bluuebunny/crossref_metadata_2025 huggingface dataset:
Selection of patients for extra-intracranial arterial bypass surgery based on rCBF measurements
Authors: Schmiedek Peter , Gratzl Otmar , Spetzler Robert , Steinhoff Harald , Enzenbach Robert , Brendel Walter , Marguth Frank
Published: May 2009

✓ Extracranial intracranial arterial anastomosis is gaining acceptance as a form of treatment in selected cases with ischemic cerebrovascular disease. To establish indications for this operation and to provide an objective assessment of postoperative results, regional cerebral blood flow (rCBF) studies were performed in 110 patients with cerebrovascular insufficiency considered for extra-intracranial bypass surgery. The 133Xe intracarotid injection method with 16 externally placed detectors was used for measuring rCBF. Postoperatively, rCBF was measured in 40 patients. From these results our present criteria for surgery have evolved. The probability of a good postoperative result is best in patients who showed focal cerebral ischemia or a moderate general reduction of CBF with an additional ischemic focus. The operation is contraindicated in patients with either normal or severely reduced CBF values (less than 60% of normal).
Clinical experience with extra-intracranial arterial anastomosis in 65 cases
Authors: Gratzl Otmar , Schmiedek Peter , Spetzler Robert , Steinhoff Harald , Marguth Frank
Published: May 2009

✓ Clinical results of an extra-intracranial arterial bypass (EIAB) procedure for cerebral ischemia are assessed in 65 patients. The 5-year study suggests that the EIAB procedure has a protective effect against further clinically significant cerebrovascular accidents in properly selected patients. Correlation with angiography and regional cerebral blood flow (rCBF) studies are discussed. It is felt that rCBF measurements offer the best diagnostic test to determine which patients are suitable for surgery by revealing if an ischemic or relative ischemic focus is present. The surgical procedure is contraindicated in acute cerebral ischemia and when the rCBF study reveals general reduction of cerebral blood flow as opposed to a localized ischemic focus.
Intradural lipomas of the spinal cord
Authors: Ammerman Bruce J. , Henry James M. , De Girolami Umberto , Earle Kenneth M.
Published: May 2009

✓ Nine original cases of intradural spinal cord lipomas have been examined from a clinical and pathological standpoint. These tumors occur more commonly in men in the second to fourth decade and are found most frequently in the thoracic spinal cord. Paraparesis, sensory changes, urinary incontinence, and pain are frequent presenting complaints. Myelography is the diagnostic study of choice. All lipomas in this series were located primarily within the cord; four of these also presented an extramedullary extension. Admixed nerve bundles were present in five cases with associated hypertrophic onion-bulb formations in three. Decompression with biopsy or subtotal resection is the operative procedure of choice.
Cerebrospinal fluid lactate and lactate/pyruvate ratios in hydrocephalus
Authors: Raisis James E. , Kindt Glenn W. , McGillicuddy John E. , Miller Carole A.
Published: May 2009

✓ Cerebral metabolism in 21 hydrocephalic patients was studied. Preoperative and postoperative specimens of cerebrospinal fluid (CSF) were obtained and the cerebral perfusion pressure (CPP) was calculated in each instance. The specimens of CSF were analyzed for lactate and pyruvate and the lactate/pyruvate (L/P) ratio was calculated for each sample. The L/P ratio, which reflects the redox state of the cell, was used to determine the extent of anaerobic metabolism. An inverse relationship was noted between CPP and lactate as well as the L/P ratio. In general, the level of anaerobic metabolism was decreased after insertion of a shunt.
Effect of intracisternal phentolamine on cerebral blood flow after subarachnoid injection of blood
Authors: Martins Albert N. , Newby Norwyn , Doyle Thomas F. , Kobrine Arthur I. , Ramirez Archimedes
Published: May 2009

✓ The hydrogen clearance method was used to measure total and focal cerebral blood flow (CBF) in the monkey before and for 5 hours after a simulated subarachnoid hemorrhage (SAH). Some monkeys also received 0.2 to 1.0 mg/kg phentolamine intracisternally 3 hours after SAH. Results show that SAH did not change cerebrovascular resistance, but as cerebral perfusion pressure decreased, CBF fell transiently. Phentolamine injected intracisternally 3 hours after SAH produced a significant fall in arterial blood pressure; cerebrovascular resistance did not change but CBF decreased significantly. These data indicate that intracisternal phentolamine cannot be considered potentially useful to treat ischemic encephalopathy after SAH.
Jefferson fracture of the atlas
Authors: Han Sang Y. , Witten David M. , Mussleman John P.
Published: May 2009

✓ Six cases of Jefferson fracture of the atlas are summarized. None had recognizable neurological signs that resulted from the injury when seen in the hospital. With conservative treatment, pain subsided and the fracture stabilized in a short period in all six patients. None of the patients underwent fusion of the cervical spine.
Nonketotic hyperglycemic hyperosmolar coma
Authors: Park Bert E. , Meacham William F. , Netsky Martin G.
Published: May 2009

✓ Seventy-eight critically ill patients who died while on the neurosurgical service were studied retrospectively to establish the prevalence of nonketotic hyperglycemic hyperosmolar coma (NHHC). All patients had been comatose before death, and all underwent necropsy. Criteria for the diagnosis of NHHC included moderate-to-severe hyperglycemia with glucosuria, absence of significant acetonuria, hyperosmolarity with dehydration, and neurological dysfunction. This study revealed seven cases of unequivocal NHHC (9%), and six of hyperosmolarity but with incomplete records. Five of the seven confirmed cases of NHHC demonstrated no evidence of cerebral edema, transtentorial herniation, or brain-stem damage, and showed central nervous system (CNS) lesions compatible with survival. Fatal complications of this syndrome, such as acute renal failure, terminal arrhythmias, and vascular accidents, both cerebral and systemic, were common in this series. The mechanism of coma in NHHC is believed related to shifts of free water from the cerebral extravascular space to the hypertonic intravascular space, with subsequent intracellular dehydration, accumulation of metabolic products of glucose, and brain shrinkage. It is uncertain whether injury to specific areas in the CNS is a predisposing factor to the development of NHHC. Factors documented to be significant in its development include nonspecific stress to primary illnesses, hyperosmolar tube feedings, dehydration, diabetes, and mannitol, Dilantin, or steroid administration.
Ultrastructural blood-brain barrier alterations and edema formation in acute spinal cord trauma
Authors: Goodman Joseph H. , Bingham W. George , Hunt William E.
Published: May 2009

✓ Endothelial changes leading to edema formation are examined in the primate spinal cord (Macaca mulatta) following a lesion created by a 20-gm weight falling 15 cm onto the exposed dura. Intravascular perfusion of a paraformaldehyde-glutaraldehyde solution followed by carbon black provides adequate fixation of vascular structures and glial elements. Myelin is poorly preserved. Ultrastructural alterations of the blood-brain barrier consist of loss of integrity of the endothelial tight junctions. Edema caused by vascular disruption and parenchymatous extravasation of intravascular contents is observed along with glial swelling. Interglial gap junctions persist in areas of marked cellular separation and do not impede the migration of edema fluid.
Glioblastoma multiforme in children
Authors: Dohrmann George J. , Farwell Jacqueline R. , Flannery John T.
Published: May 2009

✓ Of 488 children with central nervous system neoplasms, 43 (8.8%) had glioblastomas, 22 of which were in the cerebral hemispheres, 16 in the brain stem, two in the cerebellum, and three in the spinal cord. The male to female ratio was 3:2. Glioblastoma multiforme of the cerebral hemispheres occurred at a mean age of 12.7 years, and the frontal lobe was the most commonly involved. Main presenting symptoms included headache (85%), nausea or vomiting (65%), and seizures (35%). Papilledema (45%) was the most common physical finding. The longest survivals were achieved by a combination of operation and radiation (22 months). Brain stem glioblastomas occurred at a mean age of 6.7 years, with the pons as the most frequent site. Nausea or vomiting (50%) and headache (36%) were the main presenting symptoms; the major physical findings were ataxia (43%), cranial nerve palsies (28%), and paresis (28%). The length of survival was greatest with radiation alone (10.5 months). The period of survival of children with glioblastoma multiforme was significantly increased with steroid therapy. Glioblastoma multiforme behaves similarly in children and adults. Intracranial glioblastomas have a more rapidly fatal course than that of other similarly situated gliomas in childhood.
Tumor volume, luxury perfusion, and regional blood volume changes in man visualized by subtraction computerized tomography
Authors: Penn Richard D. , Walser Randal , Kurtz Diane , Ackerman Laurens
Published: May 2009

✓ Computer and photographic methods for producing subtractions of computerized axial tomographic (CAT) scans have been developed. By subtracting point for point a normal scan from one taken after intravenous infusion of contrast material, a picture of the contrast in the cerebral vessels is created. By this method, tumor size and degree of vascularity may be assessed. Furthermore, abnormalities in perfusion and changes in blood volume due to mass effects and edema may be detected. Subtracting scans should add to the diagnostic potential of CAT and provide a noninvasive way to study vascular changes in cerebral disease.
Chronic measurement of epidural pressure with an induction-powered oscillator transducer
Authors: Rylander H. Grady , Taylor H. Lyndon , Wissinger John P. , Story Jim L.
Published: May 2009

✓ An induction-powered oscillator transducer (IPOT) was designed for the chronic measurement of epidural pressure. The transducer was completely implantable so all pressure measurements were made through the intact skin. The IPOT had a linear pressure range from −50 to +200 cm H2O, was sensitive to 1 mm H2O, and had a zero drift of less than 1 mm H2O/day under full load. Zero drift was minimized by using a hermetically-sealed metal bellows transducing element which was chemically treated to prevent corrosion and creep. The correlation between epidural pressure and intraventricular pressure was determined during the first 24 hours after implantation in six dogs. Epidural pressure was found to be a linear function of intraventricular fluid pressure. Epidural pressure and intraventricular pressure were essentially equal provided the epidural wedge pressure was minimized by proper insertion of the transducer. The correlation between epidural pressure and intraventricular pressure was determined after chronic implantation in five dogs. Epidural pressure was a linear function of intraventricular pressure in the chronically implanted dogs, but epidural pressure was not equal to intraventricular pressure. After chronic implantation, the epidural pressure transducer was not responsive to changes in intraventricular pressure because of mechanical changes in the dura. The dura became stiff and noncompliant. Maximum correlation between epidural pressure and intraventricular fluid pressure in chronic implantations will depend on judicious material selection and mechanical design at the transducer-dura interface.
Pituitary failure secondary to head trauma
Authors: Winternitz William W. , Dzur James A.
Published: May 2009

✓ A patient presented with hypopituitarism, 2 years after severe head trauma. Deficits of growth hormone, follicle-stimulating hormone, luteinizing hormone, and borderline thyroid-stimulating hormone (TSH) were demonstrated. Normal TSH-releasing hormone (TRH) response and elevated prolactin indicated viable anterior pituitary tissue with inadequate hypothalamic control. Precautions are suggested for recognition and treatment of this syndrome.
Complication of a large cranial defect
Authors: Tabaddor Kamran , LaMorgese James
Published: May 2009

✓ A patient with acute subdural hematoma was successfully treated with hemicraniectomy. He developed contralateral weakness 4 months after surgery which was reversed by cranioplasty. The presumptive mechanism is a gradient between atmospheric and intracranial pressure. Early cranioplasty is suggested to prevent this phenomenon.
Cerebral arterial dolichoectasia with seizure
Authors: Thompson Joseph R. , Weinstein Philip R. , Simmons Charles R.
Published: May 2009

✓ Cerebral angiography, performed after a seizure in a patient with a life-long history of typical hemiplegic migraine, disclosed markedly dolichoectatic anterior and middle cerebral arteries. No abnormality of the adjacent capillary or venous structures was present. A positive brain scan was attributed to ischemia induced by vasospasm rather than to the corresponding large tortuous anterior and middle cerebral arteries. There were no permanent sequelae and the patient has been free of seizures on Dilantin and phenobarbital over a 3-year follow-up period. Angiographic demonstration or description of a similar ectatic set of anterior and middle cerebral arteries could not be found in the literature. The concurrence of seizures and hemiplegic migraine adds to the peculiarity of this case.
Microvascular bipolar coagulator
Authors: Jacques Skip , Bullara Leo A. , Pudenz Robert H.
Published: May 2009

✓ A bipolar coagulator fabricated from jeweler's forceps of various sizes is described. The unit has proved very useful in microvascular neurosurgical procedures that require high magnification.
Lateral microsurgical approach to intraorbital tumors
Authors: Maroon Joseph C. , Kennerdell John S.
Published: May 2009

✓ The authors describe their microsurgical lateral orbital approach to intraorbital tumors. In seven patients ultrasonic scanning, computerized axial tomography, polytomography, orbital venography, and arteriography have allowed precise intraorbital tumor localization relative to the optic nerve. The authors believe that circumscribed tumors superior, lateral, or inferior to the optic nerve can be safely and completely removed through a 30–35-mm lateral skin incision with microsurgical dissecting techniques. A combined neurosurgical-ophthalmological team approach is emphasized.
Metastasis via ventriculoperitoneal shunt in patients with medulloblastoma
Authors: Hoffman Harold J. , Hendrick E. Bruce , Humphreys Robin P.
Published: May 2009

✓ The authors have routinely inserted a ventriculoperitoneal shunt in all patients with a posterior fossa tumor and hydrocephalus some 7–10 days prior to craniotomy. Forty-one patients with medulloblastoma were treated in this fashion and of these, four metastasized through the shunt and died of systemic metastases without evidence of recurrent tumor in their central nervous system. A millipore filter which can be incorporated in the shunt has been used by the authors during the past 18 months in an effort to prevent metastatic spread through the shunt.
Infections complicating the use of external ventriculostomy
Authors: Smith Randall W. , Alksne John F.
Published: May 2009

✓ The use of external ventriculostomy at our institution has been retrospectively analyzed to determine the incidence of cerebrospinal fluid sepsis. Placement of 65 ventriculostomies over a 2-year period resulted in three cases of complicating meningitis and ventriculitis (4.5%). Duration of ventriculostomy placement did not seem related to the rate of infection but the method of placement, the prophylactic antibiotics used, and the monitoring and collecting system employed may be important.
Cerebral arterial spasm
Authors: Allen George S. , Gross Carol J. , Henderson Lavell M. , Chou Shelley N.
Published: May 2009

✓ In vitro experiments were performed using a small volume chamber to study serotonin-induced contractions of the canine basilar artery. Temperature was found to have a profound effect on the artery's response to serotonin. Raising the temperature to 40° C (104° F) increased the maximum response by 20% and lowering the temperature by 10° C caused a 40% reduction in the maximum contraction. Cumulative log-dose response curves for analogues of serotonin demonstrated a high degree of specificity for the serotonin receptor and large nonphysiological concentrations of serotonin caused relaxation of the contracted artery. Extracellular calcium was shown to be an absolute requirement for serotonin-induced contractions. Extracellular magnesium, in contrast, was shown to inhibit serotonin-induced contractions.
Moyamoya disease as a cause of subarachnoid hemorrhage in a Negro patient
Authors: Meriwether Robert P. , Barnett Hugh G. , Echols Dean H.
Published: May 2009

✓ The authors describe a case of subarachnoid hemorrhage secondary to moyamoya disease in an adult Negro. To the authors' knowledge, this is the first such case reported. Moyamoya, the Japanese word for “puff of smoke,” describes the characteristic angiographic appearance of the collateral arterial network associated with internal carotid artery occlusion. The cause is unknown. Treatment consists of supportive care; the prognosis is variable.
Treatment of acromegaly by transsphenoidal microsurgery
Authors: Giovanelli Massimo A. , Motti Enrico D. F. , Paracchi Alessandra , Beck-Peccoz Paolo , Ambrosi Bruno , Faglia Giovanni
Published: May 2009

✓ The preoperative outlook and surgical results are evaluated in 29 acromegalic patients, employing the usual serum growth hormone (GH) screening techniques in association with GH response to the thyrotropin releasing hormone (TRH) test. Results obtained by transsphenoidal microsurgical technique in adenomas of different size and sellar morphology are reported. Overall results clearly favor selective microsurgery in early diagnosed and operated tumors (microadenomas), while a less than radical approach does not hold much promise of functional normalization in larger adenomas. In nonnormalized cases the efficacy of radiotherapy is stressed. The TRH test results were a good indication for radiation therapy even in those cases in which GH normalized after surgery by common assay methods.
Body position and cerebrospinal fluid pressure
Authors: Magnaes Bjørn
Published: May 2009

✓ Lumbar cerebrospinal fluid (CSF) pressure was recorded in 116 adult neurosurgical patients in the lateral and sitting positions. The level of zero CSF pressure while in the sitting position (ZPS) and hydrostatic indifferent point (HIP) for lateral and sitting positions were determined and referred to the craniospinal axis. In control patients ZPS was located mainly at the upper cervical region, and showed nearly the same variation and frequency distribution as CSF pressure in the lateral position when efforts were made to reduce sources of error and there was no orthostatic change in CSF filling pressure. Under these circumstances ZPS may be used as a variable comparable from one subject to another. In control patients the HIP was located between C-6 and T-5. In 25 hydrocephalic patients, shunting resulted in a mean caudal shift of ZPS of 244 mm, and a mean pressure fall of 126 mm H2O in the lateral position. This difference was due to a caudal shift of HIP on shunting. A caudally located ZPS was found in patients with complete cervical subarachnoid block. Prevention and treatment of CSF leakage cranial to HIP is discussed.
Comparative study of the pressure of various aneurysm clips
Authors: Sugita Kenichiro , Hirota Toshiyuki , Iguchi Ikuzo , Mizutani Tetsuro
Published: May 2009

✓ Comparative study of the pressure and the resistance to slippage of several aneurysm clips was done. Knowledge of the physical characteristics of various clips, such as the pressure, maximum opening angle, and width and thickness of the blade is essential for their proper use.
Repair of denuded cranial bone by bone splitting and free-skin grafting
Authors: Jensen Finn , Petersen Niles C.
Published: May 2009

✓ As an alternative to the use of pedicled skin flaps for the repair of large defects of the scalp with denuded cranial bone, we recommend splitting of the bone and exposure of the diploë. The diploë is then covered with a free-skin graft, either immediately or after the formation of granulation tissue. The method is simple; it does not cause undue discomfort to the patient and does not detract from the chances of success if a more elaborate reconstructive procedure should be required later.
Sarcoidosis of the spinal cord
Authors: Snyder Robert , Towfighi Javad , Gonatas Nicholas K.
Published: May 2009

✓ A case of intramedullary sarcoidosis simulating a tumor of the cervical spinal cord is presented. Autopsy showed that the disease was limited to the cervical cord and hilar lymph nodes. The literature is reviewed and six cases of histologically documented spinal cord sarcoidosis are discussed.
Multidirectional tomography in cervical spine injury
Authors: Russin Lincoln D. , Guinto Faustino C.
Published: May 2009

✓ Forty-one patients with acute cervical spine injury were examined by both conventional radiography and multidirectional tomography and the findings compared. Indications for tomography are given.
Arteriovenous malformations of the transverse dural sinus
Authors: Kühner Andreas , Krastel Arno , Stoll Wolfgang
Published: May 2009

✓ Clinical, radioanatomical, and therapeutic aspects of dural arteriovenous malformations in the region of the transverse sinus are discussed on the basis of seven personal observations and the analysis of 72 reported cases. Common symptoms are headache and troublesome tinnitus aurium. More serious neurological deficiencies may occur as a result of disturbance in cerebral hemodynamics. A complete neuroradiological investigation is essential for adequate treatment. Most frequent arterial feeders are the occipital, tentorial, and middle meningeal arteries. Ligation of the occipital artery is not sufficient in most cases. Operative isolation of the transverse sinus by craniotomy and dural section is considered by far the most successful treatment and should be performed whenever ligations fail or are not indicated.
Facial nevi associated with anomalous venous return and hydrocephalus
Authors: Shapiro Kenneth , Shulman Kenneth
Published: May 2009

✓ The authors describe two children with anomalous intracranial venous return associated with bilateral facial nevi, macrocrania, and cephalic venous hypertension. Both children had functional absence of the jugular bulbs, forcing the intracranial venous effluent to exit through persistent emissary pathways. Both children had sustained intracranial hypertension, with one child developing symptomatic communicating hydrocephalus that responded satisfactorily to shunting. The relationship between these patients and those with Sturge-Weber syndrome is discussed. The embryologic abnormality producing the anomalous venous return is characterized. The link between venous hypertension and the development of hydrocephalus is discussed. The increased cranial compliance seen in this age group may predispose certain pediatric patients to develop hydrocephalus when stressed by venous hypertension.
Results of treatment of chronic low-back pain at the Portland Pain Center
Authors: Seres Joel L. , Newman Richard I.
Published: May 2009

✓ We have evaluated 100 consecutive patients with low-back pain admitted to the Portland Pain Center. The average patient had been disabled for about 6 years, and had had an average of two surgical attempts to improve his symptoms. Most of the patients considered had open claims with their Workmen's Compensation carriers. Significant gains were demonstrated in drug reduction, general well behavior, and increased range of motion and exercise tolerance. The Pain Center setting provides a multidisciplinary approach to the treatment of chronic low-back pain. Significant increases in functional capacity are demonstrated.
Pathogenesis of aqueductal occlusion in congenital murine hydrocephalus
Authors: Raimondi Anthony J. , Clark Sandra J. , McLone David G.
Published: May 2009

✓ In a study of congenital hydrocephalus in the murine mutant (hy-3/hy-3), the authors found that aqueductal stenosis develops during the progression of hydrocephalus. In Stage 1 hydrocephalus (ventricular dilation and open aqueduct), a block in the subarachnoid space over the cerebral convexities causes the lateral and third ventricles to enlarge. The ependyma becomes stretched and a collection of edematous fluid forms in the subependymal layer. In Stage 2 hydrocephalus (edema in white matter around lateral ventricles and compression of quadrigeminal plate), edema develops peripheral to ependyma in the aqueduct and compresses the lateral surfaces of the aqueductal wall to obstruct the lumen. While periaqueductal edema is spreading, the forces of the expanding midline structures and the cystic occipital horns alter the relationship of brain structures. There is no proliferation of glia, but, rather, a “simple stenosis” which results from a combination of ventricular dilation, cerebral edema, brain shift, brain-stem compression, and brain-stem edema. In this study, normal ependymal specializations were observed that indicate a more active functional role for aqueductal ependyma than previously recognized.
Carotid sinus syndrome
Authors: Cohen Fred L. , Fruehan C. Thomas , King Robert B.
Published: May 2009

✓ Five cases of carotid sinus syndrome are presented. The syndrome is defined by spontaneous attacks of dizziness and fainting which can be reproduced by graded pressure on one carotid sinus. Three forms of the clinical syndrome, cardioinhibitory, vasodepressor, and cerebral, are discussed. The hyperactive carotid sinus reflex, in which there is ventricular asystole lasting at least 3 seconds or a decrease of more than 50 mm Hg in systolic and diastolic blood pressure, should be differentiated from this syndrome. Treatment modalities include reassurance, drugs, radiotherapy, cardiac pacemakers, and surgical approaches. Carotid sinus syndrome should be considered in the differential diagnosis of unexplained syncope, arteriovenous block, or inappropriate sinus bradycardia.
Reversal of dementia in normotensive hydrocephalus after removal of a cauda equina tumor
Authors: Bamford Colin R. , Labadie Enrique L.
Published: May 2009

✓ An elderly man presented with signs of normotensive hydrocephalus. Elevated protein content in the spinal fluid led to the diagnosis of an “asymptomatic” cauda equina neurilemoma and its removal. Within 6 weeks the patient's mental status had dramatically improved. Chronic transudation of plasma proteins including fibrinogen into the subarachnoid space had probably impeded spinal fluid reabsorption. It is suggested that the leakage of fibrinogen into the cerebrospinal fluid may be the cause of hydrocephalus in other clinical settings in which there is an elevation of the spinal fluid protein.
Interhemispheric ependymoma mimicking falx meningioma
Authors: Hanchey Robert E. , Stears John C. , Lehman Ralph A. W. , Norenberg Michael D.
Published: May 2009

✓ A report of an interhemispheric ependymoma with classical angiographic characteristics of falx meningioma illustrates that a neoplasm of intracerebral origin may present in a predominantly extracerebral location.
Radiotherapy and CCNU in the treatment of high-grade supratentorial astrocytomas
Authors: Weir Bryce , Band Pierre , Urtasun Raul , Blain Gilles , McLean Don , Wilson Fred , Mielke Bruce , Grace Michael
Published: May 2009

✓ Forty-one consecutive patients with supratentorial primary brain tumors (38 Grade III and IV astrocytomas, one giant-cell astrocytoma, and two cases with insufficient tissue for diagnosis) were randomly allocated within 2 weeks of surgery to one of three therapeutic groups. Group 1 (15 patients) received radiation therapy totaling 4000 to 4500 rads in 4 to 5 weeks. Group 2 (13 patients) received 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) 130 mg/sq m orally every 6 weeks. Group 3 (13 patients) received radiation therapy plus CCNU as for Groups 1 and 2. When the disease progressed, patients in Groups 1 and 2 were crossed over to receive CCNU and irradiation respectively. The median survival time in these groups was 188, 259, and 252 days, and the mean survival 263, 262, and 329 days. The median time from diagnosis to crossover (Groups 1 and 2) or to progression (Group 3) was 163, 99, and 220 days, and the mean time was 172, 108, and 231 days. There was no statistically significant difference between the means or medians in any of these situations.
Direct effect of electrical stimulation on peripheral nerve evoked activity: implications in pain relief
Authors: Ignelzi Ronald J. , Nyquist Judith K.
Published: May 2009

✓ Experiments were performed with a peripheral neurostimulator, used clinically for pain relief, on isolated cat cutaneous peripheral nerve to determine the effect of electrical stimulation on components of the compound action potential. The results show that neurostimulation alters the conduction velocity and the amplitude of both the A-alpha and beta and the A-delta waves with the more slowly-conducting A-delta component showing the greatest changes. This direct alteration of peripheral nerve activity distal to the first synapse in the spinal cord might contribute to the mechanism of pain relief.
Radioisotope evaluation of experimental hydrosyringomyelia
Authors: Hall Peter V. , Kalsbeck John E. , Wellman Henry N. , Campbell Robert L. , Lewis Sidney
Published: May 2009

✓ Kaolin-induced hydrosyringomyelia in dogs has been investigated by radioisotope ventriculography using both cerebrospinal fluid radioassay and scintigraphy. The hydromyelic central canal can be differentiated from the spinal subarachnoid space by scintigraphy. Serial studies show that hydromyelia arises rapidly to decompress the associated hydrocephalus in surviving animals. Syringomyelia, after a delayed onset, originates from the enlarged central canal. Radioisotope ventriculography may be a useful clinical aid in the diagnosis of hydrosyringomyelia.
Angiographic study of the effect of laminectomy in the presence of acute anterior epidural masses
Authors: Doppman John L. , Girton Mary
Published: May 2009

✓ Laminectomies were performed in 16 monkeys to decompress simulated acute epidural masses in front of the spinal cord. When decompression restored normal arterial and venous hemodynamics, the monkeys were neurologically intact in spite of considerable mechanical distortion of the cord. When either the anterior spinal artery or the posterior spinal vein remained obstructed following laminectomy, the monkeys were paraplegic. Acute anterior epidural masses larger than 4 mm in diameter could not be adequately decompressed via the posterior approach. Only minor posterior displacement of the cord is observed following laminectomy in the presence of large anterior masses.
Late results of cervical disc surgery
Authors: Scoville William Beecher , Dohrmann George J. , Corkill Guy
Published: May 2009

✓ Late results of cervical disc surgery have been reported and statistically studied in 383 cases; 83% were lateral discs, 13% were central spondylosis discs, and 4% central soft discs. Central spondylosis occurred at a higher spinal level, and caused cord compression with or without weakness of the hands, but no pain. A posterior approach was used in all lateral discs, and either an anterior or a posterior approach, with or without fusion, for central discs. Preoperative myelography was always done and is recommended postoperatively in central disc surgery to evaluate the results. Our results were good to excellent in 95% of lateral discs, in 64% of central spondylosis discs, and in an unexpected 91% of 11 cases of central soft discs. There were no recurrences and no serious complications, although 20% developed other cervical or lumbar disc herniations.
Cerebrospinal fluid fistula from fractured acrylic cranioplasty plate
Authors: Henry Harvey M. , Guerrero Caesar , Moody Robert A.
Published: May 2009

✓ The authors report a patient who developed a cerebrospinal fluid fistula secondary to a fractured methyl methacrylate cranioplasty plate. There was no external evidence of trauma. X-ray films showed no evidence of the fracture. It is suggested that the impregnation of methyl methacrylate with a radiopaque material would result in visualization of such fractures.
Neurosurgical materials and devices
Authors: Burton Charles V. , McFadden Joseph T.
Published: May 2009

✓ The current status of voluntary consensus standards writing procedures in neurosurgery and the current progress of government efforts to regulate materials and devices are described. A survey of the national and international standards writing bodies is presented, along with an introduction to related organizations and agencies and nomenclature. The intent of this review is to provide the neurosurgeon with a reference source regarding past and present neurosurgical activities in the materials and devices field. When President Ford signed the 1976 Medical Device Amendments on May 28, 1976, the Food and Drug Administration assumed direct legal authority to control medical devices and potentially assumed the power to regulate those professionals using them.
Ependymomas and ependymoblastomas in children
Authors: Dohrmann George J. , Farwell Jacqueline R. , Flannery John T.
Published: May 2009

✓ The authors analyze histologically verified cases of ependymoma and ependymoblastoma (malignant ependymoma) occurring in children in Connecticut from 1935 to 1973. Of the 488 central nervous system tumors diagnosed in that period, 44 (9%) of the 467 intracranial neoplasms and five (24%) of the 21 intraspinal tumors were of ependymal origin. An increase in the incidence of ependymomas was noted since the mid-1950's. The mean ages at diagnosis of ependymomas and ependymoblastomas were 5.6 and 5.0 years respectively. The male to female ratio was 0.6:1 for ependymomas and 1.7:1 for ependymoblastomas. Ependymomas were found above and below the tentorium with similar frequency; however, virtually all of the ependymoblastomas occurred supratentorially. Presenting symptoms and physical findings were reviewed. A significant difference (p < 0.05) was noted in the seizure rates of supratentorial ependymomas (9%) and ependymoblastomas (38%). A significantly increased survival (p < 0.05) was associated with supratentorial ependymal neoplasms relative to infratentorial from 42 months following diagnosis onward. Contrary to the reports of no clinical difference between ependymomas and ependymoblastomas, children with supratentorial ependymomas were noted to have a significantly longer survival (p < 0.05) than those with similarly situated ependymoblastomas, with the difference noted from 18 months following diagnosis onward. The children treated by operation and irradiation had a significantly greater survival (p < 0.05) than those treated by other methods; furthermore, with this treatment, longer survivals were noted in the ependymoma patients as compared to those with ependymoblastomas. This difference became significant (p < 0.05) at 27 months after diagnosis. Operative mortality decreased from 40% to 17% in the last decade of the study as compared to the previous decade. Steroid therapy may have contributed to this decreased operative mortality, but it had no statistically significant effect on length of survival. The clinical course of intracranial ependymal neoplasms in adults and children was compared and appeared to be essentially the same.
Decadron in the treatment of cerebral abscess
Authors: Quartey Gilbert R. C. , Johnston Jane Anne , Rozdilsky Bohdan
Published: May 2009

✓ Forty rabbits were inoculated with Streptococcus pyogenes or Staphylococcus aureus to produce cerebral abscesses. One-third of the rabbits received no treatment and served as controls. One-third received dexamethasone (Decadron) plus an appropriate antibiotic. One-third received only the appropriate antibiotic in the same dosage. The animals were sacrificed 10 days after inoculation and the brains examined. In the control group, an abscess at the stage of granulation tissue encapsulation containing the inoculated organisms was found. The surrounding brain showed a marked inflammatory response. In the Decadron plus antibiotic group, necrotic lesions were found containing the inoculated organisms and surrounded by relatively normal brain. In the group treated with antibiotic alone, healed glial scars were found in relatively normal brain. Our findings are discussed with reference to the medical literature regarding the influence of glucocorticoids on the inflammatory response and the efficacy of antibiotics when this response is suppressed.
Electrophysiological technique for evaluating lesions of the conus medullaris and cauda equina
Authors: Rockswold Gaylan L. , Bradley William E. , Timm Gerald W. , Chou Shelley N.
Published: May 2009

✓ The authors describe the use of evoked electromyographic responses recorded in the anal sphincter induced by stimulation of the bladder wall and urethra in evaluating lesions of the conus medullaris and cauda equina in 110 patients. This reflex response took effect by way of the pelvic nerves and cauda equina to the sacral cord where the pudendal nerve nucleus was activated, resulting in a contraction of the external anal sphincter. Various lesions along this pathway have been shown to produce either increased latencies and depressed responses or complete loss of response depending on the extent of the lesion. The correlation of results of this technique with clinical, myelographic, and operative findings indicate it to be a useful clinical tool.
Relief of spinal block during embolization of a vertebral body hemangioma
Authors: Gross Cordell E. , Hodge Charles J. , Binet Eugene F. , Kricheff Irvin I.
Published: May 2009

✓ The authors describe a case in which a subarachnoid block caused by a thoracic vertebral hemangioma was relieved during percutaneous embolization of the tumor.
Spontaneous regression of an extra- and intracranial arteriovenous malformation
Authors: Hansen John H. , Søgaard Ib
Published: May 2009

✓ The authors report a case in which an arteriovenous aneurysm located partly extracranially and partly in the posterior cranial fossa disappeared within 15 months without bleeding episodes or surgical intervention. The patient's clinical symptoms, headache, and cranial bruit, disappeared completely over the same period.
Focal neurological deficits secondary to intraoperative CSF drainage: successful resolution with an epidural blood patch
Authors: Guido Laurance J. , Patterson Russel H.
Published: May 2009

✓ Two cases of focal neurological deficit secondary to intraoperative cerebrospinal fluid drainage are presented. Successful resolution was achieved by use of an epidural blood patch. Possible etiological mechanisms and prevention of the complication are discussed.
Ultrastructural evidence for CSF production by a choroid plexus papilloma
Authors: Ghatak Nitya R. , McWhorter Joe M.
Published: May 2009

✓ A choroid plexus papilloma (CPP) removed from a child with communicating hydrocephalus was studied with the electron microscope. In addition to the usual organelles, the neoplastic epithelial cells contained polypoid microvilli, cilia, coated pinocytotic vesicles, and apical tight junctions. The basal surfaces were consistently juxtaposed to large capillaries lined by fenestrated endothelium. The fine structural details of the tumor were essentially the same as those of normal CP and thus appeared ideally suited for an active secretory function. Two additional features in this tumor were tubular bodies in the endothelium and well developed pericytes. The present findings provide strong evidence for cerebrospinal fluid production by CPP, a phenomenon that has long been suggested by clinical observation.
Experience with Arnold-Chiari malformation, 1960 to 1970
Authors: Saez Ruben J. , Onofrio Burton M. , Yanagihara Takehiko
Published: May 2009

✓ A retrospective study of 60 adult patients with Arnold-Chiari malformation revealed that certain presenting clinical syndromes, although not pathognomonic, seemed to have definite prognostic significance. Surgical management by suboccipital decompression led to remarkable and enduring improvement in 65% of patients followed for as long as 14 years. In some patients, however, the initial postoperative benefit tended to fade into an insidious progression of neurological deficit. Despite operation, 18.6% of patients eventually experienced progressive neurological deterioration. Patients who presented with paroxysmal intracranial hypertension or cerebellar dysfunction had the best prognosis. Evidence of central cord involvement was the single most detrimental factor to neurological recovery.
Reopening some occluded carotid arteries
Authors: Shucart William A. , Garrido Eddy
Published: May 2009

✓ Four cases are presented in which intermittent ischemic symptomatology was referable to a cerebral hemisphere. Arteriography in each case showed complete occlusion of the ipsilateral internal carotid artery in the neck with collateral filling of the ipsilateral intracranial carotid artery into the cavernous portion. Endarterectomy was performed successfully in each case from 1 to 5 weeks after the demonstrated complete occlusion. The collateral circulation to the intracranial portion of the internal carotid artery and the probable reasons for the technical success of these operations are discussed.
Coincidental meningioma and glioma
Authors: Strong Anthony J. , Symon Lindsay , MacGregor Beth J. L. , O'Neill Brian P.
Published: May 2009

✓ The authors report two cases in each of which both a meningioma and a glioma were present. The anatomical and clinical presentations of double tumors are reviewed and their pathological significance considered. Some suggestions for the recognition and treatment of such tumors are offered.
Treatment of experimental delayed cerebral arterial spasm with a beta2-adrenergic stimulator and a phosphodiesterase inhibitor
Authors: Norwood Christopher W. , Poole G. Joseph , Moody Dixon
Published: May 2009

✓ Delayed cerebral arterial spasm was induced by subarachnoid hemorrhage in 11 rhesus monkeys. Ten monkeys (62%) developed spasm. Of seven monkeys treated with salbutamol (a beta2-adrenergic stimulating drug), five had relief of vasospasm. Four monkeys, one of which had failed to respond to salbutamol alone, were treated with salbutamol and aminophylline (a phosphodiesterase-inhibiting drug), and all four were relieved of their vasospasm. When considered as one group, the monkeys had an 81% response rate. The authors suggest that a combination of beta2-adrenergic stimulation and phosphodiesterase-inhibition might be of value in preventing or treating delayed cerebral arterial spasm.
Brain energetics and circulatory control after subarachnoid hemorrhage
Authors: Fein Jack M.
Published: May 2009

✓ Ischemia-provoking factors such as vasospasm, decreased cerebral perfusion pressure, and intravascular thrombosis may be present after subarachnoid hemorrhage (SAH). When these factors were not present during controlled SAH, a primary depression of cerebral glycolysis associated with normal stores of energy-rich phosphates was found. Although cerebral blood flow usually changes in response to changes in cerebral metabolic needs, this influence on the circulation was not evident in the early hours after SAH. After 3 to 4 hours an erratic decrease in blood flow occurred, probably related to vasospasm; and there were measurable decreases in energy-rich phosphates similar to those occurring after more severe and prolonged ischemias. These findings are indicative of abnormally erratic vascular responses to metabolic cues and may play a role in producing the encephalopathy of SAH.
Microvascular bypass surgery
Authors: Spetzler Robert , Chater Norman
Published: May 2009

✓ Intraoperative electromagnetic blood flow measurements were recorded in 15 patients undergoing extracranial-intracranial arterial bypass surgery. The initial average blood flow of 28.2 cc/min supplies 8.4% of the expected flow from one internal carotid artery. Blood flow probably increases postoperatively, as evidenced by angiographic enlargement of the bypass and its recipient cortical arteries.
Replacement of a self-adjusting bone flap
Authors: Khoo James C. M.
Published: May 2009

✓ Postoperative cerebral edema is often worrisome after intracranial surgery. A self-adjusting bone flap is described that uses sections of Raimondi catheter tubing.
Angiographic study of the growth of intracranial aneurysms
Authors: Allcock John M. , Canham Peter B.
Published: May 2009

✓ The authors have attempted to assess whether there is any standard rate of growth of intracranial aneurysms. Angiographic studies were performed on 67 patients with 82 aneurysms with intervals between angiograms ranging from a few days to 10 years. Examination of these records showed no consistent rate of change in size, possibly partly because of inherent inaccuracies in the method, which are discussed. The clinical reasons for the repeat studies are briefly mentioned. It is concluded that it is unwise to wait and see what may happen to any but perhaps the smallest aneurysm.
Lateral extracavitary approach to traumatic lesions of the thoracic and lumbar spine
Authors: Larson Sanford J. , Holst Robert A. , Hemmy David C. , Sances Anthony
Published: May 2009

✓ The lateral extracavitary approach to the spine was used for resection of displaced bone and disc located anterior to the dura in 62 patients with traumatic lesions of the thoracic and lumbar spine. Fifty-two patients had closed vertebral fractures and 10 had gunshot wounds. The spinal cord was involved in 44 patients, and the cauda equina in 18. A spinal subarachnoid block was demonstrated in 17 of 57 preoperative gas myelograms. Evoked potential recordings, although related to perception of joint rotation, tended to reflect the overall neurological condition and had some prognostic value. Significant improvement followed surgery in 46 patients with incomplete neurological lesions, and one was transiently worse. Before operation 18 patients were able to walk; nine with assistance and nine without. After operation 47 patients were able to walk; 12 with assistance and 35 without. Adequate bladder function was present in 17 patients before surgery, and in 44 after surgery. A laminectomy had been done previously in 16 patients, 11 of whom improved significantly after anterior resection. Spine fusions were required in 26 patients, five of whom had a prior laminectomy. The major factor in the pathogenesis of the incomplete neurological deficit appeared to be distortion of the cord and roots by displaced bone and disc. Consequently, the primary object of treatment was the restoration and maintenance of normal anatomical relationships between the spinal cord or cauda equina and the spinal canal.
Regional spinal cord blood flow in primates
Authors: Sandler Alan N. , Tator Charles H.
Published: May 2009

✓ Spinal cord blood flow (SCBF) was measured in the primate thoracic spinal cord using the 14C-antipyrine autoradiographic technique that allowed clear differentiation between white and gray matter blood flow. Individual SCBF values were obtained for 0.1-sq mm areas of the thoracic cord cross section. White matter blood flow was homogeneous throughout with a mean value of 10.3 ± 0.2 ml/100 gm/min. Graymatter flow was more variable with lower values in the dorsal horns and higher values in the central gray and anterior horns. Mean gray-matter flow was 57.6 ± 2.3 ml/100 gm/min. Arterial pO2 was 123 ± 2 torr, pCO2 was 40.2 ± 0.5 torr and pH was 7.327 ± 0.010. Mean arterial blood pressure was 113 ± 3 mm Hg and core temperature was 36.4° ± 0.1° C.