bluuebunny/crossref_metadata_2025 huggingface dataset:
Hemodynamic aspects in the aspect management of carotid-cavernous fistula
Authors: Nornes Helge
Published: May 2009

✓ A method for intraoperative evaluation of the hemodynamic state in patients with carotid-cavernous fistula is described. Electromagnetic flow probes were applied on the internal carotid artery (ICA) in the neck and on the intracranial part of the artery distal to the fistula in five patients. Fistula “steal5 ranged from 90 to 975 ml/min. Forward flow rate in the intracranial portion of the ICA, distal to the fistula, was from 40 to 170 ml/min. The reverse flow rate during test occlusion of the ICA in the neck was between 35 and 60 ml/min. The ratio reverse flow/forward flow is assumed to give an indication of the collateral capacity of the cerebral vasculature and of the tolerance to trap ligation of the ICA. The pulsatile pattern of the intracranial ICA flow in this series varied considerably, and this parameter is also found to be of importance in the evaluation of the capacity of the collateral arterial system. The monitoring of cervical ICA flow proved to be a reliable way to supervise the procedure of plugging the fistula with flow-carried muscle emboli in conjunction with trap ligation.
Hydrostatically raised intracranial pressure
Authors: Kuurne Timo , Troupp Henry
Published: May 2009

✓ Hydrostatic pressure with artificial cerebrospinal fluid (CSF) was applied through a needle inserted into the cisterna magna of rabbits breathing spontaneously. Blood pressure, confluens sinuum pressure and oxygen tension, respiratory rate and volume, and acid-base balance were recorded until respiratory arrest. Blood pressure and confluens sinuum pressure and respiratory volume rose; confluens sinuum oxygen and arterial carbon dioxide tension dropped. The significant similarities and differences in changes in the same parameters following local cold injury to the brain are discussed. Comparisons between different experimental models for raised intracranial pressure must take into consideration the differing reactions of the brain.
Direct mass spectrographic measurement of regional intracerebral oxygen, carbon dioxide, and argon
Authors: Roberts Melville , Owens Guy
Published: May 2009

✓ During 10 operative procedures on eight patients with various intracranial lesions a membrane mass spectrometer was used to measure the regional partial pressure of oxygen (pO2), carbon dioxide (pCO2), and argon (pA) in subcortical white matter. The pO2 varied from 12 to 49 mm Hg, and the pCO2 from 31 to 123 mm Hg. Lowering intracranial pressure to 0 by ventricular drainage increased the pO2 and argon washout values (except in necrotic brain where no increase occurred) and decreased the pCO2 values. In one patient restoration of intraventricular pressure to the initial level of 220 mm H2O resulted in a 20% decrease in pCO2, a 15% decrease in argon washout rate, and a 21% increase in pCO2. These data suggest that regional cerebral blood flow, pO2, and pCO2 are influenced by intracranial hypotension as well as the condition of local brain tissue.
Structural changes of the intradural arteries following subarachnoid hemorrhage
Authors: Conway Louis W. , McDonald Larry W.
Published: May 2009

✓ The histology of the intradural arteries was studied in 12 consecutive autopsy cases of patients dying 1 day to 15 months after their initial spontaneous subarachnoid hemorrhage. In all patients surviving 4 weeks or more and in one surviving 4 days, the lumina of the intracranial arteries were narrowed by subendothelial granulation tissue which thickened the intima. In all seven cases with structural changes in the intracranial arteries, vessels near the site of hemorrhage were involved; in four cases vessels remote from the site of hemorrhage were also involved. Changes were usually restricted to large arteries with a prominent muscular layer and confined to the subarachnoid space. The presence and degree of intimal thickening correlated with the distribution and amount of subarachnoid blood or its breakdown products. This process apparently does not represent an obliterative endarteritis involving vessels exclusively supplying infarcted brain, but is probably a reaction to mechanical or anoxic damage to the intima following vasoconstriction. It is suggested that this arterial structural change might be confused with delayed or prolonged “vasopasm.”
Structure of the human arachnoid granulation
Authors: Wolpow Edward R. , Schaumburg Herbert H.
Published: May 2009

✓ The human arachnoid granulation was studied by light microscopy in gapless serial sections after local postmortem perfusion of the subarachnoid space with glutaraldehyde. The smaller granulations are invested in a dural sheath several layers thick which is separated from the body of the granulation by a true subdural space. In larger granulations, there are restricted regions where the body of the granulation protrudes through the dura to enter the venous sinus directly.
Meningiochondroma of the cerebral convexity
Authors: Ploncard Philippe , Del Vivo Romeo E. , Klaiber Roland
Published: May 2009

✓ A case of meningiochondroma of the cerebral convexity is presented. The etiology of this tumor and a review of comparable cases are discussed.
Subarachnoid ependymal cyst
Authors: Tandon P. N. , Roy S. , Elvidge Arthur
Published: May 2009

✓ Two cases of subarachnoid ependymal cyst of developmental origin are described. Both were located in the Sylvian region, were lined with ciliated columnar epithelial cells, and had no communication with the ventricular system. Both were successfully removed at surgery.
Fibromuscular dysplasia involving the intracranial vessels
Authors: Iosue Albert , Kier E. Leon , Ostrow David
Published: May 2009

✓ A case of fibromuscular dysplasia involving the intracranial internal carotid artery and middle cerebral artery in a previously healthy man is presented. Symptoms were characteristic of cerebral ischemia with occlusion of a branch of the middle cerebral. The clinical significance, associated lesions, and differential diagnoses are mentioned.
Ocular palsy occurring with pituitary tumors
Authors: Robert Cavett M. , Feigenbaum Joel A. , Stern W. Eugene
Published: May 2009

✓ Pituitary tumors caused ocular paresis in nine of 64 patients studied. Most commonly affected of the ocular motor nerves was the third cranial nerve. The third nerve defect was total in three patients and partial in four. The levator palpebral superioris was the most commonly affected, causing either a partial or complete ptosis. Four of the seven patients with third cranial nerve paresis had normal pupillary function, two had sixth nerve paresis; one fourth nerve involvement, and in one, all three nerves to the ocular muscles were affected. Two patients had isolated sixth cranial nerve paralysis without involvement of the third cranial nerve. Seven of the nine patients reviewed had full return of eye movement after intracranial surgical removal of the pituitary tumor.
Effect of extracranial-intracranial vascular bypass graft on experimental acute stroke in dogs
Authors: Crowell Robert M. , Olsson Yngve
Published: May 2009

✓ Anastomosis of the superficial temporal artery (STA) to a middle cerebral artery (MCA) branch was completed about 2 hours after occlusion of the MCA root in 20 dogs. Occlusion of the MCA root without bypass grafting was performed in 11 control animals. All dogs were evaluated clinically. Two days to 3 months (usually 2 weeks) after surgery, STA catheter angiograms were made and the animals sacrificed by perfusion fixation. The brains were evaluated pathologically. Animals with patent or occluded STA-MCA bypass grafts fared better both clinically and pathologically than the controls. Hemorrhagic infarction and blood-brain barrier damage were common in untreated dogs and uncommon in treated animals. STA-MCA bypass grafts rarely led to occlusion of intrinsic collateral blood supply to the brain. The data suggest that prompt STA-MCA branch anastomosis might lead to restoration of neurological function and parenchymal structural integrity in certain patients with acute middle cerebral artery occlusion.
Disorders of growth hormone and corticotropin regulation in patients with empty sella
Authors: Faglia Giovanni , Ambrosi Bruno , Beck-Peccoz Paolo , Giovanelli Massimo
Published: May 2009

✓ Endocrine functions in seven cases of primary empty sella were studied. No clinical features of endocrine disturbances were apparent. Urinary excretion of gonadotropins, and thyroid and adrenal functions were normal. Plasma human growth hormone (HGH) concentration was also normal but did not increase after insulin-induced hypoglycemia in four patients, after arginine in one, and after a glucose load in six. Urinary excretion of 17-hydroxycorticosteroids (17-OHCS) increased normally in all patients after metyrapone administration, while plasma 17-OHCS did not increase in three subjects after insulin-induced hypoglycemia or in one after lysine-vasopressin. Two patients showed exaggerated responses to lysine-vasopressin. These results indicate an impairment of the hypothalamic HGH and corticotropin regulation in patients with empty sella. Since in chromophobe adenomas comparable changes were seen, the differential diagnosis between empty sella and chromophobe adenoma is impossible on the basis of endocrinological data alone. The only reliable diagnostic method is accurate radiological study including air contrast tomoencephalography.
Cervical intramedullary cyst due to Corynebacterium diphtheriae gravis
Authors: Jelsma Franklin
Published: May 2009

✓ An intramedullary cyst of the midcervical region, due to Corynebacterium diphtheriae gravis, is reported. The culture and identification of the organism are documented. The specific pathological findings at the initial cervical exposure and subsequent thoracic and lumbar exposures are described.
Traumatic arachnoidal diverticulum associated with paraplegia
Authors: Hoffman Edward P. , Garner John T. , Johnson David , Shelden C. Hunter
Published: May 2009

✓ A case of delayed paraplegia due to a traumatic arachnoid diverticulum from a traction injury of the brachial plexus is reported. The authors emphasize the necessity of carrying out proper radiological studies for evaluation of delayed weakness of the legs following trauma to the brachial plexus; by this means, a surgically correctable lesion can be identified.
Regional cerebral blood flow, intracranial pressure, and brain metabolism in comatose patients
Authors: Bruce Derek A. , Langfitt Thomas W. , Miller J. Douglas , Schutz Hart , Vapalahti Matti P. , Stanek Albert , Goldberg Herbert I.
Published: May 2009

✓ Cerebral blood flow (CBF), intracranial pressure (ICP), brain metabolism (CMRO2), systemic arterial pressure (SAP), and arterial blood gases were measured in comatose patients, most of whom had suffered a head injury. The patients were divided into two groups according to whether a mass lesion was or was not demonstrated by bilateral carotid angiography. In the majority of patients a control run measuring regional cerebral blood flow (rCBF) was followed by a test of cerebral autoregulation; hypertonic mannitol was then administered. During the control period there was marked and unpredictable variability in all of the parameters recorded. There was no correlation between ICP or CBF and neurological status or CMRO2 except at very high levels of ICP. Autoregulation was intact in some patients and defective in others, and there was no correlation between the status of autoregulation on the one hand and CBF or survival on the other. Mannitol increased CBF in nearly all patients, to twice the control value in a few, and CMRO2 increased with CBF in several patients. The change in CBF was independent of the initial ICP or the response of ICP to mannitol. Thus, the relationship of these parameters was unpredictable in acutely brain-damaged patients; the status of autoregulation was also unpredictable.
A survey of attitudes toward the pharmacological prophylaxis of posttraumatic epilepsy
Authors: Rapport Richard L. , Penry J. Kiffin
Published: May 2009

✓ This survey reports the current use of pharmacological prophylaxis for posttraumatic epilepsy by 1064 board-certified neurosurgeons. Sixty per cent use anticonvulsants preventively, but under a variety of conditions. The indications for therapy were usually either severe head trauma with penetration of the dura or profound evidence of cortical contusion. Few patients were treated for minimal blunt injuries. Thirty-four per cent of respondents were uncertain of the indications for prophylatic treatment. The drug regimens were based on individual experience in 90.7% of responses and were aimed principally at pretreatment of clinical phenomena rather than true prophylaxis of the epileptogenic process. Diphenylhydantoin, 300 mg/day, was the preventive treatment recommended by more than 50% of those reporting, but the duration of therapy varied widely.
Electrophysiological topography of the human diencephalon
Authors: Velasco Francisco , Molina-Negro Pedro
Published: May 2009

✓ Microelectrode recordings made in 64 human cases of movement disorder or intractable pain were used to study the relation of the site of electrical activity to the ventricular system. Standardizing the cases by dividing the AC-PC line in equal parts and using the same units to divide the areas above and below the intercommissural line and the distance of the electrodes to the midline revealed that the dispersion of the electrical activities in regard to AC-PC line was minimal and overlapping practically nonexistent. It is concluded that, at least for the areas explored, the size of each diencephalon nucleus is proportional to the size of other diencephalic nuclei, and its internal structure and relation to radiological landmarks are fairly constant.
Posterior orbital encephalocele with anophthalmos and other brain malformations
Authors: Fargueta Jose Sanchis , Menezo Jose Luis , Bordes Manuel
Published: May 2009

✓ A case is reported in which an encephalocele completely replaced the contents of one orbit. The mass was successfully removed.
Cerebellar heterotopia
Authors: Billings Kenneth J. , Danziger Franklin S.
Published: May 2009

✓ A 9-month-old child showed moderate hydrocephalus and retarded development. Ventriculography demonstrated a fourth ventricular mass which proved to be normal infantile cerebellum.
Delayed traumatic myelopathy following transfixion of the spinal cord by a knife blade
Authors: Wolf Sheldon M.
Published: May 2009

✓ A 35-year-old man who was stabbed in the back suffered only transient paresthesia in one leg. He was asymptomatic until 21 years later when, following a minor automobile accident, progressive myelopathy developed. Eight years later he showed a Brown-Sequard syndrome with a T-7 sensory level. At T-6 a knife blade was found that had transfixed the spinal cord; its removal was followed by some improvement in the neurological deficit. Comparable cases are reviewed. A second usually minor trauma may trigger a rapidly progressive neurological deficit.
Dislocated lumbar vertebral epiphysis in adolescent children
Authors: Lowrey John J.
Published: May 2009

✓ Three teenagers operated on for suspected rupture of a lumbar intervertebral disc are presented. The finding at surgery in each case was a bony, cartilaginous, and nucleus pulposus ridge crossing the anterior spinal canal. Since the bony epiphyseal ring or apophysis is said to be deficient posteriorly, these patients presumably had a dislocation of an anomalous epiphyseal ring.
Intravascular intracranial EEG recording
Authors: Penn Richard D. , Hilal Sadek K. , Michelsen W. Jost , Goldensohn Eli S. , Driller Jack
Published: May 2009

✓ Spontaneous and evoked electrical activity from the basal and medial areas of the brain not accessible in routine electroencephalography (EEG) has been recorded with single and bipolar electrodes in intracranial vessels of baboons. The report also demonstrates intracranial intravascular EEG recording in man.
Localization of intraventricular arteriovenous malformations by ventriculography combined with stereoscopic arteriography
Authors: Gerber Arthur M. , Karkazis George , Mullan Sean
Published: May 2009

✓ Two cases are presented to illustrate the value of air ventriculography combined with stereoscopic arteriography in locating intraventricular vascular malformations and arterial aneurysms. This procedure permits the neurosurgeon to plan a more direct approach to the lesion.
Ventriculofiberscope: a new technique for endoscopic diagnosis and operation
Authors: Fukushima Takanori , Ishijima Buichi , Hirakawa Kimiyoshi , Nakamura Norio , Sano Keiji
Published: May 2009

✓ The authors report a new ventriculofiberscope useful in both diagnosing and operating on lesions of the ventricular system. The technique and its advantages are illustrated in representative cases.
Outlining the cervical spinal cord with tantalum powder: application to percutaneous cordotomy
Authors: Smith Roderick
Published: May 2009

✓ Powdered tantalum introduced into the subarachnoid space at C-2 clearly outlines the anterior aspect of the cord and dentate ligaments. Accurate electrode placement for percutaneous intramedullary cordotomy is made easier by the presence of a radiopaque target.
Effects of prolonged cerebrospinal fluid shunting on the skull and brain
Authors: Kaufman Benjamin , Weiss Martin H. , Young Harold F. , Nulsen Frank E.
Published: May 2009

✓ A review of postoperative radiographs in hydrocephalic patients treated with ventriculojugular shunts reveals a marked decrease in the CSF fluid spaces, both subarachnoid and intraventricular, reflected in compensatory skull changes and alterations in ventricular configuration. Most of the changes appear to be reversible when shunt malfunction develops, with the exception of acquired synostosis. Exceptions to the generalized changes that can be expected in all cases include absence of changes in the sella turcica in the presence of an intact diaphragma sellae, persistence of the “right angle” sella turcica and concave basi-occiput in patients with an Arnold-Chiari Type II malformation, and shifts of the lateral ventricle when the septum pellucidum is intact. Experimental evidence in shunted hydrocephalic dogs suggests that differential damping of ventricular pulse pressure by the shunt is a factor.
Alteration of circadian temperature rhythm with third ventricular obstruction
Authors: Page Robert B. , Galicich Joseph H. , Grunt Jerome A.
Published: May 2009

✓ Body temperature and endocrine function were studied in three hydrocephalic patients with tumors in the region of the hypothalamus. A circadian temperature rhythm was present under normal intraventricular pressure but was upset during elevated pressure. The results suggest that the absence of a circadian temperature rhythm in patients with third ventricular neoplasms indicates ventricular obstruction with consequent intracranial pressure and/or hydrocephalus. Conversely, the presence of a circadian temperature rhythm indicates that ventricular obstruction has not occurred or that a shunt system placed to bypass such an obstruction is functioning.
Cardiovascular response to experimental spinal cord compression
Authors: Eidelberg Eduardo E.
Published: May 2009

✓ Anesthetized, and unanesthetized decerebrate, cats were used to study the arterial pressor response to spinal cord compression. To produce a cervical compression it was necessary that the cervical cord be functionally connected to the thoracic cord, pressor response by the reverse was not true. A pressor response above 200 mm Hg systolic was associated with electrocardiographic (EKG) signs of left ventricular overload and ventricular ectopic beats. These changes were not prevented by atropine, hexamethonium, or propanolol. Both the pressor response and the EKG abnormalities were prevented by an alpha-adrenergic blocking agent. The authors conclude that alpha-adrenergically mediated arterial vasoconstriction is the effector mechanism in the pressor response to increased intracranial pressure or cord compression.
Monitoring antifibrinolytic therapy in subarachnoid hemorrhage
Authors: Smith Robert R. , Upchurch John J.
Published: May 2009

✓ A modification of the fibrin plate method was developed to measure fibrinolysis in patients with subarachnoid hemorrhage and those receiving antifibrinolytic agents. During the past 2 years, 21 patients with ruptured intracranial aneurysms received epsilon aminocaproic acid. Plasma and cerebrospinal fluid were monitored in 15 of these patients. Dosage factors, duration of action, and complications of therapy are presented. Fibrinolysis in normal plasma and cerebrospinal fluid is also discussed.
Teratoma of the fourth ventricle
Authors: Morelli Robert J.
Published: May 2009

✓ The author reports a rare case in which a primary malignant teratoma presented as an obstructing mass in the fourth ventricle. The tumor was not cystic but well encapsulated, and a gross total surgical removal was accomplished. A fatal recurrence occurred within 3 months.
Post-discectomy tuberculous abscess
Authors: Kaplan Edward S.
Published: May 2009

✓ An unusual case of occult vertebral tuberculosis was detected after posterior drainage through a previously created lumbar laminectomy wound for removal of an L-5 disc extrusion. Diagnosis, treatment, and possible pathogenesis are discussed.
Tuberculous infection of the cervical spine
Authors: Jenny Arthur B. , Lehman Ralph A. W. , Schwartz Henry G.
Published: May 2009

✓ A case of severe tuberculous destruction of the cervical spine treated without bone grafting is described.
Inflammatory pseudotumor of mesentery: a complication of ventriculoperitoneal shunt
Authors: Keen Philip E. , Weitzner Stanley
Published: May 2009

A mesenteric mass simulating a neoplasm is reported as a complication of ventriculoperitoneal shunting.
Vascular ultrastructure in human meningiomas and schwannomas
Authors: Long Don M.
Published: May 2009

✓ Nineteen meningiomas and schwannomas have been studied by fluorescence microscopy and electron microscopy. Increased cerebrovascular permeability to protein was demonstrated in each tumor. The anatomical explanation for this increased permeability to protein was found in open endothelial cell junctions, gaps between endothelial cells, and fenestrations in capillary endothelial membranes.
A percutaneous technique for producing intraspinal mass lesions in experimental animals
Authors: Doppman John L. , Ramsey Roy , Thies Raymond J.
Published: May 2009

✓ The authors describe a percutaneous technique for producing extra- and intramedullary mass lesions in the dog and monkey. Small balloon catheters introduced through needles into the spinal canal can be positioned under fluoroscopic control to simulate epidural masses or masses within the cord. Selective spinal cord arteriography and silicone perfusion studies demonstrate the effect of such masses on spinal cord blood flow.
The relative significance of factors affecting postoperative survival in astrocytomas, grades 3 and 4
Authors: Weir Bryce
Published: May 2009

✓ The records of 248 patients with supratentorial astrocytomas, Grades 3 and 4, treated surgically between 1960 and 1970 were analyzed. Abstracted clinical data were transferred to magnetic tape for computer analysis of postoperative survival factors using multiple chi square test and a step-wise multiple regression equation. All patients were followed, and only four were alive at the time of the study. It appeared that radiation therapy was the most important determinant of prolonged postoperative survival. The age of the patient was the only other factor of any significance.
Chronic extradural hematomas
Authors: Iwakuma Tsutomu , Brunngraber Carl V.
Published: May 2009

✓ The authors report 21 cases of chronic extradural hematoma, including two encapsulated, five microscopically ossified, and two with a false aneurysm of the middle meningeal artery. Clinical and pathological findings are described, and the factors influencing the course discussed; the most important factors were found to be age, location, and source of bleeding.
Myelographic block caused by redundant lumbar nerve root
Authors: Gulati Des Raj , Rout Damodar
Published: May 2009

✓ A patient with weakness and muscular atrophy of the right leg was shown to have a myelographic block caused by a redundant lumbar nerve loop. Decompressive laminectomy was followed by a marked degree of recovery.
Cerebral transit time of 99mtechnetium sodium pertechnetate before and after cerebral arteriography
Authors: Crandell Donna , Moinuddin Mohammed , Fields Murray , Friedman Ben I. , Robertson James
Published: May 2009

✓ In a group of 18 patients the cerebral transit time was studied with 99mtechnetium sulfur colloid and 99mtechnetium sodium pertechnetate before and after cerebral arteriography. The results were compared with a similar study in a group of 21 control patients, and no statistical difference was noted. Cerebral arteriography, when performed without complications, does not alter the cerebral transit time.
Factors disposing to morbidity in surgery of intracranial aneurysms with special regard to deep controlled hypotension
Authors: Hugosson Rune , Högström Seth
Published: May 2009

✓ In 200 cases of intracranial saccular aneurysm a technique of short-term deep blood pressure reduction, as a rule induced with halothane, was used during the ligation of the aneurysm. The systolic blood pressure was reduced in most cases to about 50 mm Hg. This hypotension gives great advantages in the operative procedure. The vascular tree becomes more mobile, which facilitates the final phase of the dissection. The aneurysmal sac becomes softer, diminishing the risk of rupture when the ligature is being applied, and facilitating control of hemorrhage should it occur. The disadvantage of deep blood pressure reduction is the risk of anoxic damage. The surgical morbidity and mortality were therefore analyzed in detail with respect to the probable cause. In all but one case the symptoms or death could be attributed to one or more other factors (cerebral edema, vascular spasm, surgical trauma, etc.)
Aneurysms of the petrous and cavernous portions of the internal carotid artery associated with nonpenetrating head trauma
Authors: Teal James S. , Bergeron R. Thomas , Rumbaugh Calvin L. , Segall Hervey D.
Published: May 2009

✓ Four instances of aneurysms of the petrous or cavernous portions of the internal carotid artery following nonpenetrating head injury are reported and discussed.
Warning signs prior to rupture of an intracranial aneurysm
Authors: Okawara Shige-Hisa
Published: May 2009

✓ Warning signs prior to major hemorrhage were analyzed in 112 cases of single intracranial aneurysm. Fifty-four of 112 patients (48.2%) showed such signs, and the incidence for women was slightly higher (49.2%) than that for men (46.6%). Incidence decreased as patient age advanced, more steeply for men than women. Incidence and characteristics of warning signs varied according to location of aneurysm. Nineteen different signs occurred in 97 instances for 54 patients (average 1.76), and were placed into three groups according to possible etiologies: Group 1, vascular origin due to expansion of aneurysm and adjacent artery; Group 2, minor bleeding; and Group 3, ischemic lesion, arterial spasm, or occlusion. The average time interval from onset of warning sign to major hemorrhage was 20.7 days: 110.5 days for Group 1, 10.4 days for Group 2, and 21.0 days for Group 3. Therefore, signs in Group 2 suggest the necessity of most urgent medical attention. Results of treatment clearly suggested the group with warning signs fared better than the others. Possible reasons for this are discussed.
Ventriculostomy for the treatment of acute hydrocephalus following subarachnoid hemorrhage
Authors: Kusske John A. , Turner Paul T. , Ojemann George A. , Harris A. Basil
Published: May 2009

✓ The role of ventriculostomy in the treatment of acute hydrocephalus following subarachnoid hemorrhage from intracranial aneurysms is evaluated. Eleven patients treated with an external ventricular drain are compared to a matched control series of untreated patients. Improvement occurred in eight of the 11 treated patients and in only one of the nine patients in the control group. Seven of the patients in the ventriculostomy series improved sufficiently to justify definitive surgery. There were no infections. In 50% of the surviving ventriculostomy patients, permanent shunts were unnecessary. Our data emphasize the deleterious effects of hydrocephalus in the acute period following a subarachnoid hemorrhage and suggest that it may be treated effectively by external ventriculostomy.
Catheterization of the cerebral aqueduct for obstructive hydrocephalus in infants
Authors: Crosby R. M. N. , Henderson Charles M. , Paul Ronald L.
Published: May 2009

✓ Thirty hydrocephalic children with obstruction of the cerebral aqueduct were treated by aqueductal catheterization (interventriculostomy). The complications encountered in the early cases have led to the use of a two-shunt technique. The surgical mortality of 13% compares favorably with that of other methods, and the possibility of a permanent cure of the hydrocephalus eliminating the problems of shunts and shunt dependence makes this approach an appealing one to the authors.
Atresia of the rostral superior sagittal sinus: substitute parasagittal venous channels
Authors: Kaplan Harry A. , Browder Jefferson
Published: May 2009

✓ Failure of development of a rostral superior sagittal sinus results in concomitant embryonal establishment of substitute dural and cerebral venous pathways. The longer the segment of atresia of this sinus, the more extensive the compensatory venous channels. These developmental variants assume clinical importance in the interpretation of cerebral angiograms.
Metastases of glioblastoma multiforme to cervical lymph nodes
Authors: El-Gindi Sayed , Salama Mamdouh , El-Henawy Mokhtar , Farag Said
Published: May 2009

✓ Two cases of occipital glioblastoma multiforme are reported in which a metastatic lesion involving the cervical lymph nodes on the side of the previous craniotomy was verified during life. This suggests to the authors that the brain tumor metastasized via lymphatic channels.
Cystic meningioma
Authors: Lake Peter , Heiden James S. , Minckler Jeff
Published: May 2009

✓ Cystic meningiomas are rare variants of the usually solid tumor. A case is presented, together with a discussion of the relationship to cystic changes in the histologically similar angioblastic meningiomas and posterior fossa hemangioblastomas.
Medulloblastoma with striated muscle fibers
Authors: Lewis Anthony J.
Published: May 2009

✓ A case is reported in which a medulloblastoma showed evidence of striated muscle fibers. Fifteen additional cases of primary central nervous system (CNS) tumor containing muscle fibers (excluding teratomas) are reviewed. These tumors appear to be of mesenchymal, rather than teratoid, origin, and to be related to embryonal sarcomas (mesenchymomas) in other parts of the body. It is postulated that the presence of such fibers in malignant gliomas may be due to rhabdomyoblast-inducing action of mesenchyme, analogous to the fibroblastic stimulation observed in desmoplastic medulloblastomas, and the massive stimulation of perivascular tissue often associated with undifferentiated astrocytomas.
Leptomeningeal cysts in congenital ectopia lentis
Authors: Weir Bryce
Published: May 2009

✓ A case of ectopia lentis (Marfan syndrome) with a cerebral subarachnoid cyst, a spinal extradural cyst connected to a lateral intrathoracic meningocele, and perineural cysts is presented. The association of these leptomeningeal cysts in this genetic disorder of connective tissue suggests a common pathogenesis.
Edema of the spinal cord following experimental impact trauma
Authors: Yashon David , Bingham W. George , Faddoul Edward M. , Hunt William E.
Published: May 2009

✓ Identification of central nervous system edema is based on increased water content in relation to nonvolatile residue per unit weight. Nonvolatile residue in spinal cord tissue following impact trauma was determined to ascertain the magnitude and persistence of edema. High and low thoracic laminectomies were carried out on each of 17 rhesus monkeys. The lower exposed cord was traumatized with a calibrated blow of 300 gm cm. All upper exposed cords and the lower exposed cord in one monkey served as nontraumatized controls. At time intervals of 5 minutes to 20 days after trauma, cord segments were removed and assayed for water content. Increased tissue water was evident within 5 minutes and persisted for 15 days. By the 20th day it had essentially subsided. Increased tissue water content in the traumatized segment reached a maximum of 7.4% over control values at 5 days and then gradually diminished. These findings support the concept that edema following spinal trauma is unrelated to secondary effects of ischemia after 18 hours. The protracted course of increased water content (15 to 20 days) was unexpected and may indicate that edema-reducing measures should be continued for 2 to 3 weeks following spinal cord trauma with severe neurological dysfunction.
Penetration of brain abscess by systemically administered antibiotics
Authors: Black Perry , Graybill J. Richard , Charache Patricia
Published: May 2009

✓ In six consecutive patients treated with systemic antibiotics for brain abscess, chloramphenicol, methicillin, and penicillin were found capable of penetrating the abscess in therapeutic concentration. Nafcillin, a fourth antibiotic tested, failed to penetrate. While on antibiotics, all six patients continued to deteriorate neurologically until needle aspiration of the abscess was carried out, after which recovery began promptly. Organisms were found in the pus despite the presence of therapeutically effective antibiotic levels, and despite the fact that the organisms were sensitive, in vitro, to the antibiotics used. These observations confirm that antibiotics alone are insufficient and that surgical evacuation of the abscess is essential. The need for local instillation of antibiotics directly into abscesses is questionable since penetration following systemic administration of three antibiotics tested was adequate when blood levels were high. It is suggested that the instillation of penicillin or its derivatives be avoided in view of their potential epileptogenicity as well as the questionable value of this method.
Bacterial flora and infection in patients with brain injury
Authors: Romig Donald A. , Voth Douglas W. , Liu Chien , Brackett Charles E.
Published: May 2009

✓ Twenty-five patients with acute head trauma were studied prospectively for appearance of infection during hospitalization in an acute care unit. The study demonstrates: multiple changes in bacterial flora particularly in the respiratory tract, a significant morbidity due to bacterial changes in the respiratory tree, a negligible incidence of bacterial disease due to physiological monitoring procedures, and an inability to correlate changing flora with specific therapeutic or manipulative procedures except tracheostomy. Mortality correlates well with the severity of illness and indirectly with changes in bacterial flora. Despite the frequent isolation of coagulase-positive staphylococci, severity of infectious complications correlate most closely with the acquisition of gram-negative organisms in the respiratory tract.
Differential sacral rhizotomy in the treatment of neurogenic bladder dysfunction
Authors: Rockswold Gaylan L. , Bradley William E. , Chou Shelley N.
Published: May 2009

✓ This report describes a technique of differential sacral rhizotomy for the treatment of neurogenic bladder dysfunction, particularly symptoms of frequency, urgency, and incontinence due to detrusor hyperreflexia. Under cystometric control, the sacral nerve roots are stimulated and anesthetized to determine the correct roots for section. Under magnification, cutting a few but not all of the fascicles in one or two roots increases bladder capacity while preserving detrusor reflex and sphincter function. Air cystometry and selective percutaneous sacral nerve blocks are used preoperatively to determine whether the operative procedure could be of value in relieving the symptoms. Our experience with six patients so evaluated and treated has been encouraging.
Dorsal rhizotomy for the relief of intractable pain of malignant tumor origin
Authors: Barrash J. Martin , Leavens Milam E.
Published: May 2009

✓ Experience with dorsal rhizotomy in 71 patients with intractable pain is presented. The authors believe this treatment is indicated for cancer patients who are in good enough physical condition to tolerate a laminectomy, have a moderate life expectancy, and whose pain involves structures innervated by one or several roots. An extremity should be denervated only if it is already without functional value. The advantage of sensory rhizotomy is that it produces a lasting anesthesia that is tolerable to the patient. The results Were good to excellent in 50 of the 71 patients. There were five operative deaths.
Vaginal perforation as a complication of ventriculoperitoneal shunt
Authors: Patel C. D. , Matloub Hani
Published: May 2009

✓ A case in which vaginal perforation complicated a ventriculoperitoneal shunt is reported.
Tentorial block of cerebrospinal fluid associated with a lumbar neurofibroma
Authors: Neil-Dwyer G.
Published: May 2009

✓ A case is reported in which raised intracranial pressure with papilledema due to hydrocephalus resulting from a subarachnoid block at the tentorial hiatus was associated with a lumbar intradural neurofibroma. The possible significance of elevated protein content in cerebrospinal fluid samples taken above and below the tumor is discussed.
Cyst of the septum pellucidum causing increased intracranial pressure and hydrocephalus
Authors: Heiskanen Olli
Published: May 2009

✓ A 22-month-old girl had a large noncommunicating cyst of the septum pellucidum which blocked the foramen of Monro and caused increased intracranial pressure and hydrocephalus. She recovered completely after the cyst wall was removed.
Struthers ligament: a source of median nerve compression above the elbow
Authors: Smith Richard V. , Fisher Robert G.
Published: May 2009

✓ A case of median nerve entrapment at the elbow by a non-osseous fibrous ligament (Struthers) is presented. A relatively simple surgical procedure with ligament division afforded complete relief of symptoms. The existence of Struthers' ligament without a bony supracondylar process is reaffirmed, and the historical background of its identification outlined.
Cervical posterior rhizotomy for reducing spasticity in cerebral palsy
Authors: Heimburger Robert F. , Slominski Anita , Griswold Patricia
Published: May 2009

✓ Cervical posterior rhizotomy was carried out in 15 patients with cerebral palsy. Spasticity of the neck, spine, arms, and legs decreased in 13 of the 15. The improvement was not dramatic in any, but permitted improved voluntary function in five, and more effective rehabilitation in the remainder. Abnormal involuntary movement was decreased and progressive scoliosis arrested. Specific surgical problems and suggestions are discussed.
Regeneration of the human pituitary
Authors: Landolt Alex M.
Published: May 2009

✓ The pituitary remnant was examined in 13 patients in whom a stereotaxic, transsphenoidal, high-frequency coagulation had been performed because of widespread metastatic disease. The patients were divided in three groups according to the state of regeneration of pituitary tissue. The first group (patients dying 3 to 7 days after surgery) showed only signs of acute necrosis. The second group (patients dying 24 to 219 days after surgery) demonstrated mitotic figures and regenerated areas in the adenohypophysis. The third group (patients dying 252 to 353 days after surgery) showed no mitoses but large areas of regenerated glandular cells as a sign of completed regeneration. It seems that the pituitary can regenerate provided that the dominating hypothalamic centers remain undamaged during hypophysectomy.
Value of normothermic perfusion, hypothermic perfusion, and durotomy in the treatment of experimental acute spinal cord trauma
Authors: Tator Charles H. , Deecke Lüder
Published: May 2009

✓ Investigations were performed to determine the relative therapeutic value of local hypothermic perfusion, local normothermic perfusion, and durotomy in monkeys injured by circumferential compression of the spinal cord at T9–10. A new method of cord compression was used consisting of an inflatable Silastic cuff which was passed around the cord extradurally and inflated to either 350 or 400 mm Hg. At the lower compression force, both hypothermic and normothermic perfusion improved the neurological recovery compared to that in control animals. However, at the higher degree of compression only normothermic perfusion produced significantly better recovery. Durotomy was excluded as a contributing factor. The results indicate that normothermic perfusion is a better method of treatment and that the beneficial effect of hypothermic perfusion is probably due to the perfusion rather than the hypothermia. The mechanism by which perfusion exerts its beneficial effect is unknown, but it is suggested that dialysis of noxious substances from the injured cord may play a role.
The syndromes and surgical treatment of aneurysms of the great vein of Galen
Authors: Amacher A. Loren , Shillito John
Published: May 2009

✓ The authors review 37 cases of primary aneurysms of the vein of Galen reported in the literature and present five new ones. The magnitude of the shunt from arterial feeders to the primary aneurysm indicates the age at which the patient's symptoms first appeared as well as the nature and severity of those symptoms. Newborn infants have intractable heart failure, older infants have hydrocephalus, and adolescents have headache and syncope. Four clinical categories, based on the time of onset of symptoms, are described, and the diagnostic studies and surgical techniques discussed. Four-vessel angiography and ligation of the feeding vessels at the point of entry into the vein of Galen are recommended.
Successful evacuation of a pontine hematoma secondary to rupture of a pathologically diagnosed “cryptic” vascular malformation
Authors: Scott Ben B. , Seeger Joachim F. , Schneider Richard C.
Published: May 2009

✓ A posterior fossa exploration was performed on a child thought initially to have an inoperable brain stem lesion. A pontine hematoma was discovered and evacuated. The pathological specimen was designated as a “cryptic” arteriovenous malformation. All preoperative neurological deficits disappeared except for a minimal left seventh nerve palsy.
Recurrent desmoid tumor following cervical laminectomy
Authors: Wyler Allen R. , Harris A. Basil
Published: May 2009

✓ A case of recurrent desmoid is reported in which the tumor appeared 1 year after a limited cervical laminectomy, and again 6 months following primary excision. Primary radical excision is stressed as the treatment of choice for these tumors.
A three-way external vertical cannula for measurement of blood pressure at junctions of arteries in dogs
Authors: Hori Shigeaki , Goldstein Stanton L. , Himwich Williamina A.
Published: May 2009

✓ An external vertical cannula devised to measure intravascular pressure in small arteries in dogs without obstructing blood flow was modified to permit its application to junctions between arteries and side branches. The mean pressure was determined by replaying the tape recording of the pressure through a dynograph amplifier. Blood pressure was measured in the right intracranial internal carotid artery (IIC) at the origin of the posterior communicating artery (PCOM) in four adult mongrel dogs. Simultaneous measurement of blood pressure made through the cannula showed that at the junction of the IIC and PCOM the average blood pressure was 118 mm Hg and pulse pressure 34 mm Hg as compared with 129 and 42 mm Hg, respectively, in the right common carotid artery, and 133 and 55 mm Hg in the femoral artery.
Guide wire technique for revision of ventriculocardiac shunt
Authors: Reynolds John D.
Published: May 2009

✓ A simple guide wire technique is described for introducing and placing the cardiac catheter in revision of a ventriculoatrial shunt. The advantages include easier passage of a catheter through tortuous or aberrant venous channels and areas of stenosis, and more accurate cardiac catheter tip localization. Suggestions regarding manipulation of the wire and placement of the catheter are also presented.
Surgical treatment of spontaneous intracerebral hemorrhage
Authors: Paillas Jean E. , Alliez Bernard
Published: May 2009

✓ The results of the surgical treatment of cerebral hemorrhage in 250 cases are reported. Preoperative diagnosis, the selection of patients, and the favorable moment to operate are discussed.
Head injury in the chimpanzee
Authors: Ommaya Ayub K. , Corrao Paul , Letcher Frank S.
Published: May 2009

✓ Requirements for extrapolating head injury tolerance levels from subhuman primates to man necessitated data from a primate species with a brain weight between that of the rhesus monkey (100 gm) and man (1200 gm). Cerebral concussion (traumatic unconsciousness) in the chimpanzee (brain weight, 400 gm) is found to occur when the head experiences angular velocities exceeding 70 to 120 radians/ sec irrespective of how such head rotations are produced, i.e., whether indirectly by a whiplash mechanism or directly by impact to the occiput. The threshold for the production of skull fracture and visible brain lesions appears to be quite close to that found for traumatic unconsciousness. Associated neurological, cardiovascular, and pathological effects of head injury in this species are also described, and a new hypothesis for traumatic unconsciousness (cerebral concussion) is presented.
Head injury in the champanzee
Authors: Letcher Frank S. , Corrao Paul G. , Ommaya Ayub K.
Published: May 2009

✓ The effect of experimental head injury on the electroencephalogram (EEG) and cortical evoked response was studied in 11 awake, moderately restrained chimpanzees. As a base for comparison with injury effects, the waking and sleeping electroencephalogram (EEG) and the somatic and visual evoked responses (SER and VER) were investigated first. Unusually high voltage occipital waves and a propensity for photic driving characterized the EEG. Controlled blows to the occiput in 10 animals produced reversible depression of consciousness in only four. In those four, the EEG and SER were affected differently immediately after the injury; the SER showing marked suppression while the early EEG was unaffected. Recovery of the SER and of consciousness paralleled each other. With injuries causing prolonged or irreversible loss of consciousness, the later EEG showed depression or large amplitude slow waves, which became isoelectric if the blow was fatal.
Disseminated intravascular coagulation associated with massive brain injury
Authors: Keimowitz Rudolph M. , Annis Byron L.
Published: May 2009

✓ The authors report a case of disseminated intravascular coagulation in a patient with massive brain trauma. It is suggested that the condition was caused by the liberation of thromboplastin. The detailed diagnostic studies and related theories are discussed.
Intracranial hemorrhage in patients with hemophilia
Authors: Seeler Ruth Andrea , Imana Renato B.
Published: May 2009

✓ Intracranial hemorrhage occurred in four patients with hemophilia following mild head trauma. Three patients had severe factor VIII (antihemophilic factor, AHF) deficiency while one had mild (5.5%) AHF deficiency. The authors stress the need for immediate AHF replacement therapy and appropriate neurosurgical work-up, and a joint effort by hematologist and neurosurgeon to minimize neurological damage. In the four patients, three subdural hematomas, one epidural and one intracerebral hematoma were safely evacuated.