bluuebunny/crossref_metadata_2025 huggingface dataset:
Chloroethyl-cyclohexyl-nitrosourea (CCNU) in the treatment of malignant brain tumors
Authors: Rosenblum Mark L. , Reynolds Arden F. , Smith Kendall A. , Rumack Barry H. , Walker Michael D.
Published: May 2009

✓ Oral 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU), a lipid-soluble non-ionized chemotherapeutic agent, was used in the treatment of 26 patients with malignant brain tumor, primarily glioblastoma. Most patients had first received conventional surgery, and about one half had received x-ray therapy. Over 1½ years, 113 courses of CCNU (130–150 mg/m2) were given and analyzed for clinical results and agent toxicity. A new central nervous system (CNS) disease staging system was used to measure patient impairment and therapeutic response. Thirty-seven per cent of all symptomatic patients had significant remission of clinical disease, lasting a median of 5 months. Data are presented implying that the treatment of asymptomatic patients may also be of considerable value. The most significant toxicity was delayed reversible thrombocytopenia, which was less severe than that seen with nitrosourea BCNU. Despite the cumulative toxicity observed with all three bone-marrow elements, serious complications were rare. Our initial experience indicates that CCNU is an effective agent for the treatment of malignant brain tumor and that the CNS disease staging system is useful in obtaining quantitative results.
Postoperative intracavitary chemotherapy of malignant gliomas
Authors: Garfield John , Dayan Anthony D.
Published: May 2009

✓ In eight patients with malignant gliomas of the hemisphere and one with metatastic carcinoma, high doses of methotrexate were injected through an indwelling catheter into the bed of the tumor after craniotomy. Up to 1250 mg of this cystostatic agent were given in single daily doses over periods of 4 to 10 days. There were few local reactions to the injections, but despite systemic folinic acid treatment, two patients developed transient leukopenia. Clinical and pathological follow-up showed that necrosis developed in the superficial parts of the tumor. It was found possible to leave an ordinary catheter in a postoperative tumor cavity for as long as 44 days. This technique appears to be a valuable adjunct to the treatment of cerebral tumors with cytotoxic drugs since it does not necessitate exposure of other body tissues to the chemotherapeutic agents.
Surgical repair of the anterior fossa because of rhinorrhea, aerocele, or meningitis
Authors: Jamieson Kenneth G. , Yelland John D. N.
Published: May 2009

✓ The authors report their experience with 52 patients requiring specific anterior fossa repair only and 47 in whom repair was conducted during elevation of depressed fractures. The incidence of rhinorrhea, aerocele, and meningitis is related to the site of dural defect repaired at operation.
Use of tissue adhesive in the surgical treatment of cerebrospinal fluid leaks
Authors: Maxwell John A. , Goldware Stephen I.
Published: May 2009

✓ This report describes 12 cases of cerebrospinal fluid leak repaired with isobutyl 2-cyanoacrylate. We have found this tissue adhesive to be a valuable technical adjunct in the management of this problem and have not seen any general or local toxicity to the material.
Lumbosacral myelography with Dimer-X
Authors: Kosary Isaac Z. , Tadmor Rina , Ouaknine George , Braham Jackson
Published: May 2009

✓ The authors report the use of the water-soluble spinal contrast medium Dimer-X in 100 cases of suspected lumbar disc disease. It was particularly valuable in delineating small laterally-placed protrusions causing root compression, which are often difficult to demonstrate with oily contrast media. Side effects were mild and transient, and no serious complications were encountered.
En bloc subtotal temporal bone resection for cancer of the external ear
Authors: Yamada Shokei , Schuh Frederic D. , Harvin J. Shand , Perot Phanor L.
Published: May 2009

✓ The authors report their technical experience with the en bloc subtotal temporal bone resection of cancer of the external ear involving the temporal bone. With the cooperation of an experienced plastic surgery team, coverage of the large defect with a rotation flap makes this procedure successful by wound healing per primam. Complications such as hemorrhage, vascular thrombosis, and brain abscess can be minimized by strict application of neurosurgical and plastic surgery techniques. Two successful cases are described in detail.
Infratentorial arachnoid cysts
Authors: Little John R. , Gomez Manuel R. , MacCarty Collin S.
Published: May 2009

✓ A series of 20 cases of arachnoid cysts in the posterior fossa is reported. Classification was made according to the location of the cysts. Accurate clinical localization was only possible with cysts in the cerebellopontine angle. Ventriculography and pneumoencephalography were the most helpful investigations for making the diagnosis. Treatment consisted of suboccipital craniectomy and complete removal. There were four operative deaths. The remaining 16 patients had essentially complete recoveries.
The scotomata of carotid artery disease as I remember them
Authors: Murphey Francis
Published: May 2009

✓ The author relates his personal experience with scotomata, in particular as a forewarning of occlusion of the carotid artery in the neck. His hypotheses that the phenomena were due at least in part to flecks of atheromatous plaque was substantiated by the subsequent surgical findings when such a plaque was successfully removed and the scotomata ceased.
Traumatic atlantooccipital dislocation
Authors: Page Carey P. , Story Jim L. , Wissinger John P. , Branch Charles L.
Published: May 2009

✓ The successful diagnosis and management of a patient with traumatic atlantooccipital dislocation is reported. Rapid transition from skeletal traction to a four-poster brace followed by appropriately timed surgical stabilization are considered essential.
Tuberculoma of the brain stem: control of relapses by steroid therapy
Authors: Sumra R. S. , Mongia S. K. , Roy S. , Pathak S. N.
Published: May 2009

✓ A tuberculoma is reported, with an acute onset and a recurring course of remissions. The successful use of steroid therapy is discussed.
Vascular compression of the duodenum following severe brain injury
Authors: Bouzarth William F. , Crowley J. N. , Clearfield Harris R.
Published: May 2009

✓ A patient with severe brain injury began vomiting 12 weeks after admission. This magnified a progressive weight loss of 34 kg. Vascular compression of the duodenum was confirmed as the cause of the vomiting. With hyperalimentation, vomiting stopped and weight gain occurred. This easily reversible syndrome should be considered in the differential diagnosis of vomiting in brain-injured patients with weight loss.
A subarachnoid screw for monitoring intracranial pressure
Authors: Vries John K. , Becker Donald P. , Young Harold F.
Published: May 2009

✓ A new technique for monitoring intracranial pressure is presented. It is based on a hollow screw in the skull whose tip projects through the dura into the subarachnoid space. The screw can be easily inserted under local anesthesia. Pressure is monitored isovolumetrically by connecting the screw to a transducer. The system can be calibrated in situ and has been successfully used in 56 patients during a 6-month period.
Laboratory criteria of brain death
Authors: Ouaknine Georges , Kosary Isaac Z. , Braham Jackson , Czerniak Pinhas , Nathan Hillel
Published: May 2009

✓ Thirty patients with the clinical signs of brain death were subjected to a series of laboratory tests reputed to be capable of confirming this state. Three new procedures, electronystagmography, RISA intrathecal studies, and brain temperature tests, are described. The authors conclude that certain bedside tests, namely, electroencephalography, echoencephalography, electronystagmography, and electrocardiographic response to atropine, have been shown to be entirely adequate for a confident diagnosis.
Clinicopathological study of 53 tumors of the pineal region
Authors: DeGirolami Umberto , Schmidek Henry
Published: May 2009

✓ Fifty-three cases of pineal and posterior-third ventricular tumors seen at the Massachusetts General Hospital from 1920 to 1972 are reviewed. This series includes 35 pathologically verified tumors and 18 cases accepted as pineal neoplasms on clinical and radiographic grounds. A plan of management is proposed based on a correlation between the clinical and pathological features and the response of each type of tumor to the currently available modes of therapy.
Ventricular compliance in dogs with and without aqueductal obstruction
Authors: Lim Samuel T. , Potts D. Gordon , Deonarine Vishnu , Deck Michael D. F.
Published: May 2009

✓ In 10 dogs with stereotaxically-produced aqueductal blocks and in five dogs without aqueductal blocks, multiple small, equal volumes of Conray-60 were injected rapidly into one lateral ventricle while changes in the ventricular and cisterna magna pressure were recorded. In both groups of dogs the pressure rose exponentially with successive injections into the lateral ventricle. The rise was more rapid in the presence of an aqueductal block. These experiments give a measure of the response of the intracranial structures to increased pressure. Formulas are given to predict this response in animals with and without aqueductal obstruction under the conditions of the experiment. Findings are discussed in relation to the increase in ventricular size observed during fractional pneumoencephalography.
Hydrocephalus following spontaneous subarachnoid hemorrhage
Authors: Yasargil M. Gazi , Yonekawa Yasuhiro , Zumstein Bruno , Stahl Hans-Jürgen
Published: May 2009

✓ Twenty-eight cases of communicating hydrocephalus after subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms are reported. The relationship between the incidence of this complication and the various clinical features of SAH is discussed. The findings of RISA cisternography have little relationship to the findings of pneumoencephalography or the results of shunting procedures. The availability and value of echoencephalography in treating such patients is emphasized.
The effect of dexamethasone phosphate on the production rate of cerebrospinal fluid in the spinal subarachnoid space of dogs
Authors: Sato Osamu , Hara Makoto , Asai Takehiko , Tsugane Ryuichi , Kageyama Naoki
Published: May 2009

✓ The effect of intravenous dexamethasone on cerebrospinal fluid (CSF) production was studied in dogs by a method of caudocephalad perfusion of the spinal subarachnoid space with an inulin-containing buffer. The CSF production rate began to reduce immediately after the injection of 0.15 mg/kg and attained a maximal reduction of 50% in 50 minutes.
Ruptured aneurysms of the proximal middle cerebral artery
Authors: Lipovšek Matej
Published: May 2009

✓ In 57 patients with proximal middle cerebral artery aneurysms, two forms of treatment are reviewed, namely, bed rest and common carotid ligation. Patients who had no angiographic evidence of spasm or accompanying hematoma did better with carotid ligation than with bed rest if they were treated within the first week of the onset of subarachnoid hemorrhage.
Proximal carotid ligation for internal carotid aneurysms
Authors: Kak Vijay K. , Taylor Alex R. , Gordon Derek S.
Published: May 2009

✓ The results of proximal carotid ligation for internal carotid aneurysms in 106 patients over a 20-year period are presented. These confirm the belief that carotid ligation is a useful definitive procedure in patients with aneurysms on the internal carotid artery, including its bifurcation. Common carotid ligation is effective protection against recurrent hemorrhage, at the same time being safer than internal carotid ligation. Matas' test has limited applicability in patients being prepared for carotid ligation. Cerebral vasospasm seen on arteriograms, cerebral circulation studies with and without carotid compression, and intravascular pressure determinations at the time of surgery are more reliable methods to decide the timing, rate, and degree of occlusion of the vessel, and to decrease the incidence of postoperative ischemic complications.
Pituitary apoplexy in a child
Authors: Sakalas Romas , David Ronald B. , Vines Frederick S. , Becker Donald P.
Published: May 2009

✓ A rapidly growing 6-year-old boy with progressive visual loss suddenly became blind following an acute hemorrhage into an eosinophilic adenoma. The case is described and discussed, including the successful operative treatment.
Craniopharyngioma with optic canal enlargement simulating glioma of the optic chiasm
Authors: Block Michael A. , Goree John A. , Jimenez John P.
Published: May 2009

✓ A case of bilateral enlargement of the optic canals by a craniopharyngioma is documented, and the differential diagnosis from optic glioma is discussed.
Traumatic lumbar nerve root meningocele
Authors: McLennan James E. , McLaughlin William T. , Skillicorn Stanley A.
Published: May 2009

✓ A patient is described who developed an acute, occult, lumbosacral nerve root meningocele following a partial traumatic avulsion of the L-4 and L-5 nerve roots accompanied by fracture of the pelvis and fibula. Almost total functional recovery ensued. The differences between acute and chronic nerve root meningoceles are discussed, as well as the possibility of surgical intervention.
Operating microscope unit design
Authors: Rish Berkley L.
Published: May 2009

✓ A new operating microscope unit is described that provides comfort for the surgeon and stability for his hands.
The American Association of Neurological Surgeons and the era of issues
Authors: Meacham William F.
Published: May 2009

✓ The president of the American Association of Neurological Surgeons (AANS) reviews the history of the AANS and discusses some national issues affecting the practice of neurosurgery in America: government influence and control, inadequate funding for training programs and research, neurosurgical manpower, professional liability, continuing education, recertification and relicensure, medical fees, and the influence of current social, economic, and political philosophies.
Transcallosal removal of craniopharyngiomas within the third ventricle
Authors: Long Don M. , Chou Shelley N.
Published: May 2009

✓ Six cases of craniopharyngioma located wholly, or largely, within the third ventricle are described; these include four adults with tumors completely within the ventricular system and two children with recurrent tumors primarily within the third ventricle. Four of these patients were operated on by a transcallosal approach. Gross total removal was possible in all patients, but two have suffered recurrence and only one is alive and tumor-free. There were no signs or symptoms present preoperatively that allowed the intraventricular nature of the neoplasm to be correctly diagnosed. Air encephalography provided definitive tumor localization in each case. Three patients died of massive gastrointestinal hemorrhage in the immediate postoperative period. The surgical technique of transcallosal approach for removal of these neoplasms is described in detail.
The early history of neurosurgical anesthesia
Authors: Bingham William F.
Published: May 2009

✓ The author describes the many early advances in neuroanesthesiology made by pioneer neurosurgeons. Macewen first employed endotracheal intubation for anesthesia. Horsley vigorously promoted chloroform research and the development of the Vernon Harcourt regulator, the first anesthesia machine to provide safe and accurate concentrations. With the aid of the Harcourt inhaler he made many brilliant neuroanesthetic observations. Codman and Cushing collaborated on the first intraoperative anesthetic records while still medical students. Cushing later introduced the Riva-Rocci blood pressure apparatus to the United States. His early intracranial procedures were performed under ether narcosis, but Cushing's experiences during World War I led him to adopt local anesthesia for the remainder of his career. The first clinical application of insufflation anesthesia was made by Elsberg. Frazier introduced rectal ether for neurosurgical procedures. Local anesthesia enjoyed its greatest popularity during the 1920's and 1930's. Endotracheal intubation and complete respiratory control were accepted by most neurosurgical clinics around the time of World War II.
Paleoneurosurgery in Colombia
Authors: Gomez Jaime G.
Published: May 2009

✓ For the first time, cranial operations performed by representatives of primitive cultures in Colombia are documented by the discovery of three skulls from the era of the Chibcha civilizations of about 350 A.D., found in different regions of Colombia. Each skull had a surgical defect in the parietal bone.
Respiratory complications in traumatic quadriplegia
Authors: Bellamy Raymond , Pitts Fredrick W. , Stauffer E. Shannon
Published: May 2009

✓ A 20-year series of 531 patients with cervical spine fractures or dislocations is reviewed, and the records of 54 quadriplegic patients are analyzed in detail. Tracheostomy, surgery, overhydration, advanced age, severity of neurological injury, and corticosteroid therapy are discussed as factors in pulmonary complications.
Hemicraniectomy for acute extracerebral hematoma: an analysis of clinical and radiographic findings
Authors: Morantz Robert A. , Abad Raul M. , George Ajax E. , Rovit Richard L.
Published: May 2009

✓ The authors report their experience with hemicraniectomy for acute subdural or epidural hematomas in 75 patients, 18 of whom had postoperative contrast studies and/or RISA cisternograms at intervals from 1 day to 1½ years after operation. Analysis of these studies reveals: 1) Hemicraniectomy virtually eliminates the incidence of residual and recurrent postoperative hematoma. 2) Shifted midline structures may often take up to several weeks to return to normal position after operation. Return of these shifted structures may be hastened by hemicraniectomy, as compared to more restricted operations. 3) There is a general, but not absolute, correlation between the degree of postoperative shift and the clinical status of the patient. 4) An ipsilateral shift has been observed only in the presence of a mass on the opposite side or severe hydrocephalus. 5) Pneumoventriculography after hemicraniectomy usually demonstrates slight ventricular dilatation, most marked in the ipsilateral ventricle. A small percentage (16%) of postoperative patients reveal severe communicating hydrocephalus.
Side effects of spasmolytic agents in the monkey
Authors: Martins Albert N. , Wiley John K.
Published: May 2009

✓ The authors report a study of the physiological and morphological responses of the rhesus monkey brain to intracisternal injections of two potentially useful spasmolytic agents, phenoxybenzamine and phentolamine. Central nervous system function remained unaffected by intracisternal injections of either drug in doses that were small but nevertheless sufficient to attain pharmacologically effective concentrations in the cerebrospinal fluid. Larger doses of phenoxybenzamine caused a chemical basilar meningitis. Phentolamine caused arterial hypotension without meningitis. It is concluded that intracisternal spasmolytic therapy deserves further experimental evaluation.
Hemangiopericytoma of the brain
Authors: Lolova Ivanka , Kamenova Margarita
Published: May 2009

✓ The authors report the histological and histochemical examination of four cases of hemangiopericytoma. The tumors showed mature, differentiated, and undifferentiated cells with frequent mitoses, and an abundance of anaplastic cells. The histochemical characteristics of the tumor cells are summarized and compared to those of pericytes under normal or pathological conditions.
Lumbar spinal block by posterior rotation of anulus fibrosus
Authors: Lombardi Vincenzo
Published: May 2009

✓ Two cases are reported in which a protruded anulus fibrosus rotated posteriorly into the spinal canal. The clinical signs resembled those of a ruptured intervertebral disc. Diagnosis and successful treatment by operative removal are discussed.
Transient postprandial paresis associated with arteriovenous malformations of the spinal cord
Authors: Oliver Anthony D. , Wilson Charles B. , Boldrey Edwin B.
Published: May 2009

✓ Two cases of spinal arteriovenous malformation (AVM) are reported because of a previously unobserved clinical feature: recurrent transient postprandial paresis of the legs. The authors believe the paresis was caused by chronic shunting of blood away from the cord and into the low-resistance AVM. Symptomatic cord ischemia might then be precipitated by vasodilatation in other areas of the body such as the splanchnic, brachial, or uterine vessels. We believe that in some instances this mechanism should be considered as an explanation for episodic neurological deficits seen in association with spinal AVM's.
Extradural spinal depositions of urates producing paraplegia
Authors: Litvak John , Briney Walter
Published: May 2009

✓ A case of paraplegia is reported that responded to decompressive laminectomy and removal of a urate-laden ligamentum flavum compromising the cauda equina.
Hydrocephalus due to xanthogranuloma
Authors: Jaer Ørnulf , Løken Aagot Christie , Nesbakken Ragnar
Published: May 2009

✓ Xanthogranulomas and cholesterol granulomas of the choroid plexus in the lateral ventricles are usually incidental findings at autopsy. This report presents a case with hydrocephalus due to a xanthogranuloma that obstructed the foramina of Monro and was successfully treated by surgical intervention.
Cerebrospinal fluid rhinorrhea from an empty sella: transsphenoidal obliteration of the fistula
Authors: Weiss Martin H. , Kaufman Benjamin , Richards David E.
Published: May 2009

✓ A case of cerebrospinal fluid rhinorrhea developing in a progressively enlarging empty sella is described in which the fistula was successfully obliterated via a transsphenoidal approach. A modification of the standard closure for transsphenoidal hypophysectomy enabled reconstruction of the dural floor of the sella.
Effectiveness of microsurgery for intracranial aneurysms
Authors: Hollin Sidney A. , Decker Robert E.
Published: May 2009

✓ The authors report postoperative angiographic results in a series of 50 patients who had undergone microsurgery for intracranial aneurysms. The aneurysmal body and fundus were obliterated in every case. The neck was visualized postoperatively in three cases, or 6%; in one of these, later follow-up angiography demonstrated subsequent total aneurysm occlusion. No postoperative rebleeding occurred. The incidence of postoperative occlusion of the parent vessel was small, with complete occlusion in only one case and partial branch occlusion in another. These results confirm the impression that a high degree of accuracy in clip placement is possible with microsurgical technique. Routine postoperative angiography does not appear to be necessary if the surgeon has become skilled in the use of the microscope for aneurysm surgery.
The relationship of compensated to decompensated hydrocephalus in the cat
Authors: Hochwald Gerald M. , Epstein Fred , Malhan Chaman , Ransohoff Joseph
Published: May 2009

✓ The effects of removal of the calvaria and excision of the dura on the development of hydrocephalus was studied in adult cats made hydrocephalic by an intracisternal injection of kaolin. In some animals, the calvaria was removed prior to the induction of experimental hydrocephalus, and in others when the hydrocephalus was compensated. In both groups of cats, the results were similar. Ventricular dilatation was massive, often leaving a cortical mantle less than 1 mm thick. A mean ventricular volume measured in 17 cats was 16.9 ml. Cerebrospinal fluid turnover measured during steady-state ventricular perfusion showed significant increases in formation and decreases in absorption of spinal fluid when compared to that in hydrocephalic cats with intact skulls.
Shunt-independent arrest of hydrocephalus
Authors: Holtzer Gerard J. , de Lange Samuel A.
Published: May 2009

✓ Between 1959 and 1970, 202 infants were treated for progressive hydrocephalus by means of an atrial (Holter) shunt. Of these, 127 are still alive; in 34 the shunt had been removed and the patients proved to be compensated and shunt-independent. Etiology, initial air studies, ventricular size, and psychological studies of these 34 compensated patients were reviewed in a search for a common factor, but none was determined. Half of these compensated children had communicating, and half obstructive, hydrocephalus. Compensation occurred equally in children with large and small ventricles.
Electrical stimulation for relief of pain from chronic nerve injury
Authors: Long Donlin M.
Published: May 2009

✓ Ten patients with various kinds of nerve injury pain were treated by stimulation from subcutaneously implanted electrodes placed on the nerves. Placement of the electrode was proximal to the site of injury in nine patients and distal in one. Pain relief was complete in six of the 10 patients. Of the nine patients addicted to narcotics, seven were successfully withdrawn. In one patient the stimulation totally failed to relieve the pain, and in one the pain was made worse.
Circulatory disturbance of the venous system during experimental intracranial hypertension
Authors: Yada Kenzoh , Nakagawa Yoku , Tsuru Mitsuo
Published: May 2009

✓ The venous drainage system during increased intracranial pressure (ICP) was studied in dogs. The ICP was gradually increased to the level of the systemic blood pressure while related arterial and venous pressures were monitored. The blood flow through the parasagittal intradural venous channels (lateral lacuna) was also measured to test the collapsibility of these vessels. The cortical venous pressure was constantly 50 to 200 mm H2O higher than the ICP regardless of the degree of elevation, while the sagittal sinus pressure remained at 50 to 75 mm H2O unless the central venous pressure was elevated by respiratory disturbance. Flow through the lateral lacuna decreased as the ICP was increased. The authors conclude that the low pressure in the sinus and the consistency of the walls of the lateral lacuna allow gradual stenosis of the lacuna during increased ICP.
The reversal of experimental vasospasm by dibutyryl-3′, 5′-adenosine monophosphate
Authors: Peterson Eric W. , Searle Roger , Mandy Francis F. , Leblanc Richard
Published: May 2009

✓ Topical dibutyryl cyclic adenosine monophosphate (AMP) was used to reverse experimental cerebral vasospasm of the basilar artery in the cat. The combination of dibutyryl cyclic AMP and theophylline caused prolonged dilatation of the basilar artery. Dibutyryl cyclic AMP seems to be specific as a topical vasodilator, which may be useful in the postoperative management of subarachnoid hemorrhage.
Traumatic occlusion of the middle cerebral artery
Authors: Loar Charles R. , Chadduck William M. , Nugent G. Robert
Published: May 2009

✓ A case is reported of a patient rendered unconscious in a motorcycle accident. After a 6-hour lucid interval, he became unconscious again, and a left hemiplegia was noted. Arteriography demonstrated complete occlusion of the right middle cerebral artery. Comparable reported cases and theories of pathogenesis are discussed.
Surgical management of three simultaneous intracerebral abscesses with complete recovery
Authors: Friedman Harry , Kaplan Edward S. , Rockett John F.
Published: May 2009

✓ The successful surgical and medical treatment of three brain abscesses occurring simultaneously in the same patient is reported. The importance of a diagnostic brain scan is emphasized. Successful management was facilitated by the use of corticosteroids. In selected cases, surgical treatment of multiple abscesses may be performed with a reasonable chance for recovery.
Coarctation of the aorta as a cause of spinal subarachnoid hemorrhage
Authors: Banna Mohamed M. , Rose Peter G. , Pearce Goeffery W.
Published: May 2009

✓ A 40-year-old man with coarctation of the aorta suffered a subarachnoid hemorrhage but bilateral carotid and vertebral angiography as well as air ventriculography failed to demonstrate the source of bleeding. Postmortem examination showed the hemorrhage was due to rupture of a large collateral vessel on the surface of the spinal cord. The high incidence of berry aneurysms in patients with aortic coarctation is well known but where no lesion is shown intracranially, attention should be drawn to the intraspinal collateral circulation as a second possible source of subarachnoid hemorrhage.
Conray ventriculography in the diagnosis of infantile hydrocephalus
Authors: Yamada Hiroshi , Tajima Masataka
Published: May 2009

✓ A method for visualizing the third ventricle, aqueduct of Sylvius, and fourth ventricle with methylglucamine iothalamate 60% (Conray) in infantile hydrocephalus is described. Only a small amount of contrast medium is necessary to visualize these structures. This procedure has been performed in 47 infants from 7 days to 3 years of age, and has been proved simple, safe, and valuable in the diagnosis of lesions around the third and fourth ventricles.
The pathophysiological response to spinal cord injury
Authors: Osterholm Jewell L.
Published: May 2009

✓ In this review of spinal cord injury research, the author has selected contributions which in his opinion best represent modern experimental concepts regarding the mechanism and management of spinal cord injuries. He has placed special emphasis on the controversial issues appropriate to a new, stimulating, and competitive area of research.
Studies in experimental spinal cord trauma
Authors: Hedeman Lynn S. , Sil Ranajit
Published: May 2009

✓ A chronic clinicopathological study in 43 mongrel dogs evaluates the therapeutic effect of microcirculatory augmentation, an anti-edema agent, catecholamine (CA) receptor blockers, and a CA synthesis inhibitor. Results showed a high degree of clinical protection conferred by phenoxybenzamine, an alpha-adrenergic receptor blocker, and a lesser degree of protection from haloperidol, a domaminergic blocker, and low molecular weight dextran. Alpha-methyltyrosine given post-injury and steroids were of no therapeutic value. There was a correlation between microscopic white matter protection and clinical result. The presence of central gray necrosis was rather constant irrespective of therapy or clinical result.
Mechanisms of norepinephrine accumulation within sites of spinal cord injury
Authors: Vise W. Michael , Yashon David , Hunt William E.
Published: May 2009

✓ Vascularity and blood-brain barrier (BBB) function within spinal cord were studied with fluorescent microscopy at 14 intervals following 300 gm-cm injuries to the thoracolumbar spinal cord in 32 dogs. Histochemical staining with formaldehyde brought out a yellow-green fluorescence of vascular origin that was unrelated to tracer dye. This fluorescence accumulated in perivascular sites and is possibly related to catecholamine elevation within damaged spinal cord. Intrinsic CNS mechanisms for catecholamine build-up (increased transport, increased synthesis, increased release) are reviewed as well as the pharmacological action of alpha methyl tyrosine. It is hypothesized that an intrinsic CNS source of norepinephrine build-up is unlikely and that elevation of circulating catecholamine levels following stress and trauma leads to the extravasation of this material across injured BBBs within contused spinal cord.
Barbiturate-augmented hypothermia for reduction of persistent intracranial hypertension
Authors: Shapiro Harvey M. , Wyte Stephen R. , Loeser John
Published: May 2009

✓ Thiopental and pentobarbital caused further reductions in intracranial pressure (ICP) in five patients with persistent intracranial hypertension who had been previously treated with diuretics, steroids, and hyperventilation therapy. The ICP reduction obtained with these patients at normothermia was rapid. Abrupt increases in ICP could be quickly checked by barbiturate treatment. Frequently, the ICP reduction was accompanied by an improvement in the cerebral perfusion pressure. Reduction of ICP by thiopental was brief while that due to pentobarbital was more prolonged. Sustained intracranial pressure reduction could be maintained for up to 5 days by combining pentobarbital (serum concentration 3 mg%) and hypothermia (30°C) without cardiovascular instability or other untoward side-effects. The cerebral metabolic depression due to this combined therapy may be additive and therefore offer a greater protection to the brain during periods of elevated ICP.
Osteomyelitis and epidural abscess caused by Arachnia propionica
Authors: Albright Leland , Toczek Stanley , Brenner Vee J. , Ommaya Ayub K.
Published: May 2009

✓ A case of clival osteomyelitis and epidural abscess caused by Arachnia propionica is described. Primary clinical features included a 5-year illness, cervical fistulas, and episodes of meningitis that responded to penicillin. Treatment included peroral, transclival abscess removal, and prolonged antibiotic therapy. Bacteriologic features of the organism are reviewed.
Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers
Authors: Sweet William H. , Wepsic James G.
Published: May 2009

✓ The authors report their experience in the treatment of trigeminal neuralgia with controlled increments of radiofrequency heating from an electrode placed in the Gasserian ganglion or its posterior rootlets. Touch is preserved in some or all of a trigeminal zone rendered analgesic. The electrode tip is introduced through the foramen ovale and placed among the desired rootlets with the help of a combination of radiographs and the conscious patient's response to electrical stimulation with a square wave signal and gentle electrical heating. The degree of heat is measured by a thermister at the electrode tip. The patient's cooperation is maintained by the use of the neurolept anesthetic Innovar and the production of brief unconsciousness for the painful parts of the operation by methohexital (Brevital). Of 274 patients with facial pain so treated, 214 had trigeminal neuralgia; 91% of the latter group experienced relief of pain and 125 followed for 2½ to 6 years had a recurrence rate of 22%. In a total of 353 procedures, there has been no mortality and no neurological morbidity outside the trigeminal nerve. Only six of the patients with trigeminal neuralgia have complained significantly of postoperative paresthesias. The most serious undesired result has been the production of an anesthetic cornea in 28 patients, one of whom lost the sight of one eye due to corneal scarring. Correlating findings in our patients with those in studies by other authors, we conclude that the preservation of some touch is due to resistance to heating by the heavily myelinated A-beta fibers.
Neuronal alterations in developing cortical infarction
Authors: Little John R. , Sundt Thoralf M. , Kerr Frederick W. L.
Published: May 2009

✓ The sequential neuronal alterations that occur during the early phase of developing cortical infarction in the squirrel monkey were studied by light and electron microscopy. A technique used to select ischemic tissue based on spectrophotometry is described. Neuronal shrinkage, characterized by angularity, cytoplasmic eosinophilia, and nuclear pyknosis on light microscopy and by an increase in electron density of the cytoplasmic and nucleoplasmic matrix on electron microscopy, was the predominant reaction. The increased electron density of the cytoplasm and nucleoplasm suggested a diffuse alteration at the molecular level and the appearance of this abnormality between 3 and 6 hours corresponded with the development of an irreversible neurological deficit. In contrast, approximately 10% of the neurons became very swollen and pale. The pattern of perineuronal astrocytic alterations suggested that some form of interaction involving fluid transfer may exist between astrocyte and neuron and that shrinkage or swelling of neurons may depend in part upon the presence or absence of direct fluid exchange with astrocytes. Most terminal boutons became progressively shrunken and dense resembling the changes which occur in anterograde axonal degeneration. Swelling and fragmentation of large lysosomes occurred at 12 hours. Disruption of neural membranes was widespread by 24 hours and was more severe in swollen neurons.
A survey of metastatic meningiomas
Authors: Karasick Jeffrey L. , Mullan Sean F.
Published: May 2009

✓ The authors report two cases of intracranial meningiomas that metastasized to organs outside the nervous system, and review 54 comparable cases from the literature. Apparently neither previous surgery nor pulmonary involvement is a prerequisite for metastasis.
Experimental intracranial transplantation of autogenic omentum majus
Authors: Yaşargil M. Gazi , Yonekawa Yasuhiro , Denton Ira , Piroth Dieter , Benes Iwan
Published: May 2009

✓ The authors report the technique and successful results of experimental intracranial free transplantation of the greater omentum in dogs by microsurgery. The absorptive capacity of the omentum is demonstrated.
Saccular aneurysms of the distal anterior cerebral artery
Authors: Yaşargil M. Gazi , Carter L. Philip
Published: May 2009

✓ A series of 13 patients with saccular aneurysms of the distal anterior cerebral artery, operated on by the same surgeon with microtechniques, is reviewed. The incidence of aneurysms in this location was 3.4%, the median age of the patients 44 years, and the median time from most recent hemorrhage to surgery 13 days. There were five cases of multiple aneurysms. No operative mortality occurred; the operative morbidity was 15%. Because of their multiplicity, characteristic broad base, and the small subarachnoid space in the interhemispheric fissure, these aneurysms are judged technically difficult.
Colloid cysts of the third ventricle
Authors: Little John R. , MacCarty Collin S.
Published: May 2009

✓ Thirty-eight cases of colloid cyst of the third ventricle are reviewed. Headache was the most frequent complaint but a strong positional relationship, supposedly a pathognomonic feature of this tumor, was seldom seen. A combination of progressive dementia and gait disturbance without evidence of papilledema, resembling the clinical picture in “normal-pressure” hydrocephalus, was present in eight patients. Sudden deterioration and death occurred in four cases; two other deaths were precipitated by lumbar puncture and pneumoencephalography. Ventriculography was the most reliable diagnostic study. Both the demonstration of dilatation of the lateral ventricles and an upward convexity in the initial segment of the internal cerebral vein in five of the 10 angiograms performed were highly suggestive of tumor. Removal of the colloid cyst through a cortical incision in the non-dominant hemisphere was carried out in 21 cases; in six it was necessary to enlarge the foramen of Monro by dividing the ipsilateral anterior column of the fornix. There were three deaths in the early and two in the late postoperative period. The main complication associated with the transventricular approach was the development of seizures.
Spontaneous subarachnoid hemorrhage associated with spinal cord tumor
Authors: Runnels John B. , Hanbery John W.
Published: May 2009

✓ A rare case of spontaneous subarachnoid hemorrhage from an extramedullary upper thoracic astrocytoma is described. The differential diagnosis between cranial and spinal spontaneous subarachnoid hemorrhage is discussed.
Cerebral radiation necrosis simulating a brain tumor
Authors: Eyster E. Fletcher , Nielsen Surl L. , Sheline Glenn E. , Wilson Charles B.
Published: May 2009

✓ Two years after undergoing irradiation for a malignant ethmoid tumor, a 50-year-old man developed signs of increased intracranial pressure, an expanding right frontal lobe mass, and tentorial herniation. Operation revealed a mass that grossly appeared to be a glioma, but microscopically proved to be radiation necrosis of the brain.
Surgery of arteriovenous malformations in the speech and motor-sensory regions
Authors: Kunc Zdenek
Published: May 2009

✓ Eighteen large, severely symptomatic arteriovenous malformations were surgically removed from the speech and motor-sensory regions after localization by a proportional grid system. Resection caused a disability in only one patient and improved the preoperative neurological deficit in all the others. Recovery of total or modified working ability took place in 89% of the patients. The author believes that careful radical resection is the method of choice and should be performed before devastation by hemorrhage.
Giant arteriovenous malformations of infancy and childhood
Authors: Long Donlin M. , Seljeskog Edward L. , Chou Shelley N. , French Lyle A.
Published: May 2009

✓ Twelve patients are presented with giant arteriovenous malformations of the brain requiring therapy in the neonatal or infant period. Eight patients were operated on, and six survived with no neurological deficit. Four patients were not operated on and all died. The diagnostic clinical triad of enlarged head, cranial bruit, and cardiac failure or enlargement is described, and angiographic characteristics and surgical therapy discussed.
Experimental production of subdural hematomas
Authors: Apfelbaum Ronald I. , Guthkelch A. N. , Shulman Kenneth
Published: May 2009

✓ Experimental evidence is offered to refute the hypothesis that cerebrospinal fluid alters blood coagulation or clots to favor the formation of chronic subdural hematomas. Rather, the envelopment of preformed blood clots in membranes containing neovascular sinusoidal channels and their subsequent regression from the subdural space are seen as a normal biological process analogous to that occurring elsewhere in the body. The presence of fibrin and its contact with the dura have been found to be essential precursors to membrane formation. Histological evidence of bleeding into both blood and fibrin subdural clots is presented, and theoretical considerations are discussed to explain possible mechanisms of enlargement and chronicity of subdural hematomas as well as repeated failures to obtain an experimental small animal model.
Energy state and glycolysis in human cerebral edema
Authors: Schmiedek Peter , Baethmann Alexander , Sippel Gunter , Oettinger Wolfgang , Enzenbach Robert , Marguth Frank , Brendel Walter
Published: May 2009

✓ A new freeze-stop device using a liquid nitrogen reservoir and an automatic biopsy mechanism has been developed, suitable for rapid, sterile, and standardized sampling of cerebral tissue in man. In animal experiments a 200 mg piece of cerebral cortex was cooled from a room temperature of 18°C to −40°C within 7 sec which is twice as fast as when it was immersed in liquid N2. The method was then applied to metabolic tissue studies of perifocal edematous cortex from patients undergoing neurosurgery for intracranial tumors. Energy-rich phosphate compounds or parameters of the energy state were found to be less affected in this type of brain edema than the glycolytic activity which was markedly enhanced, indicated by lactic and pyruvic acid determinations. The tissue water content correlated closely with the lactic acid concentration, and very little with measurements of the energy state such as the energy charge potential or the adenosinetriphosphate-adenosinediphosphate (ATP/ADP) ratio. It is suggested that in perifocal brain edema increased levels of lactic acid are associated with mechanisms leading to an increased water uptake.
Intracranial pressure in patients with dementia and communicating hydrocephalus
Authors: Chawla Jagdish C. , Hulme A. , Cooper R.
Published: May 2009

✓ Intracranial pressure (ICP) was monitored continuously for 48 to 72 hours in 12 patients with dementia and communicating hydrocephalus, to see if this would help determine which patients might benefit from surgical shunting of CSF, since not all such patients respond to treatment. Patients who showed variability of ICP improved following surgery, while patients with consistently flat ICP tracings did not. It is suggested that continuous monitoring of ICP may help identify cases suitable for surgery.
Pontine abscess: survival following surgical drainage
Authors: VanGilder John C. , Allen William E. , Lesser Robert A.
Published: May 2009

✓ The authors report a patient who survived following surgical evacuation of a pontine abscess. The pathophysiology, neurological symptoms, and surgical findings of this rare entity are discussed.
Acute pulmonary edema following venous air embolism during a neurosurgical procedure
Authors: Chandler William F. , Dimcheff Donald G. , Taren James A.
Published: May 2009

✓ A case of venous air embolism during a procedure in the sitting position is reported in which the patient developed fulminant pulmonary edema within 2 hours of the embolus. Possible cause and effect relationships are discussed.
A technique for relief of motor and sensory deficits occurring after anterior ulnar transposition
Authors: Campbell James B. , Post Kalmon D. , Morantz Robert A.
Published: May 2009

✓ A method is described for relief of dysesthetic pain or progression of the motor and sensory deficits in previously transposed ulnar nerves that have become entrapped in the operative scar. After an external neurolysis to prevent a recurrence, a Silastic strip 15 cm long and 3 cm wide is sutured in place beneath the re-exposed nerve and covered by a strip of identical dimensions, which is also fixed to the soft tissues. The elbow joint is maintained in moderate flexion for 3 weeks by a posterior plaster splint. It is believed that this sheathing, while permitting movement of the nerve with flexion and extension, prevents re-encumbrance with adhesions. In nine cases so treated, compressive adhesions were encountered along the course of the transposed nerve rather than entrapment at the point where it has previously been brought out through the fascia. After operation, five out of nine patients maintained significant lasting motor and sensory improvement, verified bioelectrically. Minor sensory improvement was experienced by two others, and two remained unchanged.
Cerebral arterial spasm
Authors: Allen George S. , Henderson Lavell M. , Chou Shelly N. , French Lyle A.
Published: May 2009

✓ In vitro experiments were performed using a small volume chamber to determine the contractile activity of various vasoactive agents on the canine basilar and middle cerebral arteries. Cumulative dose-response curves were obtained for most of the agents tested including serotonin and three different prostaglandins; many of these curves were found to be similar for segments from both arteries. It was concluded from these curves, and the known concentrations in blood, that serotonin is probably the agent in blood responsible for the cerebral arterial spasm that often follows a subarachnoid hemorrhage. This in vitro method is capable of detecting serotonin concentrations as low as 10−12 gm/ml and may prove useful as a quantitative and well-controlled method for studying the etiology of spasm and the receptor mechanisms present in the cerebral arteries.
Cerebral arterial spasm
Authors: Allen George S. , Henderson Lavell M. , Chou Shelley N. , French Lyle A.
Published: May 2009

✓ In vitro experiments were performed to determine the contractile activity of human serum and cerebrospinal fluid on the canine basilar artery. The majority of contractile activity in these CSF samples, which were collected 2 to 7 days following a subarachnoid hemorrhage, was proven to be due to serotonin. Serotonin was capable of producing a prolonged contraction of the artery depending on its activity. Methylsergide reversibly blocked the artery's response to serotonin and caused a contraction of the basilar artery. Phenoxybenzamine irreversibly blocked the basilar artery's response to serotonin, serum, and CSF.