bluuebunny/crossref_metadata_2025 huggingface dataset:
Intracranial Pressure Changes in Brain-injured Patients Requiring Positive End-Expiratory Pressure Ventilation
Authors: Burchiel Kim J. , Steege Timothy D. , Wyler Allen R.
Published: May 2010

In 16 patients with severe head injury and 2 patients with subarachnoid hemorrhage, positive end-expiratory pressure (PEEP) ventilation was required to maintain adequate oxygenation. The effects of PEEP on intracranial pressure (ICP) were evaluated with respect to the volume-pressure response (VPR), an indicator of intracranial compliance, and the static lung compliance (CL). Based on these parameters: (a) All 11 patients with a normal VPR (<2 torr) had no significant change in ICP with PEEP therapy. (b) All 5 patients with an abnormal VPR and a normal CL (>30 ml/cm H2O) had significantly increased ICP or decreased cerebral perfusion pressure while on PEEP. (c) Two patients with both an abnormal VPR and a decreased CL had no significant change in their ICP with PEEP. (d) Significant elevations of ICP were also seen in 4 patients with abnormal VPRs concurrent with the rapid reduction or withdrawal of PEEP ventilation. Thus, the VPR is an accurate predictor of the effects of PEEP on the ICP. In addition, however, decreased lung compliance may buffer these effects in patients who have decreased intracranial compliance. We propose that ICP monitoring and intracranial compliance determination are necessary in the management of brain-injured patients requiring PEEP ventilation.
Spatial Distribution of Edema in the Cat Spinal Cord after Impact Injury
Authors: Martinez Lucas J. , Alderman John L. , Kagan Richard S. , Osterholm Jewell L.
Published: May 2010

A specific gravity, column gradient method was coupled with a tissue punch technique to measure regional edema in the traumatized spinal cord of the cat at 1 and 2 hours after a 500-g/cm impact injury. A significant increase in water content was observed at the injury site in the posterior, anterior, and lateral white columns by 1 hour after injury and extended 2 mm above and below the site by 2 hours after injury.
Temporary Microvascular Occluder
Authors: Rozario Rodney A. , Dujovny Manuel , Wackenhut Norman , Worly Paul , Semba Akio
Published: May 2010

A soft polyethylene vascular occluder for temporary vascular occlusion is described. Its mechanical efficiency and atraumatic effect on microvessels is assessed.
Vertebrobasilar Insufficiency from Carotid Disease Associated with a Trigeminal Artery
Authors: Palmer Sylvain , Gücer Gündüz
Published: May 2010

A case of vertebrobasilar insufficiency with bilateral homonymous hemianopsia and macular sparing is presented. A persistent trigeminal artery was the likely conduit for emboli to pass from an ulcerated carotid bifurcation to the vertebrobasilar circulation. The diagnostic and therapeutic implications in cerebrovascular disease are discussed.
Progressive Hydrocephalus as a Complication of Cervical Internal Carotid Artery Occlusion in a 4-Year-Old Child
Authors: Lister Richard J. , Vries John K.
Published: May 2010

A case of progressive hydrocephalus as a complication of spontaneous cervical internal carotid artery occlusion in a child is presented. This problem has not been reported previously. The diagnosis and management of this condition are greatly facilitated by computed tomographic scanning.
Intraperitoneal Pseudocyst Associated with Peritoneal Shunt
Authors: Latchaw John P. , Hahn Joseph F.
Published: May 2010

We report a case of an intraperitoneal pseudocyst as a complication of a ventriculoperitoneal shunt. The sequestration was visualized by abdominal computed tomographic scan and was heralded by an increase in hepatic enzyme levels. This complication may be related to previous abdominal surgery. A review of the literature relating to this unusual complication is presented.
Von Recklinghausen's Disease Complicated by a Brain Tumor Identified as Pinealoma
Authors: Suzuki Shigeharu , Moriyama Takashi , Suzuki Mikio , Iwabuchi Takashi
Published: May 2010

We report a case of von Recklinghausen's disease complicated by a pineal region tumor suspected, from the findings of various examinations and clinical observations, to be pinealoma. The patient is an 18-year-old boy with general café au lait spots, whose father also suffers from von Recklinghausen's neurofibromatosis.
Painless Footdrop Secondary to Lumbar Disc Herniation
Authors: Garrido Eddy , Rosenwasser Robert H.
Published: May 2010

This is a report of two patients who developed a painless footdrop due to compression of the L-5 nerve root from a herniated disc at the L-4, L-5 interspace. The diagnosis was suspected clinically, supported by myelography, and confirmed at operation. One patient has regained the strength of his foot during the follow-up period; the other has remained unchanged.
Extracranial-Intracranial Bypass in the Elderly
Authors: Levinthal Robert
Published: May 2010

The symptoms and signs of cerebrovascular insufficiency occur more frequently in the elderly population. It has often been assumed that individuals over 65 years of age are poor surgical candidates and that, therefore, prophylactic procedures should be withheld. The author reviews his experience with 25 elderly patients who had evidence of cerebrovascular insufficiency and lesions that were inaccessible to standard extracranial vascular surgical techniques. In this series, there were no deaths and there was only one neurological complication, which was a hypertensive hematoma that occurred during the immediate postoperative period. The only patient whose postoperative hospitalization was longer than 7 days was the individual who had the intracerebral hematoma. All patients with superficial temporal-middle cerebral artery anastomoses underwent angiography immediately after operation, and all of these bypass grafts were found to be patent. Extracranial-intracranial bypass grafting seems to be well-tolerated by elderly individuals, with minimal morbidity and mortality.
Management of Fractures of the Thoracolumbar and Lumbar Spine
Authors: Durward Quentin J. , Schweigel Joseph F. , Harrison Philip
Published: May 2010

Eleven cases of fracture or fracture/dislocation of the thoracolumbar or lumbar spine were studied to determine the effectiveness of three methods of management of the injuries. Ten of the patients had a neurological deficit as well as a spinal injury. All cases were studied by computed tomographic (CT) scanning of the injury site before and after treatment. CT scanning was found to be superior to linear tomography in determining the degree of canal compromise by bone at the injury site. Eight patients underwent operation, with the aims of achieving spinal stability in unstable injuries and of decompressing neural structures. These 8 patients had received Harrington distraction instrumentation (HDI) as an initial procedure. In those patients with fracture/dislocations from flexion-rotation injuries and canal compromise resulting from bony malalignment, reduction of the fracture/dislocation by HDI resulted in stabilization of the spine and increase of the open canal area at the injury site. However, in those patients with canal compromise resulting from bursting fractures with retropulsed bone fragments, HDI did not reduce the bone fragments. Removal of the anterior vertebral body and the bone fragments. however, did result in significant improvement of the canal dimensions. A poor correlation was found between the degree of canal compromise as measured by the CT scanner and the resulting neurological deficit. Reasons for this are presented. Six of the 10 neurologically compromised patients, including 2 patients with stable bursting injuries and retropulsed bone fragments treated conservatively, had improved one grade on Frankel's classification by 3 months after injury. The rate and degree of recovery were not related to the degree of canal decompression achieved at operation.
Balloon Tamponade of the Pharynx in Transnasosphenoidal Operations
Authors: de Figueiredo Djacir Gurgel , Leitão de Carvalho Francisco Flavio
Published: May 2010

The authors present a new technique for tamponade of the nasopharynx after the performance of a transnasosphenoidal approach to the hypophysis. This technique consists of placing a Foley balloon catheter in each nasal cavity, extending to the nasopharynx. The position of the balloons and the adequacy of the amount of radiopaque substance used to fill them is determined with x-ray films or a television image intensifier. Among the advantages of the method over tamponade with Vaseline-covered gauze are: (a) better tamponade; (b) the possibility of testing the position and volume of tamponade; (c) the absence of trauma to the nasopharyngeal mucosa upon removal of the catheters after deflation of the balloons; (d) the availability of two airways for respiration in addition to the mouth; and (e) the absence of blood gas alterations and infections.
Surgical Removal of a Hemangioma of the Pineal Region in a 4-Week-Old Infant
Authors: Sonntag Volker K. H. , Waggener John D. , Kaplan Allen M.
Published: May 2010

A 4-week-old infant was operated on successfully for a pineal tumor. The patient was placed in a sitting position and the supracerebellar infratentorial approach was used. The tumor was removed totally. Pathological examination showed that the tumor was a hemangioma.
Treatment of Bobble-Head Doll Syndrome by Transcallosal Cystectomy
Authors: Albright Leland
Published: May 2010

A 9-year-old boy with bobble-head doll syndrome, precocious puberty, and progressive memory loss is described. His evaluation included computed tomographic scanning with metrizamide and air ventriculography. A cyst within the 3rd ventricle was excised subtotally by a transcallosal approach. Postoperatively, his head bobbing lessened and his memory improved.
Complex Atlas Fracture with Posterior Dislocation of One Lateral Mass
Authors: Slasky Simon B. , Nelson Paul , Herbert D. L.
Published: May 2010

An unusual fracture/dislocation of the atlas that defies classification is reported. Posterior dislocation of the left occipital condyle resulted in loss of articulation with the superior articular surface of the atlas. It could be considered a unilateral atlanto-occipital dislocation or possibly a Jefferson fracture variant. The patient suffered only a mild, temporary neurological deficit and was treated conservatively.
Intracranial Developmental Cysts in Children
Authors: Stein Sherman C.
Published: May 2010

abstract

The author presents the results of primary cystoperitoneal shunting in 12 infants and children with developmental cysts in various intracranial locations. Preoperative studies were done in each child to rule out a brain tumor as the cause of the cyst and to determine whether communication existed between the cyst and the subarachnoid space. The ventricular system was also shunted in children with both noncommunicating cysts and hydrocephalus. Except for 2 children with shunt complications, shunting alone was successful in controlling symptoms and reducing the size of the cysts, and no other operation was needed during a mean follow-up period of 2.2 years. The reasons to recommend shunt insertion as the primary treatment for developmental cysts in children include safety, ease, and a high rate of success compared to attempted excision.
Labiomandibular, Transoral Approach to Chordomas in the Clivus and Upper Cervical Spine
Authors: Delgado Tomas E. , Garrido Eddy , Harwick Robert D.
Published: May 2010

abstract

Three patients with chordomas of the clivus and the upper cervical spine underwent the removal of their tumors through a transoral approach with labiomandibular splitting and microsurgical techniques. This surgical approach provided excellent visualization of the anterior craniocervical area and allowed a gross total removal in each case. Although the lesions in our patients were chordomas, this approach could also be used for other surgical lesions in this area.
Selective Resection and Denervation of Cervical Muscles in the Treatment of Spasmodic Torticollis
Authors: Xinkang Chen
Published: May 2010

abstract

The author presents a series of 60 patients with torticollis who were treated successfully by operation. He describes the clinical types of torticollis: rotational torticollis, retrocollis, antecollis, lateroflexional torticollis, and combined types. The muscular mechanism of torticollis is detailed, and the operative technique of resecting or denervating only the principal or motive muscles is explained and illustrated for each type of torticollis. The results in this series were very good: 83.3% recovered completely or were improved markedly, and there were no complications.
Development of Pseudotumor Cerebri after the Removal of an Adrenocorticotropic Hormone-secreting Pituitary Adenoma
Authors: Martin Neil A. , Linfoot John , Wilson Charles B.
Published: May 2010

abstract

A patient with Cushing's disease developed intracranial hypertension 1 month after the removal of an adrenocorticotropic hormone-secreting pituitary adenoma. A computed tomographic scan demonstrated normal ventricles and no intracranial mass, establishing the diagnosis of pseudotumor cerebri. The elevated intracranial pressure was apparently consequent to an abrupt reduction in circulating corticosteroids. The development of pseudotumor cerebri after the correction of endogenous hypercortisolism has not been reported previously. This potential complication of the surgical treatment of Cushing's disease can be managed with prompt recognition and appropriate treatment of the syndrome.
Giant Anterior Communicating Artery Aneurysm with Bitemporal Hemianopsia
Authors: Højer-Pedersen Else , Haase Jens
Published: May 2010

abstract

Giant aneurysm of the anterior communicating artery producing bitemporal hemianopsia is extremely rare. A case is presented and the literature is reviewed. The operative findings support the hypothesis that the visual defects are caused by mechanical pressure on the optic chiasm.
Chondromyxoma of the Middle Cranial Fossa
Authors: Richardson Robert R. , Deshpande Vilaya S. , Thelmo William L. , Rothballer Alan
Published: May 2010

abstract

A case of an extra-axial middle cranial fossa tumor, identified pathologically as a chondromyxoma, is presented. Whereas poorly differentiated sarcomatous neoplasms are reported infrequently in children, a cartilaginous mesenchymal tumor in an adult is a distinct rarity. The intracranial chondromyxoma is discussed in relationship to its probable origin, its unique pathological characteristics, and its clinical manifestations.
Symptomatic Spinal Epidural Lipomatosis Associated with Cushing's Syndrome
Authors: Chapman Paul H. , Martuza Robert L. , Poletti Charles E. , Karchmer Adolph W.
Published: May 2010

abstract

In cases of Cushing's syndrome, unusual amounts of fat may accumulate in the spinal epidural space, similar to centripetal fat deposits elsewhere in the body. The mass of excessive epidural fat may be responsible for neurological symptoms referable to compression of the spinal cord or cauda equina. We report three cases illustrating this unusual phenomenon and call attention to three cases reported previously, Although it is an unusual complication of Cushing's syndrome, epidural lipomatosis should be considered in the differential diagnosis of any such case with neurological symptoms referable to the spinal cord or cauda equina. The diagnosis may be confirmed by computed tomographic scanning in conjunction with myelography. Therapeutic considerations are discussed.
Laceration of the Aorta Complicating Spinal Fracture in Ankylosing Spondylitis
Authors: Fazl M. , Bilbao J. M. , Hudson A. R.
Published: May 2010

abstract

This case report concerns major vascular injury associated with fracture-dislocation of the spine after minor trauma in a patient suffering from ankylosing spondylitis. This injury resulted in laceration of the aorta with the formation of an aortic spinal subarachnoid fistula.
Effect of Prophylactic Methicillin on Cerebrospinal Fluid Shunt Infections in Children
Authors: Ajir F. , Levin A. B. , Duff T. A.
Published: May 2010

abstract

This study retrospectively and prospectively analyzes uncomplicated, noninfected, primary ventriculoperitoneal shunting procedures and ventriculoperitoneal shunt revisions in children done at the University of Wisconsin Hospital from July 1973 to December 1979. We compared the infection rates between patients whose procedures were done without prophylactic antibiotics and those who received prophylactic single dose methicillin at the time of operation. Among 105 procedures done without prophylactic methicillin, there were 8 infections: 4 occurred after 73 primary shunt placements and 4 followed 32 shunt revisions. Among 66 procedures done with prophylactic methicillin. there were 3 infections; all followed primary shunt insertions. There was no infection after 32 shunt revisions in which prophylactic antibiotics were used.
Spinal Cord Glucose Utilization after Experimental Spinal Cord Injury
Authors: Rawe Stephen E. , Lee William A. , Perot Phanor L.
Published: May 2010

abstract

Metabolic alterations after experimental contusion injury of the spinal cord were evaluated by determining qualitative spinal cord glucose utilization (SCGU), SCGU was determined by the 2-deoxy-D-[14C]glucose technique. An increase in SCGU occurred at the site of maximal impact in the white matter after an injury causing paraparesis and in near trauma regions after an injury causing either paraparesis or paraplegia. These findings are most likely due to anaerobic glycolysis resulting from a reduction in blood flow that still allows delivery of substrate to tissue. Although an initial increase was observed at the site of maximal impact after a paraplegia-causing injury. SCGU in the white matter demonstrated a progressive deterioration by 4 and 8 hours after injury. A failure of substrate delivery resulting from ischemia is the most likely cause for this reduction in SCGU. The somatosensory evoked potential was found to be a very sensitive indicator of the remaining functional axons at the injury site.
Superficial Temporal to Proximal Superior Cerebellar Artery Anastomosis for Basilar Artery Stenosis
Authors: Ausman James I. , Diaz Fernando G. , de los Reyes R. A. , Pak Hooshang , Patel Suresh , Boulos Roushdy
Published: May 2010

abstract

A newly modified revascularization procedure for vertebrobasilar insufficiency due to midbasilar stenosis is reported. The approach involves anastomosing the superficial temporal artery to a proximal segment of the superior cerebellar artery. The rationale for the procedure and the surgical technique are discussed.
Parasagittal Arachnoid Cyst
Authors: Rengachary Setti S.
Published: May 2010

abstract

The anatomical, clinical, radiological, and surgical aspects of a giant parasagittal arachnoid cyst are described.
Flow-regulated Continuous Spinal Drainage
Authors: Swanson Steven E. , Kocan Mary Jo , Chandler William F.
Published: May 2010

A new method for continuous external drainage of cerebrospinal fluid (CSF) for the treatment of CSF fistulas is described. In this system, CSF is withdrawn continuously from the lumbar subarachnoid space at a controlled flow rate calculated to be slightly less than the natural absorption rate of CSF. Controlled spinal drainage can be achieved using equipment readily available in most intensive care units. This system was developed to prevent pneumocephalus during CSF drainage, as illustrated in the case presentation.
Transcranial Enucleation for Optic Nerve Tumor
Authors: Sacks Joel G. , McLennan James E
Published: May 2010

Tumors involving both the eye and the optic nerve present a special surgical problem. Conventional enucleation techniques neither permit the surgical exploration of the optic nerve nor assure the complete removal of tumor within the orbit, and they often involve transection through tumor-containing tissue. Transcranial enucleation permits the inspection of the tumor from the back of the globe to the chiasm and its en bloc removal.
Flaccidity after Head Injury
Authors: Butterworth John F. , Selhorst John B. , Greenberg Richard P. , Miller Douglas , Gudeman Steven K.
Published: May 2010

Upon admission, 17 of 223 (8%) consecutive patients with severe head injury exhibited a flaccid, wholly unresponsive motor examination. In this study alcoholic intoxication neither caused depressed motor responsiveness in head-injured patients with high serum ethanol levels nor accounted for the motor examination in those exhibiting the flaccid state. Flaccidity was attributed principally to impaired ventilation in 4 patients, a major intracranial mass in 12. and a spinal cord injury in 1. Compared to the larger group of head-injured patients, the flaccid patients had a significantly greater incidence of hypercapnia (P < 0.001), acidosis (P < 0.01), and both elevated and uncontrollable intracranial pressure (ICP) (P< 0.001). These findings and the high mortality rate (76%) in this study suggest that the magnitude of respiratory complications and the severity of mechanical brain injury are greater in flaccid patients. The flaccid patients undergoing surgical decompression for major intracranial mass lesions (11 cases) have all died and. although still small in number, this group may represent an important subset with a poor prognosis. Nonetheless, a protocol that encourages rapid radiological and electrophysiological assessment and vigorous surgical and ICP management until the probable cause of flaccidity is identified and treated has benefit. The flaccid state was reversed and a good recovery was attained after the restoration of blood pressure and/or ventilation in 2 patients who appeared to have sustained a very grave head injury. In another patient, absent somatosensory evoked potentials greatly facilitated the diagnosis of a spinal subdural hematoma. This program of prompt diagnosis and intense therapy did not result in a protracted course or undue numbers of severely braindamaged survivors.
Spinal Epidural Abscess in Children
Authors: Fischer Edwin G. , Greene Clarence S. , Winston Ken R.
Published: May 2010

This is a report of three children with spinal epidural abscess. The literature is reviewed and the features of this condition in children are noted. Because of the nonspecificity of presenting symptoms in children, the diagnosis may be delayed. resulting in a worse outcome, especially in children under I year of age. The extensive laminectomy advised for the treatment of spinal epidural abscesses in adults is undesirable in children because of the risk of spinal deformity and in most cases is probably not necessary.
Delayed Complication of Matson Operation for Hydrocephalus
Authors: Friedman Phillip , Cass Harvey H.
Published: May 2010

A 26-year-old woman had had a lumbar subarachnoid-ureteral shunt established at the age of 10 weeks for hydrocephalus, She developed normally and had no trouble until meningitis developed because of reflux from a urinary tract infection. The meningitis responded to antibiotic treatment, and the shunt was removed from the subarachnoid space. Subsequently. the patient deteriorated clinically, with ictal episodes of altered consciousness, headache, and signs of midbrain dysfunction. Despite normal size ventricles on serial computed tomographic scans, her intracranial pressure was markedly elevated. which was shown by spinal puncture pressure. A diversionary lumboperitoneal shunt was inserted. An immediate, sustained recovery followed. The recognition of increased intracranial pressure in the absence of ventriculomegaly led to management that averted a disastrous outcome.
Traumatic Intracranial Aneurysm in an Infant
Authors: Laurent John P. , Cheek William R. , Mims Thomas , McCluggage Charles W.
Published: May 2010

Nonpenetrating head injury causing an intracranial aneurysm in an infant is rare. A case of this type is presented and the pertinent literature is reviewed. Because of the high mortality and morbidity associated with traumatic aneurysms, infants with severe head injury require cognizance that late deterioration may be due to an intracranial aneurysm.
Intracerebral Metastasis of Esophageal Carcinoma
Authors: Chalif David , Epstein Nancy , Flamm Eugene S. , Whelan Margaret , Budzilovich Gleb
Published: May 2010

Esophageal carcinoma is a rare but recognized source of intracerebral metastatic tumors. The case of a 62-year-old man with an isolated intracerebral metastasis from this primary focus is presented and discussed, Total excision was followed by complete resolution of the patient's neurological deficit.
Hyperthermia for Brain Tumors
Authors: Salcman Michael , Samaras George M.
Published: May 2010

Hyperthermia has great potential as an antineoplastic agent because: (a) it is effective against relatively radioresistant hypoxic cells and cells in S phase: (b) unlike most chemotherapeutic agents. it is effective against poorly vascularized and metabolically quiescent tissues; (c) as a physical agent, its biological effect is related to the duration and intensity of its application; (d) it seems to have no cumulative toxicity; and (e) it potentiates the effects of both chemotherapy and ionizing radiation at the cellular level. The use of hyperthermia for malignant brain tumors is constrained by a relatively narrow therapeutic index and the considerable thermal sensitivity of normal neural tissue. Glioblastoma multiforme, by virtue of its low growth fraction and heterogeneous cell populations, seems to be an ideal candidate for hyperthermia administered as part of a combined modality treatment program. Focal hyperthermia can be produced by a number of energy sources, including those utilizing ultrasound, microwave, and radiofrequency generators. The clinical safety and feasibility of a miniature microwave radiator/sensor system for direct implantation have been demonstrated. In comparison to normal feline brain, malignant brain tumors in humans are unable to dissipate heat efficiently.
Diagnosis of Acoustic Neurinoma
Authors: Harner Stephen G. , Laws Edward R.
Published: May 2010

Seventy-six patients underwent the primary removal of an acoustic neurinoma at the Mayo Clinic from 1978 through 1980. Hearing loss was present in 97% of the patients, and tinnitus and dysequilibrium occurred in 70% of the patients. The most common signs were a decreased corneal reflex. nystagmus. and facial hypesthesia. In these patients, pure tone and speech audiometry are used to define the hearing loss. When hearing is still present, the speech discrimination is often disproportionately low. Acoustic reflex testing and brain stem evoked response are used to determine whether the hearing loss is cochlear or retrocochlear. When these tests could be performed in this series of patients. they were accurate in 85 to 95%. The vestibular response to caloric testing is expected to be decreased or absent in about 90% of patients, and this was so in 86% of our patients. Radiographic studies are the most important tests currently used for the diagnosis of acoustic neurinoma. Tomography of the internal aduitory canal shows abnormalities in 80% of patients. Computed tomography with contrast enhancement demonstrates abnormalities in 90% of patients. The computed tomographic (CT) scan may reveal the location. the size, and often the consistency of the tumor. In cases still questionable after CT scanning. positive contrast rhjombencephalography is used for clarification. In this series, no single symptom. sign. abnormal audiometric test result. or abnormal radiographic finding was present in all patients; therfore, the most important factor in diagnosis is an alert physician.
Circulatory Changes Caused by a Closed, Negative Pressure Drainage System after Craniotomy
Authors: McCulloch G. A.J. , Pattison W. J.
Published: May 2010

Adverse circulatory responses such as cardiac arrhythmias, hypotension. and even cardiac arrest can be brought about by the suddeb lowering of intracranial pressure. This paper describes two cases of bradycardia and hypotension and one of hypotension alone caused by the application of closed, negative pressure drainage to a craniotomy wound.
Nonsurgical Management of Spontaneous Intracerebral Hematoma
Authors: Duff Thomas A. , Ayeni Sylovanius , Levin Allan B. , Javid Manucher
Published: May 2010

This report describes our experience with the use of osmotic diruetics, governed by continuous monitoring of intracranial pressure (ICP), as the primary treatment for 12 consecutive patients suffering from an acute, supratemtorial intracerebral hematoma. In all cases the hematoma, as shown by computed tomographic scan, had a long axis of >4.0 cm. ICP and cerebral perfusion pressure were successfully maintained within the assigned limits in all patients, and in none was surgical evacuation required. There was one death during the 6-month follow-up period. With appropriate weighting to differences in admission status, statistical comparison of the patient outcome in the present series with that reported by McKissock et al. suggests that ICP monitoring can improve the outcome of conservatively (and perhaps surgically) treated patients.
High Dose E-Aminocaproic Acid Prolongs the Bleeding Time and Increases Rebleeding and Intraoperative Hemorrhage in Patients with Subarachnoid Hemorrhage
Authors: Glikc Roberta , Green David , Ts'ao Chung-hsin , Witt Wendy A. , Yu Amy T.W. , Raimondi Anthony J.
Published: May 2010

E-Aminocaproic acid (EACA) has been used to prevent rebleeding in patients with intracranial aneurysms becuase it crosses the blood-brain barrier and is an inhibitor of fibrinolysis. Recommended doses have ranged from 24 to 48 g/day. We now describe an inhibitory effect on platelet function at the higher dose range. In vitro, a dose-dependent inhibition of adenosine diphosphate-and collagen-induced platelet aggregation was observed with concentrations of EACA beginning at 7.6 mM. In vivo. Prolongation of the template bleeding time was observed in all eight patients receiving 48 g/day (>20 minutes in four), in all five on 36 g/day (>20 minutes in three), and in none of seven on smaller doses. More importantly, rebleeding and excessive intraoperative bleeding (requiring more than I litre of bllod replacement) occurred predominantly in patients receiving the larger doses of EACA. Within 48 hours of the discontinuation of EACA, the bleeding times returned to normal values in all but one patient. We conclude that EACA exerts a dose-dependent inhibitory effect on platelet function and that patients receiveing doses in excess of 24 g/day may be at risk of serious bleeding. Patients receiving EACA should be monitored with serial bleeding time tests.
Absorbale or Nonabsorbable Suture Materials for Closure of the Dura Mater?
Authors: Vãllfors Bertil , Hansson Hans-Arne , Svensson Joel
Published: May 2010

This study was undertaken to determine which suture material would give the best results for closure of the dura mater. Because there is no need for the suture to remain longer than until healing has occurred and as remaining foreign material will predispose to foreign body reactions and infection. it was consideered important to test new absorbable materials like polyglactin 910 (Vicryl) and polyglycolic acid (Dexon) for closure of the dura mater. The reactions from these materials were compared to those of silk and polyester (Ethibond) in doge 60 days after the suture of dural incisions. The quality of healing with respect to the smoothness of the subdural surface, the presence of adhesions between sutures and the brain surface, the degree of absorption of the material, and reactions around the sutures were evaluated. Vicryl gave the best results. Providing a smooth subdural surface without adhesions. It was almost totally absorbed when healing was completed, in contrast to Dexon and the other materials. The cellular reaction around Vicryl was slight. Silk, Ethibond, and Dexon protruded from the subdural surface and adhesions to the arachnoid were common. When the dura mater was removed. these adhesions tore off the leptomeninges with their vascular supply to the cortex. The results of these experiments seem to justify the recommendation of Vicryl for suturing of the dura mater. Such an absorbable material decreases the risk of foreign body reactions, and infections will be more easily combated because of the absence of foreign material. The lack of subdural adhesions is an advantage if reoperation in necessary.
Craniocerebral Injuries from Dog Bite in an Infant
Authors: Wilberger James E. , Pang Dachling
Published: May 2010

Aniamal bite is a common cause of craniofacial injuries in children. Whereas scalp lacerations from animal bites are often extensive and severe. only four instances of compound depressed skull fractures from animal bites have been reported. A case of a dog bite to the head of an infant is presented to point out the potential for such an insult to produce cranial perforation and underlying brain damage. The associated roentgenographic and computed tomographic features are shown.
Oculomotor Palsy Caused by Aneurysm Clip
Authors: Wakai Susumu , Eguchi Tsuneyoshi , Asano Takao , Takakura Kintomo
Published: May 2010

Two cases of oculomotor palsy caused by the Sugita aneurysm clip are presented. In both patients, the palsy completely disappeared about 2 and 3 months. respectively. after reclipping the aneurysm of the internal carotid artery with another type of clip. Whenever 3rd nerve palsy develops postoperatively and is suspected of being caused by the aneurysm clip. reapplication of the clip should be performed promptly.
Redundant Nerve Roots of the Cauda Equina
Authors: Naguib Mahmoud G. , Latchaw Richard E. , Erickson Donald L. , Seljeskog Edward L.
Published: May 2010

Two cases of the syndrome of redundant nerve roots of the cauda equina are reported. Both cases were treated surgically, A review of the clinical picture, management. and etiology is presented. In each case, preoperative and postoperative myelography was performed: in one patient myelography demonstrated a complete resolution of the characteristic serpentine filling defects.
Preoperative Prognostic Factors for Rebleeding and Survival in Aneurysm Patients Receiving Antifibrinolytic Therapy
Authors: Tomer James C. , Kassell Neal F. , Wallace Robert B. , Adams Harold P.
Published: May 2010

Prognostic factors for mortality and recurrent hemorrhage in the preoperative, 2-week period were determined in 1114 patients who participated in the antifibrinolytic therapy investigations of the Cooperative Aneurysm Study between 1970 and 1977. Factors significantly related to mortality were admission neurological status, diastolic blood pressure, interval to treatment, degree of vasospasm, and medical condition. Factors associated with the likelihood of recurrent hemorrhage were interval to treatment, patient' sex, and admission neurological status. These factors need to be considered in the analysis of clinical data in the management of ruptured intracranial aneurysms.
Importance of Monitoring the Circulating Blood Volume in Patients with Cerebral Vasospasm after Subarachnoid Hemorrhage
Authors: Kudo Tadashi , Suzuki Shigeharu , Iwabuehi Takashi
Published: May 2010

We used the isotope dilution technique to monitor circulating blood volume (CBV) in three patients with ruptured cerebral aneurysms who developed pre- or postoperative ischemic symptoms that responded well to intravascular volume expansion therapy with blood transfusion and plasma expanders. In the first and second cases, predeterioration CBVs were obtained. Both of these patients showed hypovolemia and a decreased red blood cell volume at the time of neurological deterioration. A predeterioration CBV was not available for the third patient for comparison, but his red cell volume was also markedly decreased. Postrecovery CBVs were obtained in the second and third cases. Our data suggested that a depleted red blood cell volume was more responsible for neurological deterioration than was a lowered plasma volume. To prevent the occurrence of hypovolemia and anemia in aneurysm patients, we should monitor CBV not only at the time of neurological deterioration, but also at the time of admission and during the immediate postoperative period.
Monitoring of Activated Clotting Time during Carotid Endarterectomy
Authors: Rosenwasser Robert H. , Garrido Eddy , Freed Michael H. , Shupak Robert C.
Published: May 2010

The activated clotting time was monitored in 10 patients undergoing carotid endarterectomy. This measure accurately tells the surgeon the level of anticoagulation and permits him to calculate the exact amount of protamine needed for heparin reversal. This technique can be done easily and, in our opinion, enhances the safety of carotid endarterectomy.
Neurosurgical Aspects of the Parietal Boss in Patients with Chronic Subdural Hematomas
Authors: Iwabuchi Takashi , Sekiya Tetsuji , Sekiya Tetsuji
Published: May 2010

There are many modes of trephination for the treatment of chronic subdural hematoma. Angiographic and computed tomographic (CT) analysis of 60 consecutive patients with chronic subdural hematoma indicated that the parietal boss, which is likely to be overlooked by routine CT scanning, is one of the most suitable places for opening a burr hole. Our patients responded satisfactorily to irrigation therapy via a single burr hole in the parietal boss.
Extraneural Metastatic Medulloblastoma during Childhood
Authors: McComb Gordon J. , Davis Richard L. , Isaacs Hart
Published: May 2010

From 1960 to 1977, 59 patients with histologically confirmed medulloblastoma were initially treated at Childrens Hospital of Los Angeles. Of this group, 49 have died and, of these, 34 were autopsied. Among the autopsied cases, 2 infants had neck masses that proved to be medulloblastoma that had spread from the cerebellar vermis before any surgical intervention. Four additional patients who had undergone a posterior fossa craniectomy without either the pre- or postoperative placement of a cerebrospinal fluid-diverting shunt were found to have extraneural metastatic medulloblastoma at autopsy. The extraneural metastatic medulloblastoma rate in the autopsied cases was 17.6% (6 of 34). Our series shows that the incidence of the extraneural spread of medulloblastoma is associated with being young, being male, and having diffuse tumor involvement of the subarachnoid space.
Extracranial-Intracranial Bypass Grafting in the Surgical Treatment of Bacterial Aneurysms
Authors: Day Arthur L.
Published: May 2010

The use of an extracranial-intracranial arterial anastomosis in the treatment of two cases of bacterial aneurysm is reported. Utilization of this procedure may expand the indications for surgical treatment of bacterial aneurysms to include those affecting proximal and critically located arteries.
Midbrain Lesions
Authors: Rosenblum William I. , Greenberg Richard P. , Seelig John M. , Becker Donald P.
Published: May 2010

Midbrain lesions were found in 23 of 35 autopsied, head-injured people. These lesions were interpreted as “primary” that is. occurring at the time of impact. This interpretation was concordant with the clinical data, although the difficulty in establishing the precise moment at which the lesions were initiated in any individual case was recognized. Correlative clinicopathological data in head-injured people showed that midbrain damage could be determined by evoked potentials (EPs). In a total of 165 head-injured patients, the early presence or absence of evidence for midbrain lesions on EP examination was a powerful prognostic indicator of death or recovery. respectively. Autopsy and HP data showed that midbrain damage almost always occurred in the presence of hemispheric injury, but this fact should not obscure either the high frequency of midbrain lesions in those dying of head injury or the great prognostic value of their presence or absence.
Traumatic Subdural Hygroma in Adults
Authors: St. John James N. , Dila Carl
Published: May 2010

The authors review 25 cases of post-traumatic subdural hygroma in adults and report the findings of computer tomography in 4 cases. There was marked diversity in the severity of injury and in chronicity. The site of the lesion was consistently delineated by angiography, but preoperative differentiation from subdural hematoma was possible only with computed tomography. The mortality was 28%. Good recovery occurred in 48%. The prognosis was best among younger patients with subacute or chronic lesions.
Intracranial Pressure Monitoring in Severe Pediatric Near-Drowning
Authors: Dean Michael J. , McComb Gordon J.
Published: May 2010

Between April 1979 and April 1981, 20 near-drowned children admitted to Childrens Hospital of Los Angeles with a Glasgow coma score of 3 underwent intracranial pressure (ICP) monitoring and brain resuscitative therapy. By the 3rd hospital day, 14 patients had developed ICP elevation above 20 torr. and 11 of these had sustained intracranial hypertension above 30 torr. Ten of these children died, and 4 remain in a persistent vegetative state. Of 6 patients whose ICP never exceeded 20 torr. 3 recovered completely, 1 died, and 2 remain without any cognitive function. The salvage rate for patients with normal ICP after near-drowning accidents is significantly better than that for patients in whom the ICP is elevated (P = 0.017). Intracranial hypertension is associated with a uniformly bad outcome and is frequent in patients who die or suffer permanent, severe central nervous system damage after near-drowning.
Trigeminal Neuralgia Treated by the Injection of Glycerol into the Trigeminal Cistern
Authors: Håkanson Sten
Published: May 2010

Seventy-five patients with trigeminal neuralgia were treated by the injection of 0.2 to 0.4 ml of glycerol by the anterior percutaneous route into the trigeminal cistern, which was visualized by the aid of contrast medium (metrizamide). Eighty-six per cent of the patients were completely free from pain after the treatment, which produced only minimal disturbance of facial sensitivity. No complications have been observed. It is suggested that glycerol acts mainly on partly demyelinated nerve fibers, which are assumed to be involved in the trigger mechanism.
Specific Estradiol Binding in Schwannomas, Meningiomas, and Neurofibromas
Authors: Martuza Robert L. , MacLaughlin David T. , Ojemann Robert G.
Published: May 2010

The cytoplasmic fractions of schwannomas (acoustic neuromas), meningiomas, and neurofibromas were assayed for the presence of estrogen receptors. Specific estradiol binding was detected in 7 of 16 schwannomas, 7 of 10 meningiomas, and 1 of 6 neurofibromas. A nontumorous vestibular nerve was also studied and showed no estradiol binding. In the tumors, the concentration of the estradiol binding sites as estimated by saturation binding analysis covered a wide range of values (21 to 2430 fmol/g of tumor) but, overall, meningiomas contained the highest amount of estradiol binder. A Scatchard plot analysis of one of the schwannoma specimens demonstrated high affinity estradiol binding (Ka = 1.695 × 1010M−1). Although there were more females than males in each tumor category, the overall incidence of estradiol binding was similar in males (5 of 11. 45%) and in females (10 of 21, 48%r). In 5 cases, progestin binding was also measured and was delected in two meningiomas (both from female patients): one meningioma and two neurofibromas showed no progestin binding. A discussion is presented of the possible role of estradiol in the pathogenesis or modulation of meningeal and Schwann cell tumors as well as in the genetic disorder neurofibromatosis.
External Ventricular Drainage in the Management of Posterior Fossa Tumors in Children and Adolescents
Authors: Papo I. , Caruselli G. , Luongo A.
Published: May 2010

External ventricular drainage (EVD) was used before and after posterior fossa operations in 62 children and adolescents. In all cases, the removal of the tumor (midline in 47 and lateral in 15) was attempted: total removal was achieved in 41. The overall mortality was 6.5% (4 patients). Only 25% of the survivors needed permanent cerebrospinal fluid (CSF) shunting. EVD seems, therefore, to be effective in controlling preoperative intracranial hypertension and in securing a smooth postoperative course. Preoperative CSF shunting seems to be necessary or advisable only in particular circum- stances.
Spinal Cord Tumors in the People's Republic of China
Authors: Man-Kai Cheng
Published: May 2010

This paper summarizes data on 1639 pathologically confirmed spinal cord tumors described in three reports published in the People's Republic of China (PRC). The average ratio of brain to spinal cord tumors in these studies was 8:1. The ratio of neurinomas to meningiomas was 3.8:1: this value is much higher than those found in western reports (almost 1:1), but is close to the ratio reported in the Japanese literature (3.9:1). Eleven per cent of the spinal cord tumors in the PRC were dysembryoplastic. In children, the percentage was 52.7%, one of the highest values reported in the world literature. Meningioma was the only type of spinal cord tumor that occurred more frequently in females than in males (2.5:1). Children (under 16 years old) had 19% and elderly patients (over 60 years old) had 2.6% of the spinal cord tumors in the PRC.
Fibromuscular Dysplasia of the Internal Carotid Artery
Authors: Wells Ralph P. , Smith Robert R.
Published: May 2010

The natural course of fibromuscular dysplasia (FMD) of the internal carotid artery (ICA). a stenosing angiopathy associated with cerebrovascular insufficiency, has not been described. A search of medical records located 16 female patients with angiographically demonstrated FMD of the ICA. The identical twin of 1 patient was included in the registry on the basis of noninvasive studies consistent with FMD of the ICA. The mean age at diagnosis was 58 years. Follow-up examinations were performed an average of 3.8 years after diagnosis (range, 1 to 9 years); the evaluation included clinical, angiographic, and Doppler studies. Fifteen patients showed no evidence of progression of FMD, whereas 2 patients with coincident atherosclerotic disease had suffered strokes. One patient had undergone surgical dilatation of the ICA. 3 had received oral anticoagulants, and 13 had received either aspirin or no specific therapy. In light of the apparently benign clinical course of uncomplicated FMD of the ICA, it is concluded that dilatation is rarely warranted.
Cerebrospinal Fluid Shunts Interfere with Host Defenses
Authors: Borges Lawrence F.
Published: May 2010

Despite advances in neurosurgical therapeutics, cerebrospinal fluid shunt infections have continued to complicate the management of patients with shunted hydrocephalus. Although various factors have been proposed to explain the pathogenesis of these infections, they have remained poorly understood. This in vitro study determined the ability of human neutrophils and monocytes to adhere to two types of shunt catheters and to phagocytose bacteria. These white blood cells failed to adhere in normal numbers to the catheters and failed to ingest fully a bacterial innoculum on the catheters' surfaces. While in contact with the shunt apparatus, the neutrophils also exocytosed myeloperoxidase, a major component of the intracellular microbicidal system. These observations suggest that the shunt apparatus may diminish the effectiveness of the hosts' defenses at the site of implantation.
Spontaneous Dissecting Cervical Carotid Artery Aneurysm
Authors: Hodge Charles J. , Lee Seungho H.
Published: May 2010

A unique case of a large dissecting cervical carotid artery aneurysm is presented. The lesion had probably started as a spontaneous dissection 2 years before the onset of ischemic hemisphere symptoms and represents one way in which such a dissection can evolve if unchecked. The usual presentation, angiographic findings, and possible treatments of dissecting extracranial carotid aneurysms are discussed briefly.
Spontaneous Dissecting Aneurysm of the Extracranial Vertebral Artery
Authors: Hugenholtz H. , Pokrupa R. , Montpetit V. J. A. , Nelson R. , Richard M. T.
Published: May 2010

Spontaneous dissection of a cervical vertebral artery secondary to fibromuscular hyperplasia is uncommon, is often painful, and may be followed after a latent interval by further symptoms of embolism, occlusion, or hemorrhage. Accordingly, the lesion is potentially hazardous and warrants treatment when recognized.