bluuebunny/crossref_metadata_2025 huggingface dataset:
Unusual presentation of cervical chordoma with long-term survival
Authors: Shallat Ronald F. , Taekman Michael S. , Nagle Richard C.
Published: May 2009

✓ A 33-year-old woman presented with upper respiratory obstruction due to a posterior pharyngeal mass, which was subtotally resected. The mass was a chordoma arising from the C-2 vertebral body. The patient then remained asymptomatic for 15 years before presenting with signs of cord compression. A chordoma, extending from C-1 to C-4, was again subtotally resected. The unusual biological behavior of this neoplasm is discussed, and a brief review of the pertinent literature is presented.
Salmonella typhi epidural abscess occurring 47 years after typhoid fever
Authors: Herbert David A. , Ruskin Joel
Published: May 2009

✓ A Salmonella typhi epidural abscess developed in a patient 47 years after he had recovered from thyphoid fever. A search of the literature failed to reveal a previous case of epidural abscess due to Salmonella or a comparably long interval between an initial Salmonella infection and a resultant metastatic abscess. It is suggested that Salmonella be considered as the cause of focal central nervous system infection in any patient with previous salmonellosis, regardless of how long the interval between the two infections.
Technical and instrumental improvements in the surgical treatment of acoustic neurinomas
Authors: Sugita Kenichiro , Kobayashi Shigeaki
Published: May 2009

✓ Microsurgical removal of large acoustic neurinomas, more than 3 cm in diameter, has been performed by the lateral suboccipital transmeatal approach with the patient in the lateral position in 68 cases in the past 5 years. Sixty-two patients (91%) returned to their former occupations and two died: one in the immediate postoperative period and the other 16 months later. The postoperative follow-up examination showed satisfactory facial nerve function in 70% of the patients. Hearing was preserved in six of 14 patients who had preoperatively retained their auditory function. The authors emphasize the usefulness of bipolar forceps for intraoperative stimulation of the facial nerve and for facial muscle monitoring. The value of the four-pronged hook and the multipurpose head-frame in this procedure is also discussed.
Delayed pulmonary dysfunction in head-injured patients
Authors: Popp A. John , Shah Dhiraj M. , Berman Richard A. , Paloski William H. , Newell Jonathan C. , Cooper Jeffrey A. , Rahm Robin L. , Gottlieb Marc E. , Bourke Robert S. , Malik Asrar B.
Published: May 2009

✓ Intracranial pressure (ICP), cardiopulmonary function, and the degree of neurological dysfunction were measured in 13 patients with serious head injury to determine the relationship of these indices to the development of delayed pulmonary dysfunction. All patients had serious isolated head injury with Glasgow Coma Scale scores of 7 or less 6 hours after injury, and elevated ICP at the time of admission to the protocol. Three patients developed arterial pO2 of ≤ 80 torr despite the initiation of elevated inspired oxygen fraction (FIO2 ≥ 0.5) and positive end expiratory pressure (≥ 5 cm H2O). One of these three patients had a decline in neurological function, quantified by the Albany Head-Injury Watch Sheet, associated with hypoxemia. The only patients who developed intrapulmonary shunt fractions of more than 15% were five patients who had increased pulmonary vascular resistance (PVR) and elevated or increasing cardiac index, suggesting persistent perfusion to areas of the lung which normally are hypoperfused due to hypoxic pulmonary vasoconstriction. This mismatching of the distribution of ventilation and perfusion was confirmed using the multiple inert gas elimination technique in two patients with an increased shunt fraction. Unperfused gas exchange units were also found to be present, as confirmed by an abnormal multiple inert gas elimination technique, high PVR and dead space/tidal volume ratio (VD/VT), and low extravascular lung water. Abnormalities of ICP and cerebral perfusion pressure could not be correlated with changes in any of the cardiopulmonary functions studied.
Hemorrhagic encephalitis produced by selective non-occlusive intracarotid BCNU injection in dogs
Authors: Omojola Matthew F. , Fox Allan J. , Auer Roland N. , Viñuela Fernando V.
Published: May 2009

✓ A selective non-occlusive technique was developed for administration of BCNU (1,3-bis(2-chloroethyl)-1-nitrosourea) into the internal carotid artery of the dog, and the neuropathological effects in the brain were studied. One out of three dogs showed ipsilateral hemorrhagic necrotizing encephalitis at doses of 102 mg/sq m, and all of three dogs showed similar but more severe pathology at doses of 215 to 232 mg/sq m. This study and previous studies in the dog and monkey suggest definite thresholds above which cerebral toxicity occurs when BCNU is administered via the intracarotid route. Greater dilution of drug in the larger territory of supply of the human internal carotid artery allows somewhat higher doses in man. The pathology of the lesion induced by BCNU suggests a primary vascular injury as a pathogenic mechanism, consonant with similar findings following high-dose systemic BCNU administration in man. Investigators conducting ongoing and future trials of intracarotid BCNU in the human for the treatment of intracranial neoplasms should be especially vigilant for a similar toxic effect.
Ventricular size and isotope cisternography in patients with acute transient rises of intracranial pressure (plateau waves)
Authors: Hayashi Minoru , Kobayashi Hidenori , Fujii Hiroyuki , Yamamoto Shinjiro
Published: May 2009

✓ The size of the ventricular system and cerebrospinal fluid (CSF) flow were determined in 17 patients with plateau waves, using computerized tomography (CT) and isotope cisternography. Some patients had increased intracranial pressure (ICP) resulting from space-occupying lesions and other causes, and some had normal ICP observed in normal-pressure hydrocephalus. The size and shape of the ventricular system during plateau wave phases as ascertained by CT showed little or no change as compared with its size and shape during the interval phases between two waves. It was also noticed that, in patients with supratentorial masses, the midline shift showed no difference in degree between the two phases. These findings suggest that there is little change in the intracranial CSF volume between the two phases, that is, there is little compensatory outflow of the intracranial CSF for the ICP variations. These results may also support the assumption that the plateau waves are not caused by an intermittent obstruction of the CSF pathways. Isotope cisternography showed a marked delay of clearance of radioactivity from the intracranial CSF in 15 patients. The cisternographic pattern in patients with increased ICP and the absence of ventricular dilatation demonstrated an abnormally large accumulation of radioactivity over the cerebral convexities, and the pattern in patients with normal-pressure hydrocephalus showed complete obstruction of the subarachnoid space over both cerebral convexities. These observations suggest that, in patients with plateau waves, there is a marked delay in CSF absorption. The authors postulate that the reduction of CSF absorption may create a critically tight condition within the cranial cavity and act as a contributory factor in the development of the plateau waves.
Spinal cord meningioma
Authors: Levy Walter J. , Bay Janet , Dohn Donald
Published: May 2009

✓ The authors present a retrospective analysis of 97 cases of spinal meningioma. Age, sex, tumor location, and clinical presentation are similar to that reported by others. Importantly, even among paraplegic patients, one-third eventually walked. Other findings of note were poor results among those with calcified or recurrent tumors, and a high incidence of invasiveness among the rare epidural lesions. Males do not show the preference for a thoracic location that is found among females, and cervical tumors are almost all anterior to the cord. This last point suggests a different surgical approach in some cases. A large percentage of cases carried other diagnoses before tumor was recognized.
Preservation of large bridging veins during brain retraction
Authors: Sugita Kenichiro , Kobayashi Shigeaki , Yokoo Akiro
Published: May 2009

✓ The authors describe a method for preserving large bridging veins during neurosurgical procedures by stripping them from the cortex. This technique was used in 81 procedures involving a subtemporal, interhemispheric, infratentorial supracerebellar, and transsylvian approach. Although a small amount of the cortex was often sacrificed, preservation of the vein was easy, and postoperative morbidity was minimized.
Ultrasound sector scanning for the localization and biopsy of intracerebral lesions
Authors: Sjölander Ulf , Lindgren Per Gunnar , Hugosson Rune
Published: May 2009

✓ A technique is described for the intraoperative use of ultrasound sector scanning in intracerebral neoplasms (mainly gliomas) for biopsy and for the localization of minor lesions. Altogether, 13 patients underwent sonographic examination: nine had gliomas, one had a meningioma, and three had metastases. Through a trephine hole or a bone flap over the tumor, the ultrasound transducer easily localized the lesion in all cases but one. The striking concordance between the sonogram and the corresponding computerized tomography scan made it easy to take several biopsies from areas where the tumor tissue was suspected to be representative. The results show a close correlation between the biopsy specimen and the specimen obtained at extirpation. In two cases, ultrasonic scanning served as an aid for the surgeon in localizing the tumor prior to removal.
A clinical comparison of subdural screw pressure measurements with ventricular pressure
Authors: Mendelow A. David , Rowan John O. , Murray Lilian , Kerr Audrey E.
Published: May 2009

✓ Simultaneous recordings of intracranial pressure (ICP) from a single-lumen subdural screw and a ventricular catheter were compared in 10 patients with severe head injury. Forty-one percent of the readings corresponded within the same 10 mm Hg ranges, while 13% of the screw pressure measurements were higher and 46% were lower than the associated ventricular catheter measurements. In 10 other patients, also with severe head injury, pressure measurements obtained with the Leeds-type screw were similarly compared with ventricular fluid pressure. Fifty-eight percent of the dual pressure readings corresponded, while 15% of the screw measurements were higher and 27% were lower than the ventricular fluid pressure, within 10-mm Hg ranges. It is concluded that subdural screws may give unreliable results, particularly by underestimating the occurrence of high ICP.
Observer variability in assessing the clinical features of subarachnoid hemorrhage
Authors: Lindsay Kenneth W. , Teasdale Graham M. , Knill-Jones Robin P.
Published: May 2009

✓ Clinical assessment of patients with subarachnoid hemorrhage (SAH) is important both in determining management and in predicting outcome. A previous report showed considerable observer inconsistency when patients were graded with either the Hunt and Hess or the Nishioka system. This study evaluates observer variability in assessment of the individual clinical features from which these grading systems are derived. Assessment of the presence or absence of neck stiffness caused least inter-observer variability. Headache caused most variability, due to difficulty in grading its severity. Determination of the severity of a neurological deficit proved more reliable than deciding whether or not a deficit was present. The terms used to describe the level of consciousness in the Hunt and Hess and Nishioka systems were found to be significantly less consistent than the Glasgow Coma Scale. The authors suggest that when patients with SAH are assessed it is necessary to take into account the consistency with which observers can record a clinical feature, as well as its prognostic importance.
Peripheral aneurysms of the cerebellar arteries
Authors: Gács Gyula , Viñuela Fernando , Fox Allan J. , Drake Charles G.
Published: May 2009

✓ True congenital peripheral aneurysms of the cerebral arteries are rare and may constitute a special group. The authors report on 16 cases of peripheral aneurysms of the cerebellar arteries; six of them arising from vessels feeding arteriovenous malformations (AVM's). The possible causative role of increased blood flow versus developmental factors in the frequent occurrence in cases of AVM of this otherwise rare type of aneurysm is discussed. In five of the six cases with AVM's (one dural and five parenchymal), the aneurysm rather than the AVM proved to be the source of the hemorrhage. The occurrence of spasm was in inverse proportion to the distance of the aneurysm from the main arteries. The surgical result was good in 11 cases. One patient with associated AVM died, and four patients had residual symptoms.
Cerebral and systemic circulatory effects of arterial hypotension induced by adenosine
Authors: Kassell Neal F. , Boarini David J. , Olin Julie J. , Sprowell James A.
Published: May 2009

✓ In six dogs anesthetized with halothane and nitrous oxide, mean arterial pressure (MAP) was lowered to 40 mm Hg for an average of 90 minutes by intravenous infusion of adenosine. The hypotensive effect of the adenosine was potentiated by administering dipyridamole to block its intravascular inactivation. Blood flow to the brain, spinal cord, heart, kidneys, and skeletal muscle was measured six times in each animal using the radioactive microsphere technique. Determinations were made before, during, and 30 minutes after the hypotensive period.

During the hypotensive period, MAP was decreased 61% and was related to a proportional decrease in peripheral vascular resistance. Cardiac index decreased 14%. Total cerebral blood flow (CBF) decreased an average of 28% and cerebral vascular resistance decreased 53%. The reduction in CBF was heterogeneous; the cerebral cortex and corpus callosum were most affected and the brain stem least affected. No change occurred in the cerebral metabolic rate of oxygen usage (CMRO2). Left ventricle flow increased 147% and right ventricle flow increased 271%. Blood flow to the kidneys decreased 70%, and to the liver decreased to 6% of control. Jejunum blood flow increased 138% during recovery, while stomach flow varied but showed no statistical change. There was no tachyphylaxis, rebound hypertension, or toxicity associated with the adenosine-induced hypotension. These properties suggest that adenosine may be a useful agent for inducing arterial hypotension in neurosurgical patients.
Experimental craniosynostosis in growing rabbits
Authors: Nappen Dennis L. , Kokich Vincent G.
Published: May 2009

✓ Reports on the role of the periosteum in premature sutural synostosis have been contradictory. The present study summarizes a series of six experiments designed to clarify these previously conflicting findings. Twenty-five male New Zealand White rabbits were divided into six experimental groups. In four of the groups, methyl-2-cyanoacrylate was used to glue the frontal and parietal bones together and temporarily immobilize the coronal suture. In the other two groups, the sutures were not immobilized. Polyethylene was used to separate the cyanoacrylate from the periosteum in two of the groups. The experiments were performed at 5 weeks of age, and the animals were killed at either 30, 45, or 180 days postoperatively. Metallic implants were placed in the frontal and parietal bones for monitoring growth and/or sutural immobilization. Sutural fusion was confirmed radiographically or histologically. Based upon the findings it seems that mechanical immobilization of a suture does not induce fusion of that suture in rabbits. Furthermore, it appears that the mere application of methyl-2-cyanoacrylate to the periosteum overlying a suture will consistently cause the formation of a bony bridge in growing rabbits but not in nongrowing animals. The adhesive does not consistently induce synostosis if the periosteum is excised.
Cerebral angiitis and intracerebral hemorrhage associated with methamphetamine abuse
Authors: Yu Young J. , Cooper David R. , Wellenstein David E. , Block Brian
Published: May 2009

✓ A case of reversible cerebral angiitis and intracerebral hemorrhage is reported in a methamphetamine abuser. Characteristic radiographic changes were demonstrated by selective cerebral angiography and computerized tomography. These vascular abnormalities disappeared after 1 month of treatment with prednisone, during which time the patient denied further drug abuse.
Ruptured aneurysm of the anterior spinal artery associated with pseudoxanthoma elasticum
Authors: Kito Kenichi , Kobayashi Naotoshi , Mori Nobuhiko , Kohno Hiroshi
Published: May 2009

✓ An aneurysm of the anterior spinal artery associated with pseudoxanthoma elasticum is reported. This aneurysm was demonstrated by selective spinal angiography.
Suppression of cortisol secretion by low-dose dexamethasone testing in Cushing's disease
Authors: King Lucille W. , Post Kalmon D. , Yust Israel , Reichlin Seymour
Published: May 2009

✓ Pituitary-adrenal function in a patient with classical features of Cushing's disease, increased urinary excretion of cortisol, and documented pituitary adenoma was found to be suppressed by dexamethasone in doses even less than those required to inhibit secretion in normal individuals. This response was shown to be due to inappropriately high levels of dexamethasone in plasma, presumed to be the consequence of decreased peripheral clearance. Because the dexamethasone suppression test is so widely used for diagnosis of Cushing's disease, it is important to recognize that this situation can occasionally occur.
Suprasellar germinoma in association with Klinefelter's syndrome
Authors: Ahagon Asamitsu , Yoshida Yasuaki , Kusuno Koji , Uno Toshiro
Published: May 2009

✓ A case is presented of suprasellar germinoma in a 20-year-old man with Klinefelter's syndrome. Hypogonadism is known to be a characteristic of Klinefelter's syndrome, and has often been described in cases of suprasellar germinoma. Thus, both pathological entities may mimic one another. It is emphasized that a chromosomal karyotype should be determined in every case of intracranial germ-cell tumor associated with hypogonadism.
Lateral sinus pericranii
Authors: Vaquero Jesús , de Sola Rafael G. , Martínez Roberto
Published: May 2009

✓ A case of lateral sinus pericranii in a 49-year-old woman is presented. These extraordinarily rare lesions should be considered in the differential diagnosis of epicranial tumors. The lack of filling on external carotid artery angiograms may lead to the error of dismissing the possibility of a vascularized lesion.
Infratentorial approach to the pineal region in the prone position: Concorde position
Authors: Kobayashi Shigeaki , Sugita Kenichiro , Tanaka Yuichiro , Kyoshima Kazuhiko
Published: May 2009

✓ The authors present a new technique for surgery in the pineal region: a supracerebellar approach with the patient in the prone position. The surgeon sits on the left side of the patient, who lies prone with the head flexed and higher than the heart level (“Concorde position”). The main advantages of this arrangement over the sitting position include less fatigue on the part of the surgeon and decreased likelihood of air embolism. Fourteen patients have been operated on in this position. Pooling of blood in the operating field is rarely a problem.
A critical appraisal of “terminal ventriculostomy” for the treatment of syringomyelia
Authors: Williams Bernard , Fahy Gerald
Published: May 2009

✓ The clinical course of 31 patients who underwent attempted excision of the filum terminale and tip of the conus for syringomyelia is summarized. Of these patients, 17 had had some previous surgical intervention. Eleven patients were continuing to deteriorate at the time of the operation. In three cases, marked postoperative improvement was reported, and objective improvement was thought to result from the conus excision. Eighteen more patients claimed improvement in their preoperative symptoms of loss of pain sensibility, deafness, or reduced motor function, although most of such claims were unverified by objective clinical assessment. Sixteen of the patients who improved have since proceeded to deteriorate. In five of the patients, there was a long-standing improvement of at least subjective phenomena. Thirteen patients were not improved even subjectively and some of these have continued to grow worse. Proof that the greater part of the syrinx was in communication with the conus or filum was difficult to obtain even when the conus was dilated. No correlations have been found to suggest that the operation might be more effective if the central canal was patent at the conus or the filum, nor was there a correlation between a good clinical result and either the age of the patient or the age of the syrinx as judged by the history. The operation did not seem to be more or less beneficial if previous surgery had been performed. The suggestion is made that for syringomyelia with hindbrain abnormalities, other than dense arachnoiditis (particularly if there is evidence of pressure dissociation at the foramen magnum), craniovertebral decompression remains the procedure of choice. In syringomyelia with marked hydrocephalus, drainage by a valved shunt may be the preferred first procedure. If myelotomy is planned it should probably be done where the syrinx is wide, and it is more likely to succeed if the syrinx is drained to a low-pressure area outside the theca, such as the peritoneum or pleura, rather than the subarachnoid space.
Intraventricular hemorrhage in severe head injury
Authors: Cordobés Francisco , de la Fuente Marina , Lobato Ramiro D. , Roger Ricardo , Pérez Carlos , Millán Jose M. , Bárcena Alejandro , Lamas Eduardo
Published: May 2009

✓ A series of 30 patients suffering posttraumatic intraventricular hemorrhage (IVH) after closed head injury is reviewed. Clotted blood and a mixture of blood and cerebrospinal fluid could be distinguished by computerized tomography (CT). Posttraumatic IVH was associated with diffuse brain lesions in most cases; intracerebral lesions with contusion, and subdural hematomas coexisted with posttraumatic IVH in eight and four instances, respectively. In two more cases, no CT abnormality other than IVH was noted. All patients in this series were in deep coma at the time of CT examination, and only seven survived. The early clinical findings, the site of ventricular hematoma, and the final outcome are analyzed.
Failure of prophylactically administered phenytoin to prevent early posttraumatic seizures
Authors: Young Byron , Rapp Robert P. , Norton J. A. , Haack Dennis , Tibbs Phillip A. , Bean James R.
Published: May 2009

✓ A randomized double-blind placebo-controlled study was carried out to determine whether phenytoin administered soon after injury lessens the incidence of epilepsy in the 1st week after severe head trauma. In this study, 244 patients were randomized into either a phenytoin or placebo group. The patients in the phenytoin group were administered phenytoin intravenously or intramuscularly within 24 hours of hospital admission. Patients in the placebo group received intravenous or intramuscular diluent. The patients were switched from parenterally administered phenytoin or placebo as soon as oral doses could be tolerated. Over 78% of the phenytoin patients had plasma concentrations of at least 10 µg/ml at 1, 3, and 7 days after injury. There was no significant difference in the percentage of patients having early seizures in the treated and placebo groups (p = 0.99). There was no significant difference in the interval from injury to first seizure between the treated and placebo groups (p = 0.41). The early administration of phenytoin did not lessen the occurrence of seizures in the 1st week after head injury. Since the effectiveness of seizure prophylaxis has not been established, the authors suggest that anticonvulsant drugs be administered only after an early seizure has occurred.
Factors affecting coagulation: fibrinolysis in chronic subdural fluid collections
Authors: Weir Bryce , Gordon Philip
Published: May 2009

✓ Plasminogen, alpha2-antiplasmin, fibrinogen, fibrin degradation products (FDP's), and hemoglobin were measured in the supernatant fluid of 25 chronic subdural hematomas and five chronic subdural hygromas. The 30 patients underwent pre- and postoperative computerized tomography. The hematomas were characterized by low fibrinogen and high fibrin degradation product concentrations. The hemoglobin content varied directly with the alpha2-antiplasmin, and inversely with the plasminogen. Four patients underwent reoperation for recurrences. The initial fluid from these cases was characterized by relatively high plasminogen and low alpha2-antiplasmin. The hygromas had no hemoglobin, and low fibrinogen, high FDP's, low alpha2-antiplasmin, and variable plasminogen levels. It is possible that those cases having the greatest capacity to produce plasmin (high plasminogen and low alpha2-antiplasmin) can produce more FDP's which in turn causes more rebleeding and an increased risk of reaccumulation of chronic subdural hematomas.
Use of free latissimus dorsi musculocutaneous flaps in various neurosurgical disorders
Authors: Barrow Daniel L. , Nahai Foad , Fleischer Alan S.
Published: May 2009

✓ Musculocutaneous (skin-muscle) flaps have been used predominantly by plastic surgeons for a variety of reconstructive purposes. With the advent of microvascular techniques, the area to be reconstructed is no longer limited to the arc of rotation of the vascular pedicle of the muscle. Instead, the muscle and overlying skin that is best suited for the reconstructive procedure may be dissected out as a free flap, with microvascular anastomosis of an arterial supply and venous drainage to locally existing vessels.

This report demonstrates the usefulness of musculocutaneous free flaps in the repair of large defects of the scalp, cranium, and dura after trauma or resection of invasive neoplasms. The authors describe the use of a latissimus dorsi free musculocutaneous flap in eight patients who would have required multiple operations to provide coverage by other techniques. There have been no major complications, and adequate repair has been accomplished, even in cases involving exposed brain.
Multiple secreting microadenomas as a possible cause of selective transsphenoidal adenomectomy failure
Authors: Woosley Ronald E.
Published: May 2009

✓ Approximately 10% to 20% of patients who undergo selective transsphenoidal removal of secreting microadenomas fail to achieve a cure. One of the possible causes of these failures is multiple adenomas. A case history is presented of two microadenomas within the same gland, and the multiplicity of pituitary adenomas is discussed.
Sciatic nerve entrapment
Authors: Søgaard Ib
Published: May 2009

✓ A case is presented of compression of the sciatic nerve at the back of the thigh. For 3 years after a minor injury, this patient had suffered from pain and paresthesia in the left leg. There were no neurological abnormalities; electromyography was performed twice and showed normal muscular activity. At operation the nerve was found to be rotated and compressed by a tough band of connective tissue. Postoperatively, all discomfort disappeared, and 5 months later the patient remained free of pain.
Nevus of Ota associated with meningeal melanosis and intracranial melanoma
Authors: Sagar Harvey J. , Ilgren Edward B. , Adams Christopher B. T.
Published: May 2009

✓ A case is reported of a patient in whom an intracranial extracerebral melanoma developed in association with a life-long nevus of Ota. Melanotic pigmentation of the skull, periosteum, and meninges beneath the nevus was found at operation.
Traumatic intracranial aneurysm due to arterial injury at surgery
Authors: Rees Cosgrove G. , Villemure Jean-Guy , Melançon Denis
Published: May 2009

✓ A case is presented of false intracranial aneurysm of traumatic origin which developed following direct surgical attack on a congenital anterior communicating artery aneurysm. The secondary aneurysm was discovered on the 25th postoperative day and was clipped at a subsequent procedure. The possible pathophysiology is discussed with respect to other direct vessel injuries.
The role of neomembranes in formation of hematoma around Silastic dura substitute
Authors: Adegbite Andrew B. , Paine Kenneth W. E. , Rozdilsky Bohdan
Published: May 2009

✓ The authors report the formation of a hematoma within the neomembranes encasing a Silastic dura substitute, simulating recurrence of a convexity meningioma.
Agreement between physicians on assessment of outcome following severe head injury
Authors: Maas Andrew I. R. , Braakman Reinder , Schouten Hubert J. A. , Minderhoud Jan M. , van Zomeren Adriaan H.
Published: May 2009

✓ This study describes inter-observer agreement between physicians and consistency of one observer on repeated scoring in the assessment of outcome 6 to 12 months after severe head injury. Observer agreement is expressed by Kappa, taking chance agreement into account. The study was conducted in “live” and “non-live” situations, using five- and eight-category outcome scales. Kappa values were considerably higher when the five-category scale was used. However, even with the five-category scale, disagreement was considerable, and the results indicate that accurate predictions of the quality of survival will be difficult to attain. Observer agreement should be taken into account in prognosis studies, and when different therapeutic regimens are evaluated on the basis of outcome.
In vivo characterization of vasocontractile activities in erythrocytes
Authors: McIlhany Michael P. , Johns Lydia M. , Leipzig Thomas , Patronas Nicholas J. , Brown Frederick D. , Mullan Sean F.
Published: May 2009

✓ Partially purified protein from washed and artificially hemolyzed erythrocytes, known to cause significant contractions of isolated canine cerebral vessels in vitro, was injected into the cisterna magna of intact anesthetized dogs. Cerebral blood flow, measured by the xenon-133 washout technique, decreased from a control value of 49.5 ± 1.17 ml/100 gm/min to an experimental value of 34.1 ± 1.65 ml/100 gm/min at 2 hours. Cerebral vascular resistance rose from a control value of 2.05 ± 0.17 PRU (peripheral resistance units) to an experimental value of 2.91 ± 0.25 PRU at 2 hours. Mean arterial blood pressure, heart rate, intracranial pressure, and cerebral perfusion pressure remained stable. Cardiac output also fell significantly (in 2-hour control animals it was 2.89 ± 0.37 liter/min, and in 2-hour experimental animals 1.43 ± 0.13 liter/min) and peripheral vascular resistance rose. These changes were evident by 10 minutes after the cisternal injection of the hemolysate protein, and remained for the duration of the 2-hour monitoring period. Serial vertebrobasilar angiograms demonstrated marked narrowing of the intracranial basilar artery when compared to control values. The narrowing persisted for several days in most animals, and tended to increase with time. Relaxation occurred by the 10th through the 14th day. The authors conclude that this experimental preparation may be a useful model for both in vitro and in vivo investigation of chronic cerebral vasospasm.
Improved treatment of a brain-tumor model
Authors: Gerosa Massimo A. , Dougherty Dolores V. , Wilson Charles B. , Rosenblum Mark L.
Published: May 2009

✓ A combination chemotherapy regimen for brain tumors was developed, based on investigations of the survival of animals harboring the intracerebral 9L rat brain-tumor model and on analyses of their clonogenic tumor cells. Fischer 344 rats harboring 9L brain tumors were treated with 2-day courses of 5-fluorouracil (5-FU), in order to expose all cycling tumor cells to the drug during DNA synthesis and achieve maximum anti-tumor activity for this cell-cycle-specific anti-metabolite. Although a 74% cell kill was obtained for a total dose of 45 mg/kg or greater, animal life span was not increased over that of untreated tumor-bearing controls. However, when 5-FU (48 to 96 mg/kg total dose over 2 days) was administered after a single LD10 dose of BCNU (13.3 mg/kg), additive cell kill was suggested. In three large series, long-term animal survivors and occasional tumor cures were observed with this drug combination, a result never observed following BCNU alone. Schedule dependency was not apparent. A previously published protocol for treating recurrent malignant gliomas with sequential courses of BCNU and 5-FU was partially planned based upon these initial observations. Anti-tumor activity with the combination of drugs was superior to therapy with BCNU alone. Both animal and human studies confirm that, contrary to presently accepted oncological tenets, a chemotherapeutic agent that kills significant numbers of tumor cells but is clinically ineffective when given alone might, nevertheless, be useful in combination therapy regimens.
Psychosocial and cognitive function after commissurotomy for intractable seizures
Authors: Ferrell Richard B. , Culver Charles M. , Tucker Gary J.
Published: May 2009

✓ Cerebral commissurotomy appears to be an effective treatment for persons with severe epilepsy that has not responded to pharmacological treatment. Psychosocial and neuropsychological evaluation of eight patients who have received this surgical treatment suggests that patients who have an uncomplicated operative and postoperative course do not experience functionally significant intellectual, emotional, or social impairment. Limiting the operation to extraventricular division of the corpus callosum may significantly reduce postoperative morbidity. The authors suggest ethical guidelines which they believe should be carefully followed when epileptic patients are being considered for this type of surgery.
Subdural empyema and epidural abscess in children
Authors: Smith Harold P. , Hendrick E. Bruce
Published: May 2009

✓ From January 1, 1954, through December 31, 1981, 31 children were treated at The Hospital for Sick Children in Toronto, Ontario, for subdural empyema (22 cases), epidural abscess (6 cases), and infected nidi at both subdural and epidural sites (3 cases). All but four of the children with subdural empyema were from 6 months to 2 years of age or from 12 years to 16 years of age; all children with epidural abscess fitted into the older age group. The subdural empyemas developed from varied sources, but the paranasal sinuses, the ears, and the mastoids processes were predominantly affected. Five subdural empyemas developed following craniotomy or shunt procedures. The epidural abscesses developed mostly from infections in the paranasal sinuses and the middle ears. Two of the combined infections developed from the paranasal sinuses; the third followed craniotomy. The infecting bacteria varied, but were usually Streptococci and were common to both the subdural and epidural sites. The subdural empyemas presented as focal seizures in the older group, and that group of patients was more seriously ill and had greater focal deficit; the mortality rate was 13%. Epidural abscesses only rarely presented with focal deficit, and diagnosis was delayed in most instances; no deaths occurred in this group. Two cases are reported in detail to illustrate the principles and pitfalls of surgical management of these intracranial infections in the pediatric age group.
A mixed functional microadenoma and ganglioneuroma of the pituitary fossa
Authors: Burchiel Kim J. , Shaw Cheng-Mei , Kelly William A.
Published: May 2009

✓ The authors describe a case of a mixed prolactin- and somatotropin-secreting pituitary adenoma and ganglioneuroma of the pituitary fossa in a patient with galactorrhea, hyperprolactinemia, and headaches. Histological and electron microscopic findings were typical for each element of the tumor, but the finding of a ganglioneuroma within the pituitary fossa is unusual; even more unusual was its proximity to an apparently unrelated tumor in the same location. The clinical, radiological, endocrinological, and pathological findings are discussed.
Treatment of a high extracranial carotid artery aneurysm with CCA-MCA bypass and carotid ligation
Authors: Ausman James I. , Pearce Jeffrey E. , de los Reyes R. A. , Schanz George
Published: May 2009

✓ This article describes a patient who presented with a developmental aneurysm of the internal carotid artery. Because the aneurysm extended from the carotid bifurcation to the base of the skull, direct arterial reconstruction was precluded. A common carotid artery (CCA) to middle cerebral artery bypass was performed with a saphenous vein graft, followed by gradual occlusion of the distal CCA. The operative technique and a review of the treatment for high cervical carotid aneurysms are presented.
Migration of detachable mini-balloon from the ICA causing occlusion of the MCA
Authors: Langford Keith H. , Vitek Jiri J. , Zeiger Evan
Published: May 2009

✓ This patient had an aneurysm on the internal carotid artery that was responsible for episodes of severe hemorrhage through the nose. During occlusion of the aneurysm by a detachable balloon, the balloon became dislodged and migrated, obstructing the middle cerebral artery territory and causing a life-threatening situation. This was treated promptly and successfully by removal of the balloon and repair of the artery. Attention is drawn to the risk of such migration occurring, and the possible causes.
Atlantoaxial dislocation associated with neurofibromatosis
Authors: Isu Toyohiko , Miyasaka Kazuo , Abe Hiroshi , Ito Terufumi , Iwasaki Yoshinobu , Tsuru Mitsuo , Kitaoka Kenichi , Tsunoda Minoru
Published: May 2009

✓ Atlantoaxial dislocation was found in three patients with neurofibromatosis. Roentgenographic findings included marked reduction of sagittal diameter at the C-1 vertebral level, and cervical spine abnormalities associated with mesodermal dysplasia, such as posterior scalloping of the cervical spinal bodies with dural ectasia and vertebral body deformity (vertebral body dysplasia). Although the relationship of the atlas and axis did not change with neck position, all three patients had progressive neurological deficits and were treated by decompressive surgery combined with fusion. The pathogenesis of atlantoaxial dislocation associated with neurofibromatosis is discussed.
Intraventricular hemorrhage from ruptured aneurysm
Authors: Mohr Gerard , Ferguson Gary , Khan Moe , Malloy David , Watts Reginald , Benoit Brien , Weir Bryce
Published: May 2009

✓ Intraventricular hemorrhage (IVH) from aneurysm rupture is generally considered to be of grave prognostic significance. Ninety-one cases have been studied retrospectively from seven medical centers. The overall mortality rate was 64%. The dramatically poor condition of these patients leads to their rapid admission to the hospital. Eighty-seven percent were admitted on Day 0 or 1, and more than half were classified neurologically as Grade 4 or 5. A multiple regression analysis explained 56% of the variance in survival, using the variables of ventriculocranial ratio (VCR), day of admission, diastolic blood pressure, location of aneurysm, associated intracerebral hematoma, age, grade on admission, sex, and systolic blood pressure. No patient with a VCR of more than 0.25, as calculated from the initial computerized tomography (CT) scan, survived. No patient whose smallest VCR was 0.23 or more survived. This ratio can be simply measured with a millimeter ruler from the CT scan. Patients with IVH usually had enlarged ventricles, even initially. The overall results suggest that early management of intracranial hypertension should be more generally considered, although even when this was done the prognosis was still guarded. The timing of surgery was not an important determinant of outcome, although a significant number of patients died awaiting surgery.
Comparison of middle cerebral artery trunk occlusion by silicone cylinder embolization and by trapping
Authors: Okada Yoshikazu , Shima Takeshi , Yokoyama Noboru , Uozumi Tohru
Published: May 2009

✓ The authors produced occlusion of the middle cerebral artery (MCA) trunk in dogs by two methods: silicone cylinder embolization and trapping. Comparative analyses of the clinicopathological features in these models, extending from the acute to chronic stage, were performed.

Within 24 hours after embolization, the brain exhibited swelling without macroscopic infarction. Microangiograms revealed impaired filling in the deep areas of the brain with midline shift. At 4 to 7 days after embolization, the animals showed major neurological deficits, evident deep cerebral infarction, and poorly perfused areas in the deep cerebrum with prominent midline shift. At 3 to 4 weeks after embolization, the neurological deficits improved and the affected regions showed cavities or localized lesions. Microangiograms demonstrated hypervascular areas with abnormal vessels in the affected cerebrum. On the other hand, trapping of the MCA trunk produced mild neurological deficits, although there was no evidence of macroscopic lesions or impairment of filling. This study shows that silicone cylinder embolization in the MCA trunk produces a reliable and reproducible deep cerebral infarction in dogs.
Uptake and elimination of methylprednisolone from contused cat spinal cord following intravenous injection of the sodium succinate ester
Authors: Mark Braughler J. , Hall Edward D.
Published: May 2009

✓ The uptake and elimination of methylprednisolone by the injured cat lumbar spinal cord were examined following a single 30-mg/kg intravenous bolus injection of the sodium succinate ester. The findings were considerably different from those previously reported for normal lumbar cord. When the glucocorticoid was administered 30 minutes after a 400 gm-cm contusion injury, peak tissue concentrations in both injured and uninjured segments of traumatized spinal cord were not achieved until 30 minutes following drug administration. The elimination of methylprednisolone from injured spinal cord tissue was biphasic in nature, with a rapid elimination phase occurring between 1 and 2 hours after drug administration. This rapid elimination phase was followed by a slower phase which paralleled the constant elimination rate from uninjured tissue of traumatized cord (approximate half-time = 6 hours). Significantly more methylprednisolone accumulated in the injured segment of traumatized spinal cord than in an uninjured segment adjacent to the injury site. This was only true, however, if the drug was administered at times up to 1 hour after injury. If injected after 1 hour, uptake by the injured segment decreased significantly with time after trauma and was no different from that observed for the uninjured segment in the same animal, which showed no significant variation with time after trauma. The probable basis for these differences and the possible clinical implications of these pharmacokinetic characteristics are discussed.
Medulloblastoma: clinical presentation and management
Authors: Park Tae Sung , Hoffman Harold J. , Hendrick E. Bruce , Humphreys Robin P. , Becker Laurence E.
Published: May 2009

✓ The authors review the cases of 144 children with medulloblastoma treated between 1950 and 1980. Duration of time between onset of symptoms and initial treatment was less than 1½ months in 51% of cases, and less than 3 months in 76%. The tumor was located in the cerebellar vermis in 93% of patients. Brainstem infiltration was noted in 32%. Classical medulloblastomas comprised 82% of the total number reviewed, and desmoplastic medulloblastomas 15%. The majority of desmoplastic medulloblastomas were found in the midline of the cerebellum and in patients under 10 years of age. The prognosis for patients with desmoplastic medulloblastomas was worse than that for children with classical medulloblastomas. Spontaneous hemorrhage associated with primary or recurrent medulloblastoma occurred in 5.6% of the patients. Supratentorial metastases were found in 14.6% of cases, spinal cord metastases in 12.5%, and systemic metastases in 9%. The overall 5-year survival rate was 47%, and the 10-year survival rate 42%. Extent of surgical excision proved to be a statistically significant prognostic factor. Two patients developed recurrence after the “period of risk” as defined by Collins' rule. Delayed complications of radiotherapy were found to be substantial. Intelligence quotient (IQ) testing on 16 survivors revealed verbal IQ, performance IQ, and full-scale IQ to be within the normal range in 11, seven, and nine cases, respectively. Two were retarded on all scores.
Determination of CSF shunt patency with a lumbar infusion test
Authors: Schutz Hart , Ter Brugge Karel G. , Chiu Ming C. , Mongul Angele , Taylor Ferelith
Published: May 2009

✓ The authors report on the potential role of the lumbar infusion technique in the determination of cerebrospinal fluid (CSF) shunt patency. The test was performed in a series of 12 patients and reliably predicted shunt patency. This method of assessment proved to be superior to computerized tomography scanning because of its ability to demonstrate the CSF dynamics rather than the ventricular size.
The oval pupil: clinical significance and relationship to intracranial hypertension
Authors: Marshall Lawrence F. , Barba David , Toole Belinda M. , Bowers Sharon A.
Published: May 2009

✓ The oval pupil, or what has also been termed the “oblong” or “football” pupil, has been observed in 15 neurosurgical patients over a 2-year period. In 14 of the 15 patients, the intracranial pressure (ICP) was elevated, ranging from 18 to 38 mm Hg. While the oval pupil was primarily seen in patients suffering closed head injuries (11 cases), it was also observed in two patients with elevated ICP following hemorrhage from an arteriovenous malformation. In nine of the 14 patients in whom the pupillary abnormality was associated with intracranial hypertension, the oval pupil disappeared when the ICP was reduced to below 20 mm Hg. In four cases, the ICP could not be controlled and the pupil became progressively larger, and finally fixed and unreactive.

The oval pupil represents a transitional stage indicating transtentorial herniation with third nerve compression. Although it may be seen in the absence of intracranial hypertension (one case in this series), this appears to be relatively uncommon. The presence of such a pupil on examination in a patient suffering an intracranial catastrophe, be it head injury, subarachnoid hemorrhage, or intracerebral hemorrhage, suggests impending transtentorial herniation with brain-stem compression.
Tophaceous gout producing spinal cord compression
Authors: Leaney Barry J. , Calvert James M.
Published: May 2009

✓ A case of thoracic paraplegia secondary to extradural tophaceous gout is presented. The ability of gout to compromise bone elements, periarticular tissues, and neural elements in the vertebral column is discussed.
Primary cerebellar glioblastoma multiforme with an unusually long survival
Authors: Hegedüs Katalin , Molnár Péter
Published: May 2009

✓ Light microscopic and electron microscopic findings of a primary cerebellar glioblastoma multiforme (GM) are presented. An infiltrating tumor of the vermis and the right cerebellar hemisphere had been partially removed from a 39-year-old woman. Postoperative irradiation to the posterior fossa enabled her to work for the next 5½ years. At readmission, progressive pontocerebellar signs were observed. In spite of repeated irradiation and intrathecal chemotherapy, she died after 1 month. Autopsy revealed extensive tumorous infiltration of the right cerebellar hemisphere, pons, and medulla. Both the biopsy and autopsy specimens showed typical features of GM. Tumorous propagation resulted in extreme enlargement of the right inferior olive. Electron microscopic analysis disclosed characteristic bundles of glial filaments, cytoplasmic inclusions lying within nuclear folds, and intracytoplasmic granules of uncertain nature. The possible cause of the long survival is discussed and a comparison is made with previously reported cases.