bluuebunny/crossref_metadata_2025 huggingface dataset:
Cerebrovascular permeability and delivery of gentamicin to normal brain and experimental brain abscess in rats
Authors: Neuwelt Edward A. , Baker David E. , Pagel Michael A. , Blank Nathan K.
Published: May 2009

✓ Antibiotics vary widely in their ability to penetrate the blood-brain barrier. In studies of 70 rats, the permeability of the normal blood-brain barrier to gentamicin was shown to be poor. In experimental brain abscesses, during the cerebritic stage of development, the penetration of intravenous antibiotics was increased compared to normal brain but was very inconsistent. Antibiotic delivery to brain abscess was not significantly altered with the administration of high-dose steroids, but the macrophage and glial response was markedly decreased with high-dose steroid therapy. Reversible osmotic blood-brain barrier modification with mannitol increased the delivery of gentamicin both to brain abscess and to the surrounding brain. It also resulted in more consistent tissue drug levels. The clinical implications of these studies suggest that, because of the inconsistent delivery of gentamicin to brain abscess, the therapeutic efficacy of medical management alone may be quite variable. This mode of therapy could possibly increase the efficacy of medical management of brain abscesses, especially in patients with multiple or surgically inaccessible brain abscesses.
CT-guided stereotaxic evacuation of hypertensive intracerebral hematomas
Authors: Matsumoto Keizo , Hondo Hideki
Published: May 2009

✓ Computerized tomography (CT) is now available for diagnosis and localization of intracerebral hematoma. Computerized tomography-guided stereotaxic evacuation of hypertensive intracerebral hematoma was performed in 51 cases: 34 basal ganglion hematomas with or without ventricular perforation, 11 subcortical hematomas, three thalamic hematomas, and three cerebellar hematomas. Three-dimensional CT images or biplane CT images were taken to determine the coordinates of the target point, which was the center of the hematoma. A silicone tube (3.5 mm in outer diameter and 2.1 mm in inner diameter) was then inserted into the center of the hematoma through a burr-hole under local anesthesia, and the liquefied or solid portion of the hematoma was aspirated with a syringe. Immediately after the first trial of hematoma aspiration, urokinase (6000 IU/5 ml saline) was administered through this silicone tube and the drain was clipped. Subsequently, aspiration and infusion of urokinase were repeated every 6 or 12 hours until the hematoma was completely evacuated. The silicone tube was removed when repeat CT scanning revealed no residual hematoma. The follow-up results indicate that this procedure is as good as conventional craniotomy and evacuation of hematoma under direct vision. This CT-guided stereotaxic approach for evacuation of the hematoma has the following advantages: 1) the procedure is simple and safe; 2) the operation can be performed under local anesthesia; and 3) the hematoma is completely drained with the aid of urokinase. This procedure seems indicated as an emergency treatment for elderly or high-risk patients who show no signs of cerebral herniation.
Sodium 5-(3′-pyridinylmethyl)benzofuran-2-carboxylate (U-63557A) potentiates protective effect of intravenous eicosapentaenoic acid on impaired CBF in ischemic gerbils
Authors: Black Keith L. , Hsu Shan , Radin Norman S. , Hoff Julian T.
Published: May 2009

✓ Eicosapentaenoic acid (EPA) has been reported to improve postischemic cerebral blood flow (CBF). The present study was designed to determine whether sodium 5-(3′-pyridinylmethyl)benzofuran-2-carboxylate (U-63557A), a selective thromboxane synthetase inhibitor, could potentiate the effects of EPA on CBF in ischemic gerbils. Ischemia was produced by bilateral carotid artery occlusion for 15 minutes followed by reperfusion for 2 hours. Immediately after ischemia, gerbils were given either an intravenous bolus of 0.167 mg of EPA followed by a continuous infusion of EPA at 1 mg/hr, or U-63557A (10 mg/kg intraperitoneally), or U-63557A and EPA, or a saline infusion. Regional CBF was measured by the hydrogen clearance method, and brain water by the specific gravity technique. Brain prostaglandins were measured by radioimmunoassay. Preischemic CBF's ranged from 27.4 to 29.5 ml/100 gm/min for the four animal groups. After ischemia and 2 hours of reperfusion, CBF in the saline-infused gerbils was significantly decreased to 19.2 ml/100 gm/min. Gerbils treated with either EPA or U-63557A alone had a CBF of 23.7 and 21.6 ml/100 gm/min, respectively. Postischemic CBF in animals treated with both U-63557A and EPA was 30.0 ml/100 gm/min, significantly higher than in saline-infused gerbils. Brain levels of 6-keto prostaglandin (PG)F1α (the metabolite of PGI2) were significantly higher in gerbils treated with U-63557A and EPA compared to gerbils given EPA alone. This study indicates that U-63557A potentiates the effects of EPA on postischemic CBF. This is probably due to the ability of U-63557A to increase prostacyclin formation in the vessel wall.
Alternative techniques in the treatment of unilateral coronal synostosis
Authors: Jane John A. , Park T. S. , Zide Barry M. , Lambruschi Phillip , Persing John A. , Edgerton Milton T.
Published: May 2009

✓ Premature closure of one coronal suture results in bilateral abnormalities. There is always ipsilateral flatness of the orbital rim, and contralateral frontal bossing is often found. The authors have employed three operative techniques for correction of unilateral coronal synostosis: frontal bone overlay, lateral canthal advancement, and the tongue-in-groove procedure. The choice of operative technique depends upon the exact deformity to be corrected. The authors believe that altering the relations between the bone and dura by techniques such as radical remodeling and dural plication may improve the results of surgical correction of craniosynostosis.
High titer of interferon (IFN)-neutralizing antibody in a patient with glioblastoma treated with IFN-α
Authors: Otsuka Shin-ichi , Handa Hajime , Yamashita Junkoh
Published: May 2009

✓ In a patient with glioblastoma treated with interferon (IFN-α) for a long period of time, a high titer of IFN-neutralizing antibody was detected in the serum during and after IFN therapy. Computerized tomography findings and neurological symptoms in this patient were unchanged during IFN therapy. General malaise, fever, anorexia, nausea, and decrease of leukocytes, platelets, erythrocytes, hemoglobin, and hematocrit were recognized transiently as side effects of IFN administration. These side effects were not serious and resolved spontaneously without discontinuation of therapy. The appearance of IFN-neutralizing antibody is clinically important because the antibody probably neutralizes the effect of systemically administered IFN before it reaches the site of action.
Trigeminal neuralgia associated with seizure and syncope
Authors: Kapoor Wishwa N. , Jannetta Peter J.
Published: May 2009

✓ A patient with trigeminal neuralgia experienced a generalized seizure and a prolonged syncopal episode. He was found to be asystolic during the syncopal episode. There was no recurrence of loss of consciousness after implantation of a pacemaker. Mechanical stimulation of the trigeminal nerve during craniotomy for microvascular decompression of the trigeminal nerve resulted in bradycardia. Since vascular decompression of the trigeminal nerve, there has been no recurrent facial pain, and no further syncope, seizures, or bradycardia. Syncope and seizures have not been previously reported in association with trigeminal neuralgia, although they are well described with glossopharyngeal neuralgia.
CT characteristics of sacral perineural cysts
Authors: Siqueira Edir B. , Schaffer Leslie , Kranzler Leonard I. , Gan Joseph
Published: May 2009

✓ The authors report two cases in which the appearance of sacral perineural cysts, as seen in the computerized tomography scan, prompted the possible diagnosis of a neoplastic lesion. Additional investigation led to the proper diagnosis.
A variable-depth motorized skull perforator
Authors: Heifetz Milton D.
Published: May 2009

✓ A new variable-depth drill point has been designed which holds its position when applied to the skull, and which prevents plunging through the skull plate.
A radionuclide method of evaluating shunt function and CSF circulation in hydrocephalus
Authors: Howman-Giles Robert , McLaughlin Andrew , Johnston Ian , Whittle Ian
Published: May 2009

✓ A simple technique for the evaluation of shunt function and cerebrospinal fluid (CSF) circulation in hydrocephalic patients is described. The method utilizes clearance rates of a radionuclide tracer injected into the lateral ventricle via an indwelling frontal catheter which is separate from the shunt apparatus. This permits an accurate assessment of drainage of ventricular CSF via the shunt, or the patency of normal or alternative CSF pathways where the shunt is malfunctioning.
Automatic artifact rejection during intraoperative recording of somatosensory evoked potentials
Authors: Simard J. Marc , Friedman William A.
Published: May 2009

✓ A device is described that performs automatic artifact rejection for somatosensory evoked response analysis in intraoperative and other electrically noisy environments. Although based on amplitude discrimination, rejection is not triggered by the large stimulus-dependent voltage transients associated with somatosensory evoked potentials. The device readily interfaces with commercially available evoked potential equipment.
Surgical management of suprasellar meningioma
Authors: Rosenstein Jacob , Symon Lindsay
Published: May 2009

✓ Visual outcome in 101 consecutive cases of suprasellar meningioma treated over a 35-year period has been examined. Preoperative visual loss was evaluated using a scoring system that takes both visual acuity and visual fields into account. In this way a percentage visual loss was calculated for each patient before and after surgery. The effects on visual outcome of age, preoperative visual loss, duration of visual symptoms, tumor size, status of the optic disc, and binocular versus monocular involvement was examined. For the group as a whole, vision improved in 63 patients, was unchanged in 12 patients, and was worse in 24 patients. Prognosis was favorably affected by a mean duration of symptoms of less than 2 years, a tumor size of less than 3 cm, a preoperative visual loss of less than 50%, and the presence of normal optic discs on funduscopic examination. Age had some effect on prognosis, but the presence of binocular or monocular involvement had no effect.
Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury
Authors: Toutant Steven M. , Klauber Melville R. , Marshall Lawrence F. , Toole Belinda M. , Bowers Sharon A. , Seelig John M. , Varnell James B.
Published: May 2009

✓ The relationship of outcome to the appearance of the basal cisterns as seen on initial computerized tomography (CT) scanning was assessed in 218 consecutive severely head-injured patients entered into the second phase of the National Pilot Traumatic Coma Data Bank. Outcome could be directly related to the status of the basal cisterns on the initial CT scan. The mortality rates were 77%, 39%, and 22% among those with absent, compressed, and normal basal cisterns, respectively. This association between cisterns and outcome was shown to be strong after adjusting for Glasgow Coma Scale (GCS) score (p < 0.001).

The state of the cisterns was more important for those with higher GCS scores (scores 6 to 8) than for those with lower scores (scores 3 to 5). Patients with GCS scores of 6 to 8, with cisterns absent or not visualized, suffered nearly a fourfold additional risk of poor outcome, compared to those with normal cisterns. This indicates that the status of the cisterns can be used as an early noninvasive method of identifying patients at high risk of death or severe disability, in whom the initial neurological examination would potentially suggest otherwise.
Intramedullary canine spinal cord tumor model
Authors: Salcman Michael , Botero Ernesto , Rao Krishna C. V. , Broadwell Richard D. , Scott Eric
Published: May 2009

✓ The development of a transplantable model brain tumor in the neonatal dog, the adaptation of the tumor to tissue culture, and the successful growth of the tumor in adult mongrel dogs has been adapted to producing similar tumors in the thoracic spinal cord of the adult dog. Ten adult dogs, weighing 4 to 25.4 kg each, were subjected to formal laminectomy. The tumor cell suspension was injected by hand with a Hamilton syringe at two or three sites over a distance of 1 cm; each site received an injection volume to 0.02 to 0.05 cc of the cell suspension after the dura had been opened. Immediately after injection the field was copiously irrigated and the puncture area sealed with a single drop of ethyl cyanoacrylate. Tumor cells for injection were obtained by thawing ampules stored at −195°C in a mixture of 10% dimethyl sulfoxide and RPMI 1640 culture medium. Cells were resuspended in Hank's balanced salt solution and 15% fetal calf serum on ice. Solutions had 90% cell viability, and animals received a dose in the range of 3 to 13 × 106 cells. Eight animals developed tumors and became paraparetic on the 9th to 14th postinjection day. Metrizamide myelography in three animals revealed complete blocks; two animals underwent spinal computerized tomography (CT) and demonstrated syringohydromyelia. Histology revealed the tumors to be highly vascular primitive neoplasms that invaded the surrounding cord. This spinal cord tumor model is large enough to be operated on, studied by CT and myelography, and subjected to pharmacological, electrophysiological, and blood flow study.
The first primary brain-tumor operation
Authors: Kirkpatrick Douglas B.
Published: May 2009

✓ On November 25, 1884, Mr. Rickman J. Godlee performed the first recognized resection of a primary brain tumor. This operation was carried out at the suggestion of Dr. A. Hughes Bennett, a neurologist at The Hospital for Epilepsy and Paralysis, Regents Park, London, England. Other operations for intracranial tumor had been performed but were for extracerebral meningeal or osseous tumors. The “first” operation for a primary cerebral tumor by Godlee was meticulously described and well documented in the medical and popular press of the day and stimulated both professional and lay discussions of the topic that directly and indirectly led to further surgery on the cerebrum itself and the advent of modern neurosurgery. The original patient of Mr. Godlee died on the 28th postoperative day of apparent meningitis and secondary complications, but postmortem examination revealed no remnant of the excised glioma.
Effects of chlorpromazine on experimental delayed cerebral vasospasm
Authors: Nakano Masaru , Tani Eiichi , Fukumori Toyokazu , Yokota Masayuki
Published: May 2009

✓ Experimental delayed cerebral vasospasm was produced in the canine basilar artery by intracisternal injections of blood 2 days apart. The spastic basilar artery was exposed via the transclival route under a surgical microscope, and was dilated by topical application of chlorpromazine, a calmodulin antagonist. Dilatation was dose-dependent, with a median effective dose of 37 ± 16 µM. In addition, 100 µM chlorpromazine was inserted into the cisterna magna until the intracranial pressure (ICP) reached 200 mm H2O for 30 minutes, inducing a complete reversal of angiographic delayed cerebral vasospasm in two of five animals. In other studies, the intracisternal perfusion of 100 µM chlorpromazine at 1.48 ml/min for 30 minutes with an ICP of less than 200 mm H2O induced no serious abnormalities in mean arterial blood pressure and pulse rate of normal animals. Electroencephalography during the intracisternal perfusion of chlorpromazine showed a slight to moderate increase in occurrence of theta waves. No neurological deficits or significant histological abnormalities ascribable to intracisternal chlorpromazine were found.
A commentary on the biology and growth kinetics of low-grade and high-grade gliomas
Authors: Hoshino Takao
Published: May 2009

✓ Cell kinetics studies of patients with various gliomas published in the past decade have shown that the average labeling index (LI) obtained from a pulse of 3H-thymidine is very high in medulloblastomas (12.0% ± 1.3%, standard error of the mean) and glioblastoma multiforme (9.3% ± 1.0%), low in well differentiated gliomas (less than 1%), and intermediate in anaplastic astrocytomas (4.0% ± 0.8%). The higher the LI, the faster the tumor grows, probably reflecting a larger growth fraction. In tumor tissues obtained at autopsy, two glioblastomas diluted out the labeling compound in the 2- to 4-month interval after labeling, whereas three glioblastomas and two anaplastic astrocytomas retained labeled neoplastic cells for 3 weeks to 5 months. Most patients whose tumors contained foci of labeled cells at autopsy survived longer. Well differentiated gliomas harbored labeled cells for 2½ to 7 years. These findings indicate that the kinetics of proliferation in well differentiated gliomas are different from those in glioblastomas or anaplastic astrocytomas.
Growth-inhibitory effect of prostaglandin D2 on mouse glioma cells
Authors: Keyaki Atsushi , Handa Hajime , Yamashita Junkoh , Tokuriki Yasuhiko , Otsuka Shin-Ichi , Yamasaki Toshiki , Gi Hidefuku
Published: May 2009

✓ The effects of prostaglandin D2 (PGD2) on the growth of mouse malignant glioma cells were studied in vitro and in vivo. The in vitro studies consisted of various concentrations of prostaglandins (PG's) being added to cultures of mouse glioma cells. At concentrations above 2.5 µg/ml, PGD2 strongly inhibited the proliferation of glioma cells, whereas PGE2 had no effect at the same value. Exposure to 5.0 µg/ml PGD2 for more than 2 hours resulted in inhibition of glioma cell proliferation. This growth-inhibitory effect of PGD2 was related to the inhibition of DNA synthesis of the cells. The in vivo studies were performed with a subcutaneously transplanted mouse glioma model. Injection of 0.5 mg/kg PGD2 into the tumor was more effective than the same concentration given by intraperitoneal injection. In mice with intracranially transplanted glioma, daily intraperitoneal injection of 0.5 mg/kg PGD2 had no significant effect on survival time.
Intracranial germ-cell tumors
Authors: Naganuma Hirofumi , Inoue Hiroshi , Misumi Shuzo , Nakamura Masaru , Tamura Masaru
Published: May 2009

✓ Histological and immunohistochemical findings in three cases with primary intracranial germ-cell tumors are reported. Based on histological examination, they were diagnosed, respectively, as an endodermal sinus tumor with immature teratoid differentiation, teratoma and embryonal carcinoma, and choriocarcinoma and germinoma. The first case was presumed to be a combination of endodermal sinus tumor and germinoma. An immunohistochemical examination showed positive reactions to alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) in the endodermal sinus tumor, and to human chorionic gonadotropin (HCG) in the choriocarcinoma, but showed no reaction in the embryonal carcinoma. Human chorionic gonadotropin was demonstrated in syncytiotrophoblastic cells and CEA in a gland-like structure. The value of measuring CEA in cases of germ-cell tumors, in addition to AFP and HCG assays, is stressed, and the characteristics of CEA-positive tissue are discussed.
Spinal cord sarcoidosis
Authors: Martin Carolyn A. , Murali Raj , Trasi Sunil S.
Published: May 2009

✓ A case of spinal cord sarcoidosis is presented. Diagnosis was established from a biopsy of the hilar lymph node. The patient was successfully treated with corticosteroid drugs. The literature is reviewed and the deleterious effect of surgery is stressed.
Residency training in neurological surgery, 1934–1984: evolution over 50 years of trial and tribulation
Authors: Pevehouse Byron Cone
Published: May 2009

✓ The President of the American Association of Neurological Surgeons (AANS) reviews formal neurosurgical training in the United States from its inception with one program in 1934 to 1984, with 94 programs and 650 residents. He reports on the 1st year's experience with a national neurosurgical residency matching plan. He presents realistic remedies for today's professional liability dilemma and analyzes socioeconomic factors that have led to the complex challenges facing neurosurgeons in this decade, relating the importance of the AANS mission and goals in resolving these issues.
Interferon as adjuvant therapy with initial radiotherapy of patients with anaplastic gliomas
Authors: Mahaley M. Stephen , Urso Mary B. , Whaley Robert A. , Williams Thomas E. , Guaspari Alfred
Published: May 2009

✓ In a group of nine patients with anaplastic gliomas, survival following surgery and treatment with interferon and radiotherapy was comparable to survival for a matched group of patients treated with BCNU and radiotherapy following surgery.
Factors causing acute shunt infection
Authors: Renier Dominique , Lacombe Jacques , Pierre-Kahn Alain , Sainte-Rose Christian , Hirsch Jean-François
Published: May 2009

✓ A series of 1174 operations performed on 802 hydrocephalic children was analyzed in an effort to find the factors causing acute postoperative infection. Culture of the cerebrospinal fluid (CSF) samples during the operation was positive in 33 cases. These cases were excluded from the series. Ninety infections were observed in the remaining 1141 operations, an overall rate of 7.9%. Most of these infections were meningitis (56 cases). Staphylococcus epidermidis was the bacterium most frequent identified (44%).

Statistically significant relationships were found between shunt infection and the following factors: 1) age: infection was 2.6 times as frequent before 6 months than after 1 year of age (p = 0.03); 2) poor condition of the skin; 3) presence of intercurrent seats of infection at the time of surgery; 4) type of operation: the rate of infection was 8.4% in primary shunt insertions, 5% in shunt revisions, and 17.5% in reinsertions following shunt removal for infection (p = 0.0001); 5) end of the shunt requiring revision: an infection rate of 7.7% followed revision of the ventricular catheter alone, and 2.6% followed revision of the other end alone (p = 0.012); and 6) postoperative wound dehiscence or scalp necrosis. The surgical team involved was poorly correlated with the rate of infection (p = 0.12).

No statistically significant relationships have been found between infection and 1) etiology of hydrocephalus; 2) sex; 3) recent neurosurgical operation before the shunt procedure; 4) preoperative presence of an external drainage tube or CSF fistula; 5) lumbar or ventricular taps, or ventriculography; 6) number of previous operations performed on the shunt; 7) time (month and year) of operation; or 8) sugar level and cell count in the CSF.
Immunosuppression by phenytoin: implication for altered immune competence in brain-tumor patients
Authors: Kikuchi Kenji , McCormick Christopher I. , Neuwelt Edward A.
Published: May 2009

✓ This investigation was conducted to examine the immunosuppressive potential of phenytoin in vivo and to document a correlation between phenytoin therapy and depressed lymphocyte responsiveness to mitogens. It was thought that phenytoin, the most widely used anticonvulsant agent, may play some role in the immunosuppression seen in brain-tumor patients. The effect of phenytoin on mitogen-stimulated lymphocyte function was evaluated by tritiated (3H)-thymidine incorporation and lymphocyte nuclear size distribution. Lymphocytes from either phenytoin-treated or normal rabbits were incubated for 90 hours in culture medium in the presence of three mitogens: phytohemagglutinin (PHA), concanavalin A (Con A), and pokeweed mitogen (PWM). Significant suppression of mitogen-induced activation of the lymphocytes from treated animals was demonstrated. The present studies suggest a possible connection between phenytoin therapy and altered immune competence in brain-tumor patients.
Thromboxane synthetase inhibition in acute focal cerebral ischemia in cats
Authors: Moufarrij Nazih A. , Little John R. , Skrinska Victor , Lucas Fred V. , Latchaw John P. , Slugg Robert M. , Lesser Ronald P.
Published: May 2009

✓ The purpose of this investigation was to study the effects of a selective thromboxane A2 (TXA2) synthetase inhibitor (TSI) upon the evolution of cerebral infarction in the cat. Adult cats, lightly anesthetized with nitrous oxide, underwent right middle cerebral artery (MCA) occlusion for 4 hours followed by a 2-hour period of reperfusion before sacrifice. Ten cats received 3 mg/kg TSI intravenously immediately before, and 10 cats received 3 mg/kg TSI intravenously immediately after MCA occlusion. Ten cats were used as controls receiving no treatment. The bleeding time was determined at baseline and at the end of each experiment. Electroencephalographic (EEG) recordings were obtained before and after MCA clipping and MCA release, and at hourly intervals thereafter. Regional cerebral blood flow (rCBF) was measured using the xenon-133 (133Xe) clearance technique before and after MCA occlusion, after MCA reopening, and before terminating each experiment. Thirty minutes before each cat was sacrificed, Evans blue dye and sodium fluorescein were given intravenously. The animals were then perfused with colloidal carbon and the brains removed and evaluated for midline shift, Evans blue dye and sodium fluorescein extravasation, carbon staining, and infarct size. The bleeding time, arterial blood pressure, rCBF changes, brain swelling, and vital dye extravasation were not statistically different between the three treatment groups. The EEG changes, carbon staining, and infarct size differences between the three groups also failed to reach statistical significance, but there was a suggestion that these parameters were adversely affected in the cats pretreated with TSI. Ten additional cats undergoing MCA occlusion and reperfusion were used for pharmacological studies. Five of them received 3 mg/kg TSI intravenously immediately after MCA occlusion, and serial drug and thromboxane B2 (TXB2) levels (a stable metabolite of TXA2) were determined. Another five cats were not treated and serial TXB2 levels were obtained. Production of TXA2 was inhibited by 95% in cats receiving TSI. In conclusion, thromboxane synthetase inhibition failed to modify favorably the evolution of cerebral infarction. When TSI was given before MCA occlusion, cerebral infarction tended to be more extensive.
Evolution and outcome in malignant astroglial neoplasms of the cerebellum
Authors: Steinberg Gary K. , Shuer Lawrence M. , Conley Frances K. , Hanbery John W.
Published: May 2009

✓ Malignant astroglial neoplasms of the cerebellum are rare and the clinical behavior of these tumors is unpredictable. The authors describe the histological characteristics and clinical outcome in 10 patients; eight had malignant cerebellar astrocytomas, and one each had an astroblastoma and a true polar spongioblastoma. Malignant glial tumors involving the cerebellum usually behave very aggressively. Cerebellar astroblastomas and polar spongioblastomas are too rare to predict their natural history. Some hypotheses are proposed concerning the evolution and interrelationship of malignant glial tumors of the cerebellum.
Intracranial pressure changes in arrested hydrocephalus
Authors: Whittle Ian R. , Johnston Ian H. , Besser Michael
Published: May 2009

✓ Continuous intracranial pressure (ICP) monitoring was used to assess 46 children and adolescents in whom a clinical diagnosis of arrested hydrocephalus had been made. Thirty patients (Group A) had previously been treated with cerebrospinal fluid diversion and 16 patients (Group B) had no prior treatment of their hydrocephalus. All patients in Group A either had a confirmed nonfunctioning shunt or had undergone shunt removal. Continuous ICP monitoring showed that 80% of the patients in Group A and 63% of those in Group B had episodic or persistent intracranial hypertension. In four patients (25%) whose initial ICP had been normal or equivocal, repeat ICP monitoring later revealed decompensation or reversal of arrest. When serial psychometric testing demonstrated a fall in cognitive functioning, ICP monitoring revealed abnormal ICP's in 88% of patients. This study shows that many patients with apparent arrest of hydrocephalus in fact have an insidiously progressive disorder. Monitoring of ICP and serial psychometric evaluation are therefore valuable tools in the continuing assessment of arrested hydrocephalus.
Evaluation of postoperative intratumoral injection of bleomycin for craniopharyngioma in children
Authors: Takahashi Hiroshi , Nakazawa Shozo , Shimura Toshiro
Published: May 2009

✓ Total excision is the treatment of choice in preventing the relapse of craniopharyngioma, but for tumors involving an extensive area, it is often associated with increased risks of complications. The efficacy of postoperative radiotherapy has not yet been established. The authors have performed minimal tumor excision followed by intensive injection of bleomycin into the remaining tumor as postoperative adjuvant therapy in seven children with craniopharyngioma. Long-term outcome in the children with cystic-type tumors containing little or no solid tissue has proven the regimen to be more advantageous than total excision.
Vertebral artery rupture associated with closed head injury
Authors: McLean John M. , Wright Robert M. , Henderson John P. , Lister J. Richard
Published: May 2009

✓ The authors report two patients with closed head injury who suffered laceration with rupture of the third portion of the vertebral artery. One patient died suddenly, with angiographic evidence of bilateral vertebral artery rupture. The mechanism of injury to the C1–2 segment of the vertebral artery relating to head and neck injury is discussed.
Transplantation of adrenal medullary tissue to striatum in parkinsonism
Authors: Backlund Erik-Olof , Granberg Per-Ola , Hamberger Bertil , Knutsson Evert , Mårtensson Anders , Sedvall Göran , Seiger Åke , Olson Lars
Published: May 2009

✓ Autologous adrenal medullary tissue was transplanted to the striatum in two patients with severe parkinsonism. The aim was to provide the striatum with a new cellular source of catecholamines. Some rewarding effects were registered. This is the first time that such tissue has been transplanted in the human brain. The results merit further clinical trials.
The perforating branches of the middle cerebral artery
Authors: Umansky Felix , Gomes Francisco B. , Dujovny Manuel , Diaz Fernando G. , Ausman James I. , Mirchandani Haresh G. , Berman S. Kim
Published: May 2009

✓ The perforating branches (PFB's) of the middle cerebral artery (MCA) were studied in 34 unfixed brain hemispheres which were injected with a polyester resin and dissected under the operating microscope. Five hundred and eight vessels were identified and their site of origin, branching pattern, outer diameter (OD), and length recorded. Four hundred and two PFB's (79%) originated from the main trunk of the MCA before its division; the remaining 106 vessels (21%) had their origin from branches of the MCA as follows: superior trunk, 43 vessels (8.5%); inferior trunk, 30 vessels (6%); middle trunk, four vessels (0.8%); early temporal branch, 27 vessels (5.3%); and early frontal branch, two vessels (0.4%). The number of PFB's in each hemisphere varied from five to 29 (mean 14.9 ± 0.7 vessels). The great majority of PFB's (96%) originated along the proximal 17 mm of the MCA. The PFB's arising in the first 10 mm had a mean OD of 0.35 ± 0.01 mm and a mean length of 9.25 ± 0.19 mm, and those arising from the second 10 mm had a mean OD of 0.47 ± 0.02 mm and a mean length of 16.67 ± 1.4 mm. A clear distinction between a medial and lateral group of PFB's was present in only 14 hemispheres (41%). In nine hemispheres (26%), perforating vessels from the anterior cerebral artery (A1 segment) and from the recurrent artery of Heubner replaced the medial group of PFB's of the MCA. In one case this group originated in an accessory MCA. In three hemispheres (9%) a small anastomosis (OD 0.2 mm) was seen between a PFB of the recurrent artery of Heubner and one of the MCA. From a total of 508 PFB's, 255 vessels (50%) originated as single vessels, while 253 vessels (50%) originated as branches of common stems. The OD of the single vessels ranged from 0.1 mm to 1.1 mm (mean 0.39 ± 0.02 mm), and the length from 3 to 20 mm (mean 10.8 ± 0.2 mm). The common stems ranged in OD from 0.6 to 1.8 mm (mean 0.87 ± 0.04 mm), and in length from 1 to 15 mm (mean 4.1 ± 0.4 mm).

The clinical application of these anatomical data to the management of aneurysms and arteriovenous malformations of the MCA, and in the field of interventional neuroradiology is described. The most frequent pathological entities involving the perforating vessels are also discussed.
Somatosensory evoked potentials as a measure of experimental cerebral ischemia
Authors: Meyer Kathleen L. , Dempsey Robert J. , Roy Mark W. , Donaldson David L.
Published: May 2009

✓ Somatosensory evoked potentials (SEP's) reflect the integrity of the central neuronal pathway, and as such may be used to assess function that remains during a variety of cerebral insults. To evaluate the natural history and utility of SEP's during experimental cerebral ischemia and infarction, SEP's were measured in 17 adult cats at 24 hours and 1 hour prior to right middle cerebral artery (MCA) occlusion, and again immediately afterward and at either 6 hours (five cats) or 24 hours (six cats) post-occlusion. Before occlusion of the right MCA, the SEP's were identical in the right and left hemispheres. After occlusion, there was a significant slowing of the interpeak latency of the first positive peak (P1) in the right hemisphere (3.53 ± 0.6 msec before compared to 3.99 ± 0.6 msec after occlusion, p < 0.001). Maximal slowing in right hemisphere P1 latency was seen in those animals in which the stroke extended into the thalamus (4.38 ± 0.1 msec). This was significantly slower than left hemisphere values (3.92 ± 0.32 msec, p < 0.01). The ipsilateral cortical components of the SEP's, the second positive peak (P2), and the major negative deflection (MN) were slowed in all cats immediately after right MCA occlusion compared to preocclusion measurements (p < 0.001). Severe infarcts in the mid-suprasylvian and posterior ectosylvian gyri (including the somatosensory cortex) resulted in a greater slowing of the latency of MN compared to less severe infarcts in that region (20.6 ± 3.9 msec versus 16.4 ± 1.1 msec, p < 0.05). There was a precipitous decrease in the amplitude or voltage of the ipsilateral P2-MN complex immediately after occlusion (5.32 ± 0.4 µV before compared to 0.98 ± 0.3 µV after occlusion, p < 0.001). Therefore, the central latencies and cortical amplitudes of the SEP's are sensitive experimental tools as indicators of the onset and extent of a cerebral ischemic insult.
Brain targets in surgery for Parkinson's disease
Authors: Laitinen Lauri V.
Published: May 2009

✓ Sixteen neurosurgeons were requested to define their preferred surgical target for treatment of parkinsonism. The scattergram thus obtained showed a great variability among surgeons. Although there was a concentration of targets in the ventrolateral (VL) nucleus of the thalamus, there was a separation by as much as 6 to 7 mm between targets. One surgeon placed the lesion in the subthalamic white matter below the VL nucleus, and two placed it outside the thalamus in the pallidothalamic pathways in Forel's field. It is assumed that successful surgery interrupts the pallidothalamocortical pathways that transmit tremor and rigidity impulses, regardless of which part of the pathways is severed.
Failure of prophylactic barbiturate coma in the treatment of severe head injury
Authors: Ward John D. , Becker Donald P. , Miller J. Douglas , Choi Sung C. , Marmarou Anthony , Wood Cheryl , Newlon Pauline G. , Keenan Richard
Published: May 2009

✓ In certain subgroups of severely head-injured patients, the mortality rate remains unacceptably high. The authors describe a randomized, controlled trial of prophylactic pentobarbital therapy in a group of these patients. Pentobarbital was started as soon as possible after the head injury, regardless of the intracranial pressure (ICP), and was continued for a prescribed period of time. The study included 53 consecutive head-injured patients over the age of 12 years, who had either an acute intradural hematoma (subdural and/or intracerebral, large enough to warrant surgical decompression), or no mass lesion but whose best motor response was abnormal flexion or extension. All patients in the study were randomly assigned to a control group (26 cases) or a pentobarbital-treated group (27 cases) once the diagnosis had been made and informed consent obtained. All patients were treated with the same protocol of aggressive resuscitation, prompt diagnosis and treatment of mass lesions, and intensive care, with close follow-up monitoring. The randomization was effective in producing a close match between the control and treated groups with respect to age, sex distribution, cause of injury, neurological status, intracranial lesions, prevalence of early systemic insults, midline shift, and initial ICP. Outcome was essentially the same in each group. There was no difference between groups in the incidence of elevated ICP, the duration of ICP elevation, or the response of ICP elevations to treatment. Arterial hypotension occurred in 14 patients (54%) in the treated group and only two patients (7percnt;) in the untreated group. Based on these data the authors cannot recommend the prophylactic use of pentobarbital coma in the treatment of patients with severe head injury. They also believe that its use is accompanied by significant side effects which can potentially worsen the condition of a patient with severe head injury.
Multiple intracranial aneurysms in sickle cell anemia
Authors: Overby M. Chris , Rothman Allen S.
Published: May 2009

✓ Neurological complications of sickle cell anemia occur in 18% to 29% of patients with homozygous hemoglobin S disease. A review of the literature yielded reports of two cases, both treated conservatively, of multiple intracranial aneurysms occurring in patients with sickle cell anemia. The authors report two cases of subarachnoid hemorrhage secondary to multiple intracranial aneurysms in patients with sickle cell anemia. One of the two patients underwent three craniotomies for ablation of six intracranial aneurysms. The techniques used in the treatment of these patients are presented.
Bitemporal compression injury caused by static loading mechanism
Authors: Echizenya Kouhei , Satoh Masaharu , Nakagawa Tango , Koiwa Mitsuyuki , Abe Hiroshi
Published: May 2009

✓ The authors report two cases of bitemporal compression injury caused by a static loading mechanism. These head injuries resulted from gradual bitemporal compression of the head. Plain skull films showed multiple skull fractures, and carotid angiography revealed internal carotid artery obstruction at the base of the skull. Neurological examination disclosed a slight disturbance of consciousness, hemiparesis, multiple cranial nerve injuries, and Horner's syndrome. In comparison with impact head injury, the energy from this type of trauma tends to be transmitted to the foramina and hiati of the middle cranial fossa and results in multiple injuries to the cranial nerves, sympathetic nerves, and blood vessels.
Amyloidomas in the cerebellopontine angle and jugular foramen
Authors: Matsumoto Tsuyoshi , Tani Eiichi , Maeda Yukio , Natsume Shigeatsu
Published: May 2009

✓ The 47-year-old man reported here showed large encapsulated masses in the left cerebellopontine angle and 6 years later in the enlarged left jugular foramen. Histologically, the tumors demonstrated a large deposit of amyloid composed of immunoglobulin light chain-derived proteins (AL). There was no evidence of chronic inflammatory or infectious processes or immunoglobulin abnormalities.
Familial arteriovenous malformations
Authors: Boyd Michael C. , Steinbok Paul , Paty Donald W.
Published: May 2009

✓ Familial arteriovenous malformations (AVM's) are uncommon entities, with only seven reported cases in the English literature. Some have been associated with hereditary telangiectasia. A family in which AVM's were found in four male members of two generations is reported. In addition, one patient had a large cyst associated with his AVM without previous evidence of acute hemorrhage, which is an uncommon presentation. The family is discussed and a brief review of the literature is presented.
Visual function following optic canal decompression via craniotomy
Authors: Guyer David R. , Miller Neil R. , Long Donlin M. , Allen George S.
Published: May 2009

✓ Visual function was assessed in 15 eyes of 11 patients who underwent unilateral (seven patients) or bilateral (four patients) optic canal decompression for presumed compressive optic neuropathies. Both immediate and long-term postoperative vision was evaluated in all eyes. Over 90% of the eyes that had undergone nerve decompression had either the same or improved visual acuity and visual field immediately following surgery. In this group of patients there were no deaths and there was only one postoperative complication, a transient dysphasia caused by an epidural hematoma that was evacuated. Long-term follow-up evaluations revealed that most of the eyes retained their immediate postoperative visual function or showed gradual visual improvement with time. The results of this series as well as a review of the available literature indicate that optic canal decompression via craniotomy can be a safe procedure and that it appears to have lasting visual benefit in many patients.
The role of cerebral blood volume changes in brain specific-gravity measurements
Authors: Picozzi Piero , Todd Nicholas V. , Crockard Alan H.
Published: May 2009

✓ Cerebral blood volume (CBV) was calculated in gerbils from specific-gravity (SG) changes between normal and saline-perfused brains. Furthermore, changes in CBV were investigated during ischemia using carbon-14-labeled dextran (MW 70,000) as an intravascular marker. Both data were used to evaluate the possible error due to a change in CBV on the measurement of ischemic brain edema by the SG method. The methodological error found was 0.0004 for a 100% CBV change. This error is insignificant, being less than the standard deviation in the SG measured for the gerbil cortex (SG 1.0494 ± 0.0006). Thus, CBV changes are not responsible for the SG variations observed during the first phase of ischemia. These variations are better explained as an increase of brain water content during ischemia.
Thermographic presentation of cutaneous sensory and vasomotor activity in the injured peripheral nerve
Authors: Brelsford Kathleen L. , Uematsu Sumio
Published: May 2009

✓ Impaired function of cutaneous segments of monkey peripheral nerves experimentally blocked by lidocaine anesthesia was clearly visualized by means of elevated temperature measurements obtained on computerized color telethermography. Mean temperature elevations in the segments of anesthetized primate nerves were 2.40°C at the ulnar segment 17 minutes after nerve block, and 1.20°C at the peroneal nerve at 20 minutes. The vasomotor activity of specific nerves, recorded after local anesthesia and displayed by color telethermographic imaging, corresponded to the distribution of sensory segments identified by more cumbersome means. Telethermography is therefore shown to be a useful tool, both qualitatively and quantitatively, in mapping cutaneous distribution of peripheral nerves and for evaluation of peripheral nerve injuries.
Growth rate of secondary hydatid cysts of the brain
Authors: Sierra Jorge , Oviedo Jorge , Berthier Marcelo , Leiguarda Ramon
Published: May 2009

✓ Bilateral intracerebral hydatid cysts developed in a 14-year-old patient after an infarct of presumed embolic origin in the left frontotemporoparietal region. The average rate of growth of these cysts was about 5 cm per year. This suggests that the growth rate is far from uniform and indeed, particularly in young patients, may be much faster than originally estimated.
Cystic pilocytic astrocytomas of the cerebral hemispheres
Authors: Palma Lucio , Guidetti Beniamino
Published: May 2009

✓ This study concerns 51 cases of cystic pilocytic astrocytoma of the cerebral hemispheres. At operation these tumors closely resembled cerebellar astrocytomas, presenting as a big cyst contiguous with the lateral ventricle and containing a small mural nodule. The nodule was in a deep location in 26 cases, and always showed marked contrast enhancement on computerized tomography scans. The most frequent presenting symptom was epilepsy (68%), and the most common sign was papilledema (85%). The major goal of surgery was extirpation of the nodule. The follow-up period of the 34 cases available for long-term review ranged from 6 to 31 years (mean 17 years). Of these, 28 patients (82%) had a good outcome; four (12%) had a fair result, and two (6%) had a poor response. An analysis of these results shows that total extirpation of the mural tumor was associated with the best outcome, whether or not the cyst wall was completely removed. Radiation therapy was irrelevant to the prognosis for these patients. On the other hand, partial excision of the nodule, correlated with the deep location of the tumor, was the cause of the two poor results in this series and resulted in multiple operations for recurrences in two other patients. Nevertheless, two of these patients are still alive and well many years after incomplete surgical treatment. On the basis of this study, the importance of recognizing the occurrence of this “benign” tumor of the cerebral hemispheres is stressed, and the hypothesis of a common origin from subependymal glia of all pilocytic astrocytomas is supported.
Supraophthalmic carotid infusion for brain chemotherapy
Authors: Kapp John P. , Parker J. Larry , Tucker Elton M.
Published: May 2009

✓ A single-lumen catheter with a maneuverable tip which does not incorporate a balloon has been developed for supraophthalmic intracarotid infusion of chemotherapeutic agents for central nervous system neoplasms. Supraophthalmic carotid catheterization was accomplished in 48 (96%) of the first 50 consecutive infusions in which this catheter was used. None of the 31 patients who underwent this procedure developed optic neuropathy or loss of vision. Ten patients developed Marcus-Gunn pupils, ipsilateral to the infused carotid artery in two and contralateral to the infused carotid artery in eight. Thrombosis of the carotid artery occurred after infusion in one patient. Problems associated with the technique include a tendency for the catheter to retract proximally during infusion in some patients, and the necessity for surgical exposure of the carotid artery. The infusion technique protects the eye from the high-concentration first-pass of chemotherapeutic agents administered via the carotid artery. Since the tip of this catheter can be hydraulically guided, it may prove to be useful in other areas of transarterial neurosurgical procedures.