bluuebunny/crossref_metadata_2025 huggingface dataset:
Computerized tomographic and pathologic studies of the untreated, quiescent, and recurrent glioblastoma multiforme
Authors: Burger Peter C. , Dubois Philip J. , Schold S. Clifford , Smith Kenneth R. , Odom Guy L. , Crafts David C. , Giangaspero Felice
Published: May 2009

✓ Pathological findings in 20 cases of glioblastoma multiforme were correlated with clinical histories and computerized tomographic (CT) scans. This was done to define the neoplasm in three stages: before treatment, during remission, and during recurrence.

The untreated lesions were markedly cellular neoplasms composed predominantly of small anaplastic cells. The radiographic central region of low density was necrosis, the enhancing rim was a cellular zone of viable neoplasm, and the perilesional low-density area was edema with infiltrating tumor. In these 20 cases, all of the identifiable neoplasms lay within the zone of peritumoral edema or contrast enhancement, although small anaplastic cells may have been present in more distant regions. The lesions in remission were remarkable for their minimal mass effect, discrete nature, extensive necrosis, and content of large bizarre glia. The large cells were confined to the original tumor bed and were consistent with neoplastic cells inactivated and immobilized by radio- and chemotherapy. These lesions were accurately localized by CT scanning. The recurrent lesions were heterogeneous, but most were formed of widely disseminated small anaplastic cells. The highly cellular regions of such lesions could be localized by CT scanning, but CT could not detect less cellular foci in the cerebrum, cerebellum, or brain stem. In one patient, the contrast-enhancing lesions of “recurrence,” were foci of radionecrosis, underscoring the difficulty in distinguishing this entity from recurrent neoplasm.
Improved treatment of a brain-tumor model
Authors: Rosenblum Mark L. , Gerosa Massimo A. , Dougherty Dolores V. , Wilson Charles B.
Published: May 2009

✓ Clonogenic cell and animal survival studies were used to determine the most effective BCNU therapy schedule in the 9L rat brain-tumor model. Survival of tumor cells following a single LD10 dose of BCNU (13.3 mg/kg intraperitoneally) was compared to cell survival after one to four daily 0.5 × LD10 doses. The posttreatment kinetics of surviving clonogenic cells were investigated at various times after BCNU was given in single doses of 0.25 to 1 × LD10 and in two daily doses of 0.5 × LD10. The cell kill was greater, time to reinitiation of cell growth was later, posttreatment rate of clonogenic cell proliferation was slower, and the interval to total repopulation of the clonogenic cell pool was longer with a single LD10 dose as compared to the multiple-dose schedules. Animal survival studies confirmed that a single LD10 dose of BCNU was at least as effective as a cumulative level of up to 1½ times that amount when treatment was administered in smaller doses, regardless of the fractionation schedule.

Clinical experience with patients harboring malignant brain tumors has shown that a single BCNU dose of 185 to 200 mg/sq m is tolerated well. Results of these animal experiments suggest that this therapy should have anti-tumor activity at least equivalent to the more commonly employed schedule of 80 mg/sq m/day given for 3 days. Although direct comparison of treatment efficacy using the two schedules is not possible, no adverse clinical effects have been observed with the recently adopted single-dose schedule. Furthermore, the duration of patient hospitalization for chemotherapy has decreased.
Regional cerebral blood flow in the acute stage of experimentally induced subarachnoid hemorrhage
Authors: Umansky Felix , Kaspi Thalia , Shalit Mordechai N.
Published: May 2009

✓ Subarachnoid hemorrhage (SAH) was induced in 13 adult mongrel cats by a slow injection of fresh autogenous blood into the cisterna magna. Serial determinations of regional cerebral blood flow (rCBF) in the cortex and deep-seated areas (internal capsule, thalamus, and caudate nucleus) were made during the following 2 hours, while intracranial pressure (ICP) was maintained at normal values. A decrease in rCBF was observed in all the areas examined. This reduction followed a characteristic triphasic pattern with an initial steep decline immediately after the SAH. The clinical implications of these findings are discussed.
Statistical studies on evaluation of mild disturbance of consciousness
Authors: Sano Keiji , Manaka Shinya , Kitamura Koichi , Kagawa Mizuo , Takeuchi Kazuo , Ogashiwa Motohide , Kameyama Masakuni , Tohgi Hideo , Yamada Hisashi
Published: May 2009

✓ In an effort to express the grades of mild disturbance of consciousness (MDOC), or clouding of consciousness, 25 items were selected for application in clinical examination. Factor analysis of the 25 items revealed that MDOC has a two-factor structure; namely, the performance factor (F1) and the verbal factor (F2). This structure was maintained in the sequential examinations. Guttman's scale analysis showed that the scale using the 25 items may be considered to approximate a unidimensional scale. By item selection according to communality, the 25 items could be reduced to 12 items without losing the two-factor structure or the usefulness and reliability of the examination. The principal component analysis (PCA) score, the F1 score, and the F2 score, calculated from the 12 items, were found to be good scales to describe an overall picture and characteristics of the F1 and the F2 of MDOC, respectively. Furthermore, by means of the characteristic curve (ogive) method, it was revealed that MDOC consisted of four clusters of items, the F2 factor (mild), F1 factor (mild), F2 factor (moderate), and F1 factor (moderate), according to the MDOC severity, so that a simpler scale composed of a representative item from each cluster could be constructed which exhibited a high correlation coefficient with the original PCA score.
Experimental microsurgical embolectomy after middle cerebral artery embolization in the dog
Authors: Okada Yoshikazu , Shima Takeshi , Oki Shuichi , Uozumi Tohru
Published: May 2009

✓ The effects of microsurgical embolectomy were investigated clinicopathophysiologically in 60 dogs after occlusion of the middle cerebral artery (MCA) trunk with a silicone cylinder embolus. One group of animals served as a control (non-embolectomized group), and in the other two groups the embolus was removed 3 or 6 hours after occlusion (3-hour or 6-hour embolectomy group). In the non-embolectomized animals, major neurological deficits with deep cerebral infarction were observed. Regional cerebral blood flow (CBF) in the basal ganglia decreased most prominently. Sensory evoked potentials also declined to about 50% of the control level 3 hours after embolization. In the 3-hour embolectomy group, mild neurological deficits with minimal infarctions were found. One hour after embolectomy, CBF was restored to the original level in all regions, and the sensory evoked potentials surpassed the control level. In the 6-hour embolectomy group, most animals exhibited major neurological deficits and severe brain swelling with hemorrhagic infarction. This study suggests that early microsurgical embolectomy of the MCA trunk restores blood flow in the perforating arteries and prevents deep cerebral infarction.
Aspergillus infections of the lumbar disc spaces
Authors: Mawk John R. , Erickson Donald L. , Chou Shelley N. , Seljeskog Edward L.
Published: May 2009

✓ Three cases of lumbar vertebral interspace infection due to the Aspergillus fungus are presented. Two patients responded to vigorous surgical therapy in combination with prolonged administration of antifungal agents. The third patient died of complications related to the antibiotic therapy. Possible etiologies of this unusual problem are reviewed in light of the changing spectrum of nosocomial and spontaneously acquired infectious processes. Combined aggressive medical and surgical therapy is discussed with respect to the known difficulties in eradicating deep-seated osseous mycotic infections.
Jefferson fractures in children
Authors: Marlin Arthur E. , Williams Gayle R. , Lee J. Fletcher
Published: May 2009

✓ Jefferson fractures in children are exceedingly rare. A case in a 2-year-old is reported, and the other only case in the literature is reprinted. The mechanism of fracture is probably separation of the lateral masses by a force transmitted from the vertex. Because these fractures are not usually associated with neurological deficits, and because of the poor detail obtained with conventional radiography in a child, these fractures may be overlooked. Computerized tomography provides superb definition of this lesion. The preferred mode of treatment is immobilization.
Megadose steroids in severe head injury
Authors: Braakman Reinder , Schouten Hubert J. A. , Blaauw-van Dishoeck Marijke , Minderhoud Jan M.
Published: May 2009

✓ A prospective double-blind clinical trial was performed on 161 patients to determine the effectiveness of high-dose steroid therapy in patients admitted comatose after a non-missile-related head injury. Patients were randomized into a high-dose dexamethasone phosphate group and a placebo group. The initial dose of 100 mg of dexamethasone was administered within 6 hours of the accident. For statistical analysis, a sequential test was chosen, using survival at 1 month as a basic criterion of effectiveness. No significant difference was found in the 1-month survival rate or in the distribution of outcome after 6 months, either within the group as a whole, or in subgroups with varying severity of brain damage on admission. The authors conclude that dexamethasone in high doses has no statistically significant effect on morbidity or mortality in head-injured patients who are comatose on admission.
Inhibition by dipyridamole of cerebral vasospasm induced in vitro by whole blood
Authors: Linder Martin
Published: May 2009

✓ This study evaluates the effect of dipyridamole, an inhibitor of platelet aggregation, on cerebral artery contraction induced in vitro by the addition of whole blood. Whole fresh arterial blood added to isolated rabbit basilar artery bathed in a physiological buffer produces a sustained contraction in vessels observed for 60 minutes. Significant dose-dependent inhibition of contraction was observed when dipyridamole was added to the vessel bath. This effect was not influenced by preincubating cerebral vessels with aspirin, an inhibitor of prostaglandin synthesis. It is suggested that inhibition of whole blood-induced cerebral artery contraction by dipyridamole does not result from potentiation of cerebral vessel prostaglandin pathways, but possibly from a direct effect on platelets.
Intrasellar epidermoid cyst
Authors: Boggan James E. , Davis Richard L. , Zorman Greg , Wilson Charles B.
Published: May 2009

✓ The authors report the uncomplicated removal of an intrasellar epidermoid cyst that on presentation mimicked a pituitary adenoma. Current controversies regarding the differentiation of this cyst from other cystic lesions of the sellar region are reviewed.
Paroxysmal positional nystagmus in innominate and subclavian arterial occlusive disease
Authors: Gulati Surendra M. , Pugh James E. , Whitehouse Walter M. , Stanley James C.
Published: May 2009

✓ A 42-year-old woman exhibited reproducible paroxysmal nystagmus on looking upward while standing, or on turning her head to the right while reclining. She also experienced vertigo with these postural maneuvers. These neurological findings were attributed to brain-stem ischemia secondary to arteriosclerotic occlusive disease of the left subclavian and innominate arteries. Surgical restoration of normal blood flow in these extracranial vessels was associated with complete remission of the nystagmus and vertigo.
Preoperative chemotherapy and surgical resection in the management of posterior paraspinal tumors
Authors: Sundaresan Narayan , Rosen Gerald , Fortner Joseph G. , Lane Joseph M. , Hilaris Basil S.
Published: May 2009

✓ Three patients with posterior paravertebral tumors are presented to illustrate the value of preoperative chemotherapy prior to surgical resection. All three had massive tumors adjacent to the spine, extending over several vertebral segments, with myelographic evidence of epidural involvement in one patient. Tissue diagnosis by incisional biopsy confirmed the diagnosis of extraosseous osteogenic sarcoma in one, extraosseous Ewing's sarcoma in the second, and embryonal rhabdomyosarcoma in the third. All patients were treated with chemotherapy preoperatively. Marked regression in tumor size was noted, and surgical excision of the tumor along with involved segments of spine was easily accomplished. Histological examination following surgery revealed completely necrotic tumor in two patients. Preoperative chemotherapy for fully malignant tumors offers the following advantages: 1) extremely bulky and otherwise unresectable tumors can be reduced in size to enable complete surgical resection; 2) systemic chemotherapy is instituted earlier in the course of disease to prevent more effectively the appearance of metastases; and 3) the information gained regarding the sensitivity of the tumor to a particular chemotherapy regimen allows postoperative adjuvant chemotherapy to be used on a more rational basis.
Polycystic kidney disease and intracranial aneurysms
Authors: Wakabayashi Toshimitsu , Fujita Shigekiyo , Ohbora Yoshiro , Suyama Tohru , Tamaki Norihiko , Matsumoto Satoshi
Published: May 2009

✓ From August, 1981, to August, 1982, the authors performed four-vessel angiography in 17 patients with polycystic kidney disease (PKD) who had no neurological deficit and no history of subarachnoid hemorrhage. Seven cases of unruptured aneurysms were found among these 17 patients (an incidence of 41.2%). Five of the unruptured aneurysms were operated on prophylactically, with no mortality or morbidity. Nine of the 17 patients had hypertension and, of these, two (22.2%) had aneurysms. Of the eight patients without hypertension, five (62.5%) had aneurysms. This study suggests that the coexistence of PKD and intracranial aneurysms might not be due to the hypertension that occurs concomitant with PKD, but instead may be attributable to congenital factors. The authors stress the necessity of early diagnosis and early operation for unruptured aneurysms in patients with PKD.
Halo-thoracic brace immobilization in 188 patients with acute cervical spine injuries
Authors: Chan Richard C. , Schweigel Joseph F. , Thompson Gordon B.
Published: May 2009

✓ The authors report 188 patients with acute cervical spine injury with fracture who underwent Halothoracic brace immobilization. The majority of the fractures were considered unstable. Early neurological assessment revealed 24 patients without neurological deficit. There were 164 patients with associated cervical cord injury; 84 patients with incomplete, and 80 patients with complete tetraplegia. Management consisted of skull traction and application of the Halo-thoracic brace about 1.3 weeks after admission. The average radiological union time was 11.5 weeks following a mean of 10.2 weeks of immobilization in a Halo apparatus. Satisfactory restoration of bone and ligament stability, with no significant posttreatment neck pain, was obtained in 168 cases (89%). This is comparable to the fusion rate achieved for cervical fractures in the literature. The follow-up periods range from 1 month to 6 years, with a mean of 10.8 months. The management and results in 73 patients with unilaterally and bilaterally locked facets with or without fractures are discussed. Complete tetraplegia is not considered a contraindication to Halo apparatus immobilization. The multiple factors responsible for overcoming the barrier of anesthetic skin are elucidated. Use of the Halo apparatus offers early mobilization and rehabilitation without neurological deterioration. Complications are few and insignificant.
A double-blind clinical trial of iopamidol versus metrizamide for lumbosacral myelography
Authors: Drayer Burton P. , Vassallo Charles , Sudilovsky Abraham , Luther J. Scott , Wilkins Robert H. , Allen Susan , Bates Milton
Published: May 2009

✓ A double-blind study was performed to compare metrizamide with the new iodinated water-soluble nonionic contrast medium, iopamidol, for conventional and computerized tomography lumbosacral myelography. Both contrast agents were used in 30 patients, and were equivalent in terms of image quality and clinical accuracy. Headaches and nausea were less severe using iopamidol. The most striking difference was found in adverse neurobehavioral reactions and associated electroencephalographic abnormalities, which were noted in 17% of the metrizamide group but were not seen with the use of iopamidol. Iopamidol appears to be superior to metrizamide for intrathecal applications. An explanation of the differential neurotoxicity is provided.
Late seizures and morbidity after subdural empyema
Authors: Cowie Richard , Williams Bernard
Published: May 2009

✓ A survey of 89 patients with subdural empyema was conducted to assess the incidence of late seizures and morbidity in this disease. Twenty-four patients died during the acute stage of the illness and, of the 65 survivors, 13 were lost or had incomplete follow-up review. Hemiparesis occurred in 48 of the survivors during the acute stage, and all but nine recovered completely. Thirteen patients had a visual field deficit and all recovered; in three of these 13 who had speech disorders the deficits persisted. Recovery from neurological morbidity was not related to the type of surgical treatment; however, the mortality rate was improved by craniotomy.

The same incidence of early seizures occurred in those who died (62%) as in those who survived (63%). Of those who had no early seizures, 42% had late seizures, the majority appearing within 16 months. Of those who had early seizures, 71% did not have subsequent attacks. The highest incidence of seizures occurred in patients who had their empyema in the second and third decades of life. The incidence of late seizures was not influenced by the method of surgical treatment, the degree of deterioration of consciousness during the acute stage of the illness, nor by occurrence of early seizures. A significantly increased incidence of early seizures was associated with paranasal sepsis, but not with late seizures.
Precocious puberty and hypothalamic hamartoma with total recovery after surgical treatment
Authors: Alvarez-Garijo José A. , Albiach Vicente J. , Vila Manuel M. , Mulas Fernando , Esquembre Vicente
Published: May 2009

✓ A hypothalamic hamartoma was found in an 18-month-old boy who presented with mild precocious puberty. Following partial removal of the tumor, there was prompt improvement in clinical signs and plasma endocrine levels. Two years after surgery the patient was completely normal. The pathological examination of the excised tumor showed normal glial tissue.
Giant ossifying fibroma of the skull
Authors: Villemure Jean-Guy , Meagher-Villemure Kathleen
Published: May 2009

✓ A case of giant ossifying fibroma of the cranial vault is reported. The rapid extensive growth of this large parietal bone tumor inaccurately suggested malignancy. The literature relative to this benign bone tumor as well as its surgical management and follow-up findings are presented.
Subclavian to distal vertebral artery bypass
Authors: Senter Howard J. , Long Edwin T.
Published: May 2009

✓ A simple technique is described for extracranial vertebral artery vein bypass grafting, utilizing an internal shunt that avoids prohibitively dangerous vertebral artery cross-clamping. This procedure was carred out successfully in a patient with vertebrobasilar insufficiency.
A new bipolar right-angled coagulation forceps for pituitary surgery
Authors: Landolt Alex M.
Published: May 2009

✓ A new instrument is described which allows easy and precise bipolar coagulation of the anterior intercavernous sinus. In some cases this sinus covers the anterior aspect of the pituitary and may render transsphenoidal pituitary surgery difficult.
Pregnancy following transsphenoidal resection of prolactin-secreting pituitary tumors
Authors: Laws Edward R. , Fode Nicolee C. , Randall Raymond V. , Abboud Charles F. , Coulam Carolyn B.
Published: May 2009

✓ This report describes 200 women in the childbearing age group with prolactin-secreting pituitary adenomas treated by transsphenoidal microsurgery. There were 136 patients with microadenomas (10 mm or less in diameter), 30 with macroadenomas, 11 with invasive adenomas, and one with hyperplasia. The overall rate for postoperative normalization of serum prolactin was 57%, and it was 72% for those patients with microadenomas. Pregnancy was desired by 90 women, and 78 (84%) became pregnant, although 10 required postoperative bromocriptine to do so. Serious postoperative complications were rare, and produced no major morbidity. The results of surgery were most favorable in women with microadenomas and preoperative serum prolactin levels of 100 ng/ml or less.
Monitoring of antifibrinolytic therapy following subarachnoid hemorrhage
Authors: Sawaya Raymond , Sonnino Victor , McLaurin Robert L. , Perrotta Gerardo
Published: May 2009

✓ Ten cases of subarachnoid hemorrhage (SAH) from ruptured cerebral aneurysm are reported. Fibrin/fibrinogen degradation product (FDP) levels were determined simultaneously in blood and cerebrospinal fluid (CSF) at an average frequency of 1.7 days, extended over periods of 8 to 63 days. Successful antifibrinolytic therapy (AFT) correlated with FDP levels in CSF of less than 16 µg/ml. Five patients failed to respond to AFT. Levels of FDP in the CSF fluctuated widely in these five patients, and remained at or above 16 µg/ml for most of the monitoring period. Blood FDP levels were normal or minimally elevated, and could not be used in predicting or preventing rebleeding episodes. A hypothesis is presented to explain the significance of the presence of FDP's in CSF.

In spite of the many techniques employed in monitoring AFT and reviewed in this paper, little information has been gained to improve the results and therapeutic strategies. Among the different methods available, FDP measurements in the CSF have correlated best with rebleeding, and thus may be used in modifying and individualizing therapy. Suggestions are given for future studies.
Intrasellar mixed germ-cell tumor
Authors: Page Robert B. , Plourde Paul V. , Coldwell Douglas , Heald James I. , Weinstein Joel
Published: May 2009

✓ The case of a 19-year-old male with a pluripotential teratoma arising in the pituitary gland is presented. The clinical, radiological, and pathological aspects of this case are discussed. This case demonstrates that intracranial germinal tumors can arise from the pituitary gland as well as from the infundibular and pineal regions.
Intracranial arterial aneurysms in children and adolescents
Authors: Østergaard John R. , Voldby Bo
Published: May 2009

✓ Throughout the period 1943 to 1980, 1368 patients with verified intracranial saccular aneurysms were treated in the University of Aarhus neurosurgical department. Forty-three (3.1%) patients (25 boys and 18 girls) were 19 years old or younger, and 33 (77%) had an onset of symptoms typical of subarachnoid bleeding. Using the classification system of Hunt and Hess as a basis for clinical assessment on admission, 58% of the patients could be placed in Grade I or II. Cerebral vasospasm was demonstrated in 53% of the patients undergoing angiography between the 4th and 16th day after hemorrhage. There was no increased morbidity or mortality in the group of patients with vasospasm, and no cerebral infarction was demonstrated at necropsy. Therefore, it is possible that vasospasm is of minor prognostic significance in children. In 15 patients (37%), aneurysm rupture was accompanied by intracerebral hematoma. The mortality rate in this group of 15 patients was 50%, whereas in the group without hematoma it was 26%. The overall mortality rate was 33%. The surviving 29 patients were followed for 3 months to 14 years. Twenty-three patients made a good recovery (80% of survivors and 54% of the total series), five were moderately disabled, and one was severely disabled.
Cerebral arterial pathology in experimental subarachnoid hemorrhage
Authors: Yamashima Tetsumori , Yamamoto Shinjiro
Published: May 2009

✓ Pathological changes of the cerebral arteries were studied in 30 dogs after subarachnoid injections of saline, fresh autologous blood, epinephrine, blood plus epinephrine, norepinephrine, or blood plus norepinephrine. Macroscopically, the circle of Willis was maximally dilated after the injection of epinephrine and was constricted following administration of blood plus epinephrine. Microscopically, neither saline nor blood produced abnormalities, except for minor changes of the adventitia in the latter. Epinephrine produced frank necrosis of smooth-muscle cells, which was subsequently replaced by fibrosis in the media of larger subarachnoid arteries, and the leakage of necrotic material from the infarcted hypothalamus contributed to these lesions. Blood plus epinephrine produced marked changes in the internal elastic lamina and tortuosities of the nuclei of smooth-muscle cells, while norepinephrine and blood plus norepinephrine produced only minor changes.

Previously reported findings of morphological changes due to vasospasm after subarachnoid hemorrhage were confirmed experimentally, but such changes were found only after application of epinephrine. It is suggested that epinephrine produced the most severe vasospasm among the five substances tested.
Beagle puppy model of intraventricular hemorrhage
Authors: Ment Laura R. , Stewart William B. , Duncan Charles C. , Scott David T. , Lambrecht Richard
Published: May 2009

✓ The newborn beagle puppy has been demonstrated to provide a good model for neonatal intraventricular hemorrhage (IVH). A study was designed to determine if indomethacin can prevent IVH and if indomethacin would produce changes in cerebral blood flow (CBF). Newborn beagle puppies were randomized by computer into two groups: one was pretreated with indomethacin, a known inhibitor of prostaglandin synthetase, and the other was saline. The dogs in both groups were then assigned either to undergo hemorrhagic hypotension/volume reexpansion insult or to receive no insult. Twenty percent of all pups receiving indomethacin and undergoing the insult experienced IVH, compared to 71% of the pups undergoing insult that had been pretreated with saline. Significant alterations in the blood pressure responses to the hemorrhagic hypotension/volume reexpansion insult were noted in the former group compared to the saline-pretreated pups subjected to insult. Finally, employing carbon-14 autoradiography for the determination of CBF, it was demonstrated that indomethacin decreases resting CBF of the newborn beagle pups and, in indomethacin-pretreated animals subjected to insult, prevents the increases in CBF seen in the saline-pretreated traumatized pups.
Intermittent versus continuous brain retraction
Authors: Yokoh Akira , Sugita Kenichiro , Kobayashi Shigeaki
Published: May 2009

✓ Brain damage due to retraction was studied morphologically and physiologically in the dog brain. Two methods of retraction were compared using a retractor with a strain gauge: 1) continuous retraction; and 2) intermittent retraction. Total retraction time was 60 minutes for each method. Brain damage started to appear at a retraction force of 30 gm with continuous retraction, and increased in proportion to the force used. The power spectrum of the electrocorticogram showed full recovery after the release of retraction when the retraction force was less than 40 gm. With intermittent retraction, the damage was morphologically minimal with a retraction force of less than 50 gm, and recovery of the power spectrum of the electrocorticogram was prompt in comparison with continuous retraction. The results indicate the superiority of intermittent over continuous retraction.
Surgically reversible hypothalamic hypopituitarism due to aqueductal stenosis
Authors: Dempsey Robert J. , Chandler William F. , Sauder Sue Ellyn
Published: May 2009

✓ A 13-year-old girl was referred for evaluation of the deceleration in her rate of linear growth, an arrest in the progression of her pubertal maturation, and bifrontal headaches. Detailed endocrinological and radiological studies revealed the following abnormalities: partial growth hormone deficiency, prepubertal luteinizing hormone and follicle-stimulating hormone responses to exogenous gonadotropin-releasing hormone, aqueductal stenosis with obstructive hydrocephalus, and marked focal dilation of her third ventricle. Ventriculoperitoneal shunting resulted in increased linear growth, resumption of pubertal development, and correction of her documented neuroendocrine abnormalities.
Cervical intramedullary schwannoma
Authors: Rout Damodar , Pillai Sivathanoo M. , Radhakrishnan Vishnupuri V.
Published: May 2009

✓ A case of cervical intramedullary schwannoma without evidence of von Recklinghausen's disease is reported. The hypotheses regarding its histogenesis and the difficulty in diagnosis on the frozen section obtained at biopsy are discussed, along with a review of literature covering 15 previously reported cases.
Collagen deficiency and ruptured cerebral aneurysms
Authors: Neil-Dwyer Glenn , Bartlett John R. , Nicholls Alan C. , Narcisi Paolo , Pope F. Michael
Published: May 2009

✓ Skin and temporal arterial biopsies were obtained from 17 patients undergoing surgery for ruptured cerebral aneurysm, and specimens were taken from six age- and sex-matched control surgical patients. Radioactively labeled and control tissue collagen patterns were studied by interrupted polyacrylamide gel electrophoresis (PAGE), using the trisborate buffer system or by carboxymethyl cellulose (CMC) chromatography. Type III/I collagen ratios were then measured from autoradiographs of the radioactively labeled samples using the Joyce Loebl gel scanner adapted for flat bed gels. In the case of the CMC labeled material, the ratios were measured by the ratios of the summed radioactively labeled α1(III), α2(II), and α2(I) peaks. Eleven of the 17 patients were Type III collagen-deficient while all of the six control patients had normal collagen ratios. The implications of these findings are discussed.
Cortical oxidative metabolism under conditions of ischemia, hypoxia, and asphyxia in the rabbit
Authors: Koga Hiroaki , Austin George
Published: May 2009

✓ The purpose of this investigation was to compare the effects of hypoxia, asphyxia, and ischemia on brain cortical oxidative metabolism. This study was carried out using 14 New Zealand White rabbits. The effects of episodic stress were measured simultaneously on brain functional metabolism by monitoring cortical oxygen tension (brain pO2), cortical cerebral blood flow (cCBF), cortical blood volume, and mitochondrial oxidative metabolism. During hypoxia (when the fraction of inspired O2 (FiO2) was reduced to 10%) and asphyxia (induced by turning the respirator off), there was a decrease of brain pO2 but an increase of cCBF and blood volume. Similarly, there was a reduction of cortical oxidative metabolism. In post-asphyxic conditions, an overshoot of brain pO2 and post-asphyxic oxidation of cytochrome (Cyt.) aa3 were usually shown. Under ischemic conditions (induced by sudden severe hypotension plus bilateral common carotid occlusion), cCBF and blood volume were decreased. There was also a decrease of brain pO2 and a reduction of Cyt. aa3 following ischemia. These techniques are applicable in intraoperative monitoring of patients.
Combined radiotherapy and chemotherapy with dibromodulcitol and CCNU in the postoperative treatment of malignant gliomas
Authors: Áfra Dénes , Kocsis Bela , Dobay Jozsef , Eckhardt Sándor
Published: May 2009

✓ Within 4 weeks after definitive surgery, 91 patients with supratentorial glioblastomas and malignant astrocytomas were randomized to one of three treatment arms: Group 1 received radiotherapy alone; Group 2 received dibromodulcitol (DBD) during radiotherapy, and treatment was then continued with DBD; and Group 3 received DBD during radiotherapy, followed by combination chemotherapy of CCNU and DBD. No severe myelotoxicity occurred, but combined treatment with CCNU and DBD occasionally caused a transient myelosuppression. Statistical analysis of 84 evaluable patients showed a significantly longer survival period in those who received chemotherapy during and after irradiation. Median survival times in the three groups were 40, 57, and 60 weeks, respectively; the corresponding p value for Groups 2 and 3 was 0.025 and 0.0015. The ratio of patients surviving over 18 and 24 months was highest in Group 3. This study suggests that the administration of DBD during irradiation might have been the main factor in improving survival times.
Computerized tomography of peripheral nerve lesions
Authors: Powers Stephen K. , Norman David , Edwards Michael S. B.
Published: May 2009

✓ Nine patients with a peripheral nerve lesion (six intrinsic and three extrinsic) were evaluated with computerized tomography (CT). In all but one instance, the CT scans gave useful information regarding the anatomical location, size, and relationship of the lesion to surrounding structures. These cases illustrate the usefulness of CT as a diagnostic tool in the evaluation of peripheral nerve lesions.
Correlation of transient neurological deficit and somatosensory evoked potentials after intracranial aneurysm surgery
Authors: McPherson Robert W. , Niedermeyer Ernst F. , Otenasek Richard J. , Hanley Daniel F.
Published: May 2009

✓ A patient is reported in whom intraoperative somatosensory evoked potential (SEP) changes occurred in response to temporary clipping of the right middle cerebral artery. A period of 10 minutes elapsed before changes in SEP's in response to contralateral nerve stimulation were noted and, during the following 2 minutes, the waves decreased in amplitude and then were unrecordable. Waves of SEP, with amplitude similar to those recorded before clipping but with abnormal latency, returned within 45 seconds of removal of the clip, and the latency abnormalities persisted until the end of the operation. The patient awakened promptly at the end of the procedure with a dense left hemiparesis which resolved over 24 hours. At the end of 24 hours, the SEP's in response to median nerve stimulation were symmetrical in both latency and amplitude. This report demonstrates the accuracy of intraoperative evoked potential monitoring in demonstrating alterations of cerebral perfusion during aneurysm surgery. It also suggests that a prolonged period of observation may be necessary to assess the effects of temporary vessel occlusion during surgery on aneurysms or arteriovenous malformations.
Brain-stem hemangioma calcificans
Authors: Occhiogrosso Michele , Carella Aristide , D'aprile Paola , Vailati Giacomo
Published: May 2009

✓ A case of brain-stem hemangioma calcificans is described. The few cases reported in the literature prove the rarity of this tumor, which is considered a benign variant of cerebral cavernous hemangioma. Diagnosis and treatment of these tumors are briefly discussed with a review of the literature including 11 previous cases.
Immunobiology of primary intracranial tumors
Authors: Mahaley M. Stephen , Gillespie G. Yancey , Gillespie Ritchie P. , Watkins Pamela J. , Bigner Darell D. , Wikstrand Carol J. , MacQueen J. Marilyn , Sanfilippo Fred
Published: May 2009

✓ Serial serological studies were carried out on 19 of 20 patients with malignant gliomas who were actively immunized with one of two human glioma tissue culture cell lines (D-54MG or U-251MG). Most patients mounted a significant serum reaction to histocompatibility antigens (HLA's), as well as an antibody response to fetal bovine serum (FBS) which was added to the glioma-cell inoculum. These two sources of antibody accounted for greater than 90% of the antibody induced by these inoculations. Two patients continued to have significant amounts of binding antibody to the original immunizing cell line following exhaustive absorptions of FBS and HLA antibodies. One of these two had all remaining significant antibody removed by further absorption of the serum against the 2-T osteogenic sarcoma tissue culture cell line known to possess antigens cross-reactive with human gliomas. One single patient continued to show significant antibody binding to the original glioma cell line following absorption against FBS, human platelets, and the 2-T cell line, and therefore seems to have produced glioma-distinctive antibodies in response to immunization. The antibody preparation from this patient was also cytotoxic against the original glioma cell line, as well as another recently cultured human glioblastoma cell line. The significance of these serological studies is discussed as it relates to immunological responses patients with gliomas may make to active immunization.
The surgical correction of coronal and metopic craniosynostoses
Authors: Marsh Jeffrey L. , Schwartz Henry G.
Published: May 2009

✓ Procedures for relief of coronal synostosis and metopic synostosis have resulted in some undesirable sequelae. The authors present combined neurological and plastic surgical modifications to prevent additional synostoses, forehead ridging, and lateral orbital wall step-off. They recommend bifrontal craniotomy with lateral wall osteotomy into the body of the zygoma and self-retaining grafts.
Electrophrenic respiration following anastomosis of phrenic with brachial nerve in the cat
Authors: Krieger Abbott J. , Danetz Irina , Wu Shu Z. , Spatola Mark , Sapru Hreday N.
Published: May 2009

✓ Patients with high spinal cord injuries may be totally dependent on artificial ventilation. Prolonged use of mechanical devices requires intensive care, which restricts the mobility of these patients. Electrophrenic respiration has been used with success to overcome this difficulty. However, a prerequisite for electrophrenic respiration is a viable phrenic nerve. Patients with spinal cord injuries at the C-3 to C-5 levels do not have a viable phrenic nerve due to gradual degeneration of axons in these nerves.

In the present study on cats, the authors caused degeneration in one of the phrenic nerves by sectioning it low in the neck. Then the distal end of the phrenic nerve was anastomosed to the proximal segment of a sectioned brachial nerve. Sixteen to 32 weeks were allowed for the growth of brachial axons into the anastomosed phrenic nerve. Each cat served as its own control because one of the phrenic nerves was left intact. It was observed that pacing of the anastomosed phrenic nerve produced respiration comparable to spontaneous respiration or to respiration induced by pacing the intact phrenic nerve. Lack of rhythmic bursts of electrical activity in the anastomosed phrenic nerve and electromyographic activity in the ipsilateral hemidiaphragm confirmed that the anastomosed phrenic nerve remained disconnected from the respiratory motoneurons. Abundance of collagen matrix in the electron micrographs of the anastomosed phrenic nerve indicated that degeneration of the axons of phrenic motoneurons had occurred and the brachial nerve had grown into the phrenic nerve stump. These results indicate that electrophrenic respiration may be possible in patients with spinal cord injuries at the C-3 to C-5 vertebral levels if the phrenic nerve is kept viable by anastomosing it to a branch of the brachial nerve.
Chart for outcome prediction in severe head injury
Authors: Choi Sung C. , Ward John D. , Becker Donald P.
Published: May 2009

✓ An analysis of clinical and demographic data of 264 patients with severe head injury showed that a combination of the Glasgow Coma Scale (GCS) score, oculocephalic responses, and age can provide a simple but reliable prediction of outcome in severe head injury. Addition of other clinical data, excluding intracranial pressure and evoked potentials, improved the predictability only negligibly. A simple chart, which is constructed from the application of the logistic regression model, can be used to determine the odds of a good outcome from the combination of the three factors. A method is given by which the GCS score of a patient with a missing verbal response score can be accurately approximated in order to complete the chart. Among other values, the odds of a good outcome provide the clinician with a reliable measure of the relative severity of a patient's injury. The accuracy of the chart in prediction is expected to be 80% or above.
Successful treatment of spinal arachnoiditis due to coccidioidomycosis
Authors: Winston Drew J. , Kurtz Terrance O. , Fleischmann Jacob , Morgan David , Batzdorf Ulrich , Stern W. Eugene
Published: May 2009

✓ An unusual case is reported of a patient with spastic paraparesis who was found to have severe spinal arachnoiditis due to Coccidioides immitis. Despite an obstructive hydrocephalus and a spinal subarachnoid block, the patient was treated effectively with surgery (shunting) and antifungal therapy (amphotericin and ketoconazole). He remains asymptomatic 3 years after diagnosis. Aggressive surgical and medical treatment of coccidioidal infection of the central nervous system can be beneficial, even in patients with the worst prognosis.
Septate bifrontal ependymal cyst
Authors: Oro John J. , Ansbacher Linda E. , Levy Walter J.
Published: May 2009

✓ The authors describe the case of a septate ependymal cyst involving both frontal lobes. The clinicopathological features, treatment, and results of previously reported cases are reviewed, and the etiology and pathogenesis of these cysts discussed.
Primary cerebral neuroblastoma
Authors: Berger Mitchel S. , Edwards Michael S. B. , Wara William M. , Levin Victor A. , Wilson Charles B.
Published: May 2009

✓ Primary cerebral neuroblastoma is a distinct pathological and clinical entity that differs from other primitive neuroectodermal tumors. To characterize the clinical course of this lesion, the authors performed a retrospective analysis in 11 patients who ranged in age from 17 months to 26 years. The tumor had no predilection for either sex. Signs and symptoms were mostly those associated with increased intracranial pressure. The lesions commonly involved the parietal and occipital lobes. Computerized tomography scans of nine patients showed five solid and four cystic lesions; calcifications were found more commonly in the solid lesions. Contrast enhancement was seen in all tumors, yet angiograms typically showed an avascular mass. Total removal of tumor was possible in only two patients, both with cystic tumors. The remaining nine underwent subtotal resection of a solid lesion (in five) or a cystic lesion (in four). All 11 patients underwent postoperative irradiation that included the spinal axis in two cases; only one received adjuvant chemotherapy (solid tumor). Four patients, all with solid tumors that initially were subtotally resected, had evidence of tumor recurrence. The only patient with a subtotally resected solid lesion who did not have recurrence received adjuvant chemotherapy. The six patients who had cystic lesions are free of recurrent tumor at 26 to 109 months after surgery. Based on follow-up analysis of the 11 patients, recommendations are proposed for the treatment of primary cerebral neuroblastomas.
Production of collagenase and inhibitor (TIMP) by intracranial tumors and dura in vitro
Authors: Halaka Ahmed N. , Bunning Rowena A.D. , Bird Colin C. , Gibson Myles , Reynolds John J.
Published: May 2009

✓ The production of collagenase and collagenase inhibitor (TIMP) by various intracranial tumors (25 meningiomas, eight gliomas, seven metastases, four pituitary adenomas, and five others) was studied in short-term organ culture. While meningiomas produced negligible amounts of collagenase, two metastatic carcinomas of bronchial and breast origin produced significant amounts of the enzyme. Cultures of dura from an invasive meningioma and of bone invaded by a meningioma also produced collagenase. In varying amounts, TIMP was detected in culture media from most of the tumors studied; invasive tumors tended to produce less TIMP than noninvasive tumors. The results are discussed in relation to current views on tissue degradation and mechanisms of tumor invasion.
Monitoring auditory functions during cranial nerve microvascular decompression operations by direct recording from the eighth nerve
Authors: Møller Aage R. , Jannetta Peter J.
Published: May 2009

✓ A method is described for recording sound-evoked responses directly from the eighth nerve during operations in the cerebellopontine angle, particularly during microvascular decompression operations for cranial nerve dysfunction. This method provides important information to the surgeon during the operation that cannot be provided by recording brain-stem auditory evoked potentials (BAEP) using surface electrodes. By recording sound-evoked responses intracranially and recording BAEP with scalp electrodes, the risk of hearing loss in these operations is decreased.
Mannitol-induced rebleeding from intracranial aneurysm
Authors: Rosenørn Jarl , Westergaard Lars , Hansen Peter H.
Published: May 2009

✓ A case is presented in which rebleeding from an intracranial saccular aneurysm occurred a few minutes after intravenous administration of mannitol during surgery. The relationship between the reducing effect of mannitol on elevated intracranial pressure and the increased pressure gradient across the aneurysm wall, causing risk of rebleeding, is discussed. Procedures that can reduce this risk are summarized.
Ventriculoperitoneal shunt procedure complicated by ureter obstruction
Authors: Clarke Carl E. , Paul Kamal S. , Lye Richard H.
Published: May 2009

✓ The authors present the case history of a patient in whom the peritoneal catheter of a ventriculoperitoneal shunt system caused ureter obstruction. This is a rare complication of such a shunt procedure, and the patient's symptoms were relieved by shortening the peritoneal catheter.
“The Common Devotion” — Cushing's legacy and medical ethics today
Authors: Pellegrino Edmund D.
Published: May 2009

✓ The author examines the principles that have been specific to the profession of medicine. He iterates Harvey Cushing's exhortation to reaffirm adherence to traditional medical ethics which are at times strained in dealing with major congenital defects, maintenance of ancillary support, technological possibilities, and terminal illness. Moral considerations must be examined and respected, and remain the personal responsibility of the profession. The best decisions involve the patient's interests and the freedom to choose.
Legionnaire's disease in postoperative neurosurgical patients
Authors: Glazier Mark C. , Kohler Richard B. , Campbell Robert L.
Published: May 2009

✓ Legionella pneumophila postoperative pneumonia may be an important cause of morbidity and mortality in selected surgical patients. This report presents five postoperative neurosurgical patients in whom the diagnosis of Legionnaires' disease was made. Their clinical course and treatment are presented. Clinical manifestations, methods of diagnosis, and treatment of L. pneumophila pneumonia are discussed. It is pointed out that neurosurgical patients who have received high doses of corticosteroids and who develop nosocomial postoperative pneumonias should be suspected of having Legionnaires' disease.
Severe head injury managed without intracranial pressure monitoring
Authors: Stuart Gordon G. , Merry Glen S. , Smith James A. , Yelland John D. N.
Published: May 2009

✓ A prospective series of 100 consecutive severe head injuries is presented. There were 34 deaths. Intracranial pressure (ICP) was not monitored in this series, and it is suggested that the outcome compares favorably with series in which ICP monitoring was performed. Early evacuation of life-threatening intracranial hematoma and airway control remain essentials of treatment of severe head injury.