bone or extracranial. Three of the five patients with the major component of the schwannoma within the bone also had deafness. Symptomatic history was longest in those with tumor mainly involving the bone at the base of the skull, and shortest in patients with entirely extracranial tumor. Surgical resection was accomplished with a joint neurosurgical-otological approach, usually combining a posterior fossa exploration with either a translabyrinthine transcochlear or infralabyrinthine procedure. The exact nature of the operation depended upon the presence of intracranial tumor and on the extent of bone or extracranial involvement. Total excision was performed in all cases. There was no operative mortality, and surgery resulted in loss of function of the ninth, 10th, and 11th cranial nerves in most patients. The major postoperative morbidity consisted of swallowing difficulties and sputum aspiration.
A new model of transient hindbrain ischemia in gerbils
Authors: Yamada Kazuo , Hayakawa Toru , Yoshimine Toshiki , Ushio Yukitsks
Published: May 2009

✓ A model of transient hindbrain ischemia in Mongolian gerbils is described. The vertebrobasilar junction of gerbils was exposed by a transcervical approach through the space between the atlas and occipital bone. The origin of the basilar artery was occluded by a clip, and the local cerebral blood flow (CBF) was measured with carbon-14-iodoantipyrine autoradiography. This gerbil model produces ischemia in the thalamus, midbrain, pons, medulla, and cerebellum, where blood flow is supplied from the vertebrobasilar system. Recirculation of blood flow was easily accomplished by removing the clip. Local CBF returned to normal levels immediately after recirculation, then decreased at 30 minutes after recirculation (postischemic hypoperfusion). Almost no effects of local CBF in the forebrain structures were noted during and after hindbrain ischemia. The model may be useful to study the pathophysiological, metabolic, and histopathological effects of ischemia in the vertebrobasilar system.
Traumatic carotid-cavernous fistula due to transection of the intracavernous carotid artery
Authors: Sbeih Ibrahim A. , O'Laoire Sean A.
Published: May 2009

✓ The authors report a case of a high-flow posttraumatic carotid-cavernous fistula, with complete steal of the blood flow from the ipsilateral internal carotid artery (ICA). Direct attack on the intracavernous carotid artery was performed using the approach of Parkinson with temporary isolation of the ICA. Complete transection of the artery within the cavernous sinus was encountered. The fistula was occluded by clipping the two ends of the ICA within the sinus. The implications of this previously unreported finding are discussed.
Giant aneurysm arising from a single arteriovenous fistula in a child
Authors: Carrillo Rafael , Carreira Luis Miguel , Prada José , Rosas Cesareo , Egas Guillermo
Published: May 2009

✓ A case is presented of a child with an arteriovenous fistula and a giant aneurysm located beside the brain stem under the right temporal lobe. It was successfully treated by clipping its feeding artery, a branch of the right posterior cerebral artery. The similarities to, and the differences from, aneurysms of the vein of Galen are discussed.
Causalgic pain relieved by prolonged procaine amide sympathetic blockade
Authors: Leipzig Thomas J. , Mullan Sean F.
Published: May 2009

✓ Reversible sympathetic blocks diagnostically relieve causalgic pain. At times, repeated blocks may be therapeutic. Causalgic pain of the left hand was successfully treated in a nonsurgical candidate by a continuous infusion of local anesthetic (procaine) into the region of the stellate ganglion. This technique was performed without significant complication and gave relief from the causalgia for extended periods of time. It may provide an effective alternative to surgical sympathectomy in high-risk patients.
Primary cutaneous extravertebral meningioma
Authors: Zaaroor Menashe , Borovich Bernardo , Bassan Lucyna , Doron Yaffa , Gruszkiewicz Jan
Published: May 2009

✓ A case of cutaneous extravertebral meningioma is presented. It was diagnosed in infancy as a lumbar meningocele. Operation was initially refused but was subsequently demanded for cosmetic reasons. The findings were a very thick corrugated skin and a cutaneous meningioma connected by a fibrous tract to the dura mater. The presence of a fibrous stalk linking the tumor to the dura mater might have been the pathogenetic connection between the meningocele and cutaneous meningioma.
Immunohistochemistry of central nervous system tumors
Authors: Bonnin Jose M. , Rubinstein Lucien J.
Published: May 2009

✓ Immunofluorescence and immunoperoxidase (peroxidase-antiperoxidase, PAP) techniques for the demonstration of neural and non-neural cell markers are contributing greatly to increase the diagnostic accuracy of difficult tumors of the central nervous system. Well characterized nervous system markers include glial fibrillary acidic (GFA) protein, the three protein subunits of neurofilaments, neuron-specific enolase (NSE), myelin basic protein, and S-100 protein. The most important and reliable of these is GFA protein, which is widely in use for the immunohistochemical diagnosis of tumors of the glioma group. Its many practical applications are reviewed and illustrated. Other neural markers, in particular the specificity of NSE and S-100 protein, need to be critically evaluated. Problems related to the immunohistochemical diagnosis of central neuroepithelial tumors of putative neuroblastic origin remain complex and still need to be resolved. Non-neural markers, such as vimentin, desmin, cytokeratins, Factor VIII, alpha-fetoprotein, human chorionic gonadotropin, and immunoglobulins have well defined, although more restricted, applications in surgical neuropathology.
Mononuclear lymphoid populations infiltrating the microenvironment of primary CNS tumors
Authors: von Hanwehr Roger I. , Hofman Florence M. , Taylor Clive R. , Apuzzo Michael L. J.
Published: May 2009

✓ Mononuclear cell infiltrates are found to varying degrees in 30% to 60% of primary human central nervous system (CNS) gliomas. To explore the immunological importance of this, six operative glial tumors, eight non-glial tumors, and three normal brain specimens were studied. Utilizing an immunoperoxidase method, the authors examined frozen sections for lymphoid infiltrates expressing suppressor/cytotoxic and helper phenotypes, as identified with the Leu-1,2,3 monoclonal antibodies. Four of six gliomas demonstrated lymphoid infiltrates: three tumors exhibited a predominant suppressor/cytotoxic cell phenotype and the fourth showed mixed staining of suppressor/cytotoxic and helper cell phenotypes. Varying degrees of lymphoid infiltration characterized four out of eight non-glial primary CNS tumors. Two cases exhibited a prevalence of suppressor/cytotoxic phenotype cells, while two cases demonstrated a more heterogeneous pattern of phenotype expression. Normal brain sections revealed little or no evidence of mononuclear infiltrates. The immunobiological significance of these findings is discussed in the context of tumor-host interaction within the CNS.
Families, brain death, and traditional medical excellence
Authors: Pinkus Rosa Lynn
Published: May 2009

✓ Staff neurosurgeons and residents at a tertiary care hospital designated as a transplant center were surveyed regarding personal opinions concerning brain death and family conferences. Compared to an extensive survey done in 1976, the responses indicated that, while a professional consensus regarding the definition and meaning of brain death has emerged in the past 10 years, a range of personal beliefs and opinions regarding the concept still exists. In spite of the professional consensus, it is still difficult for the physician to communicate gently, yet firmly, to families both the scientific groundwork that validates the determination of brain death, the concept, and the finality of the information.
Systemic and cerebral effects of prostacyclin-induced arterial hypotension in the dog
Authors: Boarini David J. , Kassell Neal F. , Olin Julie J. , Sprowell James A.
Published: May 2009

✓ Prostacyclin has strong vasodilating and antiplatelet properties. This study was performed to investigate its potential for producing profound intraoperative hypotension. Five dogs were anesthetized with morphine, nitrous oxide, and oxygen, paralyzed with pancuronium, and ventilated to a PaCO2 of 40 torr. Mean arterial blood pressure (MABP) was lowered to 40 mm Hg with an intravenous infusion of prostacyclin in 0.05 M Tris buffer (average rate of infusion 3 ± 1 µg/kg/min). Blood flow was determined using the radioactive microsphere technique. Measurements were made before and after 20, 40, and 60 minutes of hypotension; and after a 40-minute recovery period. Infusion of prostacyclin reduced MABP 63% while increasing heart rate 51%. Tachyarrhythmias occurred in all dogs, and cardiac index decreased 18%. Myocardial blood flow decreased an average of 29%, cerebral blood flow decreased 30%, cerebellar blood flow decreased 18%, and blood flow in the brain stem and spinal cord was unchanged. Cerebral metabolic rate of oxygen, determined by measuring the oxygen content of the sagittal sinus, was unchanged. Hypotension was easily induced and maintained using prostacyclin, without apparent tachyphylaxis. However, the cardiac changes caused by this drug are more severe than those accompanying hypotension induced by most other agents, and may represent a serious contraindication to its clinical use.
Pulmonary hypertension, pulmonary edema, and decreased pulmonary compliance produced by increased ICP in cats
Authors: Newman Melvin M. , Kligerman Marta , Willcox Mary
Published: May 2009

✓ Cats, anesthetized with sodium pentobarbital, were cannulated to measure pulmonary, systemic, and left atrial pressures and pulmonary ventilation, compliance, and resistance. Intracranial pressure was elevated to 30 mm Hg by injecting silicone oil into the extradural space. After an average time of 56 minutes, pulmonary systolic and diastolic pressures more than doubled, systemic systolic pressure sometimes rose and sometimes fell, and diastolic pressure rose 5%. Left atrial pressure never exceeded 8 cm of saline. Pulmonary compliance decreased by one-half, but airway resistance was unchanged. Pulmonary edema was estimated from histological sections. The pulmonary hypertension may be the result of a sympathetic discharge confined to the lung, since no remarkable changes in heart rate or systemic blood pressure occurred. The decrease in pulmonary compliance followed the rise in pulmonary arterial pressure, and is interpreted as the result of interstitial edema. There was no evidence that left heart failure or elevated left atrial pressure caused the pulmonary edema.
Effect of high-frequency ventilation versus conventional mechanical ventilation on ICP in head-injured dogs
Authors: Grasberger Robert C. , Spatz Edward L. , Mortara Ronald W. , Ordia Joe I. , Yeston Neil S.
Published: May 2009

✓ Changes in intrathoracic pressure may influence intracranial pressure (ICP), presumably by affecting venous return. High-frequency ventilation (HFV) has been associated with lower intrapleural and airway pressures and has the potential to lower ICP. To evaluate the effects of HFV compared to conventional ventilation on ICP, normocarbia was maintained in nine dogs while alternating between conventional ventilation and HFV at 200 breaths/min. The mean ICP was raised from 6.3 ± 6.1 to 24.7 ± 1.04 mm Hg by inflation of Fogarty balloons implanted in the epidural space. The ICP peaks associated with positive inflation pressures were eliminated with HFV, but mean ICP was not significantly different between the two ventilatory modes (23.4 ± 9.7 mm Hg for the conventional system versus 26.0 ± 10.0 mm Hg for HFV). Four dogs exhibited neurogenic pulmonary edema: they developed elevated pulmonary artery and intrathoracic pressures and required increased inspiratory flow with HFV to maintain normocarbia. The authors conclude that, in this head-injury model, there did not seem to be an advantage of HFV over conventional ventilation.
Bacterial aneurysms of the intracavernous carotid artery
Authors: Rout Damodar , Sharma Ajay , Mohan Pochiraju K. , Rao Vedula R. K.
Published: May 2009

✓ Six cases of bacterial intracavernous carotid artery aneurysms of extravascular origin secondary to cavernous sinus thrombophlebitis are reported along with a review of 12 similar cases collected from the literature. Of the authors' six cases, there were three children and three adults. Meningitis was found in five patients. All patients received prolonged antibiotic therapy. Spontaneous resolution of the aneurysm occurred in one patient, thrombosis of the internal carotid artery in another, and progressive enlargement of the aneurysm was seen on sequential angiography in the other two. Evidence of associated arteritis was present in all of the patients. Carotid ligation for persistent ophthalmoplegia was carried out in two patients, of whom one had a giant aneurysm and the other progressive aneurysm enlargement. The results of treatment were good in all cases. The authors believe that carotid arteriography is obligatory in cases of cavernous sinus thrombophlebitis in which ophthalmoplegia persists despite adequate antibiotic therapy.
Changes in food intake with electrical stimulation of the ventromedial hypothalamus in dogs
Authors: Brown Frederick D. , Fessler Richard G. , Rachlin Jacob R. , Mullan Sean
Published: May 2009

✓ Six adult dogs were implanted stereotaxically with chronic indwelling Medtronic platinum-tipped electrodes in the left ventromedial hypothalamic area (VMH); two dogs with electrodes placed in the subcortical white matter served as controls. Following 24 hours of food deprivation, VMH-stimulated dogs delayed their next meal for a period ranging from 1 to 18 hours. When not stimulated, however, each dog ate immediately upon receiving its food and consumed greater than average daily intake (p < 0.005). The two control dogs ate immediately upon receiving food regardless of whether they were stimulated or not. Dogs that received 1 hour of VMH stimulation every 12 hours for 3 consecutive days maintained an average daily food intake of 35% of normal baseline levels (range 13% to 51%), and water consumption averaged 50% of baseline intake (range 29% to 67%). Both of these results were statistically significant (p < 0.01). After cessation of stimulation, food and water intake returned to normal within 6 to 9 days, with no observable “rebound hyperphagia.” The two animals that received subcortical electrodes showed no change in food or water intake with stimulation. Blood pressure, pulse, respiration, temperature, and gross behavior were not altered during or after stimulation. These results suggest that the use of electrical stimulation of the VMH may be a useful modality for regulating food intake, and deserves further examination as a potential alternative therapy for human morbid obesity.
Dorsal root entry zone lesions for the treatment of post-herpetic neuralgia
Authors: Friedman Allan H. , Nashold Blaine S. , Ovelmen-Levitt Janice
Published: May 2009

✓ Post-herpetic pain was treated in 12 patients using dorsal root entry zone (DREZ) lesions. All patients had failed to receive adequate pain relief from conservative therapy consisting of transcutaneous nerve stimulation, carbamazepine, and/or amitriptyline. Dorsal root entry zone lesions were made to include the involved dermatomes plus one-half of the dermatomes above and below the painful areas. Eight patients reported good pain relief with follow-up periods ranging from 6 to 21 months. A ninth patient obtained satisfactory pain relief, but the superior 1 cm of the original painful area was not included in the distribution of the DREZ lesions. Patients whose lesions were performed using a thermally controlled lesion probe suffered no significant postoperative neurological deficit. Dorsal root entry zone lesions appeared to be a satisfactory treatment for post-herpetic neuralgia in patients who have failed to respond to more conservative modes of therapy.
Acute nonlymphocytic leukemia following treatment of malignant glioma
Authors: Kempin Sanford , Sundaresan Narayan , Shapiro William B. , Arlin Zalmen
Published: May 2009

✓ Two patients with malignant brain tumors who developed acute nonlymphocytic leukemia after treatment with radiation and chemotherapy are described. Both patients survived more than 2 years after diagnosis of the brain tumor. Survival following the diagnosis of leukemia was short, and both patients died of hemorrhage secondary to thrombocytopenia. A review of the literature reveals that leukemia after combined-modality treatment of malignant brain tumors is rare. A prolonged survival period from diagnosis of the primary tumor, treatment with nitrosoureas and radiation, plus the development of a preleukemic myelodysplastic syndrome are all important features of therapy-related nonlymphocytic leukemia.
Acutely thrombosed aneurysm of the middle cerebral artery presenting as intracranial hemorrhage in a 3-year-old child
Authors: Andrews Brian T. , Edwards Michael S. B. , Gannon Peter
Published: May 2009

✓ Spontaneous thrombosis of aneurysms occurs rarely in children, and, to our knowledge, there are no reports of aneurysms presenting as an embolic event in a child. We describe the case of a 3-year-old boy whose symptoms initially suggested an ischemic event to the dominant hemisphere. Initial computerized tomography scans indicated an intracranial hemorrhage. Subsequent radiographic study revealed evidence of emboli and, at exploration, a large acutely thrombosed aneurysm of the left middle cerebral artery associated with arterial occlusion was found. Entrapment of the aneurysm and thrombectomy provided excellent operative results.
An unusual fibro-osseous lesion of the brain
Authors: Jun Cecil , Burdick Bruce
Published: May 2009

✓ An unusual case is described of a fibro-osseous lesion of the brain. Some other causes of densely calcified intracranial lesions are briefly discussed.
Surgical treatment of middle cerebral artery aneurysms
Authors: Suzuki Jiro , Yoshimoto Takashi , Kayama Takamasa
Published: May 2009

✓ The authors report their experience with the surgical therapy of middle cerebral artery (MCA) aneurysms in 413 cases, and describe their technique. After the M1 portion of the MCA is identified, the Sylvian fissure is opened. During the administration of 20% mannitol, temporary occluding clips are applied to the feeding and draining vessels of the aneurysm. The aneurysm is freed from all surrounding tissue, and the aneurysm neck is treated by ligation, clipping, or wrapping. Analysis of surgical results in 91 cases operated on after the surgical approach had become standardized indicates that more than 94% of patients have returned to useful social lives by the time of follow-up evaluation. Twenty-four percent of these patients were operated on within 48 hours after subarachnoid hemorrhage.
Cerebral blood flow and ICP patterns in patients with communicating hydrocephalus after aneurysm rupture
Authors: Hayashi Minoru , Kobayashi Hidenori , Kawano Hirokazu , Yamamoto Shinjiro , Maeda Toshio
Published: May 2009

✓ Cerebral blood flow (CBF) was measured, the intracranial pressure (ICP) was continuously recorded, and the ventricular system size was evaluated on serial computerized tomography scans in 43 patients. These patients all had communicating hydrocephalus after subarachnoid hemorrhage (SAH) from rupture of an intracranial aneurysm. The studies were carried out both in the acute stage (within 7 days after SAH) and in the communicating hydrocephalus stage. In patients in the acute stage who had no ventricular dilatation, but who later developed communicating hydrocephalus, the mean CBF was reduced; lower CBF was associated with poorer clinical grades and a higher resting pressure range. Communicating hydrocephalus produced a significant decrease in CBF. The ICP tracing showed continuing plateau waves in conjunction with B-waves in patients in whom recordings were begun within 63 days after SAH. In general, patients with more dilated ventricular systems, with less frequent ICP irregularities, and with lower resting pressure ranges had a more marked decrease in CBF. A significant decrease in CBF was also found in patients with diffuse vasospasm in comparison to those without vasospasm. Patients with communicating hydrocephalus in whom ICP recordings were started more than 6 months after SAH showed no ICP irregularities. In these patients, a mean CBF of less than 25 ml/100 gm/min and a markedly low resting pressure range were observed. Shunting procedures were never effective in any of these patients. The results suggest that, in patients with communicating hydrocephalus, a mean CBF below this level may cause irreversible damage to the brain tissue in the terminal stage, and may inhibit the cerebral vasomotor reaction that participates in the development of ICP irregularities.
Computerized tomography of cranial sutures
Authors: Furuya Yoshimi , Edwards Michael S. B. , Alpers Charles E. , Tress Brian M. , Norman David , Ousterhout Douglas K.
Published: May 2009

✓ Preoperative computerized tomographic (CT) scans of 24 children who had surgery for either single or multiple craniosynostoses were compared with skull radiographs and operative and pathological findings. In addition to providing accurate imaging of calvarial and skull base deformities secondary to premature suture closure, high-resolution CT with bone definition algorithms supplied valuable detail of anatomical changes at the abnormally developed suture. The CT findings varied with the location of the suture. Thickened bony ridges predominated at the sagittal suture, focal bone thickening and erosions were more likely to be found at the metopic suture, and parasutural sclerosis was the prevalent finding on one side of the lambdoid suture. No evidence of the suture could be detected in the majority of patients with complete coronal craniosynostosis. Radiographs of the skull were shown to be a relatively insensitive means of imaging the zone of limited fusion, especially the lambdoid suture. An excellent correlation was found between the CT scan and the operative and pathological findings. There was histological evidence of progressive suture fusion in virtually all patients. An asymmetrically narrowed lucent zone with parasutural sclerosis or bony ridges seen on CT scans correlated well with fibrous union of the suture found on histological examination. The authors conclude that high-definition CT used in conjunction with bone windows and thin and coronal slices for the evaluation of sagittal sutures is a useful imaging method for the evaluation of craniosynostosis.
Ultrastructure of early calcification in cervical ossification of the posterior longitudinal ligament
Authors: Kubota Toshihiko , Sato Kazuhumi , Kawano Hirokazu , Yamamoto Shinjiro , Hirano Asao , Hashizume Yoshio
Published: May 2009

✓ A case of ossification of the cervical posterior longitudinal ligament was investigated with the electron microscope. The posterior longitudinal ligament was composed of bundles of collagen fibers intermingled with occasional fibroblasts and rare blood vessels. Some ligaments contained matrix vesicles in the vicinity of degenerated cells. Hydroxyapatite crystals were frequently precipitated within the matrix vesicles. These findings are similar to the fine structure of the early stage of calcification in normal and pathological calcifying tissues described previously. In this study, the calcification process of the posterior longitudinal ligament suggests that matrix vesicles originate from degenerated cells, and acquire hydroxyapatite crystal deposits. Some eventually coalesce to form a large calcifying mass. Substantial amounts of collagen fibers comprising the ligament may serve an important role in orienting apatite crystal precipitation.
Pain relief from peripheral conditioning stimulation in patients with chronic facial pain
Authors: Eriksson Margareta B. E. , Sjölund Bengt H. , Sundbärg Göran
Published: May 2009

✓ In a prospective study, 50 consecutive patients, referred to a pain treatment unit for surgery to alleviate various forms of facial pain, were all given transcutaneous nerve stimulation (TNS) therapy and followed for 2 years. Of the 44 patients remaining at the 2-year follow-up review, 20 (45%) reported satisfactory analgesia from conventional or acupuncture-like TNS. The latter technique markedly improved the overall results. No serious side effects were seen. Atypical facial pain of known etiology responded best to treatment, but satisfactory relief was often produced with tic douloureux. Duration of the pain condition as well as sex of the patient were predictors of treatment results. It is concluded that TNS therapy represents a valid alternative to surgery when pharmacological therapy fails, especially in the elderly and in patients with atypical facial pain.
Experiences with the anti-siphon device (ASD) in shunt therapy of pediatric hydrocephalus
Authors: Gruber Rolf , Jenny Peter , Herzog Bruno
Published: May 2009

✓ A follow-up study was performed on 41 hydrocephalic children with primary (10 patients) or secondary (31 patients) placement of an anti-siphon device (ASD) connected to their shunt. The clinical course before and after ASD implantation was compared in these two groups, including studies of the head circumference, the radiological ventricular size, cerebrospinal fluid pressure studies on the supine and upright patient, and the history of shunt-induced complaints and complications leading to hospitalization. The authors discuss the pathophysiological concept of the “chronic overdrainage” or slit-ventricle syndrome based on ventricular collapse due to chronic suction-induced overdrainage by the vertical shunt system in the upright patient. The use of an ASD in connection with the regular shunt system of children with hydrocephalus is proposed. This ASD-shunt combination successfully reduced the number of complaints and shunt dysfunctions over a period of more than 6 years.
Modification of Cloward cervical retractor
Authors: Leibrock Lyal G. , Berman Bradley M.
Published: May 2009

✓ A modification of a Cloward lateral cervical retractor with sharp blades is described. The purpose of the adaptation is to help prevent injuries to soft tissues of the neck and to facilitate placement during anterior cervical discectomy and fusion.
Viral infections of the nervous system
Authors: Weiner Leslie P. , Fleming John O.
Published: May 2009

✓ Neurotropic viruses cause a number of important infectious syndromes including encephalitis, myelitis, meningitis, and radiculopathy. In this review, the biology of conventional and unconventional viruses is examined. The host immune response to viruses is discussed, and patterns of viral pathogenesis are explained. The clinical features, laboratory findings, management of important viral infections, such as herpes simplex encephalitis and epidemic encephalitis, are presented. Post-infection syndromes, such as the Guillain-Barré syndrome, and chronic viral infections, such as those causing progressive multifocal leukoencephalopathy and subacute sclerosing panencephalitis, are discussed. Current knowledge concerning the nature of unconventional virus-like agents of the spongiform encephalopathies, including kuru and Creutzfeldt-Jakob disease, is summarized. Finally, viral infections of immunocompromised patients and the possible role of viruses in the newly described acquired immunodeficiency syndrome (AIDS) are examined.
Antifibrinolytic therapy in the acute period following aneurysmal subarachnoid hemorrhage
Authors: Kassell Neal F. , Torner James C. , Adams Harold P.
Published: May 2009

✓ Antifibrinolytic therapy remains a controversial issue in the management of subarachnoid hemorrhage (SAH). The relationship of antifibrinolytic therapy with mortality, rebleeding, ischemia, hydrocephalus, and clotting abnormalities was studied in 672 patients in the International Cooperative Study on the Timing of Aneurysm Surgery. The patients with antifibrinolytic therapy had a significantly lower rebleeding rate, but higher rates of ischemic deficits and hydrocephalus. The net result was no difference in mortality in the 1st month following the initial SAH. Further clinical trials are needed to determine the overall effects of antifibrinolytic therapy.
Intracarotid slow bolus injection of nimodipine during angiography for treatment of cerebral vasospasm after SAH
Authors: Grotenhuis J. Andre , Bettag Winfried , Fiebach B. J. Othmar , Dabir Khosrow
Published: May 2009

✓ Nimodipine was given as an intracarotid slow bolus injection in six patients with subarachnoid hemorrhage (SAH) due to rupture of a cerebral aneurysm, with angiographically demonstrated vasospasm. The patients were followed by serial angiograms for demonstration of the effect of nimodipine on vasospasm. After angiography, all patients were treated with a constant venous infusion of this new calcium antagonist. Although the therapeutic regimen was started only a few hours after onset of vasospasm, there was no change in cerebral vessel caliber detectable on angiograms following the intracarotid injection. Three patients died, two patients finally recovered with neurological deficits due to cerebral ischemia, and one patient with asymptomatic vasospasm remained symptom-free. Although nimodipine may act to prevent cerebral vasospasm after SAH, the authors believe that the intracarotid application is not effective after vasospasm has occurred.
Chronic subdural hematoma: surgical management in 133 patients
Authors: Robinson Richard G.
Published: May 2009

✓ One hundred and thirty-three patients with chronic subdural hematoma were treated surgically between 1943 and 1980. The patients, aged 5 to 84 years, were graded retrospectively according to the Bender scale; 28% were in Grades 3 and 4. There were 107 unilateral and 26 bilateral hematomas. The clots were removed mostly via burr-holes without drainage. The treatment of 121 patients included an active policy of brain expansion at operation and the postoperative management of intracranial hypotension by lumbar injection. Two patients died, for a mortality rate of 1.5%. The patients who died were 54 and 59 years old, both from among the 26 cases with bilateral lesions; 107 unilateral lesions were treated, with no deaths. None of 51 patients who were aged 61 years and over died. The mean postoperative stay was 17.2 days, and at 3 weeks 77% had been discharged home. Fifteen percent of survivors had permanent disabilities. The common residual deficits were personality and memory disorders, and there was hemiparesis in Grade 4 cases. The high-riskm groups of chronic subdural hematoma were those in Grades 3 and 4, bilateral hematomas, and the elderly. These seemed to be benefited by brain inflation and lumbar injections for intracranial hypotension.
Trial of a new operative method for recurrent chronic subdural hematoma
Authors: Oku Yuzuru , Takimoto Noboru , Yamamoto Kazumi , Onishi Takanori
Published: May 2009

✓ A new operative method for treating recurrent chronic subdural hematoma is presented. This method consists of complete obliteration of the subdural hematoma cavity and conversion of the hematoma cavity into epidural space. The procedure was carried out in three patients with recurrent chronic subdural hematoma, all of whom made a complete recovery.
Infantile acute subdural hematoma
Authors: Aoki Nobuhiko , Masuzawa Hideaki
Published: May 2009

✓ Twenty-six cases of infantile acute subdural hematoma treated between 1972 and 1983 were reviewed. The series was limited to infants with acute subdural hematoma apparently due to minor head trauma without loss of consciousness, and not associated with cerebral contusion. Twenty-three of the patients were boys, and three were girls, showing a clear male predominance. The patients ranged in age between 3 and 13 months, with an average age of 8.1 months, the majority of patients being between 7 and 10 months old. Most of the patients were brought to the hospital because of generalized tonic convulsion which developed soon after minor head trauma, and all patients had retinal and preretinal hemorrhage. The cases were graded into mild, intermediate, and fulminant types, mainly on the basis of the level of consciousness and motor weakness. Treatment for fulminant cases was emergency craniotomy, and that for mild cases was subdural tapping alone. For intermediate cases, craniotomy or subdural tapping was selected according to the contents of the hematoma. The follow-up results included death in two cases, mild physical retardation in one case, and epilepsy in one case. The remaining 23 patients showed normal development.

The relationship between computerized tomography (CT) findings and clinical grading was analyzed. Because some mild and intermediate cases could be missed on CT, the importance of noting the characteristic clinical course and of funduscopic examination is stressed.
Evaluation of cervical spinal cord injuries with metrizamide myelography-CT scanning
Authors: Cooper Paul R. , Cohen Wendy
Published: May 2009

✓ In the past, patients with injuries of the cervical spine and spinal cord have been diagnosed by means of myelography and polytomography. In an attempt to improve the radiographic evaluation of patients with cervical spinal cord injuries the authors performed computerized tomography (CT) scanning of the cervical spine following injection of metrizamide into the spinal subarachnoid space. In 23 patients with cervical spinal cord injuries, metrizamide myelography was performed via a C1–2 puncture. Myelography was used only for localization of the lesion and to determine the site of CT scanning. After myelography, CT scanning of the cervical spine in the transaxial plane was effective in determining the exact nature of compressive lesions and distinguishing the etiology among hematoma, disc, bone fragments, osteophytes, or ossification of the posterior longitudinal ligament. In several patients, metrizamide could be seen entering the spinal cord and was indicative of anatomical spinal cord disruption. In patients with fractures, CT scanning identified the site and nature of the injury without the need for turning the patient to the lateral position. In several patients with an apparently stable cervical spine, the CT scan showed apophyseal joint widening indicative of instability. The authors conclude that CT scanning of the cervical spine after the introduction of metrizamide into the subarachnoid space provides a definitive evaluation of the cervical spinal cord, the bone structures of the cervical spine, and their relationship to each other.
Prognostic importance of cellular differentiation in medulloblastoma of childhood
Authors: Packer Roger J. , Sutton Leslie N. , Rorke Lucy B. , Littman Phillip A. , Sposto Richard , Rosenstock Jeffrey G. , Bruce Derek A. , Schut Luis
Published: May 2009

✓ Medulloblastoma is the most common intracranial primitive neuroectodermal malignancy of childhood. Certain parameters are predictive of survival in children with medulloblastoma; however, tumor histology is of unclear prognostic value. A classification system, proposed by Rorke for all central nervous system (CNS) neoplasms composed of primitive neuroepithelial cells, was utilized in a review of 38 consecutive patients with newly diagnosed medulloblastoma. The classification is based on the concept that medulloblastoma is not unique to the cerebellum but is similar to tumors that may arise elsewhere in the CNS consequent to neoplastic transformation of primitive neuroepithelial cells. Cells forming the tumors may remain in the undifferentiated state or they may exhibit differentiation along glial, and/or ependymal, and/or neuronal lines. For purposes of simplification, the cases were divided into two major groups: those primitive neuroectodermal tumors (PNET's) which showed no evidence of cellular differentiation (PNET-U) and those that were differentiated (PNET-D). There were 20 cases in the PNET-U group and 18 in the PNET-D group. The 4-year survival rate was 70% for PNET-U, compared to 32% for PNET-D (p = 0.004). Only one of 10 children with PNET-D with differentiation along more than one cell line survived. Other factors, including age at diagnosis, tumor metastasis (TM) stage, and extent of surgical resection, were analyzed and were of prognostic importance; but histological features remained statistically significant within each subgroup.
Fourth ventriculoceles with extracranial extension
Authors: Fenstermaker Robert A. , Roessmann Uros , Rekate Harold L.
Published: May 2009

✓ The radiographic features and long-term clinical outcome in three patients who presented at birth with a cystic suboccipital mass in direct communication with the fourth ventricle are reviewed. The pathological findings in a fourth infant who died are also discussed. All surviving infants were treated with cyst excision and diversion of cerebrospinal fluid. The prognosis in these children, followed from 6 to 20 years, surpasses that of the more common occipital encephalocele, for which this entity could be mistaken. The morphogenetic implications relative to more common congenital lesions in this location are discussed.
Combined malignant lymphoma of the eye and CNS (reticulum-cell sarcoma)
Authors: Rockwood Edward J. , Zakov Z. Nicholas , Bay Janet W.
Published: May 2009

✓ Three cases of histopathologically proven combined ocular and central nervous system (CNS) malignant lymphoma (reticulum-cell sarcoma) are presented. A review of the literature revealed 33 cases described with this syndrome. Symptoms and signs of both CNS and ocular disease are discussed. The results of computerized tomography and angiography are also reviewed. The diagnosis has been made by craniotomy, cerebrospinal fluid cytological examination, and by pars plana vitrectomy. The latter two procedures should probably be attempted prior to considering craniotomy. Reticulum-cell sarcoma of the eye and CNS possibly has a multicentric origin.
Acoustic neuroma in a child treated with the aid of preoperative arterial embolization
Authors: Rushworth Robin G. , Sorby William A. , Smith Sarah F.
Published: May 2009

✓ A child is described who presented with a large right vascular acoustic neuroma causing raised intracranial pressure and brain-stem compression. Ventriculoperitoneal shunting and arterial embolization were performed prior to total tumor excision. Acoustic neuromas are a rarity in childhood, and preoperative arterial embolization has infrequently been described as an adjunct to acoustic neuroma surgery.
Transarterial closure of persistent carotid-cavernous fistula after carotid ligation
Authors: Kapp John P. , Pattisapu Joga R. , Parker J. Larry
Published: May 2009

✓ A carotid-cavernous fistula which had recurred after trapping, embolization, intracranial packing with muscle, and excision of the cervical carotid bifurcation was successfully closed with a Fogarty catheter introduced through the fibrous remnant of the cervical internal carotid artery.
Predictive value of perfusion defect size using N-isopropyl-(I-123)-p-iodoamphetamine emission tomography in acute stroke
Authors: Lee Robert G. L. , Hill Thomas C. , Holman B. Leonard , Royal Henry D. , O'Leary Daniel H. , Clouse Melvin E.
Published: May 2009

✓ Sixteen patients with acute cerebral infarction who were studied with N-isopropyl-I-123-p-iodoamphetamine (IMP) brain scans were followed to determine if the extent of perfusion abnormality was predictive of the clinical course. Lesion size and diminished density on the scans appeared to correlate well with presenting symptoms, but were not predictive of outcome. When evaluated by IMP scanning in conjunction with computerized tomography, however, a group of patients could be identified in whom therapy may improve prognosis.
The Dandy-Walker malformation
Authors: Hirsch Jean-François , Pierre-Kahn Alain , Renier Dominique , Sainte-Rose Christian , Hoppe-Hirsch Elizabeth
Published: May 2009

✓ Forty cases of Dandy-Walker malformation referred to the Hôpital Necker Enfants-Malades between 1969 and 1982 have been reviewed. The incidence of the malformation in hydrocephalus was 2.4%. There was a slight, statistically insignificant, female prevalence.

Hydrocephalus should not be included in the definition of the syndrome. In 80% of the cases, it was actually a post-natal complication of the malformation and most often developed within 3 months after birth. In 80% of the cases, a communication, although insufficient, was found between the dilated 4th ventricle and the subarachnoid space. Since this communication is probably established through the foramina of Luschka, the definition of the Dandy-Walker malformation should only include atresia of the foramen of Magendie. Associated brain and systemic malformations were numerous. Among facial anomalies, facial angiomas were found in 10% of our cases. The association of facial and cardiovascular anomalies favors the hypothesis that the onset of the malformation occurs between the formation and the migration of the cells of the neural crest (that is, between the 3rd and the 4th post-ovulatory week, earlier than previously thought).

Except in selected patients, membrane excision has a high rate of failure and should be abandoned. Cystperitoneal shunting avoids the risk of an entrapped fourth ventricle and is presently the best surgical procedure. The overall mortality in this series was 12.5%. Intelligence quotients were over 80 in 60% of the patients. Other studies will be necessary to understand why the communication between the fourth ventricle and the subarachnoid spaces, sufficient in utero, usually becomes insufficient for a normal cerebrospinal fluid (CSF) circulation in the first months following birth. Two hypotheses are discussed: a change in CSF circulation, or bleeding in the dilated fourth ventricle during delivery.
Surgical treatment of syringomyelia
Authors: Barbaro Nicholas M. , Wilson Charles B. , Gutin Philip H. , Edwards Michael S. B.
Published: May 2009

✓ The authors reviewed the clinical findings, radiological evaluation, and operative therapy of 39 patients with syringomyelia. Syringoperitoneal (SP) shunting was used in 15 patients and other procedures were used in 24 patients. Follow-up periods ranged from 1½ to 12 years. During the period of this study, metrizamide myelography in conjunction with early and delayed computerized tomography scanning replaced all other diagnostic procedures in patients with syringomyelia. Preoperative accuracy for the two procedures was 87%.

The most common symptoms were weakness (79%), sensory loss (67%), pain (38%), and leg stiffness (28%). Surgery was most effective in stabilizing or alleviating pain (100%), sensory loss (81%), and weakness (74%); spasticity, headache, and bowel or bladder dysfunction were less likely to be reversed. Approximately 80% of patients with idiopathic and posttraumatic syringomyelia and 70% of those with arachnoiditis improved or stabilized. Better results were obtained in patients with less severe neurological deficits, suggesting the need for early operative intervention. A higher percentage of patients had neurological improvement with SP shunting than with any other procedure, especially when SP shunting was the first operation performed. Patients treated with SP shunts also had the highest complication rate, most often shunt malfunction. These results indicate that SP shunting is effective in reversing or arresting neurological deterioration in patients with syringomyelia.