bluuebunny/crossref_metadata_2025 huggingface dataset:
Prophylaxis of the laminectomy membrane
Authors: Barberá José , Gonzalez José , Esquerdo José , Broseta Jaime , Barcia-Salorio Juan Luis
Published: May 2009

✓ Sixty laminectomies were performed in dogs to investigate the prevention of the laminectomy membrane and its side effects. These operations were distributed in six groups of 10, one was a control group, and in the others the bone defect was protected with different materials (Oxicel, Silastic, Dacron, methyl methacrylate, and Kiel bone graft). After a survival of 2 months, suboccipital myelography was performed, immediately after which the animals were sacrificed and the operated spinal slice obtained. The different radiographic densities of the tissues of each slice were calculated and the diverse histological nature identified by hematoxylin and eosin, periodic acid Schiff, Masson's trichrome, and Gomori's reticulin stains. Only the acrylic plastic and the Kiel bone graft prevented expansion of the scar tissue inside the spinal canal and adhesions between the dura and the cicatricial overlying muscles. Therefore, the authors suggest that a solid barrier is necessary to effectively prevent the so-called “laminectomy membrane.”
Paracoccidioidomycosis of the skull
Authors: Saul Krivoy O. , Belfort Edgar A. , Mondolfi Alejandro , Walzer Irvin , Essenfeld Erwin , Landaeta Tomás
Published: May 2009

✓ A case of paracoccidioidomycosis of the skull is presented. No evidence of a previous lung, mucous membrane, or nervous system infection was found. Radiological and surgical findings suggested osteomyelitis. The authors stress the importance of including paracoccidioidomycosis in the differential diagnosis of osteolytic skull lesions in countries where this fungus is endemic.
Recurrence of medulloblastoma after homogeneous field radiotherapy
Authors: Hardy David G. , Hope-Stone Harold F. , McKenzie Christopher G. , Scholtz Carl L.
Published: May 2009

✓ Three cases are reported of posterior fossa medulloblastoma in children. In each case metastatic spread occurred despite homogeneous field radiotherapy to the whole neuraxis; the secondary tumor was located in the subfrontal region. In the two cases in which operative removal of the metastasis was carried out, the tumor was found to be extracerebral and was attached to the dura in the region of the cribriform plate. The “face-down” position of patients during operations on the posterior fossa makes this area the most dependent part and therefore the most likely recipient of tumor cells shed at operation. This area has not previously been included in the field of maximum dosage for radiotherapy, but as a result of these findings a modification in technique of radiotherapy has been suggested.
Congenital lumbar ridge causing spinal claudication in adolescents
Authors: Birkenfeld Ronald , Kasdon David L.
Published: May 2009

✓ Two adolescent boys had classic histories and findings of spinal claudication. Their plain x-ray films were read as normal and myelograms demonstrated a ventral defect at L4–5. Surgical exploration revealed ventral bony ridges in both cases. Laminectomy initially provided substantial relief, but spinal fusion was necessary for complete abolition of symptoms.
Development of cerebellar malignant astrocytoma at site of a medulloblastoma treated 11 years earlier
Authors: Klériga Enrique , Sher Joanna Hollenberg , Nallainathan Sanath-Kumar , Stein Sherman C. , Sacher Michael
Published: May 2009

✓ A child treated for a desmoplastic medulloblastoma of the left cerebellar hemisphere at the age of 10 months developed a malignant astrocytoma in the same site 11 years later. Theories of origin of the second tumor, particularly in relation to concepts of the genesis of medulloblastoma in general, are discussed.
Lipoma of the quadrigeminal plate causing progressive obstructive hydrocephalus
Authors: Halmagyi G. Michael , Evans William A.
Published: May 2009

✓ A patient with congenital hydrocephalus and poor vision since early childhood, but with normal motor and intellectual development, suffered progressive mental deterioration during the last decade of life. At necropsy he was found to have severe hydrocephalus secondary to a lipoma of the midbrain tectum obstructing the aqueduct of Sylvius. In addition, the septum pellucidum was absent, the corpus callosum was thinned, and the anterior visual system was atrophic. The case emphasizes the importance of full neuroradiological investigation of congenital hydrocephalus. The possible association of intracranial lipoma with septo-optic dysplasia is discussed.
Infratentorial neuroepithelial cyst (colloid cyst)
Authors: Challa Venkata R. , Markesbery William R.
Published: May 2009

✓ An asymptomatic neuroepithelial cyst (colloid cyst) located in the leptomeninges between the inferior colliculus and the paravermal region of the superior cerebellum was an incidental postmortem finding. The cyst was lined by ciliated pseudostratified columnar epithelium of the respiratory tract type as well as cuboidal epithelium of the ependymal type. Its developmental relationship to previously described colloid and paraphyseal cysts in the third ventricle is discussed.
Intracranial solitary chondroma
Authors: Dutton John
Published: May 2009

✓ A case of massive solitary intracranial chondroma involving the base of the skull in a 15-month-old baby boy was successfully treated by total excision. The diagnosis was greatly simplified by the use of computerized tomography, which materially helped in planning the surgical approach.
Neurosurgery: Considerations for strength and quality
Authors: Drake Charles G.
Published: May 2009

✓ The President of the American Association of Neurological Surgeons reviews the organization of the Association designed to represent neurosurgery and neurosurgeons. He summarizes the pertinent problems that the specialty has faced and with which it continues to deal, in persistent pursuit of its objective: to assure the highest quality of neurosurgical care for all.
Protective effects of methyl prednisolone and dimethyl sulfoxide in experimental middle cerebral artery embolectomy
Authors: Laha Ranjit K. , Dujovny Manuel , Barrionuevo Pedro J. , DeCastro Samuel C. , Hellstrom Harold R. , Maroon Joseph C.
Published: May 2009

✓ Acute arterial embolism continues to be a major cause of stroke morbidity in children and young adults. Potential therapy modalities include medical management and/or cerebral revascularization. The canine middle cerebral artery (MCA) was embolized by means of a pliable cylinder, 8 mm long by 1.6 mm in diameter, via the internal carotid artery. Control and experimental embolectomies were performed 6 hours following embolization. The experimental animals were treated with either dimethyl sulfoxide (DMSO) or methyl prednisolone. In the control animals, the average area of infarction in the brain was 1.45 cu cm. The animals treated with methyl prednisolone (2 mg/kg) or DMSO (2 gm/kg) showed no infarction of the brain, whereas methyl prednisolone (30 mg/kg) did not prevent infarction.
Modification of acute focal ischemia by treatment with mannitol and high-dose dexamethasone
Authors: Little John R.
Published: May 2009

✓ A simple implanted device was used to occlude the left middle cerebral artery (MCA) of 50 conscious cats. In the acute experiments, 10 cats were given mannitol (1.2 gm/kg intravenously) and 10 cats were untreated. The neurological status of the treated cats improved. Perfusion with a mixture of colloidal carbon and buffered paraformaldehyde was carried out from 30 minutes to 12 hours following MCA occlusion. Results of the morphological examination of the brains demonstrated that mannitol delayed the development of neuronal alterations and edema. Measurement of capillary luminal diameters in the ischemic cortex of the untreated cats revealed progressive narrowing with microcirculatory obstruction occurring at 6 hours. Capillary narrowing was absent or minimal in the treated cats during the initial 6 hours. Breakdown of the blood-brain barrier also was delayed by treatment. In the 30 subacute experiments, 10 cats were untreated, 10 cats received mannitol (1.2 gm/kg intravenously), and 10 cats were given a combination of mannitol and high-dose dexamethasone. Although early transient clinical improvement occurred in the treated animals, morphological findings in the brains of the treated and untreated cats following 48 hours of ischemia were not significantly different. Despite the finding that the beneficial effects of mannitol were relatively short-lived (6 to 12 hours), the delay in the development of irreversible changes probably is important as it would allow a longer period of time for the institution of a more definitive form of therapy.
Treatment of aneurysmal hemiplegia with dopamine and mannitol
Authors: Brown Frederick D. , Hanlon Kathryn , Mullan Sean
Published: May 2009

✓ Three patients with severe postoperative hemiplegia and one with hemiplegia following a subarachnoid hemorrhage are presented. None had hematomas. All were treated with dopamine-induced hypertension, mannitol, and large quantities of intravascular fluids. All showed a remarkable degree of clinical improvement, presumably secondary to an increase in cerebral blood flow.
Unmyelinated fibers in the trigeminal motor root
Authors: Young Ronald F.
Published: May 2009

✓ Spinal ventral roots have been shown by electron microscopy to contain a substantial number of unmyelinated fibers. Physiological studies have confirmed that many of these subserve a sensory function. In this investigation the fiber spectrum of the human trigeminal motor root was studied by electron microscopy and it was determined that up to 20% of fibers were unmyelinated. This accounted for approximately 300 to 1000 fibers per root. Since visceral efferent fibers are thought not to occur in the trigeminal root, it appears likely that these unmyelinated fibers may be afferent in nature. It is believed that the presence of a substantial number of unmyelinated fibers in the trigeminal motor root may account for residual sensation or failure of pain relief after rhizotomy of the trigeminal portio major root.
Studies of experimental cervical spinal cord transection
Authors: Tibbs Phillip A. , Young Byron , McAllister R. G. , Brooks William H. , Tackett Laddie
Published: May 2009

✓ Two distinct and sequential patterns of hemodynamic alteration were observed after acute cervical spinal cord transection in anesthetized dogs. Interruption of the cord initially caused a 45% increase in mean arterial pressure (p < 0.01), a 34% increase in systemic vascular resistance (p < 0.05), and a 92% increase in left ventricular dp/dt (p < 0.01), reflecting a generalized sympathetic response to trauma. Concomitant bradycardia and escape arrhythmias suggested relative parasympathetic hyperactivity. Resolution of the brief pressor response was followed by a second, more prolonged, period characterized by a fall in arterial pressure to 71% of control levels (p < 0.05), a 16% decrease in systemic vascular resistance, and a 58.5% decrease in left ventricular dp/dt (p < 0.01). These latter hemodynamic changes are consistent with sympathetic denervation and failure of regulatory mechanisms mediated by both alpha- and beta-adrenergic peripheral vascular and myocardial receptors.
Inhibition of Na+-K+-activated ATPase activity following experimental spinal cord trauma
Authors: Clendenon Nancy R. , Allen Norman , Gordon Wanda A. , Bingham W. George
Published: May 2009

✓ The specific activity of the membrane-bound enzyme, Na+-K+-activated adenosine triphosphatase (ATPase), has been shown to be decreased following experimental impact injury (400 gm-cm) to the spinal cord in dogs. The prompt and significant (p < 0.01) fall in activity was evident as early as 5 minutes after injury, and remained at 56% to 67% of control for the 1-hour period studied. This decrease was most prominent in the central core of the traumatized segments of spinal cord. Central core samples, excised immediately adjacent to the trauma site, gave values for the Na+-K+-activated enzyme intermediate to those of the trauma and control sites. For these same samples, the activity of the Mg+2-dependent ATPase did not change appreciably. No alterations were observed in the tissue surrounding the zone of maximum injury at these early time periods. The relationship of membrane-bound enzyme alterations to blood flow, clotting mechanisms, and abnormal free radical reactions are briefly discussed.
The effect of amphotericin B on the survival of brain-tumor-bearing mice treated with CCNU
Authors: Muller Paul J. , Tator Charles H.
Published: May 2009

✓ The membrane-active polyene, amphotericin B (AMB) has been shown to enhance or potentiate the effects of various chemotherapeutic agents against tumor cells in tissue culture. Because of the need to increase the efficacy of the nitrosoureas in brain-tumor chemotherapy, we have studied the effect of the nitrosourea, 1-(2-chloroethyl)-3-cyclohexyl-l-nitrosourea (CCNU), with or without AMB pretreatment.

The intraperitoneal administration of 25 mg/kg of AMB 24 hours before 5, 10, 20, or 30 mg/kg of intraperitoneal CCNU did not result in a significant improvement in survival. The failure of intraperitoneal AMB to potentiate the effect of CCNU was likely a failure in drug delivery, since AMB crosses the blood-brain barrier very poorly. To circumvent the drug-delivery problem, AMB was administered intracerebrally directly into the tumor-bearing hemisphere. With 0.5 mg/kg of intracerebral AMB administered 24 hours before 10 mg/kg CCNU was given intraperitoneally, the life-span was significantly increased over the control group. The same dose of CCNU alone did not significantly increase survival. When 0.2, 0.5, or 1.0 mg/kg AMB was administered intracerebrally 24 hours before 20 mg/kg of intraperitoneal CCNU, survival was significantly increased over those groups receiving the same dose of CCNU alone. It is concluded that direct intracerebral administration of AMB enhances or potentiates the therapeutic effect of CCNU in this brain-tumor model.
Delayed cure of Cushing's disease after transsphenoidal surgery of pituitary microadenomas
Authors: McDonald Stephen D. , Von Hofe Stanley E. , Dorfman Steven G. , Jordan Richard M. , LaMorgese James R. , Young Robert L.
Published: May 2009

✓ Transsphenoidal microdissection has been proposed as a preferred means of treating Cushing's disease. This procedure allows the surgeon to remove a pituitary microadenoma and at the same time to preserve normal tissue. Two cases described here were treated by this method. An interesting and important observation was that neither patient appeared to be cured for 2 to 6 weeks after surgery, as assessed by dexamethasone suppression. Later, normal suppressibility occurred and the course of each patient was compatible with cure. Patients treated by this method should not be automatically retreated because of adrenocorticotropic hormone (ACTH) non-suppressibility in the early postoperative period.
Myopathy associated with epsilon-aminocaproic acid (EACA) therapy
Authors: MacKay Alex R. , U Hoi Sang , Weinstein Philip R.
Published: May 2009

✓ The association of myopathy with epsilon-aminocaproic acid (EACA) treatment after subarachnoid hemorrhage in two cases is reported. Clinical and laboratory findings and possible mechanisms are discussed in light of the known pharmacology of the drug. Recovery ensues if EACA treatment is terminated as soon as myopathy appears.
Acoustic neurinoma presenting as subarachnoid hemorrhage
Authors: Gleeson Robert K. , Butzer John F. , Grin Oliver D.
Published: May 2009

✓ A case of an acoustic neurinoma presenting as a subarachnoid hemorrhage is described. This is the second such case in the literature.
Decreased mortality from brain abscesses since advent of computerized tomography
Authors: Rosenblum Mark L. , Hoff Julian T. , Norman David , Weinstein Philip R. , Pitts Lawrence
Published: May 2009

✓ No deaths have occurred among 20 consecutive patients with intraparenchymal brain abscesses treated at the University of California, San Francisco, since computerized tomographic (CT) brain scanning became a routine diagnostic procedure (study period: July, 1974, to June, 1977). These patients have been compared to 18 consecutive cases treated without benefit of CT analysis (January, 1970, to June, 1974) in order to determine the factors responsible for the recently improved prognosis. The mortality rate was 44% for all cases and 36% for all operated patients treated before the availability of CT. Similar morbidity (about 33%) was seen in survivors from both series. No significant differences in the two groups were noted with respect to patient population and antibiotic or corticosteroid therapy. Among the factors that may have contributed to the improved results for patients diagnosed with CT are: less frequent occurrence of multiple abscesses, fewer patients with poor preoperative clinical status, and a greater incidence of total abscess removal. In addition, CT scanning provided more accurate diagnosis and localization of abscesses and aided in the rapid detection of postoperative complications that probably accounted for six out of eight deaths in the earlier series. Serial CT studies provide a means to optimize the timing for surgical intervention and plan appropriate medical therapy. It is note-worthy that two patients have been followed by serial CT scans to non-surgical cures.
Treatment of moyamoya disease with STA-MCA anastomosis
Authors: Karasawa Jun , Kikuchi Haruhiko , Furuse Seiji , Kawamura Junichiro , Sakaki Toshisuke
Published: May 2009

✓ Moyamoya disease is a chronic occlusive cerebrovascular disease of unknown etiology for which no effective treatment has been found. The authors report the results of 23 superficial temporal-middle cerebral artery (STA-MCA) anastomoses and seven encephalomyosynangioses, performed on 13 cases with moyamoya disease and on four additional atypical cases. There were 10 children and seven adults in this study. The follow-up period ranged from 1 year and 4 months to 4 years and 1 month postoperatively; nine patients had excellent results, five good, and one fair; two patients were unchanged. The anastomotic procedure was most effective for transient ischemic attacks, reversible ischemic neurological deficits, and even minor or moderate neurological symptoms. The STA-MCA anastomosis appears to be an effective treatment for moyamoya disease.
Symptomatic subependymoma
Authors: Scheithauer Bernd W.
Published: May 2009

✓ Of 48 cases of subependymoma reported to date, 22 were associated with symptoms. In a personal series of 47 additional cases of subependymoma reviewed by the author, 21 were symptomatic. The mean age of patients with symptom-producing subependymomas was 39 years, that is, 20 years younger than that of patients with asymptomatic tumors. Symptoms were most often produced by large tumors, particularly those arising from the septum pellucidum (100%), the floor of the fourth ventricle (65%), and the lateral ventricular walls (55%). The majority of symptomatic tumors displayed the classic gross and microscopic features of subependymomas; however, large tumors more frequently demonstrated cyst formation, microcalcification, and vessel degeneration accompanied by hemorrhage. Of all subependymomas, 15% were microscopically composed of an admixture of classic subependymoma and cellular ependymoma; of these, one-half occurred within the first decade, all were situated in the fourth ventricle, and 80% were symptomatic. In contrast to pure subependymomas, the mortality rate of patients with mixed tumors was 80%, reflecting their growth potential, large size, and dangerous location.
Immediate correction of sagittal synostosis
Authors: Jane John A. , Edgerton Milton T. , Futrell J. William , Park Tae Sung
Published: May 2009

✓ A technique for correction of sagittal synostosis with achievement of an immediately pleasing cosmetic result is presented. Even with replacement of bone and no attempt to inhibit bone union, premature reclosure does not occur. Moss' theory of dural tensions is discussed to explain the effect.
Myelomeningocele before birth
Authors: Osaka Kunihiko , Tanimura Takashi , Hirayama Akihiko , Matsumoto Satoshi
Published: May 2009

✓ The authors report a study of 92 human embryos and four fetuses with myeloschisis. The characteristics of embryonic myeloschisis compared with spina bifida cystica in infants are: 1) the lesion is often more diffuse, involving the whole spinal cord (12 embryos); 2) the cervical cord is more frequently affected (23 of the remaining 80 embryos); 3) holoprosencephaly is frequently associated (18 embryos); 4) meningocele is not found; and 5) hydrocephalus and Arnold-Chiari malformation are not yet developed. Hydrocephalus and Arnold-Chiari malformation are found in myeloschistic fetuses. Almost all embryos with diffuse and cervical myeloschisis or with holoprosencephaly are extruded before birth by spontaneous abortion. Absence of meningocele in the embryonic period implies that its appearance is deferred to the fetal period. The development of hydrocephalus and Arnold-Chiari malformation also seems to be delayed until the fetal period. Our observation implies that myelomeningocele is induced by non-closure of the neural tube, not by rupture once it was closed. “Neural overgrowth” and disturbed “recanalization process” are discussed in relation to the pathogenesis of myelomeningocele.
Aneurysmal bone cyst of the skull
Authors: Mufti Samir T.
Published: May 2009

✓ A case of an aneurysmal bone cyst of the frontal bone is presented. This lesion is rare in the calvaria. It is a benign condition, and may extend intracranially. Total surgical removal is recommended whenever possible either in one stage or in multiple stages. The operation is comparatively easier in the calvaria than it is in the vertebral column or the long bones, where no more than a thorough curettage is usually possible. The fact that this is a definite, readily recognizable pathological entity is stressed. Prognosis is excellent and total removal will effect a cure.
Blow-in fracture of both orbital roofs caused by shear strain to the skull
Authors: Sato Osamu , Kamitani Hiroshi , Kokunai Takashi
Published: May 2009

✓ The authors report a case with blow-in fractures of both orbital roofs caused by horizontal shear strain to the skull. The mechanism of the injury is discussed. Ophthalmic symptoms were improved by removal of intraorbital bone fragments and by repair of the orbital roof defects with methyl methacrylate.
Bilateral intracerebellar calcification associated with cerebellar hematoma
Authors: Kawakami Yasuto , Nakao Yoshikuni , Tabuchi Kazuo , Nosaka Yoshiki , Ohmoto Takashi
Published: May 2009

✓ A case of bilateral intracerebellar calcification associated with cerebellar hematoma on the left side is reported. Clinical and microscopic examination failed to clarify the causes of calcification and hematoma. It is postulated that hemorrhage occurred from time to time through the fragile calcified vessel walls, since some portions of the organized hematoma were composed of massive erythrocytes.
Cerebral aneurysm in an infant with fibromuscular hyperplasia of the renal arteries
Authors: Bolander Hans , Hassler Ove , Liliequist Bengt , West Kurt A.
Published: May 2009

✓ The authors report a case of subarachnoid hemorrhage in an 11-month-old infant with tragic outcome. Radiological investigation showed an anterior communicating aneurysm, and postmortem examination confirmed the aneurysm to be a so-called “berry” aneurysm. There were also typical signs of fibromuscular hyperplasia of the renal arteries. The microscopic findings are discussed. In view of the rarity of both aneurysms and fibromuscular hyperplasia in such a small child, a possible association of these entities suggested by several earlier investigators is reviewed.
Asymptomatic persistence of infundibularis recessus
Authors: Cabanes Jeronimo
Published: May 2009

✓ A congenital malformation of the anteroinferior aspect of the third ventricle is described. This anomaly has been found only rarely in anatomical descriptions. The embryological development of the pituitary region is described.
The rhetoric of specialization
Authors: Hanlon C. Rollins
Published: May 2009

✓ The 1978 Cushing Orator shows the role of rhetoric in the process by which various specialties change in response to sociological and legislative demands. He discusses the effect of applying concepts of restraint of trade to medicine, and welcomes a closer liaison through the American College of Surgeons between general surgeons and other surgical specialties.
Management of 136 consecutive supratentorial berry aneurysms
Authors: Mullan Sean , Hanlon Kathy , Brown Frederick
Published: May 2009

✓ A series of 103 consecutive cases admitted to the University of Chicago Hospitals with a recently ruptured supratentorial aneurysm were medically managed by antifibrinolytic medication, and, when applicable, by hypotension, intracranial pressure control, and respiratory support. Nine patients deteriorated and died, and six rebled and died before they were judged fit for surgical treatment. Four were treated by carotid occlusion. Nine, because of refusal or medical judgment, did not have surgical treatment. Sixty-nine of these patients and a further 33, electively admitted, underwent craniotomy. In these 102 patients, there was no mortality. Seven developed postoperative hemiparesis or hemiplegia. Six recovered. One has a residual monoparesis.
An investigation with serial angiography into the evolution of cerebral arterial spasm following aneurysm surgery
Authors: Adams Christopher B. T. , Fearnside Michael R. , O'Laoire Sean A.
Published: May 2009

✓ Serial postoperative angiograms were performed in 28 patients with intracranial aneurysms, 26 of whom had presented with a subarachnoid hemorrhage. The clinical state and intracranial pressure (ICP) were also measured. Angiograms were performed in the ward using a cannula, which was passed into the proximal external carotid artery via the superficial temporal artery. Measurements of the vessel diameters were made, with the preoperative angiogram as a baseline. Patients could be placed into one of five groups depending on the presence or absence of significant arterial spasm, the clinical state of the patient, and the normality or otherwise of the ICP. No patient's condition deteriorated without an elevated ICP and/or significant arterial spasm. The study shows that this spasm is usually associated with a poor clinical state if it reaches a maximum 8 to 12 hours after the operation, although the clinical deterioration is not apparent for a further 6 to 12 hours. Knowledge of the natural history of postoperative arterial spasm may allow earlier treatment of the spasm, which may be more successful than delaying treatment until clinical deterioration has occurred. The worth of the varied drugs proposed for the treatment of spasm may be assessed using this type of protocol.
Foramen magnum tumors
Authors: Yasuoka Shozo , Okazaki Haruo , Daube Jasper R. , MacCarty Collin S.
Published: May 2009

✓ This study involved 57 patients with benign extramedullary tumors of the foramen magnum (19 neurinomas, 37 meningiomas, and one teratoma), who were operated on between 1957 and 1976. The 37 meningiomas represented 3.2% of 1139 meningiomas of the neuraxis. The initial neurological examinations of about half of these patients were unremarkable. The clinical presentation of tumors of the foramen magnum frequently mimics multiple sclerosis, cervical spondylosis, intramedullary tumor, syrinx, carpal tunnel syndrome, and even normal-pressure hydrocephalus. All operations were performed through a posterior approach, and two surgical deaths (3.5%) were recorded. No surgery for recurrence of tumor was recorded. The follow-up review of 56 patients (98.2%) showed good functional results if the tumor was detected before severe neurological deficits occurred. The possible mechanism of the sensory symptoms and muscle atrophy of the hands is discussed, and the electromyographic findings are reviewed.
The neurosurgical management of spinal metastases causing cord and cauda equina compression
Authors: Livingston Kenneth E. , Perrin Richard G.
Published: May 2009

✓ The authors report a series of 100 consecutive patients with spinal metastases causing cord or cauda equina compression, who were treated with surgical decompression. Of these, 30% (all women) had breast cancer. The most common primary neoplasm in man was prostatic carcinoma. Pain was the earliest and most prominent symptom, followed by weakness. Bladder dysfunction was recorded in 40 patients. The thoracic region was the most common site of cord compression (76 patients). Surgical treatment involved urgent and extensive laminectomy decompression. Concomitant spinal stabilization was required in 10 cases, involving posterior rib graft fusion in seven and Harrington rod instrumentation in three. At last follow-up review, 29 of these patients were living with an average postoperative survival of 2.3 years; 71 patients had died with an average survival of 8.8 months. Surgical decompression produced effective pain relief in 70% of the patients. Postoperatively, 58 patients could walk; of these, 40 were walking and continent of urine 6 months following surgery (including five patients who were totally paraplegic on admission). Positive approach and aggressive management in this problem can achieve results superior to those generally reflected in the literature.
Lymphocytic infiltrates in primary glioblastomas and recidivous gliomas
Authors: Palma Lucio , Di Lorenzo Nicola , Guidetti Beniamino
Published: May 2009

✓ The correlation existing in several human malignancies between lymphocytic infiltration and prolonged survival prompted this study. Two hundred selected patients who were operated on for glioblastoma were reviewed to investigate the incidence of the lymphocytic infiltration in the histological slides and its possible relevance to a better clinical course. The group that exhibited a definite lymphocytic infiltration (Group A, 11.5%) had a significantly longer preoperative history and postoperative survival (p < 0.01) than the other two groups that presented slight or no infiltration (Group B, 23%, and Group C, 65%, respectively). In addition, biopsies of 28 recidivous gliomas were reviewed to study the fate of this lymphocytic infiltration in relation to time and therapy, such as irradiation and steroids which are known to depress the immune response. The authors found that severe lymphocytic infiltration is a rare immunobiological reaction which significantly improves the prognosis of a malignant brain tumor and seems not to be influenced by time, local x-ray therapy, or steroids.
Catecholamine response to intracranial hypertension
Authors: Graf Carl J. , Rossi Nicholas P.
Published: May 2009

✓ Pulmonary congestion, hemorrhage, and edema, produced in the experimental animal by various methods of disturbing the central nervous system, have led to the concept that such neurogenically-initiated changes are mediated through the autonomic nervous system. Blocking the sympathetic nervous mechanisms prevents these changes. Little is found concerning the expected role of catecholamines. In this study, using a standard model of increasing intracranial pressure (ICP), intense cardiovascular changes, with blood pressure rising above 320 mm Hg and heart rate of 180 beats per minute, were noted. Within seconds, plasma catecholamine levels rose as much as 1200 times the highest normal values for epinephrine, 145 times for norepinephrine, and 35 times for dopamine. These changes occurred only when raised ICP was sustained and spatial compensation of the brain was exceeded. It is not unlikely that these events are related not only to increased ICP, but also to the effects of physical distortion of the brain stem with structural, functional, and vascular alterations within it.
Exploration of selected brachial plexus lesions by the posterior subscapular approach
Authors: Kline David G. , Kott Joseph , Barnes George , Bryant Lester
Published: May 2009

✓ The application of an old surgical technique, previously employed for treatment of thoracic outlet syndromes, to lesions of the brachial plexus is discussed. Positioning of the patient, the surgical procedure, and selected indications for a posterior subscapular approach with resection of the first rib are discussed. The indications for the use of this approach are: proximal plexus lesions involving roots and/or trunks believed to be repairable, complicated thoracic outlet syndromes, prior anterior exploration for vascular or nervous structure disease, and progressive plexus palsy associated with damage to the soft tissue of the anterior chest wall and supraclavicular regions secondary to irradiation. The authors' experience to date with 12 such cases is presented in chart form, while five cases are presented in some detail.
Supratentorial intracerebral hemorrhage following posterior fossa surgery
Authors: Haines Stephen J. , Maroon Joseph C. , Jannetta Peter J.
Published: May 2009

✓ Five cases of supratentorial intracerebral hemorrhage following posterior fossa surgery are reported. Possible etiologies are discussed, but in only one case can a definite etiology (hypertension) be found. The differential diagnosis of declining level of consciousness after posterior fossa surgery must include supratentorial intracerebral hemorrhage, and computerized tomography seems to be the diagnostic method of choice.
Immunoblastic sarcoma (histiocytic lymphoma) of the brain with B cell markers
Authors: Varadachari Chandra , Palutke Margarita , Climie A. R. W. , Weise Robert W. , Chason Jacob L.
Published: May 2009

✓ A group of central nervous system neoplasms, previously known as reticulum cell sarcoma or microglioma, and recently classified as malignant lymphoma, histiocytic type, not infrequently occur in patients with immunodeficiency, either primary or induced by immunosuppressant drugs. The authors report such a neoplasm in a patient with idiopathic thrombocytopenic purpura immunosuppressed with azathioprine and prednisone. The neoplasm was studied with several immunological techniques and by electron microscopy. The neoplasm had B lymphocyte membrane markers and showed plasmacytic differentiation. These features suggest that it was a tumor of transformed B lymphocytes (immunoblasts).
Giant serpentine intracranial aneurysm after carotid ligation
Authors: Fodstad Harald , Liliequist Bengt , Wirell Staffan , Nilsson Per-Erik , Boquist Lennart , Abdul-Rahman Ali
Published: May 2009

✓ A case is reported of a giant aneurysm of the intracavernous portion of the left internal carotid artery that was treated initially with a left common carotid artery ligation. Six months later the aneurysm was partially removed. During this time the development and evolution of thrombus formation, a serpentine channel, and a hypervascular capsule was easily followed with reeeated computerized tomography and angiography of the aneurysm.
Isolated fourth ventricle as a complication of ventricular shunting
Authors: Hawkins John C. , Hoffman Harold J. , Humphreys Robin P.
Published: May 2009

✓ Signs of cerebellar dysfunction combined with signs suggestive of shunt malfunction developed in three children with obstructive hydrocephalus. Shunt function was normal. In all cases, the cerebellar signs persisted and computerized tomography scans revealed enlargement of the fourth ventricle. Shunting of the fourth ventricle returned the patients to normal function.
Extensive cerebral nocardiosis cured with antibiotic therapy alone
Authors: Kirmani Nigar , Tuazon Carmelita U. , Ocuin Jay A. , Thompson Anne M. , Kramer Norman C. , Geelhoed Glenn W.
Published: May 2009

✓ A 34-year-old renal transplant recipient developed multiple soft tissue and extensive cerebral nocardiosis. The number and location of the cerebral abscesses and probable areas of cerebritis precluded surgical drainage procedures. Gradual resolution of all the cerebral lesions occurred over a period of 6 months with antibiotic therapy alone. A review of the literature revealed only one previous case of a patient with pulmonary nocardiosis who had a probable secondary brain abscess and who survived without surgical drainage. Thus, if surgical drainage is not possible, antibiotic therapy alone may offer a hope of survival in what otherwise has been considered a uniformly fatal disease.
The outcome with aggressive treatment in severe head injuries
Authors: Marshall Lawrence F. , Smith Randall W. , Shapiro Harvey M.
Published: May 2009

✓ In a series of 100 consecutive patients with severe head injuries, uncontrolled intracranial hypertension, which was defined as occurring when intracranial pressure (ICP) exceeded 40 mm Hg for 15 minutes or more, occurred in 25 patients. This was despite high-dose dexamethasone, hyperventilation, mannitol, normothermia, appropriate surgical evacuation, and cerebrospinal fluid drainage when possible. Persistently elevated ICP occurred in 19 patients with diffuse brain injury, and in six patients uncontrolled intracranial hypertension followed evacuation of a surgical mass. All of these patients received intravenous barbiturates to control the ICP. At the time of initial barbiturate administration, 11 of the 25 had bilaterally unreactive pupils and 12 were decerebrate. The initial pentobarbital loading dose (3 to 5 mg/kg) effectively reduced the ICP in 76% of the patients. Prolonged pentobarbital treatment with blood barbiturate levels from 2.5 to 3.5 mg% was associated with normalization of the ICP (ICP less than 15 mm Hg) in 13 patients. In those patients responding to barbiturates, the daily mannitol requirement was reduced from 4.5 to 0.5 gm/kg/day (p < 0.01). In six nonresponders to barbiturates, mannitol requirements increased to 5.9 gm/kg/day; five of these died and one remains vegetative.

Ten of the 19 barbiturate responders have returned to a productive life, two remain moderately disabled, two are severely disabled, one is vegetative, and four are dead. The high rate of good quality survival in this series of severely brain-injured patients indicates that barbiturates are useful in the treatment of uncontrolled intracranial hypertension and that a broader investigation of the clinical application of barbiturates is indicated.
Spondylolisthesis after multiple bilateral laminectomies and facetectomies for lumbar spondylosis
Authors: Shenkin Henry A. , Hash Cecil J.
Published: May 2009

✓ The authors report a further 3-year follow-up review of a series of 59 patients suffering with intractable pain due to lumbar spondylosis and treated by multiple-level bilateral laminectomies and facetectomies. Routine postoperative x-ray examination revealed that six of 59 patients had developed spondylolisthesis. Two of the six were symptomatic and required a secondary fusion procedure. Analysis of the patients who had developed vertebral slippage revealed that 6% of the patients with only two levels (L-4 and L-5) removed developed spondylolisthesis, but in those with three or more levels removed 15% showed slipped vertebrae. After an average follow-up period of 6 years, 87% of patients still had a worthwhile result as contrasted with 91% of the same series who had had a good result after a follow-up period averaging 3 years.
Experimental spinal cord injury produced by slow, graded compression
Authors: Schramm Johannes , Hashizume Keizo , Fukushima Takanori , Takahashi Hiroshi
Published: May 2009

✓ A new model of experimental spinal cord injury produced by slow, graded compression in cats is described. The extent of cord compression was evaluated by monitoring somatosensory evoked potentials (SEP's). The compression was exerted by means of a special screw-plate assembly with stepwise advancement of the compression plate at different time intervals and was completed when cortical SEP had disappeared. Every stage in the total course of gradual compression was expressed as a percentage of the total. Cortical and spinal SEP's were recorded at each increment. The SEP pattern was analyzed in terms of latency, amplitude, and wave form. It was noteworthy that SEP's were remarkably resistant to gradual compression. The amplitude of cortical SEP's began decreasing at a late stage of compression, usually at about 80% of total compression, and that of spinal SEP's some time earlier, at about 60% of total compression. They both then rapidly fell to zero. Cortical SEP's showed a slight increase in latency concurrent with the reduction of amplitude, while the latency of spinal SEP's was constant. Mid-thoracic SEP's showed considerable individual variation in wave form. Their changes were similar to those of cortical SEP. Thoracolumbar SEP's, recorded immediately rostral to the compression, showed little individual variation, and did not show flat recordings even with maximum compression. A small monophasic positive wave was present in all animals even after the cortical SEP's became flat. This “final potential” was assumed to be caused by electrotonic volume conduction from the activities of the dorsal white matter caudal to the compression site. The reversibility of SEP's after the release of compression was remarkable. Both cortical and spinal SEP's could show complete recovery even when histological examination demonstrated hemorrhagic necrosis. The present data show no linear correlation between SEP changes and degree of compression. There are no changes with slight or moderate degree of compression. Alterations of SEP's in slow compression models should suggest the presence of a severe degree of compression.
Pressor response resulting from experimental contusion injury to the spinal cord
Authors: Rawe Stephen E. , Perot Phanor L.
Published: May 2009

✓ Experimental contusion paraplegic injury to the posterior spinal cord in cats results in a sudden increase of systemic blood pressure to between 200 and 250 mm Hg, and an increase in pulse pressure and a slowing of pulse rate. This initial hypertensive phase lasts approximately 3 to 4 minutes, and then is followed by a hypotensive phase. This pressor response is mediated by the alpha adrenergic receptor sites of the peripheral sympathetic nervous system and can be blocked by intravenous phenoxybenzamine, an alpha adrenergic blocking agent. The hypotensive phase is the result of an overall reduction in alpha adrenergic vascular tone and can be reversed by the infusion of metaraminol or intravenous fluids. The alterations in blood pressure that follow impact injury are most likely related to alterations of peripheral arteriolar resistance and venous return of blood to the heart.
The contrast-enhanced CT scan in the diagnosis of isodense subdural hematoma
Authors: Tsai Fong Y. , Huprich James E. , Segall Hervey D. , Teal James S.
Published: May 2009

✓ The authors review 29 cases of surgically-proven isodense subdural hematomas examined by non-contrast and contrast-enhanced computerized tomography scans. Three types of isodense collections were noted: homogeneous isodense collections, mixed-density collections, and gravitational layering within subdural collections. Contrast enhancement within the cerebral cortex, cortical vessels, and subdural membranes led to the correct diagnosis in each case. Contrast-enhanced scans are essential for the evaluation of isodense subdural hematomas.
Histological examination of kaolin-induced hydrocephalus
Authors: DeFeo Don R. , Myers Patti , Foltz Eldon L. , Everett Bruce , Ramshaw Bruce
Published: May 2009

✓ To determine the possible efficacy of distal subarachnoid space shunting in the treatment of hydrocephalus, the brains of dogs with kaolin-induced hydrocephalus were examined histologically to discover the location of the kaolin and the nature of any biological reaction to the foreign substance. Hydrocephalus was produced by the mechanical infusion of a sterile kaolin suspension into the cisterna magna. After sacrifice the brains were removed and sectioned at the upper cervical cord, pontomedullary junction, midbrain, and optic chiasm, then histologically studied and photographed. Kaolin deposition was most notably found ventral to the brain stem, approaching the foramen of Luschka, up to and within the third ventricle. Ventrally, the kaolin and subsequent inflammatory reaction extended from the chiasmatic cistern down throughout the pre-pontine cistern to surround the cervical cord. In these cases, the kaolin was not found in the lateral ventricles, nor did it extend above the basal and ambient cisterns to cause inflammation in the cortical subarachnoid spaces. Due to the failure of the kaolin and any accompanying reaction to reach the cerebral convexities, it can be concluded that these distal spaces are potentially functional and open to cerebrospinal fluid (CSF) flow and absorption. The pathophysiology of kaolin-induced hydrocephalus is then due to the inflammatory obstruction of the CSF pathways, preventing normal bulk CSF flow to the distal subarachnoid spaces of the cerebral hemispheres thus mimicking some forms of human hydrocephalus.
Thermoregulatory sweating in palmar hyperhidrosis before and after upper thoracic sympathectomy
Authors: Shih Chun-Jen , Lin Mao-Tsun
Published: May 2009

✓ To assess thermoregulatory sweating in palmar hyperhidrosis, the authors determined the responses of three groups of normal, hyperhidrotic, and denervated subjects to a variety of ambient temperatures (TA's), 22°, 28°, and 41° C. The normal group had no hyperhidrosis, with intact T2–3 ganglia, the hyperhidrotic group had palm hyperhidrosis with intact T2–3 ganglia, and the denervated group had hyperhydrosis treated with T2–3 ganglionectomy. Both groups of hyperhidrotic and denervated subjects maintained oral and mean skin temperatures within normal limits displayed by the normal group over a wide range of TA's tested. The local sweating rate (LSR) of both the palms and the soles of the feet in the hyperhidrotic group was decreased to a minimal level by either the T2–3 ganglionectomy or the subcutaneous administration of atropine sulfate. Furthermore, the denervated group had a significantly lower LSR of both the forehead and the upper chest regions, but showed a higher LSR of both the ventral thigh and the lateral lumbar regions at a TA of 41° C when compared to the LSR of either the normal or the unoperated hyperhidrotic group. The data demonstrate that the surgical removal of both the T-2 and the T-3 ganglia, although producing no alterations in the thermal balance, does produce abnormalities in quantitative distribution of thermoregulatory sweating in man.
Multiple nevoid basal-cell carcinoma syndrome (Gorlin's syndrome): Possible confusion with metastatic medulloblastoma
Authors: Hawkins John C. , Hoffman Harold J. , Becker Laurence E.
Published: May 2009

✓ The authors report a diagnostic dilemma involving a child who, 8 years previously, had total excision of a medulloblastoma. On x-ray studies, lytic lesions of the skull were seen. The differential diagnosis and some of the clinical and pathological aspects of the nevoid basal-cell carcinoma syndrome versus metastases are discussed.
Recurrent subependymal giant-cell astrocytoma in the absence of tuberous sclerosis
Authors: Halmagyi G. Michael , Bignold Leon P. , Allsop John L.
Published: May 2009

✓ A case is described of a subependymal giant-cell astrocytoma that occurred as a mural nodule within a cyst in the parietal lobe. The tumor recurred twice over a period of 47 years despite two extensive surgical resections. Neither the patient nor any of his children suffered tuberous sclerosis, a disease with which this type of astrocytoma is associated.
Computerized tomographic demonstration of rotational atlanto-axial fixation
Authors: Rinaldi Italo , Mullins William J. , Delaney William F. , Fitzer Peter M. , Tornberg David N.
Published: May 2009

✓ The authors report a case of rotational fixation of the atlanto-axial joint in which the diagnosis was not reached by conventional radiographic techniques. The clinical impression of rotational fixation was ultimately confirmed by computerized tomography. This new diagnostic modality can be very helpful in arriving at a very difficult diagnosis.