bluuebunny/crossref_metadata_2025 huggingface dataset:
Postirradiation necrosis of the temporal lobe presenting as a glioma
Authors: Diengdoh J. Victor , Booth Anthony E.
Published: May 2009

✓ A patient is reported who presented with manifestations of a space-occupying lesion in the left temporal lobe thought to be a metastasis, but on radiological examination and surgical exploration appeared to be a diffuse infiltrative glioma. Some 21 months earlier he had received a course of fast neutron therapy to a carcinoma of the left parotid gland. Diagnosis by microscopic examination revealed changes characteristic of delayed radiation necrosis.
Normal rate of cerebrospinal fluid formation five years after bilateral choroid plexectomy
Authors: Milhorat Thomas H. , Hammock Mary K. , Chien Techen , Davis Donald A.
Published: May 2009

✓ A ventricular perfusion technique was used to determine the rate of cerebrospinal fluid (CSF) formation in a 5-year-old child who had undergone bilateral choroid plexectomy for communicating hydrocephalus during infancy. At the time of the study, the patient had a failed ventriculoperitoneal shunt and was suffering from progressive ventriculomegaly. The calculated rate of CSF formation, 0.35 ml/min, ± 0.02 standard deviation, was within normal limits.
Rapid arteriovenous shunting in a spinal cord ependymoma
Authors: Yuhl Eric T. , Bentson John R.
Published: May 2009

✓ A case of ependymoma of the conus medullaris and cauda equina is described in which spinal angiography demonstrated rapid arteriovenous shunting, an angiographic sign which is typical of arteriovenous malformations and which has not been previously reported to occur with ependymomas.
Osteoclastoma of the thoracic spine
Authors: Gonem Mohammed N.
Published: May 2009

✓ A case of osteoclastoma arising in the body of the T-9 vertebra is presented. Osteoclastoma rarely involves the vertebrae, and treatment, whether by surgery or radiotherapy, seldom results in eradication of the lesion or prevention of recurrence.
Embolization of a traumatic arteriovenous fistula of the scalp with radiopaque Gelfoam pledgets
Authors: Kasdon David L. , Altemus L. Reed , Stein Bennett M.
Published: May 2009

✓ A large traumatic arteriovenous malformation of the scalp was embolized with Pantopaque-saturated Gelfoam pledgets, which made fluoroscopic monitoring of the radiopaque emboli possible. Postembolization angiography demonstrated complete occlusion of the malformation. There is still no clinical or physical evidence of recurrence after an 8-month follow-up period.
Microblock for occlusion of small vessels
Authors: Wright Sanford J.
Published: May 2009

✓ A small microvascular occluder termed a “microblock” is described. It has the advantages of controlled gentle occlusion and small size.
Spectrum of the hangman's fracture
Authors: Seljeskog Edward L. , Chou Shelley N.
Published: May 2009

✓ The authors review their experience in managing 26 cases of “hangman's fracture.” The basic mechanism of injury was hyperextension of the upper cervical spine. Radiographic studies revealed a spectrum of injury beginning with the classical hangman's fracture and progressing to the simple C-2 laminar-pedicle fracture. Appreciation of the fracture instability will dictate the method and duration of fracture treatment. Management by a closed, nonoperative means resulted in solid union of the bone in all fully treated cases, with a minimum of morbidity.
Role of local hyperfibrinolysis in the etiology of chronic subdural hematoma
Authors: Ito Haruhide , Yamamoto Shinjiro , Komai Toshio , Mizukoshi Hidetaka
Published: May 2009

✓ The authors describe studies performed on material aspirated from chronic subdural hematomas. Patients were given 51Cr-labeled red cells prior to aspiration, and it was possible to demonstrate that the mean daily hemorrhage into the hematoma space amounted to 10.2% of its volume. Immunoelectrophoresis of the aspirated hematoma fluid by monospecific anti-human fibrinogen revealed the presence of fibrin and fibrinogen degradation products that, measured by hemagglutination-inhibition immunoassay techniques, varied between 5.0 and 10,500 µg/ml with an average of 2604 µg/ml in 18 cases. The tissue activator was demonstrated by Todd's histological localization in the outer membrane of the chronic subdural hematoma in 11 cases, but not in the inner membrane. These results indicate that if a clot in the subdural space causes the formation of neomembrane, and excessive fibrinolysis occurs, the subdural clot would not only liquefy, but also enlarge by continuous hemorrhage from the neomembrane. Therefore, local hyperfibrinolysis and continuous bleeding are important in the etiology of the chronic subdural hematoma.
Sensory and nonsensory portions of the nucleus “ventralis posterior” thalami of chimpanzee and man
Authors: Van Buren John M. , Borke Rosemary C. , Modesti Luciano M.
Published: May 2009

✓ In man and chimpanzee, the large-celled region in the posteroinferior portion of the lateroventral thalamic mass, commonly called the nucleus ventralis posterior thalami, is separated cytoarchitecturally into two regions. The anterior portion is called the nucleus ventrointermedius (Vim) and the posterior part, the nucleus ventrocaudalis (Vc). In the chimpanzee it was found that most of the fibers from the superior cerebellar peduncle entered Vim on the way to distribution in the anterior half of the lateroventral thalamic mass. Fibers from the posterior spinal column (medial lemniscus) entered the Vc. No overlap was evident in the radiations from the two sources. An unusual human case is presented supporting the sensory function of Vc since a lesion in this nucleus resulted in persistent contralateral paresthesia. On the other side, a discrete lesion in Vim caused no sensory disturbance.
Surface ultrastructure of human ependyma
Authors: Dempsey Lawrence C. , Nielsen Surl L.
Published: May 2009

✓ Specimens of human ependyma obtained immediately after death were immersion-fixed and studied with a scanning electron microscope. Human ependyma is nearly identical in its surface ultrastructural features to the ependyma of other mammals.
Shunt system patency testing by lumbar infusion
Authors: Woodford Jack , Saunders Richard L. , Sachs Ernest
Published: May 2009

✓ A simple and reliable bedside infusion test is described to evaluate shunt-system patency in adult patients with treated “normal” pressure hydrocephalus. Fifteen consecutive patients with ventriculoperitoneal shunts were tested by a two-part infusion test between 2 days and 32 months after shunt surgery. When we used the criteria presented, shunt patency could be established with certainty, and shunt malfunction could be established with relative certainty. Shunt malfunction was verified surgically.
Technique for placement of experimental indwelling carotid artery catheter
Authors: Hammock Mary K. , Di Chiro Giovanni , Pongpatirojana Apichati
Published: May 2009

✓ A technique for placement of an indwelling carotid artery catheter in the rhesus monkey is presented. These indwelling catheters have proved useful in the investigation of regional cerebral blood flow using xenon-133, positive contrast angiography, and fluorescein angiography. Although limited thus far to studies in experimental anemic stroke, this technique could be adapted to a variety of experimental situations in which serial evaluations of the cerebral vasculature are indicated.
Effect of central venous pressure on brain tissue pressure and brain volume
Authors: Cuypers Jochen , Matakas Frank , Potolicchio Sam J.
Published: May 2009

✓ In cats, brain tissue pressure (BTP) was measured by the wick-catheter method. The BTP was positive, but lower than cerebrospinal fluid pressure. Elevation of central venous pressure led only to a transient proportional increase of BTP. When the calvaria and dura of one hemisphere were removed, the rise of BTP was even less. Water content of the brain was normal in either case, even after prolonged venous hypertension. Venous hypertension led in all cases to a marked increase of the brain volume which was caused by vessel dilatation. In brain edema, produced by rinsing the brain surface with ouabain and concentrated saline, BTP was increased permanently by venous hypertension. The water content of the brain was much greater than normal. From these results it was concluded that congestive edema does not occur in the brain unless the tissue is damaged. However, venous hypertension does cause brain swelling.
Oncotic aneurysm
Authors: Helmer Fredric A.
Published: May 2009

✓ The author describes a case of intracerebral and subarachnoid hemorrhage associated with an intracranial aneurysm caused by a metastatic tumor. The aneurysm formation is explained as being a result of tumor cells invading the vessel wall while still preserving the arterial circulation.
Melanoma of the pituitary
Authors: Scholtz Carl L. , Siu Kevin
Published: May 2009

✓ A case is described in which a pigmented tumor occupied the pituitary fossa with a large suprasellar extension. Its histological and ultrastructural appearances resembled those of a melanoma. The origin of the tumor is discussed with particular reference to Rathke's pouch.
Response to vincristine of recurrent brain tumors in children
Authors: Rosenstock Jeffrey G. , Evans Audrey E. , Schut Luis
Published: May 2009

✓ Seventeen children with clinical evidence of a recurrent brain tumor were treated with vincristine 1.5 mg/sq m weekly for 12 weeks with doses on alternate weeks thereafter. Eight of the 16 patients who received four or more doses of vincristine showed significant objective responses; these included patients with high- and low-grade astrocytomas and patients with medulloblastoma. Six of the eight who responded remained asymptomatic for more than 2 years. The toxicity encountered was minimal except for seizures possibly related to vincristine in three children, who were able to resume treatment. Vincristine therapy results in long-term regression in a wide variety of pediatric brain tumors and causes little or no toxicity.
Postoperative hypertension in the management of patients with intracranial arterial aneurysms
Authors: Kosnik Edward J. , Hunt William E.
Published: May 2009

✓ Elevation of systemic arterial pressure in seven patients with intracranial arterial aneurysms has been shown to be effective in alleviating ischemic symptoms attributed to cerebral vasospasm. Autoregulation is at least partially lost in patients with cerebral hemodynamic crisis. Blood volume expansion was used to augment vasopressors in maintenance of systemic hypertension. The management of these cases is discussed. Caution in the use of this technique is advised, since the regimen is not without risk.
A method of estimating intracranial decompensation in man
Authors: Szewczykowski Jerzy , Dytko Pawel , Kunicki Adam , Korsak-Sliwka Jolanta , Sliwka Stanislaw , Dziduszko Jacek , Grochowski Witold , Augustyniak Bozena
Published: May 2009

✓ A new method of estimating intracranial decompensation in man is described. An on-line computer system is connected to an intracranial pressure (ICP) monitoring system to compute regression plots of mean ICP vs standard deviation; standard deviation is used as a measure of ICP instability. Two zones with distinctly different slopes are a characteristic feature of these plots. It is thought that the changes of slope signify intracranial decompensation.
Intercavernous connections of the cavernous sinuses
Authors: Kaplan Harry A. , Browder Jefferson , Krieger Abbott J.
Published: May 2009

✓ Morphological features of the intercavernous connections of the cavernous sinuses are described and illustrated by photographs of vinylite casts. Surgeons should be aware of the course, potential size, and arrangement of the channels in the dura of the hypophyseal fossa. This is particularly important in exposure of the pituitary gland by the transsphenoidal route.
Anatomy of the cavernous sinus
Authors: Harris Frank S. , Rhoton Albert L.
Published: May 2009

✓ Fifty cavernous sinuses from cadavers were studied in detail using magnification, with special attention to the relationships important in surgical approaches on the intracavernous structures, and to understanding arterial contributions to arteriovenous fistulas involving the cavernous sinus. Significant findings were: 1) The three main branches of the intracavernous portion of the carotid artery were the meningohypophyseal artery, present in 100% of the specimens, the artery of the inferior cavernous sinus (84%), and McConnell's capsular arteries (28%). In addition, the ophthalmic and dorsal meningeal arteries arose from the carotid artery within the cavernous sinus in 8% and 6%, respectively. The three main branches of the meningohypophyseal trunk were the tentorial artery, present in 100%, the dorsal meningeal (90%), and the inferior hypophyseal (80%). 2) The carotid artery was separated from the trigeminal nerve just proximal to the sinus by only dura in 84% of the specimens, and the artery was exposed in the floor of the middle fossa lateral to the trigeminal nerve in 38%. 3) The intracavernous portion of the carotid artery indented the lateral side of the pituitary gland in 28% of dissections but could be as far as 7 mm from it. 4) A triangular area, described by Parkinson, through which the intracavernous portion of the carotid artery could be exposed surgically was found in all specimens. 5) The sixth cranial nerve may split into as many as five rootlets as it passes lateral to the intracavernous portion of the carotid artery. 6) The three major venous spaces within the sinus were posterosuperior, anteroinferior, and medial to the intracavernous portion of the carotid artery.
Clinical radioisotope investigations in hydrosyringomyelia and myelodysplasia
Authors: Hall Peter V. , Kalsbeck John E. , Wellman Henry N. , Batnitzky Solomon , Campbell Robert L. , Lewis Sidney
Published: May 2009

✓ Radioisotope ventriculography was applied clinically in myelodysplastic hydromeyelia in three groups of patients: two patients with normal ventricles, two with obstructive hydrocephalus, and 16 with myelodysplasia. In the myelodysplastic group, radioassay in one patient demonstrated flow of radioisotope down the hydromyelic cavity. Twenty scintigraphic studies on 16 myelodysplastic patients showed hydromyelia was present in all patients with spontaneously compensated hydrocephalus but in none of those with functional ventricular shunts. This relation between the hydromyelia and disordered ventricular hydrodynamics supports the Gardner hypothesis of myelodysplasia. Radioisotope ventriculography appears a safe and useful method of diagnosing hydrosyringomyelia and evaluating treatment by means of ventricular decompression.
Sciatic entrapment neuropathy
Authors: Banerjee Timir , Hall Colin D.
Published: May 2009

✓ A case of sciatic entrapment neuropathy is discussed. When evaluating patients with unilateral leg pain and paresthesias, one should consider the possibility of entrapment of peripheral nerve. Electrodiagnostic studies are helpful in establishing the diagnosis.
Hemorrhage in bilateral choroid plexus hemangiomas demonstrated by computed tomography
Authors: Towfighi Javad , Bilaniuk Larissa T. , Zimmerman Robert A. , Langfitt Thomas W. , Gonatas Nicholas K.
Published: May 2009

✓ The authors present a case in which bilateral posttraumatic hemorrhages in choroid plexus hemangiomas were demonstrated by computed tomography and histopathological study.
Pineal apoplexy associated with anticoagulant therapy
Authors: Apuzzo Michael L. J. , Davey Lycurgus M. , Manuelidis Elias E.
Published: May 2009

✓ A case is presented with the acute development of a pineal region syndrome secondary to hemorrhage into a pineal cyst in a patient who was under anticoagulant therapy. Resolution of the symptoms and signs followed excision of the lesion.
Microsurgical anatomy of the anterior cerebral-anterior communicating-recurrent artery complex
Authors: Perlmutter David , Rhoton Albert L.
Published: May 2009

✓ The microvascular relationships important to surgery of aneurysms in the anterior communicating region were defined in 50 cadaver brains. The recurrent artery of Heubner was frequently exposed before the A-1 segment in defining the neck on anterior cerebral aneurysms because it commonly courses anterior to A-1. It arose from the A-2 segment of the anterior cerebral artery (ACA) in 78% and most commonly terminated in the area of the anterior perforated substance, and lateral to it in the Sylvian fissure. The anterior communicating artery (ACoA) frequently gave rise to perforating arteries which terminated in the superior surface of the optic chiasm and above the chiasm in the anterior hypothalamus. This finding contrasts with previous reports that no perforating branches arise from the communicating artery. The proximal half of the A-1 segment was a richer source of perforating arteries than the distal half. The A-1 branches most commonly terminated in the anterior perforated substance, the optic chiasm, and the region of the optic tract. The ACoA increased in size as the difference in the diameter between the right and left A-1 segments increased. Frequent variants such as double or triple ACoA's, triple A-2 segments, and duplication of the A-1 segments were encountered. The clinical consequences of occlusion of the recurrent artery and of the perforators from the ACoA and medial and lateral segment of A-1 are reviewed.
Cerebral circulation after head injury
Authors: Overgaard Jørn , Tweed William A.
Published: May 2009

✓ The authors have assessed the effects of subacute traumatic brain edema (BE) on cerebral circulation and metabolism, and on clinical outcome. Fifty-five severely injured, comatose, young patients who survived for more than 24 hours were studied on 78 occasions within 30 days of injury. After hematomas had been surgically evacuated, BE was diagnosed by radiological evidence of brain swelling, demonstrated by cerebral angiograms and ventriculograms. At identical levels of carbon dioxide pressure, intracranial pressure was significantly elevated in the Edema Group to twice the value in the No Edema Group (27.1 vs 14.1 torr). There were, however, no significant differences in cerebral perfusion pressure, cerebral blood flow, resistance to blood flow, cerebral metabolic oxygen rate, ventricular cerebrospinal fluid acidbase, lactate, K+ or Na+ concentrations, or in clinical outcome. It is concluded that this type of subacute traumatic BE, which is significantly associated with surgical lesions, is not of major hemodynamic or clinical significance in intensively treated patients, and does not cause cerebral ischemia. Patient outcome is determined more by the severity of the initial diffuse cortical and subcortical injury than by the presence or absence of subacute BE.
Control of shunt infection
Authors: Venes Joan L.
Published: May 2009

✓ The author analyzes 150 consecutive ventriculovenous, ventriculoperitoneal, and lumboperitoneal shunt procedures with particular attention to shunt colonization by Staphylococcus epidermidis. There was one primary infection with Staphylococcus epidermidis early in the series, and in two other cases, the organism was felt to be a secondary invader. In those procedures involving either primary placement or revision of a ventriculovenous shunt, there was not a single infection. The operative protocol that has virtually eliminated Staphylococcus epidermidis is outlined.
Unruptured aneurysm of the anterior spinal artery presenting as paraparesis
Authors: Leech Peter J. , Stokes Bryant A. R. , Apsimon Trevor , Harper Clive
Published: May 2009

✓ A case is presented in which spinal cord compression was caused by an unruptured aneurysm of the anterior spinal artery. The nature of the mass was not disclosed until it was surgically exposed. Resection of the sac was followed by neurological recovery.
Giant intracranial aneurysm associated with Marfan's syndrome
Authors: Finney H. Lee , Roberts Theodore S. , Anderson Robert E.
Published: May 2009

✓ The authors describe a giant intracranial internal carotid aneurysm in a patient with Marfan's syndrome. Treatment consisted of internal carotid ligation with subsequent thrombosis of the lesion. The patient's course was complicated by carotid arterial dissection and possible laminar thrombosis within the aneurysm increasing the size of the lesion. Three clinical syndromes, Marfan's, Ehlers-Danlos, and pseudoxanthoma elasticum, are discussed. The literature is reviewed with reference to the hazards of treatment of vascular pathology in patients with these connective tissue disorders.
Neurenteric cyst with meningomyelocele
Authors: Odake Genya , Yamaki Tarumi , Naruse Shoji
Published: May 2009

✓ A case is reported of lumbosacral meningomyelocele with a neurenteric cyst and superficial presentation of the mucosa. Development and inversion of the cyst is discussed.
Lateral canthal advancement of the supraorbital margin
Authors: Hoffman Harold J. , Mohr Gerard
Published: May 2009

✓ In coronal synostosis, in addition to fusion of the coronal suture, the frontosphenoidal and frontoethmoidal sutures are usually closed. A linear craniectomy along the coronal sutures does not affect the synostotic process at the base of the skull. The facility with which the supraorbital margin could be mobilized in Tessier's method of craniofacial repair suggested to us that we could easily modify our approach to coronal synostosis and advance the supraorbital margin, creating an artificial suture at the base of the skull and allowing for proper correction of this disorder. During the past 3 years, we have treated 15 patients with coronal synostosis by this technique, which we have termed lateral canthal advancement. The method of this form of surgical management and its results are discussed.
Physiopathogenesis of subdural hematomas
Authors: Labadie Enrique L. , Glover David
Published: May 2009

✓ The dorsal subcutaneous injection in rats of 12 ml or more of autologous hemolyzed whole blood clotted in situ induced the formation of sterile, hemispheric lesions, 47% of which showed an initial decrease in volume followed by a progressive enlargement. The behavior, histology, and biochemical characteristics of the liquid contents of these lesions were found to be remarkably similar to those of subdural hematomas in man. To evaluate the role of the various blood components that may have influenced the formation and growth of these lesions, more than 150 clots composed of human platelet-free plasma, autologous hemolyzed blood, or autologous whole blood were implanted subcutaneously in rats by either surgical or injection techniques. The in vitro behavior of the different clots used was also assessed. This systematic approach led to the following conclusions: 1) the composition and volumes of the clots are critical variables; 2) plasma-fibrin provides the matrix shape of the lesions; 3) the breakdown products derived from erythrocytes, hemoglobin, leukocytes, and other solid blood elements induce neomembrane formation and contribute to the lesion's subsequent growth; and 4) inflammation mechanisms appear to be essential, while cerebrospinal fluid plays no discernible role in this process.
Physiopathogenesis of subdural hematomas
Authors: Glover David , Labadie Enrique L.
Published: May 2009

✓ A previously described experimental hematoma model, achieved by the subcutaneous injection of 12 ml of autologous hemolyzed blood clotted in situ, was made in 33 rats. Seventeen animals served as controls; the other 16 received daily intramuscular injections of dexamethasone. After an initial decrease in size, 47% of the lesions in the control animals enlarged to a mean weight of 12.1 ± 2.5 gm, while the lesions in the 16 steroid-treated rats weighed 3.2 ± 0.70 gm (p < 0.01). Histologically, lesions from the steroid group showed absence of neomembrane formation. These data offer further support to the theory that the neomembrane development and subsequent enlargement of subdural hematomas is due to inflammatory reactions of tissues in contact with large blood clots.
Clinical and pathological study of 24 cases of gliosarcoma
Authors: Morantz Robert A. , Feigin Irwin , Ransohoff Joseph
Published: May 2009

✓ The authors review the clinical and pathological features of 24 patients with gliosarcoma. The study revealed the following findings. Gliosarcoma occurs more frequently than is indicated in the literature, and in our series was present in 8% of all cases of glioblastoma multiforme. The presenting features are not significantly different from those of glioblastoma multiforme. The lesion often presents itself at surgery as a firm, well circumscribed mass within the temporal lobe, and at surgery it is commonly mistaken for a meningioma. There is an increased likelihood of metastasis compared to that of glioblastoma. The prognosis is no worse than that of glioblastoma, in spite of the addition of sarcomatous elements.
Effect of acetylcholine on cerebral circulation
Authors: Matsuda Masayuki , Meyer John Stirling , Deshmukh Vinod D. , Tagashira Yukio
Published: May 2009

✓ Effects of intravertebral, intracarotid, and intravenous infusion of acetylcholine on cerebral blood flow (CBF) and metabolism were studied in 17 baboons anesthetized with pentobarbital. We measured CBF by the bilateral jugular venous outflow technique using two electromagnetic flowmeters. Effect of acetylcholine infusion on cerebral vascular response to hypercapnia was also assessed. Intravertebral infusion of acetylcholine (0.01 mg/kg/min) increased CBF by 27% and cerebral metabolic rate for oxygen by 19% and decreased cerebral vascular resistance by 25%. On intracarotid injection of acetylcholine, only an 8% increase in CBF was observed, and intravenous infusion produced no change in the parameters observed. Acetylcholine administered by any of the three routes did not enhance the CBF response to hypercapnia. Increase in CBF on intravertebral administration of acetylcholine is associated with an arousal effect and an increase in cerebral metabolism.
Restricted fluid intake
Authors: Shenkin Henry A. , Bezier Honorio S. , Bouzarth William F.
Published: May 2009

✓ Water balance studies in postcraniotomy patients indicate that restriction of fluid intake to 1 liter daily maintains the patient in homeostatic balance. A larger fluid intake will expand the extracellular space and presumably unfavorably influence cerebral edema. Daily observation of serum sodium and osmolarity and blood urea nitrogen, and preserving their normalcy, is a rational way of regulating fluid intake of the brain-injured patient. Fluid restriction should be used with caution if hyperosmolar agents, diuretics, or dexamethasone are also administered.
Meningiomas causing spontaneous intracranial hematomas
Authors: Modesti Luciano M. , Binet Eugene F. , Collins George H.
Published: May 2009

✓ Four cases of spontaneous intracranial hematomas caused by unsuspected meningiomas are reported. Nine previous cases were found in the literature and the entire series of 13 cases is reviewed. Because of their unusual clinical presentation, these cases were not diagnosed correctly prior to radiological studies. Hypertension, trauma, and blood dyscrasia played no significant pathogenetic role. The histological features of these hemorrhagic meningiomas are described, and the importance of adequate radiological investigations and early radical surgery is stressed.
Treatment of hydrocephalus and bilateral subdural effusions in a patient with closed sutures
Authors: Sivalingam Selvadurai , Corkill Guy
Published: May 2009

✓ For management of bilateral subdural hematomas in a hydrocephalic child with fused sutures, a simple technique is described that involves minimal cranial procedures for modification of an already installed ventriculoperitoneal shunt system.
Persistent hypoglossal artery associated with aneurysms
Authors: Kodama Namio , Ohara Hiroo , Suzuki Jiro
Published: May 2009

✓ Two cases of persistent hypoglossal artery associated with aneurysm are presented. In one case the aneurysm arose from the anterior communicating artery and in the other from the persistent hypoglossal artery itself. Both aneurysms were treated successfully with direct surgery.
Percutaneous epidural dorsal column stimulation
Authors: Zumpano Bernard J. , Saunders Richard L.
Published: May 2009

✓ The authors describe a method of epidural electrode placement and electrically induced paresthesia localization without x-ray guidance.
Microsurgery of Arnold-Chiari malformation in adults with and without hydromyelia
Authors: Rhoton Albert L.
Published: May 2009

✓ Microsurgical exploration of 15 adults with Arnold-Chiari malformation with and without hydromyelia using 3 to 20 × magnification has led to the following conclusions. Hydromyelia, associated with Arnold-Chiari malformation, is a progressive mechanical disorder that causes spinal cord deficits by pressure distention of the cord. Arnold-Chiari malformation causes slowly or suddenly progressive bulbar dysfunction by impaction of the malformation in the foramen magnum. Decompression of both can be achieved by a suboccipital craniectomy, upper cervical laminectomy, establishing an outlet from the fourth ventricle, and opening the distended cord in the thinnest exposed area, which is usually along the dorsal root entry zone. If Pantopaque myelography in patients in the supine position shows the Arnold-Chiari malformation, hydromyelia can be established as a cause of central cord deficit even if myelography shows the cord size to be normal. Syringomyelia, traditionally considered a degenerative disease, is a less common cause of a slowly progressive central cord deficit than either hydromyelia or intramedullary tumor.
Endothelial cell damage by temporary arterial occlusion with surgical clips
Authors: Gertz S. David , Rennels Marshall L. , Forbes Michael S. , Kawamura Junichiro , Sunaga Toshiaki , Nelson Erland
Published: May 2009

✓ The effects of temporary vascular occlusion with surgical clips on the underlying endothelial lining were studied with scanning (SEM) and transmission (TEM) electron microscopy. Twenty-five rabbits were anesthetized and both common carotid arteries exposed. A Heifetz clip was used to occlude the right carotid artery for 5, 15, and 30 minutes, and 2 hours in five animals each. The clips were removed and the vessels immediately perfused with glutaraldehyde. In the five remaining animals, the right carotid arteries were occluded for 30 minutes followed by removal of the clip and resumption of blood flow for 30 minutes prior to fixation. Combined SEM and TEM examination of the endothelium of compressed segments revealed “craters” and “balloons,” blebs and vacuoles, swollen mitochondria, dilated granular endoplasmic reticulum, and subendothelial edema. There were also areas of endothelial cell flattening, discontinuity, and desquamation exposing the subendothelial tissues. Following restoration of flow, platelets and fibrin were found adherent to altered endothelial cells and to exposed subendothelial tissues. Endothelial craters and balloons were also found distal and, significantly less frequently, proximal to the site of occlusion. It is suggested that antiplatelet aggregating agents may prove beneficial for the prevention of thrombus formation at the site of the clip as well as craters and balloons distal to the clip following procedures requiring temporary vascular occlusion.
Fluid-percussion model of mechanical brain injury in the cat
Authors: Sullivan Humbert G. , Martinez Jullo , Becker Donald P. , Miller J. Douglas , Griffith Richard , Wist Abund O.
Published: May 2009

✓ Mechanical brain injury was produced in 36 cats with a fluid-percussion model in which brain damage or dysfunction is produced by a single, brief, hydraulically-induced pressure transient that is conducted through the brain. Fluid-percussion injury induces elastic deformation of the brain resembling the brain deformation known to occur following head impact. Physiological responses and pathological changes following injury were expressed as a function of peak pressure. Macroscopic central nervous system lesions concentrated at the pontomesencephalic junction, cervicomedullary junction, and in the cerebellar tonsils were consistently observed at and above 2.6 atmospheres (atm). At higher levels of injury (≥ 3.2 atm) there was extensive basal subarachnoid hemorrhage. At very high levels of injury (>4.0 atm) hemorrhagic contusions were noted at the cerebral hemisphere impact site. A spectrum of neuronal alterations was identified in the damaged areas. Computer analysis showed correlation of electroencephalographic (EEG) changes with the neuropathological changes, since EEG recovery became severely impaired above 2.6 atm. No EEG changes were noted below 1.5 atm. From 1.5 to 2.2 atm there was a physiological response to injury but no significant changes were seen on neuropathological examination. This range of injury should permit further studies of the more subtle changes following mechanical brain injury without intraparenchymal hemorrhage or subarachnoid hemorrhage. The fluid-percussion model relates brain deformation following mechanical loading to a single pressure transient that is easily measured and controlled. Further quantitative investigation into the pathobiology of mechanical brain injury following graded brain deformation is thus made possible.
Effect of increasing the plasma oxygen diffusivity on experimental cryogenic edema
Authors: Gainer James V. , Nugent G. Robert
Published: May 2009

✓ Mongrel cats with experimental cryogenic brain lesions were treated with the carotenoid compound crocetin. It has been shown that crocetin increases the diffusion speed of oxygen through plasma, and should provide a net increase in available oxygen to the capillary endothelial cell. The treated group of animals showed a significant reduction in edema as compared to a comparable control group. It is suggested that oxygen availability is an important factor in vasogenic edema.
Activation of neurons in the cerebellar nuclei and ascending reticular formation by stimulation of the cerebellar surface
Authors: Bantli Heinrich , Bloedel James R. , Tolbert Daniel
Published: May 2009

✓ Electrical stimulation of the cerebellar surface has been used therapeutically for the control of certain epileptic seizure and motor disorders. Recent hypotheses suggest that the therapeutic results in the treatment of epilepsy might be a consequence of the activation of Purkinje cells which subsequently inhibit the epileptic activity in the cerebrocerebellar loop. These experiments establish that an anatomical substrate exists whereby the effects of stimulating the cerebellar surface might be mediated by the ascending reticular formation and the non-specific thalamic nuclei. Specifically, the stimulation of the cerebellar surface activates not only Purkinje cells but also cerebellar afferent systems, climbing fibers and mossy fibers, and neurons in the cerebellar nuclei and reticular formation. In addition, recordings from neurons in the ascending reticular formation suggest that stimulation of the cerebellar surface can affect processing of ascending sensory information, thus influencing neural integration of non-specific sensory systems.
Laminotomy and total reconstruction of the posterior spinal arch for spinal canal surgery in childhood
Authors: Raimondi Anthony J. , Gutierrez Francisco A. , Di Rocco Concezio
Published: May 2009

✓ Kyphosis, anterior subluxation, and instability of the spine are reported as postoperative complications of multiple level laminectomies in children. The surgical procedure of multiple level laminotomies is proposed as an alternative. Indications in infants and children, the surgical technique, and the postoperative management are presented. The goal is preservation of the normal architecture of the spine in patients who are still developing.
Pathogenesis of hematogenous bacterial meningitis in rabbits
Authors: Gregorius F. Karl , Johnson B. Lamar , Stern W. Eugene , Brown W. Jann
Published: May 2009

✓ The authors present data obtained from a series of 27 rabbits studied following intracarotid injection of saline, brain-heart infusion broth, aerobic, or anaerobic bacteria. These data support the hypothesis that injection of cultures of both aerobic and anaerobic organisms by way of the carotid artery disrupts the blood-brain barrier over the cerebral convexities within 15 minutes; however, the inflammatory response and bacterial proliferation occur much more rapidly in the ventricular system. Within 3 hours, the barrier over the convexities is intact, but leukocytes and organisms may be seen in the long cilia of the aqueductal region. A relative failure of leucotaxis over the convexities of the brain is the most likely explanation of these preliminary findings in this experimental model.
Detection of small trigeminal neurinomas
Authors: Levinthal Robert , Bentson John R.
Published: May 2009

✓ Four cases of trigeminal neurinoma are reviewed with particular attention to clinical signs and symptoms, lumbar puncture, electroencephalogram, brain scan, plain skull and tomographic radiographs, and angiographic and pneumoencephalographic findings. Pneumoencephalography, with special tomographic projections to identify various portions of the trigeminal nerve, delineated the tumor in all cases. Tumor removal was complete in three patients and nearly complete in the fourth. There was no operative morbidity or mortality.
Late pseudotumoral brain necrosis following irradiation of a scalp neoplasm
Authors: Queiroz Luciano de S. , da Cruz Neto Joaquim N.
Published: May 2009

✓ The authors report the case of a 70-year-old man who developed intracranial hypertension and left-arm paresis 2 years after irradiation for a right preauricular basal cell epithelioma. Angiography disclosed a right temporal lobe mass and the histopathological diagnosis was late postirradiation necrosis of the brain. Postoperatively, dexamethasone was given in increasing doses up to 60 mg/day for control of cerebral edema. The patient died of gastrointestinal bleeding on the 60th postoperative day.
Symptomatic Rathke's cleft cyst
Authors: Eisenberg Howard M. , Sarwar Mohammed , Schochet Sydney
Published: May 2009

✓ A case of a symptomatic Rathke's cleft cyst in a 10-year-old boy is described. The importance of the intraoperative differentiation between this rare tumor and a craniopharyngioma is discussed.
Assessment, accomplishments, and anxieties
Authors: DeSaussure Richard L.
Published: May 2009

✓ The President of the American Association of Neurological Surgeons discusses recertification, relicensure, self-assessment, and means of continuing medical education. He further proposes a new, top-level Socio-Economics Committee able to handle at once urgent problems pertaining to neurosurgery.
Review of the effect of spinal cord trauma on the vessels and blood flow in the spinal cord
Authors: Sandler Alan N. , Tator Charles H.
Published: May 2009

✓ The effect of spinal cord trauma on the vasculature and blood flow of the spinal cord is reviewed. Both quantitative and nonquantitative studies are critically discussed and reasons sought for some of the major controversies that have arisen. Differences in methodology, species variation, and variation in the degree and type of cord injury may all be important factors in producing the conflicting results reported in the literature. In general, it can be said that trauma has a profound effect on the vasculature and blood flow in the cord and that severe compression injury of the cord causes marked ischemia in the gray and white matter.
Prediction of mobility gains in patients with cervical spinal cord injuries
Authors: Mason Robert L. , Gunst Richard F.
Published: May 2009

✓ A measure of mobility for patients with spinal cord injuries is introduced that is very useful in determining patient recovery. The index is used to obtain a prediction equation for motor skills 1 year after injury. Important predictor variables identified include the patient's sex, rectal status, total reflexes, two treatment combinations, motor and sensory neurological history since injury, neurological status, and initial mobility score. Interpretations are made to explain the meaning of the contributions of these variables and show the usefulness of the prediction equation.
Myelotomy for control of mass spasms in paraplegia
Authors: Yamada Shokei , Perot Phanor L. , Ducker Thomas B. , Lockard Isabel
Published: May 2009

✓ A new myelotomy knife is described and a procedure, designed to sever certain reflex connections while preserving as many corticospinal connections as possible, is presented. Through intermittent dorsal midline incisions the gray matter lateral to the central canal is severed bilaterally under the microscope from L-1 to S-1. This procedure relieved mass spasms and hyperactive reflexes in 14 paraplegic or tetraplegic patients, but preserved postural reflexes and whatever voluntary motor power the patients had prior to myelotomy. Before myelotomy all patients were bedridden. Afterward nine patients were able to use a wheel chair and five were able to walk with the use of parallel bars or crutches.
Peripheral nerve stimulation in the treatment of intractable pain
Authors: Campbell James N. , Long Donlin M.
Published: May 2009

✓ Peripheral nerve stimulating devices were implanted for pain control in 33 patients with a variety of disabling chronic pain conditions, which had persisted despite usual medical and surgical therapy. The implants were placed on major nerves innervating the area of the patient's pain. Records were obtained of each patient's stated relief from pain produced by nerve stimulation, along with assessments of narcotic withdrawal, ability to return to work, sleep pattern, and relief from depression. Based on these five criteria 17 patients were judged to be treatment failures, while eight patients had excellent results, and seven had intermediate results. Twelve of the failures were in patients with either low back pain with sciatica, or pain from metastatic disease. The most dramatic successes occurred in patients with peripheral nerve trauma. The incidence of complications has been low, and two patients have used the stimulator for 5 years without adverse effects. Techniques of peripheral stimulator implantation, possible mechanisms of action, and conclusions regarding peripheral nerve stimulation in the treatment of chronic pain are discussed.
Management of intracerebral hemorrhage in idiopathic thrombocytopenic purpura
Authors: Humphreys Robin P. , Hockley Anthony D. , Freedman Melvin H. , Saunders E. Fred.
Published: May 2009

✓ There has been little comment on the specific management of intracerebral bleeding occurring in patients suffering idiopathic thrombocytopenic purpura. The authors present the cases of four children with intracerebral hemorrhage due to this coagulation disturbance. A plan of management is described based on this experience; it includes immediate control of cerebral edema, emergency splenectomy, supportive care with platelet transfusions and corticosteroids, cerebral angiography, and a definitive neurosurgical procedure. If necessary, the radiological investigation and surgical therapy can be performed with a single general anesthetic. Three of the patients have survived without major neurological sequelae.
Stereotaxic clipping of arterial aneurysms and arteriovenous malformations
Authors: Kandel Edward I. , Peresedov Vyacheslav V.
Published: May 2009

✓ In carefully selected cases of arterial aneurysms and deep-seated arteriovenous malformations (AVM), when direct attack may be dangerous or impossible, the authors advocate stereotaxic clipping. A special device and technique for its application are described. The instrument is introduced through a trephine opening and clipping is monitored by angiography. Successful results have been obtained in 10 operations performed on eight patients, three of whom had arterial aneurysms (two internal carotid and one anterior cerebral-anterior communicating) and five with AVM's.
Neurosurgical procedures in Olmsted County, Minnesota, 1970–1974
Authors: Glista Glen G. , Miller Ross H. , Kurland Leonard T. , Jereczek Mark L.
Published: May 2009

✓ To help determine neurosurgical needs within communities and within the nation, operations and diagnostic procedures performed by neurosurgeons on residents of Olmsted County, Minnesota, in the 5 years of 1970 through 1974, were tabulated. This county was studied because its medical records are virtually complete. Annual rates (per 100,000 population) were 42 for lumbar disc removal, six for cervical disc removal, and seven for brain-tumor therapy. Other less frequent occasions for neurological surgery are also tabulated.
Cranial zygomycosis caused by Saksenaea vasiformis
Authors: Dean David F. , Ajello Libero , Irwin Richard S. , Woelk William K. , Skarulis Gregory J.
Published: May 2009

✓ A previously healthy youth who had sustained severe head trauma and had received steroids and broad-spectrum antimicrobial agents developed a cranial zygomycotic infection with Saksenaea vasiformis. This is the first time this zygomycete has been implicated as a disease agent. Early identification of the fungal infection and subsequent vigorous medical and surgical therapy led to recovery.
Benign pituitary adenoma associated with hyperostosis of the sphenoid bone and monocular blindness
Authors: Milas Robert W. , Sugar Oscar , Dobben Glen
Published: May 2009

✓ The authors describe a case of benign chromophobe adenoma associated with hyperostosis of the lesser wing of the sphenoid bone and monocular blindness in a 38-year-old woman. The endocrinological and radiological evaluations were all suggestive of a meningioma. The diagnosis was established by biopsy of the tumor mass. After orbital decompression and removal of the tumor, the patient was treated with radiation therapy. Her postoperative course was uneventful, and her visual defects remained fixed.
Giant serpentine aneurysm
Authors: Segal Harold D. , McLaurin Robert L.
Published: May 2009

✓ The authors describe two cases of giant middle cerebral artery aneurysms presenting as mass lesions. Angiograms in each case revealed a distinctive serpentine vascular channel surrounded by an avascular area causing a “mass effect.” Both lesions were resected in toto with excellent clinical results. Similar lesions in the literature are noted and the pathophysiology and origin of this group of aneurysms are discussed.
Brain-tumor chemotherapy
Authors: Ausman James I. , Levin Victor A. , Brown Willis E. , Rall David P. , Fenstermacher Joseph D.
Published: May 2009

✓ An implanted choriocarcinoma growing in the brains of monkeys was used as a brain-tumor model for the study of the cerebral distribution of two commonly used physiological markers, inulin and albumin; tissue samples were obtained from the tumor, adjacent brain, and distant brain. An extravascular inulin space was calculated by subtracting the albumin (plasma) space from the total inulin spaces. The extravascular inulin space in the tumor was found to be 24%, a value significantly larger than that in distant brain (0.6%). The large inulin space of the tumor was probably the result of increases in both capillary permeability and the extracellular space within this area. Determination of the inulin space in 1 to 2-mm thick samples of tissue taken serially from the tumor center to the distant brain indicated a gradual decline in inulin concentration from the tumor's edge to distant brain. This distribution pattern could be the result of either a continuous decrease, running from the tumor to distant brain, in capillary permeability to inulin, or a diffusional flow of inulin from the tumor into the adjacent tissue. The failure of drugs to inhibit such a tumor in view of these observations is discussed.