bluuebunny/crossref_metadata_2025 huggingface dataset:
The binding influence of the Journal of Neurosurgery on the evolution of neurosurgery
Authors: Laws Edward R.
Published: May 2009

✓ The author, who is currently a member of the Editorial Board of the Journal of Neurosurgery, examines the development of the specialty of neurosurgery and the timing of first publication of the Journal. He describes the role played by the Journal in the constantly advancing specialty and its importance to neurosurgery as a whole.
Posterior plates in the management of cervical instability: long-term results in 44 patients
Authors: Fehlings Michael G. , Cooper Paul R. , Errico Thomas J.
Published: May 2009

✓ Although posterior plates are increasingly used to manage cervical spinal instability, long-term follow-up evaluation of patients with a critical analysis of efficacy and complications has not been reported. The authors have retrospectively analyzed the outcome in 44 consecutive patients (37 males and seven females, age range 16 to 80 years) treated with posterior cervical plates. The indications for instrumentation were instability due to trauma in 42 cases, tumor in one, and infection in one. In four patients the follow-up period was limited to 3, 5, 11, and 16 months. Two patients died of chronic medical problems 4 and 9 months after treatment. The remaining 38 patients were followed from 2 to 6 years (mean 46 months). One motion segment was stabilized in 23 patients using two-hole plates; two motion segments were stabilized in the other 21 patients using three-hole plates. In the majority of patients (37 cases), supplemental bone grafting was not used. Patients were immobilized postoperatively in a Philadelphia collar. Solid arthrodesis was achieved in 39 (93%) of 42 patients. Three patients required revision of the cervical plating: in one patient with a C-5 burst fracture, two-hole plates were applied at C5–6 and progressive kyphosis mandated anterior fusion; the second patient required posterior wiring due to screw pull-out resulting from a technical error in screw insertion; the third patient, who refused to wear an orthosis postoperatively, also developed screw pull-out. In two patients who went on to spinal fusion, there was an increase in sagittal kyphosis (6° and 8°) without clinical sequelae. Screw loosening was noted in five patients, involving eight (3.8%) of the 210 lateral mass screws; this complication resulted in instrumentation failure or increased kyphosis in three cases. There were two superficial infections.

This analysis indicates that posterior cervical plating is highly effective; at long-term follow-up review the cervical spine was successfully stabilized in 93% of cases. Plate failure was related to faulty screw placement, failure to include sufficient motion segments, and noncompliance with postoperative orthoses. Halo vest immobilization was unnecessary and supplemental bone grafting was generally not required for recent trauma.
Growth suppression and astrocytic differentiation of glioma cells by interleukin-1
Authors: Tanaka Satoshi , Nagashima Tadashi , Manaka Shinya , Hori Tomokatsu , Yasumoto Shigeru
Published: May 2009

✓ The effect of recombinant human interleukin-1 (rHuIL-1) derivatives on human glioma cell lines was examinedin vitro. Five glioma cell lines, U-251 MG, U-373 MG, U-87 MG, A-172, and T98G, were incubated in medium containing 1% fetal calf serum and various concentrations of different types of rHuIL-1: OCT-43 (rHuIL-1β), OCT-7000 (rHuIL-1α), and OCT-8000 (rHuIL-1α). The high-affinity IL-1 receptors were expressed in the U-251 MG and U-373 MG cell lines, and rHuIL-1 was found to suppress cell growth and to induce morphological differentiation of these cell lines. Growth inhibition occurred in a dose-dependent manner in concentrations or rHuIL-1 ranging between 1 and 100 ng/ml. Interestingly, rHuIL-1 induced a transient growth of glioma cells shortly after administration, then suppressed cell growth with accompanying elongation of cytoplasmic processes. This unique process of transient growth stimulation followed by growth suppression was parallel to the efficacy of bromodeoxyuridine uptake in the rHuIL-1-treated cells. Concomitantly, accumulation of glial fibrillary acidic protein and cyclic adenosine monophosphate contents was observed in four glioma cell lines. Continuous rHuIL-1 treatment for longer than 30 days elicited irreversible astrocytic terminal differentiation. These results indicate that IL-1 is an effector on the growth regulation of glioma cells, resulting in astrocytic differentiationin vitro.
Analysis of intra- and intercellular calcium signaling in a mouse malignant glioma cell line
Authors: Yamasaki Toshiki , Enomoto Kou-Ichi , Moritake Kouzo , Maeno Takashi
Published: May 2009

✓ Intra- and intercellular calcium signaling in glioma cells was examined by mechanical stimulation of a monolayer cell line of methylcholanthrene-induced mouse ependymoblastoma, 203-glioma, with a fine round-tip glass needle. A fura-2 fluorescence image of the glioma revealed a four- to eightfold increase in the cytosolic calcium ion concentration in directly stimulated signal cells. The increased calcium spread to surrounding cells at a speed of 20 µm/sec for a distance of up to 200 µm. Calcium was transmitted between adjacent cells and even in cells up to 200 µm distant from the initially stimulated cell. Microinjection of Lucifer yellow dye showed no gap junctional communication between cells. Depletion of extracellular calcium ion inhibited both cytosolic calcium elevation and propagation to neighboring cells by mechanical stimulus. An intracellular calcium blocker, TMB-8, eliminated the cytosolic calcium mobilization in a mechanically stimulated cell, but had no effect on calcium diffusion to surrounding cells. Nifedipine and verapamil, antagonists of voltage-dependent calcium channels, did not act on the mechanically induced calcium response. This suggests that some stimulating factor may trigger transmission of calcium, which may be ejected directly from single stimulated cells and mediated via a membrane receptor but not through a gap junction. The calcium signaling in a mechanically stimulated cell may be related to both an influx and a redistribution of intracellular calcium from internal stores, while calcium propagation to neighboring cells may involve calcium influx alone.
Pathways leading to glioblastoma multiforme: a molecular analysis of genetic alterations in 65 astrocytic tumors
Authors: Lang Frederick F. , Miller Douglas C. , Koslow Maxim , Newcomb Elizabeth W.
Published: May 2009

✓ To characterize some of the genetic events underlying the development of glioblastoma multiforme, the authors analyzed 65 astrocytic tumors (seven pilocytic astrocytomas, eight astrocytomas, 16 anaplastic astrocytomas, and 34 glioblastomas multiforme) for loss of heterozygosity for chromosome 17p, loss of heterozygosity for chromosomes 10p and 10q, amplification of the epidermal growth factor receptor (EGFR) gene, and amplification of the oncogenes N-myc, c-myc, and N-ras using Southern blot analysis. Alterations of the p53 gene (positive immunostaining for p53 protein in tumors with or without p53 gene mutations) in these 65 tumors were analyzed previously. None of the 65 tumors showed amplification or rearrangement of N-myc, c-myc, or N-ras oncogenes.

The molecular analysis presented here demonstrates distinct variants of astrocytic tumors, with at least three genetic pathways leading to glioblastoma multiforme. One pathway was characterized by 43 astrocytomas with alterations in p53. Glioblastomas with p53 alterations may represent tumors that progress from lower-grade astrocytomas. This variant was more likely to show loss of chromosome 17p than tumors without p53 alterations (p < 0.04). Seventy-five percent of tumors with loss of one 17p allele demonstrated mutations in the p53 gene. Loss of chromosome 10 was associated with progression from anaplastic astrocytoma (13%) to glioblastoma (38%) (p < 0.04). Amplification of the EGFR gene was a rare (7%) but late event in tumor progression (p < 0.03). A second pathway was characterized by six astrocytomas without p53 alterations and may represent clinically de novo high-grade tumors. These tumors were more likely to show amplification of the EGFR gene (83%) than tumors with p53 alterations. Sixty percent of tumors with EGFR amplification also showed loss of chromosome 10; loss of chromosome 17p was infrequent in this variant. One or more alternative pathways were characterized by 16 astrocytomas without p53 alterations and with none of the genetic changes analyzed in this study. Glioblastomas are a heterogeneous group of tumors that may arise via multiple genetic pathways.
Effects of extravascular acidification and extravascular alkalinization on constriction and depolarization in rat cerebral arterioles in vitro
Authors: Dietrich Hans H. , Dacey Ralph G.
Published: May 2009

✓ The relationship between cell membrane potential, vessel diameter, and pH in small cerebral arterioles is not completely understood. This study involved direct, simultaneous measurement of cell membrane potential and vessel diameter at various extracellular pH levels. Arterioles ranging from 44 to 91 µm in diameter were isolated, transferred to a temperature-controlled microscope chamber, which was used as an organ bath, and observed through an inverted videomicroscope. Two vessel cannulation procedures were used: a single-sided cannulation with the other side occluded, and a double-sided and perfused cannulation. After cannulation, the vessels were pressurized to 60 mm Hg intraluminally and the bath temperature was raised to 37°C. Cell membrane potentials of vessel wall cells were obtained after the bath temperature reached 37°C with the vessels partly constricted and again after spontaneous tone (constriction) of the healthy vessels had developed.

The effect of extraluminal pH on cell membrane potentials was studied by changing the bath pH from 7.3 to either 7.65 or 6.8 in the single-sided cannulation. The average cell membrane potential for vessels at 37°C, with 60 mm Hg of intraluminal pressure and pH 7.3, was −37.5 mV. The cell membrane potential depolarized to −30.9 mV at pH 7.65 and hyperpolarized to −58.4 mV at pH 6.8, with a slope of 25.8 mV/pH unit. The effect of depolarizing extracellular potassium ions on the cell membrane potential was examined by perfusing two vessels with modified Ringer's solution containing 70 mM KCl. This perfusion method decreased the vessel diameter by 48% and depolarized the observed cell membrane potential from −41.9 to −19.8 mV, with a slope of −0.42 mV per percentage diameter change.

These data provide the first measurements of membrane potentials of isolated penetrating arteriole wall cells in vitro. The results indicate that the cell membrane potential relates linearly to the vessel diameter. This new technique opens the possibility for studying vessel response to stimuli under controlled conditions and regulatory mechanisms such as the propagation of vasomotor responses.
Reversible visual deficit following debulking of a Rathke's cleft cyst: a tethered chiasm?
Authors: Fischer Edwin G. , DeGirolami Umberto , Suojanen James N.
Published: May 2009

✓ Delayed chiasmal syndromes after emptying of a Rathke's cleft cyst have not been reported previously. When these deficits occur following the treatment of parasellar lesions they are usually associated with the descent of a scarred optic system into an empty sella, and vision often improves promptly when the optic system is elevated. Two months after transsphenoidal surgery with emptying of a large intrasellar cyst, a 22-year-old man developed recurrent bitemporal visual field deficits over a 3-day period. Sagittal magnetic resonance images demonstrated an enhancing band of tissue extending anteriorly from the normally placed chiasm down to the anterior portion of the sella turcica. At craniotomy the enhancing tissue was found to be scar extending from the anterior border of the chiasm to the diaphragma sellae. The anterior portion of the diaphragm was resected as widely as possible without dissecting the scar itself from the chiasm. A membrane consistent with the wall of a Rathke's cleft cyst was found attached to the resected tissue. The patient's vision was improved 2 days after surgery. This case illustrates that traction by scar extending from the chiasm to the diaphragm, even when the chiasm is in its normal anatomical location, may cause progressive visual loss; and that untethering of the chiasm by resecting the diaphragm while leaving the scar intact can result in improved vision.
Thalamostriate artery aneurysm within the third ventricle
Authors: Bergsneider Marvin , Frazee John G. , DeSalles Antonio A.
Published: May 2009

✓ The authors report the case of a 7-mm saccular aneurysm, located within the third ventricle and arising from the distal portion of a thalamostriate artery. The patient presented with an intraventricular hemorrhage and was treated via a frontotemporal craniotomy with translamina-terminalis approach for resection of the aneurysm. The etiology of the aneurysm was presumed to be idiopathic. Previously only one other third ventricular aneurysm has been reported. An intraventricular aneurysm arising from a perforating artery should therefore be considered as a rare cause of an intraventricular hemorrhage. Potential surgical approaches to third ventricular aneurysms are discussed.
The use of clip-suture in thoracic sympathectomy
Authors: Beatty Robert A.
Published: May 2009

✓ A technique is described for using a clip-suture to expedite handling of the divided sympathetic chain in a deep, small upper-thoracic exposure. No late failures were experienced in 23 patients with hyperhydrosis surgically treated using this technique.
Cranioplasty with the Medpor porous polyethylene Flexblock implant
Authors: Couldwell William T. , Chen Thomas C. , Weiss Martin H. , Fukushima Takanori , Dougherty William
Published: May 2009

✓ The authors describe the use of a porous polyethylene Flexblock implant for cosmetic cranioplasty. The implant may be used to cover any small- or medium-sized (< 8 cm) cranial defect, offering similar cosmetic results to standard alloplast cranioplasty while decreasing operation time. The porous implant design permits ingrowth of soft tissue and bone to increase implant strength and decrease the risk of infection. The Flexblock alloplast has been utilized in 25 cases with excellent cosmetic results and no implant-related complications.
Hans Sølling: Danish pioneer neurosurgeon
Authors: Søgaard Ib , Ljunggren Bengt
Published: May 2009

✓ Hans Adolf Sølling (1879–1945), working completely on his own in the small town of Horsens, was Denmark's first neurosurgeon. Sølling was an admirable and talented man who performed major intracranial operations on more than 130 patients suffering from trigeminal neuralgia, as well as treating epilepsy, craniotrauma, brain tumors, glossopharyngeal neuralgia, and myelomeningoceles. Although not in the same league as Harvey Cushing (1869–1939), Vilhelm Magnus in Norway (1871–1929), and Herbert Olivecrona in Sweden (1891–1980), Sølling was a true Danish pioneer.
Obstruction of the superior sagittal sinus caused by parasagittal meningiomas: the role of collateral venous pathways
Authors: Oka Kazunari , Go Yoshinori , Kimura Hideo , Tomonaga Masamichi
Published: May 2009

✓ The authors present studies of eight patients who had obstruction of the superior sagittal sinus caused by parasagittal meningioma. The results indicate that meningeal veins and end-to-end anastomoses of the superficial veins of the cerebrum play important roles as collateral venous pathways. This assessment suggests that, in patients with obstruction of the superior sagittal sinus, venous phase angiography should be carefully interpreted before surgery is attempted for parasagittal meningiomas.
Intracranial infantile myofibromatosis
Authors: Rutigliano Michael J. , Pollack Ian F. , Ahdab-Barmada Mamdouha , Pang Dachling , Albright A. Leland
Published: May 2009

✓ Infantile myofibromatosis is a proliferative disorder of infancy and early childhood characterized by nodular or diffuse growth of lesions that are comprised of a mixture of mesenchymal elements within the skin, subcutaneous tissues, skeletal muscle, bone, and/or visceral organs. Although these pseudotumors are considered to be the most common fibrous “neoplasm” of infancy, central nervous system involvement is reportedly rare. During the last 7 years, the authors have treated three children with intracranial myofibromas who presented at 6 weeks, 7 months, and 3 3/4 years of age, respectively. Each child had a large calvarial mass that produced significant brain compression despite a paucity of neurological signs. On computerized tomography, these tumors were isodense to brain tissue, enhanced strongly with intravenous contrast material, and showed smoothly marginated bone erosion without surrounding sclerosis. On magnetic resonance imaging, the tumors were hypointense on T1-weighted images, with dense enhancement following the administration of intravenous contrast medium, and hyperintense on T2-weighted images. At operation, the tumors were highly vascular and appeared to arise from within the leaves of the dura, eroding through the overlying bone, but not violating the galeal or arachnoidal layers. Two of the lesions were adherent to major dural venous sinuses. Both of these lesions were completely resected in continuity with the involved dura, and have not recurred 6 years and 1 year, respectively, postoperatively. However, in one patient in whom the involved dura was not resected at the initial procedure, the tumor recurred rapidly. A complete excision of the tumor and involved dura was then performed and the patient is now recurrence-free, 5 1/2 years after the second surgical resection. All patients tolerated resection well, but two have required cranioplasty for persistent calvarial defects. The surgical experience with these lesions is reviewed and the distinctive features of their clinical presentation, radiographic appearance, operative management, and outcome are discussed.
Vascular permeability factor in brain metastases: correlation with vasogenic brain edema and tumor angiogenesis
Authors: Strugar John , Rothbart David , Harrington William , Criscuolo Gregory R.
Published: May 2009

✓ Metastatic brain tumors are almost always associated with vasogenic brain edema, which in turn plays a pivotal role in the evolution of neurological morbidity associated with these lesions. Attention has recently focused on a group of proteinaceous vascular permeability factors (VPF's) that are capable of inducing angiogenesis and promoting increased capillary permeability. To test the hypothesis that metastatic brain tumors expressing VPF's are associated with peritumoral cerebral edema, a rabbit polyclonal immunoglobulin (Ig) G anti-VPF was used to immunostain pathological specimens of metastatic cerebral tumors obtained from 22 patients who underwent surgery at Yale-New Haven Hospital. Magnetic resonance (MR) imaging was used to correlate VPF staining in tumor tissue with the occurrence of peritumoral brain edema. A histological antigen, using two gliosis specimens as controls. Results revealed 21 of 22 tumors stained positively for VPF's; the negative-VPF tumor was a melanoma that exhibited no peritumoral edema. Twenty of 22 tumors had MR imaging-evident vasogenic edema. The presence and intensity of VPF immunostaining of microvascular features were noted and compared. Factor VIII staining demonstrated tumor vascularity to be most abundant in VPF-rich regions of tumor. The authors therefore report a high correlation between the presence of VPF's and the occurrence of peritumoral brain edema associated with cerebral metastases.
Optic pathway glioma infiltrating into somatostatinergic pathways in a young boy with gigantism
Authors: Manski Thomas J. , worth Charles S. Ha , Duval-Arnould Bertrand J. , Rushing Elisabeth J.
Published: May 2009

✓ The authors report gigantism in a 16-month-old boy with an extensive optic pathway glioma infiltrating into somatostatinergic pathways, as revealed by magnetic resonance imaging and immunocytochemical studies. Stereotactic biopsies of areas showing hyperintense signal abnormalities on T2-weighted images in and adjacent to the involved visual pathways provided rarely obtained histological correlation of such areas. The patient received chemotherapy, which resulted in reduction of size and signal intensity of the tumor and stabilization of vision and growth velocity.
Immune response in hosts with cadaveric dural grafts
Authors: Alleyne Cargill H. , Barrow Daniel L.
Published: May 2009

✓ The use of cadaveric human dura has been critical in the repair of dural defects since the dawn of neurosurgery. Reports in the literature of immune response to this type of graft have been extremely rare. Two patients are presented who received cadaveric dural implants with resulting meningeal signs and cerebrospinal fluid eosinophilia several weeks after surgery. Peripheral eosinophilia was present in one patient. The signs and symptoms resolved temporarily during corticosteroid therapy and permanently upon removal of the offending grafts. These cases illustrate that an immune-type reaction can occur with significant morbidity in patients receiving cadaveric dural grafts. A proposed mechanism for this response is discussed.
Rotational vertebrobasilar insufficiency as a component of thoracic outlet syndrome resulting in transient blindness
Authors: Sell James J. , Rael Jesse R. , Orrison William W.
Published: May 2009

✓ Cases of unilateral vertebral artery compression associated with thoracic outlet syndrome infrequently result in symptoms and, of those that do, most involve the brain stem. Reports of transient blindness resulting from this condition are even more rare. The authors describe the case of a middle-aged woman who presented with transient blindness when she turned her head excessively to the left. She also exhibited other less severe brainstem symptoms. Arteriography demonstrated occlusion of the left vertebral artery only when her head was rotated to the left. Surgical exploration revealed entrapment of the left vertebral artery by a tight anterior scalene muscle, release of which resulted in complete resolution of her symptoms. Both neurosurgeons and radiologists need to be aware that extrinsic compression of the vertebral artery precipitated by head rotation may sometimes result in transient cortical blindness.
Commemorative Article: Comments for the 50th anniversary of the Journal of Neurosurgery: First series
Authors: Welch Keasley , Turnbull Frank , Alexander Eben
Published: May 2009

✓ Three authors, who were all individual contributors to the first volume of the Journal of Neurosurgery, share some thoughts and remembrances of their original published articles. They also speak to the history of the Journal and its relationship to the growth of neurosurgery.
Toward better balance
Authors: Hoff Julian T.
Published: May 2009

✓ The AANS was founded in 1931 as an educational and scientific organization whose principal purpose was to foster optimum neurosurgical care. Because socioeconomic and political pressures on medicine generally and neurosurgery specifically have escalated in recent years, the American Association of Neurological Surgeons (AANS) has been required to respond effectively to matters beyond its traditional role. However, the AANS has lacked an effective, focused policymaking process to deal with socioeconomic concerns despite existing expertise within the specialty. The AANS now needs to develop a comprehensive socioeconomic effort that is consistent with its more traditional educational and scientific activities. A Task Force on Governance has been appointed to address how the Association's governance structure can reflect all the needs of our specialty in times of economic uncertainty and health care reform.
Hunterian proximal arterial occlusion for giant aneurysms of the carotid circulation
Authors: Drake Charles G. , Peerless Sydney J. , Ferguson Gary G.
Published: May 2009

✓ Hunterian proximal artery occlusion was used in the treatment of 160 of 335 patients harboring giant aneurysms of the anterior circulation. One hundred and thirty-three of these aneurysms arose from the internal carotid arteries, 20 from the middle cerebral arteries, and seven from the anterior cerebral arteries. Ninety percent of the patients had satisfactory outcomes. The safety of internal carotid artery occlusion has been greatly enhanced by preoperative flow studies and by test occlusion with an intracarotid balloon to identify those patients who require preliminary extracranial-to-intracranial bypass, which was used in all of the middle cerebral occlusions. The anterior cerebral artery had magnificent leptomeningeal collateral flow that prevented infarction even without cross flow. Obliteration of the aneurysm by thrombosis was complete, or nearly so, in all but four patients whose treatment was completed. Analysis of poor outcome in 16 patients revealed that hemodynamic ischemic infarction was known to occur after only two of the carotid occlusions.
Outcome after laminectomy for lumbar spinal stenosis
Authors: Tuite Gerald F. , Stern Joseph D. , Doran Stephen E. , Papadopoulos Stephen M. , McGillicuddy John E. , Oyedijo Dotun I. , Grube Susan V. , Lundquist Craig , Gilmer Holly S. , Schork M. Anthony , Swanson Steven E. , Hoff Julian T.
Published: May 2009

✓ All patients who underwent decompressive lumbar laminectomy in the Washtenaw County, Michigan metropolitan area during a 7-year period were studied for the purpose of defining long-term outcome, clinical correlations, and the need for subsequent fusion. Outcome was determined by questionnaire and physical examination from a cohort of 119 patients with an average follow-up evaluation interval of 4.6 years. Patients graded their outcome as much improved (37%), somewhat improved (29%), unchanged (17%), somewhat worse (5%), and much worse (12%) compared to their condition before surgery. Poor outcome correlated with the need for additional surgery, but there were few additional significant correlations. No patient had a lumbar fusion during the study interval.

The outcome after laminectomy was found to be less favorable than previously reported, based on a patient questionnaire administered to an unbiased patient population. Further randomized, controlled trials are therefore necessary to determine the efficacy of lumbar fusion as an adjunct to decompressive lumbar laminectomy.
Influence of major depression on 1-year outcome in patients with traumatic brain injury
Authors: Jorge Ricardo E. , Robinson Robert G. , Starkstein Sergio E. , Arndt Stephan V.
Published: May 2009

✓ The authors examine those factors that contributed to deterioration in social functioning, activities of daily living, or intellectual functioning during a 1-year period after traumatic brain injury (TBI). Fifty-two patients suffering an acute TBI were evaluated for existence and severity of mood disorders and impairment during their hospital stays and at 3-, 6-, and 12-month follow-up examinations. Patients whose scores on intellectual function, social function, or daily activities deteriorated during the 1-year period after trauma were considered to have a poor outcome.

Eleven of 52 patients had a poor outcome in social function, which was associated with race, right-hemisphere lesions, intellectual impairment, and prolonged major depression. Seven of 52 patients had a poor outcome in daily activities, which was associated with a major depression of more than 6 months' duration and severity of Hamilton Depression Rating Scale scores. Eleven of these patients had a poor outcome in cognitive function, which was associated with cognitive impairment immediately after TBI.

A major depression lasting more than 6 months was associated with deterioration of social functioning and activities of daily living during the 1-year period after TBI.
Subcellular boron-10 localization in glioblastoma for boron neutron capture therapy with Na2B12H11SH
Authors: Haselsberger Klaus , Radner Herbert , Gössler Walter , Schlagenhaufen Claudia , Pendl Gerhard
Published: May 2009

✓ Because of the short range of the highly energetic particles helium-4 and lithium-7 that results from neutron-induced disintegration of boron-10, the efficacy of Boron Neutron Capture Therapy (BNCT) is heavily dependent on 10B-microlocation. Despite the crucial importance of boron-10, there is little specific information with regard to the agent currently used for inducing BNCT, namely Na2B12H11SH. In the present study, a subcellular 10B-location was investigated in tumor tissue obtained from seven patients with glioblastoma World Health Organization Grade IV. These patients received Na2B12H11SH at doses used in therapeutic trials (75 mg/kg body weight in five patients, and 150 mg/kg body weight in two patients, respectively). In three cases, boron-10 was identified in glioblastoma cells by laser microprobe mass analysis. In these tumors, boron-10 was found only in the nuclei of neoplastic cells but not in other cell compartments. These preliminary results suggest a predominant association of Na2B12H11SH with the nuclei of malignant glioma cells and thus support the value of Na2B12H11SH as a suitable boron carrier for BNCT.
Prevention of delayed vasospasm by an endothelin ETA receptor antagonist, BQ-123: change of ETA receptor mRNA expression in a canine subarachnoid hemorrhage model
Authors: Itoh Shouichi , Sasaki Tomio , Asai Akio , Kuchino Yoshiyuki
Published: May 2009

✓ The authors investigated the roles of endothelin (ET)-1 and the ETA receptor in the pathogenesis of delayed cerebral vasospasm following subarachnoid hemorrhage (SAH). A study was made of the preventive effect of a novel ETA receptor antagonist, BQ-123, on vasospasm and the expression of the ETA receptor messenger ribonucleic acid (mRNA) using a canine two-hemorrhage SAH model. Continuous intrathecal administration of BQ-123 (5 × 10−6 mol/day) prevented narrowing of the basilar artery on Day 7 after SAH in 97.6% of cases in the study group versus 70.7% of cases in the control group (p < 0.05). While expression of the mRNA-coding ETA receptor was not detected in the control animals, it markedly increased on Day 3 after SAH and was also detected on Day 7. The results suggest that endothelin-1 and the ETA receptor participate in the pathogenesis of delayed cerebral vasospasm following SAH.
Choristoma of the intracranial maxillary nerve in a child
Authors: Lena Gabriel , Dufour Thierry , Gambarelli Danielle , Chabrol Brigitte , Mancini Josette
Published: May 2009

This report describes what the authors believe to be the first reported case of choristoma of the intracranial maxillary nerve. This 12-year-old girl presented with a 5-year history of severe isolated left-sided trigeminal neuralgia. Computerized tomography and magnetic resonance imaging revealed a mass below the anterior portion of the left cavernous sinus, enlarging the foramen rotundum. Total resection was achieved via a pterional extradural approach. Histological examination revealed a choristoma composed of smooth-muscle fibers. The histogenesis of these tumors when they develop in a nerve remains unclear. They may represent abnormal migration or proliferation of neuroectodermal tissue in or close to a peripheral nerve. Total removal of these tumors should be attempted at initial diagnosis.
Primary ependymoma of a cranial nerve
Authors: Little Nicholas S. , Morgan Michael K. , Eckstein Robert P.
Published: May 2009

✓ Ependymomas arising from peripheral or spinal nerves are extremely rare. Other ectopic ependymomas are found mostly in the sacrococcygeal region, possibly in association with developmental anomalies. The case of an ependymoma arising from a cranial nerve in a 40-year-old man is described.
Right-angle partially compressible hemostatic clip applier
Authors: Davidson Robin I. , Rodgers Cyril
Published: May 2009

✓ A modification of a hemostatic clip applier is described that can apply clips at right angles to the plane of the handles. This device may be particularly useful in certain neurosurgical settings where use of the conventional clip applier is difficult. This device also prevents overcompression of clips.
Retroauricular subcutaneous Dacron tunnel for extracranial-intracranial autologous vein bypass graft
Authors: Okada Yoshikazu , Shima Takeshi , Nishida Masahiro , Yamane Kanji
Published: May 2009

✓ The authors describe the application of a Dacron tube as a retroauricular subcutaneous tunnel in extracranial-intracranial autologous vein bypass graft.
Comments for the 50th anniversary of the Journal of Neurosurgery: Final series
Authors: Sheldon C. Hunter , Pudenz Robert H. , Hamby Wallace B , Meacham William F.
Published: May 2009

✓ In the second and final series of comments solicited for the Journal of Neurosurgery's 50th anniversary, four additional authors, each of whom was an original contributor to the first volume of the Journal, share some thoughts and anecdotes regarding their first articles.
Diffuse bilateral cerebral astrocytomas with atypical neuroimaging studies
Authors: Rogers Lisa R. , Weinstein Meredith A. , Estes Melinda L. , Cairncross J. Gregory , Strachan Thomas
Published: May 2009

✓ The authors describe the clinical behavior of eight patients with cerebral astrocytomas, in whom computerized tomography (CT) or magnetic resonance (MR) imaging of the brain was characterized by diffuse bilateral cerebral hemisphere tissue density abnormalities and minimal focal mass effect. Five patients were newly diagnosed, and three others had been treated for focal low-grade astrocytoma. Histological diagnoses included anaplastic astrocytoma (three patients), low-grade astrocytoma (three patients), glioblastoma (one patient), and gliosis with later development of glioblastoma (one patient). In five patients, brain tumor was not suspected from the neuroimaging studies, the findings of which were mistaken for radiation leukoencephalopathy, vasogenic edema, or multiple sclerosis. Serial CT scans or MR images undertaken over intervals of 3 to 184 weeks showed progression of abnormal tissue densities in seven patients and multifocal contrast-enhancing masses developed on CT scan in two patients. An autopsy in each of four patients showed diffuse cerebral infiltration by astrocytoma. It is concluded that neuroimaging studies in some patients with diffusely infiltrating cerebral astrocytoma are atypical for neoplasm and can be mistaken for other diseases, especially those that predominantly affect cerebral hemisphere white matter.
Effect of stable xenon inhalation on intracranial pressure during measurement of cerebral blood flow in head injury
Authors: Plougmann Jan , Astrup Jens , Pedersen Jens , Gyldensted Carsten
Published: May 2009

✓ Xenon-enhanced computerized tomography (CT) is well suited for measurements of cerebral blood flow (CBF) in head-injured patients. Previous studies indicated divergent results on whether inhalation of xenon may cause a clinically relevant increase in intracranial pressure (ICP). The authors employed Xe-enhanced CT/CBF measurements to study the effect of 20 minutes of inhalation of 33% xenon in oxygen on ICP, cerebral perfusion pressure (CPP), and arteriovenous oxygen difference (AVDO2) in 13 patients 3 days (mean 1 to 5 days) after severe head injury (Glasgow Coma Scale score ≤ 7). The patients were moderately hyperventilated (mean PaCO2 4.3 kPa or 32.3 mm Hg). Six patients were studied before and during additional hyperventilation. All 13 patients reacted with an increase in ICP and 11 with a decrease in CPP. The mean ICP increment was 6.9 ± 7.7 (range 2 to 17 mm Hg). The mean CPP decrement was −9.7 ± −14.6 (range 17 to 47 mm Hg). The time course of the ICP changes indicated that ICP increased rapidly during the first 5 to 6 minutes, then declined to a plateau (peak-plateau type in four of 13 patients), remained at a plateau (plateau type in six of 13), or continued to increase in three of 13, indicating individual variance in xenon reactivity. Additional hyperventilation had no effect on the xenon-induced increments in ICP but these occurred at lower ICP and higher CPP baseline levels. The AVDO2 values, an index of flow in relation to metabolism, indicated a complex effect of xenon on CBF as well as on metabolism.

This study indicates that xenon inhalation for Xe-CT CBF measurements in head-injured patients according to our protocol causes clinically significant increments in ICP and decrements in CPP. It is suggested that the effect of xenon is analogous to anesthesia induction. Individual variations were observed indicating possible individual tolerance, possible influence of type and extent of the cerebral injury, disturbances in cerebrovascular reactivity, and possible influence of medication. These effects of xenon suggest that hyperventilation should be ensured in patients with evidence of reduced compliance or high ICP. On the other hand, inhalation of stable xenon is not believed to pose a risk because no signs of cerebral oligemia or ischemia were indicated in the AVDO2 values.
Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: a meta-analysis
Authors: King Joseph T. , Berlin Jesse A. , Flamm Eugene S.
Published: May 2009

✓ A meta-analysis of the literature on morbidity and mortality from elective surgery for asymptomatic unruptured intracranial aneurysms was performed to obtain a more precise, accurate, and generalizable estimate of operative risk than is currently available. The authors used a MEDLINE search from 1966 to 1992, supplemented with manual searches, to locate studies containing four or more patients who had undergone elective surgery for these aneurysms. Only patients with asymptomatic, unruptured aneurysms were eligible for inclusion. Demographic and clinical data were collected from each series; aneurysms were categorized as incidental, multiple, or unclassifiable. Data were analyzed using Fisher's exact test and logistical regression.

There were twenty-eight articles containing data on 733 patients who met eligibility criteria. The mean patient age was 48.6 ± 5.5 years, and 55% ± 17% of the patients were women. There was a total of 30 deficits for a morbidity rate of 4.1% (95% confidence interval 2.8, 5.8%) and a total of seven deaths for a mortality rate of 1.0% (95% confidence interval 0.4, 2.0%). There was insufficient statistical power to detect a difference in morbidity or mortality rates related to study size, year of publication, or potential risk factors such as patient sex or age, or aneurysm size, location, or category (incidental, multiple, or unclassifiable) (for all analyses, p ≥ 0.16).

Elective surgery for asymptomatic unruptured intracranial aneurysms, as reported in the literature, has low rates of morbidity (4.1%) and mortality (1.0%). At present there is insufficient detail in the literature to understand the impact of patient and aneurysm characteristics on elective surgical outcomes.
Surgical excision of meningiomas involving the clivus: preoperative and intraoperative features as predictors of postoperative functional deterioration
Authors: Sekhar Laligam N. , Swamy Narayana K. S. , Jaiswal Viswadarshi , Rubinstein Elaine , Hirsch William E. , Wright Donald C.
Published: May 2009

✓ Neurological deterioration is commonly seen after surgical excision of clival meningiomas; however, an understanding of the risk factors associated with postoperative deterioration can lead to improvements in outcome.

In 75 patients with clival meningiomas operated on over a 7-year period, the following data were studied: preoperative variables such as presenting Karnofsky scale score, age, sex, and prior operations or radiation therapy. Radiological findings on magnetic resonance imaging or arteriography, such as the development of the arachnoidal cleavage plane between tumor and the brain stem, brainstem edema, tumor size, extent of compression on the brain stem, vascular encasement, and blood supply from the basilar artery were among other data studied. In addition, intraoperative findings such as development of the arachnoid plane, vascular encasement, and the difficulty of dissection were noted. Finally, each patient's neurological and functional statuses were recorded at 1 week postoperatively and at follow-up examinations.

Early postoperative functional deterioration occurred in 45 patients (60%) and ranged from mild (30 patients) to severe (three patients). Significant improvement had occurred by the time of follow-up examination in all but four patients; however, permanent postoperative dysfunction was present in 12 patients. Statistical analysis revealed significant correlations between early functional deterioration and preoperative Karnofsky scale scores, male gender, radiological findings of the absence of an arachnoid plane, edema of the brain stem, and arteriographic supply from the basilar artery. Operative features included difficulty with dissection, an absent arachnoidal cleavage plane, and incomplete tumor resection. Permanent functional deterioration was statistically associated with the following: blood supply from the basilar artery, difficulty of dissection, incomplete tumor resection, and early postoperative dysfunction. Logistical regression analysis revealed that the most important risk factor for early postoperative deterioration was tumor size. Patients with large or giant tumors had a 6.7 to 13 times greater risk of functional deterioration, respectively, than patients with small- or medium-sized tumors. Excluding tumor size, the most important factor for permanent deterioration was blood supply from the basilar artery. Patients in this category had a 4.4 times greater risk of permanent functional deterioration.

Three stages of tumor relationship to the brainstem arachnoid and pial membranes are proposed. Based on the results of this clinical study of clival meningiomas, suggestions are made for changes in the management strategy of these difficult lesions.
Transethmoidal transsphenoidal approach for embolization of a carotid-cavernous fistula
Authors: Barker Frederick G. , Ogilvy Christopher S. , Chin John K. , Joseph Michael P. , Pile-Spellman John , Crowell Robert M.
Published: May 2009

✓ The authors describe a case of carotid-cavernous fistula that was not treatable by the standard interventional neuroradiological techniques of transarterial or transvenous occlusion of the fistula because access was blocked by prior trapping procedures. Access to the venous side of the fistula was gained by means of a transethmoidal transsphenoidal exposure, making it possible to embolize the lesion with coils. The details of this approach are described.
Giant aneurysm of anterior ethmoidal artery presenting with intracranial hemorrhage
Authors: Ranjan Alok , Joseph Thomas
Published: May 2009

✓ This forty-five-year-old woman presented with a history suggestive of an intracranial hemorrhage. Clinical examination indicated mild right pyramidal signs and neck stiffness. Computerized tomography demonstrated contrast enhancement in the region of a left frontal intraparenchymal hematoma with an adjacent subdural hematoma. Angiography revealed the presence of a giant aneurysm on the left anterior ethmoidal artery. Surgical evacuation of the hematoma with excision of the aneurysm and coagulation of the feeding artery was achieved. Postoperative recovery was uneventful. Vascular lesions of the anterior ethmoidal artery and the rarity of a giant aneurysm at this site are discussed.
Intramedullary hemorrhage in spinal cord hemangioblastoma
Authors: Yu John S. , Short M. Priscilla , Schumacher James , Chapman Paul H. , Harsh Griffith R.
Published: May 2009

✓ The authors describe two cases of intramedullary hemorrhage caused by thoracic hemangioblastoma. Both patients presented with acute paraplegia. The lesion in the first case was diagnosed by myelography and in the second by magnetic resonance imaging. Emergency surgical evacuation of the intramedullary hematoma and tumor was performed in these patients. Hemangioblastoma was confirmed by histopathological examination in both cases. Both patients remain paraplegic after 7 and 1 years, respectively. Intramedullary hemorrhage is a rare and devastating effect of spinal hemangioblastoma.
The “filum intermedium” sign: focal in utero spinal cord infarct and extraspinal thecal sac
Authors: Mamelak Adam N. , Cogen Philip H. , Barkovich A. James
Published: May 2009

✓ This report describes the unique case of a child born with paraplegia and a neurogenic bladder who was found to have a dysplastic, nonossified T-12 vertebral body, midline fusion of the T-12 neural arches, obliteration of the spinal canal at T-12, and an extraspinal thecal sac in the T11—L1 region. Neural tissue was focally absent from T9–12, but neural structures above and below were preserved. Narrowing of the thecal sac on myelograms and sagittal magnetic resonance images signifies in utero focal infarction of the spinal cord after neurulation but before formation of the posterior half of the spinal canal. The infarction resulted in severe focal narrowing of the thecal sac from T10—L1, resembling a premature and duplicated filum terminale; to denote the radiographic appearance of these anomalies, the authors have coined the term “filum intermedium” sign.

The extremely unusual radiographic findings in this child illustrate the important interactions between neural tube, neural crest, and somite in the development of the spinal cord and spinal column. Correlation of the radiographic findings with the embryological differentiation and migration of these structures suggests that the spinal anomalies were caused by a focal insult, probably vascular in origin, occurring between the sixth and eighth weeks of gestation. The identification of a focally narrowed thecal sac and spinal cord (the “filum intermedium” sign) localizes the time of the insult to between the first and third month of gestation, and therefore is a useful marker in understanding developmental malformation of the spinal cord.
Seroprevalence and mortality in chickens caused by pullorum disease and fowl typhoid in certain government poultry farms in Bangladesh
Authors: Hossain MA , Islam MA
Published: May 2009

This study was conducted to determine the seroprevalence and mortality in chickens caused by pullorum disease and fowl typhoid in five different government poultry farms according to three age groups during the period from June 2002 to May 2003. The overall seroprevalence of salmonellosis, especially pullorum disease and fowl typhoid was 26.67%. The mean seropositivity of five farms in three different age groups from each farm was 18.97Â±2.27%, 33.20Â±3.53% and 27.84Â±2.67% on 10th, 24th and 40th week of age, respectively. The mean seropositivity of three different age groups from each farm was 36.77Â±5.40%, 24.05Â±3.97%, 26.80Â±3.90%, 25.77Â±4.49% and 19.93Â±3.28% in Mirpur, Savar, Bogra, Kishoregonj and Tangail poultry farm, respectively. Fowl typhoid caused by S. gallinarum was the most predominant organism accounting for 295 isolates, and only 74 isolates were identified as pullorum disease caused by S. pullorum. The highest mean proportion of mortality due to fowl typhoid among five farms was 43.36Â±2.39% and was highly significant (P < 0.001) in 27-39 weeks age group. The proportion of mortality due to Pullorum disease was highly significant (P < 0.001) in day 0-13 weeks age groups and in respect of age, the highest mean value of pullorum disease was 10.47Â±1.14 from five farms.Key Words: seroprevalence; mortality; pullorum disease, fowl typhoid, chickensdoi: 10.3329/bjvm.v2i2.2539Bangl. J. Vet. Med. (2004). 2 (2): 103-106