bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of survival following direct surgery for anterior communicating artery aneurysms
Authors: Sengupta Ram P. , Chiu James S. P. , Brierley Harry
Published: May 2009

✓ The authors describe a series of 32 patients with ruptured aneurysms of the anterior communicating artery who were admitted during a 3-year period. In 28, the aneurysms were treated by direct surgery with no deaths; 26 of these patients were studied psychometrically from 4 to 33 months after operation. There was no evidence of postoperative intellectual impairment; however, there were personality changes associated with loss of interest, initiative, and energy. Analysis of the different factors involved suggests to the authors that the outcome of surgery depends mainly on preoperative clinical condition which, in turn, reflects the severity of the hemorrhage.
Late appearance of meningioma at the site of partially removed oligodendroglioma
Authors: Tanaka Junichi , Garcia Julio H. , Netsky Martin G. , Williams J. Powell
Published: May 2009

✓ A case is presented in which a meningioma and a glioma grew in the region where, 23 years before, a glial tumor had been partially removed and irradiated. The authors suggest that surgical trauma and ionizing radiation may have influenced the tumor's development.
Cloverleaf skull syndrome
Authors: Muller Paul J. , Hoffman Harold J.
Published: May 2009

✓ The authors report a case of cloverleaf skull syndrome (Kleeblattschädel) and describe how early surgical management of this condition appears to offer hope for a reasonable cosmetic result, as well as improvement in cerebral function to the point where children with this syndrome may avoid institutional care.
Bilateral aberrant regeneration of the third cranial nerve following trauma
Authors: Keane James R.
Published: May 2009

✓ This 6-year-old boy, after recovery from prolonged coma following head trauma, exhibited the rare phenomenon of bilateral oculomotor nerve misdirection manifested by ipsilateral eyelid elevation on adduction of either eye.
Carpal tunnel syndrome in pediatric mucopolysaccharidoses
Authors: Miner Michael E. , Schimke R. Neil
Published: May 2009

✓ Four pediatric patients with mucopolysaccharidoses and an associated carpal tunnel syndrome are presented. Findings in these cases were typical of the adult form of median nerve compression at the wrist, but the patients had minimal symptoms in view of these findings. The importance of careful clinical examination and early surgical decompression is emphasized.
Arteriovenous malformation and oligodendroglioma
Authors: Crowell Robert M. , DeGirolami Umberto , Sweet William H.
Published: May 2009

✓ The coincidence of arteriovenous malformation (AVM) and primary brain neoplasm is rare. We are reporting a case of oligodendroglioma within an arteriovenous malformation.
Perforation of the intestine by a Raimondi peritoneal catheter
Authors: Peirce Kenneth R. , Loeser John D.
Published: May 2009

✓ The authors report a case in which the cut end of a Raimondi peritoneal catheter apparently caused intestinal perforation and contamination of the shunt system. The authors advise that if this type of catheter is to be divided the cut should be distal to the end of the sharp wire contained in it, which otherwise will protrude.
Chemotherapeutic implications of growth fraction and cell cycle time in glioblastomas
Authors: Hoshino Takao , Wilson Charles B. , Rosenblum Mark L. , Barker Marvin
Published: May 2009

✓Four patients received 3H-thymidine 4 to 7 days and vinblastine 4 to 6 hours prior to operation for recurrent malignant gliomas (three glioblastomas and one anaplastic astrocytoma). Tumor biopsies obtained at operation were fixed for routine histological studies and radioautography. The tumors' growth fractions averaged 0.28 with a range of 0.14 to 0.39. The tumor cell cycle time calculated in three patients had a mean duration of 57 hours with a standard deviation of 6 hours. The authors concluded that: 1) single short-term courses of cell-cycle specific chemotherapeutic agents alone will probably fail to achieve either significant reduction in tumor mass or dramatic clinical improvement; 2) cell-cycle phase-specific drugs should be administered to maintain effective blood levels over 2 to 3 days for maximal tumor cell kill. Tumor growth rate appears to correlate with the fraction of proliferating cells rather than the length of the tumor cell cycle. The scientific basis for combination drug and multimodality therapy is discussed.
Computer-assisted analysis of intraventricular pressure after mannitol administration
Authors: Szewczykowski Jerzy , Sliwka Stanislaw , Kunicki Adam , Korsak-Sliwka Jolanta , Dziduszko Jacek , Dytko Pawel , Augustyniak Bozena
Published: May 2009

✓The effect of prolonged mannitol infusion upon intraventricular pressure was investigated with the aid of a specially-designed automatic digital recording system; the data recorded were processed off-line by a minicomputer. The character of the pressure curves is thought to result from interaction between the mannitol effect and the observed system's shifting equilibrium position, which is caused by other factors. The character of the pressure curves prior to mannitol infusion must be taken into consideration in estimating the actual effect of the drug; the authors suggest that in certain cases it might be possible to decrease further the rate of mannitol administration. The advantages of statistical approach to the evaluation of intracranial pressure variations are discussed.
Cerebral dynamic studies for early detection of recurrent anaplastic intracranial gliomas
Authors: Witherspoon Lynn R. , Mahaley Moses S. , Leonard John R. , Tyson J. Wendell , Harris C. Craig , Goodrich Jack K.
Published: May 2009

✓ The authors compared radionuclide cerebral dynamic studies, brain scans, and clinical evaluation as indicators of recurrence of intracranial anaplastic gliomas and found cerebral dynamic studies more sensitive to tumor growth than static brain scans. The former may show changes prior to clinical evidence of tumor progression.
Miniature intravascular pCO2 sensors in neurosurgery
Authors: Neumark Julius , Bardeen Ann , Sulzer Edith , Kampine John P.
Published: May 2009

✓ In this study the authors compared PaCO2 measurements from a newly developed miniature intravascular pCO2 sensor for continuous on-line monitoring with those from a Radiometer bench instrument. In 10 patients undergoing craniotomy procedures, 84 paired comparisons were made. At the same time it was possible to follow continuously the trend of PaCO2 during deliberate hyperventilation, during the apneic period following hyperventilation, and during spontaneous respiration in the postoperative period. The comparisons showed an average difference in pCO2 of 1.62 ± SE 0.15 torr. The apneic threshold for PaCO2 after passive hyperventilation was lower than in the awake patient. After the period of apnea no hypoxemia occurred. In the recovery room the PaCO2 increased and the PaO2 decreased. The latter decreased to subnormal levels in two patients more than an hour postoperatively.
Empty sella syndrome as complication of benign intracranial hypertension
Authors: Weisberg Leon A. , Housepian Edgar M. , Saur David P.
Published: May 2009

✓ An empty sella was demonstrated on air study in five patients with the benign intracranial hypertension (BIH) syndrome. All patients had a protracted course and very high cerebrospinal fluid pressure; two required a shunt procedure. No patient had any endocrine symptoms or visual field defects but an air study was done to exclude a mass lesion in the sella region. Among the last 50 patients seen with the BIH syndrome, there were five cases of an associated empty sella (10%). In these cases, the empty sella is a probable consequence of the long-standing intracranial hypertension associated with a congenital deficiency of the diaphragma sellae.
Long-term survival of patients treated with BCNU for brain tumors
Authors: Calogero John , Crafts David C. , Wilson Charles B. , Boldrey Edwin B. , Rosenberg Alan , Enot K. Jean
Published: May 2009

✓The authors present three patients who, after excision and irradiation of their brain tumors, were treated with BCNU for recurrence. All three patients responded well and now are without evidence of tumor, 37, 30, and 36 months after BCNU was stopped. Although these patients represent only a small fraction of those treated with BCNU, they indicate the potential role of chemotherapy in the management of glial tumors.
Neurological manifestations of primary rhabdomyosarcoma of the head and neck in children
Authors: Fleischer Alan S. , Koslow Maxim , Rovit Richard L.
Published: May 2009

✓The authors describe four of their own cases of primary rhabdomyosarcoma (RMS) of the head and neck and summarize an additional 25 cases collected from the world literature, each manifesting neurological involvement. The need for early diagnosis and radical surgery is stressed.
Air gun pellet embolizing the intracranial internal carotid artery
Authors: Padar Stephen C.
Published: May 2009

✓A rare case of a pellet embolus to the internal carotid artery is reported, and similar cases are briefly reviewed.
Choroid plexus carcinoma
Authors: Dohrmann George J. , Collias James C.
Published: May 2009

✓The authors report a case of carcinoma of the choroid plexus and review the 22 cases reported since 1844 that adhere to the criteria for primary choroid plexus carcinoma. Two-thirds of the tumors are found in children and all of these are located in the lateral ventricles. In adults most of the tumors are present in the fourth ventricle. Differentiation of this neoplasm from papillary ependymomas, choroid plexus papillomas, secondary carcinomas, and “collision tumors” is discussed.
Ascites from a ventriculoperitoneal shunt
Authors: Weidmann Michael J.
Published: May 2009

✓ An unusual case of ascites secondary to a ventriculoperitoneal shunt is presented. The ascites did not redevelop following diversion of the distal catheter into the right atrium, and no adequate explanation was found as to why the cerebrospinal fluid was not absorbed by the peritoneum.
Therapeutic percutaneous embolization for extra-axial vascular lesions of the head, neck, and spine
Authors: Hilal Sadek K. , Michelsen Jost W.
Published: May 2009

✓ Therapeutic percutaneous embolization of extra-axial vascular tumors and arteriovenous malformations was performed 41 times in 27 patients. Twenty-one patients (78%) had a clinically favorable result. In 11 of these patients, the procedure was preoperative and caused a dramatic reduction of surgical blood loss. In the remaining 10 patients with a favorable result, therapeutic embolization alone resulted in a significant clinical amelioration documented by a detailed follow-up varying from 2 to 5 years. In patients with uncontrollable epistaxis, the procedure was life-saving. The guidelines and instrumentation for a safe and effective technique are presented, based on the authors' experience with more than 100 cases of vascular lesions of the brain and spinal cord. A low-viscosity silicone polymer was developed by the authors and used clinically as an intravascular adhesive for the embolization of vascular tumors.
Experimental cerebral oligemia and ischemia produced by intracranial hypertension
Authors: Marshall Lawrence F. , Durity Felix , Lounsbury Robert , Graham David I. , Welsh Frank , Langfitt Thomas W.
Published: May 2009

✓ Cerebral blood flow, electrical activity, and neurological function were studied in rabbits subjected to either 15 minutes of oligemia (20 torr cerebral perfusion pressure) or complete cerebral ischemia produced by cisterna magna infusion. During oligemia, flow was reduced from 68.4 ± 4.2 ml/100 gm/min to 26.3 ± 4.4 (p < .01), and during ischemia animals had no proven flow. By 5 minutes after oligemia or ischemia significant symmetrical hyperemia occurred and there was no evidence of the no-reflow phenomenon. The electroencephalogram became isoelectric significantly later and returned significantly sooner in oligemia than in ischemia. Oligemic animals had earlier and better return of neurological function than their ischemic counterparts, although postinsult hypocapnia improved functional recovery in both groups. These experiments do not support the concept that oligemia is a more severe insult than complete ischemia. In intracranial hypertension produced by this model, the no-reflow phenomenon does not occur.
Experimental cerebral oligemia and ischemia produced by intracranial hypertension
Authors: Marshall Lawrence F. , Welsh Frank , Durity Felix , Lounsbury Robert , Graham David I. , Langfitt Thomas W.
Published: May 2009

✓ The authors studied the effect on cortical metabolites of intracranial hypertension produced by the infusion of mock cerebrospinal fluid into the cisterna magna in rabbits subjected to 15 minutes of cerebral oligemia (20 torr) or 15 minutes of complete ischemia. In both groups high-energy metabolites were exhausted within the first 5 minutes of the 15-minute insult. Significant recovery of the high-energy intermediates occurred within 15 minutes of reperfusion, well before return of electroencephalogram (EEG) activity. Continued reperfusion, during which electrical activity and function were returning, brought only moderate improvement in energy metabolites. In contrast, severe lactic acidosis persisted at least 15 minutes after insult, but was reduced by the time EEG activity returned. At no time were there striking differences in metabolites between the oligemic and ischemic groups. These results indicate that recovery in general, and the significantly earlier recovery of oligemic as compared to ischemic animals, cannot be explained on the basis of energy supply. Whether the persistence of lactic acidosis is an important factor limiting return of function requires further study.
Spinal evoked response in the cat
Authors: Sarnowski Robert J. , Cracco Roger Q. , Vogel Harold B. , Mount Fred
Published: May 2009

✓ Summated evoked potentials to sciatic nerve stimulation were recorded from surface electrodes placed over the spine of cats. The response progressively increased in latency rostrally. It was largest and most complex in configuration in leads placed over the caudal spinal cord where sciatic nerve roots enter and begin to ascend the cord. The conduction velocity of the response was about 90 m/sec from rostral sacral to cervical regions.

A comparison of surface-recorded evoked responses to stimulation of the sural nerve, the nerve to the medial head of the gastrocnemius muscle and the sciatic nerve suggest that the peripheral nerve fibers that mediate the response to sciatic nerve stimulation are primarily muscle nerve afferents. In surface, lamina, and durai recordings made over similar segmental levels, the response to sciatic nerve stimulation progressively increased in amplitude, duration, and wave form complexity from surface to depth. Failure of transmission across complete cord transections was demonstrated. Results in preparations with partial cord sections suggest that the surface-recorded response is mediated by multiple spinal cord afferent pathways which are situated primarily ipsilateral to the stimulated peripheral nerve.

The data indicate that summated evoked responses arising in spinal cord afferent pathways can be recorded from surface-recording electrodes in cats. They suggest that this animal model may prove useful in the study of certain aspects of spinal cord pathology.
Treatment of internal carotid bifurcation aneurysms by direct surgery
Authors: Sengupta Ram P. , Lassman Laurance P. , de Moraes Ailton A. , Garvan Neil
Published: May 2009

✓ Nine cases of aneurysm at the bifurcation of the internal carotid artery are described. All patients were submitted to direct intracranial surgery and the neck of the sac in eight cases was occluded by spring clip. There was no mortality and only one poor result. From an analysis of these cases and a review of the literature, some characteristics of these aneurysms and their management are described.
Sphenoid sinus mucoceles
Authors: Hakuba Akira , Katsuyama Junsuke , Matsuoka Yoshimi , Shim Jae Hong , Nishimura Shüro
Published: May 2009

✓ Two cases of mucocele of the sphenoid sinus that involved visual impairment and headache are presented. A transpalatal approach is considered best for cases with extensive sphenoidal bone destruction in which the preoperative diagnosis is uncertain.
Effects of increased intracranial pressure on cerebral blood volume, blood flow, and oxygen utilization in monkeys
Authors: Grubb Robert L. , Raichle Marcus E. , Phelps Michael E. , Ratcheson Robert A.
Published: May 2009

✓ The relationship of cerebral blood volume (CBV) to cerebral perfusion pressure (CPP), cerebral blood flow (CBF), and the cerebral metabolic rate for oxygen (CMRO2) was examined in rhesus monkeys. In vivo tracer methods employing radioactive oxygen-15 were used to measure CBV, CBF, and CMRO2. Cerebral perfusion pressure was decreased by raising the intracranial pressure (ICP) by infusion of artificial cerebrospinal fluid (CSF) into the cisterna magna. The production of progressive intracranial hypertension to an ICP of 70 torr (CPP of 40 torr) caused a rise in CBV accompanied by a steady CBF. With a further increase in ICP to 94 torr, CBV remained elevated without change while CBF declined significantly. Cerebral metabolic rate for oxygen did not change significantly during intracranial hypertension. For comparison, CPP was lowered by reducing mean arterial blood pressure in a second group of monkeys. Only CBF was measured in this group. In this second group of animals, the lower limit of CBF autoregulation was reached at a higher CPP (CPP ∼ 80 torr) than when an increase in ICP was employed (CPP ∼ 30 torr).
Chronic cerebral arterial spasm
Authors: Farrar J. Keith
Published: May 2009

✓ The author used isolated rabbit common carotid and femoral arteries perfused at a constant pressure of 90 mm Hg to examine the variation of flow (F) with transmural pressure (TMP). When the TMP was reduced below 50 to 60 mm Hg in arteries with normal smooth muscle tone, arterial resistance increased significantly causing a reduction in flow. It is suggested that the diffuse arterial narrowing that occurs in patients with severe intracranial hypertension may be the result of a similar reduction in TMP. In the presence of active vasoconstriction, any increase in extraluminal (intracranial) pressure (ICP) resulted in a substantial increase in arterial resistance and subsequent reduction of flow. This F-TMP relationship depended only on the initial degree of constriction and was independent of the vasoconstrictor used to achieve this constriction and of the artery in which this constriction was produced. A review of the literature suggests that human cerebral arteries normally exhibit only mild constrictions in response to subarachnoid blood during the chronic phase of spasm. In the present study, a mild constriction in the absence of increased ICP or a moderate increase in ICP (45 mm Hg) in the absence of constriction produced minor reductions in arterial diameter and an average flow reduction of only 5% to 10%. However, when ICP was increased to 45 mm Hg in the presence of a mild constriction, severe arterial narrowing resulted and flow was reduced by 50%. Therefore, it is suggested that chronic arterial spasm is the result of a mild constriction which is amplified by the simultaneous occurrence of increased ICP. Phenoxybenzamine was found to be effective in reversing and preventing these contractions. The improvement in flow produced by phenoxybenzamine decreased as the TMP was reduced below 60 mm Hg. The effects of both diffuse and local spasm on cerebral blood flow are discussed.
Clinical results with metrizamide ventriculography
Authors: Skalpe Ingar O. , Amundsen Per
Published: May 2009

✓ Seventeen ventriculograms with the non-ionic water-soluble contrast medium, metrizamide, were performed in 15 patients, with negligible adverse effects. Visualization of the ventricular system was good in most of the patients. A combined technique, using both metrizamide and gas, increased the diagnostic value of the procedure in some cases.
Use of the operating microscope in anterior cervical discectomy without fusion
Authors: Hankinson Hal L. , Wilson Charles B.
Published: May 2009

✓ The authors report their experience using the operating microscope in 52 anterior cervical discectomies without fusion. They found long-term results highly satisfactory, even in difficult cases with multiple-level disease, and complications from bone grafting were obviated. They highly recommend this approach for radicular, nonradicular, or myelopathic symptoms.
Experimental hydrosyringomyelia, ischemic myelopathy, and syringomyelia
Authors: Hall Peter V. , Muller Jans , Campbell Robert L.
Published: May 2009

✓ The authors found that cavities in the spinal cord of dogs appearing after the intracisternal administration of kaolin are not due to ischemic softening, but rather to distention and subsequent rupture of the central canal. Ischemic lesions could be produced and were found to have a quite different histopathology; this supports the hydrodynamic hypothesis of cavitary myelopathy following adhesive arachnoiditis, probably as a compensatory mechanism to the associated hydrocephalus. The similarities to human syringomyelia are discussed.
Abdominal pseudocysts and ascites formation after ventriculoperitoneal shunt procedures
Authors: Parry S. Walton , Schuhmacher John F. , Llewellyn Raeburn C.
Published: May 2009

✓The authors report three patients with abdominal pseudocysts and one with cerebrospinal fluid ascites as late complications of ventriculoperitoneal shunts. The presenting signs and symptoms were those of an intraabdominal abnormality, with no neurological symptoms suggestive of shunt malfunction.
Spontaneous umbilical fistula from ventriculoperitoneal shunt drainage
Authors: Antunes Ápio C. M. , Ribeiro Telmo R.
Published: May 2009

✓ Two cases of spontaneous fluid fistula through the umbilicus connected with the drainage from a ventriculoperitoneal shunt are described. In neither case was it necessary to remove the shunt.
Complete embolization of artery of Adamkiewicz to obliterate an intramedullary arteriovenous aneurysm
Authors: Decker Robert E. , Stein Harry L. , Epstein Joseph A.
Published: May 2009

✓ A case history of an intramedullary arteriovenous aneurysm of the thoracolumbar junction is presented, and an unusual 14-year follow-up after the original sub-arachnoid bleeding episode is detailed. Embolization of anterior and mixed angiomas involving the artery of Adamkiewicz may be feasible when the artery is large and shunting is present.
Persistent proatlantal artery with carotid-vertebral anastomosis
Authors: Rao T. Surya , Sethi Prahlad K.
Published: May 2009

✓ The authors describe the occurrence of proatlantal artery as an incidental angiographic observation in a young Indian soldier. This primitive anastomotic channel is seen extending from near the origin of the external carotid artery to the suboccipital region, traversing the foramen magnum and coursing beyond like a vertebral artery. The developmental and roentgenological aspects of carotid-basilar and carotid-vertebral anastomosis are discussed, along with a review of four similar cases reported previously.
Clinical manifestations of aqueductal stenosis in adults
Authors: Little John R. , Houser O. Wayne , MacCarty Collin S.
Published: May 2009

✓ The authors review 17 cases of aqueductal stenosis in adults and describe five modes of clinical presentation. The average duration of symptoms was 6 years. Dementia was infrequent. Skull x-ray films frequently demonstrated some degree of cranial enlargement and signs of chronic increased intracranial pressure. Characteristic alterations of the sella included elongation of the anterior wall and flattening, erosion, and anterior displacement of the dorsum. Aqueductal configurations as defined by ventriculography and pneumoencephalography in all cases, and the angiographic findings in seven cases are described. Most of the patients improved substantially after shunt insertion. The clinical findings suggested that aqueductal narrowing and associated hydrocephalus had been present in most of these patients since early life.
Agenesis of arachnoid granulations and its relationship to communicating hydrocephalus
Authors: Gutierrez Yezid , Friede Reinhard L. , Kaliney William J.
Published: May 2009

✓ The authors discuss reabsorption of cerebrospinal fluid in relation to the postmortem findings in two children, one with total agenesis of the Pacchionian system accompanied by hydrocephalus, and the other with a subtotal agenesis and no hydrocephalus. Case 1 is the only known documented case of total agenesis of the Pacchionian system and gives credence to the idea that an impaired reabsorption of cerebrospinal fluid at the level of the Pacchionian system is a cause of hydrocephalus. The patient in Case 2 showed only two small areas of arachnoid granulations containing a few flattened, microscopic villi of normal cellularity.
Ultrastructural observations of the capsule of chronic subdural hematoma in various clinical stages
Authors: Sato So , Suzuki Jiro
Published: May 2009

✓ The authors used light and electron microscope to examine the capsules of chronic subdural hematoma in 33 cases. In cases with neurological deficits, capillary endothelial cells in the capsule had many cytoplasmic protrusions and fenestrations, suggesting high permeability of the capillary wall. Endothelial degeneration was also observed in these cases. These morphological changes were reversed by osmotherapy. Formation of collagen fibrils from fibroblasts in the hematoma capsule was frequently observed in the cases treated by osmotherapy.
Indications for surgical treatment of intracerebral hemorrhage
Authors: Tedeschi Gabriele , Bernini Francesco Paolo , Cerillo Adolfo
Published: May 2009

✓ The authors report a series of 71 patients with intracerebral hemorrhage: 57 underwent surgery and 14, although suitable candidates for surgery, refused operation. The results are assessed in relation to the site of the hemorrhage, mode of onset, and interval between accident and operation.
Neurinomas of the facial nerve
Authors: Isamat Fabian , Bartumeus Federico , Miranda Antonio M. , Prat Jaime , Pons Luis C.
Published: May 2009

✓ Three cases of neurinomas of the facial nerve are reported. Two of them originated from the labyrinthine portion of the nerve and the other from the vertical portion. Neurinomas of the first part of the facial nerve can be suspected preoperatively since they seem to give rise to specific clinical and radiological manifestations that can be distinguished from tumors of other portions of the nerve, the petrous bone area, or the cerebellopontine angle. The reported cases of neurinomas of the facial nerve are reviewed and analyzed.
Embolic posterior cerebral artery occlusion secondary to spondylitic vertebral artery compression
Authors: Sullivan Humbert G. , Harbison John W. , Vines Frederick S. , Becker Donald
Published: May 2009

✓ The authors report a case of isolated homonymous hemianopsia secondary to embolic occlusion of the posterior cerebral artery. The cause of embolism was demonstrated to be spondylitic vertebral artery compression. The importance of arteriography is emphasized since the clinical syndrome may be nonspecific and myelographic or plain x-ray changes may be minimal. Surgical therapy is also discussed.
Superimposed chronic subdural hygromas
Authors: Maurice-Williams Robert S.
Published: May 2009

✓ Two cases are reported of separate but superimposed chronic subdural collections occurring over one cerebral hemisphere convexity. It is suggested that this phenomenon may account for some apparent recurrences of chronic subdural collections after simple burr-hole evacuation.
Extradural guinea-worm abscess
Authors: Khwaja Mohammed S. , Dossetor Jonathan F. B. , Lawrie James H.
Published: May 2009

✓ Two cases are reported of extradural abscess from guinea-worm infection, one that resulted in paraplegia, and the other in motor weakness of the legs.
Pneumocephalus following ventriculoperitoneal shunt
Authors: Pitts Lawrence H. , Wilson Charles B. , Dedo Herbert H. , Weyand Robert
Published: May 2009

✓ The authors describe a case of massive pneumocephalus following ventriculoperitoneal shunting for hydrocephalus. After multiple diagnostic and surgical procedures, congenital defects in the tegmen tympani of both temporal bones were identified as the sources for entry of air. A functioning shunt intermittently established negative intracranial pressure and allowed ingress of air through these abnormalities; when the shunt was occluded, air did not enter the skull, and there was no cerebrospinal fluid leakage. Repair of these middle ear defects prevented further recurrence of pneumocephalus.
Intraoperative use of Doppler to detect successful obliteration of carotid-cavernous fistulas
Authors: Matjasko M. Jane , Williams J. Powell , Fontanilla Manuel
Published: May 2009

✓ The authors describe their use of a Doppler flow detector in the treatment of carotid-cavernous fistulas to monitor the ocular bruit, the clinical sign usually used to detect obliteration of the fistula. In seven procedures the Doppler ultrasonic flow detector has yielded satisfactory proof that the flow sounds were no longer audible, and that the surgery was successful.
Watertight closure of spinal dura mater
Authors: Mayfield Frank H. , Kurokawa Kensuke
Published: May 2009

✓ The authors describe a technique by which a plug of fat is used to repair small rents in the spinal dura mater.
Surgical removal of arteriovenous malformations from the brain stem and cerebellopontine angle
Authors: Drake Charles G.
Published: May 2009

✓ The author reports his surgical experience with five cases of arteriovenous malformation of the brain stem and cerebellopontine angle causing multiple hemorrhages and severe neurological deficits. Surgical removal of the lesions had good results in four cases; there was one death.
Neurogenic control of cerebral blood flow in the baboon
Authors: Kawamura Yasuo , Meyer John Stirling , Hiromoto Hideharu , Aoyagi Minoru , Tagashira Yukio , Ott Erwin O.
Published: May 2009

✓ Cerebral chemical vasomotor reactivity and autoregulation were tested in normal baboons before and after the intravenous or intravertebral infusion of atropine sulfate (0.02 mg/kg). Atropine did not appreciably affect autoregulatory response, but intravertebral injection suppressed the increase of cerebral blood flow (CBF) by inhalation of 5% CO2 and enhanced the decrease of CBF induced by hyperventilation. These changes produced by intravertebral injection of atropine were not observed after intravenous injection. Since the vertebrobasilar arterial system supplies the brain stem and diencephalon, this suggests that a central vasodilator tonus of the cerebral vessels is maintained by the innervation of the cerebral vessels by cholinergic neurons which have their central origin in the brain stem and diencephalic area.
Regional cerebral blood flow studies following superficial temporal-middle cerebral artery anastomosis
Authors: Heilbrun M. Peter , Reichman O. Howard , Anderson Robert E. , Roberts Theodore S.
Published: May 2009

✓ Regional cerebral blood flow (rCBF) studies were performed during the postoperative period on 16 patients with internal carotid occlusions and inaccessible stenoses, and middle cerebral artery occlusion and stenoses, who underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomoses. The intra-arterial xenon method with selective application of the xenon bolus through the internal carotid and the newly established superficial temporal channel has allowed comparison of the flow provided by the pathological input with flow through the new input. The results show that initial rCBF (rCBF1) was globally reduced in all patients to a mean of 28.4 ± 11.9 ml/100 gm/min at a mean pCO2 of 29.6 ± 9.55 mm Hg. Patients with transient ischemic attacks (TIA) and minor strokes with minimal residua (RIND) had a mean rCBF1 of 30.4 ± 11.6 ml/100 gm/min at a mean pCO2 of 30 ± 10 mm Hg, while patients with completed strokes had a mean rCBF1 of 25.0 ± 12.4 ml/100 gm/min at a mean pCO2 of 29.1 ± 8.8 mm Hg. There was no significant difference between these two groups. This finding suggests that in this small group of patients with TIA's and RIND's, the cause of the stroke is probably related more to decreased perfusion than embolus, and may explain why these patients' symptoms improve after STA-MCA anastomosis. The results of this study suggest that in addition to an inaccessible lesion, global or focal decreased rCBF is a necessary criterion in the definition of indications for intracranial revascularization procedures.
Analysis of the treatment of basilar skull fractures with and without antibiotics
Authors: Ignelzi Ronald J. , VanderArk Gary D.
Published: May 2009

✓ The efficacy of chemoprophylaxis in the treatment of basilar skull fractures was studied in 129 patients over a 2-year period; antibiotics were found ineffective in preventing central nervous system infections, and in some cases may have proved harmful. It is suggested that a more rational approach to the treatment of basilar skull fractures includes close observation of the patient for early signs of meningitis, and if these should develop, treatment with antibiotics appropriate to the organism involved.
Infiltrative potentiality of brain tumors in organ culture
Authors: Sorour Osman , Raafat Mostafa , El-Bolkainy Nabil , Rifaat Mohamed
Published: May 2009

✓ The invasive potential of 15 brain tumors (seven meningiomas, and eight astrocytomas) as studied in cultures with Gelfoam used as a substrate. A three-stage system is introduced to classify in vitro invasiveness according to the depth of Gelfoam infiltration after 2 weeks' culture. This system proved to be simple and accurate. Meningiomas revealed greater activity in culture as compared to astrocytomas and infiltrated deeper into the Gelfoam. Dura mater explants were placed next to the culture of the tumors to study their interaction. Dura mater acted as a relatively strong barrier against tumor cell invasion in culture. In the majority of the explants, tumor cells revealed either contact arrest or spread underneath the dura and rarely spread over it. Tumor cells were seen infiltrating the dural explants in three cases, all of which were meningiomas.
Transsphenoidal selective anterior hypophysectomy in cats for microsurgical training
Authors: Snyckers Frank D.
Published: May 2009

✓ A technique for selective anterior hypophysectomy along a transsphenoidal route in the cat is described in detail. This operation is valuable for advanced microneurosurgical training.
Cerebrospinal fluid creatine phosphokinase in acute subarachnoid hemorrhage
Authors: Greenblatt Samuel H.
Published: May 2009

✓ The author measured the level of creatine phosphokinase (CPK) in 35 cerebrospinal fluid (CSF) specimens from 30 patients with acute subarachnoid hemorrhage, and correlations were sought with 17 other clinical and laboratory parameters. Elevations of CSF CPK have no diagnostic specificity. However, they do show a statistically significant correlation with the existence of any destructive process in cerebral tissue (hydrocephalus, infarction, intraparenchymal hemorrhage, or intraventricular clot). Yet arterial spasm without infarction does not raise the CSF CPK level. During the preoperative management of ruptured aneurysms and vascular malformations, a significant elevation of the CSF CPK level can thus provide a clue to the presence or significance of one or more of these destructive processes.
Compound elevated fractures of the skull
Authors: Ralston Bruce Lawrence
Published: May 2009

✓ The author presents two cases of compound elevated fractures of the skull and discusses the mechanics of their production. These lesions, seldom recognized in modern clinical practice, are first described in the oldest scientific and surgical treatise known, the Edwin Smith Surgical Papyrus, over 5000 years ago.
Spontaneous cerebral revascularization in a patient with STA-MCA anastomosis
Authors: Ausman James I. , Moore James , Chou Shelley N.
Published: May 2009

✓ The authors report a case with spontaneous revascularization of the brain after surgical anastomosis of the superficial temporal artery to the middle cerebral artery.
Suprasellar osteogenic sarcoma following radiation for pituitary adenoma
Authors: Amine Abdul R.C. , Sugar Oscar
Published: May 2009

✓ The authors report a case in which sellar and suprasellar osteogenic sarcoma developed 10 years after radiation therapy for pituitary adenoma. The literature is reviewed and the rarity of this condition discussed.
Intracranial ectopic pituitary adenoma
Authors: Rothman Lewis M. , Sher Joanna , Quencer Robert M. , Tenner Michael S.
Published: May 2009

✓ The authors report a unique case of ectopic intracranial pituitary adenoma, associated clinically with generalized seizures and aggressive behavior. The lesion presumably arose from cells in the pars tuberalis and did not involve the sella turcica.
Chronic petrous pyramid abscess presenting as a cerebellopontine angle mass
Authors: Glasauer Franz E. , Grand Walter
Published: May 2009

✓ The authors present the case of a 5-year-old boy with a chronic petrous pyramid abscess and without a history of otitis media. Treatment by posterior fossa exploration and drainage with antibiotics was successful.
A simple test of shunt function: the shuntgram
Authors: Dewey Richard C. , Kosnik Edward J. , Sayers Martin P.
Published: May 2009

✓ The authors present an x-ray film method to ascertain the function of ventricular shunts in hydrocephalic patients. No special equipment is required. Representative x-ray films and analysis of results in 131 determinations are presented.
Degenerative lumbar spondylolisthesis with an intact neural arch (pseudospondylolisthesis)
Authors: Epstein Joseph A. , Epstein Bernard S. , Lavine Leroy S. , Carras Robert , Rosenthal Alan D.
Published: May 2009

✓ Twenty patients treated for degenerative spondylolisthesis with an intact neural arch principally at the L4–5 interspace had neural compression caused by dislocation of the vertebral bodies and intrusions of lamina and enlarged, arthrotic facets into a stenotic spinal canal. The resulting “pincer” effect caused complete or partial block demonstrable on myelography, with nerve root and cauda equina compression. Most of the patients were women aged 45 to 84 years. Seven had neurogenic claudication. The majority had unrestricted straight-leg raising, and no signs of acute neural entrapment were seen as in patients with a herniated disc. Absent ankle reflexes, and weakness and atrophy of the anterior tibial muscle group were common, while sensation was relatively undisturbed. Treatment consisted of liberal laminar decompression including foraminotomy and medial or total facetectomy. Good-to-excellent results were obtained, and no patient was made worse by the procedure.
Effect of intermittently raised intracranial pressure on breathing pattern, ventilatory response to CO2, and blood gases in anesthetized cats
Authors: Jennett Sheila , North J. Brian
Published: May 2009

✓ In anesthetised cats, breathing pattern, blood gases, and ventilatory response to CO2 were recorded before and during intermittent 10-minute episodes of hydrostatically raised intracranial pressure. The first effect on breathing was a stimulation which was followed at higher pressures by irregularity, depression, and periods of apnea; hyperventilation at high intracranial pressure (ICP) was rare. Raised ICP did not consistently depress the ventilatory response to CO2 until ventilation during airbreathing was already depressed; therefore, we cannot experimentally justify applying this test clinically to detect incipient ventilatory depression. When hypoxemia developed during raised ICP, it was compatible with the degree of hypoventilation due to central depression of breathing; thus, there was no evidence of a neurally mediated effect on the lungs, causing defective gas exchange.
Management of the uninhibited bladder by selective sacral neurectomy
Authors: Torrens Michael J. , Griffith Huw B.
Published: May 2009

✓ The authors report the treatment of incontinence due to uninhibited bladder contractions by selective sacral neurectomy in nine patients, four without evidence of neurological disease. A detailed and objective analysis of bladder and urethral function, together with quantitation of clinical features, was made before and after operation. Seven patients were either cured or greatly improved. The overall increase in bladder capacity and reduction of uninhibited activity were statistically significant. The resting urethral sphincter pressure was unchanged, but the contractility of the voluntary external sphincter was slightly impaired. Criteria for such neurectomies are discussed.
Controlled study of CCNU and radiation therapy in malignant astrocytoma
Authors: Reagan Thomas J. , Bisel Harry F. , Childs Donald S. , Layton Donald D. , Rhoton Albert L. , Taylor William F.
Published: May 2009

✓ The authors report 63 patients with biopsy-proved malignant (Grades 3 and 4) astrocytomas who were randomly placed in one of three treatment schedules within 2 weeks of surgery. One group (22 patients) received radiation therapy alone; the second group (22 patients) received 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) orally at intervals of 8 weeks; and the third group (19 patients) received combined radiation and drug therapy. Patients who received radiation therapy, with or without the drug, had a significantly longer survival than did those who received the drug alone. There was no difference in survival between the two groups who received radiation. The nitrosourea derivative CCNU does not seem to be an effective agent in the therapy of primary malignant brain tumors.
Dynamic changes in regional CBF, intraventricular pressure, CSF pH and lactate levels during the acute phase of head injury
Authors: Enevoldsen Erna M. , Cold Georg , Taagehøj Jensen Finn , Malmros Richard
Published: May 2009

✓ The authors measured regional cerebral 133xenon (133Xe) blood flow (rCBF), intraventricular pressure (IVP), cerebrospinal fluid (CSF) pH and lactate, systemic arterial blood pressure (SAP), and arterial blood gases during the acute phase in 23 comatose patients with severe head injuries. The IVP was kept below 45 mm Hg. The rCBF was measured repeatedly, and the response to induced hypertension and hyperventilation was tested. Most patients had reduced rCBF. No correlation was found between average CBF and clinical condition, and neither global nor regional ischemia contributed significantly to the reduced brain function. No correlation was found between CBF and IVP or CBF and cerebral perfusion pressure (CPP). The CSF lactate was elevated significantly in patients with brain-stem lesions, but not in patients with “pure” cortical lesions. The 133Xe clearance curves from areas of severe cortical lesions had very fast initial components called tissue peaks. The tissue peak areas correlated with areas of early veins in the angiograms, indicating a state of relative hyperemia, referred to as tissue-peak hyperemia. Tissue-peak hyperemia was found in all patients with cortical laceration or severe contusion but not in patients with brainstem lesions without such cortical lesions. The peaks increased in number during clinical deterioration and disappeared during improvement. They could be provoked by induced hypertension and disappeared during hyperventilation. The changes in the tissue-peak areas appeared to be related to the clinical course of the cortical lesion.
Changes in local cerebral blood flow following profound systemic hypotension
Authors: Gamache Francis W. , Myers Ronald E. , Monell Esteban
Published: May 2009

✓ The authors studied local cerebral blood flow in monkeys rendered hypotensive by infusion of a ganglionic blocking agent. Application of the 14C-antipyrine method demonstrated that the blood flow: 1) normally varies reproducibly from one structure to another within the brain; 2) appears at its lowest level in all structures during the early minutes of a rapid-onset hypotension; 3) maintains the same general rank order of blood flow rate during hypotension as was present during normotension; and 4) returns to supranormal levels immediately following the rapid restoration of blood pressure. The values for local cerebral blood flow remain close-to-normal in some animals and diminish significantly in others during late recovery from hypotension. The close-to-normal values accompany uncomplicated recoveries while the diminished values appear in those animals which became neurologically depressed. Areas of the brain considered predisposed to hypotensive injury did not exhibit depressions in blood flow rate during hypotension more markedly than did other brain areas. The present results are interpreted as strong evidence against the “border zone” hypothesis.
Traumatic fistula between a lacerated middle meningeal artery and a diploic vein
Authors: Ishii Ryoji , Ueki Komei , Ito Jusuke
Published: May 2009

✓ A traumatic fistula occurring between a lacerated middle meningeal artery and a diploic vein was treated conservatively, and was no longer demonstrable at follow-up examination about 1½ years after the injury.
Fluoroscopy of foramen ovale as an aid to thermocoagulation of the Gasserian ganglion
Authors: Tator Charles H. , Rowed David W.
Published: May 2009

✓ The authors describe a fluoroscopic method of guiding percutaneous needle penetration of the foramen ovale. The advantages are simplicity, speed, accuracy, and comfortable patient positioning. Radiation exposure is minimized.
New lumboperitoneal shunt for communicating hydrocephalus
Authors: Hoffman Harold J. , Hendrick E. Bruce , Humphreys Robin P.
Published: May 2009

✓ The authors describe a T-tube Silastic shunting device which has been used for lumboperitoneal shunting in 62 patients with communicating hydrocephalus during the past 3 years. In 38 patients it was inserted as a primary shunting procedure; 24 patients had the shunt inserted following problems secondary to arachnoiditis created by a polyethylene-type lumboperitoneal shunt. The shunt described here has not led to arachnoiditis when inserted as a primary shunting procedure. In 61% of patients no operative revisions of their shunt has been required to date, and 81% continue to do well on their T-tube type shunt.
Anterior cervical discectomy with and without interbody bone graft
Authors: Martins Albert N.
Published: May 2009

✓Fifty-one patients with symptomatic cervical disc disease refractory to conservative management were allocated at random to one of two treatment groups. The standard anterior approach devised by Cloward was used for 25 patients, and radical discectomy and foraminotomy for the other 26. All patients were followed for 6 months or longer with interview, physical examination, and radiographic evaluation. There was no difference in the success rate between the two groups. The large majority (92%) of patients in both groups were pleased with results of their operation. Because of technical factors related to operative exposure of the spinal canal and nerve roots, we prefer the Cloward procedure for patients symptomatic from advanced spondylosis and reserve discectomy without bone graft insertion for those with minimal spondylosis or soft disc herniations.
Anatomical observations of the subarachnoid cisterns of the brain during surgery
Authors: Gazi Yaşargil M. , Kasdaglis Konstantin , Jain Kewal K. , Weber Hans-Peter
Published: May 2009

✓ Subarachnoid cisterns and their contents are described briefly in the light of observations made during microsurgical explorations. The concept of intracranial surgery in terms of moving from one cistern to another is presented here with particular emphasis on the cisterns in surgical approaches to intracranial vessels and nerves for the treatment of aneurysms, arteriovenous malformations, and for surgery of basal tumors.