bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Resonance Imaging in Syringomyelia
Authors: Kokmen E. , Marsh W.R. , Baker H.L.
Published: May 2010

Myelography and myelography assisted with computed tomography have been the most commonly used radiographic methods in the study of syringomyelia. These studies have never been entirely reliable in demonstrating the syrinx cavity and its relationship to other intracranial structures. During the 1st year of operation of the magnetic resonance imaging facility, the syringomyelic cavity was demonstrated in 15 patients who all had typical clinical signs and symptoms associated with syringomyelia. Nine cases were syringomyelia with Chiari malformation. One case showed additional hydrocephalus. Four cases were idiopathic, and 1 case was remotely posttraumatic. Magnetic resonance imaging, although it is in its infancy, already promises to be the most important radiographic technique for syringomyelia because it provides an anatomically truthful visualization of the sagittal plane of the cervical cord and can demonstrate the syrinx cavity and its relationship with the cerebellar tonsils, the 4th ventricle, and other related structures.
Myxomatous Degeneration of the Lumbar Intervertebral Disc
Authors: Beatty Robert A.
Published: May 2010

Sixteen patients were operated on for lumbar pain and pain radiating into the sciatic nerve distribution. In all 16, when the anulus fibrosus was incised, soft, gray disc material extruded under pressure like toothpaste being squeezed from a tube. This syndrome of myxomatous degeneration is a distinct entity, different from classical fibrotic disc degeneration or herniated nucleus pulposus. Surgical removal associated with partial facetectomy produced excellent results. The concept of incompetence of the anulus fibrosis is discussed.
Intracranial and Otological Presentation of Acute Lymphocytic Leukemia
Authors: Nabors Michael W. , Narayan Raj K. , Poplack David G.
Published: May 2010

The authors report a patient with acute lymphocytic leukemia in hematological remission who presented with both intracranial and otological manifestations of the disease. The patient presented with clinical symptoms and computed tomographic findings consistent with otomastoiditis and a contiguous brain abscess. However, both lesions were identified at operation as leukemic infiltrates. Intracranial mass lesions and otological complications associated with leukemia are reviewed.
Subarachnoid Hemorrhage Due to a Cerebral Aneurysm at the Anastomotic Site between the Frontoorbital Artery and the Anterior Ethmoidal Artery: A Case Report
Authors: Enomoto Hitomi , Goto Hiroshi , Murase Mikio
Published: May 2010

The authors present a case of a ruptured saccular aneurysm at the anastomotic site between the left frontoorbital artery and the left anterior ethmoidal artery.
Methodology and Clinical Experience with Computed Tomography and a Computer-resident Stereotactic Atlas
Authors: Kall Bruce A. , Kelly Patrick J. , Goerss Stephan , Frieder Gideon
Published: May 2010

We have developed a computer-resident stereotactic atlas of the human brain that quantitatively defines subcortical structures within anatomical landmarks detected on obliquely reconstructed computed tomography (CT) slices. Horizontal stereotactic atlas sections can be stretched and contracted by polar transformation and labeled by a computer to fit within these CT scan-defined landmarks. The stereotactic coordinates of any substructure on the atlas-labeled CT slice may then be calculated by the computer and expressed in mechanical adjustments on a stereotactic surgical frame located in the operating room. We demonsrate the use of this method in the stereotactic treatment of movement disorders as an augmentation to conventional ventriculography and microelectrode recording.
Surgical Decompression of Anterior and Posterior Malignant Epidural Tumors Compressing the Spinal Cord: A Prospective Study
Authors: Siegal Tzony , Siegal Tali
Published: May 2010

Of 167 episodes of spinal epidural neoplastic compression, 86 were treated by operation. The surgical approach was prospectively selected according to the location of the tumor in the spinal canal. Decompression was achieved by 61 vertebral body resections (VBRs) and by 25 laminectomies. The indications for operation were: (a) neurological relapse after previous radiotherapy, (b) the need to make a tissue diagnosis, (c) a radioresistant tumor, and (d) neurological deterioration during radiotherapy. Before VBR, 28% (17 of 61) were still able to walk, 51% (31 of 61) were pareparetic, and 21% (13 of 61) were paraplegic. Bowel and bladder dysfunction was present in 49% (30 of 61). After VBR, the outcome of only 57 procedures was available for evaluation because of the postoperative death of 4 patients. Eighty per cent (46 of 57) were able to walk, 18% (10 of 57) were paraparetic, and 2% (1 of 57) were paraplegic. Ninety-three per cent had normal sphincter control. Before laminectomy, 8% (2 of 25) were ambulatory, 84% (21 of 25) were paraparetic, and 8% (2 of 25) were paraplegic. Bowel and bladder dysfunction was present in 76% (19 of 25). After laminectomy, only 23 procedures were evaluated because of the postoperative death of 2 patients. Thirty-nine per cent (9 of 23) were ambulatory, 35% (8 of 23) were paraparetic, and 26% (6 of 23) were paraplegic. Fifty-seven per cent regained normal sphincter control. The operative mortality was 7% (4 of 61) in VBR and 8% (2 of 25) in laminectomy. The surgical morbidity was 11% (7 of 61) in VBR and 28% (7 of 25) in laminectomy, mainly delayed wound healing. Neurological worsening as a result of laminectomy occurred in 20% (5 of 25) and was transient after 1 VBR (2%). Dislodgement of the vertebral body replacement construct occurred in 3 patients, but has not occurred since the introduction of an improved instrumentation technique. In view of the encouraging results with anterior decompression of the spine, the role of surgical decompression as the primary treatment for ventrally located tumors should be reconsidered. The role of laminectomy in posterior compartment tumors deserves further study.
Radiation-associated Gliomas: A Report of Four Cases and Analysis of Postradiation Tumors of the Central Nervous System
Authors: Liwnicz Boleslaw H. , Berger Thomas S. , Liwnicz Regina G. , Aron Bernard S.
Published: May 2010

Four cases of radiation-associated gliomas are described. All patients were white men, irradiated in childhood for craniopharyngioma, anaplastic ependymoma, retinoblastoma of the orbit, and Burkitt's lymphoma, respectively. The dose ranged from 1800 to 5900 rads, and the latency period was 5 to 25 years. All primary and secondary tumors were verified histologically, and no evidence of persistence of the primary tumors was found. All secondary tumors arose in the fields of irradiation. Ninety-six cases of radiation-induced tumors of the central nervous system have been reported in the literature to date. Twenty-four were gliomas and occurred mainly in young men.
Visual Recovery after Transsphenoidal Removal of Pituitary Adenomas
Authors: Cohen Alan R. , Cooper Paul R. , Kupersmith Mark J. , Flamm Eugene S. , Ransohoff Joseph
Published: May 2010

We reviewed the records of 100 consecutive patients with histologically verified pituitary adenomas who underwent transsphenoidal decompression of the optic nerves and chiasm. The patients' ages ranged from 18 to 80 years, with a median of 52 years. Preoperatively, all patients had objective signs of visual acuity or field defects. Postoperatively, visual acuity was normal or improved in 79% of the eyes and the visual fields were normal or improved in 74%. The visual outcome (for both acuity and fields) was better in younger patients and those with a shorter duration of symptoms. Patients with lesser degrees of preoperative visual acuity compromise had better postoperative visual acuity outcome. However, the severity of preoperative visual field defects did not seem to predict postoperative field outcome, and even patients with severe preoperative field defects often had striking postoperative improvement. Patients who had undergone prior operation were less likely to have either visual acuity or visual field improvement after reoperation. Postoperative deterioration in visual acuity was noted in only 5 patients (6 eyes). Complications were few. There were 4 instances of cerebrospinal fluid rhinorrhea, but only 2 patients needed operative repair. There was no instance of permanent diabetes insipidus, although 17 patients developed transient diabetes insipidus. In most cases, visual improvement was sustained. The average duration of follow-up was 26 months. Three patients required a subsequent operation to correct visual loss in the immediate postoperative period, but only 1 patient has undergone late operation for recurrence of tumor. There was no operative mortality.
Reconstruction of the Pituitary Fossa in Transsphenoidal Surgery: An Experience of 140 Cases
Authors: Spaziante Renato , de Divitiis Enrico , Cappabianca Paolo
Published: May 2010

Even though the main problems of transsphenoidal surgery are encountered during the intra- and suprasellar portions of the operation, proper reconstruction of the sella turcica plays an important role in the overall results, greatly influencing the final outcome. Improper measures may bring about a complicated postoperative course, whereas a wise and precise method allows one to control any surgical condition, preventing the more dangerous consequences of the transsphenoidal approach (i.e., empty sella, cerebrospinal fluid leakage, hemorrhage, infection, etc.). The authors review the different methods of sellar plugging and, on the basis of their own experience, indicate the most suitable one for each of the more usual situations. A good result is achievable if only natural materials are used and one avoids synthetic prostheses. Extradural packing is the technique of choice whenever a hermetic closure and a particularly effective intrasellar plug are required.
Bilateral Spontaneous Carotid-Cavernous Fistulas Treated by the Detachable Balloon Technique: Case Report
Authors: Yamamoto Isao , Watabe Tsuneya , Shinoda Masaki , Hasegawa Yohko , Sato Osamu
Published: May 2010

This report describes the case of a 39-year-old woman with bilateral spontaneous carotid-cavernous fistulas that were treated successfully by the detachable balloon technique. The clinical features and management are reviewed.
Use of the Extracranial-Intracranial Arterial Bypass in the Management of Refractory Vasospasm: A Case Report
Authors: Rosenstein Jacob , Batjer Hunt H. , Samson Duke S.
Published: May 2010

Cerebral arterial vasospasm after aneurysmal subarachnoid hemorrhage remains one of the major causes of morbidity and mortality in patients surviving the initial hemorrhage. Once established, no known method has been shown to reverse this process in humans. Although intravascular volume expansion and induced arterial hypertension have been shown to be effective in the reversal of neurological deficits secondary to vasospasm, a large proportion of patients remain refractory to these methods. We report one such case successfully managed by the estalishment of an extracranial-intracranial anastomosis in an attempt to augment collateral flow.
Discrepancy between Computed Tomography and Magnetic Resonance Imaging in a Case of Medulloblastoma
Authors: Heafner Michael D. , Schut Luis , Packer Roger J. , Bruce Derek A. , Bilaniuk Larissa T. , Sutton Leslie N.
Published: May 2010

In a 2-year-old girl with signs and symptoms of a posterior fossa tumor, the computed tomographic scan showed what appeared to be a brain stem glioma. However, magnetic resonance imaging (MRI) demonstrated the lesion to be extrinsic to the brain stem. Posterior fossa exploration disclosed a medulloblastoma filling the 4th ventricle. This discrepancy in imaging techniques points out the usefulness of MRI in the evaluation and treatment of posterior fossa lesions.
One-Stage Reduction Cranioplasty for Macrocephaly Associated with Advanced Hydrocephalus
Authors: Park T. S. , Grady M.Sean , Persing John A. , Delashaw Johnny B.
Published: May 2010

A reduction cranioplasty in one stage was performed on a child with massive enlargement of the head secondary to advanced hydrocephalus. The authors discuss the techniques and advantages of a modified head position and a cross bar craniotomy for reduction cranioplasty.
Computed Tomographic Grading with Hounsfield Number Related to Delayed Vasospasm in Cases of Reptured Cerebral Aneurysm
Authors: Fujita Shigekiyo
Published: May 2010

The relationship between cisternal high density calculated by Hounsfield number (HN) in computed tomography and the subsequent development of cerebral infarction due to delayed vasospasm was studied retrospectively in 36 cases of ruptured cerebral aneurysm. All patients were hospitalized within 24 hours and underwent operation within 48 hours after subarachnoid hemorrhage. Extensive removal of cisternal blood clots was carried out after obliteration of the aneurysm. The patients were divided into two groups according to the occurrence of vasospasm. In the group without vasospasm, the average HN was 65.7 preoperatively; after operation, the HN declined significantly to 62.2. In the group with vasospasm, the average HN was 77.6 preoperatively and 77.5 postoperatively. The relation between HN in postoperative computed tomography and vasospasm was as follows. When HN was 68 or less, vasospasm did not occur in any case. When HN ranged from 68 to 73, the incidence of vasospasm was 50%. When HN was 73 or more, vasospasm occurred in all cases. We propose a new system using HN to predict the incidence of vasospasm. This system is useful in deciding the timing of operation and determining the amount and location of clots to be removed.
Central Herniation Revealed by Focal Decrease in Blood Flow without Elevation of Intracranial Pressure: A Case Report
Authors: Wozney Paul , Yonas Howard , Latchaw Richard E. , Gur David , Good Walter
Published: May 2010

Until recently, in standard hospital settings the tissue blood supply could be inferred only from indirect measures such as assessment of the clinical signs and intracranial pressure (ICP) monitoring. This critical parameter can now be imaged directly with stable xenon-enhanced computed tomographic (CT) imaging. The procedure requires only an additional 10 minutes after a standard head study, yet it provides potentially vital information about tissue perfusion. We describe here a patient in whom a frontal lobe hematoma produced a direct mass effect, causing an element of central herniation with relative sparing of lateral and posterior cortical regions. Although the ICP recordings remained unchanged, symptoms of brain stem compression became apparent. Xenon/CT cerebral blood flow (CBF) mapping demonstrated a flow decrease mainly within the left frontal lobe and throughout central ganglionic structures. After removal of the left frontal hematoma, both clinical status and local and central flow improved. Because the xenon/CT method combines direct anatomical information with blood flow information in one examination, it may be a valuable clinical tool in providing a better understanding of pathophysiology in patients with head injuries and other mass lesions.
Symptomatic Rathke's Cleft Cyst with Pituitary Adenoma: Case Report
Authors: Swanson Steven E. , Chandler William F. , Latack Joseph , Zis Katerina
Published: May 2010

A rare case of a pituitary adenoma found in association with a symptomatic Rathke's cleft cyst in a 34-year-old woman presenting with headaches, visual symptoms, and amenorrhea is described. The diagnostic evaluation and operative treatment of these coincident lesions are discussed.
Anesthesia and Surgery in the Seated Position: Analysis of 554 Cases
Authors: Matjasko Jane , Petrozza Patricia , Cohen Melvin , Steinberg Polly
Published: May 2010

Because controversy exists regarding continued use of the seated position for neurosurgical procedures, this prospective (1981-1983) and retrospective (1972-1981) analysis of 554 seated patients was done to establish the incidence and severity of venous air embolism (VAE) related to type of surgical procedure and anesthetic technique; to examine the impact of specific monitoring practices on detection, morbidity, and mortality; and to establish the incidence of other complications related to the seated position (hypotension, quadriplegia, and arterial air embolism (AAE)). The overall morbidity and mortality related to the seated position was 1% (2 VAE, 1 AAE, 2 hypotension, 1 myocardial infarction) and 0.9% (1 VAE, 1 AAE, 2 hypotension, 1 quadriplegia), respectively. There has been no mortality since 1975. N2O did not seem to increase the incidence or severity of VAE. The seated position is safe in experienced hands if appropriate surgical and anesthetic skills are exercised in patient selection and management. Caution is advised in patients with atherosclerotic cardiovascular disease, severe hypertension, cervical stenosis, and right to left intracardiac shunts.
Microsurgical Anatomy of the Superficial Veins of the Cerebrum
Authors: Oka Kazunari , Rhoton Albert L. , Barry Margaret , Rodriguez Roland
Published: May 2010

The microsurgical anatomy of the superficial cortical veins was examined in 20 cerebral hemispheres. The superficial cortical veins are divided into three groups based on whether they drain the lateral, medical, or inferior surface of the hemisphere. The veins on the three surfaces are further subdivided on the basis of the lobe and cortical area that they drain. The superficial cerebral veins collect into four groups of bridging veins: a superior sagittal group, which drains into the superior sagittal sinus; a sphenoidal group, which drains into the sphenoparietal and cavernous sinuses on the inner surface of the sphenoid bone; a tentorial group, which converges on the sinuses in the tentorium; and a falcine group, which empties into the inferior sagittal or straight sinus or their tributaries. The superior sagittal group drains the superior part of the medial and lateral surfaces of the frontal, parietal, and occipital lobes and the anterior part of the basal surface of the frontal lobe. The sphenoidal group drains the parts of the frontal, temporal, and parietal lobes adjoining the sylvian fissure. The tentorial group drains the lateral surface of the temporal lobe and the basal surface of the temporal and occipital lobes. The falcine group drains an area that includes the cingulate and parahippocampal gyri and approximates the cortical parts of the limbic lobe of the brain. The relationship of these veins to the venous lacunae was also examined.
Tuberous Sclerosis and Multiple Intracranial Aneurysms: Case Report
Authors: Blumenkopf Bennett , Huggins Michael J.
Published: May 2010

A 6-year-old girl with tuberous sclerosis was found to have multiple intracranial fusiform arterial aneurysms. This represents the fifth reported case of this association. The concepts of an arterial dysplasia being present in cases of tuberous sclerosis and of developmental defects being the cause of some intracranial aneurysms are discussed. The need for a prospective study to assess the prevalence of intracranial aneurysms in patients with tuberous sclerosis is suggested.
Traumatic Aneurysm of the Anterior Cerebral Artery Associated with a Contralateral Carotid-Cavernous Fistula: A Case Report
Authors: Noterman J. , Flament-Durand J. , Hermanus N. , Brotchi J.
Published: May 2010

An unusual case of traumatic aneurysm of the A-1 part of the anterior cerebral artery associated with a contralateral carotid-cavernous fistula is presented. Trapping of the fistula was carried out, and an attempt to repair the vessel wall was made. Thrombosis of the vessel occurred, but remained asymptomatic. Causes, physiopathology, and treatment of traumatic aneurysms are discussed.
Dangerous Rises in Blood Pressure upon Heating of Trigeminal Rootlets; Increased Bleeding Times in Patients with Trigeminal Neuralgia
Authors: Sweet William H. , Poletti Charles E. , Roberts James T.
Published: May 2010

During radiofrequency (RF) heating of trigeminal rootlets, we regularly measured blood pressure rises to 250 to 300 mm Hg, confirming two previous reports. We also found abnormally increased bleeding times in 12% of 127 patients awaiting operation for trigeminal neuralgia. These two facts probably explain 6 fatalities and 2 lasting hemiplegias from intracranial bleeding unrelated to vascular puncture by the needle electrode during RF procedures for trigeminal neuralgia. We recommend correction of the abnormal bleeding time and control of the blood pressure rises by i.v. sodium nitroprusside.
Contrasting Actions of Naloxone in Experimental Spinal Cord Trauma and Cerebral Ischemia: A Review
Authors: Hamilton Allan J. , Black Peter McL. , Carr Daniel B.
Published: May 2010

Endorphins have been implicated in the pathophysiology of both spinal cord injury and cerebral ischemia. This review examines the nature of the experimental evidence to support this hypothesis. Present studies suggest that naloxone administration improves neurological function and outcome in the setting of the spinal cord trauma by centrally inhibiting an opiate receptor-mediated diminution of spinal cord flow. In the setting of spinal shock, naloxone administration is associated with improvement in vital sign and cardiovascular parameters as measured by mean arterial pressure, cardiac output, body temperature, and ventilation. Experiments using a variety of animal stroke models similarly support the notion that naloxone improves neurological function in the setting of cerebral ischemia by a stereospecific opiate receptor-mediated effect, but this improvement does not seem to be accompanied by augmentation of blood flow to affected areas of the brain or by any improvement in vital signs or cardiovascular parameters as seen in spinal cord trauma. A variety of mechanisms are discussed to explain these observations. The therapeutic implications of administering opiate agonists and antagonists in the setting of neurological deficits are outlined for the neurosurgeon.
Pathophysiology of Nonneoplastic Obstruction of the Foramen of Monro and Progressive Unilateral Hydrocephalus
Authors: Shizuo Oi , Matsumoto Satoshi
Published: May 2010

Our experience with progressive unilateral hydrocephalus in children and the pathophysiology of nonneoplastic obstruction of the foramen of Monro has been analyzed. The status of the foramen of Monro in either congenital or acquired progressive unilateral hydrocephalus was classified into the following four categories: Category 1, atresia of the foramen; Category 2, morphological obstuction; Category 3, functional obstruction; and Category 4, patent foramen. Illustrative cases including hydrodynamic studies and intracranial pressure monitoring are discussed.
Brain Tumors during the First Twenty-four Months of Life
Authors: Tomita Tadanori , McLone David G.
Published: May 2010

One hundred patients with brain tumors were diagnosed and treated during the first 24 months of life. They represent 16% of 608 children with brain tumors treated from 1952 through 1984. The most common histological type of brain tumors during the first 24 months are benign astrocytoma, medulloblastoma, and choroid plexus papilloma. The tumor location is distributed relatively evenly among the cerebellum and the 4th ventricle, the cerebral hemisphere (including the lateral ventricle), and the suprasellar region and 3rd ventricle. The chief presenting signs and symptoms are a full fontanelle, macrocephaly, changes of behavior, and delayed developmental milestones. Localizing signs are infrequent. Ninety-two patients underwent craniotomy with a one-month surgical mortality rate of 12%. The surgical mortality rate was 5.6% among 36 recent patients diagnosed by computed tomography. The 5-year survival rate is 41% in the patients younger than 12 months and 74% in patients diagnosed during the 2nd year of life. This study indicates the validity of Collins' rule for medulloblastomas during the first 24 months of life, but not for benign or malignant astrocytomas.
Basal Arterial Occlusive Disease
Authors: Quest Donald O. , Correll James W.
Published: May 2010

Seventeen patients with basal occlusive disease have been seen over the past 4 years. Nine of these had a classical moyamoya appearance on angiography. Of these nine, seven were adults and two were children. Eight had ischemic episodes, and one had a hemorrhage. One had neurofibromatosis with a chiasmal glioma and had received radiotherapy. Eight patients underwent superficial temporal-middle cerebral artery (STA-MCA) bypass, and one refused operation. Six patients improved, one had a stroke on the opposite side, and one died. Eight patients had unilateral basal arterial occlusive disease. Of these, three had ischemic episodes, four had hemorrhages, and one had only headaches. Four were adults, and four were children. Five underwent STA-MCA bypass with improvement, one with headaches had an aneurysm treated, and two were not operated upon. Considerations regarding the cause, therapeutic options, and disease course in these patients are discussed.
Delayed Chiasmal Decompression after Transsphenoidal Operation for a Pituitary Adenoma
Authors: Goldman James A. , Hedges Thomas R. , Shucart William , Molitch Mark E.
Published: May 2010

A patient with a large pituitary adenoma and visual field loss showed no significant change 6 weeks after transsphenoidal operation, but marked and abrupt improvement occurred at 10 weeks. The implications of this delayed improvement are discussed
Diaphragm Pacing by Electrical Stimulation of the Phrenic Nerve
Authors: Glenn William W. L. , Phelps Mildred L.
Published: May 2010

Sophisticated techniques for electrical stimulation of excitable tissue to treat neuromuscular disorders rationally have been developed over the past 3 decades. A historical review shows that electricity has been applied to the phrenic nerves to activate the diaphragm for some 200 years. Of the contemporary methods for stimulating the phrenic nerve in cases of ventilatory insufficiency, the authors prefer stimulation of the phrenic nerve in the thorax using a platinum ribbon electrode placed behind the nerve and an attached subcutancously implanted radiofrequency (RF) receiver inductively coupled to an external RF transmitter. Instructions are given for implanting the electrode-receiver assembly, emphasizing atraumatic handling of the phrenic nerve and strict aseptic techniques. Diaphragm pacing is conducted with low frequency electrical stimulation at a slow repetition (respiratory) rate to condition the diaphragm muscle against fatigue and maintain it fatigue-free. Candidates for diaphragm pacing are those with ventilatory insufficiency due to malfunction of the respiratory control center or interruption of the upper motor neurons of the phrenic nerve. In the Yale series, there were 77 patients treated by diaphragm pacing; 63 (82%) started before 1981 and thus were available for follow-up for at least 5 years; 33 (52%) were paced for 5 to 10 years, and 15 (24%) were paced for 10 to 16. Long term stimulation of the phrenic nerves to pace the diaphragm is an effective method of ventilatory support in selected cases
Hydrocephalus and Vasospasm after Subarachnoid Hemorrhage from Ruptured Intracranial Aneurysms
Authors: Black Peter McL.
Published: May 2010

The incidence of hydrocephalus and vasospasm and the relationship between them were analyzed retrospectively in 87 patients with subarachnoid hemorrhage from ruptured intracranial aneurysms. Sixty-seven per cent of the patients showed ventricular enlargement on a computed tomographic scan done within 30 days of the hemorrhage; in patients whose first scan was done within 3 days of the hemorrhage, 63% seemed to have ventricular enlargement by a neuroradiologist's interpretation. Shunts were required in 14% of the patients because of delayed neurological deterioration or enlarging ventricles; 3% required ventriculostomy shortly after admission. Seventy-four per cent of the patients had angiographic spasm on an angiogram done within the first 30 days after hemorrhage. Sixty-two per cent of the patients had both hydrocephalus and vasospasm: 22% had neither. Five per cent had hydrocephalus, but no spasm; 11% had spasm. but no hydrocephalus. Hydrocephalus and vasospasm were significantly associated (P < 0.01, x2). These data document a high incidence of mild ventricular enlargement and angiographic vasospasm after subarachnoid hemorrhage. They also emphasize that these two sequelae of subarachnoid hemorrhage are closely linked, probably by the presence of blood in the basal cisterns obstructing cerebrospinal fluid flow and surrounding arteries there.
Intracranial Arteriovenous Malformations Associated with Aneurysms
Authors: Batjer Hunt , Suss Richard A. , Samson Duke
Published: May 2010

The presence of intracranial aneurysm in association with arteriovenous malformation has been well documented. Aneurysms have been described in typical proximal sites along the feeding system to the arteriovenous malformation, in abnormal distal locations along feeding vessels, and in sites remote and apparently hemodynamically unrelated to the arteriovenous malformation. Little attention has been focused on the most appropriate medical and surgical care of patients harboring these lesions. Since 1977, 22 patients with this combination of lesions have been evaluated at our institution. Nine patients (41%) presented after intracranial hemorrhage. The remaining 13 patients were investigated because of seizures in 5 patients (23%), headaches in 4 patients (18%), and progressive ischemia in 4 patients (18%). Among the patients suffering intracranial hemorrhage, 78% had bled from an aneurysm, with 22% having hemorrhaged from their arteriovenous malformation. All 7 of the patients who suffered aneurysmal hemorrhage bled from atypical distal aneurysms on major feeding vessels. Our experience and that of others has led us to believe that the safest approach to patients with this combination of lesions is to treat the aneurysm before microsurgical resection of the associated arteriovenous malformation. Hemodynamic changes associated with the abrupt elimination of an arteriovenous malformation may place associated aneurysms at immediate risk.
Suppression of Pain in Trigeminal Neuropathy by Electric Stimulation of the Gasserian Ganglion
Authors: Meyerson B. A. , Håkanson S.
Published: May 2010

Lesions of the peripheral part of the trigeminal nerve may cause trigeminal neuropathy associated with severe pain. Such pain usually does not respond to carbamazepine and analgesics, and it is continuous and lacks the characteristic paroxysmal character of tic douloureux. These patients often present with complex changes of facial sensibility in the form of dysesthesia, hyperalgesia, and allodynia. The pain sometimes responds favorably to transcutaneous nerve stimulation, but direct stimulation of the trigeminal ganglion and rootlets via an implanted electrode provides a greater likelihood of pain relief. Fourteen patients diagnosed as having painful trigeminal neuropathy received implants of a gasserian ganglion-stimulating electrode. The mean follow-up period is 4 years (range, 1 to 7 years). Eleven of the patients have retained the pain-relieving effect, and 1 had pain disappear without further stimulation. Eight of the patients estimated their pain relief to be complete or very good. There were no serious complications, but in several of the patients the electrode had to be exchanged because the insulation of the lead wires broke. For the selection of patients for permanent electrode implantation, a method has been developed for trial stimulation via a percutaneous electrode introduced into the trigeminal cistern. Temporary trial stimulation can be performed for several days. It is concluded that stimulation of the trigeminal ganglion and rootlets with the aid of an implanted electrode may effectively relieve certain forms of trigeminal pain that are otherwise extremely difficult to manage.
Posttraumatic Intracranial Meningioma: A Case Report and Review of the Literature
Authors: Barnett Gene H. , Chou Samuel M. , Bay Janet W.
Published: May 2010

A case of posttraumatic meningioma with pathological evidence of intimate association with a nidus of chronic inflammatory reaction is presented. The literature regarding the controversial association of trauma with this neoplasm is critically reviewed. Although meningiomas are not common sequelae of head trauma, it is proposed that they may arise when the injury results in chronic inflammation.
Giant Congenital Cellular Blue Nevus of the Scalp of a Newborn with an Underlying Skull Defect and Invasion of the Dura Mater
Authors: Spetzler Robert F. , Marano Stephen R. , Brooks Robert A. , Rekate Harold L.
Published: May 2010

A case of a giant congenital cellular blue nevus of the scalp of a newborn with focal areas of malignant melanoma is presented. The nevus was associated with focal invasion of the underlying soft tissues, calvarium, epidural space, and dura mater. The later appearance of pigmented nevi in the submandibular region, sternocleidomastoid muscle, and testicular hydrocele raises the question of future metastases despite the nonmalignant microscopic appearance. Therapy consisted of total excision with cranioplasty and rotation and split skin grafts after temporary closure with silicone mesh.
Subarachnoid Hemorrhage and the Heart
Authors: Marion Donald W. , Segal Ricardo , Thompson Mark E.
Published: May 2010

Electrocardiographic abnormalities, both morphological and rhythmic, are frequently seen in association with spontaneous subarachnoid hemorrhage. These changes, which often reflect subendocardial damage, seem to be caused by hypothalamic stimulation leading to an acute increase in sympathetic tone. As a result, potentially life-threatening ventricular arrhythmias may develop in subarachnoid hemorrhage patients. These arrhythmias have responded to sympathetic blocking agents, which may also have a protective effect on subendocardial tissue in this setting. There is no evidence that the prophylactic administration of propranolol or other autonomic blockers significantly alters outcome in these patients. Ultimate morbidity and mortality are clearly related to the degree of intracerebral-intraventricular hemorrhage and vasospasm. This article reviews experimental and clinical evidence regarding the causes of cardiac abnormalities after subarachnoid hemorrhage, the types of abnormalities most frequently seen, their relationship with subendocardial lesions, and the role of autonomic blockers.
Basilar Aneurysm Surgery: The Subtemporal Approach with Section of the Zygomatic Arch
Authors: Sergio Domingos Pitelli , Gilberto G. M. Almeida , Edison J. Nakagawa , Antonio J. T. Marchese , Nilton Domingos Cabral
Published: May 2010

The authors propose a modification of the classic subtemporal approach for basilar aneurysm. This modification allows excellent access to the floor of the temporal fossa, the tentorial edge, and the interpeduncular fossa with less brain retraction than is required with the original technique. The procedure is described, our experience with it is presented, and suggestions are made for its use
Neuroleptic Malignant Syndrome Complicating Closed Head Injury
Authors: Vincent Frederick M. , Zimmerman J. Eric , Van Haren James
Published: May 2010

Lethargy, hyperpyrexia, tremor, and rigidity associated with leukocytosis and elevation of the creatine kinase level occurred in a patient with a closed head injury who was being treated with haloperidol for control of agitation. This constellation of symptoms, known as the neuroleptic malignant syndrome (NMS), partially improved when the neuroleptic medication was stopped, but complete resolution of the syndrome did not occur until the patient was treated with bromocriptine. Because haloperidol is the most widely used medication for the agitation that develops in patients with significant closed head injuries, neurosurgeons should be aware of the NMS. The NMS is caused by neuroleptic medications and may initially present with unexplained hyperpyrexia, leukocytosis, and elevated creatine kinase levels. Halting the neuroleptic, supportive care, and the use of dantrolene sodium and bromocriptine are the treatment modalities of choice for this syndrome, which has a mortality rate of 20 to 30% and may be linked to malignant hyperthermia.
Traumatic False Aneurysms of the Middle Meningeal Artery
Authors: Flores Jorge Salazar , Vaquero Jesus , Sola Rafael Garcia , Rossi Eduardo , Martinez Roberto , Martinez Pedro , Santos Hugo , Bravo Gonzalo
Published: May 2010

The authors report a rare case of traumatic false aneurysm of the middle meningeal artery associated with a delayed contralateral extradural hematoma. The extradural hematoma was evacuated, and the pseudoaneurysm was removed to avoid delayed rupture. The literature on traumatic aneurysms is reviewed.
Variant Aneurysms of the Fenestrated Basilar Artery
Authors: Andrews Brian T. , Michael Brant-Zawadzki , Wilson Charles B.
Published: May 2010

Two cases of aneurysm occurring on a fenestrated basilar artery are reported. One patient had a saccular aneurysm in the typical location at the vertebrobasilar junction at the proximal end of the fenestrated basilar segment. The aneurysm sac projected dorsally into the brain stem. The other patient had a blister-like aneurysm distal to a fenestration of the terminal basilar artery. The development of a distal aneurysm on a fenestrated basilar artery is predictable based on the reported morphology of the vessel wall in this vascular anomaly.
Case Report: Subarachnoid Hemorrhage Due to Anterior Spinal Artery Aneurysm
Authors: Smith Bryson S. , Penka Christopher F. , Erickson LaVerne S. , Matsuo Fumisuke
Published: May 2010

This case report describes a 29-year-old man with subarachnoid hemorrhage due to an anterior spinal artery aneurysm. Surgical obliteration of the aneurysm was successful. This is the sixth reported case of an isolated symptomatic aneurysm of a spinal artery.
Potential Roles for Early Revascularization in Patients with Acute Cerebral Ischemia
Authors: Batjer Hunt , Mickey Bruce , Samson Duke
Published: May 2010

The risk of carotid endarterectomy in acute cerebral ischemic situations is well documented. By using the superficial temporal or occipital artery, it is possible to provide relatively low flow revascularization conduits, potentially avoiding the risk of postoperative hemorrhage. Eighteen patients at The University of Texas Health Science Center at Dallas, Texas, have been treated recently with extracranial to intracranial bypass in the setting of acute neurological deficit, stroke in evolution, or recent completed infarction. Angiographic causes of these deficits included cervical carotid occlusion in 5 patients, carotid siphon disease in 2 patients, middle cerebral stenosis or occlusion in 3 patients, and delayed cerebral ischemia following subarachnoid hemorrhage in 8 patients. Neurological improvement was demonstrated within 24 hours following revascularization in 15 cases (83%); 3 patients were unchanged following bypass, and no patient's condition was worsened. The only case of postoperative intracerebral hemorrhage occurred 1 week following a long saphenous vein graft from the subclavian to the middle cerebral artery. After an average follow-up of 19 months, 7 patients are neurologically normal, 8 patients have mild to moderate deficits, and 3 patients have died. Low flow revascularization procedures appear to be safe in the setting of acute cerebral ischemia and may in selected patients boost regional cerebral blood flow from levels of symptomatic ischemia into a range compatible with normal neuronal function. (Neurosurgery 18:283-291, 1986)
Occipital Lobe Infarction Caused by Tentorial Herniation
Authors: Sato Masaharu , Tanaka Shigeru , Kohama Akitsugu , Fujii Chiiho
Published: May 2010

Occipital lobe infarction caused by tentorial herniation was described based on computed tomography findings in nine patients. The whole area of the occipital lobe was involved in five patients; some areas were spared in the others. Infarction other than the ipsilateral occipital lobe was seen in four areas of nine patients: the ispsilateral posterior limb of the internal capsule, contralateral Ammon's horn, and two contralateral occipital lobes. Hemorrhagic infarction was seen in two patients.
Experience in the Management of Odontoid Process Injuries: An Analysis of 128 Cases
Authors: Dunn Mary Elizabeth , Seljeskog Edward L.
Published: May 2010

The authors present a retrospective analysis of 128 cases of odontoid process injury treated at the University of Minnesota and affiliated hospitals between the years 1967 and 1983. Of these 128 cases, 110 were acute fractures, while 18 patients suffered from old, unstable odontoid injuries. Motor vehicle accident was the leading cause of injury, and the largest group of patients was in their second decade. Type II fractures were the most commonly encountered type of injury, and anterior subluxation was the most common displacement. Posterior subluxation, however, had the highest incidence of associated neurological deficit. Regarding treatment, the 110 acute fracture patients fell into the following groups: 16 patients died during the acute phase, 14 patients underwent early posterior cervical fusion, and 80 patients underwent a course of external skeletal fixation. The remaining 18 patients with old unstable injuries underwent posterior cervical fusion. An analysis of the results in these groups led to the elucidation of certain factors that likely are important in determining the treatment of each individual patient. These factors include age of the patient, type of odontoid fracture, direction and degree of fracture displacement, and diagnostic delay. Fracture reduction and halo immobilization are the treatments preferred for patients who are diagnosed within 1 week of injury, who are less than 65 years of age and who have anteriorly, nondisplaced, or minimally posteriorly subluxed (<2 mm) Type II fractures, or who have any Type III injury. In contrast, posterior cervical fusion should be considered seriously in those patients over 65 years of age with Type II fractures or with posterior subluxations greater than 3 mm, in patients with diagnosis later than 7 days after injury, and especially in patients who have suffered redislocation while undergoing a closed form of management.
Cervical Spine Fractures with Major Associated Trauma
Authors: Reiss Steven J. , Raque George H. , Shields Christopher B. , Garretson Henry D.
Published: May 2010

A detailed review of 88 consecutive patients placed in skeletal tong traction for cervical fractures by the University of Louisville Neurosurgical Service during a 5-year period from July 1, 1979, through June 30, 1984, was carried out. Of this group, 60% of the patients had a major associated injury consiting of major facial and skull fractures, cerebral contusions or intracerebral blood clots, cardiac or pulmonary contusions, major thoracic injuries including rib fractures and hemo- or pneumothoraces, intra-abdominal injuries, and major extremity fractures. An additional 24% of the patients had minor associated injuries, including facial or scalp lacerations, general body lacerations, or abrasions and cerebral concussions. Only 16% of patients with cervical fractures had no evidence of any other associated injury. Acute cervical spine fractures require prompt assessment and resuscitation by personnel from multiple specialties, usually available only in major trauma centers where experienced personnel capable of handling diverse injuries are always present.
Surgical Treatment of Sagittal Synostosis
Authors: Olds Meredith V. , Storrs Bruce , Walker Marion L.
Published: May 2010

A technique for the correction of scaphocephaly is described. It is safe, is technically straightforward, and rapidly corrects the deformity. The results of a standardized operative procedure in 50 patients are reviewed.
Percutaneous Placement of Ventriculoatrial Shunts: Four-Year Case Experience
Authors: Carol Mark , Robinson Walker , Harris Bruce S.
Published: May 2010

During the past 4 years, we have used percutaneous placement of the atrial catheter in 39 patients who have undergone ventriculoatrial shunting. The age range of our patients has been from 9 to 74 years of age, with routine indications existing. Both subclavian and internal jugular venous access have been utilized, with the latter being our preferred route of access for reasons of safety. Average operative time has been approximately 35 to 40 minutes. Both traditional and split-sheath introducer catheters have been used. Patient follow-up has been up to 4 years. Intraoperative complications have been limited to puncture of the carotid artery on two occasions; neither affected the ultimate performance of the procedure. Postoperative complications have been limited to those peculiar to shunt procedures in general and have required revision in four instances. One patient suffered an infection secondary to shunting. The benefits of this procedure seem to include safety, decreased operative site exposure, and decreased operative time, all factors that may contribute to a lower than normal infection rate and may warrant consideration of this procedure in adolescents and adults for whom ventriculoatrial shunting is indicated.
Syringomyelia and Syringobulbia Associated with an Ependymoma of the Cauda Equina Involving the Conus Medullaris: Case Report
Authors: Nagahiro Shinji , Matsukado Yasuhiko , Kuratsu Jun-ichi , Saito Yoshiki , Takamura Seishi
Published: May 2010

A patient with syringomyelia and syringobulbia secondary to an asymptomatic ependymoma of the cauda equina involving the conus medullaris is described. Delayed metrizamide computed tomography myelography was decisive for making the diagnosis of a highly extended syrinx associated with the tumor. Syringomyelic symptoms improved remarkably following the removal of the tumor, and the syrinx was not visualized in a postoperative study. The pathogenesis of syringomyelia associated with a caudally located spinal cord tumor is discussed.
Primary Leptomeningeal Gliomatosis and “Numb, Clumsy Hands”: A Case Report
Authors: Blumenkopf Bennett , Gutierrez Jorge , Bennett William
Published: May 2010

A 48-year-old man presented with the numb, clumsy hand syndrome. Evaluation revealed a high cervical cord lesion. Surgical exploration discovered leptomeningeal gliomatosis with no discernible intraparenchymal component. The clinical features of the case, the neuroimaging studies including magnetic resonance scanning, and the most unusual pathological nature of the lesion are discussed.
Orbitocraniobasal Approach for Anterior Communicating Artery Aneurysms
Authors: Fujitsu Kazuhiko , Kuwabara Takeo
Published: May 2010

We describe an orbitofrontotemporobasal craniotomy technique that allows excellent access to anterior communicating artery aneurysms. This orbitocraniobasal approach is particularly useful for the surgical treatment of ruptured aneurysms in the acute stage of subarachnoid hemorrhage, when retraction of the brain needs to be kept to a minimum. With this approach, retraction of the orbital contents decreases the amount of retraction of the brain to such an extent that a brain spatula is not necessary for access to the anterior communicating artery complex. The procedure is described, as is a modification of the approach for removal of large tumors on the skull base.
Pyogenic Abscess of the Medulla Oblongata
Authors: Dake Michael D. , McMurdo Keith S. , Rosenblum Mdark L. , Brant-Zawadzki Michael
Published: May 2010

Pyogenic brain stem abscess is rare. A case of spontaneous abscess of the medulla oblongata is reported in which the diagnosis was made preoperatively by computed tomography. Surgical drainage resulted in good functional recovery and radiological resolution of the lesion. This is the first reported case of survival in a patient with an abscess of the medulla oblongata. The pathophysiology, clinical symptoms, and radiological appearance of the entity are discussed. Prompt diagnosis and drainage are emphasized as important factors influencing survival.