bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Treatment of Common Carotid Artery Occlusion
Authors: Collice Massimo , D'Angelo Vincenzo , Arena Orazio
Published: May 2010

Complete occlusion of the common carotid artery (CCA) has been found in 4 to 5% of patients suffering from cerebral ischemia due to atherosclerotic lesions. The classical surgical treatment of the lesion consists of retrograde thromboendar-terectomy or bypass grafting between the subclavian artery and the carotid bifurcation with the aim of restoring flow into the internal carotid artery (ICA) or revascularizing the external carotid artery (ECA) when the ICA is definitively occluded. Recent reconstructive microneurosurgical techniques offer these patients alternative or additional possibilities of cerebral revascularization. During the last 5 years, we have treated nine patients with CCA occlusion, using different techniques mainly according to the site and extent of obstruction and the anatomical conditions of the arteries. In only one patient was the ICA found to be patent: a subclavian-ICA bypass was performed. In four other patients with occlusion of the full length of the CCA (proximal lesion) and ICA occlusion, attempts at retrograde thromboendarterectomy were made and then subclavian-ECA bypass and superficial temporal-middle cerebral artery (STA-MCA) bypass were performed in two steps. In four patients with CCA obstruction limited to the carotid bifurcation area (distal lesion) and with ICA occlusion, the following techniques were used: (a) endarterectomy of the CCA and ECA and STA-MCA bypass in two steps (one case), (b) CCA-ECA bypass and STA-MCA bypass in two steps (one case), and (c) subclavian-MCA bypass (two cases). Four of nine patients were treated by contralateral ICA endarterectomy after repair of the CCA obstruction. Angiography was performed 7 to 10 days after every surgical procedure, and all arteries and grafts, originally opened, were found to be patent. No operative death occurred in the series, but one patient suffered a transient neurological deficit. During the follow-up period (average, 14 months), no ischemic episode occurred. These data suggest that a versatile surgical approach is rational for the treatment of CCA occlusion.
Clinical Evaluation of a Depth Electroencephalography Electrode
Authors: Maxwell Robert E. , Gates John R. , Fiol Miguel E. , Johnson Michael J. , Yap Jesse C. , Leppik Ilo E. , Gumnit Robert J.
Published: May 2010

Stereo depth electroencephalography (EEG) is of proven benefit in lateralizing and localizing seizure origin in select cases of epilepsy. There are potential hazards and technical considerations inherent with depth EEG, however, that have limited the general applicability of this technique. A new depth EEG electrode with materials and design features that facilitate safe insertion and artifact-free recording has been developed. The design features and technique for inserting the electrode are described. The electrode was evaluated during 2600 hours of implantation and recording in seven patients. With the use of stereotactic techniques, the electrode could be positioned accurately within precise anatomical landmarks such as the amygdaloid nucleus and the hippocampus. After insertion, no hemorrhage or edema was detected along the electrode tracts by third generation computed tomographic scanning. There was no evidence of pyrogenicity or infection. Electrode migration was not observed. A large electrical field could be sampled because of the relatively large surface of the cylindrical depth electrode contacts.
Intradiploic Meningioma of the Orbital Roof
Authors: Pompili Alfredo , Caroli Fabrizio , Cattani Fabio , Iachetti Massimo
Published: May 2010

The intradiploic meningioma of the orbital roof may be classified as a subgroup of intraosseous ectopic meningiomas. To date, only four cases have been described. This report examines one other case. Pathological features, diagnostic criteria, and surgical possibilities are discussed in an attempt to identify some homogenous characteristics of these five cases, which would better define the intradiploic meningioma of the orbital roof.
Combined Reconstruction of the Vertebral and Carotid Artery in One Single Procedure
Authors: Diaz Fernando G. , Ausman James I. , de los Reyes R. A. , Pearce Jeffrey , Shrontz Carl , Mehta Bharat , Patel Suresh , Dujovny Manuel
Published: May 2010

Patients suffering from vertebrobasilar insufficiency frequently have multiple areas of involvement in the extracranial circulation. Eight patients admitted to Henry Ford Hospital had symptoms suggestive of vertebrobasilar insufficiency and angiograms showing multiple abnormalities. A combined operation that reconstructed the carotid and vertebral circulations in one single procedure was completed in all patients with minimal morbidity and no mortality. The surgical procedure is described in detail.
Control of Hypertension and Prophylaxis against Vasospasm in Cases of Subarachnoid Hemorrhage: A Preliminary Report
Authors: Rosenwasser Robert H. , Delgado Tomas E. , Buchheit William A. , Freed Michael H.
Published: May 2010

Thirty hypertensive patients with subarachnoid hemorrhage were divided randomly into two groups. The treated group was begun on preliminary volume expansion, and control of hypertension was carried out using vasodilators and centrally acting drugs. The control group was treated in the classical manner for hypertension, with a diuretic as the foundation for therapy. The incidence of clinical vasospasm was compared to that of angiographic spasm. The incidence of preoperative vasospasm in the treated group was 20%, as compared to 60% in the untreated group (P < 0.01). Of the treated group, 87% survived to operation, whereas only 53% of the control group survived to operation (P < 0.01).
Stereotactic Radiosurgery in Cases of Acoustic Neurinoma: Further Experiences
Authors: Norén Georg , Arndt Jürgen , Hindmarsh Tomas
Published: May 2010

Fourteen patients with acoustic neurinomas varying in size from 7 to 30 mm were treated by stereotactic radiosurgery and then were followed for 4 years. The tumors of eight patients decreased 1 to 10 mm in diameter, no change was found in two, and the tumor increased slightly in three patients. Loss of the ability to enhance with contrast administration on computed tomographic scan was a common effect of the treatment. One patient in poor general condition died from intercurrent disease 6 months after radiosurgery. At postmortem examination, a large central necrosis was found. Among five patients with hearing before treatment, full preservation was demonstrated in one; in the other four, the mean impairment of speech discrimination score was 43%. One patient with total unilateral deafness regained hearing and achieved a discrimination score of 60% at 1 year after treatment. There was transient facial weakness in five patients, which was detectable only by electromyography in one. Facial hypesthesia appeared in two patients and was transitory in one of them. Thirteen of the patients are in good or excellent general condition. Stereotactic radiosurgery offers the only therapeutic alternative to open operation in the management of acoustic neurinomas. It is worth considering for every patient, but especially for poor risk patients and those with bilateral tumors.
Epidural Morphine for Control of Pain after Spinal Surgery: A Preliminary Report
Authors: Schmidek Henry H. , Cutler Scott G.
Published: May 2010

Epidural opiates have been used successfully for the control of postoperative pain after obstetrical, abdominal, and orthopedic procedures. The use of these agents for the control of pain after operation on the thoracic and lumbar spine is reported. A catheter is inserted under direct vision into the epidural space after semihemilaminectomy and disc excision, posterior decompressive lumbar laminectomy, and anterolateral thoracolumbar decompression and just before wound closure. Excellent postoperative pain relief is achieved for 8 to 20 hours after single epidural injections of between 2 and 6 mg of morphine. Catheters are left in situ for 2 to 5 days. To date, no complications requiring treatment have been encountered with this approach.
A Suprasellar Atypical Teratoma Presenting as an Intrasellar Mass: A Case Report
Authors: Fults Dan , Kelly David L.
Published: May 2010

Intracranial atypical teratomas are midline brain tumors with both germinomatous and teratomatous elements. When they occur in the suprasellar region, they usually present with a classic triad of visual disturbances, diabetes insipidus, and hypopituitarism. We report the case of a suprasellar atypical teratoma that presented as an intrasellar lesion and caused secondary amenorrhea in a 15-year-old girl.
Computed Tomography of Traumatic Atlantooccipital Dislocation
Authors: Gerlock Amil J. , Mirfakhraee Mansour , Benzel Edward C.
Published: May 2010

Although atlantooccipital dislocation is a well-recognized radiological entity, its computed tomographic (CT) recognition has not been previously described. It is the purpose of this report to show the complementary role of CT in precisely defining the abnormalities in both the coronal and the sagittal reconstruction planes. A case is presented and the literature is reviewed.
Calcified Metastases to the Brain in a Child: Case Report
Authors: Tomita Tadanori , Larsen Marianne B.
Published: May 2010

A child with calcified intracranial metastases of undifferentiated sarcoma of the mediastinum is described. Calcifications in metastatic neoplasms to the brain are rare, but must be considered in the differential diagnosis of intracranial calcified lesions.
Total Removal of a Brain Stem Arteriovenous Malformation: Case Report
Authors: Yonekawa Yasuhiro , Handa Hajime , Taki Waro
Published: May 2010

The successful total removal of a brain stem arteriovenous malformation (AVM) in a two-staged operation is reported. The importance of selection of the approach for such an AVM because of the topographical anatomy is emphasized.
Extradural Hematoma: Toward Zero Mortality
Authors: Bricolo Albino P. , Pasut Luisa M.
Published: May 2010

This is a prospective analysis of 107 consecutive cases of extradural hematoma treated during the last 3 years at the Department of Neurosurgery of the University Hospital of Verona (Italy). The overall mortality was 5%; 89% of the patients made a good recovery or had only moderate residual disability. We regard this as meaningful progress compared to recent reports from other sources showing mortality rates of approximately 20%. The majority of our patients (57%) underwent operation within 6 hours of injury; 60% went into surgery with a Glasgow coma scale (GCS) score between 8 and 15. No deaths occurred among patients reaching surgery with a GCS score of 8 or better; all patients with scores of 8 to 15 made a good recovery (63 cases). Seventeen patients went into surgery while still free of neurological signs, and 8 had only one dilated pupil; all 25 made good recoveries. A flexion posture at admission cuts the chances of a good outcome by one-half; an extension posture cuts the chances to one-fourth. Ninety-five per cent of the patients had fractures of the skull; only 21% had the classical lucid interval. The cause of all 5 deaths was identified as stemming from avoidable errors in management in outlying hospitals (2 cases) or in our own department (3 cases). The results of this study indicate that zero mortality from extradural hematoma is a realistic goal for a modern, well-run care system for head-injured patients that includes prompt referral by community doctors and suitable hospital facilities for constant access to emergency neurosurgery.
Hemifacial Spasm Caused by a Venule: Case Report
Authors: Jannetta Peter J.
Published: May 2010

The syndrome of hemifacial spasm occurs as a consequence of compression, almost universally by blood vessels, of the root entry zone of the facial nerve. The vascular compression is usually obvious at operation, but may be subtle. The author describes a case in which a venule running in an anterior-posterior direction across the caudal aspect of the root entry zone of the facial nerve, which was thought to be causing the spasm, was coagulated and divided. A small, more distal arteriole, probably not contributory, was decompressed away from the nerve. After operation, the patient improved gradually, and she remains free of facial spasm or weakness. This is the most subtle vascular compression seen by the author and his colleagues in over 400 microvascular decompressions for hemifacial spasm.
Petriellidium boydii Pachymeningitis Treated with Miconazole and Ketoconazole
Authors: Schiess Robert J. , Coscia Michael F. , McClellan George A.
Published: May 2010

A very rare case of Petriellidium boydii pachymeningitis is described. Rarer still is the stabilization of this case for a prolonged period. Miconazole and ketaconazole both seemed useful in the treatment. and their role is discussed.
Management of Hydrocephalus Secondary to Intracranial Hemorrhage in the High Risk Newborn
Authors: James H. E. , Bejar R. , Merritt A. , Gluck L. , Coen R. , Mannino F.
Published: May 2010

The experience of the Special Care Nursery of the University of California Medical Center, San Diego, in the management of the high risk newborn with progressive ventricular enlargement is reviewed, and the physiopathological basis of progressive ventricular enlargement is analyzed. (Neurosurgery 14:612-618, 1984)
Primary Spinal Chondrosarcoma with Eighteen-Year Follow-up: Case Report and Literature Review
Authors: Hirsh Leonard F. , Thanki Ashok , Spector Harvey B.
Published: May 2010

Although chrondrosarcomas are common primary bone tumors, their occurrence in the spine is very rare. Because total excision in such cases is seldom possible, few long term survivors have been reported. We are reporting one patient with a high thoracic spinal chondrosarcoma who survived with useful function for over 18 years because of repeated local tumor excisions. The literature is reviewed, and an aggressive surgical treatment of spinal chondrosarcoma is recommended.
Indirect Injury of the Optic Nerve
Authors: Kline Lanning B. , Morawetz Richard B. , Swaid Swaid N.
Published: May 2010

Visual loss due to optic nerve injury after closed head trauma constitutes a formidable diagnostic and therapeutic challenge for the clinician. Assessment must be made of the site of optic nerve injury, and this is often difficult in the patient with an altered level of consciousness. A decision regarding optic nerve decompression must be formulated, yet the literature is confusing with regard to operative indications. In reviewing current pathogenetic theories, clinicopathological data, and therapeutic options, this report attempts to clarify the role of surgical intervention in indirect optic nerve injury.
Incidence of Skull Fractures in Olmsted County, Minnesota
Authors: Nelson Evan Lloyd , Melton Joseph L. , Annegers John F. , Laws Edward R. , Offord Kenneth P.
Published: May 2010

Between 1935 and 1974, 3598 episodes of head trauma among Olmsted County, Minnesota, residents resulted in 1097 skull fractures. Of these, 53% were simple, 16% were depressed, 12% were compound, and 19% were basilar. The age- and sex-adjusted incidence of skull fractures was 44.3 per 100,000 person-years overall, was somewhat greater in the urban than in the rural areas of Olmsted County, and was relatively stable for the final 30 years of the study. Age-specific incidence rates were highest for the very young, and simple linear fractures were the predominant type of skull fracture in this age group and among the elderly. The male:female ratio of incidence rates varied from 2.1:1 to 4.5:1 depending on fracture type. Motor vehicle accidents accounted for 38% of the skull fractures and were a particularly important cause among young males. Falls accounted for 37% of the skull fractures and were the major cause of fractures in the elderly and pediatric age groups. The results of this population-based study may be helpful in formulating recommendations for the evaluation and management of head-injured patients.
Postoperative Regression of Opticochiasmatic Astrocytoma: A Case for Expectant Therapy
Authors: Venes Joan L. , Venes Joan L. , Latack Joseph , Kandt Raymond S.
Published: May 2010

After incisional biopsy, an opticochiasmatic astrocytoma in a 2-year-old child with neurofibromatosis was seen to regress by computed tomographic scanning. This case illustrates the need for expectant therapy in this entity.
Primary Intracranial Choriocarcinoma: A Report of Two Cases and a Review of the Literature
Authors: Chan Helen S. L. , Humphreys Robin P. , Hendrick Bruce E. , Chuang Sylvester H. , Fitz Charles R. , Becker Laurence E.
Published: May 2010

Among 848 cases of primary intracranial malignancy seen during a 63-year period at a pediatric hospital, there were 2 cases of primary pineal choriocarcinoma. The clinical and laboratory findings of these 2 cases were similar to those of 33 cases of intracranial choriocarcinoma reported in the literature. In 1 patient with precocious puberty, the diagnosis was confirmed by labeling human chorionic gonadotropin (HCG) within the tumor, which had been stored for 25 years. In the other patient, who is alive and well 18 months after diagnosis, the response to cranial irradiation and intensive chemotherapy was monitored with serial measurements of serum, cerebrospinal fluid, and urinary HCG and with computed tomography. We conclude that intensive chemotherapy, radiation, and tumor resection, if feasible, offer the best chance of curing this otherwise fatal disease.
Intraventricular Pneumocephalus Secondary to Subcutaneous Emphysema: A Case Report
Authors: Horton Donald D. , Pollay Michael , Reynolds Arden F.
Published: May 2010

Intraventricular tension pneumocephalus is an unusual complication of surgically treated hydrocephalus. This is a life-threatening complication requiring prompt diagnosis and treatment. A case is presented wherein tension pneumocephalus developed as a result of cervicocranial subcutaneous emphysema in the presence of a ventriculoperitoneal shunt.
Intrathecal Paraganglioma of the Cauda Equina
Authors: Reyes Marcelino G. , Torres Hernando
Published: May 2010

A 33-year-old obese woman with chronic pain in her lower back presented with weakness of her right quadriceps and diminution of her patellar reflex. Her myelogram revealed an intradural oval mass at level of the interspace between her 3rd and 4th lumbar vertebrae. Operation disclosed an encapsulated mass attached to her filum terminale. Histopathological examination showed a paraganglioma with typical dense core granules, confirmed by electron microscopic examination. We report our patient to call attention to intrathecal paragangliomas as a rare and treatable cause of the cauda equina syndrome.
Cerebrospinal Fluid Rhinorrhea 34 Years after Trauma: A Case Report and Review of the Literature
Authors: Russell Tom , Cummins Brian H.
Published: May 2010

Posttraumatic cerebrospinal fluid (CSF) rhinorrhea has been recognized since the 17th century, and its association with intracranial infection has been well documented. However, CSF rhinorrhea usually presents during the 1st month after trauma. Cases presenting more than 3 months after trauma are unusual. The authors report a case of CSF rhinorrhea that presented 34 years after head injury.
Pseudobulbar Palsy after Posterior Fossa Operation in Children
Authors: Wisoff Jeffrey H. , Epstein Fred J.
Published: May 2010

The authors describe their experience with an unusual postoperative syndrome of pseudobulbar palsy occurring a few days after the extirpation of large midline vermian/4th ventricular tumors in children. The patients had a delayed onset of supranuclear cranial nerve palsies associated with emotional incontinence and lability that resolved over several weeks to months. It is postulated that retraction pressure on the medial cerebellum and split vermis is the operative insult responsible for edema that subsequently tracked along fiber pathways in the middle and superior cerebellar peduncles into the upper pons and midbrain. Modifications of operative technique to eliminate the need for retraction are presented.
Bilateral Traumatic Abducens Nerve Palsy without Skull Fracture and with Cervical Soine Fracture: Case Report and Review of the Literature
Authors: Arias Manuel J.
Published: May 2010

Bilateral traumatic abducens nerve palsy is a rare condition. Here a case without skull fracture and associated with cervical spine fracture is reported. Only two cases like this were found in a review of the literature. The mechanism of the lesion is discussed in light of the two main theories proposed thus far. When the injury is acute, as happens in the majority of cases, the nerve lesion probably is due to contusion and stretch of the nerve trunk against the ridge of the petrous bone and the rigid dural hole of entrance in the extradural space at the basilar process.
Arteriovenous Malformations of the Cerebellar Vermis
Authors: Samson Duke , Batjer Hunt
Published: May 2010

Fifteen cerebellar vermian arteriovenous malformations were surgically treated over a 7-year period. Intracranial hemorrhage was the presenting symptom in 73% of the cases and recurrent bleeding episodes occurred in 60%. Computed tomographic scans demonstrated the site of the malformation in 80% and documented the presence of intracerebral bleeding in all posthemorrhage patients. Angiography revealed two consistent patterns of arterial supply depending on the involvement by the malformation of the superior inferior cerebellar vermis. All lesions were surgically removed via a midline suboccipital posterior fossa microsurgical approach. Intraventricular extension of arteriovenous malformation was common, often in association with the choroid plexus of the 4th ventricle. Immediate postoperative angiography was used to document arteriovenous malformation removal. Three instances of unsuspected residual malformation were documented and required reexploration. The total operative mortality was 7%, and the neurological morbidity was 21%.
Microsurgical Recovery of a Migrated Balloon from the Internal Carotid Artery of a Child
Authors: Tranmer Bruce I. , Humphreys Robin P. , Chuang Sylvester H.-S.
Published: May 2010

A child developed a traumatic intrapetrous internal carotid aneurysm after a routine myringotomy. The aneurysm was treated by occlusion of the internal carotid artery by the detachable balloon technique. Unfortunately, both balloons migrated and ischemic sequelae resulted when one of the balloons became lodged in the bifurcation of the internal carotid artery. The balloon was successfully retrieved during an emergency microsurgical embolectomy, and the child's neurological deficit was reversed. The management of both the intrapetrous aneurysm and the balloon migration are discussed.
Surgical Approach to the High Subcranial Internal Carotid Artery
Authors: Balagura Saul , Carter Jeffrey B. , Gossett Donald L.
Published: May 2010

Two cases are presented to describe surgical approaches to the high cervical internal carotid artery permitting surgical treatment of conditions such as aneurysms of the high carotid artery, fibromuscular dysplasia, and arteriosclerosis by endarterectomy or resection of a segment with the interposition of a graft.
Nonoperative Management of Extradural Hematoma
Authors: Bullock R. , Smith R.M. , van Dellen J.R.
Published: May 2010

Extradural hematomas (EDHs) do not always require surgical evacuation. We report a subgroup of conscious patients harboring EDHs who were referred for computed tomographic (CT) scanning several days after head injury with neurological signs that were static or improving. Twelve patients with EDHs 12 to 38 ml in volume were offered nonsurgical management and were followed by serial CT scanning. All patients made a complete neurological recovery and showed resolution of the hematoma on CT scanning over a period of 3 to 15 weeks. The features that may make an extradural hematoma suitable for conservative treatment are discussed.
Vertebral Artery Occlusion at the Narrowed “Scalenovertebral Angle”: Mechanical Vertebral Occlusion in the Distal First Portion
Authors: Kojima Noriaki , Tamaki Norihiki , Fujita Kathuzo , Matsumoto Satoshi
Published: May 2010

We report a patient who developed occasional vertigo when turning his head to the right side. Occlusion of the right vertebral artery occurred at the narrowed “scalenovertebral angle” with this rotational head movement. This triangular tunnel consisted of the hypertrophied ligament of the longus colli muscle and the anterior scalene muscle. Decompression of these extraluminal compressive factors led to relief of the symptoms. Two different kinds of extrinsic compression at the first portion of the vertebral artery are discussed.
A Variant of Cerebral Glioma Called Pleomorphic Xanthoastrocytoma: Case Report
Authors: Gomez Jaime G. , Garcia Julio H. , Colon Lillian E.
Published: May 2010

A newly recognized type of cerebral astrocytoma has been described in the last 5 years among patients under the age of 30. The designation of pleomorphic xanthoastrocytoma has been suggested for this neoplasm on the basis of its unique histological features. These include abundant lipid droplets in the astrocytic cytoplasm. We report an additional case of this cerebral hemisphere astrocytoma, which (in common with 17 others reported before) occurred in a young patient. His postoperative course has been benign and he remains ambulatory and almost symptom-free 9 years after the initial tumor excision. The diagnosis of pleomorphic xanthoastrocytoma should be entertained in patients in whom a superficially placed intracerebral tumor (i.e., one that seems to be in contact with the meninges) develops during the juvenile years.
Cerebral Glioblastomas Can Be Cured!
Authors: Bucy Paul C. , Oberhill H.R. , Siqueira Edir B. , Zimmerman H.M. , Jelsma Richard K.
Published: May 2010

In 1959, a 30-year-old man underwent the removal of a glioblastoma multiforme from the right parietal lobe of his brain. After the operation, he received x-ray therapy. He made a complete recovery. Today, over 25 years later, he is alive and well and is regularly employed full-time. If glioblastomas and other cerebral gliomas are removed completely, the patients can be cured of their tumors.
Superior Sagittal Sinus Thrombosis after Closed Head Injury
Authors: Hesselbrock Roger , Sawaya Raymond , Tomsick Thomas , Wadhwa Subodh
Published: May 2010

A case of superior sagittal sinus thrombosis after a closed head injury is presented along with a review of 11 other reported cases. Review of the literature indicates that this condition is rarely recognized and that further investigation is necessary to define the incidence, prognostic factors, and optimal therapy of this condition.
Primary Intracranial Rhabdomyosarcoma
Authors: Olson Jeffrey J. , Menezes Arnold H. , Godersky John C. , Lobosky Jeffrey M. , Hart Michael
Published: May 2010

Primary intracranial rhabdomyosarcoma is rare. Twenty-one cases with dismal outcomes have been reported. We add five children with this disease treated between 1977 and 1982. Their therapy consisted of surgical resection, craniospinal irradiation, and intravenous-intrathecal chemotherapy. Two children have recovered, 21 and 67 months after diagnosis; the last is the longest survival reported in the literature. Two succumbed to tumor recurrence, and one died due to pulmonary embolism. The posterior fossa was invariably a site of tumor at presentation. Diagnosis with light microscopy can be elusive; electron microscopic and immunohistochemical evaluation are necessary to confirm the pathological condition. This is essential so that early, aggressive therapy can be instituted. These diagnostic and therapeutic techniques have led to a reevaluation of this malignancy and its prognosis.
Cholesterol Granuloma of the Petrous Apex and Sphenoidal Sinus: A Case Report
Authors: Gray William C. , Salcman Michael , Rao Krishna C. V. G. , Hafiz Mohammad A.
Published: May 2010

A case of a cholesterol granuloma located in the petrous apex and eroding into the sphenoidal sinus is reported. Cholesterol granuloma is thought to occur when pneumatized cells in the temporal bone become obstructed. Although usually ocurring in the middle ear, it can occur in the petrous apex. The diagnosis and surgical management are discussed.
Transdiaphragmatic Migration of a Ventriculoperitoneal Catheter
Authors: Lourie Herbert , Bajwa Saeed
Published: May 2010

A child developed an infected hydrothorax and respiratory distress 3 years after the insertion of a ventriculoperitoneal shunt. The distal catheter had penetrated the right pleural space via retrohepatic transdiaphragmatic migration.
Extraneural Metastases in Gliosarcoma: A Case Report and Review of the Literature
Authors: Cerame Mario A. , Guthikonda Murali , Kohli Chander M.
Published: May 2010

This report details the case of an 11-year-old girl with gliosarcoma and her rapid demise after a brief asymptomatic postcraniotomy period. The discussion that follows is a collective review of the several aspects illustrated by the case history. Special attention is directed toward the pathological features of this histological variant of glioblastoma multiforme. The topic of extraneural metastasis is reviewed with regard to frequency, mechanisms, sites, and prognosis.
Use of the Cavitron Ultrasonic Surgical Aspirator and Evoked Potentials for the Treatment of Thalamic and Brain Stem Tumors in Children
Authors: Albright A. Leland , Sclabassi Robert J.
Published: May 2010

We subtotally removed nine pediatric central gliomas (five brain stem and four thalamic) with the Cavitron ultrasonic surgical aspirator (CUSA). Greater than 70% of the tumor was removed in eight of the nine cases. Evoked potentials were monitored during six of the operations. Of the six children who were operated on with monitoring, four had no deficit and two had single cranial nerve palsies. Of the three children who were operated on without evoked potential monitoring. one had no deficit, one was in a permanent state of obtundation, and one died of a pulmonary embolus 6 weeks postoperatively. Because the prognosis of children with malignant astrocytomas correlates with the extent of tumor removal, extensive tumor removal with the CUSA is probably indicated for some children with relatively discrete, enhancing central gliomas. Evoked potential monitoring may be useful during such operations.
Microsurgery for Giant Craniopharyngiomas in Children
Authors: Al-Mefty Ossama , Hassounah Maher , Weaver Philip , Sakati Nadia , Jinkins John R. , Fox John L.
Published: May 2010

The authors report 20 cases of giant craniopharyngioma in children operated on during the 6-year period from 1978 through 1984. The tumor size (maximal diameter) ranged from 5 to 11 cm. These patients presented with increased intracranial pressure, severe visual loss, and neurological and endocrinological deficits. Tumor growth had occurred in several directions, causing displacement of the circle of Willis, the optic apparatus, and the hypothalamus, as well as encroachment into the interpeduncular and prepontine cisterns and into the frontal, temporal, and posterior fossae. The surgical technique for total removal of these giant tumors in the last 10 cases is described. Emphasis is placed on the use of microsurgical technique during the first operation, close endocrinological follow-up, and early reevaluation by computed tomographic scanning.
Delayed Cerebral Vasospasm after Uncomplicated Operation on an Unruptured Aneurysm: Case Report
Authors: Bloomfield Stephen M. , Sonntag V. K. H.
Published: May 2010

We present the case of a patient who developed significant vasospasm on the 9th postoperative day after the uneventful clipping of an unruptured asymptomatic berry aneurysm. We discuss the literature and potential mechanisms for vasospasm in the absence of subarachnoid hemorrhage.
Giant Osteoma of the Sphenoid Sinus Reached by an Extradural Transbasal Approach: Case Report
Authors: Pompili Alfredo , Caroli Fabrizio , Iandolo Bruno , Mazzitelli Maria R. , Riccio Antonio
Published: May 2010

Giant osteomas of the paranasal sinuses are infrequent. Those of the sphenoid sinus with neurological symptoms are even rarer. We report here the case of a woman with a giant osteoma of the sphenoid sinus who presented with bitemporal quadrantanopsia and underwent operation via an extradural transbasal approach.
Prognostic Factors in Microvascular Decompression for Trigeminal Neuralgia
Authors: Szapiro Jacek , Sindou Marc , Szapiro Jerzy
Published: May 2010

The results of microvascular decompression (MVD) in 68 patients with trigeminal neuralgia followed for 1 to 5 years were compared with the clinical and operative findings and with the surgical modalities. Among 20 factors analyzed, the mode of pain manifestation proved to be the only factor significantly related to prognosis (p < 0.001). In patients with paroxysmal pain only, a cure was obtained in 95%, whereas in those with paroxysmal and permanent pain, 58% were cured. None of the remaining factors showed any unfavorable influence on the results of MVD in cases of paroxysmal pain only. Some factors seemed to be related to prognosis in patients with a permanent pain component, and the following conclusions concern this group of patients only. Two factors proved to be statistically significant. First, patients with pain extending to two or three branches responded to MVD less favorably than those with pain in one branch only. The interposition of a piece of periosteum to separate a conflicting artery from the root led to worse results than the use of a square of Dacron. Other conclusions were based on small numbers and should be verified. A sensory deficit extending to two or three branches was related to worse results that a sensory deficit in one branch or its absence; a prior surgical procedure plays an additional unfavorable role. The patients with the least advanced degree of vasculonervous conflict (VNC) responded to MVD less favorably than those with severe cross compression; a posterosuperior site of VNC seems to play an additional unfavorable role. The distribution of some factors among types of pain manifestation showed marked differences, which seem to relate to results. The clinical and operative findings indicate that the sensory deficit corresponds to the extent of compression by the conflicting vessel. The necessity of distinguishing various clinical forms of trigeminal neuralgia for practical and cognitive reasons is emphasized.
Ventriculoperitoneal Shunts in Low Birth Weight Infants with Intracranial Hemorrhage: Neurodevelopmental Outcome
Authors: Bruce R. Boynton , Carole A. Boynton , Allen T. Merritt , Yvonne E. Vaucher , Hector E. James , Raul F. Bejar
Published: May 2010

Fifty preterm infants (mean birth weight, 1266 ± 303 g: mean gestational age, 30 ± 2 weeks) who required a ventriculoperitoneal (VP) shunt for posthemorrhagic hydrocephalus (92% with Grade III or IV hemorrhage) were followed for neurodevelopmental problems. VP shunts were placed at a median age of 29 days (range, 18 to 87 days) after serial lumbar punctures failed to control progressive and symptomatic ventriculomegaly. A total of 34 infants (68%) required one shunt revision or more, and the overall infection rate per patient was 50%. Seven infants died, 2 from shunt infections. The infants were evaluated with audiological, ophthalmological, and neurodevelopmental examinations. Of the survivors, 11 (28%) have severe visual loss and 10 (24%) have hearing impairment. Of the infants, 21 (49%) have severe motor handicaps and 19 (38%) have seizure disorders. Developmental and motor scores were obtained using the Bayley or Knobloch-Gesell scales. Seven infants (18%) have normal developmental outcomes: 26 (60%) have multiple handicaps. Grade IV hemorrhage or the occurrence of seizures was a predictor of poor neurode-velopmental outcome. We conclude that progressive posthemorrhagic hydrocephalus in low birth weight infants is associated with multiple handicaps despite early VP shunt placement.
Comparison of Surgical and Anesthetic Complications in Neurosurgical Patients Experiencing Venous Air Embolism in the Sitting Position
Authors: Young Marie L. , Smith David S. , Murtagh Frederick , Vasquez Angel , Levitt Jerry
Published: May 2010

Because venous air embolism (VAE) has been considered to be a major deterrent to use of the sitting position, records of 255 patients undergoing neurosurgery in the sitting position from 1975 to 1982 were reviewed to determine the nature of morbidity and mortality in relation to the surgical procedure as well as to the occurrence of VAE. Complications were classified as surgical or anesthetic during joint review by a neurosurgeon and two neuroanesthesiologists. Outcome was classified on the basis of postoperative hospital course and discharge examination. The incidence of VAE was 30%. Although there was a variety of perioperative complications in patients with and without VAE, most of the complications were related to the operative procedure, not the sitting position or VAE. The episodes of VAE did not seem to be significant factors in the perioperative morbidity and mortality in our series of patients operated upon in the sitting position. Two case reports are discussed in detail.
Clivus Epidural Hematoma: A Case Report
Authors: Orrison William W. , Rogde Sidsel , Kinard Richard E. , Williams John E. , Torvik A. , Sackett Joseph F. , Amundsen Per
Published: May 2010

An acute traumatic epidural hematoma extending from the odontoid process to the dorsum sella is described. The mechanism for the formation of an extradural hematoma in this unusual location seems to be related to age and a severe hyperflexion injury.
Aneurysm Arising from the Medical Branch of the Superior Cerebellar Artery
Authors: Matricali Bartolomeo , Seminara Pietro
Published: May 2010

A case is presented of an aneurysm arising from the distal portion of the medical branch of the superior cerebellar artery. The aneurysm was discovered after a subarachnoid hemorrhage and was clipped successfully. We found no similar distally located aneurysm in a review of the literature. The close relationship between the superior cerebellar artery and the posterior cerebral artery is discussed to facilitate the proper choice of surgical approach.
A Case of Moyamoya Disease Accompanied by an Arteriovenous Malformation
Authors: Kayama Takamasa , Suzuki Shinsuke , Sakurai Yoshiharu , Nagayama Toru , Ogawa Akira , Yoshimoto Takashi
Published: May 2010

It is well known that moyamoya disease sometimes is accompanied by cerebral aneurysm; however, no case of moyamoya disease with arteriovenous malformation has previously been published. We report such a case. A 33-year-old man suffered from transient left motor weakness and visual disturbance. Plain computed tomography (CT) showed a low density area in the left parietooccipital cortex. Enhanced CT revealed a ribbon-shaped enhanced area in the right temporooccipital cortex and a spotty enhanced area in the right frontal subcortex. Cerebral angiography revealed moyamoya disease. On the basis of Suzuki's angiographic classification, the patient was diagnosed as Stage III. Right carotid angiography revealed an arteriovenous malformation fed by basal moyamoya vessels and draining to the vein of Trolard and the sylvian vein of the right frontal lobe. This arteriovenous malformation consisted of feeders, the nidus, and drainers. Trolard's vein, which was one of the draining veins of the arteriovenous malformation, flowed to the moyamoya vessels of the right parietal vault.
Central Nervous System Anomalies Associated with Meningomyelocele, Hydrocephalus, and the Arnold-Chiari Malformation: Reappraisal of Theories Regarding the Pathogenesis of Posterior Neural Tube Closure Defects
Authors: Gilbert James N. , Jones Kenneth L. , Rorke Lucy B. , Chernoff Gerald F. , James Hector E.
Published: May 2010

Complete gross and microscopic neuropathological examinations of 25 children who died with meningomyelocele, the Arnold-Chiari malformation, and hydrocephalus revealed a wide range and frequency of associated central nervous system malformations. The most remarkable of these anomalies were hypoplasia or aplasia of cranial nerve nuclei (20%), demonstrable obstruction of cerebrospinal fluid flow within the ventricular system (92%), cerebellar dysplasia (72%), a disorder of migration of cortical neurons (92%), fusion of the thalami (16%), agenesis of the corpus callosum (12%), and complete or partial agenesis of the olfactory tract and bulb (8%). The anomalies associated with posterior neural tube closure defects can no longer be considered secondary, but rather must be considered part of a spectrum of malformations caused by an unidentified primary insult to the central nervous system. The frequency and pattern of brain malformations associated with neural tube defects of some children with meningomyelocele suggest that such malformations may seriously affect intellectual outcome.
Common Origin of the Arterial Blood Flow for an Arteriovenous Medullar Fistula and the Anterior Spinal Artery: A Case Report
Authors: Clavier Erick , Tadie Marc , Thiebot Jacques , Presles Olivier , Benozio Michel
Published: May 2010

A common origin of the blood supply to a dural arteriovenous malformation and to the spinal cord from the same segmental artery is very rare. This obviously contraindicates embolization of the fistula. Demonstrating the location of the normal spinal blood supply system is therefore mandatory to avoid postoperative complications. The visualization of the normal blood vessels can be masked by a steal phenomenon, but it must at all costs be obtained. The authors describe one such case.
Spontaneous Healing of Acute Extradural Hematomas: Study of Twenty-two Cases
Authors: Pozzati Eugenio , Tognetti Francesco
Published: May 2010

A series of 22 patients with acute extradural hematomas that were not evacuated surgically is presented. Patients were asymptomatic or had only minimal neurological disturbances on admission. In all cases, serial computed tomographic scanning documented the progressive resolution of these clots, the great majority within 1 month of injury. The decision of conservative vs. surgical treatment may be guided by the thickness, configuration, location, and possible association with intradural parenchymal lesion.
Attempts at Prevention or Treatment of Intracranial Arterial Spasm: An Update
Authors: Wilkins Robert H.
Published: May 2010

Numerous approaches to the prevention and treatment of intracranial arterial spasm have been made during the past three decades. In the present article, the author has assembled data about such attempts that were not included in a similar compilation published in 1980. Since 1980, there has been some progress toward the satisfactory management of this detrimental condition, but much remains to be done. (18:808–825, 1986)
Ossification of the Posterior Longitudinal Ligament in Caucasians: Diagnosis and Surgical Intervention
Authors: Klara Peter M. , McDonnell Dennis E.
Published: May 2010

Six cases of ossification of the posterior longitudinal ligament (OPLL) in Caucasians have been diagnosed during a 2-year period at Walter Reed Army Medical Center. Five cases were in men and one was in a woman. Three cases presented as myelopathy and three as radiculopathy. Diagnosis was best confirmed with computer-assisted tomography. All six cases were treated surgically via an anterior approach, microsurgical resection of the OPLL, and autograft fusion. Patients with radiculopathy had immediate pain relief after operation. Those with myelopathy required vertebrectomy and regained strength after operation. All patients improved with operation. OPLL is not a rare condition in Caucasians. With diagnosis and proper surgical intervention, prognosis for improvement is good.
Use of Extracranial-Intracranial Bypass in the Management of Symptomatic Vasospasm
Authors: Batjer Hunt , Samson Duke
Published: May 2010

Delayed ischemic deficits from vasospasm after subarachnoid hemorrhage remain a major source of death and disability to patients surviving subarachnoid hemorrhage. Ideal treatment for this condition would prevent or reverse spasm in major subarachnoid vessels. This goal remains elusive. Considerable success has been obtained with augmentation of flow in ischemic regions by induced hypertension and hypervolemia. Some patients are not good candidates for this therapy because of underlying cardiovascular disease or the presence of unsecured aneurysms. A total of 11 patients have recently undergone extracranial-intracranial bypass for the treatment of symptomatic vasospasm. Bypass was performed in 4 patients due to failure of medical management and in 7 patients due to our reluctance to induce hypertension in the setting of unsecured aneurysms. Eight of the 11 patients responded neurologically to the bypass procedure within 24 hours. In 6 cases, neurological deficits either improved or resolved. After operation, all 8 patients maintained their preoperative neurological status with lower mean arterial blood pressures than before bypass. Noncomatose patients with focal middle cerebral ischemic deficits and secured aneurysms in whom medical management has failed or in whom these measures are contraindicated may indeed benefit from extracranial-intracranial bypass. Patients with unsecured aneurysms remote from an ischemic middle cerebral territory should probably be revascularized if cautious hypertension fails to improve their conditions.
Leptomeningeal Metastasis from Supratentorial Malignant Gliomas
Authors: Awad Issam , Bay Janet W. , Rogers Lisa
Published: May 2010

The clinical and diagnostic findings in 13 patients with leptomeningeal metastasis from supratentorial malignant gliomas are reported. Criteria for inclusion in this study were positive myelographic examination, positive cerebrospinal fluid cytology on two or more samples, or evidence of leptomeningeal seeding at autopsy. Eight patients had premortem symptoms of leptomeningeal metastasis, with the diagnosis confirmed during life in 5 patients. Average survival after the onset of symptoms was 3 months (range, 1 to 5 months). Comparison of the autopsied group with 10 concurrent autopsied patients without leptomeningeal gliomatosis did not reveal any significant differences in age, but leptomeningeal gliomatosis was more prevalent in patients with longer postoperative survival. Leptomeningeal involvement at autopsy was more extensive in symptomatic patients. Cerebrospinal fluid examination often gave nondiagnostic or nonspecific results. Computed tomography of the brain showed evidence of ventriculomegaly, periventricular contrast enhancement, or multifocal tumor involvement in every case. Iophendylate myelography was the most reliable diagnostic tool and established the diagnosis whenever performed. The natural history and clinical significance of leptomeningeal metastasis from supratentorial malignant gliomas are discussed.
Patient Positioning and Nasal Intubation for Carotid Endarterectomy
Authors: Weiss Robert M. , Smith Harold P. , Smith Harold P. , Patterson Knox A. , Weiss Robert M.
Published: May 2010

Exposure of a very rostral carotid bifurcation for endarterectomy may occasionally be difficult. We are reporting a simple yet effective way to gain several centimetres of exposure of the distal cervical portion of the internal carotid artery in this circumstance.
Multiple Progressive Familial Thrombosed Arteriovenous Malformations
Authors: Bucci Michael N. , Chandler William F. , Gebarski Stephen S. , McKeever Paul E.
Published: May 2010

Thrombosed arteriovenous malformations initially diagnosed as low-grade gliomas in a child and her maternal uncle are presented. In both patients, there was progression of the disease as evidenced by the formation of new lesions at distant sites in the brain.
Trigeminal Neurinoma Associated with Suprasellar Arachnoid Cyst: Case Report
Authors: Amagasa Masaharu , Sato Hiroo , Niizuma Hiroshi , Suzuki Jiro
Published: May 2010

The first case of trigeminal neurinoma associated with suprasellar arachnoid cyst is presented. Coexistence of these two lesions may be accidental, but it is also possible that the arachnoid cyst was secondary to the neurinoma. (Neurosurgery) 19:454-457, 1986)