bluuebunny/crossref_metadata_2025 huggingface dataset:
Results and complications of surgical management of 809 intracranial aneurysms in 722 cases
Authors: Sundt Thoralf M. , Kobayashi Shigeaki , Fode Nicolee C. , Whisnant Jack P.
Published: May 2009

✓ Data from 722 consecutive cases with intracranial aneurysms were stored in a computer and later retrieved for analysis. Results and complications (including preoperative death and morbidity) of the surgical management of these patients were correlated with the Botterell grade of the patient in individuals with a recent subarachnoid hemorrhage (SAH), with the type of aneurysm, and with the timing of the surgical procedure. Patients with no SAH within 30 days prior to hospital admission were classified as “no SAH.” Approximately 30% of all patients had sustained more than one hemorrhage. Death and morbidity rates prior to surgery in good-grade patients with a recent SAH exceeded the risk of surgery itself. Rebleeding was the primary cause for death and morbidity in Grade 1 patients: 3% of Grade 1 patients died from a recurrent hemorrhage and 7% deteriorated to a lower grade. Deterioration from ischemia produced by vasospasm related or unrelated to rebleeding exceeded the risks of rebleeding in Grade 2 patients. There was an operative morbidity of 2% and mortality of 2% in patients who were classified as Grade 1 at the time of surgery, but an overall management morbidity of 3% and mortality of 6% in patients who were in Grade 1 at the time of hospital admission. Early surgery in Grade 1 patients was not associated with an increased incidence of delayed ischemia postoperatively. In Grade 2 patients, the operative morbidity and mortality was 7% and 4%, respectively, and the management morbidity and mortality 16% and 11%, respectively. Early surgery in this group was associated with a high frequency of postoperative delayed ischemia (particularly in patients with more than one SAH). Epsilon-aminocaproic acid appeared to protect against a rebleed, but was associated with a higher incidence of postoperative pulmonary emboli. Intraoperative complications were related both to the size of the aneurysm and to its location. Repair of multiple aneurysms did not adversely affect the result. The surgical approach, the importance of using a self-retaining brain retractor, and the technical complications in these cases are discussed.
Cerebral vasoactivity of heme proteins in vitro
Authors: Wellum Glyn R. , Irvine Thomas W. , Zervas Nicholas T.
Published: May 2009

✓ The dose responses of canine basilar arteries to human hemoglobin, rabbit hemoglobin, horse-heart myoglobin, and human methemoglobin and cyanomethemoglobin are compared in this paper. The in vitro arterial segments responded similarly to the hemoglobins and myoglobin when doses were based on the hemoglobin dimer rather than on the tetramer. Superoxide free radicals produced by the autoxidation of hemoglobin to methemoglobin do not seem to be involved in the mechanism of hemoglobin-induced vasocontraction, as the contraction cannot be blocked by superoxide dismutase or other agents known to react with superoxide-generated products. Nonspecific uptake of hemoglobin into the smooth-muscle cells by pinocytosis is also discounted.
Cerebrospinal fluid drainage as influenced by ventricular pressure in the rabbit
Authors: McComb J. Gordon , Davson Hugh , Hyman Shigeyo , Weiss Martin H.
Published: May 2009

✓ Artificial cerebrospinal fluid (CSF) containing radioisotope iodinated (125I) serum albumin (RISA) and either blue dextran or indigo carmine was given to white New Zealand rabbits over 4 hours. In one group it was given by ventriculocisternal perfusion, in one by ventricular infusion, and in one by cisterna magna infusion. Blood was sampled continuously from the superior sagittal sinus (SSS) or intermittently from the systemic arterial circulation. Removal of CSF from the cisterna magna during the ventriculocisternal perfusion kept the intracranial pressure (ICP) at 0 to 5 torr, whereas ventricular or cisterna magna infusion raised the ICP to 20 to 30 torr and 15 to 20 torr, respectively. In the two groups with raised ICP, an increased concentration of RISA was present in the optic nerves, olfactory bulbs, episcleral tissue, and deep cervical lymph nodes; but this was not found in the group with normal ICP. In all three groups, the concentration of RISA in the SSS blood was the same as in the systemic arterial blood. The concentration gradient of RISA across the cerebral cortex was similar in both the ventriculocisternal perfusion and the ventricular infusion groups. With cisterna magna infusion, the concentration of RISA was the same on the cortical surface and less in the ventricles compared with the ventricular infusion. It is concluded that, with elevated ICP, CSF drained via pathways that are less evident under normal pressure. Drainage of CSF was similar irrespective of whether the infusion site was the ventricles or cisterna magna. It did not appear that acute dilatation of the ventricles during ventricular infusion compromised the subarachnoid space over the surface of the hemisphere, as the concentration of RISA on the convexities and in the SSS blood did not significantly differ between the groups. Transcortical bulk transfer of CSF was not evident with raised ICP.
Medial occipital arteriovenous malformations
Authors: Martin Neil A. , Wilson Charles B.
Published: May 2009

✓ In a consecutive operative series of 115 intracranial arteriovenous malformations (AVM's), 16 occupied the medial occipital region. Typically, the patients with medial occipital AVM's presented with bleeding, often accompanied by homonymous visual field deficit, or with migrainous headache. The malformations were supplied principally by branches of the posterior cerebral artery. Through an occipital craniotomy, a surgical approach along the junction of the falx and tentorium provided access to the arteries feeding the AVM and facilitated excision of the malformation. There were no deaths in the series. The incidence of visual field deficit after the operation varied, but in only five cases was the visual field worsened postoperatively. All patients who had a history of intractable headache were cured or improved after surgery. These lesions are favorably situated for surgical treatment.
Correlation of methylprednisolone levels in cat spinal cord with its effects on (Na+ + K+)-ATPase, lipid peroxidation, and alpha motor neuron function
Authors: Braughler J. Mark , Hall Edward D.
Published: May 2009

✓ Large intravenous doses of methylprednisolone sodium succinate are associated with biochemical and electrophysiological effects in the cat spinal cord which may be of therapeutic value in the treatment of spinal cord injury. The potentially beneficial effects of large doses of the glucocorticoid include: 1) an enhancement of spinal cord (Na+ + K+)-ATPase activity; 2) an attenuation of lipid peroxide formation; 3) a hyperpolarization of motor neuron resting membrane potentials; and 4) an accelerated impulse conduction along the myelinated portion of the motor axon. Each of these is apparent with spinal cord tissue levels of methylprednisolone around 1.3 µg/gm wet weight, which are rapidly obtained following a single intravenous dose of 30 mg/kg. The half-life of methylprednisolone in cat spinal cord following a single intravenous administration, as well as the duration of its pharmacological actions, is roughly 3 hours. The data suggest that, in order to be of therapeutic value in the treatment of acute spinal cord trauma, early intervention with high-dose intravenous methylprednisolone (30 to 40 mg/kg) is necessary, followed by intravenous maintenance dosing of 15 to 20 mg/kg every 2 to 3 hours. The rationale and duration for this regimen are discussed.
Carotid fibromuscular dysplasia and paresis of lower cranial nerves (Collet-Sicard syndrome)
Authors: Havelius Ulf , Hindfelt Bengt , Brismar Jan , Cronqvist Sten
Published: May 2009

✓ A patient suffered the acute onset of unilateral pareses of the ninth through 12th cranial nerves (Collet-Sicard syndrome). Ipsilateral retrograde jugular phlebography and carotid angiography revealed irregular aneurysmal changes of the internal carotid artery at the base of the skull, causing compression of the internal jugular vein below the jugular foramen. This finding is discussed in relation to the clinical symptoms and signs, and possible mechanisms are examined. Family history as well as the clinical and roentgenological findings were compatible with a diagnosis of fibromuscular dysplasia.
Resolution of occlusion in spontaneously dissected carotid arteries
Authors: Pozzati Eugenio , Gaist Giulio , Poppi Massimo
Published: May 2009

✓ Two cases of internal carotid artery occlusion secondary to spontaneous dissection are reported. Both patients presented with transient ischemic attacks. Both had antiplatelet aggregation therapy, followed by spontaneous resolution of the occlusion. The period of healing seems to be relatively short. In both cases, restoration of flow was angiographically documented 14 days and 10 weeks after the initial arteriogram. Strategies for treatment of such patients are discussed.
Late sequelae of spinal cord trauma
Authors: Osborne Dennis R. S. , Vavoulis George , Nashold Blaine S. , Dubois Philip J. , Drayer Burton P. , Heinz E. Ralph
Published: May 2009

✓ Eighteen patients with posttraumatic paraplegia were examined myelographically at 2 months to 30 years after the injury, and the findings correlated with surgical exploration. The following six myelographic patterns were seen: 1) tethered cord and subarachnoid adhesions; 2) proximal cord cysts; 3) loculated subarachnoid cysts; 4) proximal cord atrophy; 5) extradural fibrosis; and 6) complete obliteration of the subarachnoid space at the level of trauma due to extradural fibrosis and/or bone encroachment on the vertebral canal. Myelography with or without computerized tomography (CT) accurately reflected the gross pathological process. The examination is indicated prior to surgical intervention: the structural lesion in four patients extended two or more vertebral levels above the site of the original bone injury and was not easily predictable preoperatively. When combined with CT, myelography allowed evaluation of the transverse anatomy of the vertebral canal and its contents; it was especially useful when the canal was narrowed or distorted by bone and soft tissue. Water-soluble contrast media provided a more detailed evaluation of the spinal cord and subarachnoid space, and were the preferred agents. If a posttraumatic syrinx is suspected, these are the agents of choice.
Clinical recording of pressure on the spinal cord and cauda equina
Authors: Magnaes Bjørn
Published: May 2009

✓ To define the site, degree, and dynamics of mechanical compression of the spinal nerve roots, pressure was measured in 42 patients with clinical symptoms and myelographic findings indicating central lumbar spinal stenosis. Pathological pressure on the cauda equina was found in 67% of the patients. The pressure in the region of the spinal block was high during standing and walking, and in several patients exceeded mean arterial blood pressure. The block pressure was the main mechanical factor in the central part of the spinal canal causing pain and paresis. Elevated fluid pressure caudal to the block was an additional but usually subordinate factor. In 33% of the patients, normal pressure on the cauda equina was found, and lateral compression of multiple nerve roots seemed to be the only mechanical symptom-causing factor. Clinically, these patients could not be distinguished from patients with central compression. After laminectomy with decompression of the cauda equina, the field should be inspected for lateral narrowing which, if present, should be treated.
Myopathy induced by epsilon-aminocaproic acid
Authors: Brown Jeffrey A. , Wollmann Robert L. , Mullan Sean
Published: May 2009

✓ The authors present a case of proximal myopathy secondary to epsilon-aminocaproic acid (EACA) administration. This well recognized entity does not occur immediately after institution of therapy, but follows a delay of several days and a cumulative dose. Its consequences include a spectrum of symptoms from myalgias to severe myopathy with rhabdomyolysis, myoglobinuria, and acute tubular necrosis. A presenting symptom of calf pain in a patient receiving EACA should not automatically imply deep vein thrombosis. Serial creatine phosphokinase measurements are essential in monitoring a patient undergoing EACA therapy, especially after 2 weeks of treatment and a total dose of greater than 500 gm.
Intramedullary spinal neurinomas
Authors: Cantore Giampaolo , Ciappetta Pasquale , Delfini Roberto , Vagnozzi Roberto , Nolletti Albino
Published: May 2009

✓ Two cases of intramedullary neurinoma are presented in patients with no signs of von Recklinghausen's disease. Only 16 similar cases have been published so far. The relevant literature is reviewed.
Ultrasound-guided biopsy for deep-seated brain tumors
Authors: Tsutsumi Yutaka , Andoh Yukihiko , Inoue Norio
Published: May 2009

✓ An easy, accurate, and safe biopsy technique for deep-seated brain tumors using a newly devised real-time ultrasonic apparatus is presented. Three lesions, one large pituitary adenoma and two pineal region tumors, were biopsied successfully by this technique.
Cerebrovascular permeability following MCA occlusion in the rat
Authors: Tyson George W. , Teasdale Graham M. , Graham David I. , McCulloch James
Published: May 2009

✓ A quantitative autoradiographic technique that utilizes carbon-14-aminoisobutyric acid (14C-AIB) as a tracer was used to study alterations in cerebral microvascular permeability in 15 rats. Five were “sham-operated” controls and 10 underwent microsurgical, unilateral occlusion of the proximal middle cerebral artery (MCA). Histological changes indicative of focal cerebral ischemia were observed in only the latter 10 animals. These changes were confined to tissue normally perfused by the occluded MCA. After MCA occlusion, five animals were also subjected to transient halothane-induced hypotension (mean arterial blood pressure 50 mm Hg) for 20 to 30 minutes. Only in these five animals were blood-to-brain transfer constants (ki) significantly increased (by approximately 100%) at 4 hours after MCA occlusion. The topographical distribution of this alteration in cerebral microvascular permeability corresponded closely with the histological changes. Neither proximal MCA occlusion nor halothane-induced hypotension alone was associated with any focal or diffuse increase in ki after 4 hours.
Chronic cerebral vasospasm after large subarachnoid hemorrhage in monkeys
Authors: Espinosa Francisco , Weir Bryce , Boisvert Donald , Overton Thomas , Castor William
Published: May 2009

✓ The authors have developed a model of chronic cerebral vasospasm analogous to the clinical situation, by inducing a large subarachnoid hemorrhage (SAH) in monkeys. With this model, the size of the SAH apparent on the first computerized tomography (CT) scan was correlated with the incidence and severity of cerebral vasospasm that developed. Indices monitored for up to 21 days after SAH included cranial CT scan, cerebral blood flow, vessel caliber, and neurological status. The 18 monkeys studied for 48 hours or more were divided into two groups according to the size of the SAH on CT scan. Vasospasm was more common in the group with large SAH. In this group, on Days 0, 7, and 14, the incidence of vasospasm was significantly higher than at other times (p < 0.001, p < 0.01, and p < 0.05, respectively), and the percentage reduction in vessel caliber was significantly greater than in the group with small/medium SAH (Day 7, p < 0.02; Days 0 and 14, p < 0.05). Delayed neurological deficit developed in two monkeys with large SAH. Apathy was noted from Day 17 to Day 21 in one, and unsteadiness and drowsiness were noted on Days 4 and 5 in the other. Overall, the incidence, degree, and time course of vasospasm reflected the size of the hemorrhage.
Translabyrinthine repair for cerebrospinal fluid otorhinorrhea
Authors: Harner Stephen G. , Laws Edward R.
Published: May 2009

✓ Cerebrospinal fluid (CSF) otorhinorrhea may occur as a complication of surgery for removal of acoustic neurinomas. The CSF leak usually appears within the first 2 weeks after surgery, and the diagnosis is obvious. The fistulous site is frequently inaccessible and may be difficult to repair by reexploring the suboccipital craniectomy. Successful closure of the fistula is accomplished by obliterating the space between the posterior fossa dura and the eustachian tube orifice with homograft muscle, using a radical translabyrinthine approach.
Reversible facial pain due to hydrocephalus with trigeminal somatosensory evoked response changes
Authors: Findler Gideon , Feinsod Moshe
Published: May 2009

✓ A patient with hydrocephalus due to aqueductal stenosis suffered facial pain which was relieved after the insertion of a ventriculoperitoneal shunt. The trigeminal somatosensory evoked response (TSER) of the affected side showed lower amplitudes and longer latencies as compared to the unaffected side. Following surgery, the waves regained higher amplitudes and shorter latencies. An episode of shunt malfunction was accompanied by recurrent facial pain and impairment of the TSER. Both improved after revision of the shunt. The possible etiology of facial pain in patients with hydrocephalus is discussed.
Intradural herniated cervical disc
Authors: Roda José M. , Gonzalez Cesáreo , Blázquez Martín G. , Alvarez Marcelino P. , Arguello Cesar
Published: May 2009

✓ An unusual case is presented in which a fragment of cervical disc was found within the dura. The literature has been reviewed and only two similar cases, which are described, have been found. The pathogenic factors of the lesion are discussed.
Histological structural abnormalities of superficial temporal arteries used for extracranial-intracranial anastomosis
Authors: Diaz Fernando G. , Chason Jacob , Shrontz Carl , Ausman James I. , Dujovny Manuel
Published: May 2009

✓ Histological evaluation of the superficial temporal artery resected at the time of extracranial-intracranial anastomosis was performed in 64 consecutive patients. A neuropathologist who was not aware of the medical condition of these patients studied all specimens under light microscopy with hemotoxylin and eosin, Verhoff, and Mallory strains. Intimal proliferation was observed in 62 samples, intimal fibrosis in 56, fragmentation of the internal elastic lamina in 45, splitting of the internal elastic lamina in 41, fragmentation of the media in 38, and fragmentation of the minimal external elastic tissue in 17. Stenosis of the vessel was observed, and graded from 0% to 50%, with a mean of 20%. The development of intraluminal stenosis was considered to be secondary to the development of intimal fibrosis and hyperplasia. The changes observed were progressive and conformed with those previously described; there was no evidence of correlation with sex, diabetes, or hypertension. The implications for the development of occlusion of the anastomosis or stroke, and for patient survival are discussed.
Current prognosis in overt neonatal hydrocephalus
Authors: McCullough David C. , Balzer-Martin Lynn A.
Published: May 2009

✓ Chiefly because of advances in prenatal diagnostic ultrasonography, prognostic data on congenital hydrocephalus have increased in pertinence. Neurosurgeons may be confronted with requests for prognostic information after discovery of gestational hydrocephalus. Because previous reports reflect technical problems, complications, and less favorable results of an evolutionary period in hydrocephalus therapy, the authors have attempted to update the prognostic picture with a review of their results in hydrocephalus that is overt at birth. The status of 37 children treated with cerebrospinal fluid shunts after delivery at term with overt hydrocephalus was evaluated after an average 6-year follow-up period. They represented 8% of all children being followed for hydrocephalus. Outcome was also reviewed in 11 patients with severe hydrocephalus who were not treated. Of treated patients, 86% survived 1 to 16 years, while all of the untreated infants died at an average of 2.5 months. Approximately two-thirds of treated patients have normal or borderline intellectual capabilities (mean IQ 96, standard deviation 22). Dandy-Walker malformation was associated with a high mortality and a very low IQ in survivors. Congenital aqueductal atresia was also associated with intellectual impairment, but children with communicating hydrocephalus and myelomeningocele were not intellectually impaired. Among the survivors with low IQ, the poor outcome was generally predictable on the basis of cortical mantle thickness and “brain mass” calculations before therapy. The findings from this partially selected series indicate that the majority of babies born with overt hydrocephalus have a good prognosis with appropriate therapy.
Simplified and accurate CT-guided needle biopsy of central nervous system lesions
Authors: Yeates Andrew , Enzmann Dieter R. , Britt Richard H. , Silverberg Gerald
Published: May 2009

✓ Computerized tomography-directed needle biopsy of intracranial lesions, when correctly performed, offers a high diagnostic yield for both benign and malignant lesions, with relative safety. The simple method described stresses how careful positioning of the patient simplifies the mechanics of the procedure. This non-stereotaxic approach has wide application.
Role of protein content in CSF ascites following ventriculoperitoneal shunting
Authors: Adegbite Andrew B. , Khan Moe
Published: May 2009

✓ The case is reported of an 11-year-old girl with a recurrent craniopharyngioma who developed massive ascites following a ventriculoperitoneal (VP) shunt procedure for hydrocephalus, associated with an elevated cerebrospinal fluid (CSF) protein level. The ascites resolved after removal of the shunt. The CSF protein returned to normal levels following excision of the recurrent craniopharyngioma, and ascites did not recur after a second VP shunt was inserted for recurrent hydrocephalus. In this case, elevated CSF protein is believed to have been responsible for ascites developing after VP shunting. There was no recurrence of ascites after the peritoneal cavity was again used for shunting, at which time the protein had returned to normal values. Twelve previous cases of ascites complicating VP shunting are reviewed and the etiology of this condition is discussed.
Neck paraganglioma with a pituitary adenoma
Authors: Blumenkopf Bennett , Boekelheide Kim
Published: May 2009

✓ A 66-year-old man presented for evaluation of a mass of the sella turcica. Previously, he had undergone resection of a neck paraganglioma, which subsequently metastasized to the lungs. A tumor was removed transsphenoidally that proved to be a pituitary adenoma. This combination failed to fit the classical multiple endocrine neoplasia syndromes.
Radiofrequency trigeminal rhizotomy in treatment of symptomatic non-neoplastic facial pain
Authors: Broggi Giovanni , Franzini Angelo
Published: May 2009

✓ Twenty patients suffering from non-neoplastic symptomatic facial pain underwent percutaneous radiofrequency trigeminal thermo-rhizotomy. Fourteen patients had long-standing severe multiple sclerosis, two patients had intracranial aneurysms, three patients had basilar impression secondary to Paget's disease and developmental malformation of the skull, and one patient was suffering from chronic ocular pain that developed after retinal hemorrhage. Pain paroxysms similar to tic douloureux were present in patients with multiple sclerosis and in those with basilar impression, while continuous aching pain was present in the others. After thermo-rhizotomy, pain disappeared in all patients; however, at 1 to 4 years follow-up examination, a high recurrence rate (40%) was present in the multiple sclerosis group, and the percutaneous procedure was successfully repeated. In the patients with intracranial aneurysm not amenable to direct surgery, and in the other non-neoplastic diseases, complete pain relief was found at 4 years follow-up review.
Microvascular decompression for trigeminal neuralgia
Authors: Breeze Robert , Ignelzi Ronald J.
Published: May 2009

✓ Fifty-one consecutive patients with trigeminal neuralgia underwent 52 procedures for microvascular decompression of the trigeminal nerve root entry zone. There was an 85% early success rate; however, after a longer follow-up period, a 13% late recurrence rate was found. In all, 60% of the patients experienced some form of complication, but in only 23% was the complication persistent.
A three-dimensional reconstruction of the human brain stem
Authors: Afshar Farhad , Dykes Eric
Published: May 2009

✓ Advances in computer technology and color graphics have been applied to the sections in a stereotaxic atlas of the human brain stem to enable three-dimensional reconstructions of nuclei and tracts. Techniques for viewing the reconstructed brain stem from multiple directions and in stereo have been achieved. The application of these methods and the use of color graphics are discussed with respect to stereotaxic surgery and computer dissection in neuroanatomical studies.
Intracranial physiology and biomechanics
Authors: Paltsev Eugeny I. , Sirovsky Edward B.
Published: May 2009

✓ The intracranial pressure-volume (PV) relationship was examined postoperatively after removal of brain tumors in two groups of patients (13 in all). Changes of ventricular fluid pressure were analyzed by a method involving fluid injection into the lateral ventricle. A technique has been developed which provides quantitative data on the PV relationship with minimal error. The results confirm the exponential nature of the PV relationships. Various parameters characterizing the intracranial volume compliance, the cerebrospinal fluid pressure, and their interrelationship were investigated. It was found that 1) intracranial PV dependence is accurately defined by three parameters; 2) in patients who are not critically ill, ΔP/ΔV at P = Pmeandoes not vary statistically, and may be used as one of the important parameters to determine the regulation of the intracranial PV relationships. Examples are presented of the use of the data from the PV test for the control of the intracranial PV relationship. Examples are also given of the computation of volume redistribution in the cranium, both spontaneous and evoked by clinical tests. Analysis of the results allows the conclusion that the intracranial volume compliance concerned is an active compliance, which is controlled by the systems maintaining brain function.
Primary intranasal encephalocele
Authors: Choudhury A. Rashid , Taylor Julien C.
Published: May 2009

✓ Four cases of primary intranasal encephalocele are presented. Three of the patients had been treated for nasal polyps. One of these three patients presented with persistent cerebrospinal fluid (CSF) rhinorrhea after a fourth polypectomy, another with recurrent CSF rhinorrhea and bacterial meningitis following a second polypectomy, and the third case with recurrence of meningitis, also following polypectomy. Recurrent bacterial meningitis was the mode of presentation in the fourth case. Encephalocele was the isolated abnormality in three, but the fourth had a degree of associated hypertelorism. The diagnosis of encephalocele should be considered in any patient with a nasal polyp, especially in children and in patients with recurrent bacterial meningitis, with or without rhinorrhea, in the absence of cranial trauma or surgery, or in the absence of external craniospinal anatomical defects.
Management of intrauterine hydrocephalus
Authors: Cochrane David D. , Myles S. Terence
Published: May 2009

✓ The aggressive treatment of hydrocephalus has been of benefit to many children. Sophisticated two-dimensional ultrasound techniques allow the diagnosis of prenatal hydrocephalus to be made with accuracy and ease. In the past, the medical decisions governing the management of hydrocephalus in utero were made by obstetricians and were directed at reducing maternal mortality and morbidity. Now, with improved diagnosis and support facilities for the newborn, neurosurgical input is being requested as more concern is expressed for the fetus.

Based on their experience with seven cases of intrauterine hydrocephalus in the past 3 years, the authors present their program for the management of this problem. If antenatal ultrasonography shows hydrocephalus without other anomalies, they recommend that the fetus be born by elective Caesarean section at the time of pulmonary maturity, and that early ventricular shunting be carried out. This plan should minimize nervous system trauma resulting from hydrocephalus and the birth process. If, however, antenatal diagnostic studies show cerebral or other major system anomalies in addition to hydrocephalus, then standard obstetrical care should be given. Antenatal ultrasonography has been found to be reliable in assessing fetal lateral ventricular size and shape, and to correlate well with the results of postnatal computerized tomography scanning.
Effects of vertebral column distraction in the monkey
Authors: Cusick Joseph F. , Myklebust Joel , Zyvoloski Mark , Sances Anthony , Houterman Chris , Larson Sanford J.
Published: May 2009

✓ Experiments were performed to assess the effects of vertebral column distraction on evoked potential responses from multiple recording sites along the conducting pathway in the monkey, and on concurrent blood flows, measured with the radioactive microsphere technique, along the axis of the central nervous system. Linear distractive loads were applied until the amplitude of the evoked response was significantly reduced. In four monkeys, the loads (100 to 150 lb) were sustained, whereas in two monkeys the forces (80 to 110 lb) were relaxed. The earliest response changes were most marked in recordings dependent upon the integrity of the upper cervical dorsal columns or brain stem-lemniscal pathway. The responses returned to control levels with load relaxation, but maintenance of the tractive load produced generalized and progressive response attenuation. At selected periods of significant changes in the evoked potential response, blood flow remained stable except for the late onset of regional ischemia in the middle cervical through upper thoracic spinal cord levels in the animals undergoing sustained loads. These findings indicate that brain-stem or spinal cord dysfunction occurring with both acute and gradual elongation of the spinal canal are the result of excess tensile stress acting on fiber tracts, and the delayed onset of spinal cord ischemia is the probable result of a similar mechanical process acting upon intrinsic spinal cord blood vessels.
Long-term axonal apposition in rat sciatic nerve neuroma
Authors: Bernstein Jerald J. , Pagnanelli David
Published: May 2009

✓ Long-term electrophysiological cross-talk between nerve fibers has been demonstrated in rat sciatic nerve following induction of an amputation neuroma. Experiments were designed to establish an anatomical basis for this phenomenon. The sciatic nerve was transected and the epineurium oversewn with 10-0 nylon in 16 adult male Sprague-Dawley rats. The resulting neuromas were prepared for ultrastructural analysis 7, 14, 30, and 60 days later. An analysis of the unmyelinated nerve fibers showed normal configurations of the fibers, with normal organelles, separated by Schwann cell processes in the neuroma. However, degenerating unmyelinated nerve fibers and nerve fibers with masses of neurofilaments were often observed. In approximately 10% of the total population observed, there were two or more unmyelinated nerve fibers in a single Schwann process fascicle. Some of the multiple unmyelinated nerve fiber fascicles had nerve fibers that were in membranous apposition. This configuration of unmyelinated axons could form the anatomical basis for long-term physiological cross-talk between axons in a neuroma, and could be of consequence in pain production.
Pencil gliomas of the aqueduct of Sylvius
Authors: Sanford Robert A. , Bebin Jose , Smith R. Wayne
Published: May 2009

✓ The authors present the cases of two young adults with low-grade astrocytomas limited to the aqueductal region of the tectum of the mesencephalon. The characteristic presentation of hydrocephalus without brain-stem signs is described. Careful radiological examination, including computerized axial tomography, failed to reveal any evidence of tumor. The diagnosis was established at postmortem examination. Literature review yielded 12 previous cases of similar presentation.
Method of eyelid closure in facial nerve paralysis
Authors: Zlotnik Ephraim I. , Smeyanovich Arnold F. , Tyappo Eugene P.
Published: May 2009

✓ The authors present a method of temporary eyelid closure consisting of air inflation of the subcutaneous connective tissue. This method is effective for prevention and treatment of conjunctival inflammation due to facial paralysis developing after total removal of acoustic neurinomas.
Hemifacial spasm
Authors: Iwakuma Tsutomu , Matsumoto Akihisa , Nakamura Nishio
Published: May 2009

✓ Patients with hemifacial spasm were treated by three different surgical procedures: 1) partial sectioning of the facial nerve just distal to the stylomastoid foramen; 2) selective neurectomy of facial nerve branches; and 3) microvascular decompression. A retromastoid craniectomy with microvascular decompression was most effective in relieving hemifacial spasm and synkinesis.

In a postmorten examination on one patient, microscopic examination of the facial nerve, which was compressed by an arterial loop of the posterior inferior cerebellar artery at the cerebellopontine angle, revealed fascicular demyelination in the nerve root. On the basis of surgical treatment, electromyography, and neuropathological findings, the authors conclude that compression of the facial nerve root exit zone by vascular structures is the main cause of hemifacial spasm and synkinesis.
A 10-year experience in the treatment of trigeminal neuralgia
Authors: van Loveren Harry , Tew John M. , Keller Jeffrey T. , Nurre Mary A.
Published: May 2009

✓ Of 1000 patients with classic trigeminal neuralgia who were treated during the last 10 years, 90% had an initial favorable response to medical therapy, but 75% (750 patients) failed to achieve satisfactory long-term relief. Of these, 700 patients were treated by percutaneous stereotaxic rhizotomy (PSR) and 50 were selected for posterior fossa exploration (PFE).

Of the 50 patients undergoing PFE, 82% had neurovascular contact at the trigeminal root entry zone, but only 46% were judged to have had significant neurovascular compression. Exploration was negative in 16% of patients and revealed neural compression by bone in 2%. Patients with neurovascular compression were treated by microvascular decompression (MVD); all other patients with exploratory surgery underwent partial sensory rhizotomy. At 3 years after PFE, 84% of patients are pain-free. Results are excellent in 68%, good in 12%, fair in 4%; 12% had a recurrence of their neuralgia. The 700 patients treated by PSR have been followed for 6 years. Results are excellent in 61%, good in 13%, fair in 5%, and poor in 1%; 20% had a recurrence.

This study indicates that there is no significant difference in results between PSR and PFE in the treatment of trigeminal neuralgia. The concept that neurovascular compression is a mechanical factor in the etiology of trigeminal neuralgia was supported, but neurovascular compression was less common than previously reported. Percutaneous stereotaxic rhizotomy is a less formidable procedure than PFE, and is easily repeated. Recent technical advances have improved the results obtained with PSR. Therefore, PSR remains the procedure of choice for the majority of patients with trigeminal neuralgia.
Early death from rupture of an intracranial aneurysm
Authors: Hijdra Albert , van Gijn Jan
Published: May 2009

✓ The authors studied the clinical features and computerized tomography scans of 31 patients who died within 24 hours after the rupture of an intracranial aneurysm. Nine patients showed evidence of an intracerebral hematoma and brain shift, eight of a massive intraventricular hemorrhage, eight of both a hematoma and ventricular hemorrhage, and six of only subarachnoid hemorrhage (SAH). These anatomical types of hemorrhage could not be distinguished clinically. Four of the six patients with only SAH suffered initial apnea and circulatory arrest. In these cases, secondary brain damage may have been caused by anoxia, and therefore might have been reversible.
Saccular aneurysm of the anterior inferior cerebellar-internal auditory artery
Authors: Zlotnik Ephraim I. , Sklyut Joseph A. , Smejanovich Arnold F. , Stasenko Eugene N.
Published: May 2009

✓ The authors document a rarely encountered aneurysm of the anterior inferior cerebellar-internal auditory artery. In the absence of subarachnoid hemorrhage, the aneurysm produced a typical picture of neurinoma of the acoustic nerve. Clipping of the aneurysm resulted in almost full recovery of the patient.
Spinal extradural arachnoid pouches
Authors: McCrum Conal , Williams Bernard
Published: May 2009

✓ Two cases of extradural arachnoid cysts or pouches of the thoracic spine are described. Surgical removal was effective in both instances. Theories of etiology are reviewed, particularly in regard to cerebrospinal fluid (CSF) dynamics. A simplified model of the development of these lesions is proposed, relating the law of Laplace to the cyst wall and neck. This theory, in conjunction with fluctuation of CSF pressure in response to venous influences, may explain the expansion of these loculations within the spinal canal.
Cervical-peritoneal shunt in the treatment of pseudotumor cerebri
Authors: Beatty Robert A.
Published: May 2009

✓ Pseudotumor cerebri occasionally requires a cerebrospinal fluid shunting procedure, usually placement of a lumboperitoneal shunt, to preserve the patient's vision. This paper describes a cervical-peritoneal shunt which is simple to insert and effective, and which can be directly evaluated by palpation.
Quality of life in children treated for brain tumors
Authors: Kun Larry E. , Mulhern Raymond K. , Crisco J. Jeffrey
Published: May 2009

✓ Thirty children with primary brain tumors were evaluated for alterations in intellectual, emotional, and academic functions. Nine were studied following surgery (prior to irradiation) and 21 after postoperative irradiation. Twenty-four patients (80%) showed no serious disabilities on routine medical and neurological examinations. Nineteen patients (63%) had normal intelligence quotient (IQ) levels. Qualitative disabilities on routine examinations were observed in six children: two of nine tested postoperatively, one of six tested after posterior fossa irradiation, and three of 15 tested after cranial irradiation. Subnormal IQ levels were also noted in two of nine children tested prior to irradiation and one of six after posterior fossa irradiation. Of the 15 studied after cranial irradiation, eight had subnormal IQ scores. Serial postirradiation testing in 10 patients revealed improvement in two, stability in five, and further deterioration in three. Ten children were placed in learning disability settings due to achievement delays or problems with selective attending. Social-emotional evaluations detected excessive tendencies toward psychotic symptomatology. Potential etiological factors, including primary tumor site, extent of irradiation, age, and increased intracranial pressure, are discussed. Preliminary findings suggest a greater than normal risk for late neuropsychological alterations among children with supratentorial tumors and/or cranial irradiation.
Delayed cerebral vasospasm is not reversible by aminophylline, nifedipine, or papaverine in a “two-hemorrhage” canine model
Authors: Varsos Vassilios G. , Liszczak Theodore M. , Han Dae Hee , Kistler J. Philip , Vielma Juan , Black Peter McL. , Heros Roberto C. , Zervas Nicholas T.
Published: May 2009

✓ Angiographic spasm of cerebral arteries was produced in dogs by successive injections of cisternal blood 48 hours apart. Angiograms were taken before and after each cisternal injection. There was progressively greater angiographic vasospasm of the basilar artery. Intravenous aminophylline, 10 mg/kg/hr, reversed vessel constriction on the 1st and 3rd day after one injection of cisternal blood. On the 5th day after two blood injections (on Day 1 and Day 3), intravenous aminophylline, nifedipine (1 mg/kg), and intra-arterial bolus injection of 2 mg/kg papaverine failed to reverse the constriction. The intractable constriction produced in this model resembles that found in patients. The calcium antagonist, nifedipine, is as ineffective as the more traditional vasodilators in reversing vasospasm in this model.
Cerebral arterial constriction after experimental subarachnoid hemorrhage is associated with blood components within the arterial wall
Authors: Liszczak Theodore M. , Varsos Vassilios G. , Black Peter McL. , Kistler J. Philip , Zervas Nicholas T.
Published: May 2009

✓ Sequential cisternal blood injections in dogs reproduce some of the morphological and physiological features seen in man after subarachnoid hemorrhage-induced vasospasm. This study reports the morphological features observed in cerebral vessels in areas exposed to subarachnoid blood. Subarachnoid hemorrhage was produced in dogs by two cisternal injections of non-heparinized autologous blood 48 hours apart. Dogs were sacrificed 48 hours after the second injection. Angiographic narrowing of the basilar artery was routinely present 48 hours after the second injection, and there was a good correlation between angiographic vasospasm and a narrowed arterial lumen at postmortem examination. All basilar arteries showed structural changes with electron microscopic examination; these included endothelial cell vacuoles, early smooth-muscle cell necrosis, intimal changes, and adventitial erythrocytes, leukocytes, and mast cells. The finding that accompanied vessel constriction most uniformly was packing of the adventitial cerebrospinal fluid spaces with erythrocytes. Angiographically visible spasm was resistant to vasodilators. These data suggest that infiltration of blood elements into the arterial wall is an important concomitant feature of morphological and angiographic vasospasm.
Light and electron microscopic studies of phrenic nerves after long-term electrical stimulation
Authors: Kim Jung H. , Manuelidis Elias E. , Glenn William W. L. , Fukuda Yoshitaka , Cole Douglas S. , Hogan James F.
Published: May 2009

✓ Light and electron microscopic evaluations were carried out on canine phrenic nerves subjected to long-term electrical stimulation. A total of 34 stimulated and 19 control nerves were studied by light microscopy, and 10 stimulated and five control nerves were evaluated by electron microscopy. Except in a few cases in which a higher current was used, the current used for stimulation was between 1 and 2 mA. The pulse width was 150 µsec. The typical charge per pulse was 0.22 µC and charge density per pulse 1.125 µC/sq cm of real area. The total number of days of electrical stimulation in individual phrenic nerves ranged from 4 to 374. No morphological changes in the phrenic nerve that could be attributed to the electrical stimulation were observed by light or electron microscopic study. There were, however, two phrenic nerves cuffed with bipolar electrodes which showed focal demyelination at the electrode level, but these changes were caused by factors other than the electrical stimulation. The results of the studies have direct clinical implications to long-term stimulation of phrenic nerves.
Response of the diaphragm muscle to electrical stimulation of the phrenic nerve
Authors: Ciesielski Thomas E. , Fukuda Yoshitaka , Glenn William W. L. , Gorfien Jack , Jeffery Kathryn , Hogan James F.
Published: May 2009

✓ The histological, histochemical, and ultrastructural features of canine diaphragms subjected to pacing by high-frequency electrical stimulation (27 to 33 Hz) of the phrenic nerve are compared with unstimulated diaphragms and with diaphragms subjected to pacing by low-frequency stimulation (11 to 13 Hz). The high-frequency group showed a reduced tidal volume (fatigue) after long-term stimulation, and myopathic changes which included enlarged internal and sarcolemmal nuclei, ring fibers, moth-eaten fibers with irregular histochemical staining, core/targetoid fibers, and smearing and aggregation of Z-band material with electron microscopy. The low-frequency group did not develop a significant degree of fatigue or pathological changes, and showed histochemical evidence of transformation to fast-twitch (type II) fibers. Possible pathogenic mechanisms and their similarity to those in certain human neuromuscular diseases are discussed. The application of the findings resulting from high- and low-frequency stimulation to long-term diaphragm pacing in humans with chronic ventilatory insufficiency is also discussed.
Cerebral dissecting aneurysms in patients with moyamoya disease
Authors: Yamashita Masanori , Tanaka Kenzo , Matsuo Takefumi , Yokoyama Kazumasa , Fujii Toru , Sakamoto Haruhiko
Published: May 2009

✓ Dissecting intracranial arterial aneurysms were identified in a 16-year-old girl and a 48-year-old man with moyamoya disease. Hemiplegia or tetraplegia rapidly developed. Angiography revealed bilateral stenoses or occlusion of the bifurcation of the internal carotid arteries (ICA's) and an unusual vascular network at the base of the brain. Autopsy confirmed massive hemorrhage from the thalamus and putamen, with intraventricular extension. The intracranial segments of both ICA's were markedly stenotic in both patients, due to eccentric fibroelastic intimal thickening. In one patient, a dissecting aneurysm was identified microscopically, involving the proximal segment of the left anterior cerebral artery. In the other patient, the right middle cerebral artery (MCA) was dissected beneath the internal elastic lamina along the entire length of the horizontal segment of the MCA. Thus, cerebral dissecting aneurysms may be present in patients with moyamoya disease.
Giant calcified and ossified midbrain tuberculoma
Authors: Selekler Kaynak , Erbengi Aykut , Saribaş Okay , Önol Behsan
Published: May 2009

✓ A case of a giant calcified midbrain tuberculoma is presented. Although clinically the diagnosis of tuberculoma was suspected, the conclusive diagnosis could not be established before autopsy. Autopsy findings revealed an ossified and healed tuberculoma. The clinical and pathological findings are discussed.
Fascial closure in low myelomeningocele repairs
Authors: Voorhies Rand M. , Fraser Richard A. R.
Published: May 2009

✓ A simple method, utilizing a vertically hinged flap of lumbodorsal fascia, is described for closure of lowlying myelomeningocele defects.