bluuebunny/crossref_metadata_2025 huggingface dataset:
Middle Fossa Facial Schwannoma Removed Via the Intracranial Extradural Approach: Case Report and Review of the Literature
Authors: Rosenblum Bruce , Davis Raphael , Camins Martin
Published: May 2010

A case of an intracranial facial schwannoma originating from the geniculate ganglion in a patient without neurofibromatosis is presented. Preoperative diagnosis and determination of site of origin along the facial nerve course is stressed through analysis of radiographic and clinical features. The tumor was completely removed using an intracranial, extradural approach. (Neurosurgery 21:739-741, 1987)
Anatomical Study of the Cavernous Sinus Emphasizing Operative Approaches and Related Vascular and Neural Reconstruction
Authors: Sekhar Laligam N. , Burgess James , Akin Osman
Published: May 2010

The efficacy of three operative approaches to the cavernous sinus (CS) and the possibilities of vascular and cranial nerve reconstruction in and around the CS were studied in 50 cadaver specimens (25 heads). The lateral operative approach was through the lateral wall, between Cranial Nerves V1 and IV, or between Cranial Nerves V1 and V2. The superior approach was through the superior wall of the CS after removing the anterior clinoid process and unroofing the optic canal. The inferior approach followed the petrous internal carotid artery (ICA) into the CS after an extradural subtemporal exposure or after a combined subtemporal and infratemporal fossa exposure. The different exposures of the spaces of the CS and of the intracavernous structures provided by the superior and the lateral approaches were complementary. The exposure provided by the inferior approach was minimal; however, the junction of the petrous and cavernous ICA was best exposed by this route. The combined subtemporal and infratemporal fossa approach exposed the petrous ICA (for proximal control or for reconstruction) with the greatest ease and with the least temporal lobe retraction. The combination of the superior and lateral approaches and the complete mobilization of the intracavernous ICA facilitated its repair after experimental lacerations. Lacerations of either the inferior and the inferomedial aspects of any portion of the cavernous ICA or of the anterior surface of the posterior vertical segment of the artery were the most difficult to repair. End-to-end anastomosis was more difficult with the posterior third of the artery than with the anterior two-thirds. A vein graft with an average length of 3.5 cm could be sutured from the petrous to the supraclinoid ICA to bypass the cavernous ICA, with an average occlusion time of 45 minutes. End-to-end technique was judged better for the proximal anastomosis, but end (graft)-to-side anastomosis was easier to perform at the distal end because of the location of the ophthalmic artery. Resuture of Cranial Nerves III and VI could not be performed in fresh cadavers if the gap exceeded 0.3 cm. In 3 specimens, the exposure of Cranial Nerve VI in the posterior fossa through the petrous apex and in the orbital apex was followed by graft placement (bypassing the CS). The complex anatomy of the cranial nerves at the apex of the CS was also defined in 10 specimens. Surgeons who perform operations in and around the CS for neoplastic and vascular lesions will find these studies useful.
Higher Cortical Disorders: An Unusual Presentation of an Arteriovenous Malformation
Authors: Overbeeke J.J.v. , Bosma N.J. , Verdonck A. F. M. M. , Huffelen A. C. v.
Published: May 2010

The authors present a patient with a large arteriovenous malformation in the temperoparietooccipital region of the dominant hemisphere that caused seizures, a homonymous hemianopia, and broad neuropsychological disturbances probably caused by a cerebral steal syndrome. There was no history of hemorrhage. Surgical resection resulted in marked improvement of neuropsychological function and disappearance of the hemianopia. The authors discuss the pre- and postoperative neuropsychological findings, the pathogenesis of the steal phenomenon, and the indications concerning the resection of this large and deep-seated arteriovenous malformation in a functionally important region of the left hemisphere. They state that surgical resection is the method of choice.
Isolated Radial Nerve Palsy Due to Metastasis from a Primary Malignant Lymphoma of the Brain
Authors: vanBolden Vernon , Kline David G. , Garcia Carlos A. , vanBolden Georgia D.
Published: May 2010

A malignant lymphoma of the reticulum cell sarcoma variety developed in the right radial nerve of a 60-year-old man 3 years after he had presented with a primary malignant lymphoma of the brain. Serial evaluations and metastatic workups over several years failed to demonstrate evidence of extraneural metastasis.
Microsurgical Resection of Solitary Intramedullary Spinal Cord Metastases
Authors: Findlay Max J. , Bernstein Mark , Vanderlinden Graham R. , Resch Lothar
Published: May 2010

Two cases of solitary intramedullary spinal cord metastasis treated primarily by surgical excision are presented. It has been generally thought that appropriate management for the rare metastasis within the spinal cord is radiation and corticosteroids. The excellent palliative results obtained in our patients suggest that, in selected cases, surgical removal is technically feasible and can be of considerable benefit to the patient.
Painless Glossopharyngeal “Neuralgia” with Syncope: A Case Report and Literature Review
Authors: Reddy K. , Hobson D.E. , Gomori A. , Sutherland G.R.
Published: May 2010

Glossopharyngeal neuralgia is an uncommon craniofacial pain syndrome. An association with syncope is even less common. We report a case illustrating that the glossopharyngeal neuralgia-syncope syndrome can occur without pain in the sensory distribution of the glossopharyngeal nerve and that it can have similar consequences. We suggest that permanent cardiac pacing alone may be a viable option in the initial management of such cases.
Angiographic Revascularization of the Brain after Encephaloduroarteriosynangiosis: A Case Report
Authors: Matsushima Yoshiharu , Suzuki Ryuta , Ohno Kikuo , Masaoka Hiroyuki , Wakabayashi Shin-ichi , Maehara Taketoshi
Published: May 2010

Preoperative and postoperative angiograms of a 13-year-old Japanese girl with moyamoya disease are compared. She underwent an indirect extracranial/intracranial bypass operation called encephaloduroarteriosynangiosis (EDAS). Post-EDAS angiograms clearly show revascularization of the brain through the donor scalp artery and decrease in moyamoya vessels, leptomeningeal anastomoses, and preexisting spontaneous transdural anastomoses.
Preoperative Balloon Occlusion of Arteriovenous Malformations
Authors: Van Halbach V. , Higashida Randall T. , Yang Peter , Barnwell Stan , Wilson Charles B. , Hieshima Grant B.
Published: May 2010

Many materials have been utilized to embolize cerebral arteriovenous malformations (AVMs) preoperatively. Specific vascular anatomy with large feeding vessels deep to the nidus or aneurysms within feeding arteries favor the use of detachable balloons over other embolic agents. Detachable balloons allow test occlusion of a vascular pedicle before permanent occlusion and can obliterate aneurysms in feeding arteries. We describe 36 feeder arterial balloon occlusions performed in 31 patients. Twenty-nine patients subsequently had surgical resection. None of the patients developed normal perfusion pressure breakthrough or required blood transfusions. The preoperative balloon occlusion was judged by the neurosurgeon to decrease significantly the difficulty in surgical resection of the malformation. The remaining 2 patients underwent embolization before radiosurgery. One patient had aneurysms in the feeding artery, which was balloon-occluded to diminish the risk of hemorrhage. There were two neurological deficits and three asymptomatic arterial dissections related to the balloon procedure. Balloon occlusion of feeding arterial pedicles in selected cerebral AVMs may be a valuable surgical adjunct. (Neurosurgery 22:301-308, 1988)
Giant and Multiple Aneurysms of the Distal Posterior Inferior Cerebellar Artery
Authors: Dernbach Paul D. , Sila Cathy A. , Little John R.
Published: May 2010

A case involving giant and multiple aneurysms of the distal posterior inferior cerebellar artery (PICA) is presented. Of the 130 reported cases of peripheral aneurysms of the PICA, 6 have been described as giant aneurysms and 5 have involved multiple aneurysms located on a single PICA. The occurrence of multiple aneurysms including one giant aneurysm has not been reported previously. A clinical description of our case as well as a review of the literature is presented. (Neurosurgery 22:309-312, 1988)
Spinal Fixation after Anterior Decompression for Symptomatic Spinal Metastasis
Authors: Perrin Richard G. , McBroom Robert J.
Published: May 2010

Surgical strategies for the treatment of symptomatic spinal metastases must take into account both decompression of the spinal cord and stabilization of the spinal column. A method is described for securing spinal stabilization in patients who have undergone surgical decompression for symptomatic spinal metastases by an anterior approach. The fixation device used is a tailor-made prosthesis consisting of a U-shaped stainless steel plate permitting screw fixation to secure axial and rotational stability with an interposed methyl methacrylate strut to provide axial strength and support. The device has been used successfully in 51 patients who have undergone anterior decompression procedures for symptomatic spinal metastases. (Neurosurgery 22:324-327, 1988)
Comparison of Magnetic Resonance Imaging and Computed Tomography in the Preoperative Evaluation of Pituitary Adenomas
Authors: Nichols Douglas A. , Laws Edward R. , Houser O. Wayne , Abboud Charles F.
Published: May 2010

Twenty surgically verified pituitary adenomas were imaged in a systematic comparative fashion with high field strength magnetic resonance imaging (MRI) and computed tomography (CT) before operation. The study group included 11 microadenomas, 4 macroadenomas, 2 recurrent microadenomas, and 3 recurrent macroadenomas. The MRI and CT examinations were evaluated for lesion detection, pituitary stalk displacement, cavernous sinus displacement or invasion, hemorrhage, cystic degeneration within the adenoma, bony erosion, detection of suprasellar extension, and displacement of suprasellar structures. T1 and T2 relaxation characteristics of the adenomas were evaluated on MRI examinations, and contrast enhancement characteristics were evaluated on CT examinations. MRI was superior to CT for detecting the extrasellar extent of tumor. Within the sella turcica, MRI and CT were equivalent with regard to lesion detection, except for 1 patient in whom CT was able to detect a surgically confirmed 3-mm microadenoma that was not visualized on the MRI examination. (Neurosurgery 22:380-385, 1988)
Acute Subdural Hematoma Associated with Nontraumatic Middle Meningeal Artery Aneurysm: Case Report
Authors: Korosue Kazuyoshi , Kondoh Takeshi , Ishikawa Yoshihiro , Nagao Tomonori , Tamaki Norihiko , Matsumoto Satoshi
Published: May 2010

A rare case of acute subdural hematoma from rupture of a nontraumatic aneurysm of the middle meningeal artery is described. The subdural hematoma was evacuated and the aneurysm was removed. The literature on nontraumatic aneurysm of the middle meningeal artery is reviewed. The importance of cerebral angiography in the patient with an unexplained subdural hematoma is emphasized. (Neurosurgery 22:411-413, 1988)
Intraspinal Schwannoma Presenting Solely with Rectal Pain
Authors: Kornel Ezriel Edward , Vlahakos Demetrios
Published: May 2010

A cauda equina schwannoma presented solely with rectal pain. The tumor was found to have infarcted and hemorrhaged. A discussion of rectal pain is included, and it is speculated that some forms of rectal pain, especially those classified as proctalgia fugax or rectal neuralgia, may be due to cauda equina tumors. (Neurosurgery 22:417-419, 1988)
Amyloidoma of the Cervical Spine: A Case Report
Authors: Dickman Curtis A. , Sonntag Volker K.H. , Johnson Peter , Medina Marjorie
Published: May 2010

This is the first published report of an amyloidoma localized to the cervical spine. Primary amyloidosis of bone is rare. Only 5 cases involving the spine have been described. We present a 74-year-old man with cervical and occipital radicular pain as the manifestations of an amyloidoma involving the 2nd cervical vertebra. The signs and symptoms of this disease, when localized to the vertebrae, are nonspecific and result from bony destruction and compression of neural structures. Diagnosis requires a high index of suspicion and, ultimately, adequate tissue biopsy for histopathological studies. Curative resection is possible for well-localized lesions. Additionally, external immobilization with a halo vest and bony grafting for fusion may be indicated when the cervical spine is involved. (Neurosurgery 22:419-422, 1988)
Malignant Transformation in Craniopharyngioma
Authors: Nelson Glenn A. , Bastian Frank O. , Schlitt Michael , White Robert L.
Published: May 2010

Malignant transformation in a craniopharyngioma has not been described previously. A 49-year-old woman presented with recurrence of a suprasellar craniopharyngioma diagnosed 35 years previously. The patient had been treated surgically for recurrence on five occasions. Radiation therapy had been administered 7 years before the final presentation. Tissue obtained from the fifth operation revealed malignant degeneration in a typical craniopharyngioma. (Neurosurgery 22:427-429, 1988)
Use of Halifax Interlaminar Clamps for Posterior C1-C2 Arthrodesis
Authors: Cybulski George R. , Stone James L. , Crowell Robert M. , Rifai M.H.S. , Gandhi Yogesh , Glick Roberta
Published: May 2010

Eight patients with atlantoaxial instability secondary to trauma or rheumatoid arthritis were treated with posterior C1-C2 arthrodesis using the Halifax interlaminar clamp and autogenous bone graft or methylmethacrylate. Thus far, with an average follow-up of 6 months, satisfactory stability has been achieved with no instrument failure. (Neurosurgery 22:429-431, 1988)
Stereotactic Aspiration of Putaminal Hemorrhage Using a Double Track Aspiration Technique
Authors: Niizuma Hiroshi , Suzuki Jiro
Published: May 2010

Double track aspiration was used to remove the hematoma between 6 and 24 hours from onset in nine cases of putaminal hemorrhage. This technique was used in cases where an approach along the long axis of the hematoma was not feasible. With this method, aspiration is done at two target points lying anterior and posterior of the somewhat harder central region, at which aspiration is not attempted. This technique allows aspiration of most of the serum components, which are depicted as low density areas in computed tomographic (CT) scans, and some 53 to 85% of the main mass of the hematoma, which is seen on CT as high density areas. There was no rebleeding among these nine patients, and the remaining hematoma in all cases was located between two target points-a fact that is thought to indicate that the central portion of the hematoma is in fact somewhat harder than the peripheral portions. Although the double track aspiration technique has the disadvantage of producing two tracks, it is thought to be an effective method in such cases because it allows safe and thorough hematoma aspiration. (Neurosurgery 22:432-436, 1988)
Survival after Stereotactic Biopsy of Malignant Gliomas
Authors: Coffey Robert J. , Lunsford L. Dade , Taylor Floyd H.
Published: May 2010

For many patients with malignant gliomas in inaccessible or functionally important locations, stereotactic biopsy followed by radiation therapy (RT) may be a more appropriate initial treatment than craniotomy and tumor resection. We studied the long term survival in 91 consecutive patients with malignant gliomas diagnosed by stereotactic biopsy: 64 had glioblastoma multiforme (GBM) and 27 had anaplastic astrocytoma (AA). Sixty-four per cent of the GBMs and 33% of the AAs involved deep or midline cerebral structures. The treatment prescribed after biopsy, the tumor location, the histological findings, and the patient's age at presentation (for AAs) were statistically important factors determining patient survival. If adequate RT (tumor dose of 5000 to 6000 cGy) was not prescribed, the median survival was <11 weeks regardless of tumor histology or location. The median survival for patients with deep or midline tumors who completed RT was similar in AA (19.4 weeks) and GBM (27 weeks) cases. Histology was an important predictor of survival only for patients with adequately treated lobar tumors. The median survival in lobar GBM patients who completed RT was 46.9 weeks, and that in lobar AA patients who completed RT was 129 weeks. Cytoreductive surgery had no statistically significant effect on survival. Among the clinical factors examined, age of less than 40 years at presentation was associated with prolonged survival only in AA patients. Constellations of clinical features, tumor location, histological diagnosis, and treatment prescribed were related to survival time. For patients with deep or midline malignant gliomas and for selected patients with lobar tumors in critical areas, stereotactic biopsy followed by RT and nonoperative adjuvant therapy is a rational treatment strategy to prolong survival and preserve neurological function. (Neurosurgery 22:465-473, 1988)
Cerebrovascular Hemodynamics in Arteriovenous Malformation Complicated by Normal Perfusion Pressure Breakthrough
Authors: Batjer H. Hunt , Devous Michael D. , Meyer Yves J. , Purdy Phillip D. , Samson Duke S.
Published: May 2010

Catastrophic hyperemic states are known complications after the treatment of certain types of intracranial arteriovenous malformations (AVMs). A case is presented in which a large AVM was preoperatively embolized and later resected. There was clear intra- and postoperative evidence of edema and hemorrhage, which resulted in a fatal outcome. Regional cerebral blood flow (rCBF) data from this patient obtained with single photon emission computed tomography (SPECT) both before and after embolization were compared with data from four patients with similar size supratentorial AVMs treated and studied in a similar protocol who did not develop perfusion breakthrough. Pretreatment hemispheric rCBF was significantly reduced in this patient's ipsilateral hemisphere (50 ml/100 g/min) compared to the control group mean (83 ± 9.5 ml/100 g/min). A similar relative depression was found in the contralateral hemisphere. After therapeutic embolization, the ipsilateral rCBF increased by 33 ml/100 g/min and the contralateral hemispheric rCBF increased by 30 ml/100 g/min; this embolization-induced increase in rCBF was significantly higher than in the control group. Acetazolamide, known to increase rCBF in normal tissue by 35 ± 3%, resulted in a 56% augmentation of ipsilateral hemispheric flow before embolization in the reported patient vs. a 22 ± 10% increase for the control group. Postembolization, this hyperresponsiveness to acetazolamide remained unchanged. It is possible that these hemodynamic derangements may indicate a dissociation between the vasoconstrictive and vasodilatory reactivity in chronically hypoperfused territories adjacent to AVMs such that pharmacological or metabolic stimuli may induce further vasodilation, but sudden redistribution of large volumes of flow will not promote protective vasoconstriction. (Neurosurgery 22:503-509, 1988)
Petrosal Approach for Petroclival Meningiomas
Authors: Al-Mefty Ossama , Fox John L. , Smith Robert R.
Published: May 2010

Thirteen patients harboring large petroclival meningiomas are reported. The evolution of the petrosal approach is discussed, and modifications for improvement in surgical technique are described. There was no mortality in this series, and total removal was achieved in all but two patients. Morbidity included cranial nerve deficit, pulmonary embolism, and hemiparesis. (Neurosurgery 22:510-517, 1988)
Intramedullary Spinal Cord Tumors Resected with CO2 Laser Microsurgical Technique: Recent Experience in Fifteen Patients
Authors: Herrmann Hans-Dietrich , Neuss Michael , Winkler Dietrich
Published: May 2010

We have operated upon 15 intramedullary spinal cord tumors with the aid of a CO2 laser attached to the microscope. The operative technique is described. Most of the tumors were localized within the cervical spinal cord. Nine tumors were benign gliomas: 4 ependymomas, 1 subependymoma, 3 astrocytomas, and 1 ganglioglioma. Six were removed totally, and 3 were removed subtotally. The remaining 6 tumors consisted of 3 hemangioblastomas, 1 intramedullary neurofibroma, 1 lipoma, and 1 primary intramedullary melanoma. Neurological function postoperatively compared to the preoperative function of the upper extremities was unchanged in 13 patients (86.5%), improved in 1, and worse in 1 patient. In the lower extremities, the preoperative neurological status was unchanged in 11 patients (73.3%), improved in 1 patient, and worse in 3 patients (20%). Magnetic resonance imaging was superior to myelography and computed tomography in localizing these lesions. Enhancement with paramagnetic substances (e.g., gadolinium-DTPA) helps to localize solid tumor within cysts. Histological evaluation of small tissue biopsies or frozen section histology is unreliable. The entire lesion should be exposed in all cases, and an attempt should be made to remove the tumor totally or, if this is not possible, to resect as much of the center of the tumor as is possible until the cord is decompressed. The decision to administer further treatment is based on the histological features of the tumor. (Neurosurgery 22:518-522, 1988)
Ruptured Aneurysm of the Posterior Spinal Artery of the Upper Cervical Spinal Cord: Case Report
Authors: Goto Yasunobu , Kamijyo Yoshinari , Yonekawa Yasuhiro , Kikuchi Haruhiko
Published: May 2010

A case of aneurysm of the posterior spinal artery of the upper cervical spinal cord is presented. The patient had severe intracranial subarachnoid hemorrhage with disturbance of consciousness. Four-vessel angiograms showed neither anomalous arrangement of the arteries nor arteriovenous malformation intracranially or in the spinal subarachnoid space. Operation disclosed a thrombosed aneurysm of the posterior spinal artery, which was radically excised and histologically examined. (Neurosurgery 22:558-560, 1988)
Restoration of Hearing after Removal of Cerebellopontine Angle Meningioma: Diagnostic and Therapeutic Implications
Authors: Maurer Paul Kurt , Okawara Shige H.
Published: May 2010

A case of cerebellopontine angle meningioma with restoration of hearing from a profoundly deaf state is presented. Meningiomas of the posterior fossa commonly present with decreased or absent hearing and can appear deceptively similar to acoustic neurinomas on radiographic and audiometric testing. Because total restoration of hearing can occur with meningioma, even with significant preoperative deficit, utilization of the translabyrinthine approach is less desirable if any preoperative question as to the diagnosis exists. Any hearing-impaired patient with a cerebellopontine angle mass that is not conclusively thought to represent acoustic neurinoma should be approached by the suboccipital technique to maximize the opportunity for restoration of hearing. (Neurosurgery 22:573-575, 1988)
Gangliocytoma of the Cerebellum: Ultrastructure and Immunohistochemistry
Authors: Izukawa D. , Lach B. , Benoit B.
Published: May 2010

A 31-year-old man presenting with a cerebellopontine angle syndrome underwent subtotal resection of a gangliocytoma of the left middle cerebellar peduncle. The tumor was positive for 68-kD neurofilament protein and vasoactive intestinal peptide. No glial cells were identified on immunohistochemical or ultrastructural examination. Electron microscopic study of neoplastic ganglionic cells revealed the presence of dense core vesicles, synaptic junctions, Hirano bodies, and marked dystrophic changes in the neuritic processes. The nosology of this lesion is discussed. Similarities between the morphological changes shown by mature neoplastic ganglion cells and comparable structural alterations seen in the physiological senescence of nonneoplastic neurons are stressed. (Neurosurgery 22:576-581, 1988)
Carcinoid Tumor in a Presacral Teratoma Associated with an Anterior Sacral Meningocele: Case Report and Review of the Literature
Authors: Fiandaca Massimo S. , Ross Wayne K. , Pearl Gary S. , Bakay Roy A.E.
Published: May 2010

We report a case of a presacral teratoma containing a malignant carcinoid component associated with an anterior sacral meningocele that presented in a 35-year-old woman. The clinical, radiographic, and pathological features of these rare tumors, of presacral meningoceles, and of the hereditary presacral teratoma syndrome are discussed. (Neurosurgery 22:581-588, 1988)
Infantile Chronic Subdural Hematoma with Local Protrusion of the Skull in a Case of Osteogenesis Imperfecta
Authors: Tokoro Kazuhiko , Nakajima Fumoto , Yamataki Akira
Published: May 2010

Osteogenesis imperfecta with infantile chronic subdural hematoma is extremely rare and has not been previously described in the literature. Our patient was a baby girl suffering from osteogenesis imperfecta tarda (Type I) who had an acute subdural hematoma at birth and who developed a progressive chronic subdural hematoma with local protrusion of the overlying skull. She was treated surgically with a good result. This rare complication is due to weakness of an insufficiently calcified skull, which is peculiar to this disorder of bone and connective tissue development. (Neurosurgery 22:595-598, 1988)
Cysts with Mural Tumor Nodules in the Cerebral Hemispheres
Authors: Maiuri Francesco
Published: May 2010

Ten cases of cystic tumor with mural nodules in the cerebral hemispheres are reported. The tumors include five benign astrocytomas, two meningiomas, one ependymoma, one neuroblastoma, and one hemangioblastoma. In all cases, computed tomography showed enhancing mural tumors without enhancement of the cyst wall. Complete removal of the mural tumor without excision of the cyst is the goal of operation. The prognosis for patients with cystic tumors with mural nodules is excellent, clearly better than that of solid tumors.
Cervical Spinal Cord Stimulation for Spasticity in Cerebral Palsy
Authors: Hugenholtz Herman , Humphreys Peter , McIntyre William M. J. , Spasoff Robert A. , Steel Kate
Published: May 2010

A prospective double-blind study of high cervical spinal cord stimulation conducted in eight moderately disabled, spastic, cerebral palsied children failed to demonstrate any significant improvement over base line function during chronic spinal cord stimulation at either optimal stimulation parameters or random placebo parameters. Chronic stimulation included 4 consecutive months of stimulation for 24 hours each day. Stimulators were randomly programmed at optimal parameters for 2 of the 4 months and at placebo parameters for the remaining 2 months. At the end of each month of chronic stimulation, subjects were assessed with a multidisciplinary test battery that included a self-assessment, specific clinical examinations, tests of gross and fine motor control, neuropsychological and neurophysiological tests, a detailed gait analysis, and video recordings. By 6 months after the completion of the study, only 1 of the 8 subjects continued to use his stimulator on a regular basis, with minimal benefit.
Preliminary Experiences with Brachial Plexus Exploration in Children: Birth Injury and Vehicular Trauma
Authors: Piatt Joseph H. , Hudson Alan R. , Hoffman Harold J.
Published: May 2010

The application of microsurgical techniques to the peripheral nervous system has made possible the reconstruction of the brachial plexus after vehicular and penetrating injuries. We now report our preliminary experiences utilizing these same techniques in the microsurgical management of brachial plexus birth injury. In contrast to other authors and in distinction from our own experiences with vehicular trauma in children, we did not find lesions requiring reconstruction by grafting or neurotization in any of seven plexus explorations for birth injury. The history of the surgical management of brachial plexus birth injury is reviewed, and the rationale for exploration is developed in the context of the natural history of the condition. Differences between our experiences and the existing literature are analyzed, with particular regard for timing of operation and technique of intraoperative assessment of nerve injury. All children with birth injuries of the brachial plexus require careful, repeated neurological evaluation during the first few months of life. Although the great majority make a rapid and satisfactory spontaneous recovery, the minority who do not recover are destined to suffer significant, life-long disability. Microsurgical brachial plexus exploration may benefit this select group of patients.
Surgical Treatment of Brain Abscess
Authors: Stephanov S.
Published: May 2010

The author reviews the methods of surgical treatment of brain abscess. All methods are grouped into the following six catagories: tube drainage, marsupialization, the migration method of Kahn, tapping only, aspiration, and excision. At present, only two methods are used: aspiration and excision. Antibiotics and computed tomographic (CT) scanning play important roles in the surgical treatment of a brain abscess. The use of CT scanning is invaluable in the management of brain abscess for early and exact localization, assessment of the adequacy of operation, and sequential follow-up.
Intramedullary Spinal Tuberculoma
Authors: Rhoton Eric L. , Ballinger William E. , Quisling Ronald , Sypert George W.
Published: May 2010

A case report of intramedullary spinal tuberculomas presenting as cervical myelopathy is described. The rarity of these lesions in North America make this case unique. The use of modern neurodiagnostic and microsurgical techniques as well as the use of postoperative antituberculous drugs resulted in a good outcome. The first known description of magnetic resonance imaging of intramedullary spinal tuberculomas is presented. The gross and microscopic appearances of the lesion are given.
Resolution of Syringomyelia and Chiari I Malformation by Ventriculoatrial Shunting in a Patient with Pseudotumor Cerebri and a Lumboperitoneal Shunt
Authors: Sullivan Lawrence P. , Stears John C. , Ringel Steven P.
Published: May 2010

A sneeze caused acute left arm pain in a 36-year-old woman with a lumboperitoneal (LP) shunt that had been placed 3 years earlier for relief of headaches caused by pseudotumor cerebri. Numbness progressed up the left arm, neck, and back of the head and finally into the left face along with weakness of the hand and arm. Magnetic resonance imaging (MRI) and computed tomography revealed new tonsillar herniation and a large eccentric syrinx extending from C2 to T6. The functioning LP shunt was clamped, and a ventriculoatrial shunt was placed. Pain lessened and motor function improved slightly. MRI revealed complete resolution of the syrinx and resolution of the tonsillar herniation. Theories of syringomyelia formation, the relationship to Chiari I malformation, and the implications of this case are discussed.
Hydrocephalus and Intraspinal Tumor
Authors: Zavala L. Manuel , Adler John R. , Greene Clarence S. , Winston Ken R.
Published: May 2010

Hydrocephalus with spinal subarachnoid obstruction is rare, and its cause is obscure. Two such patients are presented. The pathophysiology is reviewed. Spinal absorptive pathways for cerebrospinal fluid are postulated to play a critical role in such cases.
Detection of Shunt-induced Intracerebral Hemorrhage by Postoperative Skull Films: A Report of Two Cases
Authors: Derdeyn Colin P. , Delashaw Johnny B. , Broaddus William C. , Jane John A.
Published: May 2010

The authors report two cases of large intracerebral hematomas complicating venticuloperitoneal shunting for normal pressure hydrocephalus. This potentially devastating consequence of shunting is rarely reported. In each case, an abnormal course of the ventricular catheter was evident on postoperative skull films.
Radiation-induced Meningiomas in Pediatric Patients
Authors: Moss S. David , Rockswold Gaylan L. , Chou Shelley N. , Yock Douglas , Berger Mitchel S.
Published: May 2010

Radiation-induced meningiomas rarely have latency periods short enough from the time of irradiation to the clinical presentation of the tumor to present in the pediatric patient. Three cases of radiation-induced intracranial meningiomas in pediatric patients are presented. The first involved a meningioma of the right frontal region in a 10-year-old boy 6 years after the resection and irradiation of a 4th ventricular medulloblastoma. Review of our pediatric tumor cases produced a second case of a left temporal fossa meningioma presenting in a 15-year-old boy with a history of irradiation for retinoblastoma at age 3 years and a third case of a right frontoparietal meningioma in a 15-year-old girl after irradiation for acute lymphoblastic leukemia. Only three cases of meningiomas presenting in the pediatric age group after radiation therapy to the head were detected in our review of the literature.
Cerebellar Hemangioblastoma Symptomatic during Pregnancy
Authors: Kasarskis Edward J. , Tibbs Phillip A. , Lee Charles
Published: May 2010

An 18-year-old woman presented during the 2nd month of her pregnancy with noncommunicating hydrocephalus due to a cerebellar hemangioblastoma. The tumor rapidly enlarged over a 12-day period after ventriculoperitoneal shunting, probably because of expansion of the vascular compartment. Serial computed tomography and magnetic resonance imaging observations support previous speculations in the literature that vascular engorgement of hemangioblastomas probably accounts for the rapid deterioration of some patients during pregnancy.
Altered Cerebral Autoregulation and CO2 Reactivity after Aneurysmal Subarachnoid Hemorrhage
Authors: Dernbach Paul D. , Little John R. , Jones Stephen C. , Ebrahim Zeyd Y.
Published: May 2010

Disruption of local cortical blood flow (CBF) autoregulation and CO2 reactivity, or vasoparalysis, has been documented in humans after aneurysmal subarachnoid hemorrhage (SAH). Generally, the degree of vasoparalysis is related to the patient's clinical grade. Using intraoperative measurement of local CBF, we evaluated pressure autoregulation and CO2 reactivity in patients after SAH. Fourteen patients with SAH and 10 patients with asymptomatic aneurysm underwent craniotomy for clipping of their aneurysms. During operation, local CBF was recorded with thermal conductivity probes placed on the middle frontal gyrus, 4 to 6 cm from the nearest point of retraction. Before retractor placement, CBF was measured with the PCO2 at 25 and 35 mm Hg and the mean arterial blood pressure (MABP) between 70 and 80 mm Hg. After aneurysm clipping, flows were again measured. With the PCO2 at 25 mm Hg, the MABP was raised from 65 to 85 mm Hg. The PCO2 was then allowed to rise to 35 mm Hg, after which the MABP was lowered from 85 to 65 mm Hg. Six patients underwent operation within the 1st week after SAH (Grade I, n = 3; Grade II, n = 3). The remainder (n = 8) were operated on 9 days to 3 months after SAH. After aneurysm clipping, significant CBF changes (P < 0.001) with PCO2 alteration occurred in control patients and those operated on more than 7 days after SAH. There was no significant change in CBF in patients operated on within 7 days after SAH. Changes in CBF reactivity to alteration of MABP were significantly larger in early operation patients than in other groups (P < 0.008). Pressure autoregulation and CO2 reactivity are significantly disturbed in good grade patients after early operation.
Analysis of Cervical Spine Curvature in Patients with Cervical Spondylosis
Authors: Batzdorf Ulrich , Batzdorff Alfred
Published: May 2010

Computer-aided design techniques were used to analyze the degree of spinal curvature shown on cervical spine radiograms of 28 patients. On films standardized as to size, a geometrical chord was constructed from the 2nd to the 7th cervical vertebrae (C2 to C7), and an arc was drawn along the posterior margin of the vertebrae. The resulting area was used as an index of curvature, and the spinal canal diameter was measured. Severity of myelopathy as well as clinical improvement was related to the geometrical data. There was no clear correlation between severity of the preoperative myelopathy and degree of curvature. Severe myelopathy was seen in association with straight, lordotic, and hyperlordotic spines. Neck pain was most severe in patients with reversed cervical curvature. The degree of curvature, however, seems to relate to the postoperative clinical outcome. Patients with relatively normal curvature showed the greatest improvement in symptoms and signs. Postoperative magnetic resonance scanning confirms that posterior migration of the spinal cord after laminectomy may be inadequate to clear osteophytes in patients with straightened or reversed curvature of the cervical spine. Spinal geometry should be considered in the selection of the best surgical procedure and the extent of laminectomy for patients with spondylotic myelopathy. Significant abnormalities of spinal curvature may account for some instances of poor outcome after laminectomy.
Improvement in Regional Cerebral Blood Flow and Cerebral Vasoreactivity after Extracranial-Intracranial Arterial Bypass
Authors: Batjer Hunt H. , Devous Michael D. , Purdy Phillip D. , Mickey Bruce , Bonte Frederick J. , Samson Duke
Published: May 2010

Regional cerebral blood flow was measured with xenon-133 inhalation single photon emission computed tomography in a patient who developed a neurological deficit after carotid ligation. Hemispheric hypoperfusion was noted in resting studies and impaired vasoreactivity was suggested by lack of symmetrical flow augmentation after acetazolamide administration. Because of progressive neurological deterioration, an extracranial-intracranial bypass was performed. After prompt neurological improvement, repeat cerebral blood flow measurements at 1 and 9 weeks postoperatively confirmed improvement in resting flow and vasoreactivity. It is possible that decreased cerebrovascular reserve implied by measurements of vasoreactivity can identify patients who will benefit from surgical revascularization.
Tandem Bypass: Occipital Artery to Posterior Inferior Cerebellar Artery Side-to-Side Anastomosis and Occipital Artery to Anterior Inferior Cerebellar Artery End-to-Side Anastomosis—a Case Report
Authors: Ausman James I. , Pearce Jeffrey E. , Vacca Dante F. , Diaz Fernando G. , Shrontz Carl E. , Patel Suresh
Published: May 2010

A unique example of posterior fossa revascularization is presented. A tandem bypass was performed by anastomosing the midoccipital artery to the posterior inferior cerebellar artery in a side-to-side fashion followed by an anastomosis of the distal occipital artery to the anterior inferior cerebellar artery in an end-to-side fashion. The operation was designed to revascularize two separate vascular territories that were isolated in a patient thought to have an extremely compromised posterior circulation. The patient is doing well and is asymptomatic 3 years postoperatively.
Intrasphenoidal Encephalocele: Report of a Case
Authors: Abiko Seisho , Aoki Hideo , Fudaba Hiroyoshi
Published: May 2010

The diagnosis of intrasphenoidal encephalocele may be difficult because of its rarity and its nonspecific signs and symptoms. The authors report a patient with intrasphenoidal encephalocele who was operated on by the transsphenoidal approach with a good result. They also review five reported cases, with discussion of their clinical characteristics and operative indications.
Orthodromic (Intra/Extracranial) Neurography to Monitor Facial Nerve Function Intraoperatively
Authors: Schmid U. D. , Sturzenegger M. , Ludin H. P. , Seiler R. W. , Reulen H. J.
Published: May 2010

This report introduces the technique of orthodromic neurography for monitoring of facial nerve function during operation in the cerebellopontine angle. By stimulation of the intracisternal segment of the facial nerve, a compound nerve action potential with amplitudes of 15 to 480 μV can be recorded extracranially from the nerve near the stylomastoid foramen after 0.95 to 2.27 ms. Usually there is no need for signal averaging, and the method is independent of the effect of muscle relaxants. With the use of the same electrophysiological equipment as for evoked potential neuromonitoring, immediate and repeated localization of the facial nerve and its discrimination from the trigeminal and the lower cranial nerves during nerve preparation within the tumor capsule is possible.
The Adrenal Medullary Transplant Operation for Park in son's Disease : Clinical Observations in Five Patients
Authors: Penn Richard D. , Goetz Christopher G. , Tanner Caroline M. , klawans Harold L. , Shannon Kathleen M. , Cornelia Cynthia L. , Witt Thomas R.
Published: May 2010

The recent report by Madrazo and coworkers on the successful treatment of Parkinson's disease using adrenal meduilary tissue transplanted to the caudate nucleus has aroused international interest in the procedure. The present article reports our initial experiences with the operation in five patients and discusses the postoperative effects of the procedure, the protocol used to monitor motor performance, and the need for cooperation with the two registries that have been created to follow morbidity, mortality, and efficacy. We intend to alert the neurosurgeon to important side effects, but not to assess the long term efficacy of the procedure. Postoperatively, a number of transient effects were seen in our patients, the most striking being somnolence, delusions, and lack of significant pain in spite of a large abdominal incision. The only complications have been respiratory. After the early postoperative period, gradual improvement of on-off times and Schwab-England disability scores was seen over 20 weeks. Long term cooperative studies are needed to demonstrate the efficacy of this procedure. Neurosurgeons doing transplant operations are urged to join the registries so that uniform information can be collected.
Anterior Cervical Fusion with the Caspar Instrumentation System
Authors: Tippets Richard H. , Apfelbaum Ronald I.
Published: May 2010

Twenty-eight patients with a variety of cervical spine abnormalities underwent anterior cervical spine stabilization with the Caspar osteosynthetic plate/intervertebral body bone graft technique. The available hardware and operative technique are presented, and case reports illustrate clinical applications. Complications and results of the series are presented. A brief discussion of applicable biomechanical principles and of technical pitfalls leading to potential fusion failures and a review of experience and developments in cervical plating techniques are included.
Diffuse Idiopathic Skeletal Hyperostosis Presenting with Thoracic Outlet Syndrome and Dysphagia
Authors: Kritzer Randy O. , Rose Janies E.
Published: May 2010

A case of diffuse idiopathic skeletal hyperostosis (DISH) presenting with thoracic outlet syndrome and dysphagia is reported. Although extraspinal manifestations have been reported in these patients, thoracic outlet syndrome, particularly the anatomical anomaly found at operation, is previously unreported in patients with DISH. In addition to discussing DISH and thoracic outlet syndrome, we readvocate the anterior approach for 1st rib resection that was introduced in 1967 by Gol and associates. The direct visualization offered by this approach allowed us to avoid a potential injury to the brachial plexus that may have occurred had the transaxillary approach been used.
Histiocytosis-X: A Rare Cause of Radiculopathy
Authors: Padovani Roberto , Cavallo Michele , Tonelli Maria Pia , Poletti Venerino , Ferracini Romano
Published: May 2010

A rare case of histiocytosis-X of the spine is presented. The clinical and histological features of histiocytosis-X are reviewed. Complete neurological recovery was exhibited by the patient after surgical treatment and radiotherapy. The literature dealing with the eight cases previously reported is reviewed.
Dural Arteriovenous Malformations and Papilledema
Authors: Gelwan Mark J. , Choi In Sup , Berenstein Alejandro , Pile-Spellman John M. D. , Kupersmith Mark J.
Published: May 2010

We examined and managed two patients with posterior fossa dural arteriovenous malformations (DAVMs) and papilledema. Both DAVMs had venous drainage into the transverse, straight, and sigmoid dural venous sinuses. The mechanism of papilledema in the first case was presumed venous hypertension resulting in impaired cerebrospinal fluid absorption, as the malformation drained into the single transverse sinus. This was cured by selective arterial embolization of the causative DAVM. The second patient had venous sinus thrombosis that impaired venous drainage despite embolization. A lumboperitoneal shunt was necessary to treat the elevated intracranial pressure.
Palinacousis: A Case Report
Authors: Patterson M. C. , Tomlinson F. H. , Stuart G. G.
Published: May 2010

Palinacousis (auditory perseveration) is a rarely reported symptom of temporal lobe dysfunction. We describe a new case. A 50-year-old woman presented with nausea, vomiting, and global dysphasia, followed by two generalized seizures. Examination was otherwise normal, and computed tomography showed a small area of enhancement near the left sylvian fissure; there was a left temporal focus on the electroencephalogram. Treatment with phenytoin was instituted, and speech improved, with residual fluent dysphasia. Three days postictally, the patient complained of “echoing voices” in her right ear. Words or fragments of sentences recently uttered by the patient or others were perceived to recur unaltered for minutes to hours. Sounds other than speech were also affected. One week later the voices had disappeared, but a ticking sound was present; this also faded subsequently. The palinacousis never recurred; the patient was later found to have a Grade IV astrocytoma of the left temporal lobe, which caused her demise 8 months later. The features of this case are similar to those previously reported and favor an epileptic etiology. Palinacousis should be recognized as a sign of organic temporal lobe disease and not confused with manifestations of psychotic illness.
Malignant Growth Hormone-secreting Pituitary Adenoma with Hematogenous Dural Metastasis: Case Report
Authors: Asai Akio , Matsutani Masao , Funada Nobuaki , Takakura Kintomo
Published: May 2010

A rare case of growth hormone-secreting pituitary adenoma with hematogenous metastasis to the dura mater of the cerebral convexity is presented. Immunohistological staining was essential to the diagnosis. The histological findings demonstrated that the metastasis was blood-borne. Extensive removal of the tumor and postoperative chemotherapy resulted in partial remission. The mechanism of metastasis, the histological findings, the treatment, and the prognosis are discussed.
Chondroblastoma of the Temporal Bone
Authors: Blaauw Gerhard , Prick Jan J.W. , Versteege Cees
Published: May 2010

A chondroblastoma within the temporal bone in a 16-year-old boy is reported. The tumor recurred after intracapsular resection and curettage. After reoperation, radiotherapy was performed. The data from 137 cases of chondroblastoma are summarized.
De Novo Saccular Aneurysms
Authors: Misra Basant K. , Whittle Ian R. , Steers A. James W. , Sellar Robin J.
Published: May 2010

The authors report two patients with aneurysmal subarachnoid hemorrhage in whom carotid arteriography revealed aneurysms that had developed at previously normal locations and from infundibula during the years since initial angiography. Neither of these patients had congenital anomalies of the cerebral circulation and, apart from smoking in excess of 30 cigarettes a day, there were no common clinical features. The role of congenital and environmental factors in the formation of aneurysms and the enlargement of infundibula are reviewed.