bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of intravenous methylprednisolone on spinal cord lipid peroxidation and (Na+ + K+)-ATPase activity
Authors: Hall Edward D. , Braughler J. Mark
Published: May 2009

✓ The present study was undertaken to examine the ability of a single large intravenous dose of methylprednisolone (15, 30, or 60 mg/kg) to attenuate lipid peroxidation and enhance (Na+ + K+)-ATPase activity during the 1st hour after a 400 gm-cm injury to the cat spinal cord. The contusion injury was associated with a rise in the concentration of fluorescent lipid peroxy products in the injured segment at 1 hour. In addition, the accumulation of cyclic guanosine 3″,5″-monophosphate (cyclic GMP), which was used as a new index of injury-induced free radical reactions, in the injured spinal segment was twice control levels. The injury-induced increase in fluorescence and cyclic GMP content in the contused spinal segment at 1 hour was completely prevented by the administration of 15 or 30 mg/kg of methylprednisolone at 30 minutes after injury. A 60-mg/kg dose, however, did not prevent the elevation in cyclic GMP. A concomitant examination of the acute effects of glucocorticoid administration on (Na+ + K+)-ATPase activity in the injured cord revealed a striking increase of enzyme activity after the 30-mg/kg dose, but a depression in activity with the 60-mg/kg dose. These results demonstrate that a single massive dose of methylprednisolone can beneficially reduce free-radical reactions and lipid peroxidation as well as enhance the activity of neuronal (Na+ + K+)-ATPase during the early phase after spinal cord contusion. The requirement for doses to be in the range of 15 to 30 mg/kg in order to produce these neurochemical changes is consistent with other studies that have demonstrated significantly greater recovery and tissue preservation in spinal cord-injured animals treated with comparable doses of methylprednisolone soon after injury. These findings suggest the need for a rigorous approach to glucocorticoid therapy in central nervous system trauma.
Evaluation of CSF shunt patency by means of technetium-99m DTPA
Authors: Graham Peter , Howman-Giles Robert , Johnston Ian , Besser Michael
Published: May 2009

✓ Evaluation of 192 cerebrospinal fluid shunts was performed using 1 mCi of technetium-99m DTPA which was injected into the shunt tubing. This was found to be a safe, simple method of evaluating shunt patency. No complications were noted with this procedure, nor was there any documented case of infection related to the injection of the isotope. The sensitivity of the test for evaluation of patency was 97%, specificity 90%, and accuracy 93%. Various patterns of tracer clearance are noted and discussed. The role of this test as an aid in making management decisions is detailed.
Lipoma of the corpus callosum
Authors: Gerber Samuel S. , Plotkin Reuben
Published: May 2009

✓ Lipoma of the corpus callosum is a rare intracranial condition, possibly congenital. It is often asymptomatic, but may present with headaches, seizures, hemiplegia, or dementia. An example of this disease is reported, and the condition reviewed. The radiological appearance is described, with emphasis on the value of computerized tomography in making the diagnosis. Surgery is of limited value but may be required in specially selected cases.
Cerebral amyloid angiopathy with multiple intracerebral hemorrhages
Authors: Tyler Kenneth L. , Poletti Charles E. , Heros Roberto C.
Published: May 2009

✓ Cerebral amyloid angiopathy (CAA) has been associated with atypical dementia and a variety of other neurological disorders. Intracerebral hemorrhage is the most striking manifestation of CAA. A 63-year-old patient is described who sustained four intracerebral hemorrhages although he had no predisposing factors other than CAA. The neurological and pathological features of CAA are reviewed, with particular emphasis on the problem of CAA-associated intracerebral hemorrhage. On the basis of the experience with this case, it is recommended that adjacent brain parenchyma be biopsied in all patients undergoing evacuation of intracerebral hematomas of unclear etiology.
Intermittent exophthalmos studied with computerized tomography
Authors: Rivas Juan J. , Lobato Ramiro D. , Cordobés Francisco , Barcena Alejandro , Millán José M.
Published: May 2009

✓ Two cases of intermittent exophthalmos are reported. In both instances, cerebral angiography and orbital venography failed to outline the lesion, which was clearly demonstrated with the aid of computerized tomography. An orbital varix was seen to be the cause of proptosis in one surgically verified case, whereas in the other this same diagnosis was suspected on the basis of the clinicoradiological findings. The etiology, clinical manifestations, and management of orbital varix are briefly discussed.
Aneurysms of the vein of Galen
Authors: Hoffman Harold J. , Chuang Sylvester , Hendrick E. Bruce , Humphreys Robin P.
Published: May 2009

✓ A study of the literature published between 1937 and 1981 revealed 128 aneurysms of the vein of Galen. Their clinical course and management are reviewed. During the years 1950 to 1980, 29 patients with an aneurysm of the vein of Galen were seen at The Hospital for Sick Children. In 14 of these patients surgical obliteration of their aneurysm was attempted, and in six this proved successful.
Prostacyclin and cerebral vessel relaxation
Authors: Paul Kamal S. , Whalley Eric T. , Forster Christine , Lye Richard , Dutton John
Published: May 2009

✓ The authors have studied the ability of prostacyclin to reverse contractions of human basilar arteries in vitro that were induced by a wide range of substances implicated in the etiology of cerebral arterial spasm. Prostacyclin (10−10 to 10−6M) caused a dose-related reversal of contractions induced by 5-hydroxytryptamine, noradrenaline, angiotensin II, prostaglandin (PG)F2α, and U-46619 (a thromboxane-A2 mimetic). These agents were tested at concentrations or volumes that produced almost maximum or maximum responses and those that produced approximately 50% of the maximum response. Contractions induced by maximum concentrations of angiotensin II and U-46619 were least affected by prostacyclin. In addition, contractions induced by thromboxane-A2 generated from guinea-pig lung were reversed in a dose-dependent fashion by prostacyclin. This ability of prostacyclin to physiologically antagonize contractions of the human basilar artery in vitro induced by high concentrations of various spasmogenic agents suggests that such a potent vasodilator agent or more stable analogue may be of value in the treatment of such disorders as cerebral arterial spasm following subarachnoid hemorrhage.
Conducted somatosensory evoked potentials during spinal surgery
Authors: Macon James B. , Poletti Charles E.
Published: May 2009

✓ Intraoperative recordings of conducted bipolar epidural somatosensory evoked potentials (SEP's) generated by unilateral common peroneal nerve stimulation have been obtained in 27 patients. The SEP's were multiphasic, 0.3 to 1.5 µV in amplitude, and recorded in 100% of patients with normal cords or in patients with spinal lesions, at a site caudal to the lesions. Control spinal conduction velocities (CV's), measured in the midthoracic to lower cervical regions, were in the range of 65 to 85 m/sec. Control lumbar and lower thoracic CV's were in the range of 30 to 45 m/sec. The CV values were obtained periodically throughout the course of surgery and were plotted as a function of time. In control patients with extradural lesions and neuroleptic anesthesia, the CV's remained constant (± 3%). The consistency, sensitivity, and safety of SEP recordings obtained by this technique make precise monitoring readily available during spinal operations.
Conducted somatosensory evoked potentials during spinal surgery
Authors: Macon James B. , Poletti Charles E. , Sweet William H. , Ojemann Robert G. , Zervas Nicholas T.
Published: May 2009

✓ In 27 patients undergoing laminectomy, spinal cord function was monitored by epidural bipolar recordings of conducted spinal somatosensory evoked potentials (SEP's) across the laminectomy site, with calculation of spinal conduction velocity (CV). In control cases without myelopathy, the CV remained relatively constant (± 3%) even during prolonged operations, despite markedly changing levels of anesthesia. Acute CV changes were detected intraoperatively in three cases: these patients displayed improvement after extramedullary (Case 1) and intramedullary decompression (Case 2), and deterioration after direct unilateral dorsal column injury (Case 3). These intraoperative CV alterations correlated postoperatively with changes in the neurological examination. Although a unilateral lesion confined to the dorsal column abolished the ipsilateral SEP in Case 3, complete anterior quadrant lesions did not consistently change the CV (Case 4). This further suggests that the SEP is generated entirely by ipsilateral dorsal column activation. Accurate measurement of this dorsal column conduction velocity across the operative field provides a very sensitive means of monitoring spinal cord function during operations for neurosurgical spinal lesions.
Benefit from and tolerance to continuous intrathecal infusion of morphine for intractable cancer pain
Authors: Greenberg Harry S. , Taren James , Ensminger William D. , Doan Kathleen
Published: May 2009

✓ A patient with painful bilateral metastatic lumbosacral plexopathy from cervical cancer was treated with levorphanol tartrate (Levo-Dromoran), 4 mg orally every 4 hours, with poor pain relief. A lumbar subarachnoid catheter was then placed percutaneously. A bolus of 1 mg of morphine gave complete pain relief for 17 hours. Over the next week, the dose requirement increased to 10 mg/day, infused by an external pump. A permanently implantable infusion pump with a 50-cc drug chamber and flow rate of 3.4 cc/day was placed in the abdomen and attached to the lumbar subarachnoid catheter. The pump was refilled by percutaneous injection. Morphine was infused continuously at 15 mg/day, affording the patient increased mobility and no pain for 7 days. When the pain returned, the morphine dose was increased to 17.5 mg/day, and the patient was allowed to take oral Levo-Dromoran for pain. The intrathecal morphine dose was constant within 2-week periods, but was increased from 17.5 to 96 mg/day because of inadequate pain relief. Oral Levo-Dromoran intake averaged 3.4 mg/day. Levo-Dromoran intake was less during the 1st week of each 2-week cycle than the last week (mean 15.0 versus 38.0 mg/wk, p < 0.05). No sedation or respiratory depression was seen.
Combined epidural and peripheral nerve stimulation for relief of pain
Authors: Urban Bruno J. , Nashold Blaine S.
Published: May 2009

✓ A technique is described that combines percutaneous epidural with peripheral nerve stimulation to provide limited paresthesia to a lower extremity. The peripheral electrode is placed percutaneously and positioned along the course of the anterior division of the spinal nerve anterolateral to the vertebral bodies. This is accomplished by a modified epidural tap. Combined stimulation was carried out in 23 patients with intractable leg pain. Sixteen patients proceeded to chronic autostimulation; follow-up time extended to 18 months. The procedure proved simple; there were no perioperative and only few minor late complications. Results were similar to those from conventional epidural stimulator implantation. It is concluded that combined epidural-peripheral nerve stimulation constitutes a valid therapeutic alternative for patients with unilateral lower extremity pain.
Intracranial pressure in craniostenosis
Authors: Renier Dominique , Sainte-Rose Christian , Marchac Daniel , Hirsch Jean-François
Published: May 2009

✓ In this study, intracranial pressure (ICP) was recorded with an epidural ensor for periods of 12 to 24 hours in 92 cases of craniosynostosis. Pre- and postoperative recordings were performed in 23 patients, and 55 children underwent preoperative psychometric testing. The ICP was found to be normal in one-third of the cases, was obviously elevated in one-third, and was borderline in one-third. Waves of increased ICP were recorded during rapid eye movement (REM) sleep. After surgery, ICP decreased progressively and returned to normal in several weeks. A significant statistical relationship was found between the patients' ICP and their mental level: the higher the ICP the lower the mental level. The regression curve of ICP as a function of age shows that ICP is maximal at the age of 6 years and decreases later. The significance of these results is discussed. The authors recommend that ICP be recorded in cases of craniosynostosis since it is of some help in deciding whether patients should undergo surgery.
Local cerebral glucose utilization in the beagle puppy model of intraventricular hemorrhage
Authors: Ment Laura R. , Stewart William B. , Duncan Charles C.
Published: May 2009

✓ Local cerebral glucose utilization has been measured by means of carbon-14 (14C)-autoradiography with 2-deoxyglucose in the newborn beagle puppy model of intraventricular hemorrhage. Our studies demonstrate gray matter/white matter differentiation of uptake of 14C-2-deoxyglucose in the control pups, as would be expected from adult animal studies. However, there is a marked homogeneity of 14C-2-deoxyglucose uptake in all brain regions in the puppies with intraventricular hemorrhage, possibly indicating a loss of the known coupling between cerebral blood flow and metabolism in this neuropathological condition.
Quantitative autoradiographic measurements of blood-brain barrier permeability in the rat glioma model
Authors: Yamada Kazuo , Ushio Yukitaka , Hayakawa Toru , Kato Amami , Yamada Noriko , Mogami Heitaro
Published: May 2009

✓ Quantitative autoradiographic technique was applied in measuring blood-brain barrier (BBB) permeability of autochthonous gliomas in rats. In small tumors (less than 2 mm in diameter), no increase in BBB permeability was noted. As the tumor grew and neovascularization occurred, BBB permeability increased in the center of the tumor, and it was suggested that the BBB was partly disrupted in the neovascularized vessels. In the fully grown tumors, BBB permeability was markedly increased in the viable part of the tumor to levels similar to the choroid plexus. Yet, the BBB was partly preserved at the periphery of the tumor and in the brain adjacent to the tumor. The heterogeneity of the BBB phenomenon according to the stage of tumor growth may be a major obstacle for uptake of chemotherapeutic drugs that do not cross the BBB easily.
Spinal epidural extramedullary hematopoiesis with cord compression in a patient with refractory sideroblastic anemia
Authors: Heffez Dan S. , Sawaya Raymond , Udvarhelyi George B. , Mann Risa
Published: May 2009

✓ Spinal cord compression by epidural extramedullary hematopoiesis (EMH) is a rare phenomenon. A case of acute compressive myelopathy is reported in a 72-year-old man with EMH secondary to sideroblastic anemia. Technetium colloid scanning was used to document extensive ectopic marrow formation. The patient improved following surgery and radiotherapy. A review of the literature revealed 23 other cases of symptomatic spinal epidural EMH. The underlying hematological disorder varied but was always of long duration. Eighty-eight percent of the patients were males. Symptoms lasted longer than 1 week in 90% of cases, and 91% demonstrated incomplete neurological deficits. Plain x-ray films were rarely helpful in establishing the diagnosis. Technetium sulfur colloid bone marrow scanning has been used successfully to detect EMH and has led to preoperative diagnosis in one case. Decompressive laminectomy with or without postoperative irradiation is the suggested therapy, although there is evidence that radiotherapy alone may be adequate in some cases. Good recovery is the rule despite long-standing neurological deficits.
Computerized tomography of a sellar spine
Authors: LaMasters David L. , Boggan James E. , Wilson Charles B.
Published: May 2009

✓ A presumed developmental variant of the dorsum sellae was found in a patient undergoing evaluation for a suspected pituitary adenoma. An initial computerized tomography (CT) scan suggested a suprasellar mass; however, high-resolution CT with reformations clearly revealed the mass to be the pituitary gland, which was deformed and displaced upward by an osseous spine projecting from the dorsum sellae. The radiographic appearance and etiology of this anomaly are discussed. Neurosurgeons and neuroradiologists should be aware of this anomaly when evaluating a patient for pituitary adenoma.
Persisting recessus infundibuli and empty sella
Authors: Vallee Bernard , Besson Gérard , Person Hervé , Mimassi Nagi
Published: May 2009

✓ In a patient with thrombosis of the central retinal artery, plain skull radiographs showed an enlarged sella turcica and computerized tomography revealed ventricular dilatation. Neuroradiological examination demonstrated stenosis of the Sylvian aqueduct and an unusual type of empty sella due to intrasellar persistence of the recessus infundibuli and the presence of an intrasellar arachnoidocele. The former anomaly has been reported in only three cases; in none of them was it associated with the latter abnormality.
Traumatic aneurysms of the supraclinoid internal carotid artery
Authors: Pozzati Eugenio , Gaist Giulio , Servadei Franco
Published: May 2009

✓ This paper describes two patients with traumatic aneurysms of the supraclinoid internal carotid artery, which occurred after a closed-head injury and without demonstrable basal skull fracture. In the first case, the traumatic origin of the aneurysm was demonstrated by repeat angiograms. The second case documents the formation of a giant, traumatic, true aneurysm of the supraclinoid carotid artery over a period of less than 2 months; there was an associated traumatic partial occlusion of the vessel proximal to the aneurysm. The mechanisms of injury of the supraclinoid carotid artery are discussed.
Incidence of spinal column deformity after multilevel laminectomy in children and adults
Authors: Yasuoka Shozo , Peterson Hamlet A. , MacCarty Collin S.
Published: May 2009

✓ Fifty-eight patients, all less than 25 years of age, underwent multilevel laminectomy for conditions that in themselves do not usually cause spinal deformity. Spinal deformity developed in 46% (12 of 26) of the patients who were less than 15 years of age, but in only 6% (two of 32) of the patients aged 15 to 24 years. Spinal deformity developed in all (100%) patients who had cervical laminectomy, in 36% of those who had thoracic laminectomy, and in none (0%) of those who had lumbar laminectomy. There was no correlation between the occurrence of deformity and sex, number of laminae removed, neurological condition after laminectomy, or length of time after surgery.
Medulloblastoma and other primary malignant neuroectodermal tumors of the CNS
Authors: Allen Jeffrey C. , Epstein Fred
Published: May 2009

✓ Studies to evaluate the extent of their disease were performed on 30 children with newly diagnosed malignant neuroectodermal tumors of the central nervous system, including 25 children with medulloblastomas. The studies consisted of postoperative computerized tomography scanning, cerebrospinal fluid (CSF) cytology, myelography, and bone marrow aspiration. In 11 patients (36%) one or more of these studies was positive, indicating disease dissemination (Group 1), and in 19 (64%) all four studies were negative (Group 2). The CSF cytology was positive for malignant cells in all 11 Group 1 patients; myelograms indicated subclinical filling defects in nine, and the bone marrow aspirate from two patients revealed extrinsic cells.

All patients received a conventional course of neuraxis radiation therapy as tolerated, and some also received chemotherapy. Patients with abnormal myelograms received additional radiation to areas of identifiable subarachnoid disease. The median survival time in Group 1 was 12 months, with five patients still surviving. The prognosis for Group 2 patients was considerably more favorable; only three of the 19 had died at the time of this report. Four of the six deaths in Group 1 were related to disease dissemination, the other two to chemotherapy toxicity. All three deaths in Group 2 were related to local tumor recurrence.

The mean age of Group 1 patients was 3.9 years compared to 11 years for Group 2. Of the 14 patients aged 5 years and under in both groups, nine presented with widely disseminated disease (Group 1), six of whom had a relatively short survival time. The performance of a postoperative extent-of-disease evaluation is especially important in young children with medulloblastoma. Knowledge of disease dissemination at diagnosis not only helps determine prognosis, but also assists in planning treatment. Aggressive multimodal therapy appears warranted in younger patients who present with widely disseminated disease.
The neurosurgical management of optic glioma
Authors: Tenny Robert T. , Laws Edward R. , Younge Brian R. , Rush James A.
Published: May 2009

✓ A series of 104 patients with surgically verified optic nerve gliomas is presented. Anterior lesions primarily affecting the optic nerve were present in 42 patients, who have a long-term survival rate of 85.5%. Posterior lesions primarily affecting the optic chiasm were present in 62 patients, most of whom underwent radiation therapy postoperatively, and they have a long-term survival rate of 50%. Unequivocal signs of neurofibromatosis were present in 14%. On the basis of these findings and a review of the literature, recommendations are made for the surgical management of these tumors.
Surgical control of chronic migrainous neuralgia by trigeminal ganglio-rhizolysis
Authors: Maxwell Robert E.
Published: May 2009

✓ Chronic migrainous neuralgia is not diagnosed as often as the periodic or “cluster” form of Horton's syndrome. The distinguishing features of chronic migrainous neuralgia, compared with the periodic variety, are the frequency and persistence of the attacks of hemicraniofacial pain and the intractability to medical management. Eight male patients ranging in age from 22 to 45 years received prompt, although transient, pain relief by blockade of the Gasserian ganglion on the side of their hemifacial pain with a local anesthetic. Prolonged relief was subsequently achieved by percutaneous radiofrequency trigeminal ganglio-rhizolysis. There were no significant complications from this procedure. Review of the literature indicated that other ablative neurosurgical procedures, such as alcohol injection of the Gasserian ganglion and trigeminal rhizotomy by the subtemporal craniectomy approach, have relieved migrainous neuralgia, but with a greater risk and incidence of complications. The characteristic clinical features of migrainous neuralgia and the medical and surgical approaches to therapy are discussed.
Synergistic effect of perfluorochemicals on BCNU chemotherapy
Authors: Kuwamura Keiichi , Kokunai Takashi , Tamaki Norihiko , Matsumoto Satoshi
Published: May 2009

✓ In a study of the effect of adding perfluorochemicals to BCNU chemotherapy, 7 × 105 9L tumor cells were implanted in the right cerebral hemisphere of Fischer 344 rats weighing about 100 gm each. On the 7th day after implantation, rats were given BCNU or Fluosol-43 (perfluorochemical artificial blood substitute), or a combination of the two, and the therapeutic effects of these treatments were studied. Mean survival time of control animals was 15.23 days ± 2.84 days (standard deviation); in the group treated with Fluosol-43 and kept in an oxygen chamber (95% O2, 5% CO2), survivial time was 15.30 ± 2.11 days. The BCNU treatment alone and BCNU in rats kept in an oxygen chamber prolonged the mean survival time to 20.90 ± 3.80 days and 21.10 ± 2.14 days, respectively. Survival times in rats receiving BCNU plus Fluosol and breathing normal air, BCNU plus dextran-40 and breathing normal air, and BCNU plus dextran-40 in an oxygen chamber were 21.20 ± 2.63 days, 22.90 ± 1.52 days, and 22.20 ± 1.79 days, respectively. On the other hand, treatment with BCNU plus Fluosol-43 in rats kept in an oxygen chamber resulted in a significant increase of mean survival time of 32.27 ± 4.80 days (p < 0.005). From these results, it seems likely that Fluosol-43 with oxygen might have a synergistic effect for BCNU chemotherapy in malignant brain tumors.
Choice of treatment of odontoid fractures
Authors: Schiess Robert J. , DeSaussure Richard L. , Robertson James T.
Published: May 2009

✓ This paper presents a discussion of the diagnosis and treatment of odontoid fractures, based upon the authors' experience with this entity over the last 10 years. Conservative therapy and surgical fusion are compared with respect to efficacy and duration of hospitalization. Arthrodesis is recommended for consideration in the initial treatment of all unstable odontoid fractures.
Thrombosed arteriovenous malformations of the brain
Authors: Wharen Robert E. , Scheithauer Bernd W. , Laws Edward R.
Published: May 2009

✓ Thrombosed arteriovenous malformations (AVM's) in patients with no previous history of hemorrhage are uncommon but benign lesions that present with clinical and radiographic findings which are often indistinguishable from those of other mass lesions, particularly low-grade gliomas. The authors report seven cases of thrombosed AVM's presenting as intractable seizure disorders in which the radiographic studies had suggested a low-grade glioma. All seven patients are now seizure-free 2 to 40 months postoperatively. The importance of surgical exploration in the management of such patients is emphasized. A review of 32 cases reported in the literature is presented. The reasons why angiography may fail to demonstrate an AVM, and the possible etiologies for the spontaneous thrombosis of an AVM are discussed.
Delineation of unruptured cerebral aneurysms by computerized angiotomography
Authors: Asari Syoji , Satoh Toru , Sakurai Masaru , Yamamoto Yuji , Sadamoto Kazuhiko
Published: May 2009

✓ Unruptured aneurysms were diagnosed in 15 of 86 patients with cerebral aneurysms during 2 years beginning in April, 1979. One patient with severe head injury was excluded from the series. Fifteen aneurysms in the other 14 patients were first detected by computerized angiotomography. Six aneurysms were located in the middle cerebral artery, three in the upper half of the basilar artery, two in the anterior communicating artery, two in the posterior cerebral artery, and two at the internal carotid-posterior communicating artery junction (both in the same patient). Three were smaller than 5 mm, eight were between 6 and 10 mm, and four were larger than 10 mm. The noncontrast-enhanced computerized tomography (CT) findings associated with 15 aneurysms were as follows: five showed defects in the basal cistern or Sylvian fissure, four were calcified or high-density masses, and in six instances there was no evidence of an aneurysm. Unruptured aneurysms may be suggested by a well demarcated, round, isodense mass which forms a defect in the basal cistern or Sylvian fissure on a plain CT image, and are highly and homogeneously enhanced by computerized angiotomography. A carotid artery blood iodine level of 15 mg/ml is required to obtain clear images. The authors conclude that computerized angiotomography is useful in the delineation of unruptured aneurysms.
Persistence and late malignant transformation of childhood cerebellar astrocytoma
Authors: Alpers Charles E. , Davis Richard L. , Wilson Charles B.
Published: May 2009

✓ A 5-year-old girl with juvenile pilocytic astrocytoma subsequently had multiple episodes of symptomatic recurrence over the course of 21 years of follow-up review. This lesion underwent histological transformation to an anaplastic small-cell neoplasm 21 years after the initial resection and diagnosis. Late transformation of benign childhood cerebellar astrocytomas to malignant astrocytic tumors is very rare; transformation to an anaplastic small-cell neoplasm has not been reported previously. This case and other reported cases in which juvenile pilocytic astrocytoma recurred after a long interval indicate the requirement of long-term follow-up review of these patients before assuming either a cure or arrest of the tumor's growth.
Investigation and management of suprasellar arachnoid cysts
Authors: Hoffman Harold J. , Hendrick E. Bruce , Humphreys Robin P. , Armstrong Edward A.
Published: May 2009

✓ Suprasellar arachnoid cysts, although rare, are now being found with increasing frequency with the help of the computerized tomography (CT) scanner. Forty-six cases have been reviewed from the literature, and the authors add eight patients seen at their institution during the past 6 years. This latter group have all been diagnosed by CT scan combined with an injection of metrizamide through an implanted diversionary cerebrospinal fluid shunt. Patients in whom the suprasellar arachnoid cyst had produced hydrocephalus were treated by communicating the cyst with the ventricular system via a transcallosal route, with very satisfactory results.
Craniovertebral junction malformations
Authors: Di Lorenzo Nicola , Fortuna Aldo , Guidetti Beniamino
Published: May 2009

✓ The fate of a series of 63 patients operated on between 1953 and 1979 was studied retrospectively to assess the efficacy of neurosurgical treatment in relieving symptoms associated with craniovertebral junction (CVJ) malformations. Fifty-eight patients underwent posterior cervicomedullary decompression, and the other five underwent transoral clivus-atlanto-odontoidectomy. Long-term results with the posterior approach showed that 50% of the patients benefited from surgery, 25% remained unchanged, and 25% continued to deteriorate or died. Patients with dorsal nervous tissue and/or meningeal anomalies, such as Arnold-Chiari malformation, hydrosyringomyelia, dural fibrous ring, or obstruction of the cisterna magna, did better than patients with ventral cervicomedullary indentation caused by a clivus-atlanto-odontoid bone complex. Anterior decompression is preferable to a posterior approach only if the CVJ malformation involves a ventral deformity in the absence of dorsal compression by soft tissue.
Reversal of intracerebral steal by STA-MCA anastomosis
Authors: Laurent John P. , Lawner Pablo M. , O'Connor Michael
Published: May 2009

✓ A major factor determining the severity of neurological deficits caused by cerebral ischemia is the ability of the vasculature to provide collateral circulation to the ischemic areas. By establishing a major conduit by means of extracranial-intracranial anastomosis, the increased perfusion pressure through the collateral arterioles may reduce morbidity in these patients. Twenty-seven patients were selected for superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis based on clinical and angiographic evidence of lesions of the internal carotid arterial system. Cerebral blood flows (CBF's) were determined by the xenon-133 inhalation method using 16 symmetrically placed scintillator probes; two-compartment analysis was used to compute a mean flow for the compartment. An average mean flow was computed for each hemisphere, and for four regions with the lowest mean CBF in each hemisphere. The CBF was measured preoperatively and within 8 weeks postoperatively.

The average mean flow was 29 ml/100 gm/min in the symptomatic hemisphere, and 30 ml/100 gm/min in the asymptomatic hemisphere. In 11 patients, the mean flow for the symptomatic hemisphere increased by 24% postoperatively, and for the asymptomatic hemisphere by 23%. Regions with lowest CBF showed an increase of 32% in the symptomatic hemisphere, and of 35% in the asymptomatic hemisphere. The low-flow regions differed from the total hemisphere (symptomatic: p < 0.02; asymptomatic: p < 0.05). Areas of lowest blood flow preoperatively had the greatest increase in flow postoperatively. Postoperative elevation of CBF in the contralateral hemisphere is consistent with an “intracerebral steal” before surgery. The postoperative elevation of flow in the asymptomatic hemisphere is related to improved perfusion pressure in the symptomatic hemisphere.
Cerebrospinal fluid edema: a rare complication of shunt operations for hydrocephalus
Authors: Chiba Yasuhiro , Takagi Hiroshi , Nakajima Fumoto , Fujii Satoshi , Kitahara Takao , Yagishita Saburo , Itoh Yoji
Published: May 2009

✓ Three cases are presented in which a rare complication occurred after a shunt operation for hydrocephalus. On postoperative computerized tomography (CT) scans, extensive low-density areas appeared in the white matter along the ventricular catheter. After shunt revision, gradual resolution or disappearance of the low-density area was clearly demonstrated on CT. In one patient, a collection of cerebrospinal fluid (CSF) was confirmed at operation and appeared to lie in the extracellular spaces of the white matter. The phenomenon is considered to be localized CSF edema, different from porencephaly.
Spontaneous intracranial extradural hematoma
Authors: Marks Sidney M. , Shaw Malcolm D.M.
Published: May 2009

✓ A case is described of spontaneous intracranial extradural hematoma in which the clinical presentation and the underlying mechanism differed from those previously described.
Femoral nerve injury following appendectomy
Authors: Kourtopoulos Harry
Published: May 2009

✓ The author reports a case of femoral nerve damage following appendectomy, and discusses its pathophysiology and successful treatment. The anatomical and clinical presentation of this entity in the literature is reviewed, and some suggestions for its recognition and treatment are offered.
Research and training in the neurosurgical sciences
Authors: Langfitt Thomas W.
Published: May 2009

✓ The author surveys the past and looks to the future in presenting the goals of research and research training in neurosurgery. He describes several categories of research which appear to be open and attractive, and the types of program organization designed to achieve the desired goals. Acquisition of new knowledge about the nervous system, leading to improvement in diagnosis and management of patients, will probably remain within the surgical domain, but nonsurgical intervention will continue to demand and attract the active interest of neurosurgeons. The past and present contributions of neurosurgeons to basic neurophysiology and functional neurology dictate the ongoing need for the neurosurgeon to participate in the evolution of new developments in fundamental neurosciences and their clinical application.
Facial nerve preservation during surgery for removal of acoustic nerve tumors
Authors: Lye Richard H. , Dutton John , Ramsden Richard T. , Occleshaw Joseph V. , Ferguson Iain T. , Taylor Ian
Published: May 2009

✓ A series of 33 patients with 35 acoustic nerve tumors is reviewed. Tumor size was estimated from computerized tomography (CT) scans, and its influence on anatomical and functional preservation of the facial nerve was assessed. Six tumors (one invading the petrous bone, three medium and two large tumors) were not detected on CT scans. The translabyrinthine approach was used in seven instances (one small and six medium tumors) and the suboccipital transmeatal approach for 28 tumors (seven medium and 21 large tumors). Anatomical preservation of the facial nerve was achieved in 83% of operations for tumor removal, two of which were subtotal. A further two patients underwent subtotal removal, but the facial nerve was destroyed. Large tumors carried an increased risk of damage to the facial nerve, but even in this group the nerve was preserved anatomically intact in 70% of cases. Damage to the facial nerve occurred more frequently in patients with preoperative evidence of facial weakness; however, this factor did not appear to influence functional recovery of the facial nerve, provided that the nerve was intact at the end of the operation.

A simple grading system for facial nerve function is described. Only 76% of anatomically intact facial nerves showed any evidence of function 1 month after surgery. Postoperatively, facial function improved with time. At the latest review, 45% of these patients had normal facial function or mild facial weakness (Grades I and II).
Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries
Authors: Aaslid Rune , Markwalder Thomas-Marc , Nornes Helge
Published: May 2009

✓ In this report the authors describe a noninvasive transcranial method of determining the flow velocities in the basal cerebral arteries. Placement of the probe of a range-gated ultrasound Doppler instrument in the temporal area just above the zygomatic arch allowed the velocities in the middle cerebral artery (MCA) to be determined from the Doppler signals. The flow velocities in the proximal anterior (ACA) and posterior (PCA) cerebral arteries were also recorded at steady state and during test compression of the common carotid arteries. An investigation of 50 healthy subjects by this transcranial Doppler method revealed that the velocity in the MCA, ACA, and PCA was 62 ± 12, 51 ± 12, and 44 ± 11 cm/sec, respectively. This method is of particular value for the detection of vasospasm following subarachnoid hemorrhage and for evaluating the cerebral circulation in occlusive disease of the carotid and vertebral arteries.
Traumatic intracranial hemorrhage in children with rare coagulation disorders
Authors: Findler Gideon , Aldor Amiram , Hadani Moshe , Sahar Abraham , Feinsod Moshe
Published: May 2009

✓ Children with rare coagulation disorders are at high risk from intracranial bleeding with even minor head injury. Treatment by transfusion of fresh frozen plasma is limited because of the large volumes required for restoring the missing coagulation factor. Furthermore, even when concentrates of such a factor are available, their use may prove ineffective due to circulating specific antibodies. Three patients with rare coagulation disorders are presented who suffered head injury complicated by intracranial hemorrhage.
Prognosis of severe head injuries
Authors: Levati Anna , Farina Maria L. , Vecchi Giuseppe , Rossanda Marina , Marrubini Marialuisa B.
Published: May 2009

✓ The authors have analyzed retrospectively a series of 288 consecutive patients with severe head injury observed between January, 1977, and May, 1980. Seventy-three patients were excluded as not being compatible with those of the International Data Bank. The remaining 215 patients complied with the definition of coma given by Jennett. All patients, after appropriate cardiopulmonary resuscitation, diagnostic measures, and, when required, surgical treatment, were managed in the Neurosurgical Intensive Care Unit with endotracheal intubation, controlled hyperventilation, mild dehydration, dexamethasone in standard doses, and sedation. The mortality rate was 39.5%. Of the survivors, 59.2% made a good recovery, 18.4% remained moderately disabled, 6.1% were severely disabled, and 1.5% were in a persistent vegetative state. The most reliable predictive criteria were: absence of brain-stem reflexes, neurological status, abnormal motor patterns, arterial hypotension, and presence of mass lesions. It is concluded that no sign has an absolute prognostic value when considered independently of its time course.
The femoral stretching test
Authors: Estridge M. N. , Rouhe Stanley A. , Johnson Neil G.
Published: May 2009

✓ The femoral stretching test is a valuable sign in diagnosing upper lumbar nerve root compression. We believe that it has the same significance for upper lumbar disc herniation as the sciatic stretching test has for the lower.
Spontaneous regression of intracranial arteriovenous malformations
Authors: Omojola Matthew F. , Fox Allan J. , Viñuela Fernando V. , Drake Charles G.
Published: May 2009

✓ This is a report of spontaneous regression of intracranial arteriovenous malformations (AVM's) in three female patients; two of these patients had complete angiographic disappearance of the AVM, including an instance of intimate association of the AVM with an astrocytoma. The AVM's in these two patients were unicompartmental medium- to large-sized lesions supplied by a single feeder and draining principally through one large vein; spontaneous thrombosis is suggested as a cause of the AVM regression. Partial regression in the third patient might have been partially due to embolism from a clot-filled aneurysm on the feeding vessel. The significance of such disappearance of AVM's in relation to persistence or otherwise of the neurological status of these patients is discussed.
Contralateral pterional approach to a carotid-ophthalmic aneurysm ruptured at surgery
Authors: Milenković Zoran , Gopić Hranislav , Antović Pavle , Joviĉić Vitomir , Petrović Budimir
Published: May 2009

✓ During surgery undertaken for a symptomatic middle cerebral artery (MCA) aneurysm, an asymptomatic carotid-ophthalmic artery aneurysm on the contralateral side was inadvertently ruptured. The carotid-ophthalmic aneurysm was clipped successfully via the contralateral pterional approach. The MCA aneurysm was also clipped at the same time.
Ruptured aneurysm at the anterior cerebral artery fenestration
Authors: Yamada Tohru , Inagawa Tetsuji , Takeda Tetsuji
Published: May 2009

✓ Fenestration of the anterior cerebral artery is rare. The authors describe a case of a ruptured aneurysm arising from the proximal end of a fenestration of the anterior cerebral artery. The lesion was demonstrated by angiography and confirmed at surgery.
Benign intracranial hypertension with spinal and radicular pain
Authors: Bortoluzzi Marco , Di Lauro Leonardo , Marini Giovanni
Published: May 2009

✓ A case of benign intracranial hypertension with polyradiculopathy and spinal pain is reported. Radioactive iodinated serum albumin (RISA) cisternography demonstrated the absence of cerebrospinal fluid (CSF) flow into the intracranial cisterns, and gave evidence of CSF absorption through the spinal arachnoid villi.
Growth of hydatid cysts evaluated by CT scanning after presumed cerebral hydatid embolism
Authors: Vaquero Jesús , Jiménez Carlos , Martínez Roberto
Published: May 2009

✓ A case of presumed cerebral hydatid embolism in the course of cardiac surgery for echinococciasis is reported. Follow-up computerized tomography immediately after embolization, and 1 and 5 years later suggested an average growth pattern of 1 cm/year for intracranial hydatid cysts in the adult.
Clinical characteristics and CT findings in lipoma of the cerebellopontine angle
Authors: Graves Virgil B. , Schemm George W.
Published: May 2009

✓ The authors present a rare case of symptomatic lipoma of the cerebellopontine angle, and describe the computerized tomography and operative findings. These are tumors of maldevelopmental origin, and the three cases reported to date have shown many similarities.
Chondroid chordoma
Authors: Clark W. Craig , Robertson Jon H. , Lara Rafael
Published: May 2009

✓ A case of the very rare chondroid variant of chordomas at the base of the skull is presented. The characteristic presentation, radiological and computerized tomographic appearance, findings at surgery, pathology, and treatment of this lesion are discussed. Neurosurgeons should be aware of this variant, due to its predilection for occurrence at the base of the skull and its more favorable prognosis compared with that of typical chordoma.
Spinal cord compression in a new homozygous variant of beta-thalassemia
Authors: Luitjes Willem F. , Braakman Reinder , Abels Johannes
Published: May 2009

✓ A patient is reported with a new genetic variant of beta-thalassemia, who suffered from a progressive partial transverse cord lesion caused by epidural hematopoietic tissue. He recovered after partial surgical removal of this tissue and subsequent radiotherapy.
Enzymatic changes in serum and cerebrospinal fluid in neurological injury
Authors: Bakay Roy A. E. , Ward Arthur A.
Published: May 2009

✓ Enzymatic determinations in serum and cerebrospinal fluid (CSF) of creatine phosphokinase (CPK) and its isoenzymes, lactic dehydrogenase (LDH) and its isoenzymes, and glutamic oxaloacetic transaminase (GOT) were performed on patients with closed head injury with Glasgow Coma Scale (GCS) scores of 3 to 15. The purpose of the work was to study the usefulness of these determinations as a biochemical index of brain injury. Detailed analysis of serum determinations on 139 patients demonstrated a prognostic correlation for only the CPK1 isoenzyme. The presence of the CPK1 isoenzyme correlated with the degree of head injury (as indexed by the GCS) and with the ultimate outcome. Although the presence of the CPK1 isoenzyme was a foreboding sign, it was not consistently present even with severe head injury, and its presence was not invariably associated with poor outcome. Therefore, serum enzymatic determinations have an inadequate sensitivity and specificity for use as an index of neurological trauma.

Fifty-seven patients had CSF enzymatic determinations, and each of the enzymes studied was correlated directly with GCS and with the ultimate outcome. Within the subgroup of severely head-injured patients with a GCS score of 3 to 7, only the CPK1 and LDH1 isoenzymes correlated with the degree of head trauma and outcome. The CPK1 isoenzymes were not detectable in CSF from control patients, but were invariably present following head trauma. These CPK1 isoenzymes in the CSF were particularly useful in that they appeared in the acute course and were subsequently absent unless secondary injury to the brain occurred causing additional neurological damage. Secondary injuries due to delayed hemorrhage, infarction, hypoxia, or pathological evaluations of intracranial pressure were readily detected. The LDH1 isoenzyme is present in the CSF from normal patients and does elevate with neurological trauma; these LDH1 isoenzymes appear to be elevated for a period of weeks to months following injury and thus are less useful in detecting secondary injuries. An attempt was made to investigate the effect of Decadron (dexamethasone) on these enzymatic changes, but no significant effect was identified. Also noted in this study was the presence of CPK1 isoenzymes in the CSF of patients with gunshot wounds to the head, spinal cord injuries, and herniation syndromes. It is concluded, therefore, that CPK1 isoenzymes in the CSF appear to be a specific marker for neurological trauma, and may be of value both in clinical practice and in clinical investigations.
Spinal evoked potentials from the motor tracts
Authors: Levy Walter J.
Published: May 2009

✓ There is a need to monitor the motor system, but it has a different blood supply and a different location in the spinal cord from those measured by traditional somatosensory evoked potential monitoring. This paper reports a motor evoked potential monitoring system that uses direct spinal cord stimulation overlying the areas of the motor tract in the cord. In nine cats, evoked potentials were recorded from the dura, which gave a much faster main signal component than the traditional dorsal column evoked potentials, which were also recorded. This 100-m/sec signal was not affected by sectioning of the dorsal columns, which was verified histologically. This mode of monitoring the motor system can be used during surgery. It may also provide a better evaluation of patients after spinal cord trauma.