bluuebunny/crossref_metadata_2025 huggingface dataset:
Electrophysiological Assessment of Spinal Circuits in Spasticity by Direct Dorsal Root Stimulation
Authors: Fasano Victor Aldo , Barolat-Romana Giancarlo , Zeme Sergio , Sguazzi Angelo
Published: May 2010

Experimental researchers have shown that, because of normal inhibitory processes, repetitive orthodromic stimulation of the dorsal spinal roots induces a depression of the reflex discharge in the spinal motoneurons that is a function of the stimulation rate. Because a lack of inhibitory processes is considered to be the basic mechanism of spasticity, intraoperative stimulation of dorsal spinal roots from L-1 to S-1 bilaterally was performed in 80 patients affected by cerebral palsy. In these patients spasticity (exaggerated stretch reflexes, marked increase of proprioceptive reflexes, and clonus) was the main symptom. We stimulated the dorsal roots adjacent to the spinal cord and recorded motor responses by electromyogram (EMG) in the corresponding muscle groups. The most important findings were that: (a) variable inhibition (diminished, increased, or normal) was encountered in the spinal circuits of the spastic patient; and (b) the individual roots and rootlets can have different effects upon segmentary output. The absence of normal inhibitory processes was the most common finding; surgical sectioning of the corresponding roots resulted in immediate reduction in muscle tone in the related muscles. Selecting the dorsal roots for section results in a remarkable reduction of negative side effects that may follow total or random rhizotomy (marked hypotonia, ataxia, sensory defects) and of the percentage of late recurrences. This procedure results in additional positive effects at segmentary and suprasegmentary levels. These results confirm the idea that the basic mechanism of spasticity is a central defect in the traffic regulation of peripheral afferents as they are transmitted to the spinal cord. This defect causes segmentary and suprasegmentary adaptive reactions that extend the negative outcome of the local increase of muscle tone.
Alexia without Agraphia in a Musician after Transcallosal Removal of a Left Intraventricular Meningioma
Authors: Levin Harvey S. , Rose James E.
Published: May 2010

After a meningioma situated in the trigone of the left lateral ventricle was excised by the transcallosal approach of Kempe and Blaylock, a right-handed musician with a right hemianopsia developed alexia without agraphia. In contrast to previously reported cases of this syndrome arising from other etiologies, he was unable to read single letters or numbers. Neuropsychological studies at 42 and 126 days after operation also disclosed an inability to associate auditory or tactile stimuli with visually perceived material, whereas speech and verbal comprehension were intact. Although the alexia extended to musical notes, he could interpret other musical symbols (e.g., treble clef). Appreciation of rhythm and expressive musical ability were relatively preserved, although judgment of other musical features (including discrimination of pitch, duration, and loudness) was compromised. The findings suggest that alexia may occur as a consequence of the transcallosal procedure when a right hemianopsia is present. However, other linguistic abilities may be better preserved by the transcallosal approach to the ventricle than by a transcortical operation.
Diencephalic Syndrome and Its Relation to Opticochiasmatic Glioma
Authors: DeSousa Alonso L. , Kalsbeck John E. , Mealey John , Fitzgerald Joseph
Published: May 2010

This report, which includes 12 cases of opticochiasmatic glioma with diencephalic syndrome, is a 22-year review of such cases at Indiana University Medical Center. These patients were initially seen because of their failure to thrive, and all were without significant subcutaneous fat. All had pneumoencephalography or ventriculography that showed a suprasellar mass displacing the anterior 3rd ventricle. Surgical confirmation of the diagnosis was obtained in every case. Ten patients underwent radiotherapy with subsequent reversal of the diencephalic syndrome.
Peripheral Nerve Injection Injury
Authors: Gentili Fred , Hudson Alan , Kline David G. , Hunter Dan
Published: May 2010

In an attempt to answer questions regarding nerve injection injuries, we injected 11 agents in current use and commonly administered by intramuscular injection into the sciatic nerves of adult Wistar rats. Equal volumes of normal saline were used as control. We harvested the sciatic nerves at various times after injection and examined them by both light and electron microscopy. We performed myelinated nerve fiber counts and constructed histograms. Any impairment of motor function was also noted. We gave injections to 79 animals a total of 158 times; 116 injections were directly into the nerve fascicle (intrafascicular) and 42 were into the epineural tissue (extrafascicular). The results revealed considerable variation in the degree of nerve fiber injury according to the agent injected. Minimal damage resulted from the injection of irondextran. meperidine, and cephalothin, and maximal nerve injury followed the injection of penicillin, diazepam, and chlorpromazine. The site of injection was crucial. Intrafascicular injection was invariably associated with severe nerve injury, but, with few exceptions, extrafascicular injection resulted in minimal damage. The quantity of drug injected was also important in determining the degree of injury. Large, heavily myelinated fibers were more susceptible to injection injury than smaller, thinly myelinated nerve fibers. The effect of the injected drug seemed to be related to injury of the nerve fiber unit—both the axon and the Schwann cell with its myelin sheath. Regeneration in damaged nerves was a constant finding; even the most severely injured nerves, with total axonal degeneration, underwent subsequent regeneration.
Technique for Spinal Drainage
Authors: Post Kalmon D. , Stein Bennett M.
Published: May 2010

The authors describe a modification of the technique of lumbar subarachnoid catheter drainage of cerebrospinal fluid.
Osteochondroma of the Cervical Spine
Authors: MacGee Edwin E.
Published: May 2010

A 16-year-old girl presented with the sudden onset of transient quadriplegia that occurred while she was swimming. Roentgenograms showed abnormal intraspinal calcification. A computerized tomographic scan was virtually diagnostic of a solitary osteochondroma arising from the posterior arch of the atlas. Surgical excision was curative.
Intraoperative Monitoring of Facial Muscle Evoked Responses Obtained by Intracranial Stimulation of the Facial Nerve
Authors: Delgado Tomas E. , Buchheit William A. , Rosenholtz Henry R. , Chrissian Shavarash
Published: May 2010

abstract

Total microsurgical removal of 14 acoustic neuromas greater than 2 cm in diameter was performed through a unilateral suboccipital approach. Precise quantitative intracranial stimulation of the 7th nerve and recording of the evoked responses of the facial muscles were used to improve the identification and facilitate the dissection of the facial nerve. Preoperative evaluations, techniques, and results are discussed.
Neurofibromatosis and Optic Glioma
Authors: Stern Jack , DiGiacinto George V. , Housepian Edgar M.
Published: May 2010

abstract

Although an association between optic glioma and neurofibromatosis is well recognized, there has been no previous analysis of cases relating the locus of tumor to the presence or absence of von Recklinghausen's disease. This paper presents the results of such an analysis as well as a description of the comparative histology of optic gliomas in patients with and without neurofibromatosis. We conclude that optic gliomas in patients with neurofibromatosis present preferentially as multicentric lesions or as lesions affecting the optic nerve alone without invasion of the chiasm, that these tumors frequently differ morphologically, and that patients with neurofibromatosis and optic glioma may have a clinical course different from that of patients with optic glioma unassociated with neurofibromatosis. Previously published reports are reviewed in light of these observations.
Visual Evoked Potentials
Authors: Sklar Frederick H. , Ehle Albert L. , Clark Kemp W.
Published: May 2010

abstract

Visual evoked potentials (VEPs) to repetitive flash stimuli were abnormal in 10 patients with documented hydrocephalus. Abnormalities included latency delays, fatigability, and asymmetries. Both latency and wave form disturbances improved in the postshunt period. Clinical progression of the hydrocephalus occurred in several patients, and this correlated well with worsening of the VEPs. We suggest that this noninvasive technique may be valuable in following patients with cerebrospinal fluid shunts, patients with presumed “arrested” hydrocephalus, and patients who are being weaned from their shunts.
Radionuclide Cerebral Angiography and the Timing of Aneurysm Surgery
Authors: Kelly P.J. , Gorten R.J. , Rose J.E. , Grossman R.G. , Eisenberg H.M.
Published: May 2010

Forty-five patients with subarachnoid hemorrhage due to verified intracranial aneurysms were studied prospectively to determine whether delaying operations in those patients with abnormal cerebral perfusion, assessed by radionuclide dynamic scanning, would lower case management mortality. Twenty-nine patients had intracranial operations when their radionuclide dynamic scans demonstrated normal perfusion. The one death in this group occurred in a patient who suffered a massive hemorrhage during operation as the bone flap was elevated. There were no instances of delayed spasm after operation. Of the 16 remaining patients who were treated without operation, 5 died. Only 1 of these deaths resulted from recurrent hemorrhage. This patient had normal cerebral perfusion but was not operated upon because of severe associated medical problems. Cerebral infarction occurred in 10 of the 16 unoperated patients, all of whom had persistently decreased cerebral perfusion. Four of these patients died of their infarctions or related causes. Although a trend related vessel caliber as seen on arteriograms and perfusion delay seen on dynamic scanning, individual exceptions were numerous. This study shows that radionuclide scanning, a safe procedure, is useful for identifying two types of patients: those with normal perfusion prone to rebleeding in whom an early operation is safe and those in whom perfusion is decreased. The latter group is prone to cerebral infarction, but rebleeding from the aneurysm is unlikely. Operation should be delayed in these patients until cerebral perfusion returns to normal or for several weeks if cerebral perfusion remains diminished.
Surgical Treatment of Basilar Aneurysms
Authors: Wright Donald C. , Wilson Charles B.
Published: May 2010

The surgical therapy and results in 17 cases of basilar aneurysm are reported, extending a series of 15 reported previously. Three surgical approaches were used: subtemporal, pterional, and suboccipital. The subtemporal route was satisfactory for most lesions, although the pterional approach has advantages for upper basilar aneurysms projecting either more than I cm above the dorsum sellae or directly anteriorly. A low lateral-suboccipital approach is described and recommended for aneurysms of the proximal basilar trunk and vertebrobasilar junction. The recent literature regarding surgical results, classification, pathogenesis, and technical developments for management of these lesions is reviewed. Most of the morbidity resulting from surgery in the midbrain and pontine region is due to direct or indirect injury to perforating vessels. Superiorly directed bifurcation aneurysms carry the highest risk because of their association with perforating vessels. General precepts regarding size, location, patient condition, and timing of operation with respect to aneurysms of the anterior circulation hold true for aneurysms of the posterior circulation.
Reversible Constructional Apraxia from a Floating Bone Flap
Authors: Rengachary Setti S. , Amini Jafar , Batnitzky Solomon
Published: May 2010

A patient with reversible constructional apraxia from a floating parietal bone flap is presented.
Extrusion of Peritoneal Catheter through Abdominal Incision
Authors: DeSousa Alonso L. , Worth Robert M.
Published: May 2010

A rare complication of a ventriculoperitoneal shunt is reported. The peritoneal catheter extruded through the well-healed abdominal incision. This is the first report of such an occurrence in an adult patient.
Artificial Vision for the Blind by Electrical Stimulation of the Visual Cortex
Authors: Dobelle William H. , Dobelle William H. , Quest Donald O. , Antunes Joao L. , Roberts Theodore S. , Girvin John P.
Published: May 2010

Artificial vision for the blind may be feasible by interfacing a television camera with electronics stimulating the visual cortex. The status of a major collaborative effort involving the College of Physicians and Surgeons of Columbia University, the University of Utah, and the University of Western Ontario is reviewed. Results have been very encouraging, although much work remains to be done.
Spinal Cord Injury in the Monkey
Authors: Black Perry , Shepard Richard H. , Markowitz Ronald S.
Published: May 2010

We have investigated the effectiveness of surface cord cooling in reducing spinal cord temperature with respect to the rate of cooling and the temperature gradient within the spinal cord parenchyma. Another question of some practical importance if spinal cooling is to be used clinically is that of the temperature within the spinal cord as a function of the dura being intact or open. In five monkeys, a laminectomy was carried out at T-10 and an impact injury of 350 g-cm force was applied to the spinal cord with the dura intact. Hypothermic perfusion with Elliott's B solution (artificial cerebrospinal fluid) was started, and we measured temperatures in the spinal cord with a thermistor probe mounted on a stereotactic drive. A series of measurements were made with the dura intact and the measurements were then repeated with the dura open. For comparison, we also recorded temperatures in one animal that had not been cord-injured. The rate of cord cooling was rapid during the first 3 minutes of hypothermic perfusion, after which there was a slight further reduction in cord temperature; a low level plateau of 6.7° C was reached within 21 minutes after the start of cooling. The temperature gradient at varying depths of the spinal cord was approximately 6° C (3.8° C at the posterior surface to 10.1° C in the deepest portion of the spinal cord), representing a temperature gradient of 1.3° C/mm of cord tissue. Transmission of the cooling effect from perfusate to the spinal cord was not appreciably affected by the dura being intact or open.
Trigeminal Neuralgia and Multiple Sclerosis
Authors: Lazar Martin L. , Kirkpatrick Joel B.
Published: May 2010

Trigeminal neuralgia is unique to humans. The most common cause seems to be an injury to the myelin of the trigeminal nerve root entry zone as it extends for several millimeters lateral to the pons. Jannetta has developed an elegant retromastoid microsurgical approach to this region. He has identified a compression-distortion phenomenon of this nerve root entry zone, usually from an anomalous position of the superior cerebellar artery. Trigeminal neuralgia can also occur in association with multiple sclerosis, when the plaque lies in this same location. The historical evidence for this explanation is reinforced by the electron microscopic demonstration of the plaque in this region in a patient with multiple sclerosis who was suffering from tic douloureux.
Hypoglycorrhachia after Subarachnoid Hemorrhage
Authors: Vincent Frederick M.
Published: May 2010

The cerebrospinal fluid (CSF) of 33 patients with a nontraumatic subarachnoid hemorrhage was analyzed to determine whether hypoglycorrhachia occurred frequently after a subarachnoid hemorrhage. Twenty-three patients (70%) developed an abnormally low CSF glucose concentration or a lowered CSF-blood glucose ratio after their hemorrhage. Thus, hypoglycorrhachia seems to be a common spinal fluid finding after subarachnoid hemorrhage.
Microsurgical Endarterectomy of the Intracranial Vertebral Artery for Vertebrobasilar Transient Ischemic Attacks
Authors: Allen George S. , Cohen Ronald J. , Preziosi Thomas J.
Published: May 2010

Two patients who had typical vertebrobasilar transient ischemic attacks (TIAs) that were refractory to anticoagulation with dicumarol and to antiplatelet therapy with aspirin and/or dipyridamole are described. Angiography revealed in both patients a stenotic atherosclerotic plaque of the intracranial vertebral artery between the posterior and anterior inferior cerebellar arteries. At operation, the first patient had an atherosclerotic plaque extending into the basilar artery, and no endarterectomy was attempted. The second patient had a 1-cm localized plaque that was removed successfully from the vertebral artery. Neither patient sustained a neurological deficit as a result of the operation. The patient whose plaque was not removed at operation continues to have vertebrobasilar TIAs and suffered a brain stem stroke 2 weeks after operation. The patient whose plaque was removed at operation continues to be free of TIAs 8 months later, and angiography performed 3 months after operation showed a widely patent vertebral artery. A portion of the intracranial vertebral artery has now been shown to be accessible to endarterectomy using the operating microscope. Angiography is helpful in determining this accessibility preoperatively.
Intraneural Ganglion
Authors: Scherman Brian M. , Bilbao Juan M. , Hudson Alan R. , Briggs Sandra J.
Published: May 2010

We report a case of common peroneal mononeuropathy caused by an intraneural ganglion in a 9-year-old boy. The mass and the contiguous nerve fascicles were excised under the operating microscope. Histologically, the cyst wall was composed of layers of elongated cells merging with fascicles that exhibited changes suggestive of a pressure-ischemia effect. Electron microscopy showed that the cells forming the cyst wall were myofibroblasts, similar to the cells found in ganglia arising from joints elsewhere in the body. A review of the English literature on intraneural ganglia discloses 44 additional cases, of which 86% involved the common peroneal nerve. The most common clinical feature was motor dysfunction (followed by pain, sensory loss, and the presence of a palpable mass), and a significant male predominance is noted. The pathogenesis of this nerve lesion is discussed in light of our findings.
Primary Meningeal Myxochondrosarcoma Presenting as a Cerebellar Mass
Authors: Smith Thomas W. , Davidson Robin I.
Published: May 2010

This report describes a malignant cartilagenous tumor that originated from the dura at the base of the skull near the foramen magnum and presented as an intracerebellar mass in a 12-year-old boy. The histopathology of the tumor was confusing because of its prominent myxoid stroma and lack of well-defined cartilage. The presence of sulfated mucopolysaccharides in the matrix and the ultrastructural characteristics of the tumor cells established the cartilagenous nature of the neoplasm.
Craniopharyngioma
Authors: Lipper Maurice H. , Kishore Pulla R. S. , Ward John D.
Published: May 2010

abstract

Craniopharyngioma usually presents on a computed tomographic (CT) scan as a hypodense or isodense lesion, with calcification, in the suprasellar region. A case with atypical CT findings of a huge, homogeneous, high density, apparently solid, lobulated suprasellar mass is presented. An explanation for the appearance of the tumor is discussed based upon clinical analysis of the tumor contents.
Overall Management of Ruptured Aneurysm
Authors: Kassell Neal F. , Boarini David J. , Adams Harold P. , Sahs Adolph L. , Graf Carl J. , Torner James C. , Gerk Mary K.
Published: May 2010

The overall management results with 61 consecutive patients admitted within 3 days of subarachnoid hemorrhage from a ruptured intracranial aneurysm were analyzed. During the course of this study, the preferred method of management shifted from late surgery (planned at least 7 days after the last hemorrhage) to early surgery (within 4 days of the last hemorrhage). Ten moribund patients were excluded from analysis, leaving 24 in the late group and 27 in the early group. Both groups had comparable patient demographic characteristics and neurological conditions, and their care was supervised by one neurosurgeon (N.F.K.). A microsurgical intracranial operation was performed on all patients who survived long enough to have surgery, The intraoperative conditions and complications were similar for the two groups. The average length of follow-up was 11 months in the late and 9 months in the early group. The overall management results for the late group showed a 42% favorable outcome, a 17% unfavorable outcome, and a 42% mortality. The early group had an 81% favorable outcome, a 7% unfavorable outcome, and an 11% mortality. Patients in both good and poor conditions fared better in the early group. Seven late group patients rebled, compared to none in the early group. The number of medical complications, the length of hospitalization, and the occurrence of symptomatic vasospasm were all greater in the late group. Vasospasm in the early group occurred only postoperatively and, with the aneurysms secured, was treated more aggressively and successfully with hypertensive/hypervolemic therapy than the predominantly preoperative vasospasm in the late group.
Cerebellar Hemorrhage Complicating Cervical Laminectomy
Authors: Chadduck William M.
Published: May 2010

A case of cerebellar hemorrhage complicating the postoperative course of a patient who had undergone a cervical laminectomy in the sitting position is presented. The drop in cerebrospinal fluid pressure accompanying the procedure is thought to have had some role in the development of the hemorrhage.
Primary Osteogenic Sarcoma of the Skull
Authors: Wang Y. C. , Shih C. J. , Leu F. J. , Tu Y. C.
Published: May 2010

A young man suffered from a tumor mass in the skull, which proved to be a rare case of primary osteogenic sarcoma. The histological findings obtained at autopsy showed metastatic lesions in the lungs, left diaphragm, and other areas. The diagnosis, treatment, and autopsy findings of this case are presented.
Microsurgical Treatment of Intractable Hemifacial Spasm
Authors: Yeh Hwa-Shain , Tew John M. , Ramirez Rafael M.
Published: May 2010

Ten patients with intractable hemifacial spasm were treated by posterior fossa exploration and microsurgical technique. These patients have been followed 1 to 5 years. The spasmodic motor disorder was related to compression of the 7th nerve or its exit zone at the brain stem by a dolichoectatic anterior inferior cerebellar artery in eight patients and to kinking and ectasia of the basilar or vertebral artery in two patients. In five patients. There were prominent arachnoidal adhesions in the cerebellopontinc angle, and an arachnoid cyst was a component of the lesion in another patient. Additional conditions associated with hemifacial spasm in cluded geniculate neuraligia, facial paresis, vertigo, hearing loss, and trigeminal neuralgia. The surgical morbidity and postoperative results are discussed
New Options for the Microsurgeon
Authors: Greenberg I. M.
Published: May 2010

Using the Greenberg universal retraction system, a single surgeon can control four or more microinstruments simultaneously in a single microsurgical field. By decreasing the number of hand movements heretofore required and by increasing the surgeon' biotechnological options, the entire microsurgical procedure becomes more efficient and more economical, maximizing the surgeon' capabilities and performance.
Giant Intrasacral Schwannoma
Authors: Rengachary Setti S. , O'Boynick Paul , Batnitzky Solomon , Kepes John J.
Published: May 2010

A case of a large intrasacral neurilemoma with extension into the presacral space is presented. A brief outline of the differential diagnosis is given.
Odontoid Fracture
Authors: Ekong Chris E. U. , Schwartz Michael L. , Tator Charles H. , Rowed David W. , Edmonds Virginia E.
Published: May 2010

Twenty-two patients with C-2 fractures involving the odontoid process were treated by immobilization in a halo device. Six had associated spinal cord injury (1 complete and 5 incomplete), and 16 had no spinal cord injury. The age of the patients ranged from 20 to 86 years, with a mean age of 53. There were 15 cases in which the fracture line went through the base of the odontoid process only (Type 2), 1 case with a Type 2 odontoid fracture associated with a Jefferson fracture, 4 in which the fracture line involved the body of C-2 (Type 3), and 2 cases with a Type 3 odontoid fracture associated with a Jefferson fracture. Eighteen of the patients were followed for at least 6 months (the mean follow-up period was approximately 2/12; years) to determine the results of bony fusion and neurological improvement. Three patients died early: 1 had no spinal cord injury and died of an associated head injury; 2 had spinal cord injuries and died of respiratory failure. One was lost to follow-up. Successful bony healing and stability at the fracture site as indicated by flexion and extension roentgenograms of the cervical spine were achieved in 10 (59%) of 17 patients treated with the halo ring and vest only. Early fusion was required in 1 patient, and late fusion was required in 5 patients. The remaining 2 patients refused operation. Improvement in neurological status was noted in all four surviving patients with spinal cord injury. and none of the patients without spinal cord injury developed a neurological deficit during the course of the halo treatment. The average duration of hospitalization was 27 days for those without spinal cord injury and 70 days for those with spinal cord injury. Complications related directly to the halo devices were few and minor and included scalp infection, pressure sores, loosening of the halo pins, and 1 case of osteomyelitis of the skull. We found that the halo device is useful for immobilizing the cervical spine even in the presence of diminished sensation over the trunk. Except for the presence of certain types of coexisting head injury, an absolute contraindication to its use has not been encountered. The major advantage of the halo vest is that it allows external maneuvering of bony injuries in all three planes followed by fixation when acceptable reduction is attained without the need for early operation in patients who may already be very ill. The halo vest also allows early mobilization of patients and early discharge from the hospital.
Treatment of Trigeminal Neuralgia and Other Facial Pains by Retrogasserian Injection of Glycerol
Authors: Sweet William H. , Polelti Charles K. , Maeon James B.
Published: May 2010

Håkanson's treatment of trigeminal neuralgia by injecting 0.2 to 0.4 ml of glycerol into the cerebrospinal fluid in Meckel's cave was carried out in 27 patients with trigeminal neuralgia, 3 with atypical facial neuralgia, and 1 with post-traumatic facial neuralgia. Minor modifications of his technique are described based on our finding of a greater pain and sensory loss upon injection than he noted. We present evidence that glycerol is more toxic than its cryoprotectant effect would intimate and that it selectively eliminates those components of the compound action potential in the trigeminal rootlets customarily associated with pain. We conclude that the method is probably going to be an improvement over radiofrequency heating for the treatment of trigeminal neuralgia in many situations.
Photoradiation Therapy in the Treatment of Malignant Brain Tumors
Authors: Laws Edward R. , Cortese Dennis A. , Kinsey James H. , Lagan Robert T. , Anderson Robert L.
Published: May 2010

Hematoporphyrin derivative accumulates in malignant brain tumors and, when activated by light, can produce a cytotoxic reaction. A system for utilizing this concept in the treatment of human malignant brain tumors has been developed and tested in a small series of patients. No significant adverse reactions have occurred, and further development and research are planned.
Sacral Fracture
Authors: Weaver Edgar N. , England George D. , Richardson Donald E.
Published: May 2010

Sacral fractures are either transverse or longitudinal (vertical). Transverse fractures may be isolated and can be subdivided into two types. Upper transverse fractures occur in younger people and result from severe traumatic flexion of the upper body on the fixed pelvis. Lower transverse fractures result from a hard blow to the coccyx, as in a fall. Vertical fractures are essentially never isolated, always being associated with an anterior break in the pelvic ring. These result from extreme forces transmitted through the ilium. Any of these fractures can cause injury to neural elements, and surgical decompression may be indicated in certain of the transverse types.
Occipital Artery to Posterior Inferior Cerebellar Artery Bypass for Vertebrobasilar Ischemia
Authors: Roski Richard A. , Spetzler Robert F. , Hopkins Leo N.
Published: May 2010

Fourteen patients who underwent occipital to posterior inferior cerebellar arterial bypass are reviewed. All of the patients were treated for severe vertebrobasilar ischemia secondary to lesions of the distal vertebral artery. There was no operative death or permanent postoperative morbidity. On follow-up evaluation (averaging 13 months after operation), there has been 100% graft patency and a noticeable improvement in the neurological function in all patients. Operating with the patient in the prone position and avoiding intraoperative hypotension help to minimize the operative morbidity from this procedure.
Intraventricular Cerebrospinal Fluid Antibiotic Concentrations in Patients with Intraventricular Infections
Authors: James H. E. , Wilson H. D. , Connor J. D. , Walsh J. W.
Published: May 2010

The antibiotic concentration of the fluid from either lateral ventricle was determined 104 times in 37 patients through direct ventricular puncture, external ventricular drainage (EVD). or cerebrospinal fluid shunt sampling. The patients were 1 month to 12 years old. When the patients were receiving maximal intravenous antibiotic therapy alone, the concentrations for the most part were below 5 μg/ml. whereas patients receiving an antibiotic through direct ventricular puncture, EVD. or a shunt reservoir usually had concentrations over 5 μ/ml. However, wide variations from patient to patient were found with all forms of treatment despite similar dosages. Clustering of the concentration tended to occur in each individual patient. The authors conclude that, to obtain a high concentration of an antibiotic in the ventricular fluid, one should administer it directly into the ventricle.
Aneurysmal Bone Cyst of the Cervical Spine
Authors: Bret Philippe , Confavreux Christian , Thouard Hervé , Pialat Jean
Published: May 2010

The authors report the case of a 62-year-old woman with an aneurysmal bone cyst of the cervical spine. The patient presented with a progressive tetraparesis. Cervical computed tomographic scanning revealed a mass involving three contiguous vertebral bodies. The patient underwent two consecutive surgical procedures: (a) laminectomy and metallic plate osteosynthesis and (b) an anterior approach for curettage of the cyst and autologous grafting. Twelve months after operation, the patient was given a course of radiation therapy in the cervical area. She was found to be asymptomatic at the 20-month follow-up examination. The authors discuss the etiological, anatomical, and radiological features of vertebral aneurysmal bone cysts and evaluate treatment methods.
Extraneural Metastasis of Cerebellar Glioblastoma Multiforme
Authors: Pang Dachling , Ashmead Josephine W.
Published: May 2010

The first case of glioblastoma multiforme of the cerebellum with extraneural metastasis is presented, and the literature on the postoperative extraneural spread of neuroectodermal tumors is reviewed. It is thought that an open dura mater at the operative site increases the contact of tumor cells with extrameningeal tissues, where lymphatic and vascular invasion can take place. Every effort should be made to close the posterior fossa dura mater after resection of a malignant neoplasm.
Computed Tomography in Pott's Disease
Authors: Gropper Gary R. , Acker James D. , Robertson Jon H.
Published: May 2010

Computed tomography (CT) has become increasingly useful in diagnosing various disorders of the spine. However, the value of CT in infectious disease of the spine must be defined. A case of Pott's disease with CT demonstration of associated bony and soft tissue changes is presented.
Reversible Panhypopituitarism Caused by a Suprasellar Aneurysm
Authors: Verbalis Joseph G. , Nelson Paul B. , Robinson Alan G.
Published: May 2010

A case of panhypopituitarism and hyperprolactinemia caused by a giant intracranial aneurysm is presented. The case is unique because both the pattern of the pituitary dysfunction and the complete normalization of all pituitary function after decompression of the aneurysm demonstrate the importance of pure compressive effects of mass lesions on pituitary function. The literature regarding return of pituitary function after resection of sellar and suprasellar masses is reviewed, and a schema for classification of pituitary dysfunction caused by mass lesions is proposed.
Familial Primary Nervous System Neoplasms in Three Generations
Authors: Wald Steven L. , Liwnicz Boleslaw H. , Truman Thomas A. , Khodadad Ghahreman
Published: May 2010

A familial cluster of primary nervous system tumors is described. Four members of the same family in three generations developed central nervous system tumors: two glioblastomas, a craniopharyngioma, and a spinal cord tumor.
Post-traumatic Spinal Epidural Hematoma
Authors: Foo Dominic , Rossier Alain B.
Published: May 2010

Five patients with vertebral fracture and spinal epidural hematoma (SEH) are described. Another 58-year-old man developed a post-traumatic SEH without bony damage. From the literature, 38 patients (31 male, 4 female, and 3 unknown) were collected. Ankylosing spondylitis or rheumatoid arthritis was noted in 9 of 12 subjects between 50 and 75 years of age. Two groups of patients were identified: Group 1—16 patients with spinal fracture (aged 23 to 63 years), and Group 2—22 patients without spinal fracture (the age was less than 18 years in 12 subjects). In Group 2, a coagulation defect or spinal epidural vascular malformation resulted in a SEH in 6 patients. The preoperative myelopathy was complete in 3 patients each from Group 1 (23.1%) and Group 2 (16.7%). Of the 31 patients operated upon, 9 of the 13 from Group 1 (69.3%) and 6 of the 18 from Group 2 (33.3%) underwent laminectomy within I week after the onset of symptoms. Postoperative neurological return was observed in 38.5% (5 of 13) and 88.9% (16 of 18) of these two groups of patients, respectively. Post-traumatic SEHs, predominant in the male population, are often associated with vertebral disease in elderly patients. In the very young patient, there is usually no fracture/dislocation of the spine. A predisposing lesion may be present when spinal fracture is not evident. The prognosis after surgical intervention is better in patients without spinal fracture than in those with vertebral damage, probably because of less contusion to the spinal cord and the presence of very young subjects in the former group of patients.
Central Nervous System Involvement in the Nevoid Basal Cell Carcinoma Syndrome: Case Report and Review of the Literature
Authors: Naguib Mahmoud G. , Sung Joo Ho , Erickson Donald L. , Gold Lawrence H. A. , Seljeskog Edward L.
Published: May 2010

The characteristic features of central nervous system involvement in the nevoid basal cell carcinoma syndrome are reviewed. Emphasis is given to the frequent association of medulloblastoma with the syndrome.
Solitary Cerebral Metastasis: The Effect of Craniotomy on the Quality and the Duration of Survival
Authors: Chan Richard C. , Steinbok Paul
Published: May 2010

The authors report 57 patients in whom craniotomies for solitary intracranial metastatic tumor were performed in Vancouver General Hospital between 1970 and 1980. The median survival after craniotomy varied between 3.5 and 10 months depending upon the types of primary tumors. Patients with metastatic central nervous system (CNS) tumor from breast, kidney, or an unknown primary site had longer periods of survival than those with bronchogenic carcinoma. The outcome for metastatic melanoma was poor. Eighty-two per cent of the patients were able to enjoy home life and were self-dependent at the time of discharge from the hospital. A long latent interval between the primary tumor diagnosis and secondary CNS metastasis favored longer survival for patients with bronchogenic carcinoma, but not for those with melanoma. The presence of systemic metastases was an adverse factor. There was no significant difference in the duration of survival between patients with right- or left-sided cerebral lesions, but those with right hemispheric involvement had a better quality of survival. The use of computed tomographic scanning improved both the duration and the quality of postoperative survival.
Chondromyxoid Fibroma of the Cervical Spine—a Case Report with a Review of the Literature and a Description of an Operative Approach to the Lower Anterior Cervical Spine
Authors: Standefer Michael , Hardy Russell W. , Marks Kenneth , Cosgrove D. M.
Published: May 2010

A case of chondromyxoid fibroma arising from the C-7 vertebral body and involving the epidural space and paraspinal soft tissues is presented. The surgical treatment of this tumor is described, and the pertinent literature is reviewed.
Recurrence of Cerebral Aneurysm after Initial Neck Clipping
Authors: Ebina Kunihiko , Suzuki Mikio , Andoh Akira , Saitoh Kazuko , Iwabuchi Takashi
Published: May 2010

Neck clipping has generally been believed to be among the most reliable of the operative modalities for cerebral aneurysm. However, recurrences with catastrophic outcome have been known to occur. We recently treated two patients who each had a new aneurysm at the site of the initial clipping. In both cases, the recurrence was found several years after the aneurysm neck had been closed successfully with a silver clip, which had been confirmed by intraoperative inspection and by postoperative angiographic studies demonstrating disappearance of the aneurysm. Histological examination of the recurrent aneurysm showed that the arterial wall had apparently been damaged by the clip edge, which resulted in thinning and disruption of both the muscle layer and the internal elastic lamina. Therefore, local fragility of the arterial wall adjacent to the aneurysm seems to have been the cause of the formation of a new aneurysm. The need to reinforce the thin-walled parent artery and the usefulness of high resolution computed tomography for the early detection of recurrent aneurysms are emphasized.
Spontaneous Regression of Arteriovenous Malformations
Authors: Nehls Daniel G. , Pittman Hal W.
Published: May 2010

Spontaneous regression of an arteriovenous malformation (AVM) is quite rare. When a regression does occur, there is usually an associated factor, such as intracranial hemorrhage, operation, radiation therapy, or new neurological deficit. Twenty-one cases of AVM regression identified in the literature are reviewed. An additional case in which the resolution was totally spontaneous is presented. Regressions occurred over intervals ranging from 7 months to 21 years. Several mechanisms for regression are discussed.
Traumatic Ophthalmic Fistula Simulating Carotid-Cavernous Fistula
Authors: Freitas Miguel A. L. , Filho Cyro A.B. , Lima Ranulfo , Marchiori Edson
Published: May 2010

In a patient with a penetrating lesion of the right orbit with proptosis and a bruit in this region, carotid angiography revealed an ophthalmic fistula between the ophthalmic artery and the superior ophthalmic vein. Three days after admission, the symptoms disappeared, and repeat angiography showed the spontaneous thrombosis of the fistula.
Intradural Chondroma: A Case Report and Review of the Literature
Authors: Mapstone T. B. , Wongmongkolrit T. , Roessman U. , Ratcheson R. A.
Published: May 2010

We present a rare case of intradural chondroma. Its clinical and radiological presentation, with special emphasis on the computed tomographic appearance, and its surgical management are discussed and compared to previously published reports.
Cavernomas of the Brain
Authors: Vaquero Jesús , Leunda Guillermo , MartÍnez Roberto , Bravo Gonzalo
Published: May 2010

Our clinical and surgical experience with 16 cases of cavernous hemangioma (cavernoma) of the brain is presented. In 50% of the cases, symptoms appeared during the 3rd decade of life. The clinical picture included seizures in 50% of the cases and a brain tumor-like syndrome in 37.5%, and 12.5% of the cases began with an intracerebral hemorrhage. In our series females predominated over males by 2:1. Computed tomographic (CT) scanning is the best procedure for the diagnosis of cavernomas. However, exact preoperative diagnosis of these lesions is infrequent because cavernomas are generally accepted to be very rare. A slightly hyperdense nodule, poorly enhanced after contrast administration, is the prominent feature on the CT scan. A small, hypodense zone surrounding the lesion and calcifications within the nodule are also found. An excellent result after operation was obtained in all cases of cavernoma located in the brain hemispheres. In deeply placed cavernomas (basal ganglia or brain stem), the surgical prognosis is doubtful, and features such as the size of the lesion and its anatomical location are important.
Quadriplegia Secondary to Hematoma after Lateral C-1, C-2 Puncture in a Leukemic Child
Authors: Mapstone Timothy B. , Rekate Harold L. , Shurin Susan B.
Published: May 2010

Epidural, subdural, and intramedullary hemorrhage developed after lateral cervical (C-1, C-2) puncture in a thrombocytopenic patient with meningeal leukemia and increased intracranial pressure. Aggressive platelet support before the procedure did not prevent the hemorrhagic complication. Complete recovery from total motor paralysis with respiratory arrest followed immediate surgical decompression and continuing platelet support. The potential dangers of otherwise minor procedures in compromised patients are reiterated. Neurological recovery as seen here argues for immediate surgical intervention with the development of such potentially life-threatening events.
Abscess Formation within Pituitary Tumors
Authors: Nelson Paul B. , Haverkos Harry , Martinez Julio A. , Robinson Alan G.
Published: May 2010

Three consecutive cases where abscesses were found within pituitary tumors are presented. In all cases, the diagnosis was made preoperatively and the patients were begun on stress doses of hydrocortisone and antibiotics before surgical drainage of the abscess. All patients recovered with minimal neurological deficits. Review of the literature reveals that the diagnosis is seldom made preoperatively or before autopsy and is associated with high mortality and morbidity. Early suspicion of a pituitary abscess leading to early treatment with antibiotics and operative drainage seem to be important factors in decreasing this high mortality and morbidity.
Intracranial Adenocystic Carcinoma Presenting as a Primary Brain Tumor
Authors: Piepmeier Joseph M. , Virapongse Chat , Kier Leon E. , Kim Jung , Greenberg Alvin
Published: May 2010

We present a case of an intracranial adenocystic carcinoma that clinically and radiographically mimicked a primary intracranial tumor. The radiological work-up of this tumor is presented in detail. We suggest that perineural intracranial invasion by the tumor along the trigeminal nerve resulted in its presentation as a primary intracranial tumor.
Quantitation of Hematoporphyrin Derivative in Human Gliomas, Experimental Central Nervous System Tumors, and Normal Tissues
Authors: Wharen Robert E. , Anderson Robert E. , Laws Edward R.
Published: May 2010

A simple and reproducible method of quantitating the amount of hematoporphyrin derivative by fluorescence microscopy in biopsies of tumors from patients undergoing photoradiation therapy is presented, substantiated by laboratory studies of experimental central nervous system tumors and normal rat tissues. The literature regarding the quantitation of hematoporphyrin is reviewed, and implications of this study for the future application of photoradiation therapy and the design of laboratory studies are discussed.
Sclerosing Orbital Pseudotumor
Authors: Abramovitz Joel N. , Kasdon David L. , Sutula Francis , Post Kalmon D. , Chong Frank K.
Published: May 2010

We report two patients who underwent orbital exploration yielding the diagnosis of sclerosing orbital pseudotumor. The presenting symptoms were exophthalmos, visual loss, abnormal ocular mobility, and ocular pain. Computed tomographic (CT) scans showed masses in the orbital apex. Steroids were ineffective. Orbital pseudotumor is a heterogeneous diagnostic category of lymphoid infiltrations of the orbit with a wide spectrum of pathological conditions and intraorbital locations. The clinical presentation typically includes the sudden onset of pain, diplopia, lid edema, and exophthalmos. Visual loss is uncommon. Most cases resolve spontaneously or respond to steroid treatment. Although fibrosis may be a prominent histological finding, the literature contains little information concerning its significance. We discuss the evidence for considering the sclerosing pseudotumors to be a significant variant with unique clinical behavior. Although features suggestive of pseudotumor were present in our cases, the presence of visual loss and an apical mass shown on the CT scan led to the presumptive diagnosis of tumor and exploratory operation. Neurosurgeons should be aware of this entity as a cause of visual loss and orbital mass. Proper suspicion may in some cases permit transorbital biopsy and avoid craniotomy, inasmuch as operation is of no therapeutic benefit in this disease.
Brain Stem Auditory Evoked Potentials in Posterior Circulation Surgery
Authors: Little John R. , Lesser Ronald P. , Lueders Hans , Furlan Anthony J.
Published: May 2010

The objectives of this study were to evaluate the use of brain stem auditory evoked potentials (BAEPs) in 10 adult patients with vascular disorders of the posterior circulation that were treated surgically and to compare the BAEPs with the neurological findings. The vascular lesions included basilar artery stenosis in 3 patients. vertebral artery stenosis in 1 patient, brain stem/cerebellar arteriovenous malformation in 2 patients. and basilar artery aneurysm in 4 patients. Measurement of BAEPs were carried out during operation in all cases. Eight patients had BAEPs measured before operation. and 9 patients had BAEPs measured after operation. Repeat postoperative studies were performed in patients with changes in neurological status. In general, BAEP abnormalities correlated with the neurological findings before and after operation. Six patients had normal intraoperative studies. None of them had clinical findings of pontomesencephalic dysfunction after operation. Three patients with significant BAEP abnormalities during operation had neurological findings of pontomedullary ischemia after operation. Transient BAEP changes in 1 patient were thought to be the result of brain stem retraction. The BAEPs were lost in 3 patients who died. The use of BAEP measurement did not lengthen the operative procedures. However, the technique used in this study required 4 to 8 minutes for the accumulation and interpretation of each average, thereby delaying feedback to the surgeon. The results of this study suggest a potential role for BAEP monitoring in identifying brain stem injury during posterior circulation surgery.