bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of hyperbaric oxygen therapy on long-tract neuronal conduction in the acute phase of spinal cord injury
Authors: Higgins Alfred C. , Pearlstein Robert D. , Mullen John B. , Nashold Blaine S.
Published: May 2009

✓ To study the acute effects of hyperbaric oxygen ventilation (HBO) on long-tract function following spinal cord trauma, the authors employed a technique for monitoring spinal cord evoked potentials (SCEP) as an objective measure of translesion neuronal conduction in cats subjected to transdural impact injuries of the spinal cord. Control animals subjected to injuries of a magnitude of 400 or 500 gm-cm occasionally demonstrated spontaneous return of translesion SCEP within 2 hours of injury when maintained by pentobarbital anesthesia and by ventilation with ambient room air at 1 atmosphere absolute pressure (1 ATA). Animals sustaining corresponding injuries but receiving immediate treatment with HBO at 2 ATA for a period of 3 hours following impact demonstrated variable responses to this treatment modality. Animals sustaining injuries of 400 gm-cm magnitude showed recovery of translesion SCEP in four of five cases, while animals sustaining injuries of 500 gm-cm magnitude responded to HBO treatment by recovery of SCEP no more frequently than did control animals. When the onset of HBO therapy was delayed by 2 hours following impact, there appeared to be no demonstrable protective effect on long-tract neuronal conduction mediated by HBO alone.

The observations suggest that HBO treatments can mediate preservation of marginally injured neuronal elements of the spinal cord long tracts during the early phases of traumatic spinal cord injury. These protective effects may be based upon the reversal of focal tissue hypoxia, or by reduction of tissue edema, or possibly by both of these mechanisms. Increasing magnitudes of impact force and delay in the onset of HBO treatment markedly diminished the protective effects of HBO on long-tract neuronal conduction following traumatic spinal cord injury.
Recurrent retinal ischemia beyond cervical carotid occlusions
Authors: Countee Roger W. , Vijayanathan Thurairasah , Chavis Pamela
Published: May 2009

✓ Seventeen patients with persistent amaurosis fugax ipsilateral to angiographically documented internal carotid artery (ICA) occlusions in the neck have been treated by the authors over the past 5 years. Complete cerebral arteriography in each case demonstrated that the symptomatic ophthalmic artery was perfused exclusively by the ipsilateral external carotid artery (ECA), which invariably had an obstructive and/or ulcerative lesion at its origin, and/or an adjacent residual “stump” of the occluded ICA. In nine patients, retinal artery branch emboli were visible on funduscopy. One patient had angiographic evidence of intracranial embolization via the ophthalmic artery from the ECA. Although ipsilateral superficial temporal-middle cerebral artery anastomosis in one patient, and endarterectomy of a contralateral carotid stenosis in another patient, failed to relieve symptoms, endarterectomy of the ECA with resection of the “stump” of the occluded ICA effectively terminated symptoms in 10 of 11 patients. Anticoagulant drug therapy promptly abolished symptoms in four nonsurgical patients as well as in two patients with failed operations.

It is concluded that recurrent retinal ischemia beyond cervical carotid occlusions frequently results from microembolism via the ipsilateral ECA. Patients with this mechanism of postocclusion recurrent ischemia can be identified on the basis of clinical history, ophthalmological examinations, and complete cerebral arteriography. Termination of embolic phenomena should be the major treatment goal in these individuals, and ECA endarterectomy is recommended. Anticoagulant drugs are an effective alternative treatment in patients who are poor surgical risks.
Cancer pain relieved by long-term epidural morphine with permanent indwelling systems for self-administration
Authors: Poletti Charles E. , Cohen Alfred M. , Todd Donald P. , Ojemann Robert G. , Sweet William H. , Zervas Nicholas T.
Published: May 2009

✓ Clinical trials for abatement of intractable pelvic cancer pain were conducted in two patients, each electing surgical implantation of one of two indwelling catheter systems for administration of morphine into the spinal epidural space. Both systems, one consisting of a partially indwelling Broviac catheter, and the other, completely indwelling, consisting of a morphine reservoir connected to a shunt pump and on-off Hakim valve assembly, permitted the patients to return home where they could self-administer epidural morphine. Each patient reported that 2 mg of epidural morphine provided 8 to 12 hours of pain relief at a level superior to their previous systemic narcotic medication. On a regimen of 2 mg of epidural morphine administered twice daily, both patients experienced analgesia for 6 months, unaccompanied by alterations in sensory, motor, or cognitive functioning, and with little drug tolerance reaction.
Primary demyelinating disease simulating glioma of the corpus callosum
Authors: Rieth Kenneth G. , Chiro Giovanni Di , Cromwell Laurence D. , McKeever Paul E. , Kornblith Paul L. , Kufta Conrad V. , Pleet A. Bernard
Published: May 2009

✓ Computerized tomography (CT) has made it easier to distinguish tumoral from nontumoral diseases of the central nervous system. In the presence of mass effect, however, this distinction may be difficult or impossible to make. Primary demyelinating disease may occasionally present as a focal cerebral mass. The authors report three cases of primary demyelinating disease of the brain involving the corpus callosum and periventricular white matter and associated with mass effect, which proved difficult to differentiate from infiltrating “butterfly” gliomas.
Vancomycin and rifampin therapy for Staphylococcus epidermidis meningitis associated with CSF shunts
Authors: Gombert Myles E. , Landesman Sheldon H. , Corrado Michael L. , Stein Sherman C. , Melvin Ellen T. , Cummings Marinella
Published: May 2009

✓ Three patients with Staphylococcus epidermidis meningitis associated with cerebrospinal fluid (CSF) shunt devices were treated with a combination of intravenous vancomycin and oral rifampin. Two of the isolates were methicillin-resistant. All patients had a favorable clinical response. Time-kill curves showed that the addition of rifampin to vancomycin resulted in enhanced bactericidal activity against all isolates when compared to either antibiotic alone. This finding suggests that the combination of oral rifampin and intravenous vancomycin may be useful in the treatment of methicillin-resistant and recalcitrant methicillin-sensitive S. epidermidis meningitis associated with CSF shunts. In vitro susceptibility testing should be performed.
Dermatofibrosarcoma protruberans of the scalp treated by radical excision, immediate cranioplasty, and free groin flap
Authors: Lobay Gary W. , Weir Bryce , Carter Robert
Published: May 2009

✓ The authors describe a case of dermatofibrosarcoma protruberans of the frontal region in a young girl. The condition was treated by radical excision of the scalp, frontal bone, and sinuses, and immediate reconstruction with an acrylic cranioplasty and microsurgical transfer of a free groin flap. Pathological examination revealed the margins of the excised specimen were clear of tumor. The initial flap failed, but a second graft was immediately transferred successfully, with a good cosmetic result.
Giant cyst of the septum pellucidum
Authors: Garza-Mercado Román
Published: May 2009

✓ Symptomatic cysts of the septum pellucidum are rare. Up to 1969, only 17 published cases were considered to be symptomatic. In the case reported here, a 9-week-old girl was hospitalized because of disproportionate progressive enlargement of the head, lumbar myelomeningocele, and a history of generalized seizures. A giant septum pellucidum cyst was demonstrated on Conray ventriculography and later on computerized tomography (CT) scanning. Aqueductal stenosis was suspected. The cyst was excised at craniotomy. A ventriculoperitoneal shunt was required to treat the accompanying hydrocephalus.
Unusual CT-dense posterior fossa epidermoid cyst
Authors: Dunn Robert C. , Archer Carol A. , Rapport Richard L. , Looi L. M.
Published: May 2009

✓ A posterior fossa epidermoid cyst with high computerized tomographic attenuation is reported. The pathological and radiological features of this unusual case are presented.
Effects of positive end-expiratory pressure on intracranial pressure in dogs with intracranial hypertension
Authors: Huseby Jon S. , Luce John M. , Cary Jeffrey M. , Pavlin Edward G. , Butler John
Published: May 2009

✓ Positive end-expiratory pressure (PEEP) is used to improve oxygenation in patients with the adult respiratory distress syndrome. Nevertheless, this treatment may increase intracranial pressure (ICP) and be detrimental to certain neurosurgical patients. This clinical situation was simulated by administering PEEP to dogs with normal and elevated ICP. Increases in PEEP increased ICP in all animals. However, the presence of intracranial hypertension diminished the increase in ICP seen at a given level of PEEP. Cerebral perfusion pressure also fell less in the presence of intracranial hypertension than it did in its absence, although in the former situation cerebral perfusion pressure was at the lower limits of the range of cerebral autoregulation. These findings suggest that PEEP is no more detrimental to patients with elevated ICP than it is to patients whose ICP is normal, assuming that their cerebral autoregulation is not impaired.
Oxygenated fluorocarbon perfusion as treatment of acute spinal cord compression injury in dogs
Authors: Hansebout Robert R. , van der Jagt Richard H. C. , Sohal Sarvjit S. , Little John R.
Published: May 2009

✓ Experiments were conducted to determine the therapeutic value of subarachnoid perfusion of the traumatized dog spinal cord with the fluorocarbon, Fluosol-DA (20%). Control dogs without lesions, but which had durotomy, subarachnoid catheter placement, and saline irrigation for 4 hours, did not have any residual neurological deficit. A series of 41 dogs underwent an acute spinal cord compression using an epidural balloon inflated to a pressure of 160 mm Hg and maintained for 1 hour. Treatment included durotomy only (11 dogs), durotomy with saline perfusion at room temperature (15 dogs), and durotomy with oxygenated Fluosol-DA perfusion at room temperature (15 dogs). The dogs underwent daily grading of neurological status for a 60-day period. Dogs undergoing perfusion of the spinal cord with either saline or oxygenated Fluosol-DA had significantly improved motor recovery (p < 0.004) compared with dogs undergoing durotomy only. Perfusion with oxygenated Fluosol-DA resulted in significantly better motor recovery (p < 0.05) than did perfusion with normal saline. Microscopic examination of the traumatized spinal cords failed to reveal a substantial difference between the three groups. However, dogs with better functional results tended to have less destruction of the white matter. Hemorrhagic necrosis of the central gray matter was consistently observed in all traumatized spinal cords.
High-dose cyclophosphamide chemotherapy for recurrent CNS tumors in children
Authors: Allen Jeffrey C. , Helson Lawrence
Published: May 2009

✓ A Phase II chemotherapy trial was conducted in 18 children with recurrent brain tumors, using high doses (80 mg/kg or greater) of intravenous cyclophosphamide. All eight patients with medulloblastomas responded; two patients with systemic metastases had complete responses and six others had partial responses. In seven patients with gliomas, there were one complete and four partial responses. In a third group, all three patients with intracranial germ-cell tumors had partial responses. The overall response rate was, therefore, 89% (16 of 18 patients), and the mean duration of response was 7 months (range 2 to 24 or more months). The hematological toxicity was considerable, with two deaths possibly related to chemotherapy: one patient, a recipient of unirradiated packed cells, died from a graft versus host reaction, and the other died from an intracranial hemorrhage during a thrombocytopenic episode. Four patients had prior chemotherapy, and 10 patients had prior neuraxis radiation therapy. These patients tolerated aggressive chemotherapy reasonably well. The results are sufficiently encouraging to justify a Phase III trial in patients with newly diagnosed disease.
External ventricular drainage for control of posthemorrhagic hydrocephalus in premature infants
Authors: Harbaugh Robert E. , Saunders Richard L. , Edwards William H.
Published: May 2009

✓ Over a 3-year period, 11 premature infants with intraventricular hemorrhage and posthemorrhagic hydrocephalus were managed initially with prolonged external ventricular drainage via a subcutaneously tunneled catheter. The mean duration of drainage for this group was 20.7 days. Although two patients died before shunting was considered, no morbidity or mortality was observed to result from this technique. Seven patients required a shunt after stabilization of their medical problems. Two patients, followed for 24 and 40 months, have not required shunting procedures. External ventricular drainage via a subcutaneously tunneled catheter has been found to be a safe and reliable initial method of treating posthemorrhagic hydrocephalus in premature infants.
Transient encephalopathy and asterixis following metrizamide myelography
Authors: Chehrazi Bahram , Virapongse Chat
Published: May 2009

✓ A case is presented in which cervicolumbar myelography with metrizamide was followed by transient encephalopathy and asterixis. Metabolic etiology was excluded. A large degree of intracranial penetration of metrizamide was demonstrated by computerized tomography. Residual symptoms persisted for 10 days.
Ulnar nerve entrapment at the elbow by persistent epitrochleoanconeus muscle
Authors: Gessini Lucido , Jandolo Bruno , Pietrangeli Alberto , Occhipinti Emanuele
Published: May 2009

✓ A case of ulnar nerve entrapment in the cubital tunnel by persistent epitrochleoanconeus muscle is reported. The anatomy of the anomalous muscle is outlined, and previous cases are briefly summarized.
Successful surgical treatment of an odontogenic ossified craniopharyngioma
Authors: Alvarez-Garijo José A. , Froufé Agustin , Taboada Dario , Vila Manuel
Published: May 2009

✓ A large, highly ossified craniopharyngioma was diagnosed and surgically treated in a 2-year-old girl. About 20 teeth were macroscopically identified in the operative specimen, some of them totally developed, complete with crown and root. Pathological study established the diagnosis of craniopharyngioma with formation of teeth. Only five cases have been reported previously, and only one patient survived the operation. The patient is alive 3 years after surgical treatment. Radiotherapy was not used.
Documentation of fourth ventricle entrapment by metrizamide ventriculography with CT scanning
Authors: Collada Mauricio , Kott Joseph , Kline David G.
Published: May 2009

✓ Documentation by metrizamide ventriculography with computerized tomography (CT) of fourth ventricle entrapment is presented. Reevaluation of the cerebrospinal fluid pathways is suggested whenever fourth ventricle enlargment is seen on CT scans of patients with ventriculoperitoneal shunts for communicating hydrocephalus.
Effects of indomethacin and prostacyclin on isolated human pial arteries contracted by CSF from patients with aneurysmal SAH
Authors: Brandt Lennart , Ljunggren Bengt , Andersson Karl-Erik , Hindfelt Bengt , Uski Tore
Published: May 2009

✓ In small human cerebral arteries preincubated with indomethacin, contractions induced by cerebrospinal fluid (CSF), from patients with subarachnoid hemorrhage were markedly increased. Also contractions induced by noradrenaline, but not 5-hydroxytryptamine, were augmented. Prostacyclin and its metabolite 6-keto-prostaglandin (PG)E1 reversed the contractions induced by CSF, as well as by noradrenaline, 5-hydroxytryptamine, and PGF2α. The findings suggest that these substances are able to counteract the influence of vasoconstrictor material in hemorrhagic CSF. If the capacity to synthesize these “protective” arachidonic acid metabolites is reduced, the resulting imbalance between contractile and relaxant forces acting on the vessel wall may lead to sustained cerebral vasoconstriction.
Neurons in human epileptic cortex
Authors: Wyler Allen R. , Ward Arthur A.
Published: May 2009

✓ During craniotomy for surgical treatment of medically intractable epilepsy, single neurons were recorded from the lateral temporal cortex of 11 awake patients. A total of 83 neurons were recorded, and their response to repetitive direct cortical stimulation with ascending and descending frequency ramps between 1 to 10 Hz was evaluated. More normal units from the suspected epileptogenic cortex responded to repetitive stimulation at frequencies between 5 to 10 Hz with augmented action potential bursts than did units from cortex thought not to be primarily epileptogenic. This burst response might persist for up to 30 seconds after the frequency ramp had descended from 10 to 1 Hz. Except in two cases, this augmentation of burst response was not accompanied by afterdischarge on electroencephalography. These data would indicate that neurons within the region of suspected epileptogenic cortex demonstrate a greater propensity for afterdischarge to repetitive stimuli than do neurons in more normal cortex.
Hyponatremia in intracranial disease: perhaps not the syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
Authors: Nelson Paul B. , Seif Said M. , Maroon Joseph C. , Robinson Alan G.
Published: May 2009

✓ Patients with intracranial disorders are prone to develop hyponatremia with inability to prevent the loss of sodium in their urine. This was originally referred to as “cerebral salt wasting,” but more recently is thought to be secondary to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Blood volume determinations were made in 12 unselected neurosurgical patients with intracranial disease who fulfilled the laboratory criteria for SIADH. Ten of the 12 patients had significant decreases in their red blood cell mass, plasma volume, and total blood volume. The finding of a decreased blood volume in patients who fulfill the laboratory criteria for SIADH is better explained by the original concepts of cerebral salt wasting than by SIADH. The primary defect may be the inability of the kidney to conserve sodium.
Diagnosis of intraventricular and cisternal cysticercosis by computerized tomography with positive intraventricular contrast medium
Authors: Madrazo Ignacio , Garcia Renteria Jose A. , Paredes Gonzalo , Olhagaray Bernardo
Published: May 2009

✓ Computerized tomography (CT) has replaced pneumoencephalography and ventriculography in the diagnosis of intraventricular cysticercosis. The authors present a refinement in the use of CT by introducing a positive contrast medium into the ventricles to increase the definition of plain and contrast-enhanced scans in the diagnosis of intraventricular cysticercosis. Eleven cases of Cysticercus cyst are presented, 10 of which were precisely delineated by CT-iodoventriculography. In the remaining case, lack of definition was due to obstruction of the cerebral aqueduct. Surgical confirmation was obtained in all cases.
Malignant fibrous histiocytoma of the meninges
Authors: Kalyanaraman Uma P. , Taraska John J. , Fierer Joshua A. , Elwood Patrick W.
Published: May 2009

✓ A case of malignant fibrous histiocytoma arising from the meninges in a 12-year-old boy is reported. This tumor presented as an extracerebral hemorrhagic mass in the left frontal lobe without obvious invasion of the underlying brain. Histologically, a malignant tumor with the characteristic storiform pattern of malignant fibrous histiocytoma with focal areas of hemorrhage was observed. Ultrastructurally, fibroblastic cells, undifferentiated cells, histiocytic-type cells, multinucleated tumor giant cells, and xanthomatous cells were distinctly seen. The possible cell of origin of these meningeal tumors and their prognosis are discussed. The significance of considering this entity in the differential diagnosis of those tumors of the central nervous system with a spindle-cell or xanthomatous component is discussed, and the value of ultrastructural and immunocytochemical study with glial fibrillary acidic protein in the diagnosis is stressed.
Transsphenoidal microsurgery for prolactin-secreting pituitary adenomas
Authors: Faria Miguel A. , Tindall George T.
Published: May 2009

✓ The authors present the results of transsphenoidal microsurgery in 100 women with the amenorrhea-galactorrhea syndrome caused by pituitary adenomas associated with hyperprolactinemia (prolactinomas). As the surgical results were closely related to the preoperative levels of serum prolactin, the patients were divided into two groups: patients with preoperative prolactin less than 200 ng/ml (Group 1), and those with preoperative prolactin greater than 200 ng/ml (Group 2). The results in Group 1 (72 patients) were significantly better. In this group, 56 (78%) patients regained normal menstrual cycles, and 55 (76%) had return of elevated prolactin levels to normal following surgery. In Group 2 (28 patients), however, only 11 (39%) resumed normal menstrual periods postoperatively, and 13 (46%) had return of elevated prolactin levels to normal. There was good correlation between tumor size and the preoperative level of prolactin. Of the 72 women in Group 1, 58 (81%) had tumors less than 1 cm (microadenomas), whereas of the 28 women in Group 2, only four (14%) had tumors of that size. All patients with visual field deficits preoperatively improved or had a normal visual examination postoperatively; none was made worse by surgery. Four patients (three in Group 2) have required additional surgery and/or irradiation.

In the last six patients of the series, contrast-enhanced coronal computerized tomography slices made with the updated General Electric scanner detected five microadenomas. Considering that a relatively high percentage of sellar polytomograms are negative in patients with proven microadenomas (that is, only 40 of 72 patients in Group 1 had abnormal polytomography), it is likely that sellar polytomography will significantly decrease in importance in the diagnostic work-up of these patients. The authors provide a rationale for transsphenoidal microsurgery in these patients as opposed to other forms of management, such as bromocriptine therapy and irradiation.
Arteriovenous malformations of the medial temporal lobe
Authors: Heros Roberto C.
Published: May 2009

✓ Arteriovenous malformations (AVM's) of the medial temporal lobe frequently involve the basal ganglia and the thalamus and, for this reason, are commonly judged to be inoperable. However, when the medial involvement is limited to the posterolateral part of the thalamus and to the inferior portion of the basal ganglia lateral to the internal capsule, the lesions may be excised safely. Three patients who underwent successful excision of AVM's of this region are presented. A transcortical surgical approach through the inferior portion of the temporal lobe was used to minimize retraction of the temporal lobe and damage to the optic radiation, and to avoid postoperative dysphasia.

The following neuroradiological criteria indicate that the bulk of the lesion is in the temporal lobe, that only noncritical portions of the basal ganglia and thalamus are involved, and that, therefore, surgical resection is relatively safe: 1) primary supply by the anterior choroidal artery and by laterally oriented branches of the posterior cerebral artery; 2) primary venous drainage into the basal vein of Rosenthal and medial Sylvian veins; 3) projection below the plane of the middle cerebral artery in the lateral carotid arteriogram; 4) projection lateral to the sweep of the posterior cerebral artery in the anteroposterior or Towne's view of the vertebral angiogram; and 5) demonstration of an intratemporal clot or intraventricular blood by computerized tomography.
Platelet interaction within giant intracranial aneurysms
Authors: Sutherland Garnette R. , King Martin E. , Peerless S. J. , Vezina William C. , Brown G. William , Chamberlain Mike J.
Published: May 2009

✓ Turbulence within intracranial aneurysms may result in tearing of the aneurysmal wall, exposing the subendothelial matrix to circulating platelets. In this study, platelet interaction in giant intracranial aneurysms was evaluated by a dual-isotope technique employing 111In-labeled platelets and 99mTc-labeled red blood cells. The use of two isotopes allows the subtraction of the blood pool and the calculation of the ratio indium deposited:indium blood pool (In(D)/In(BP)). A ratio greater than zero indicates platelet deposition within the aneurysm.

Thirteen patients were evaluated in this way, with platelet deposition demonstrated in six. In these six patients, the ratio In(D)/In(BP) was found to be significantly elevated, with a mean value of 0.96 ± 0.65. Three of these six patients had symptoms of recurrent transient neurological deficits; one of these three suffered a complete stroke following documentation of platelet deposition. In this case, the aneurysm was obtained at surgery and was found to contain intraluminal platelet aggregation when viewed by scanning electron microscopy. In the remaining seven patients, the ratio In(D)/In(BP) was found not to be significantly elevated (mean −0.03 ± 0.06), indicating the absence of active platelet deposition. Two of these patients had prior symptoms of cerebral ischemia; one of these was found to have an ulcer in the ipsilateral internal carotid artery which was probably responsible for thromboembolic events to the hemisphere.

The authors conclude that platelet aggregation occurs more frequently than previously recognized in giant intracranial aneurysms, and their data substantiate the hypothesis that platelet metabolic products or thrombi originating from a large aneurysm may embolize to distal cerebral vessels.
Effect of extracranial-intracranial bypass and pentobarbital on acute stroke in dogs
Authors: Lawner Pablo M. , Laurent John P. , Simeone Frederick A. , Fink Eugene A.
Published: May 2009

✓ Ninety-three mongrel dogs underwent intracranial carotid and middle cerebral artery occlusions. They were then randomized into four groups: 1) the untreated control group (no surgical or medical therapy) showed significant neurological deficit, 16% mortality, and 17% mean hemisphere infarction; 2) in the bypass group (superficial temporal to middle cerebral artery (STA-MCA) anastomosis completed within 3 hours of occlusion), neurological deficit was diminished, mortality was 7%, and mean infarction 5.66%; 3) in the pentobarbital group (single dose of pentobarbital, 35 mg/kg administered intravenously 30 minutes after occlusion), neurological deficit was essentially the same as in the previous group, there was no mortality, and mean infarction was 5.52%; and 4) in the pentobarbital/bypass group (pentobarbital dose plus STA-MCA bypass), neurological deficit was slightly lower than in previous treatment groups, there was no mortality, and mean hemisphere infarction was 1.78%. Extracranial-intracranial bypass produced an immediate 31.6% increase in regional cortical blood flow. The combination of pentobarbital postocclusive therapy and early extracranial-intracranial bypass showed beneficial synergism.
Surgical treatment of 63 cases of conjoined nerve roots
Authors: White James G. , Strait Timothy A. , Binkley Joseph R. , Hunter Samuel E.
Published: May 2009

✓ The operative results of 63 cases of lumbar disc disease with surgically confirmed conjoined nerve roots are reviewed. The first 55 patients were treated by standard hemilaminectomy and discectomy, with only 30% reporting a good result. Of the last eight patients treated by hemilaminectomy, pediculectomy, and discectomy, seven patients returned to work. The rationale for and the technique of pediculectomy are discussed in detail. Clinical, radiological, and surgical clues indicating the presence of the conjoined nerve root anomaly are reviewed.
Presentation and management of mesencephalic hematoma
Authors: Durward Quentin J. , Barnett Henry J. M. , Barr Hugh W. K.
Published: May 2009

✓ Two patients presenting with a mesencephalic hematoma are reported. Clinical features, particularly paralysis of all vertical eye movements and a marked tendency to fall backwards when standing, allowed accurate localization of these lesions. In one case, the etiology was a proven arteriovenous malformation, and the other was suspected to be due to hypertensive arteriolar rupture. Deterioration resulted from further expansion of the mesencephalic mass in one patient. A subtemporal approach allowed excellent exposure of the midbrain for evacuation of the hematoma. The other patient developed hydrocephalus due to obstruction of the aqueduct and was treated successfully by placement of a ventriculoperitoneal shunt. Both patients survived, although one remains moderately disabled. The authors emphasize the importance of initial close observation and supportive care in the stable patient with a mesencephalic hematoma. Surgery is indicated for those who show evidence of deterioration from rebleeding or hydrocephalus.
Nontraumatic dissecting aneurysm of the vertebral artery
Authors: Senter Howard J. , Sarwar Mohammad
Published: May 2009

✓ A case is described of a nontraumatic dissecting aneurysm of the vertebral artery, which presented as a subarachnoid hemorrhage (SAH). Differentiation from vasospasm and from atherosclerosis is critical. Dissection between the adventitia and media should be noted in the differential diagnosis of SAH when an aneurysm or vascular malformation is not demonstrated angiographically.
Thoracic spinal cord ependymoma presenting with ejaculatory failure
Authors: Berciano Jose , Gutierrez Jaime , Rebollo Mariano , Dierssen Guillermo
Published: May 2009

✓ A case of thoracic spinal cord ependymoma presenting with ejaculatory failure is described. This mode of onset has not previously been reported in patients with thoracic intraspinal tumors.
Spontaneous migration of an intracranial bullet to the cervical spinal canal causing Lhermitte's sign
Authors: Arasil Ertekin , Taşçioğlu Ali O.
Published: May 2009

✓ A case is presented of a woman who was shot in the left occipital area with a .32 caliber automatic pistol. She was neurologically intact on admission, and skull x-ray films revealed the bullet in the right suboccipital area. On the 2nd day of her admission she developed Lhermitte's sign. Repeat films showed that the bullet had migrated to the C-4 vertebral level. The bullet was subsequently removed via a total laminectomy at C3–4.
Considerations in early surgery on good-risk patients with ruptured intracranial aneurysms
Authors: Hugenholtz Herman , Elgie Robert G.
Published: May 2009

✓ A retrospective analysis of 100 consecutive patients with proven ruptured intracranial aneurysms, classified as Botterell Grades I to III on admission, was carried out to evaluate the efficacy of early operation. Surgical and management mortality/morbidity rates were lower for cases in which a single hemorrhage was operated on within 48 hours than when surgery was delayed for 7 days or more. Surgical and management mortality/morbidity rates were worse in good-risk patients treated surgically between the 3rd and 7th days following a hemorrhage, reflecting the increased incidence of postoperative vasospasm and raised intracranial pressure encountered at surgery during this interval.
Barbiturate inhibition of lymphocyte function
Authors: Neuwelt Edward A. , Kikuchi Kenji , Hill Suellen A. , Lipsky Peter , Frenkel Eugene
Published: May 2009

✓ The present studies evaluated the effect of phenobarbital, pentobarbital, and thiopental at concentrations comparable to those attained during therapeutic barbiturate-induced coma, on in vitro mitogen-induced lymphocyte activation. Lymphocytes from normal volunteers were incubated for 72 hours in culture medium containing mitogen (phytohemagglutinin) and a range of concentrations of the barbiturates (5 to 833 µg/ml). Three parameters of lymphocyte activation (mitogen-induced blast transformation, 3H-thymidine incorporation, and cell proliferation) were all suppressed by the barbiturates. The suppression was dose-dependent. The greatest suppression was caused by the short-acting barbiturate, thiopental. Lymphocyte responses were much less affected by the long-acting barbiturate, phenobarbital. The intermediateacting barbiturate, pentobarbital, was also intermediate in its ability to inhibit lymphocyte activation. The two- to threefold difference between the effects of thiopental and pentobarbital on lymphocyte function may have direct clinical relevance, since it is primarily these two agents that are employed to induce therapeutic “barbiturate coma.” Since lymphocyte suppression appears to be much more marked in the presence of thiopental, these observations support a role for the other barbiturates in programs of induced coma.
Paraganglioma of the cauda equina
Authors: Binkley William , Vakili Saeed T. , Worth Robert
Published: May 2009

✓ An unusual, well demarcated, and encapsulated neoplasm of the cauda equina is presented. At first, the tumor was considered to be a variant of myxopapillary ependymoma, but the reaction for glial fibrillary acidic protein was negative. At the ultrastructural level, the neoplastic cells contained many small dense core vesicles, and the diagnosis of paraganglioma was established. The literature and histogenesis of paraganglioma of the cauda equina is reviewed.
Gangliocytic paraganglioma in cauda equina region, with biochemical and neuropathological studies
Authors: Llena Josefina F. , Wisoff Hugh S. , Hirano Asao
Published: May 2009

✓ Biochemical analysis of a nonfunctional paraganglioma in the cauda equina region demonstrates that its catecholamine content is predominantly dopamine with small amounts of noradrenaline and adrenaline. Scattered mature large neurons characterize the tumor as gangliocytic paraganglioma. Ultrastructural study shows intracytoplasmic neurosecretory granules in the neoplastic cells.
Extradural aerocele
Authors: Alexander Eben , Davis Courtland H. , Suwanwela Charas
Published: May 2009

✓ The 20-year follow-up results of a case of extradural aerocele (pneumatocele) are reported.
Carpal tunnel syndrome caused by Mycobacterium fortuitum and Histoplasma capsulatum
Authors: Randall Gayle , Smith Philip W. , Korbitz Bernard , Owen Donald R.
Published: May 2009

✓ Two unusual cases are presented in which carpal tunnel syndrome was found to be the presenting manifestation of Histoplasma capsulatum and atypical mycobacterial infection. General diagnostic and therapeutic points are reviewed.
Stereotaxic device for percutaneous twist-drill insertion of depth electrodes and for brain biopsy
Authors: Olivier André , Bertrand Gilles
Published: May 2009

✓ A stereotaxic device is described for percutaneous twist-drill insertion of depth electrodes for seizure recording and brain biopsy. This apparatus, which permits a lateral orthogonal approach, has been used in conjunction with a Leksell type of stereotaxic frame. Its main advantages are the ample working space it provides at the site of insertion of intracerebral electrodes, and the stable attachment it offers in fixing these electrodes on the skull.
Clinical and pathological study of meningiomas of the first two decades of life
Authors: Deen H. Gordon , Scheithauer Bernd W. , Ebersold Michael J.
Published: May 2009

✓ The clinical features and pathological materials of 51 cases of histologically verified meningiomas in patients under 21 years of age were reviewed. The age range was 7 to 20 years, with the majority of cases being clustered in the second decade of life. There was virtually a 1:1 sex ratio, with 26 females and 25 males. Thirty-eight patients had intracranial meningiomas, three had intraorbital tumors, and 10 had intraspinal tumors. Twelve patients (24%) had neurofibromatosis. Twenty patients (39%) had tumor recurrence. The cases were subdivided into five histological categories: meningotheliomatous, fibrous, transitional, psammomatous, and papillary. In each case, the clinical course was correlated with histological subtype. The 15-year survival rate in patients with intracranial meningiomas of all types was 68%. Factors adversely affecting survival included infratentorial location, papillary histology, and evidence of brain invasion.
Use of metrizamide in computerized tomography to diagnose the Chiari I malformation
Authors: Woosley Ronald E. , Whaley Robert A.
Published: May 2009

✓ To properly diagnose and treat the Chiari I malformation, it is necessary to know: 1) the position of the cerebellar tonsils; 2) the degree of compression of the upper cervical cord and medulla; 3) the status of the spinal cord, particularly whether a syringohydromyelic condition exists; 4) whether basal arachnoiditis is present; 5) the nature of the communication between the fourth ventricle and the subarachnoid space; and 6) the overall ventricular size. The use of computerized tomography (CT) alone is not sufficient to furnish all of this information. The addition of metrizamide to the CT study enables the exact delineation of the basic pathology of the Chiari I malformation and its associated complications. A total of seven patients with surgically proven Chiari I malformation were included in this study. In all of these cases, CT with metrizamide was the essential diagnostic procedure. Plain films appear to be necessary only to facilitate the diagnosis of an associated Klippel-Feil syndrome or scoliosis.
Central nervous system amyloid presenting as a mass lesion
Authors: Townsend Jeannette J. , Tomiyasu Uwamie , MacKay Alexander , Wilson Charles B.
Published: May 2009

✓ Amyloidomas of the central nervous system are rare. Two cases involving middle-aged patients with neurological symptoms are presented. Massive focal accumulations of amyloid in the cerebral hemispheres were confirmed pathologically.
The case of General Wood
Authors: Ljunggren Bengt
Published: May 2009

✓ The first successful operation ever on a parasagittal meningioma was performed in 1910 by Harvey Cushing. The operation turned out to be a critical event in his career as a neurosurgeon and made him confident about the possibilities of brain surgery. The patient was Leonard Wood, Major General and Chief of Staff of the United States Army, who was a military surgeon turned career officer. In the election campaign for the president to succeed Woodrow Wilson in 1920, Leonard Wood, the personification of competence, became the Republican favorite. General Wood was, however, eliminated from the presidential election campaign by complicated intrigues. From the next year on, General Wood experienced increasing warning signs of a recurrent tumor, which he unfortunately neglected. Not until 1927 did Wood again come under the care of Dr. Cushing, who had just returned from Britain, where in the course of a single month he had been awarded no less than seven distinctions from different medical societies. Deeply concerned at Wood's condition, Cushing decided to attempt extirpation of the recurrent tumor. General Wood died a few hours after the operation. No tragedy caused Cushing more distress than the death of General Wood, who 7 years earlier had been on the verge of being nominated President of the United States.
Congenital inclusion cyst of the subgaleal space
Authors: Chaudhari A. Basit , Ladapo Foluso , Mordi Victor P. N. , Choudhury Kalyanpury J. , Naseem Attia , Obe Joan A.
Published: May 2009

✓ An unusual type of congenital subgaleal cyst, either dermoid or epidermoid, was found in 21 Nigerian infants. This entity was located in the midline of the scalp, anywhere from above the nasion to the inion, and occupied the subgaleal space. These cysts were noted soon after birth and gradually enlarged. They had no intracranial extension and were easily excised intact. Clinically, radiologically, and histologically they were similar to congenital inclusion dermoid cysts of the anterior fontanel. The histology and some of the peculiarities of these cysts are described. Although most of these cysts occur at the anterior fontanel, they can occur anywhere in the midline, and the subgaleal space of the anterior fontanel is not the exclusive site, as has been claimed by previous authors.
Sensory evoked response to electrical stimulation of the trigeminal nerve in humans
Authors: Findler Gideon , Feinsod Moshe
Published: May 2009

✓ Electrical stimulation of the upper and lower lips of normal subjects evoked a consistent response recorded from over the face area of the ipsi- and contralateral hemispheres. This response consisted of seven discrete waves. Peak latencies ranged from as early as 8 msec to 115 msec. Stimulation of the lower lip evoked a response of lower amplitude and reversed polarity, as compared to the upper lip stimulation response. The data support the validity of the trigeminal sensory evoked response in the evaluation of the trigeminal pathways. Previously reported methods are reviewed and compared.
Evaluation of histocompatibility as a factor in the repair of nerve with a frozen nerve allograft
Authors: Zalewski Andrew A. , Gulati Adarsh K.
Published: May 2009

✓ Host axons in dogs can regenerate through a long nerve allograft provided that the allograft bears only minor transplantation antigens, and is frozen and thawed before transplantation. The authors have tried to confirm this important observation in rats. Host rats received a 4-cm fresh or frozen nerve isograft (that is, a non-antigenic nerve), or a fresh or frozen nerve allograft with cells containing only minor transplantation antigens. The results showed that after 2 and 9 months only a fresh isograft permitted many host axons to traverse its entire length. Only a few host axons grew into the proximal 1 to 2 cm of a frozen isograft or into an allograft (fresh or frozen). Because frozen grafts failed, the authors examined some specimens after 2 weeks and found that freezing killed most of the Schwann cells. On the other hand, many proliferating Schwann cells were found in 2-week fresh isografts. In addition, hosts that received a frozen nerve allograft underwent regrafting after 9 months with an isograft and allograft (of the same genotype as the original nerve allograft) of nodose ganglion. These rats accepted the isograft but rejected the allograft of ganglion. It is concluded that axonal regeneration through a long frozen nerve graft fails in rats because freezing destroys Schwann cells. Moreover, a frozen nerve allograft does not induce a state of immunological tolerance, as has been suggested, because these recipients reject a second allograft. Since the present data failed to confirm findings obtained in dogs, the clinical use of a frozen nerve allograft is not recommended.
Statistical analysis of central nervous system tumors in China
Authors: Huang Wen-qing , Zheng Shi-ju , Tian Qing-sheng , Huang Jian-qing , Li Yu-xia , Xu Qing-zhong , Liu Zi-jun , Zhang Wen-cui
Published: May 2009

✓ The authors present a statistical survey of the general incidence, age distribution, and preferential sites of 25,122 tumors of the central nervous system (CNS), from 12 centers in China. Of these tumors, 22,457 were intracranial and the rest intraspinal.

Of the 22,457 intracranial neoplasms collected, tumors of neuroepithelial tissue comprised 43.85%, meningiomas 16.58%, tumors of nerve sheath cells 9.5%, pituitary adenoma 9.52%, congenital tumors 8.46%, secondary tumors 6.8%, vascular malformations and tumors 3.82%, and primary sarcomas 0.72%. Neuroepithelial and meningeal tumors occurred first and second in all series, but the other tumors varied in frequency. There was a higher incidence of nerve-sheath tumors in southern than in northern regions. The age distribution of Chinese patients with tumors of the CNS was lower than that of Caucasians: nearly two-thirds (64.57%) had the clinical onset of their tumor between the ages of 31 and 40 years, with the peak incidence at 35 years. Nearly 20% of tumors of the CNS occurred before 20 years of age. The male:female ratio was 1.53:1; the only tumor with a definite preponderance of females over males was the meningioma.

Intraspinal tumors derived from nerve sheaths comprised 47.13% of all tumors within the spinal canal. Meningiomas were second with an incidence of 14.06%, then followed congenital tumors (12.06%) and neoplasms of neuroepithelial tissue (10.83%). Secondary tumors, vascular malformations and neoplasms, and sarcoma were next in order of frequency with 4.6%, 4.5%, and 4.16%, respectively.
Femoral neuropathy caused by an iliopsoas bursal cyst
Authors: Lavyne Michael H. , Voorhies Rand M. , Coll Raymond H.
Published: May 2009

✓ This case presents a rare occurrence of femoral neuropathy due to iliopsoas bursitis as a consequence of hip osteoarthritis. A computerized tomography scan of the hip revealed a smooth-walled nonenhancing cystic mass adjacent to the hip joint and elevating the components of the homolateral femoral triangle. The differential diagnosis and operative management of this entity are reviewed.
Laparoscopic retrieval of disconnected ventriculoperitoneal shunt catheters
Authors: Guzinski Gay M. , Meyer William J. , Loeser John D.
Published: May 2009

✓ Retrieval of free abdominal ventriculoperitoneal shunt catheters usually requires laparotomy. The authors describe successful removal of free peritoneal catheters by means of commonly available adult laparoscopic equipment in four pediatric patients aged 2 to 12 years.
Granular-cell pituicytoma associated with multiple endocrine neoplasia type 2
Authors: Cusick Joseph F. , Ho Khang-Cheng , Hagen Thad C. , Kun Larry E.
Published: May 2009

✓ Granular-cell pituicytomas of the neurohypophysis have a controversial histogenesis and oncological behavior. The occurrence of such a tumor in a patient whose father and daughter had endocrine neoplasms suggests a neuroectodermal origin for these tumors. Although all of the conditions considered in this report are unusual clinical entities, their correlation offers considerations in understanding the importance of genetic factors in tumor development.
Neurosurgical manpower: the physician's viewpoint
Authors: Watts Clark , Mendenhall Robert C. , Radecki Stephen E. , Girard Roger A.
Published: May 2009

✓ This paper reports a national study of physicians in 24 medical and surgical specialties, and reveals the opinions of neurosurgeons and their professional colleagues with regard to the adequacy of the supply of neurosurgical manpower. Among neurosurgeons, 30.4% believe the supply to be excessive, 60.1% think it is about right, 7.5% believe that there is a shortage, and 2.0% have no opinion. Neurologists' opinions do not differ significantly from those of neurosurgeons, but physicians and surgeons in 22 other specialties are significantly less likely to regard the supply as excessive, and are more likely to perceive a shortage. Primary care physicians, as a group, are most likely to perceive a shortage, and least likely to indicate an excess. Among the 24 specialties studied, 9.3% of physicians believe the supply of neurosurgeons to be excessive, 55.1% think it is about right, 22.9% believe that there is a shortage, and 12.8% have no opinion.
Differential intracranial pressure in patients with unilateral mass lesions
Authors: Weaver David D. , Winn H. Richard , Jane John A.
Published: May 2009

✓ Four patients with unilateral mass lesions are presented in whom bilateral supratentorial subarachnoid pressures were continuously recorded. A significant pressure differential between the ipsi- and contralateral side was documented in each case. The possible relationship of this phenomenon to various factors involved in producing increased intracranial pressure, including cerebrospinal fluid flow dynamics, vascular reactivity, elasticity, and brain tissue pressure, are discussed. This study suggests that supratentorial subarachnoid pressure should be measured ipsilateral to the site of a focal mass lesion.