bluuebunny/crossref_metadata_2025 huggingface dataset:
Optic canal syndrome due to posterior ethmoid sinus mucocele
Authors: Yue Chung P. , Mann Kirpal S. , Chan Fu L.
Published: May 2009

✓ A case of mucocele of the posterior ethmoid sinus presenting as unilateral blindness without pain, proptosis, or diplopia is reported. Computerized tomography (CT) demonstrated the precise anatomical relationship of the mucocele to the optic nerve inside the optic canal. It is proposed to use the term “optic canal syndrome” for patients with such clinical and CT presentation. Combined transcranial excision and transnasal drainage resulted in dramatic recovery of vision.
The significance of unruptured intracranial saccular aneurysms
Authors: Wiebers David O. , Whisnant Jack P. , Sundt Thoralf M. , O'Fallon W. Michael
Published: May 2009

✓ The authors report the results of a long-term follow-up study of 130 patients with 161 unruptured intracranial saccular aneurysms. Their findings suggest that unruptured saccular aneurysms less than 10 mm in diameter have a very low probability of subsequent rupture; The mean diameter of the aneurysms that subsequently ruptured was 21.3 mm, compared with a diameter of 7.5 mm for aneurysms defined after rupture at the same institution. Part of the explanation for this discrepancy may be that the size of the filling compartment of the aneurysm decreases after rupture. There is also evidence from the present study that intracranial saccular aneurysms develop with increasing age of the patient and stabilize over a relatively short period, if they do not initially rupture, and that the likelihood of subsequent rupture decreases considerably if the initial stabilized size is less than 10 mm in diameter. Consequently, the critical size for aneurysm rupture is likely to be smaller if rupture occurs at the time of or soon after aneurysm formation. There seems to be a substantial difference in potential for growth and rupture between previously ruptured and unruptured aneurysms.
The minor leak preceding subarachnoid hemorrhage
Authors: Leblanc Richard
Published: May 2009

✓ Thirty-four of 87 consecutive patients with subarachnoid hemorrhage from a cerebral aneurysm had a premonitory minor leak. There were 12 men and 22 women, aged 25 to 73 years (mean 44.4 years). Twenty-two had a small and 12 had a large aneurysm located on the internal carotid artery (17 cases), anterior communicating artery (10 cases), middle cerebral artery (five cases), and pericallosal artery (two cases). Fifty-two percent of patients with a minor leak from an internal carotid artery aneurysm had ipsilateral, hemicranial, hemifacial, or periorbital pain. Half of the patients initially saw a physician, but in no case was the correct diagnosis made. Twenty-five patients had a major rupture within 24 hours to 4 weeks after findings suggesting a minor leak, with a mortality rate of 53%. Nine other patients were diagnosed by lumbar puncture or computerized tomography (CT) scanning after initial misdiagnosis and were operated on, without mortality, before a major rupture could occur. The CT scans were negative in 55% of patients with a minor leak, but lumbar puncture, when performed, was always positive.

A minor leak prior to major aneurysmal rupture is a common occurrence and, if unrecognized, is associated with a high mortality. Computerized tomography scanning is unreliable in diagnosing this event, and lumbar puncture is the examination of choice once intracranial hypertension has been ruled out.
Changing concepts in the treatment of colloid cysts
Authors: Hall Walter A. , Lunsford L. Dade
Published: May 2009

✓ Since computerized tomography (CT) scanning became available at the University Health Center of Pittsburgh in July, 1975, 17 patients have undergone removal of colloid cysts of the third ventricle by transfrontal, transcallosal, or stereotaxic surgery. All patients presented with symptoms and signs of increased intracranial pressure; CT scanning proved to be the best neurodiagnostic test to define the colloid cysts. Since the development of CT-guided stereotaxic surgery, the authors have preferentially performed stereotaxic aspiration in seven patients; three of these subsequently required craniotomies to remove residual cysts producing persistent symptoms. The viscosity of the intracystic colloid material and/or displacement of the cyst away from the aspiration needle were reasons for unsuccessful aspiration; the CT appearance did not correlate with the ability to aspirate the lesion by the stereotaxic technique. Postoperative patency of the ventricular system was documented by intraoperative CT ventriculography performed during stereotaxic surgery. Removal of the cyst wall was not necessary. Because of the low associated morbidity rate, percutaneous stereotaxic aspiration is recommended as the initial treatment of choice for colloid cysts of the third ventricle. If stereotaxic aspiration fails and symptoms persist, craniotomy should be performed.
Brain-stem tumors in childhood: a prospective randomized trial of irradiation with and without adjuvant CCNU, VCR, and prednisone
Authors: Jenkin R. Derek T. , Boesel Carl , Ertel Inta , Evans Audrey , Hittle Robert , Ortega Jorge , Sposto Richard , Wara William , Wilson Charles , Anderson James , Leikin Sanford , Hammond G. Denman
Published: May 2009

✓ Seventy-four children with a brain-stem tumor diagnosed between 1977 and 1980 were entered into a prospective study in which exploration and assessment for resection were optional, radiation treatment using standard methods was required, and randomization occurred with regard to the use of adjuvant chemotherapy (l-(2-chloroethyl)-l-nitrosourea, vincristine, and prednisone) or no further treatment. The overall 5-year survival rate was 20% and was not improved by the adjuvant chemotherapy program. An increased risk of infection was associated with the adjuvant therapy.
Hyperosmotic blood-brain barrier disruption in brains of rats with an intracerebrally transplanted RG-C6 tumor
Authors: Inoue Tooru , Fukui Masashi , Nishio Shunji , Kitamura Katsutoshi , Nagara Hitoshi
Published: May 2009

✓ To test the results of blood-brain barrier (BBB) disruption in the treatment of brain tumor, RG-C6 glioma was transplanted into the brains of rats. Intracarotid infusions of normal saline and hyperosmotic mannitol were then made, followed by intravenous injection of Evans blue dye plus albumin (EB, MW 68,000), horseradish peroxidase (HRP, MW 40,000), and 5-fluorouracil (5-FU, MW 130). Uptake of the drug and the consistency of drug levels in the normal brain and tumor varied widely among these three agents. Both EB and HRP penetrated the brain tumors but did not stain the normal brain tissues. After BBB opening, penetration of EB and HRP into the normal brain was drastically increased; however, the uptake of EB and HRP in the tumor was not increased. The concentration of 5-FU in the tumor was higher than that in the serum and, although it increased 1.5-fold after BBB opening, the increase was not statistically significant. Conversely, there was a progressive increase in concentrations of 5-FU in the tumor-free brain regions (p < 0.05). These observations suggest that an intracarotid infusion of hyperosmotic mannitol may increase neurotoxicity because it allows greater delivery of anticancer drugs into the normal brain tissue than into the tumor tissues.
Feasibility of intracranial surgery in the primate fetus
Authors: Brodner Robert A. , Markowitz Ronald S. , Lantner Howard J.
Published: May 2009

✓ A research model for intracranial surgery in the primate fetus was developed and tested in 10 timed-pregnant rhesus monkeys. With general anesthesia and sterile surgical technique, a laparotomy followed by a lower uterine segment hysterotomy was performed at a site avoiding the placenta. The amnion was opened carefully by use of the operative microscope and the fetal head was exposed. A scalp incision was made over the frontal region and a small craniectomy and cortical incision were carried out. In three of the fetuses, ventricular shunts were also placed. A layered closure was performed and the uterus was returned to the peritoneal cavity. Placental integrity and fetal viability were assessed before surgery and 1 week postoperatively by ultrasonography. The survival rates were 100% for the mothers and 80% for the fetuses. One fetus died in utero after an overdose of a sedative to the mother, and another was stillborn. Postmortem examination revealed no intracranial or systemic abnormalities in either case, and the cause of death was attributed to drug overdose and a naturally occurring stillbirth, respectively. Newborns were maintained either with their mothers or in a nursery, where they were observed and evaluated for 3 weeks. Weight, crown-rump length, and occipitofrontal head circumference were measured. General patterns of behavior and neurological assessments were recorded weekly. The eight surviving neonates were normal with respect to all parameters evaluated. Several principles of fetal intracranial surgery are emphasized as important: uterine relaxation by prostaglandin inhibition; low-dose halothane anesthesia supplemented by nitrous oxide in oxygen; perioperative ultrasonography and intraoperative transillumination of the uterus for placental localization; lower uterine segment opening; controlled exposure of the fetal cranium; minimization of amniotic fluid loss; enhancement of fetal anesthesia by injection of a local anesthetic agent at the fetal operative site; and multilayered watertight closure.
Multiple thoracic disc herniations
Authors: Chin Lawrence S. , Black Keith L. , Hoff Julian T.
Published: May 2009

✓ A patient with herniated thoracic discs in tandem is reported. The previous literature is reviewed. Difficulties with the preoperative diagnosis and the surgical approach to these lesions are discussed.
Clipping of an AVM arterial feeder through a burr hole prior to radical surgery
Authors: Kandel Edward I.
Published: May 2009

✓ If the main feeder of an arteriovenous malformation (AVM) is a branch of the middle cerebral artery, one segment of which lies on the brain surface, it is advisable to clip it through a burr hole placed at an angiographically preselected point. The technical details of the procedure are described. This simple maneuver performed directly prior to radical surgery decreases the risk of possible rupture of an AVM during craniotomy and facilitates radical AVM excision.
Surgical treatment of arteriovenous malformations of the striatothalamocapsular region
Authors: Shi Yu-quan , Chen Xian-cheng
Published: May 2009

✓ Sixteen patients with arteriovenous malformations (AVM's) located in the striatothalamocapsular region were treated microsurgically at the Hau Shan Hospital, Shanghai. These AVM's had a tendency to bleed intracerebrally and typically presented with hemiplegia, hemianesthesia, and hemianopsia. Angiographically the lesions were primarily located in the triangle of Reil. Postoperative outcome was not as good as that of AVM's in other locations, but the operation may have prevented the risk of further hemorrhage. This report details the operative technique used and the clinical course in this group of patients.
Risk of intracranial hemorrhage in glioma patients receiving anticoagulant therapy for venous thromboembolism
Authors: Choucair Ali K. , Silver Pamela , Levin Victor A.
Published: May 2009

✓ To determine the risk of intracranial hemorrhage in patients with malignant gliomas who are treated with anticoagulant drugs for late postoperative venous thromboembolism, the authors retrospectively reviewed the computerized data base of all patients with primary brain tumors seen at the University of California, San Francisco, over a 9-year period. Of 915 patients 18 years of age or older who had a pathological diagnosis of malignant glioma and an initial Karnofsky performance scale score of 60% or higher, 36 (4%) developed venous thromboembolism 6 to 246 weeks postoperatively and 22 were treated with anticoagulant drugs. Anticoagulant therapy usually consisted of intravenous heparin for 7 to 10 days, followed for at least 3 to 6 months by either subcutaneous heparin (5000 to 8000 U twice daily) or oral warfarin. All patients were closely monitored to ensure control of hypertension, compliance with therapy, maintenance of prothrombin time within the therapeutic range, and early recognition of adverse side effects. No patient had an intracranial hemorrhage. Thus, anticoagulant agents can be safely administered after intracranial operations for malignant gliomas without increased risk of morbidity or mortality if the patients are carefully monitored according to established guidelines.
Intraoperative measurement of cortical blood flow adjacent to cerebral AVM using laser Doppler velocimetry
Authors: Rosenblum Bruce R. , Bonner Robert F. , Oldfield Edward H.
Published: May 2009

✓ Standard methods for measurement of cerebral blood flow (CBF) are not optimal for continuous intraoperative recording. Laser Doppler velocimetry has been used for evaluation of microcirculatory flow in a variety of human tissues, including skin, muscle, and retina. The authors report the use of this technique for measuring flow in human cerebral cortex. The physiological changes associated with excision of a cerebral arteriovenous malformation are interpreted using CBF recorded intraoperatively with the laser Doppler probe.
Deterioration following spinal cord injury
Authors: Marshall Lawrence F. , Knowlton Sharen , Garfin Steven R. , Klauber Melville R. , Eisenberg Howard M. , Kopaniky Dennis , Miner Michael E. , Tabbador Kamran , Clifton Guy L.
Published: May 2009

✓ The results are presented of a prospective study of the course of 283 spinal cord-injured patients who were consecutively admitted to five trauma centers participating in the Comprehensive Central Nervous System Injury Centers' program of the National Institutes of Health. Of the 283 patients, 14 deteriorated neurologically during acute hospital management. In 12 of the 14, the decline in neurological function could be associated with a specific management event, and in nine of these 12 the injury involved the cervical cord. Nine of the 14 patients who deteriorated had cervical injuries, three had thoracic cord injuries, and two had thoracolumbar junction injuries. Management intervention was identified as the cause of deterioration in four of 134 patients undergoing operative intervention, in three of 60 with skeletal traction application, in two of 68 with halo vest application, in two of 56 undergoing Stryker frame rotation, and in one of 57 undergoing rotobed rotation. Early surgery on the cervical spine when cord injury is present appears hazardous, since each of the three patients with a cervical cord injury who deteriorated was operated on within the first 5 days. No such deterioration was observed following surgery performed from the 6th day on. In two other patients, deterioration did not appear to be related to management but was a direct product of the underlying disease or of systemic complications.

Deterioration following hospitalization for spinal cord injury is relatively uncommon — 4.9% in this large series. In most instances, decline in function could be attributed to specific management procedures. These changes must not be interpreted as representing failure to provide optimal care but rather should be seen as the inevitable product of an attempt to manage patients with spinal cord and column injuries, many of which are clearly unstable.
Correlation of meningioma hormone receptor status with hormone sensitivity in a tumor stem-cell assay
Authors: Grunberg Steven M. , Daniels Anna Marie , Muensch Helmut , Daniels John R. , Bernstein Leslie , Kortes Virginia , Weiss Martin H.
Published: May 2009

✓ Several investigators have detected progesterone receptors in a high percentage of meningioma specimens and have noted progesterone receptors to be more common than estrogen receptors in these specimens. However, a functional significance of such hormone receptor positivity in control of meningioma growth has not been described. This paper describes a paired test of the estrogen and progesterone receptor assay as the biochemical assay and of the human tumor stem-cell clonogenic assay (HTSCCA) as the functional assay in 17 meningioma specimens. Only one (6%) of the 17 specimens was estrogen receptor-positive, while 11 (69%) of 16 specimens were progesterone receptor-positive. The HTSCCA revealed that only two (15%) of 13 specimens were sensitive to estradiol while five (31%) of 16 specimens were sensitive to progesterone. Comparison of progesterone results for the 15 specimens on which both hormone receptor assay and HTSCCA were performed revealed correlation in a majority of cases; four specimens were positive for both assays and five specimens were negative for both assays. No specimen that was negative for progesterone receptors was sensitive to progesterone by HTSCCA. These results suggest that the hormone receptor and sensitivity pattern of meningiomas may differ from that of breast cancer, and that progesterone addition or ablation may be a reasonable therapeutic approach for meningiomas.
Adoptive immunotherapy of human meningeal gliomatosis and carcinomatosis with LAK cells and recombinant interleukin-2
Authors: Shimizu Keiji , Okamoto Yutaka , Miyao Yasuyoshi , Yamada Masanobu , Ushio Yukitaka , Hayakawa Toru , Ikeda Hiroya , Mogami Heitaro
Published: May 2009

✓ Previous in vitro studies have demonstrated that peripheral blood lymphocytes activated with recombinant interleukin-2 (rIL-2) generated cells that were lytic for fresh autologous tumor cells but not for normal lymphocytes or lymphoblasts. Adoptive transfer of autologous lymphokine-activated killer (LAK) cells induced in vitro with rIL-2 was used in two patients: one with meningeal gliomatosis and the other with meningeal carcinomatosis. The adoptive transfer of LAK cells was very effective in reducing the clinical symptoms and signs, and in eliminating the malignant cells from the cerebrospinal fluid. Thus, this therapy is an attractive approach for the treatment of malignant tumors that have poor immunogenicity and are insensitive to several anti-cancer agents, and for patients with severe immunosuppressive conditions induced by repeated radiation therapy or chemotherapy.
Hemodynamic and metabolic effects of cerebral revascularization
Authors: Leblanc Richard , Tyler Jane L. , Mohr Gérard , Meyer Ernst , Diksic Mirko , Yamamoto Lucas , Taylor Laughlin , Gauthier Serge , Hakim Antoine
Published: May 2009

✓ Pre- and postoperative positron emission tomography (PET) was performed in six patients undergoing extracranial to intracranial bypass procedures for the treatment of symptomatic extracranial carotid occlusion. The six patients were all men, aged 52 to 68 years. Their symptoms included transient ischemic attacks (five cases), amaurosis fugax (two cases), and completed stroke with good recovery (one case). Positron emission tomography was performed within 4 weeks prior to surgery and between 3 to 6 months postoperatively, using oxygen-15-labeled CO, O2, and CO2 and fluorine-18-labeled fluorodeoxyglucose. Cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral metabolic rates for oxygen and glucose (CMRO2 and CMRGlu), and the oxygen extraction fraction (OEF) were measured in both hemispheres. Preoperatively, compared to five elderly control subjects, patients had increased CBV, a decreased CBF/CBV ratio, and decreased CMRO2, indicating reduced cerebral perfusion pressure and depressed oxygen metabolism. The CBF was decreased in only one patient who had bilateral carotid occlusions; the OEF, CMRGlu, and CMRO2/CMRGlu and CMRGlu/CBF ratios were not significantly different from control measurements.

All bypasses were patent and all patients were asymptomatic following surgery. Postoperative PET revealed decreased CBV and an increased CBF/CBV ratio, indicating improved hemodynamic function. This was associated with increased CMRO2 in two patients in whom the postoperative OEF was also increased. The CMRGlu and CMRGlu/CBF ratio were increased in five patients. Changes in CBF and the CMRO2/CMRGlu ratio were variable. One patient with preoperative progressive mental deterioration, documented by serial neuropsychological testing and decreasing CBF and CMRO2, had improved postoperative CBF, CBV, and CMRO2 concomitant with improved neuropsychological functioning and oxygen hypometabolism. It is concluded that symptomatic carotid occlusion is associated with altered hemodynamic function. Cerebral revascularization results in decreased CBV, indicating improved hemodynamic reserve, but does not consistently improve oxygen metabolism.
DNA in meningioma tissues and explant cell cultures
Authors: Ironside James W. , Battersby Robert D. E. , Lawry John , Loomes Reginald S. , Day Christopher A. , Timperley Walter R.
Published: May 2009

✓ Flow cytometry was performed on stored frozen tissues and explant cell cultures from 39 meningiomas using ethidium bromide and mithramycin in a selective staining technique for deoxyribonucleic acid (DNA). The ploidy index and percentage of cells in the G0/G1, S, and G2/M phases were calculated for each specimen. The results were compared with the age and sex of the patients; the site, the histological subtype, and mitotic rate of the neoplasms; and the estrogen and progesterone-receptor levels assayed in cytosol-enriched supernatants from cryostat-cut sections. Sixteen neoplasms (41%) were aneuploid. These included two recurrent neoplasms, seven of the eight neoplasms from patients with multiple meningiomas, and three clinically aggressive neoplasms (one hemangiopericytic and two anaplastic meningiomas). Significant correlations were found between values for the ploidy index (r =0.75, p < 0.01), the percentage of S-phase cells (r = 0.82, p < 0.01), and the percentage of G2/M-phase cells (r = 0.69, p < 0.05) in vivo and in vitro. The results support the suggestion that flow cytometry for DNA in meningiomas may be of value in predicting the behavior of these neoplasms, and indicate that under controlled conditions explant cell cultures may provide a useful model for the proliferative characteristics of meningiomas in vivo.
Evolution of tissue damage in compressive spinal cord injury in rats
Authors: Iizuka Hideaki , Yamamoto Hirotaka , Iwasaki Yuzo , Yamamoto Teiji , Konno Hidehiko
Published: May 2009

✓ The evolution of tissue damage in compressive spinal cord injuries in rats was studied using an immunohistochemical technique and by sodium dodecyl sulfate-polyacrylamide gel electropheresis (SDS-PAGE) analysis. The rupture of small vessels accompanied by intense tissue permeation of serum components in and around the hemorrhagic foci appeared to be immediate consequences of the mechanical insult. The loss of cell membrane integrity in neural elements became evident within 1 hour after injury as shown by the diffuse albumin-immunoreactivity of the cytoplasm. At the site of mechanical insult, approximately 30% of the neurofilament proteins were degraded within 1 hour, and 70% of them were lost within 4 hours after injury. A large number of cells positive for glial fibrillary acidic protein were found to demarcate the injured tissue within 1 hour after injury. The progression of tissue damage largely subsided within 48 hours. One week after, injury, severe degeneration of the ascending tracts in the posterior funiculus was shown clearly by axon staining and less convincingly by myelin staining. Secondary degeneration of the corticospinal tract in distal segments remained inconspicuous for up to 3 months.
Catecholamine-secreting paragangliomas of the base of the skull
Authors: Matishak Mark Z. , Symon Lindsay , Cheeseman Anthony , Pamphlett Roger
Published: May 2009

✓ Two cases of catecholamine-secreting paragangliomas of the base of the skull are described. The patients presented with uncontrollable hypertension and, after investigation, tumors were discovered in the regions of the glomus jugulare and pterygopalatine ganglion, respectively. After cardiovascular stabilization and tumor embolization, the tumors were surgically removed, with subsequent resolution of hypertension. The incidence of these tumors is discussed.
Acute herniated nucleus pulposus with cauda equina compression syndrome following chemonucleolysis
Authors: Smith Samuel , Leibrock Lyal G. , Gelber Benjamin R. , Pierson Eric W.
Published: May 2009

✓ Three cases of acute disc herniation causing cauda equina compression syndrome after chemonucleolysis are described. All three patients had myelographic blocks and, despite emergency decompression procedures, were left with residual neurological deficits. Recommendations are made regarding evaluation and therapeutic intervention, and possible etiologies of this problem are reviewed.
Squamous cell carcinoma as a late complication of intracerebroventricular epidermoid cyst
Authors: Goldman Steven A. , Gandy Samuel E.
Published: May 2009

✓ Primary intracerebral squamous cell carcinoma is a rare sequela of benign cerebral epidermoid cysts. A case of presumed malignant transformation in a lateral ventricular epidermoid cyst is described, in which squamous cell carcinoma arose 33 years after the surgical resection of a benign epidermoid cyst. Three years after diagnosis of malignancy, the patient remains functional with a slowly invasive tumor. This case provides a rare description of the natural history of forebrain squamous cell carcinoma, which would appear to be a more indolent tumor than previously realized.
Geoffrey Jefferson (1886–1961), neurosurgeon, physiologist, philosopher
Authors: Guthkelch A. Norman
Published: May 2009

✓ In the centenary year of his birth, the work of Sir Geoffrey Jefferson (1886–1961) is reviewed with special reference to his views on the seat of consciousness and on the application to medicine of the scientific method.
Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm
Authors: Møller Aage R. , Jannetta Peter J.
Published: May 2009

✓ Facial electromyographic (EMG) responses were monitored intraoperatively in 67 patients with hemifacial spasm who were operated on consecutively by microvascular decompression of the facial nerve near its exit from the brain stem. At the beginning of the operation, electrical stimulation of the temporal or the zygomatic branch of the facial nerve gave rise to a burst of EMG activity (autoexcitation) and spontaneous EMG activity (spasm) that could be recorded from the mentalis muscle in all patients. In some patients, the spontaneous activity and the autoexcitation disappeared after the dura was incised or when the arachnoid was opened, but stimulation of the temporal branch of the facial nerve caused electrically recordable activity in the mentalis muscle (lateral spread) with a latency of about 10 msec that lasted until the facial nerve was decompressed in all but one patient, in whom it disappeared when the arachnoidal membrane was opened.

When the facial nerve was decompressed, this lateral spread of antidromic activity disappeared totally in 44 cases, in 16 it was much reduced, and in seven it was present at the end of the operation at about the same strength as before craniectomy. In four of these last seven patients there was still very little improvement of the spasm 2 to 6 months after the operation; these four patients underwent reoperation. In two of the remaining three patients, the spasm was absent at the 3- and 7-month follow-up examination, respectively, and one had mild spasm. Of the 16 patients in whom the lateral spread response was decreased as a result of the decompression but was still present at the end of the operation, 14 had no spasm and two underwent reoperation and had mild spasm at the last examination. Of the 44 patients in whom the lateral spread response disappeared totally, 42 were free from spasm and two had occasional mild spasm at 6 and 13 months, respectively, after the operation.

Monitoring of facial EMG responses is now used routinely by the authors during operations to relieve hemifacial spasm, and is performed simultaneously with monitoring of auditory function for the purpose of preserving hearing. The usefulness of monitoring both brain-stem auditory evoked potentials recorded from electrodes placed on the scalp and compound action potentials recorded directly from the eighth cranial nerve is evaluated.
“Extrapolated” creatine kinase-BB isoenzyme activity in assessment of initial brain damage after severe head injury
Authors: Hans Pol , Born Jacques Daniel , Albert Adelin
Published: May 2009

✓ The severity of initial brain damage is an important risk factor in determining the prognosis of head trauma. It can be assessed by assigning neurological scores or by determining the cerebrospinal fluid (CSF) activity of the isoenzyme creatine kinase-BB (CK-BB). In 10 severely head-injured patients serial CSF samples were obtained during the first 24 hours after trauma, and exponential decay of CK-BB activity with an average half-life of 4.5 hours was demonstrated. This finding led the authors to propose an “extrapolated” CK-BB activity, which theoretically occurs immediately after injury and is calculated from a single CK-BB recording, as a new index for assessing the degree of initial brain damage.

In 50 patients with severe head injury, the prognostic ability of “observed” and “extrapolated” CK-BB activity was compared with two clinical scoring systems that evaluate severity of head trauma (the Glasgow and the Glasgow-Liège Coma Scales). “Extrapolated” CK-BB activity proved to be the best prognostic factor. With a CK-BB cutoff point of 330 U/liter, a true-positive rate of 79% and a true-negative rate of 73% were obtained. These results suggest the usefulness of measuring CK-BB activity in CSF as soon as possible after hospital admission for head injury.
Changes of neuropeptide immunoreactivity in cerebrovascular nerve fibers after experimentally produced SAH
Authors: Uemura Yoshihiko , Sugimoto Tetsuo , Okamoto Shinichiro , Handa Hajime , Mizuno Noboru
Published: May 2009

✓ The immunoreactivity of vasoactive intestinal polypeptide (VIP)-, substance P (SP)-, and neuropeptide Y (NPY)-containing nerve fibers in the basilar artery (BA) and proximal portion of the middle cerebral artery (M1) was immunohistochemically examined in the dog after experimentally produced subarachnoid hemorrhage (SAH). The SAH was produced by a single injection of fresh autologous arterial blood (1 ml/kg body weight) into the cisterna magna. The density (the averaged number of nerve fibers in a unit area) of VIP-, SP-, and NPY-immunoreactive perivascular nerve fibers in the M1 segment and the BA was markedly decreased (5% to 40% of the normal value) immediately after the injection. The density of VIP- and SP-immunoreactive perivascular fibers increased 2 or 3 weeks after SAH and became normal by the 63rd day after injection. On the other hand, no substantial recovery was observed in the density of NPY-immunoreactive perivascular fibers by 63 days after injection.
Clinically silent hypersecretion of growth hormone in patients with pituitary tumors
Authors: Klibanski Anne , Zervas Nicholas T. , Kovacs Kalman , Ridgway E. Chester
Published: May 2009

✓ Hypersecretion of growth hormone (GH) was found in three women aged 25 to 35 years old, with somatotroph adenomas without clinical stigmata of acromegaly. The patients had previously been diagnosed as having nonfunctioning pituitary macroadenomas, with extrasellar extension. Concentrations of GH were elevated preoperatively in all subjects and could not be suppressed during oral glucose tolerance testing. Somatomedin-C concentrations were elevated in two patients. Immunocytochemical studies of surgically obtained tumor tissue demonstrated sparse positive staining for GH in all subjects. Gel-chromatographic analysis of serum and tumor tissue samples demonstrated that the immunoactive GH was authentic GH. On pathological examination, the tumor was cellular in all cases, consisting of partly acidophilic and partly chromophobic cells. Electron microscopic analysis of one tumor showed a cell composition not previously described. These studies further characterize GH hypersecretion in a subset of patients with clinically nonfunctioning pituitary macroadenomas.
Conus medullaris nerve root avulsions
Authors: Moossy John J. , Nashold Blaine S. , Osborne Dennis , Friedman Allan H.
Published: May 2009

✓ The association of avulsive lesions and pain has been well established in avulsions of the brachial plexus from the cervical spinal cord, but avulsive lesions of the conus medullaris have not previously been recognized or documented by direct observation. Six patients with intractable lower-extremity pain due to avulsion of nerve roots from the conus medullaris were treated by thoracolumbar laminectomy and dorsal root entry zone (DREZ) lesions. Patients with avulsion of lumbosacral roots from the conus medullaris have a characteristic clinical presentation. They are usually young men who, as a result of a motorcycle accident, have suffered multiple pelvic or long-bone fractures or traumatic amputation of part of the lower extremity. Early in their course there is pain not directly attributable to the injured part. The pain is described as intense and burning, with episodic radiation and electric shock-like sensations in the injured or phantom limb. If the leg is intact, there is usually a dermatomal pattern to the distribution of the pain and neurological deficit. A myelogram often reveals a traumatic pseudomeningocele similar to those seen in the cervical region after avulsion of the brachial plexus. Surgical exploration of the conus medullaris usually reveals the extent of nerve root avulsion, and an appropriate DREZ operation can be performed.
Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasms
Authors: Kelly Patrick J. , Daumas-Duport Catherine , Kispert David B. , Kall Bruce A. , Scheithauer Bernd W. , Illig Joseph J.
Published: May 2009

✓ Forty patients with previously untreated intracranial glial neoplasms underwent stereotaxic serial biopsies assisted by computerized tomography (CT) and magnetic resonance imaging (MRI). Tumor volumes defined by computer reconstruction of contrast enhancement and low-attenuation boundaries on CT and T1 and T2 prolongation on MRI revealed that tumor volumes defined by T2-weighted MRI scans were larger than those defined by low-attenuation or contrast enhancement on CT scans. Histological analysis of 195 biopsy specimens obtained from various locations within the volumes defined by CT and MRI revealed that: 1) contrast enhancement most often corresponded to tumor tissue without intervening parenchyma; 2) hypodensity corresponded to parenchyma infiltrated by isolated tumor cells or in some instances to tumor tissue in low-grade gliomas or to simple edema; and 3) isolated tumor cell infiltration extended at least as far as T2 prolongation on magnetic resonance images. This information may be useful in planning surgical procedures and radiation therapy in patients with intracranial glial neoplasms.
Magnetic resonance imaging of gadolinium-labeled monoclonal antibody polymers directed at human T lymphocytes implanted in canine brain
Authors: Kornguth Steven E. , Turski Patrick A. , Perman William H. , Schultz Ronald , Kalinke Tom , Reale Richard , Raybaud Francois
Published: May 2009

✓ Two different murine monoclonal anti-human T cell antibodies, that were coupled to gadolinium (Gd), bind specifically to human T lymphocyte cells implanted in canine brain. This binding was at a concentration of Gd sufficient to detect the implanted cells and to distinguish them from the surrounding brain tissue with magnetic resonance imaging (MRI) at a field strength of 1.5 Tesla. These Gd-labeled immunoglobulin preparations did not bind bovine T cells at a concentration sufficient to be detected on MRI. A protein solution containing the immunoglobulins (100 µg), gelatin (2 mg), and bovine serum albumin (2.5 mg) was reacted with the dianhydride of diethylenetriaminepenta-acetic acid (DTPA); the DTPA serves as a metal chelator and as a protein crosslinking agent. The DTPA-protein complex was reacted with Gd chloride. There were approximately 10 DTPA residues per protein molecule in the modified protein mixture. Isolated human or bovine monocytes (approximately 12 million cells) were implanted in the brains of anesthetized dogs in a volume of 40 µl. The blood-brain barrier was then disrupted by the intra-arterial injection of hyperosmotic mannitol, and the Gd-labeled antibodies were injected through a catheter placed at the branch of the internal and external carotid arteries. The brains were imaged 48 to 72 hours later. The MRI scans revealed a markedly decreased T1 relaxation time with a high signal intensity (TE = 25 msec, TR = 200 msec) related to the human T cell implants. There was no evidence of decreased T1 at the site of the bovine T cells. Neither control murine gamma globulin coupled to Gd-DTPA nor anti-human T cell antibodies uncoupled to Gd modified the MRI contrast of the human T cells in the brain.
Occlusion of the basilar artery within a fracture of the clivus
Authors: Anthony Douglas C. , Atwater Susan K. , Rozear Marvin P. , Burger Peter C.
Published: May 2009

✓ Following a 15-foot fall from a roof, a 70-year-old man became comatose and developed signs of pontine dysfunction. There was a severely comminuted fracture of the distal left femur suggesting that he had landed in an upright position. It was clinically unclear whether the fall was secondary to a pontine infarct; however, an autopsy revealed a fracture of the clivus which had entrapped and occluded the basilar artery, causing death. These findings, and those in similar cases, suggest that this entity results from a force transmitted in an axial direction.
Mapping human somatosensory cortex with positron emission tomography
Authors: Fox Peter T. , Burton Harold , Raichle Marcus E.
Published: May 2009

✓ Positron emission tomography measurements of regional cerebral blood flow were used to detect focal neuronal activation in the first somatosensory cortex (SI) of humans induced by cutaneous vibratory stimulation. Intravenously administered water labeled with oxygen-15 (H215O) was used as a blood flow tracer to obtain five stimulated-state and two resting-state blood flow images in each of eight normal volunteers. Three cutaneous surfaces were tested: lips, fingers, and toes. Intense, highly focal SI responses were seen during all 39 stimulated-state trials. The SI responses from the three stimulation sites were anatomically distinct and formed a medial-to-lateral homonculus in every subject. Response magnitudes (increase in local blood flow) and response locales (expressed as proportionately measured bicommissural stereotaxic coordinates) were highly consistent among subjects and on repeated trials for each subject. These findings suggest that eliciting cerebral blood flow responses by cutaneous vibration provides a safe, rapid, and reproducible tool for locating and assessing the functional status of somatosensory cortex, and offers potential clinical and research utility. This study has established normative values for future applications of this experimental paradigm.
Bilateral trigeminal neuralgia
Authors: Brisman Ronald
Published: May 2009

✓ Bilateral trigeminal neuralgia occurred in 32 (11.9%) of 269 consecutive patients who were treated with radiofrequency electrocoagulation (RFE). This is a higher incidence than has been reported before and may be explained by the prospective nature of the present study, the long follow-up period, and the inclusion of patients with mild bilateral symptoms. Multiple sclerosis is the most common predisposing factor and occurred in 18% of those with bilateral trigeminal neuralgia. Although patients with bilateral trigeminal neuralgia were more likely to have had prior surgery than those with unilateral neuralgia, they did not have a higher recurrence rate following treatment. Percutaneous RFE of the retrogasserian rootlets and gasserian ganglion, with or without glycerol, is effective in managing patients whose pain is intractable to medical therapy. The preservation of most trigeminal sensory and motor functions, the low morbidity rate, and the ability to repeat the procedure are particularly advantageous for patients with bilateral involvement.
Role of the medulla oblongata in plateau-wave development in dogs
Authors: Hayashi Minoru , Ishii Hisamasa , Handa Yuji , Kobayashi Hidenori , Kawano Hirokazu , Kabuto Masanori
Published: May 2009

✓ Plateau waves reflect both dilatation of the cerebral vessels and an increase in the cerebral blood volume under increased intracranial pressure (ICP). They are often associated with changes in arterial blood pressure (BP) and respiration, suggesting a role of the brain stem in their development. In experiments conducted on dogs in which intracranial hypertension was induced by occluding the neck veins, the authors stimulated the brain-stem reticular formation in the medulla oblongata and caudal pons to identify the brain sites that produce plateau-like responses. A rise in ICP was observed following stimulation of most areas of the brain stem and was associated with changes in arterial BP, cerebral perfusion pressure (CPP), cerebral blood flow (CBF), respiration, and pulse rate. The stimuli delivered to the medial reticular formation of the caudal medulla caused an arterial depressor response, a decrease in CPP and CBF, suppressed ventilation, and bradycardia; these responses were similar in many respects to plateau waves observed in clinical practice and almost corresponded to the depressor region of the vasomotor center. It is hypothesized that the medullary depressor area may play a role in eliciting cerebral vasomotor reaction concerned with the development of plateau waves in a state of increased ICP.
A reproducible model of metastatic brain and ocular tumor by hematogenous inoculation of the VX2 tumor in rabbits
Authors: Frank Joseph A. , Girton Mary , Dwyer Andrew J. , Cohen Paul J. , Knop Richard H. , Diggs Richard , Cobb Joseph , Doppman John L.
Published: May 2009

✓ A metastatic brain-tumor model has been developed in rabbits by infusing the VX2 carcinoma into the internal carotid artery to simulate hematogenous dissemination of tumor. In a series of 25 New Zealand White rabbits, multiple metastases arose in the hemisphere of 24 (96%) and in the eye of 22 (92%); in all instances ocular metastases were ipsilateral to the site of infusion. Ocular metastases were visible in the anterior chamber in 80% of animals 3 to 12 days after the infusion of VX2 tumor cell suspension. All rabbits deteriorated neurologically or died by Day 15 after the inoculation. Multiple metastases were demonstrated by magnetic resonance imaging as early as 5 to 7 days after infusion of the tumor cells and were confirmed at autopsy. This technique models hematogenous metastases to the brain and eye and is useful in evaluating the response of metastases to chemotherapy and radiation therapy directed to the brain and eye.
Chronic granulomatous disease with cranial fungal osteomyelitis and epidural abscess
Authors: Pollack Ian F. , Pang Dachling , Schuit Kenneth E.
Published: May 2009

✓ A patient is described with osteomyelitis of the cranium and epidural abscess due toAspergillus fumigatusas the presenting manifestations of chronic granulomatous disease. The diagnosis was suggested by the unusual nature of the organism isolated and confirmed by appropriate laboratory studies. The details of diagnostic assessment and therapeutic management are discussed, and the central nervous system manifestations of chronic granulomatous disease are reviewed.
Chronic intrathecal morphine for intractable pain
Authors: Penn Richard D. , Paice Judith A.
Published: May 2009

✓ Forty-three patients with intractable pain received intrathecal morphine delivered by implanted continuous-infusion (Infusaid) or programmable (Medtronic) devices. In 35 patients the pain was due to cancer, and eight patients had chronic nonmalignant pain. The origin of the nonmalignant pain included lumbar arachnoiditis, multiple sclerosis, severe osteoporosis resulting in a thoracic compression fracture, and intractable pain as a consequence of cancer therapy in individuals cured of their disease. Twenty-eight (80%) of the patients with cancer-related pain experienced excellent or good relief. Side effects were rare. Tolerance occurred infrequently and could be managed effectively. The results of this study support earlier studies on the application of chronic intrathecal morphine for intractable cancer pain. These findings also indicate that, in carefully selected patients, nonmalignant pain may be managed satisfactorily with this technique.
Continuous monitoring of intracranial pressure with a miniaturized fiberoptic device
Authors: Ostrup Richard C. , Luerssen Thomas G. , Marshall Lawrence F. , Zornow Mark H.
Published: May 2009

✓ A No. 4 French fiberoptic catheter initially developed as an intravascular pressure sensor was incorporated into a system to be used as an intracranial pressure (ICP) monitor. Initially, a series of acute and chronic animal experiments carried out in the rabbit and pig, respectively, demonstrated the reliability and safety of the device. Subsequently, this new monitor was compared to a concurrently functioning ICP monitor in 15 adult and five pediatric patients. This clinical experience also confirmed the safety, accuracy, and reliability of the device. Since these initial studies, this monitor has been used to routinely measure ICP in a large number of adult and pediatric patients. The monitor has functioned well, and there have been no complications related to its use except for an occasional problem with breakage of the optic fiber as a result of patient movement or nursing maneuvers, which has been easily corrected by replacement of the probe. As nursing personnel and ancillary services have become familiar with this new monitor, breakage has not been a problem. This new device can be placed into the ventricular system, the brain parenchyma, or the subdural space, and appears to offer substantial advantages over other monitors presently in use.
Activation of immunoregulatory lymphocytes obtained from patients with malignant gliomas
Authors: Elliott Lucinda H. , Brooks William H. , Roszman Thomas L.
Published: May 2009

✓ The responsiveness of T cells and their subsets (T-helper cells and T-suppressor cells) obtained from patients with malignant gliomas was evaluated in an effort to further define the mechanism of their impaired host immunocompetence. This study demonstrates that peripheral blood lymphocytes obtained from these patients have impaired responsiveness to a variety of mitogens including phytohemagglutinin, concanavalin A, pokeweed mitogen, and anti-T3 monoclonal antibody. The impaired lymphocyte responsiveness does not result from the inability of these cells to express receptors for a specific mitogen or antibody. The mitogenic responsiveness of purified T cells is markedly reduced when compared to values obtained from control subjects. Therefore, the decreased T cell reactivity of patients with malignant gliomas does not result simply from a diminution in the absolute number of potentially responding lymphocytes. The mitogen reactivity of the T cell subsets, CD4+helper cells, and CD8+cytotoxic/suppressor cells was also investigated. These results demonstrate that the responsiveness of the CD4+T-helper cell subset obtained from these patients is consistently diminished as compared to control values. In contrast, the reactivity of the CD8+T cell subset was not nearly as dramatically impaired. Thus, these results indicate that the proliferative defect observed in T cells obtained from patients is located predominantly in the T-helper cell subset. Functional deficiencies in this important subpopulation of T lymphocytes may explain, in part, the presence of depressed immune responsiveness in patients with malignant glial tumors.