bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiation necrosis or glioma recurrence: is computer-assisted stereotactic biopsy useful?
Authors: Forsyth Peter A. , Kelly Patrick J. , Cascino Terrence L. , Scheithauer Bernd W. , Shaw Edward G. , Dinapoli Robert P. , Atkinson Elizabeth J.
Published: June 2009

✓ Fifty-one patients with supratentorial glioma treated with external beam radiotherapy (median dose 59.5 Gy) who then demonstrated clinical or radiographic evidence of disease progression underwent stereotactic biopsy to differentiate tumor recurrence from radiation necrosis. The original tumor histological type was diffuse or fibrillary astrocytoma in 21 patients (41%), oligodendroglioma in 13 (26%), and oligoastrocytoma in 17 (33%); 40 tumors (78%) were low-grade (Kernohan Grade 1 or 2). The median time to suspected disease progression was 28 months. Stereotactic biopsy showed tumor recurrence in 30 patients (59%), radiation necrosis in three (6%), and a mixture of both in 17 (33%); one patient (2%) had a parenchymal radiation-induced chondroblastic osteosarcoma. The tumor type at stereotactic biopsy was similar to the original tumor type and was astrocytoma in 24 patients (47%), oligodendroglioma in eight (16%), oligoastrocytoma in 16 (31%), unclassifiable in two (4%), and chondroblastic osteosarcoma in one patient (2%). At biopsy, however, only 19 tumors (37%) were low grade (Kernohan Grade 1 or 2). Subsequent surgery confirmed the stereotactic biopsy histological findings in eight patients. Follow-up examination showed 14 patients alive with a median survival of 1 year for the entire group. Median survival times after biopsy were 0.83 year for patients with tumor recurrence and 1.86 years for patients with both tumor recurrence and radionecrosis; these findings were significantly different (p = 0.008, log-rank test). No patient with radiation necrosis alone died. Other factors associated with reduced survival were a high proportion of residual tumor (p = 0.024), a low proportion of radionecrosis (p < 0.001), and a Kernohan Grade of × or 4 (p = 0.005).

In conclusion, in patients with previously irradiated supratentorial gliomas in whom radionecrosis or tumor recurrence was clinically or radiographically suspected, results of stereotactic biopsy could be used to differentiate tumor recurrence, radiation necrosis, a mixture of both lesions, or radiation-induced neoplasm. In addition, biopsy results could predict survival rates.
Combination therapy with cisplatin and nifedipine inducing apoptosis in multidrug-resistant human glioblastoma cells
Authors: Kondo Seiji , Yin Dali , Morimura Tatsuo , Takeuchi Juji
Published: June 2009

✓ The authors found that multidrug-resistant human glioblastoma GB-1 cells demonstrated significantly more resistance to cisplatin than did nondrug-resistant human glioblastoma U87-MG cells (p < 0.1). They therefore attempted to determine whether calcium channel blockers enhance the antitumor activity of cisplatin against GB-1 cells. Nifedipine, a dihydropyridine calcium channel blocker, significantly enhanced the antitumor effect of cisplatin on GB-1 cells (p < 0.05). In the absence of normal extracellular Ca++, nifedipine enhanced the cytotoxicity of cisplatin. In addition, the antitumor activity of combined cisplatin and nifedipine was inhibited both by actinomycin D and cycloheximide, suggesting that such activity is dependent upon new RNA and protein synthesis. Surprisingly, DNA fragmentation assay demonstrated that synergism between cisplatin and nifedipine resulted in apoptosis (programmed cell death) at a relatively low concentration of cisplatin, which when tested alone did not induce apoptosis. In addition, it was demonstrated that nuclei from GB-1 cells lacked a Ca++-dependent endonuclease that degrades chromatin into nucleosomes and that calcium ionophore A 23187 did not decrease the viability of GB-1 cells. The above findings suggest the hypothesis that the noncytotoxic agent nifedipine synergistically enhances the antitumor effect of cisplatin on multidrug-resistant GB-1 cells lacking Ca++-dependent endonuclease, and subsequently induces apoptosis via its interaction with an as yet uncharacterized functional site other than the calcium channel on GB-1 cells.
Effectiveness of controlled release of a cyclophosphamide derivative with polymers against rat gliomas
Authors: Judy Kevin D. , Olivi Alessandro , Buahin Kwame G. , Domb Abraham , Epstein Jonathan I. , Colvin O. Michael , Brem Henry
Published: June 2009

✓ Most malignant gliomas grow despite treatment by standard chemotherapeutic agents. The authors explored the use of an innovative drug, 4-hydroperoxycyclophosphamide (4HC), delivered via a controlled-release biodegradable polymer to determine whether local delivery would enhance efficacy. This drug is an alkylator-type chemotherapeutic agent derived from cyclophosphamide. Unlike the parent drug, which requires activation by hepatic microsomes, 4HC is active in vitro. Two rat glioma cell lines, 9L and F98, were treated in cell culture with medium containing 4HC. Both cell lines were more sensitive to 4HC than to a nitrosourea, BCNU, an agent of established value in the local therapy of gliomas.

Ninety Fischer 344 rats implanted with 9L or F98 gliomas were treated with an intracranial polymer implant containing 0% to 50% loaded 4HC in the polymer, and it was found that 20% 4HC—loaded polymers caused minimum local brain toxicity and maximum survival. These polymers were then used to compare the in vivo efficacy of 4HC to BCNU in rats implanted with 9L glioma. Animals with brain tumors treated with 4HC had a median survival span of 77 days compared to the median survival of 21 days in BCNU-treated animals and median survival of 14 days in untreated animals. Long-term survival for more than 80 days was 40% in the 4HC-treated rats versus 30% in the BCNU-treated rats.

The polymer carrier used in this study was a copolyanhydride of dimer erucic acid and sebacic acid 1:1, which was able to maintain the hydrolytically unstable 4HC in a stable state for local delivery. Thus, it is concluded that 4HC-impregnated polymers provide an effective and safe local treatment for rat glioma.
Carcinoembryonic antigen production associated with an osteolytic meningioma
Authors: Partington Michael D. , Scheithauer Bernd W. , Piepgras David G.
Published: June 2009

✓ An elevated serum carcinoembryonic antigen (CEA) without evidence of neoplasia was noted in an 84-year-old woman. She subsequently developed a lytic skull lesion, which at surgery proved to be an atypical meningioma. Immunohistochemical analysis demonstrated that this tumor was producing CEA. This aggressive meningioma required two further resections and adjuvant radiotherapy in the following 18 months. Serum elevation of CEA has been reported only twice in association with meningiomas; both of those tumors were of the secretory subtype.
Tonsillar ectopia and Chiari malformations: monozygotic triplets
Authors: Cavender Richard K. , Schmidt John H.
Published: June 2009

✓ A unique case of monozygotic triplets, each of whom exhibits variable degrees of tonsillar ectopia, is reported. Patient X presented with a Chiari I malformation and associated syringomyelia; examination of patients Y and Z showed 4 mm and 2.5 mm of tonsillar ectopia, respectively. No such case has been reported in the literature. The discussion defines the current magnetic resonance criteria for diagnosis of hindbrain malformations and addresses the question of whether these disorders represent a spectrum or separate disease entities, with specific emphasis on genetic predisposition. Due to the 100% concordance in this case the presence of a common hereditary factor in the etiology of these malformations is highly suggested.
Preoperative magnetic resonance imaging localization of convexity brain lesions
Authors: Ashkenazi Ely , Pomeranz Shlomo , Umansky Felix , Gomori John M.
Published: June 2009

✓ The authors present a simple and accurate new technique for preoperative localization of convexity lesions of the brain by means of magnetic resonance (MR) imaging. This method uses measurements from the initial diagnostic MR image and provides precise intraoperative guidance to cortical and subcortical cerebral lesions.
Surgical treatment of trigeminal schwannomas
Authors: Samii Madjid , Migliori Matteo M. , Tatagiba Marcos , Babu Ramesh
Published: June 2009

✓ A total of 27 patients with trigeminal schwannoma were treated between 1982 and 1992 at the Neurosurgery Department of Nordstadt Hospital. Twelve cases of solitary schwannoma without any family history or physical stigmata of neurofibromatosis were included and form the basis of this study. There were four women and eight men (mean age 44 years) in this series. Duration of symptoms ranged from 2 months to 6 years. The most frequent symptoms were either pain or numbness of the ipsilateral hemiface. The surgical approach was chosen depending on the tumor type. Tumors that belonged to Type A (five cases), which were predominantly in the middle fossa, were approached using a transsylvian method; Type B (one case), which presented predominantly in the cerebellopontine angle, was operated on via a retrosigmoid suboccipital craniectomy; Type C (five cases), which were dumbbell-shaped extending into both the middle and posterior fossa, were removed via a combined temporal craniotomy—presigmoidal method; and in Type D (one case), in which tumor was primarily extracranial with intracranial extension, an infratemporal extradural approach was undertaken. There was no operative mortality or long-term disability in this series. The follow-up period ranged from 12 to 60 months; during that time magnetic resonance imaging revealed tumor recurrence in two cases after 12 and 48 months, respectively, and these were excised again. An additional 178 cases collected from the world literature are also reviewed and analyzed.
Unilateral posterolateral decompression without stabilization for neurological palliation of symptomatic spinal metastasis in debilitated patients
Authors: Weller Simcha J. , Rossitch Eugene
Published: June 2009

✓ Patients with symptomatic spinal metastases and limited life expectancy are often too debilitated to withstand anterior or posterolateral spinal cord decompression and segmental stabilization. More limited surgery aiming solely at preservation or restoration of neurological function and relief from pain offers the potential for significant improvement in the quality of remaining life without incurring undue perioperative morbidity and mortality.

Eight patients with spinal metastases and limited life expectancy underwent a unilateral transpedicular decompression procedure on their most symptomatic side and/or the side of maximum tumor involvement. All patients were neurologically improved within the 1st postoperative week; all were ambulatory and continent postoperatively. Postoperatively, all five patients with preoperative motor deficits demonstrated increased motor strength, and the three patients with predominant radicular pain reported marked improvement. There were no perioperative deaths and two transient perioperative complications. The average length of hospitalization was 6 days for patients without complications and 10 days for the entire group.

Unilateral transpedicular decompression without stabilization is an effective and safe method for palliating symptomatic spinal metastases in debilitated patients with widespread malignancy and limited life expectancy. This therapeutic option should be considered in select cases as an alternative to either nonoperative management or anterior or posterolateral decompression and segmental stabilization.
Effects of coregistration of MR to CT images on MR stereotactic accuracy
Authors: Cohen Douglas S. , Lustgarten Jonathan H. , Miller Erik , Khandji Alexander G. , Goodman Robert R.
Published: June 2009

✓ Coregistration of different modality imaging serves to increase the ease and accuracy of stereotactic procedures. In many cases, magnetic resonance (MR) stereotaxis is supplanting computerized tomography (CT). The advantages of increased anatomical detail and multiplanar imaging afforded by MR, however, are offset by its potential inaccuracy as well as the more cumbersome and less available nature of its hardware. A system has been developed by one of the authors by which MR imaging can be performed separately without a stereotactic fiducial headring. Then, immediately prior to surgery, a stereotactic CT scan is obtained and software is used to coregister CT and MR images anatomically by matching cranial landmarks in the two scans. The authors examined this system in six patients as well as with the use of a lucite phantom. After initially coregistering CT and MR images, six separate anatomical (for the patients) and eight artificial (for the phantom) targets were compared. With coregistration, in comparison to CT fiducial scans, errors in each axis are less than or equal to 1 mm using the Cosman-Roberts-Wells system. In fact, the coregistered images are more accurate than MR fiducial images, in the anteroposterior (p = 0.001), lateral (p < 0.05), and vertical (p < 0.03) planes. Three-dimensional error was significantly less in the coregistered scans than the MR fiducial images (p < 0.005). The coregistration procedure therefore not only increases the ease of MR stereotaxis but also increases its accuracy.
Patterns of peptide-containing perivascular nerves in the circle of Willis: their absence in intracranial arteriovenous malformations
Authors: Maynard Kenneth I. , Ogilvy Christopher S.
Published: June 2009

✓ Using standard immunohistochemical techniques and an improved procedure for whole-mount vascular preparations, the authors describe the pattern and density of innervation of calcitonin gene—related peptide (CGRP)-like, neuropeptide Y (NPY)-like and vasoactive intestinal polypeptide (VIP)-like immunoreactivity in major arteries of postmortem adult human circles of Willis. Calcitonin gene—related peptide-, NPY-, and VIP-LI exhibited a variety of varicose and nonvaricose single axons, and small and large perivascular nerve bundles. Although the density of innervation within each vascular segment was highly variable, the pattern of innervation for each neuropeptide observed was consistent throughout the circle of Willis. With the use of human and rat circles of Willis as positive control preparations, the lack of CGRP-LI, NPY-LI, and VIP-LI in vessel segments taken from five cases of intracranial arteriovenous malformations (AVMs) is also reported. It is concluded that adult human circles of Willis exhibit CGRP-LI, NPY-LI, and VIP-LI perivascular nerves. In addition, intracranial AVMs do not possess these peptide-containing nerves that, in animals, normally mediate neurogenic control in the cerebrovasculature. It is hypothesized that this lack of innervation, and hence neurotrophic influence, may contribute to the development of AVMs.
Protein kinase C and diacylglycerol content in basilar arteries during experimental cerebral vasospasm in the dog
Authors: Yokota Masayuki , Peterson John W. , Kaoutzanis Marios C. , Yamakawa Kenta , Sibilia Robert , Zervas Nicholas T.
Published: June 2009

✓ Sixteen dogs were entered into a study of the double subarachnoid hemorrhage (SAH) model of cerebral vasospasm. Six animals were sacrificed 72 hours after the first experimental SAH, and the remaining 10 animals were killed 72 hours after the second experimental SAH; ten additional animals served as controls. Basilar arteries were rapidly excised from the dogs and frozen. Multiple segments of the frozen arteries were analyzed independently for total protein and 1,2-diacylglycerol (DAG) content, which averaged 3.17 (± 0.27 standard error of the mean; SEM) pmol DAG/µg protein for all 25 arteries analyzed. A slight decreasing trend in DAG content relative to that of control vessels was found in vessels chronically constrictedin situby subarachnoid blood clot; however, this trend did not attain statistical significance. Two segments of the same vessels were assayed independently for protein kinase C (PKC) activity, which averaged 1.21 (± 0.08 SEM) pmol phosphate incorporation per minute per µg protein for all 24 arteries analyzed. A small decrease in PKC content was noted in vessels that experienced a single SAH; however, PKC returned to near control value in vessels subjected to double SAH. The ratio of particulate (membrane bound) to soluble PKC activity, an indicator of PKC translocation to the membrane and hence PKC activation, showed a small but statistically significant trend to increase with experimental SAH.
Expression of monocyte chemoattractant protein-1 in meningioma
Authors: Sato Kyoichi , Kuratsu Jun-Ichi , Takeshima Hideo , Yoshimura Teizo , Ushio Yukitaka
Published: June 2009

✓ Monocyte chemoattractant protein-1 (MCP-1), purified from glioma cell line (U-105MG) culture fluid, attracts monocytes but not neutrophils. Macrophage accumulation is one of the pathological features of meningioma. To investigate the mechanism of macrophage infiltration into meningioma, the expression and localization of MCP-1 in 16 cases of meningioma were studied using Northern blot analysis and immunohistochemistry. Seven of 16 meningiomas expressed MCP-1 messenger ribonucleic acid and protein, and some degree of macrophage infiltration was seen in all 16 meningiomas.

There was a relationship between MCP-1 expression and the degree of macrophage infiltration; MCP-1 was strongly expressed in meningiomas with a high degree of macrophage infiltration. Sometimes the meningioma was accompanied by perifocal edema; a correlation between macrophage infiltration into brain tumors and perifocal edema has already been reported. It was found that the degree of MCP-1 expression is not correlated with the extent of perifocal edema.

The authors' findings suggest that MCP-1 plays an important role in macrophage infiltration into meningioma.
Endocrine and metabolic characteristics of polyoma large T transgenic mice that develop ACTH-producing pituitary tumors
Authors: Helseth Are , Haug Egil , Nesland Jahn M. , Siegal Gene P. , Fodstad Øystein , Bautch Victoria L.
Published: June 2009

✓ The authors have analyzed several endocrine and metabolic parameters in polyoma large T transgenic mice (PyLT-1) that develop adrenocorticotropic hormone (ACTH)-immunoreactive pituitary tumors and in nontransgenic mice with tumor transplants. All clinically ill PyLT-1 mice (13 to 16 months of age) had pituitary macroadenomas and elevated plasma ACTH levels. Compared to PyLT-1 transgenic mice, the ACTH plasma concentrations in immunocom-petent mice with transplant tumors were markedly raised. In these animals, a secondary effect of hypercorticotropism was documented by a moderate hyperglycemia. Furthermore, mice with transplant tumors had a pathological weight increase from the time the tumor was palpable. The present study supports and extends the authors' previous morphological documentation of the similarity between the ACTH-producing tumors in this mouse model and human Cushing's disease.
Tentorial meningioma and painful tic convulsif
Authors: Ogasawara Hidenori , Oki Shuichi , Kohno Hiroaki , Hibino Seiichiro , Ito Yoko
Published: June 2009

✓ A case is presented of painful tic convulsif caused by a posterior fossa meningioma, with right trigeminal neuralgia and ipsilateral hemifacial spasm. Magnetic resonance images showed an ectatic right vertebral artery as a signal-void area in the right cerebellopontine angle. At operation the tentorial meningioma, which did not compress either the fifth or the seventh cranial nerves directly, was totally removed via a suboccipital craniectomy. The patient had complete postoperative relief from the trigeminal neuralgia and her hemifacial spasm improved markedly with decreased frequency. From a pathophysiological standpoint, the painful tic convulsif in this case was probably produced by the tumor compressing and displacing the brainstem directly, with secondary neurovascular compression of the fifth and seventh nerves (the so-called “remote effect”).
Use of a new aneurysm clip with an inverted-spring mechanism to facilitate visual control during clip application
Authors: Perneczky Axel , Fries Georg
Published: June 2009

✓ When operating on deep-seated cerebral aneurysms, the surgeon's visual control of clip application may be impaired by the clip holder unless adjacent structures are retracted. To improve visual control and reduce the necessity for retraction, the senior author (A.P.) developed a new concept: an aneurysm clip with an inverted-spring mechanism. The clip has two jaws that point away from the clip blades. The jaws of the clip holder articulate with the inner side of the clip jaws. By distending the jaws of the clip holder the blades of the clip are opened and vice versa. Thus the visual field increases while the clip application is proceeding. This instrumentation is useful, especially in cases of deep-seated aneurysms arising from the posterior circulation and in multiple aneurysms. In these latter cases even lesions located contralaterally could be reached with good visual control.
Early history of neurosurgery in Manitoba: threads in the tapestry of world neurosurgery
Authors: Parkinson Dwight
Published: June 2009

✓ The author describes the history of neurosurgery in Manitoba, with particular emphasis on events that occurred after his arrival there in 1950. Highlights of global neurosurgery are spliced into the author's reminiscences to anchor the local history with that of neurosurgery as a whole.
Neurinomas of the first two cervical nerve roots: a series of 42 cases
Authors: George Bernard , Lot Guillaume
Published: June 2009

✓ A group of 42 patients with C-1 and C-2 neurinomas treated during the 10-year period 1982 to 1992 has been collected, including 25 cases from 20 French neurosurgical departments and 17 personal cases from the Neurosurgical Department of the Lariboisière University Hospital, Paris. Analysis of this series reveals some interesting findings relating to multiplicity of tumors, extradural extension, and neurofibromatosis.

There were seven patients with multiple lesions (bilateral C-2 neurinomas in six cases and two neurinomas at C-2 and one at C-1 in one case). In the 35 other cases, 16 lesions were entirely extradural and 19 had an hourglass configuration. Thirteen patients presented signs of neurofibromatosis. One lesion had a melanotic form and another was a radiation-induced schwannoma.

Surgical results were excellent in most cases with no immediate postoperative death. Best results in terms of complete removal and neurological condition were achieved with posterolateral or anterolateral surgical approaches (17 cases) as compared with the standard midline posterior route (25 cases).
Supratentorial—infraoccipital approach for posteromedial temporal lobe lesions
Authors: Smith Kris A. , Spetzler Robert F.
Published: June 2009

✓ The use of the supratentorial—infraoccipital approach is reported in seven patients with posteromedial temporal lobe lesions. No patient had permanent morbidity. Gross total resection of three low-grade gliomas and two gangliogliomas was achieved in five patients; one patient had subtotal resection of a low-grade glioma with adjacent gliosis, and one was initially thought to have a glioma but proved to have encephalomalacia on final pathological analysis. The patients ranged in age from 5 to 34 years. All seven patients presented with seizures, and four had uncontrolled seizures preoperatively. Six have been seizure-free since surgery (mean follow-up period 15 months), and one is well controlled on anticonvulsant medication. An anatomical study was performed to delineate the microsurgical anatomy relevant to operating on the medial temporal lobe through this posterior approach. A viewing wand intraoperative navigational system was utilized with this approach and proved helpful in gaining access as far anterior as the uncus through this occipital craniotomy. This approach is favorable in selected patients with posterior, medial, temporal lobe tumors because resection of otherwise difficult lesions may be accomplished without sacrificing lateral temporal lobe cortex or transecting the optic radiations.
One-year outcome following craniotomy for traumatic hematoma in patients with fixed dilated pupils
Authors: Sakas Damianos E. , Bullock M. Ross , Teasdale Graham M.
Published: June 2009

✓ Forty consecutive patients who underwent craniotomy for traumatic hematoma after developing bilateral fixed dilated pupils were studied to determine the factors influencing quality of survival and to seek criteria for management. Clinical and computerized tomography (CT) data were correlated with outcome 1 year after craniotomy. The functional recovery (good outcome or moderate disability) rate was 25%, with a mortality rate of 43%. Patients with subdural hematoma had a higher mortality rate (64%) compared to patients with extradural hematoma (18%) (chi-square test, p > 0.05). Other factors associated with markedly increased morbidity and mortality were increasing age (> 20 years), a prolonged interval (> 3 hours) between loss of pupillary reactivity and craniotomy, compression of basal cisterns, and presence of subarachnoid hemorrhage on CT. There were no survivors among patients exhibiting any of the following features: surgery 6 hours or more after bilateral loss of pupillary reactivity; age greater than 65 years; or absent motor response. Apart from the latter group, the nature of motor response (before pharmacological paralysis and intubation) was not a reliable predictor of mortality. The results suggest that the presence of an acute subdural hematoma is the single most important predictor of negative outcome in patients with bilateral unresponsive pupils.
Computerized tomography—guided stereotactic surgery for brainstem masses: a risk—benefit analysis in 71 patients
Authors: Rajshekhar Vedantam , Chandy Mathew J.
Published: June 2009

✓ The benefits of the use of computerized tomography (CT)-guided stereotactic surgical techniques for the management of intrinsic brainstem masses diagnosed from clinical evaluation and imaging studies were evaluated vis-à-vis the risks involved in 71 consecutive patients. Seventy-two procedures were performed. The masses were diffuse, involving two or three contiguous brainstem segments, in 60 patients and focal in 11 patients. On the CT scans, 25 patients had hypodense nonenhancing masses, two had isodense nonenhancing masses, 19 had ring-enhancing masses, and 25 had heterogeneously enhancing masses. A positive biopsy was obtained in 68 of 69 patients (98.5%) undergoing a biopsy procedure. In nine patients (12.6%) with suspected malignant masses a benign pathology was diagnosed (four tuberculomas, two epidermoid cysts, one pyogenic abscess, one epidermal cyst, and one case of encephalitis). Additionally, fluid from cystic masses could be aspirated in eight cases, providing benefit in six (four patients had benign lesions and two had neoplastic lesions). Thereby, a total of 13 patients (18.3%) were deemed to have benefited from the surgery (two patients were included in both categories). Patients with focal masses and ring-enhancing masses had the highest proportion of benign lesions (60% and 36.8%, respectively) and therefore derived the most benefit from histological verification. There was no procedurerelated mortality. One patient (1.4%) suffered permanent morbidity and four others (5.6%) had transient worsening attributable to the procedure. The authors conclude that CT-guided stereotactic surgery of the brainstem is safe and reliable. Histological verification of all enhancing (especially ring-enhancing) and focal brainstem masses should be undertaken to identify patients with benign nonneoplastic lesions. Selected patients with diffuse hypodense nonenhancing masses with atypical clinical or imaging features may also benefit from stereotactic biopsy. Even in these patients the lack of enhancement on a contrast-enhanced magnetic resonance image, rather than the diffuse location of the tumor alone, should form the basis for diagnosing a malignant glioma. The main value of stereotactic surgery lies in the identification of benign masses in a significant proportion of patients with intrinsic brainstem masses and in providing a rapid and safe method for evacuation of the contents of cystic masses.
Presurgical localization of functional cortex using magnetic source imaging
Authors: Gallen Christopher C. , Schwartz Barry J. , Bucholz Richard D. , Malik Ghaus , Barkley Gregory L. , Smith Joseph , Tung Howard , Copeland Brian , Bruno Leonard , Assam Sam , Hirschkoff Eugene , Bloom Floyd
Published: June 2009

✓ The boundaries of somatosensory cortex were localized noninvasively by means of a large-array biomagnetometer in six patients with mass lesions in or near eloquent cortex. The results were used by neurosurgeons and neurologists in preoperative planning and for reference in the operating room. The magnetic source imaging (MSI) localizations from somatosensory evoked potentials were used to predict the pattern of phase reversals measurable intraoperatively on the cortical surface, providing a quantitative comparison between the two measures. The magnetic localizations were found to be predictive in all six cases, with the two sets of localizations falling within an 8-mm distance on average. Somatosensory localizations using MSI offer accuracy in localizing somatosensory cortex stereotactically and in depicting its relationship to lesions. Such data are valuable preoperatively in assessing the risks associated with a proposed surgical procedure and for optimizing subsequent minimum-risk surgical strategy.
Clinicopathological investigation of gyral high density on computerized tomography following severe head injury in children
Authors: Onuma Takehide , Shimosegawa Yasuko , Kameyama Motonobu , Arai Hiroaki , Ishii Kiyoshi
Published: June 2009

✓ The authors have treated five cases of severe head trauma in children in which abnormally high density along gyri, “gyral high density,” was seen on plain computerized tomography (CT) scans in the subacute stage of the injury. The prognosis in all cases was poor, with either severe disability or a vegetative state as the outcome due to significant brain atrophy following gyral high density. This pathology was classified into three clinical stages: 1) acute stage, cerebral ischemia in which there is diffuse low density of the cerebrum on CT scans (most marked on the 3rd and 4th days); 2) subacute stage, hemorrhagic infarction showing gyral high density on plain CT scans (between 1 and 4 weeks); and 3) chronic stage, brain atrophy (beginning 4 weeks after the trauma).

In their consecutive series of head-injured patients (516 children, 1459 adults), the authors did not find gyral high density on CT scan in adults. This is probably due to the fact that adults who suffer the severe head trauma associated with diffuse brain swelling or diffuse brain edema cannot survive, thus making this gyral high density unique to children.
Knotted bowel: small-bowel obstruction from coiled peritoneal shunt catheters
Authors: Sanan Abhay , Haines Stephen J. , Nyberg Scott L. , Leonard Arnold S.
Published: June 2009

✓ Knotting of a peritoneal catheter around a loop of bowel is a rare occurrence, which may lead to bowel obstruction. The incomplete removal of two ventriculoperitoneal shunts resulted in two cases of iatrogenically knotted peritoneal catheters. One patient underwent a laparotomy for relief of obstruction and the other was successfully treated by uncoiling the catheter by means of a wire passed into its lumen. A plan for management of a knotted peritoneal catheter is outlined.
Schistosoma mansoni infection involving the spinal cord
Authors: Ueki Keisuke , Parisi Joseph E. , Onofrio Burton M.
Published: June 2009

✓ The authors report a case of transverse myelitis caused by Schistosoma mansoni. Although this is a treatable disease if diagnosed in the early stage, it is very rarely seen in developed countries and can result in complications if diagnosis is delayed.
Cyclosporine A toxicity presenting with acute cerebellar edema and brainstem compression
Authors: Nussbaum E. Spencer , Maxwell Robert E. , Bitterman Peter B. , Hertz Marshall I. , Bula Wolodemeir , Latchaw Richard E.
Published: June 2009

✓ A 38-year-old man receiving cyclosporine A after bilateral lung transplantation for cystic fibrosis presented with cortical blindness, generalized seizures, and cerebellar edema. Progressive brainstem compression necessitated emergency posterior fossa decompression. Replacement of cyclosporine A with an alternative immunosuppressive agent, FK506, was followed by rapid neurological recovery and dramatic resolution of radiographic abnormalities. The etiology, clinical features, and radiographic findings of cyclosporine A neurotoxicity are discussed. The pertinent literature is reviewed.
Lessons from a case of kleeblattschädel
Authors: Thompson Dominic N. P. , Hayward Richard D. , Harkness William J. , Bingham Robert M. , Jones Barry M.
Published: June 2009

✓ The authors describe the clinical, radiological, and postmortem findings of a case of cloverleaf skull syndrome. The presence of hindbrain herniation, abnormal cervical segmentation, and atlantoaxial subluxation illustrate the anatomical complexity of the skull base and the craniocervical junction that may coexist in this condition. Unavoidable division of occipital emissary veins during elevation of the skin flap at the time of vault remodeling surgery led to an acute and, ultimately, fatal rise in intracranial pressure. Postmortem examination and review of magnetic resonance imaging revealed an anomalous pattern of venous drainage of the intracranial structures that appeared to have developed in response to venous obstruction, secondary to intraosseous venous sinuses and stenosis of the jugular foramina.

The relationship between venous hypertension, hindbrain herniation, and hydrocephalus in this situation is reviewed, and the implications for evaluation and management of this vexing disorder are discussed.
A noninvasive thermoplastic head immobilization system
Authors: Pilipuf Marc N. , Goble John C. , Kassell Neal F.
Published: June 2009

✓ The authors have developed a noninvasive head immobilization system for use in neuroimaging (magnetic resonance imaging, computerized tomography, single photon emission computerized tomography, and projection angiography), neurosurgical planning, and neurosurgery. These diagnostic and surgical procedures require patient immobilization, reproducible patient positioning, and anatomical localization. The thermoplastic system described in this technical note addresses each of these requirements with a high degree of accuracy and with no bone fixation. The reproducibility of positioning and effectiveness of immobilization were evaluated using nine healthy volunteers during repeated sessions of magnetic resonance imaging. The mean axial displacement for repeated positioning was 0.6 mm (variance 0.1 mm); the mean displacement during robust patient motion in the axial direction was 1.8 mm (variance 0.9 mm).
Celebrating the centennial (1894–1994): Leonardo Gigli and his wire saw
Authors: Brunori Andrea , Bruni Patrizio , Greco Romano , Giuffré Renato , Chiappetta Francesco
Published: June 2009

✓ In spite of the recent introduction of craniotomes in neurosurgical practice, the simple but brilliant wire saw invented by Leonardo Gigli still holds an important place in neurosurgical instrumentation. Born in Florence in 1863, Gigli was forced by circumstances to leave Italy soon after getting his medical degree. He first spent 2 years attending the most celebrated obstetrical clinics in Paris and London and then, in 1892, moved to Breslau where he worked with Fritsch and Mikulicz. During this successful and rewarding period, Gigli proposed the lateralized pubiotomy (Gigli's operation) for safe delivery in cases of maternal pelvic deformities and, inspired by the sight of a jagged knife during a country banquet, conceived his wire saw to simplify the procedure. In 1894, at Professor Obalinski's suggestion, he successfully tested a modified saw type with a whalebone guide for the preparation of osteoplastic cranial flaps. In spite of his great popularity and the high esteem in which he was held abroad, Gigli's aims were systematically belittled in Italy, where he never qualified for a university teaching position. He died in 1908, at age 44.

Although the once celebrated Gigli's operation has merely historical interest today, the favorable features of his wire saw make it a safe and efficient tool in the hands of twentieth-century neurosurgeons worldwide.
Evidence for segregated pain and temperature conduction within the spinothalamic tract
Authors: Friehs Gerhard M. , Schröttner Oskar , Pendl Gerhard
Published: June 2009

✓ The lateral spinothalamic tract, located in the anterolateral quadrant of the white matter of the spinal cord, is one of the most important structures in transmitting pain within the central nervous system. It has been known for almost a century that destruction of fibers in this tract results in analgesia contralateral to the lesion. The effectiveness and clinical importance of interruption of the lateral spinothalamic tract has been proven in many studies. Today cordotomies are still a useful neurosurgical treatment modality, especially when pain can no longer be sufficiently controlled by analgesic drugs. Although analgesia on the contralateral side is the desired effect, one must also expect to cause disturbance in temperature sensation when performing a cordotomy.

The authors' observations showed that after a cordotomy the dermatome level of analgesia can be variable within certain limits, which is in accordance with the literature. Surprisingly, however, the loss of temperature sensation may differ significantly from the loss of pain sensation. It was also found to be possible to perform a successful cordotomy without altering the sensation of temperature at all. This indicates that pain and temperature sensations may be conducted via separate pathways. Possible mechanisms underlying this phenomenon are discussed.
Measurement of exercise tolerance on the treadmill in patients with symptomatic lumbar spinal stenosis: a useful indicator of functional status and surgical outcome
Authors: Deen H. Gordon , Zimmerman Richard S. , Lyons Mark K. , McPhee Malcolm C. , Verheijde Joseph L. , Lemens Susan M.
Published: June 2009

✓ A prospective study of patients with neurogenic claudication and lumbar spinal stenosis was undertaken to determine whether measurement of exercise tolerance on the treadmill would be useful in defining baseline functional status and response to surgical treatment. Twenty patients with an average age of 73 years, all of whom had intractable neurogenic claudication and radiographically confirmed severe lumbar spinal stenosis, were studied. Lumbar decompressive laminectomy was performed in all patients. Preoperatively and 2 months postoperatively, quantitative assessment of ambulation was conducted on a treadmill at 0° ramp incline at two different speeds: 1.2 mph and the patient's preferred walking speed. The following information was recorded: time to first symptoms, time to severe symptoms, and nature of symptoms (leg pain, back pain, or generalized fatigue). The examination was stopped after 15 minutes or at the onset of severe symptoms.

In the preoperative 1.2-mph trial, the mean time to first symptoms was 2.68 minutes (median 1.31) and the mean time to severe symptoms was 5.47 minutes (median 3.42). In the postoperative trial at the same speed, 13 patients (65%) were able to walk symptom free for 15 minutes. The mean time to first symptoms was 11.12 minutes (median 15) and the mean time to severe symptoms was 11.81 minutes (median 15). Similar findings were recorded in the preferred walking—speed trials. There were no complications from the treadmill testing procedure. These findings indicate that exercise stress testing on a treadmill is a safe, easily administered, and quantifiable means of assessing baseline functional status and outcome following laminectomy in patients with symptomatic lumbar spinal stenosis.
A clinical and neuroradiological study of X-linked hydrocephalus in Japan
Authors: Yamasaki Mami , Arita Norio , Hiraga Shoju , Izumoto Shuichi , Morimoto Kazuyoshi , Nakatani Susumu , Fujitani Ken , Sato Noriko , Hayakawa Toru
Published: June 2009

✓ To clarify the clinicopathological features of X-linked hydrocephalus, the authors studied 30 affected males from 15 families.In uteroultrasonography, performed at 21 to 40 weeks of gestation, revealed 18 fetuses with hydrocephalus. Computerized tomography (CT) revealed bilateral enlargement of the lateral ventricle with preponderant dilation of the posterior horn. In five patients with complete magnetic resonance (MR) imaging data, the most specific finding was localized atrophy of the anterior vermian lobe. Other MR imaging findings included a large massa intermedia, flat corpora quadrigemina, a small brainstem, and diffuse hypoplasia of the cerebral white matter. In all cases, the corpus callosum was hypoplastic or aplastic. The aqueduct was patent in four of five cases. Asymmetrical reduction of the ventricular size and a rippled ventricular wall were characteristic postshunt CT findings. Progressive macrocephaly and symptoms due to increased intracranial pressure were ameliorated by the shunt; however, the neurological outcome was not improved by shunting. Of 14 patients who lived to be between 2 and 18 years of age, all are retarded. These results indicate that X-linked hydrocephalus is not a disease of simple ventriculomegaly due to aqueduct stenosis alone but involves other complicated central nervous system anomalies.
Natural history of intracranial cavernous malformations
Authors: Aiba Toyotaka , Tanaka Ryuichi , Koike Tetsuo , Kameyama Shigeki , Takeda Norio , Komata Tadashi
Published: June 2009

✓ The authors have reviewed the clinical records of 110 patients with intracranial cavernous malformations diagnosed by histological examination and/or magnetic resonance imaging over a mean follow-up period of 4.71 years. These cases were divided, based on their presentation, into a hemorrhage group, a seizure group, and an incidentally diagnosed group. The rate of subsequent symptomatic bleeding was investigated in relation to age at onset, sex, and location of the initial lesion. A high rate of subsequent symptomatic bleeding episodes was found in the hemorrhage group, especially among younger females. The nonhemorrhagic-onset cases had a very low incidence of bleeding. The outcome was generally good, except in patients with lesions in the basal ganglia and brainstem. These findings will be helpful in planning a rational therapeutic strategy for intracranial cavernous malformations.
The anatomy of epileptic auras: focal pathology and surgical outcome
Authors: Fried Itzhak , Spencer Dennis D. , Spencer Susan S.
Published: June 2009

✓ An aura is generally understood to be the beginning of a seizure. Yet, following successful surgery for intractable epilepsy, patients may have persistent auras even though they are otherwise seizure free. Ninety patients with intractable seizures and auras underwent resective surgery. Forty-three patients had hippocampal sclerosis and 47 had temporal or extratemporal lesions such as glial tumors or vascular malformations. The semiology of the auras was found to have value in localization but not lateralization of the pathology. Epigastric auras as well as gustatory and olfactory auras were significantly more frequent in patients with hippocampal sclerosis than in those with temporal or extratemporal lesions. Auras of vertigo or dizziness were most frequent in patients with extratemporal pathology.

There was a significant difference between the pathology groups in the efficacy of resection in eliminating the auras. Of the patients with hippocampal sclerosis who were rendered seizure free, 18.9% had persistent auras, whereas only one (2.6%) of the patients with temporal or extratemporal lesions who were rendered seizure free had persistent auras. These findings suggest that for patients with hippocampal sclerosis an anatomical dissociation between seizure and aura may occur, whereas this dissociation is not present in patients with lesions. Patients suspected of having hippocampal sclerosis should be counseled preoperatively as to the significant likelihood of persistent auras even if seizures are successfully abolished.
Electrical stimulation of the trigeminal nerve root for the treatment of chronic facial pain
Authors: Young Ronald F.
Published: June 2009

✓ Between March 1990 and December 1992, 23 patients with chronic intractable facial pain due to various forms of injury to the trigeminal nerve or nerve root underwent implantation of an electrical stimulating system to treat their pain. All patients had failed previous extensive pain treatment efforts. A monopolar platinum-iridium electrode was implanted on the trigeminal nerve root via percutaneous puncture of the foramen ovale. All patients experienced at least 50% reduction in pain intensity during a period of trial stimulation and underwent internalization of the electrode and connection to a completely implanted pulse generator. Independent assessment of the effect of stimulation was obtained by a specially trained nurse practitioner.

Over a mean follow-up period of 24 months, six patients reported nearly complete relief of pain and six others reported at least a 50% reduction in pain intensity using a visual analog scale. Thus, 12 (52%) of the 23 patients achieved 50% or greater reduction in pain intensity. Although changes in the patterns of analgesic medication usage were few, six patients (26%) now experience a normal life style. Only one complication was seen, namely a dislocated electrode, which was easily replaced. Chronic electrical stimulation of the trigeminal nerve root appears to be an easy and safe technique for providing relief of chronic facial pain related to injury to the trigeminal nerve in a significant number of patients.
Performance of sulfhydryl boron hydride in patients with grade III and IV astrocytoma: a basis for boron neutron capture therapy
Authors: Ceberg Crister P. , Persson Anders , Brun Arne , Huiskamp René , Fyhr Ann-Sofie , Persson Bertil R. R. , Salford Leif G.
Published: June 2009

✓ This study investigated the rationale of boron neutron capture therapy (BNCT) for the treatment of Grade III and IV astrocytoma. The European Community joint research program on BNCT plans to use sulfhydryl boron hydride (BSH) in clinical trials.

The work presented here, examines the performance of BSH in eight patients with Grade III and IV astrocytoma using a measurement technique which precisely correlates the boron uptake with the histology of the tumor and the peritumoral brain. Astrocytomas are exceptionally heterogeneous and spread migrating tumor cells into the surrounding brain. The patients were infused with 50 mg BSH per kilogram of body weight at 12, 18, 24 or 48 hours before surgery. At the time of operation, specimens were obtained of the tumor, skin, muscle, dura, blood, urine, and, when surgically possible, the brain adjacent to tumor. In three patients the intracellular boron distribution was investigated by subcellular fractionation. The blood clearance was biphasic with half-lives of 0.6 and 8.2 hours. After 3 days, approximately 70% of the dose injected was excreted in the urine. The maximum boron concentration in the tumor was 20 ppm, 12 hours after the infusion. The tumor-to-blood ratios ranged between 0.2 and 1.4, with the highest values after 18 to 24 hours. In the brain specimens the boron concentration never exceeded 1 ppm. This work confirms a selective uptake of boron in the tumor compared to the surrounding brain and that boron, to some extent, is incorporated in the tumor cells.