bluuebunny/crossref_metadata_2025 huggingface dataset:
Transependymal Benign Dorsally Exophytic Brain Stem Gliomas in Childhood: Diagnosis and Treatment Recommendations
Authors: Stroink Ann R. , Hoffman Harold J. , Hendrick Bruce E. , Humphreys Robin P. , Davidson George
Published: May 2010

Sixteen children with dorsally exophytic transependymal benign brain stem gliomas were treated at the Hospital for Sick Children, Toronto, between 1949 and 1985. The diagnosis of these benign brain stem gliomas was based on neuroradiographic and operative observations. Five children were diagnosed in the pre-computed tomography (CT) era using ventriculography and pneumoencephalography, and 11 children were diagnosed using CT with and without contrast enhancement. Histological diagnosis was obtained in all 16 cases. In 1980, we first described this distinct group of benign brain stem gliomas, which accounted for 8% (total, 121 cases) of all brain stem gliomas diagnosed at our institution. However, with the use of high resolution CT in recent years, earlier and better definition of this particular type of brain stem tumor can be made. During the 10 years (1976 to 1985) in which CT has been used for preoperative evaluation in our institution, we have treated 49 patients with primary brain stem tumors. Eleven of these cases (22%) fell into the category of dorsally exophytic transependymal benign brain stem tumors. These tumors characteristically protrude into and largely fill the 4th ventricle, breaking through the overlying ependyma and frequently extending into the cisterna magna. On CT, they are isodense and enhance brightly with contrast agent. Clinically, these patients have a longer history of symptoms in comparison with patients with the more malignant, intrinsic types of brain stem tumor. All of our patients were treated by subtotal resection. Radiotherapy was utilized in 7 of the 16 patients. Periodic CT allowed close follow-up and helped to establish guidelines in the management of these particular patients. Fifteen of the 16 patients are presently alive with follow-up as long as 23 years.
Trigeminal Sensory Evoked Potentials in Patients with Trigeminal Neurinoma: Report of Two Cases
Authors: Takayasu Masakazu , Shibuya Masato , Suzuki Yoshio , Harada Tsutomu , Kanamori Masahiko , Kageyama Naoki
Published: May 2010

The trigeminal sensory evoked potentials (TEPs) in two patients with trigeminal neurinoma are reported. In contrast to the two cases previously reported by others, in which the preoperative TEPs were normal, the two cases reported herein showed significant changes on the affected side: (a) the sensory thresholds were greater and (b) the peak latencies of P19and N28were longer on the affected side than those on the normal side. Our results confirm that a TEP measurement is very useful in a preoperative examination of patients with trigeminal neurinoma, when the function of the trigeminal nerve should be evaluated objectively.
Ossified Prolactinoma: Case Report
Authors: Mukada Kazutoshi , Ohta Masahiro , Uozumi Tohru , Arita Kazunori , Kurisu Kaoru , Inai Kouki
Published: May 2010

The authors report a case of ossified prolactinoma that was identified as a calcified nodule on the roentgenograms. Histologically, the ossified tissues were diffuse, and the osteoid was mineralized in various degress, subsequently forming bones. Adenoma cells were sparse among the ossified tissues. This is probably the first report of ossified pituitary adenoma associated with osteoid metaplasia. The pathogenesis of osteoid metaplasia in pituitary adenomas is possibly due to proliferative connective tissue resulting from degeneration of the pituitary adenoma; this connective tissue may possess osteogenic potency.
Case Report: Myelopathy Secondary to Congenital Osteopetrosis of the Cervical Spine
Authors: McCleary Larry , Rovit Richard L. , Murali Raj
Published: May 2010

A rare occurrence of osteopetrosis involving cervical vertebrae and producing a compressive myleopathy is described. Clinical and radiographic findings are presented, and the pathophysiology of this unusual entity is discussed.
Pain Management after Lower Extremity Amputation
Authors: Iacono Robert P. , Linford Jennifer , Sandyk Reuven
Published: May 2010

Phantom pain may occur in up to 85% of patients after limb amputation. Although the pathophysiology of postamputation phantom pain is not well understood, it seems to be produced by a complex multifactorial interaction between the peripheral, sympathetic, and central nervous systems. The theoretical aspects of this are reviewed. Management of phantom limb pain may be both medical and surgical. Among the pharmacological agents proved effective against phantom pain are B-blockers, tricyclic antidepressants, and anticonvulsants. Surgical management includes peripheral nerve stimulation, thermocontrolled coagulation of the spinal cord, spinal cord stimulation, transcutaneous nerve stimulation, and stereotactic deep brain stimulation.
Neurolysis Combined with the Application of a Silastic Envelope for Ulnar Nerve Entrapment at the Elbow
Authors: Benoit Brien G. , Preston David N. , Atack David M. , Da Silva Vasco F.
Published: May 2010

Sixty-six patients with ulnar nerve entrapment at the elbow underwent neurolysis and the application of a Silastic envelope in an attempt to prevent postoperative scarring and recurrence of symptoms. All patients were evaluated pre- and postoperatively using a numerical scoring system that included clinical, motor, and sensory evaluation as well as nerve conduction studies. The Silastic material was well tolerated in the 70 cases. The overall 66% score improvement was more closely related to clinical relief (64%) than to improvement in motor conduction velocities (45%). Our 10-year experience indicates that ulnar neurolysis with Silastic envelope interposition is a safe surgical method of treatment for ulnar nerve entrapment at the elbow.
Craniometaphyseal Dysplasia Associated with Hydrocephalus: Case Report
Authors: Hudgins Roger J. , Edwards Michael S. B.
Published: May 2010

Craniometaphyseal dysplasia is a rare bone disorder that may cause a variety of neurological abnormalities; hydrocephalus has not been observed with this disorder, however. A case of craniometaphyseal dysplasia associated with hydrocephalus is reported, and possible causes are discussed.
Chronic Posttraumatic Lumbar Intradural Arachnoid Cyst with Cauda Equina Compression: Case Report
Authors: Zuccarello Mario , Powers Gerald , Tobler William D. , Sawaya Raymond , Hakim Simon Z.
Published: May 2010

An unusual case of a chronic posttraumatic lumbar intradural arachnoid cyst causing compression of the cauda equina is reported. The etiological, pathological, and clinical features are discussed. Emphasis is placed on the importance of a correct interpretation of radiological findings.
Prevention of Deep Venous Thrombosis in Patients with Acute Spinal Cord Injuries: Use of Rotating Treatment Tables
Authors: Becker Daniel M. , Gonzalez Marco , Gentili Amilcare , Eismont Frank , Green Barth A.
Published: May 2010

A randomized clinical trial of 15 patients with acute spinal cord injuries was performed to test the hypothesis that rotating treatment tables prevent deep venous thrombosis in this population. Four of 5 control (nonrotated) patients developed distal and proximal thrombi, assessed by 125I fibrinogen leg scans and impedance plethysmography. In comparison, only 1 of 10 treated (rotated) patients developed both distal and proximal thrombosis (P = 0.007). These results suggest but do not prove that rotating treatment tables prevent the development of proximal deep venous thrombosis in spinal cord-injured patients. Larger clinical trials are needed to confirm this heretofore undocumented benefit of rotating treatment tables.
Evoked Potential Monitoring during Aneurysm Operation: Observations after Fifty Cases
Authors: Friedman William A. , Kaplan Barry L. , Day Arthur L. , Sypert George W. , Curran Michael T.
Published: May 2010

Somatosensory or brain stem auditory evoked potentials (EPs) were monitored during 50 aneurysm procedures. Base line EPs were obtained shortly after the induction of general anesthesia and were recorded continuously during operation. Absolute latency, interpeak latency, and cortical EP amplitude were subsequently determined. Statistical analysis confirmed that significant changes in these parameters are routine during aneurysm operation. Arbitrary definitions of abnormal latency and amplitude changes led to an excessive false-positive/false-negative rate. From the time of dural opening to the time of closure, prolongation of central conduction time, decrease in cortical amplitude, or disappearance of the EP was predictive of postoperative sensory or motor deficit in all patients monitored, except those undergoing operation on basilar artery aneurysms. In basilar aneurysm cases, outcome could not be reliably predicted with either EP technique.
Malignant and Atypical Meningiomas: A Reappraisal of Clinical, Histological, and Computed Tomographic Features
Authors: Alvarez Fernando , Roda José M. , Romero Mercedes Pérez , Morales Carmen , Sarmiento Maria A. , Blázquez Martin G.
Published: May 2010

A series of 21 patients with atypical and malignant meningiomas is presented. Histological criteria such as high cellularity, typical and atypical mitosis, necrosis, infiltration of the underlying brain, poor differentiation, and distant metastasis define nonbenign meningiomas. Male predominance in this nonbenign group is significant when compared to a group of 205 benign meningiomas, which were also operated on. The malignant and atypical meningiomas are compared with the benign meningiomas, and special emphasis is placed on their computed tomographic features. The presence of tumor fringes (suggesting invasion of the brain substance) and intratumoral hypodense areas were both significant signs of malignancy of atypia. Radical surgical excision is still considered the treatment of choice.
Effect on Management Mortality of a Deliberate Policy of Early Operation on Supratentorial Aneurysms
Authors: Disney Lew , Weir Bryce , Petruk Kenneth
Published: May 2010

Of 736 patients with intracranial aneurysms seen at the University of Alberta from 1968 to 1985, 437 were admitted on the day of or the day after subarachnoid hemorrhage (SAH) from a supratentorial aneurysm. Of these, 205 were managed from 1968 through 1977 and 232 were managed from 1978 through early 1985 after a policy of early aneurysm operation had been implemented. Postoperative and management mortality and morbidity rates were related to the grade of the patient at the time of admission and the time interval before operation. Overall management mortality (and postoperative mortality) rates for patients treated before 1978 were 47% (19%) for all grades, 17% (12%) for Grades 1 and 2, 51% (25%) for Grades 3 and 4, and 100% (100%) for Grade 5. Since 1978, mortality has been reduced to 38% (11%) for all grades, 10% (5%) for Grades 1 and 2, 39% (17%) for Grades 3 and 4, and 96% (60%) for Grade 5. Management mortality for patients operated on Day 0 to 3 was lower than for those operated later after SAH both before and after 1978. Postoperative mortality was lowered in all patients operated from 1978 to 1985 regardless of the interval from SAH to operation, and management mortality was reduced overall, as well as for patients operated on day 0 to 3, in those treated from 1978 to 1985. The authors conclude that a policy of early aneurysm operation has contributed to a reduction of both postoperative and management mortality.
Solitary Histoplasmoma of the Thalamus: Case Report and Literature Review
Authors: Venger Benjamin H. , Landon Gene , Rose James E.
Published: May 2010

Only nine cases of solitary thalamic abscess have been reported. All were of bacterial origin, and three were successfully treated by surgical drainage and antibiotic therapy. The authors present the history of a patient with a histoplasmoma of the thalamus. As is often the case with solitary thalamic lesions, this lesion was initially assumed to be a tumor and was first treated with radiotherapy. Despite the sensitive location of the lesion, tissue diagnosis and decompression was safely accomplished with the aid of ultrasonic localization. Appropriate antifungal treatment was given, and the patient made a good recovery.
Surgical Results in Obese Patients with Sciatica
Authors: Hanigan William C. , Elwood Patrick W. , Henderson John P. , Lister Richard J.
Published: May 2010

A prospective study was done to determine the effect of obesity on the surgical results in patients with intractable sciatica. One hundred ten patients entered the study over an 8-month period. Five patients (1 obese) were excluded. Seventeen patients were included in the obese group. The two populations did not differ in age, sex, occupation, level of disc herniation, involvement of compensation, length of hospitalization, duration of disability, or incidence of surgical complications. At the 6-month follow-up assessment, 14 obese patients vs. 80 nonobese patients rated their surgical results good or excellent. Patients with postoperative weight loss were equally distributed between the groups. The data demonstrate that obesity should not be considered a prognostic factor when patients are eligible for surgical therapy.
Toleration of Head Injury by the Elderly
Authors: Amacher Loren A. , Bybee David E.
Published: May 2010

Fifty-six patients 80 or more years of age, admitted because of head injury, provide a clinical profile of the effects of head injury upon an aging population. The mortality rate is high, even in those with good admission Glasgow coma scores. The incidence of intracranial mass hematoma is striking. Falls in the residence constitute the principal mechanism of injury, and preexisting medical conditions are important contributing factors. A significant proportion (60%) of old people may make a full recovery from head injury.
Transoral Transclival Removal of Anteriorly Placed Meningiomas at the Foramen Magnum
Authors: Miller Elizabeth , Crockard Alan H.
Published: May 2010

Anteriorly placed meningiomas at the level of the foramen magnum are rare, are difficult to diagnose, and present technical problems for a conventional posterior fossa removal. The authors describe the successful transoral transclival excision of two such tumors. Cerebrospinal fluid (CSF) fistula can be avoided by dural repair using a thrombin glue and long term CSF diversion. This modification enables the transoral route to be considered for anteriorly placed intradural lesions.
Phenylpropanolamine: An Over-the-Counter Drug Causing Central Nervous System Vasculitis and Intracerebral Hemorrhage
Authors: Glick Roberta , Hoying John , Cerullo Leonard , Perlman Susan
Published: May 2010

Phenylpropanolamine (PPA) is the major ingredient in more than 70 over-the-counter preparations including diet pills, nasal decongestants, and the legal “look-alike” stimulants. Structurally and functionally similar to amphetamine and ephedrine, PPA has recently been associated with several neurological manifestations including psychosis, stroke, severe headache, seizures, and intracerebral hematoma. We report a case of intracerebral hematoma and subarachnoid hemorrhage in a young woman with angiographic and biopsy-proven vasculitis of the central nervous system (CNS) induced by PPA in her diet pills. From review of the literature, we distinguish drug-induced vasculitis as a separate entity from primary CNS vasculitis, both clinically and pathologically. This report should alert physicians, in general, to this potentially fatal side effect of PPA, a commonly used over-the-counter drug. Also, neurosurgeons in particular should consider the possibility of drug-induced vasculitis when faced with cases of intracerebral or subarachnoid hemorrhage without apparent cause.
Radiation Therapy in the Treatment of Cerebral Astrocytoma
Authors: Morantz Robert A.
Published: May 2010

With the advent of more sensitive diagnostic techniques, we are encountering an increasing number of young patients harboring cerebral astrocytoma. The great danger in such patients is that the astrocytoma cells will undergo dedifferentiation to a higher state of malignancy. An essential question is whether the use of postoperative adjuvant radiation therapy can decrease the incidence of this event. Because a prospective, randomized study has never been carried out, it is extremely difficult to ascertain whether radiation therapy should be given to these patients. This article reviews the main retrospective clinical studies in an attempt to determine whether the addition of radiation therapy increases the length or quality of survival in patients with astrocytoma. Based on this literature review, the following tentative conclusions have been reached: (a) All reported studies are inconclusive; therefore, dogmatic statements as to whether radiation therapy should be used are not warranted. (b) One should try to obtain pathological confirmation of the precise nature of all tumor-like cerebral lesions that have been detected on neuroradiological studies. (c) Consistent with sound neurosurgical judgment, every attempt should be made to carry out a gross total removal of the hemispheric astrocytoma. (d) In the case of such a gross total surgical removal and even in its absence in the case of a juvenile pilocytic astrocytoma, radiation therapy may be withheld and the patient carefully followed for tumor recurrence. (e) In those cases where total removal cannot be accomplished, postoperative radiation therapy seems warranted. (f) Such radiation therapy should be given in a conventional fractionated schedule to a maximum of 5500 rads. The radiation therapy should not be given to the whole brain, but rather to the tumor plus a limited surrounding margin as determined by computed tomography/magnetic resonance imaging. Such a treatment regimen may reasonably be expected to lead to a 5-year survival rate of approximately 40%.
Whatever Happened to Stereotactic Surgery?
Authors: Gildenberg Philip L.
Published: May 2010

The field of human stereotactic surgery began when Spiegel and Wycis introduced their stereoencephalotome in 1947, reached its epitome in the early 1960s, and declined sharply after the introduction of l-dopa in 1968. When the development of implantable stimulators provided an abrupt expansion of techniques in nonstereotactic functional neurosurgery, the field became “stereotactic and functional neurosurgery.” The marriage of stereotactic surgery with computed tomography has reawakened the use of stereotactic surgery and brought it closer to general neurosurgery than ever before. Stereotactic and functional neurosurgery as a subspecialty has expanded rapidly and will continue to expand at an unprecedented rate, with significant changes reflecting the continuing advances in technology begun 15 years ago. It is becoming an increasingly important part of the field of neurosurgery and has extended its influence in many new clinical areas previously outside the realm of stereotaxis.
Sylvian Fissure Arteriovenous Malformations
Authors: Sugita Kenichiro , Takemae Toshiki , Kobayashi Shigeaki
Published: May 2010

We have operated on 16 cases of arteriovenous malformation (AVM) in and around the sylvian fissure. We call these lesions “sylvian fissure AVMs” and classify them into four subdivisions, namely, pure, lateral, medial, and deep AVMs. By others, they have been variously called AVMs of the basal ganglia, insula, anterior choroidal artery, frontal lobe, or temporal lobe. These sylvian fissure AVMs showed similar angiographic findings: the feeders in all cases were branches of the middle cerebral artery; in some cases, additional feeders from the anterior and posterior choroidal and posterior communicating arteries were present also. We describe the characteristic features of these AVMs from the anatomical and surgical points of view. The surgical results were satisfactory in 15 cases (no additional neurological deficits), and 1 patient died. (Neurosurgery 21: 7-14, 1987)
Magnetic Resonance Imaging of Cerebral Arteriovenous Malformations
Authors: Leblanc Richard , Levesque Michel , Comair Youssef , Ethier Romeo
Published: May 2010

Magnetic resonance imaging (MRI) was performed in 15 patients with small to very large supratentorial arteriovenous malformations (AVMs). Unlike non-contrast infused computed tomographic (CT) scanning, MRI demonstrated the AVM in all cases. The nidus had a characteristic honeycomb appearance, and in all cases feeding arteries and deep or superficial draining veins were demonstrated without intervening bone artifact. The relationship of the AVM to surrounding cortical areas, deep nuclei, important white matter tracts, and the ventricular system was well appreciated. These characteristics make MRI useful for the diagnosis of cerebral AVMs and add to the accuracy of systems that grade operability on the basis of the angiographic demonstration of size, location, depth, arterial supply, and venous drainage. In many cases, based on the MRI appearance of the AVM and its relationship to important brain structures, the lesion can be deemed inoperable or unsuitable for other forms of treatment, making angiography unnecessary. Thus, the superior anatomical and morphological resolution of MRI, the lower false-negative rate, and the independence from x-ray and contrast material make MRI more useful than CT scanning for the diagnosis of AVMs and as an aid in the management of specific cases. (Neurosurgery 21: 15-20, 1987)
Primary Oligodendroglioma of the Septum Pellucidum
Authors: Garza-Mercado Román , Campa Hernán , Grajeda Jorge
Published: May 2010

The oligodendroglioma is an infrequent cerebral tumor of glial ancestry. It is even rarer when primarily arising within the confines of the ventricles and particularly if originating from the septum pellucidum. A 22-year-old man harboring a primary oligodendroglioma of the septum pellucidum was successfully treated by intraventricular tumor removal through a left transcortical-transventricular approach, using microsurgical technique. A brief review of relevant data about both intraventricular oligodendrogliomas and tumors of the septum pellucidum is presented. (Neurosurgery 21: 78-80, 1987)
Cerebellar Medulloblastoma in a 73-Year-Old Woman
Authors: Kepes John J. , Morantz Robert A. , Dorzab William E.
Published: May 2010

A case of a 73-year-old woman with cerebellar medulloblastoma is described. The patient presented with the classical symptoms and signs of a medulloblastoma, and radiological findings were also consistent with this entity. Nevertheless, because of the patient's advanced age, the possibilities of metastatic tumor involving the cerebellum or a primary cerebellar lymphoma were considered before operation. Pathological examination of the operative specimen showed a classical medulloblastoma with occasional areas of early neuroblastic differentiation. Immunoperoxidase stains for neurofilaments were of help in confirming the neurogenic origin of the neoplastic cells. Although medulloblastomas in adults are not rare, onset after the age of 50 is exceptional, with only two cases on record in patients 65 or older. The present patient seems to be the oldest individual with a cerebellar medulloblastoma thus far reported. (Neurosurgery 21: 81-83, 1987)
Traumatic Bilateral Ophthalmic Artery Aneurysms: A Case Report
Authors: Hahn Yoon S. , McLone David G.
Published: May 2010

A case of bilateral ophthalmic artery aneurysm of traumatic origin is discussed. The patient presented with progressive loss of vision, memory deficit, and expressive aphasia. A computed tomographic scan revealed enhancing lesions near the region of the optic chiasm. The diagnosis of cerebral aneurysm was confirmed by cerebral angiography. At operation, bilateral ophthalmic artery aneurysms were successfully clipped. (Neurosurgery 21: 86-89, 1987)
Diastematomyelia of the Cervical Spinal Cord with Tethering in an Adult
Authors: Wolf Aizik L. , Tubman David E. , Seljeskog Edward L.
Published: May 2010

A case of cervical diastematomyelia associated with spinal cord tethering in an adult is presented. The differences between cervicodorsal and lumbar region spinal dysraphic states are emphasized with a review of the embryological factors involved. Possible causes and subsequent treatment are outlined. (Neurosurgery 21: 94-98, 1987)
Three-Dimensional Computed Tomography in the Diagnosis of Vertebral Column Pathological Conditions
Authors: Hadley Mark N. , Sonntag Volker K. H. , Amos Rob M. , Hodak John A. , Lopez Lynda J.
Published: May 2010

Three-dimensional computed tomographic scanning is a valuable adjunct in the diagnosis and treatment of disease processes involving the spine. We present our experience with this noninvasive radiological diagnostic technique in 32 patients with vertebral column abnormalities ranging from craniovertebral junction disorders to fractures of lumbar vertebrae. The three-dimensional CT images often demonstrate pathological conditions and occult lesions that are not adequately defined by conventional radiographic means.
Hearing Preservation after Acoustic Neurinoma Operation
Authors: Frerebeau Ph. , Benezech J. , Uziel A. , Coubes P. , Segnarbieux F. , Malonga M.
Published: May 2010

Between 1981 and 1984, 44 patients underwent acoustic neurinoma removal by a posterior cranial fossa approach with an attempt to preserve hearing. Seven tumors were small (<20 mm), 28 were medium (20 to 40 mm), and 9 were large (>40 mm). Preoperatively, 4 patients had normal hearing, 15 had serviceable hearing, 10 had poor hearing, and 15 had no hearing. Postoperative hearing was preserved in 11 cases. Of the 19 patients with normal or serviceable hearing, 8 (42%) had serviceable hearing preserved postoperatively. Hearing preservation was achieved in 43% of the patients with small tumors, 25% of those with medium tumors, and 11% of those with large tumors. This study confirms the value of the suboccipital approach, which can be used in an attempt to preserve hearing whenever the patient has serviceable hearing preoperatively and whenever the tumor size makes it feasible.
Effect of the Extent of Surgical Resection on Survival and Quality of Life in Patients with Supratentorial Glioblastomas and Anaplastic Astrocytomas
Authors: Ammirati Mario , Vick Nicholas , Youlian Liao , Ivan Ciric , Mikhael Michael
Published: May 2010

Thirty-one patients operated upon for supratentorial glioblastomas or anaplastic astrocytomas were studied to evaluate the effect of the extent of surgical resection on the length and quality of survival. The median age was 50 years and the median preoperative Karnofsky rate was 80. Twenty-one patients (68%) had glioblastoma multiforme, and 10 patients (32%) had anaplastic astrocytoma. Early postoperative enhanced computed tomography was used to determine the extent of tumor resection. Gross total tumor resection was accomplished in 19 patients (61%), and subtotal resection was performed in 12 patients (39%). The two groups were comparable regarding age, sex, pathological condition, preoperative Karnofsky rating, tumor location, postoperative radiation therapy, and postoperative chemotherapy (P > 0.05). The gross total resection group lived longer than the subtotal resection group by life table analysis (P < 0.001; median survival of 90 and 43 weeks, respectively). Postoperatively, the mean functional ability measured by the Karnofsky rating was significantly increased in the gross total resection group (P = 0.006), but not in the subtotal resection group (P > 0.05). The difference in degree of change between preoperative and postoperative Karnofsky rating in the two groups was statistically significant (P = 0.002). The gross total resection group spent significantly more time after the operation in an independent status (Karnofsky rating ≥ 80) compared to the subtotal resection group (P = 0.007; median time of 185 and 12.5 weeks, respectively). Gross total resection of supratentorial glioblastomas and anaplastic astrocytomas is feasible and is directly associated with longer and better survival when compared to subtotal resection.
Long Term Results of Transsphenoidal Adenomectomy in Patients with Cushing's Disease
Authors: Nakane Toshichi , Kuwayama Akio , Watanabe Masao , Takahashi Tatsuo , Kato Tetsuo , Ichihara Kaoru , Kageyama Naoki
Published: May 2010

As part of an ongoing series, 100 patients with Cushing's disease underwent transsphenoidal operations. Pituitary adenomas were confirmed in 93 patients, and initial remission was achieved in 86 (92%) of them. Hypercortisolemia was not corrected in 7 patients, and in 4 this was due to invasive adenomas. These patients were subjected to irradiation, medical treatment, or both after operation. Only 7 of the 100 patients had no pituitary adenoma found at operation, and they obtained no clinical remission even after partial or subtotal hypophysectomy. Follow-up review, with an emphasis on endocrinological studies, was performed on these patients for a mean period of 38 months. Seventy-eight patients were in long term remission after operation and had restoration of noncorticotropic hormone secretion as well as pituitary-adrenal function. Recurrence was noted in 8 patients after 19 to 82 months in remission. In all of these patients, pituitary adenomas were verified by reoperation and no case of corticotrophic cell hyperplasia was noted. We conclude that late recurrence of Cushing's disease may occur after adenoma removal and is due to the regrowth of adenoma cells left behind in the peritumoral tissue at the first operation. In view of the overall remission rate, transsphenoidal adenomectomy is considered a highly effective treatment for Cushing's disease.
Spinal Cord Decompression for Gaucher's Disease
Authors: Goldblatt Jack , Keet Peter , Dall Desmond
Published: May 2010

We report an individual with Type I nonneuronopathic Gaucher's disease who experienced the rare complication of spinal cord compression secondary to a sclerotic vertebral fracture. He successfully underwent anterolateral spinal cord decompression and spinal fusion despite the severity of his generalized skeletal disease.
Spinal Cord Proliferative Sparganosis in Taiwan: A Case Report
Authors: Lo Yuk-keung , Chao David , Yan Sui-hang , Liu Hsiu-chi , Chu Fu-li , Huang Chun-I , Chang Tsuen , Liu Hung-cheng
Published: May 2010

A 43-year-old woman suffered from low back pain and bilateral footdrop. A cisternal myelogram unexpected revealed multiple filling defects in the spinal canal extending from the lower cervical region to the caudal equina. Diagnostic exploration revealed numerous cystic organisms adhering to the spinal cord and nerve roots. Histopathological examination showed these organisms to be proliferative sparganum cestode larvae. Although these cestode larval infections have been reported a dozen times in humans from various parts of the world, this is probably the first reported case of spinal cord infection.
Multiple Sclerosis Plaque Simulating Cerebral Tumor: Case Report and Review of the Literature
Authors: Mastrostefano Roberto , Occhipinti Emanuele , Bigotti Giulio , Pompili Alfredo
Published: May 2010

Multiple sclerosis rarely may present as a focal cerebral mass with clinical features and computed tomographic scan appearances of cerebral tumor. Distinguishing between these can be difficult or impossible. We report a case of a multiple sclerosis plaque involving the parietal lobe with mass effect; clinical and radiological features had led to a diagnosis of cerebral tumor.
Demyelinating Disease of Corpus Callosum Presenting as Glioma on Magnetic Resonance Scan: A Case Documented with Pathological Findings
Authors: Kalyan-Raman Uma P. , Garwacki Dennis J. , Elwood Patrick W
Published: May 2010

Magnetic resonance imaging (MRI) has improved the diagnosis of several pathological entities of the brain. MRI especially has been credited with distinguishing demyelinating diseases of the central nervous system from other diseases. The presence of a mass effect in a demyelinating disorder, however, makes difficult the distinction between tumor and a demyelinating disease. We report a case of a demyelinating disorder simulating an infiltrating glioma of the corpus callosum on MRI scan, resulting in surgical intervention. To our knowledge, this is the first case to be reported with MRI and documented pathological findings.
Spinal Cord Stimulation for Amelioration of Spasticity: Experimental Results
Authors: Maiman Dennis J. , Myklebust Joel B. , Barolat-Romana Giancarlo
Published: May 2010

Fourteen cats underwent 500-g/cm dorsal impact injuries to the spinal cord and the placement of stimulating electrodes above and below the level of injury at T8. After recovery from the surgical procedure and the development of spasticity, each animal participated in several trials of spinal cord stimulation (SCS). Cord stimulation was provided above or below the level of injury using currents of less than 0.75 mA at 100 Hz. Electromyogram changes in hamstring and quadricep muscles (during spasms induced by dorsiflexion of the paw) were monitored. All animals showed complete paraplegia and, at 3 weeks, severe spasms. Spasticity was aggravated by SCS delivered above the level of injury. Spasms were markedly suppressed by monopolar stimulation delivered below the level of the lesion. Effects were maximal with the negative electrode applied to the cord and were slightly less with reversal of polarity. Muscle excitation was seen before diminution of spasms when bipolar currents were used. All effects lasted only as long as currents were delivered. These animal trials suggest that the effects of SCS are directly related to the current and its type. Beneficial effects were seen only when currents were delivered below the level of injury; this suggests that SCS activates local inhibitory processes or depolarizes local excitatory pathways. The poor results with bipolar stimulation do not support action on a multisynaptic cord system in short term stimulation.
Hydrosyringomyelia and Its Management in Childhood
Authors: Hoffman Harold J. , Neill John , Crone Kerry R. , Hendrick Bruce E. , Humphreys Robin P.
Published: May 2010

Syringomyelia, once regarded as a degenerative disease of adults, is now recognized to be a disorder usually associated with the Chiari malformation and occurring in patients of all ages. We have reviewed 47 patients with syringomyelia treated on the Neurosurgical Service at the Hospital for Sick Children during the years 1977 to 1985. Twelve of these patients had a Chiari I malformation, 30 had a Chiari II malformation, and 5 had an acquired Chiari malformation. Thirty-one of these patients were treated by decompression of the Chiari malformation and plugging of the obex, 5 were treated by a simple posterior fossa decompression, 9 were treated by shunting of the syringomyelic cavity, and 2 were treated by a combined decompression of the posterior fossa and shunting of the syrinx. The Gardner procedure (decompression of the Chiari malformation and plugging of the obex) was the procedure most commonly used in managing our group of patients and resulted in improvement in over 70% of patients.
Comparative Evaluation of Intracranial Epidermoid Tumors with Computed Tomography and Magnetic Resonance Imaging
Authors: Olson Jeffrey J. , Beck David W. , Crawford Stephen C. , Menezes Arnold H.
Published: May 2010

The diagnosis of intracranial epidermoid tumors with computed tomography (CT) is often difficult because of indistinct margins, close proximity to the skull base, and a density similar to that of cerebrospinal fluid (CSF). Recent experience with six histologically confirmed epidermoid tumors served to emphasize the value of magnetic resonance (MR) imaging in studying these lesions. MR images were obtained using varying spin echo and inversion recovery techniques with a 0.5-tesla superconducting magnet. CT with and without enhancement had been performed in each case. In Case 1, CT showed an ill-defined left cerebellopontine angle hypodensity. MR imaging clearly showed the presence of abnormal tissue at that location. Case 2 showed a CSF density mass in the right upper posterior fossa. MR imaging of that area showed a variegated signal of a mass extending supratentorially. CT of Case 3 showed a left medial middle fossa hypodensity with an enhancing rim. MR imaging showed a clearly extraaxial mass in that location. In Case 4, a diffuse cerebellar hemispheric hypodensity was observed on CT and was clearly demarcated by MR studies. A huge lesion, thought initially to be an arachnoid cyst on CT of Case 5, was seen on MR imaging to be a large, extraventricular mass displacing the temporal lobe. Finally, CT in Case 6 was suggestive of a poorly demarcated right cerebellopontine angle lesion, which was seen on MR images to be extraaxial, displacing the brain stem. Various MR images more clearly demonstrate the extent of abnormal tissue than CT of epidermoid tumors. Although it does not give a specific tissue diagnosis, MR is of great value in planning the optimal surgical approach to these lesions.
“Giant Pneumoaneurysm” after Combined Internal Carotid Artery Occlusion and Extracranial-Intracranial Anastomosis
Authors: Inagawa Tetsuji , Ogasawara Hidenori , Kamiya Kazuko , Taguchi Haruyoshi
Published: May 2010

A patient with a giant aneurysm of the internal carotid artery (ICA) was treated by combined ICA occlusion in the neck and superficial temporal artery to middle cerebral artery anastomosis. Six months after complete closure of the ICA, the patient had episodes of nasal discharge mixed with dark red, old blood. Computed tomographic scan demonstrated that the lumen of the giant aneurysm was filled with a large amount of air, which communicated with the nasal cavity. Not finding a similar case in the literature, we named this entity “giant pneumoaneurysm.” After direct operation, the giant pneumoaneurysm collapsed. This unusual complication may be due to a decrease of blood supply to the aneurysmal wall through the vasa vasorum.
Demonstration by Magnetic Resonance of Symptomatic Spinal Epidural Lipomatosis
Authors: Healy Mark E. , Hesselink John R. , Ostrup Richard C. , Alksne John F.
Published: May 2010

In patients with Cushing's syndrome or morbid obesity, excessive accumulation of fat in the hips, upper back, abdomen, and mediastinum is well known (1, 3, 7). Excessive deposition of fat in the epidural space is less common, but must be recognized as a potential cause of neurological deficit (1-8). We report a patient with iatrogenic Cushing's syndrome, in whom magnetic resonance imaging (MRI) established the specific diagnosis of spinal cord compression secondary to excess epidural fat.
Myelopathy Due to Diffuse Thickening of the Cervical Dura Mater in Maroteaux-Lamy Syndrome: Report of a Case
Authors: Tamaki Norihiko , Kojima Noriaki , Tanimoto Michinori , Suyama Touru , Matsumoto Satoshi
Published: May 2010

A rare case of diffuse thickening of the cervical dura mater leading to cord compression in Maroteaux-Lamy syndrome (mucopolysaccharidosis VI) is reported. Spinal computed tomographic scans after intrathecal metrizamide injection and magnetic resonance images are shown. This condition presents as cervical myelopathy. Early decompression can be beneficial for patients with this infrequent metabolic disorder.
Tumors of the Brachial Plexus
Authors: Lusk Michael D. , Kline David G. , Garcia Carlos A.
Published: May 2010

Over a 17-year period, 56 patients with 57 tumors involving the brachial plexus were operated upon. The 40 neural sheath tumors included 26 neurofibromas, 8 schwannomas, 4 malignant neural sheath tumors, 1 fibrosarcoma, and 1 meningioma. Nine of the neurofibromas were associated with von Recklinghausen's disease (VRD), and 2 others were what was termed regionalized neurofibromatosis characterized by involvement of one limb with extension along the course of one or more plexus elements. Seventeen tumors were not of neural sheath origin; 7 were benign and 10 were metastatic malignant tumors compressing or invading the plexus. Benign neurofibromas and malignant sheath tumors almost always presented with pain or functional neural deficit, whereas schwannomas often presented with a palpable mass as their only initial symptom. Patients with solitary neurofibromas were significantly older, often female, and more likely to have tumor on the right side than patients with schwannomas, malignant neural sheath tumors, or neurofibromas associated with VRD. Solitary neurofibromas could often be totally resected without added deficit by sacrificing fascicles entering and leaving tumor that were determined to be “nonfunctional” by intraoperative nerve action potential recordings. Resection of neurofibromas associated with VRD sometimes but not always resulted in significant loss. Operation is nonetheless recommended, especially when malignancy is suspected because of rapidly increasing size, when severe pain or neural deficit is present, or when compression of adjacent plexus elements is a concern. Schwannomas and benign non-neural sheath tumors can usually be extirpated without damage to plexus elements. Forequarter amputation is advised for malignant intrinsic tumors involving distal plexus elements even though gross total resection seems feasible.
Somatosensory Evoked Potential Monitoring of Temporary Middle Cerebral Artery Occlusion during Aneurysm Operation
Authors: Mooij Jan J. A. , Buchthal Anna , Belopavlovic Milan
Published: May 2010

Somatosensory evoked potentials (SEPs) in response to median nerve stimulation were used as a guide to cortical function during temporary occlusion of the distal M1 segment of the middle cerebral artery (MCA) in the surgical treatment of five large aneurysms of the MCA bifurcation. MCA occlusion times ranged from 8 to 19 minutes under moderate hypothermia at 28.8° to 30.3°C. SEPs were preserved for variable times during MCA occlusion, ranging from no increase in latency after 13 minutes of occlusion to severe deterioration after 6 minutes. In no case was MCA occlusion maintained for longer than 3 minutes in the presence of a severely disturbed SEP. Recovery of the SEP to its preoperative relationship with that of the nonoperated hemisphere was seen in all cases before the end of operation. All patients were awake after rewarming at the end of operation without any neurological deficit. Monitoring the SEP pertaining to the territory of a cerebral artery during its temporary occlusion can help avoid ischemic damage and will allow the surgeon to take advantage of the several benefits of this technique in aneurysm surgery. (Neurosurgery 21:492-496, 1987)
Sciatica and Epidural Gas
Authors: Beatty Robert A.
Published: May 2010

Epidural gas in the patient with sciatica can sometimes provide a clue that there is a surgically treatable lesion. Our patient had the sudden onset of sciatica at night, which was relieved by walking. An intraspinal synovial cyst was associated with epidural gas. (Neurosurgery 21:537-539, 1987)
Cerebellar Abscess: The Impact of Computed Tomographic Scanning
Authors: van Dellen James Rikus , Bullock Ross , Postma Martinus Hermannus
Published: May 2010

Thirty-four cases of cerebellar abscess, diagnosed by computed tomographic (CT) scanning, were managed according to a standard protocol during a 4-year period. Triple high dosage intravenous antibiotics were used, open catheter drainage of the abscess was instituted, and external ventricular drainage was added if obvious hydrocephalus was present. Seventeen patients made a good recovery, and five remained minimally disabled. Ten patients died, and two were left severely disabled. A relationship between the level of consciousness on admission and final outcome was established. In addition, two particular CT scan features (viz. the presence of hydrocephalus and the stage of the abscess) were significant adverse prognostic factors. (Neurosurgery 21:547-550, 1987)
Solitary Plasmacytoma of the Calvarium: Two Cases Treated by Operation Alone
Authors: Arienta Cesare , Caroli Manuela , Ceretti Laura , Villani Roberto
Published: May 2010

Two cases of solitary plasmacytoma of the calvarium operated on with radical removal are reported. The two patients were not submitted to postoperative radiotherapy, unlike other cases reported in the literature. The authors stress that soiltary plasmacytoma of the calvarium may have a good prognosis if radically removed, and in these cases radiotherapy is not necessary. (Neurosurgery 21:560-563, 1987)
Unilateral Normal Perfusion Pressure Breakthrough after Carotid Endarterectomy: Case Report
Authors: Andrews Brian T. , Levy Michael L. , Dillon William , Weinstein Philip R.
Published: May 2010

The authors report a case of unilateral malignant cerebral edema that occurred after the removal of a high grade atheromatous lesion of the ipsilateral internal carotid artery. A form of unilateral normal perfusion pressure breakthrough caused by postischemic impairment of cerebrovascular autoregulation and exacerbated by systemic hypertension is thought to have contributed to this complication. Control of the hypertension and treatment of the cerebral edema with mannitol and dexamethasone led to a complete neurological recovery. (Neurosurgery 21:568-571, 1987)
Anterior Inferior Cerebellar Artery Aneurysm, Carotid Bifurcation Aneurysm, and Dural Arteriovenous Malformation of the Tentorium in the Same Patient
Authors: Kaech Denis , de Tribolet Nicolas , Lasjaunias Pierre
Published: May 2010

An exceptional combination of intracranial vascular malformations is reported: distal anterior inferior cerebellar artery (AICA) aneurysm, carotid bifurcation aneurysm, and dural arteriovenous malformation (DAVM) of the tentorium. The AICA aneurysm was the source of recurrent subarachnoid and cerebellar hemorrhage, revealed only after repeated vertebral angiography. After external drainage of associated hydrocephalus, both aneurysms were successfully clipped and the dural malformation was subtotally embolized. The literature concerning AICA aneurysms, DAVMs, and combined intracranial vascular malformations is reviewed and discussed. (Neurosurgery 21:575-582, 1987)
Intracerebral Hemorrhage and Hematoma in Behçet's Disease: Case Report
Authors: Altinörs Nur , Şenveli Engin , Arda Nuri , Türker Ayhan , Kars Zafer , çinar Nusret , özkan Seyhan
Published: May 2010

The authors describe a patient with Behçet's disease who suffered from intracerebral hemorrhage 2½ years after the initial diagnosis. There is strong evidence that this situation is not merely a coincidence; rather, these two abnormalities have a cause and effect relationship. (Neurosurgery 21:582-583, 1987)
Intrasellar Tuberculoma: Case Report
Authors: Esposito Vincenzo , Fraioli Bernardo , Ferrante Luigi , Palma Lucio
Published: May 2010

We report a unique case of exclusively intrasellar tuberculoma. The patient was operated on by the transsphenoidal approach, which allowed total removal of the lesion and prevented cerebrospinal fluid contamination. After histological diagnosis, the patient was treated with isoniazid, 300 mg daily for 3 months, as prophylaxis against tuberculous meningitis. (Neurosurgery 21:721-723, 1987)
Subdural Empyema Occurring 20 Years after Trauma: Case Report
Authors: Tokoro Kazuhiko , Yamataki Akira , Nakajima Fumoto
Published: May 2010

The authors report a case of subdural empyema that occurred 20 years after a severe closed head injury and was treated surgically with good results. Traumatic subdural empyema of this late onset is rare. The literature is reviewed, and the mechanism of a delayed presentation is discussed. (Neurosurgery 21:724-726, 1987)
Neurinoma of the Trigeminal Root Presenting as Atypical Trigeminal Neuralgia: Diagnostic Values of Orbicularis Oculi Reflex and Magnetic Resonance Imaging
Authors: Tanaka Akira , Maruta Yoshirou , Maruta Yoshirou
Published: May 2010

A case of trigeminal root neurinoma presenting as atypical trigeminal neuralgia was reported. The orbicularis oculi reflex was absent on the affected side, but reappeared after operation. The demonstration of the tumor was much clearer on magnetic resonance imaging. The usefulness of these electrophysiological and radiological studies in differentiating varied entities of trigeminal neuralgia is stressed. (Neurosurgery 21:733-736, 1987)