bluuebunny/crossref_metadata_2025 huggingface dataset:
Ventriculoatrial Shunt Infection Due to Cryptococcus neoformans: An Ultrastructural and Quantitative Microbiological Study
Authors: Walsh Thomas J. , Schlegel Robert , Moody Marcia M. , Costerton John W. , Salcman Michael
Published: May 2010

A 28-year-old man presented with hydrocephalus due to an infection by Cryptococcus neoformans involving his ventriculoatrial shunt. Ultrastructural studies of the ventriculoatrial shunt demonstrated yeastlike organisms consistent with C. neoformans within a biofilm on the appliance. Quantitative microbiological studies of segments of the shunt demonstrated C. neoformans in a concentration gradient from 9 × 106 colony-forming units (CFU)/0.5-cm section involving the ventricular portion of the catheter to 1 × 102 CFU/0.5-cm section at the vascular tip. The clinical, microbiological, and ultrastructural data suggest that this cryptococcal infection started as a ventriculitis or encephalitis with extension to the meningeal surface. Future application of these methods may further elucidate the pathogenesis of ventriculoatrial shunt infections.
Progressive Multifocal Leukoencephalopathy: Three Patients Diagnosed by Brain Biopsy, with Prolonged Survival in Two
Authors: Schlitt Michael , Morawetz Richard B. , Bonnin Jose , Chandra-Sekar B. , Curtiss John J. , Diethelm Arnold G. , Whelchel John D. , Whitley Richard J.
Published: May 2010

Since 1980, three immunocompromised patients have been proved to have progressive multifocal leukoencephalopathy (PML) by brain biopsy at the University of Alabama at Birmingham. Two patients presented with focal neurological findings, and the third presented with dementia. Computed tomography (CT) revealed white matter low density lesions in areas appropriate to the neurological abnormalities. Brain biopsy of areas that were abnormal on CT produced diagnostic tissue in all three patients. No patient suffered ill effects from the biopsy. Neuropathological findings on light microscopy were compatible with PML in each case, although there was diversity within the group. Involvement of gray and white matter was present in all biopsy specimens; oligodendrocytes, astrocytes, and neurons were affected. Electron microscopic demonstration of particles compatible with polyoma virus confirmed the diagnosis in each case. Immunosuppressive medication was discontinued in two of the patients; these two have survived more than 2 years after diagnosis. One of these two has gradually improved and is independent in simple activities of daily life. Brain stem and cerebellar involvement and seizure disorders have been present in all reported cases. PML can be accurately and rapidly diagnosed by brain biopsy, enabling therapeutic manipulations that may prolong survival.
Experience with External Pneumatic Calf Compression in Neurology and Neurosurgery
Authors: Black Peter McL. , Baker Mary F. , Snook Curtis P.
Published: May 2010

This report reviews our experience with external pneumatic compression (EPC) therapy in preventing clinically evident deep venous thrombosis (DVT) and pulmonary emboli (PE) in neurological and neurosurgical patients. A total of 523 patients admitted to the Departments of Neurology and Neurosurgery at the Massachusetts General Hospital from December 1980 through January 1984 are included. The incidence of DVT despite EPC use was 2.3%. The incidence of PE diagnosed by lung scan and usually confirmed by angiography was 1.8%. In conjunction with previously published reports of the incidence of DVT and PE, these data suggest that EPC may be efficacious in decreasing the incidence of DVT but may not prevent PE in neurological and neurosurgical patients.
Spontaneous Arteriovenous Fistulas of Cerebral Vessels in Association with Fibromuscular Dysplasia
Authors: Hieshima Grant B. , Cahan Leslie D. , Mehringer Mark C. , Bentson John R.
Published: May 2010

Four cases of spontaneous arteriovenous fistula seen in association with fibromuscular dysplasia of the parent artery are presented. In two patients, the fistula was between the carotid artery and cavernous sinus; in two others, the fistula involved the vertebral artery and paravertebral veins. It is postulated that the angiopathy was responsible for the fistula. Treatment by detachable balloon embolization was successful in each case; however, the presence of the fibromuscular dysplasia made treatment more difficult.
Surgical Management of Cerebellar Peduncle Lesions in Children
Authors: Tomita Tadanori
Published: May 2010

Four children with intrinsic cerebellar peduncle lesions (three benign astrocytomas and one histiocytic encephalitis) are reported. Each patient underwent a resection of mass lesions through posterior fossa craniotomy with microsurgical techniques and a surgical laser. None showed permanent neurological deficits postoperatively. A brief anatomical consideration of cerebellar peduncle lesions and the surgical approach used are described.
Scheuermann's Dorsal Kyphosis and Spinal Cord Compression: Case Report
Authors: Klein David M. , Weiss Richard L. , Allen James E.
Published: May 2010

Although Scheuermann's disease (juvenile dorsal kyphosis) is a common problem of late childhood and adolescence, its potential for neurological complications is not widely appreciated. In rare instances, spinal cord compression appears to be produced by the kyphotic protrusion alone, and we present an example of this unusual problem. Although the results of surgical treatment in this situation cannot be substantiated, anterior spondylotomy and decompression followed by posterior fixation appear to offer the best mechanical relief. Spinal cord compression can also be produced by extradural cysts, with which Scheuermann's disease is frequently associated. Scheuermann's disease also is reported to occur in combination with thoracic disc protrusion, but the coincidence here may be random. Pertinent literature is reviewed.
Intraoperative Aneurysmal Rupture: Incidence, Outcome, and Suggestions for Surgical Management
Authors: Batjer Hunt , Samson Duke
Published: May 2010

Intraoperative rupture of an intracranial arterial aneurysm can dramatically interrupt a deliberate microsurgical procedure and jeopardize the patient's chances for a favorable outcome. Intraoperative rupture occurred in 58 of 307 (19%) consecutive aneurysm procedures done at The University of Texas Health Science Center. Rupture occurred during three specific periods: early or predissection in 7%, dissection in 48%, and clip application in 45%. Outcome after rupture during the predissection interval was poor, with only 1 of 4 patients surviving. Aneurysmal rupture during dissection could be attributed to blunt dissection techniques in 75% of the cases and to sharp subarachnoid dissection in 25%. The outcome was favorable in only 50% of the patients sustaining blunt dissection errors, whereas all patients sustaining intraoperative rupture during sharp dissection recovered well. Rupture during clip application was attributed to incomplete dissection in 65%, poor clip application in 31%, and a mechanical clip failure in 1 case. Eighty-eight per cent of the patients who underwent uneventful operative procedures had favorable outcomes, whereas only 62% of the patients suffering intraoperative rupture recovered well. The use of sharp microsurgical techniques with a systematic contingency plan for dealing with sudden hemorrhage and the judicious use of temporary clips should minimize the adverse effect of intraoperative rupture on overall management morbidity and mortality.
Retinal Artery Pressure and Cerebral Artery Perfusion Pressure in Cerebrovascular Occlusive Disease
Authors: Little John R. , Tomsak Robert L. , Ebrahim Zeyd Y. , Furlan Anthony J.
Published: May 2010

The objectives of the investigation were to measure the retinal artery pressure (RAP) and cortical artery pressure (CAP) in patients undergoing superficial temporal artery to middle cerebral artery (STA-MCA) bypass, to study the relationship between these pressures, and to evaluate our ability to predict CAP on the basis of RAP. The 44 patients undergoing bypass surgery included 26 with ipsilateral internal carotid artery (ICA) occlusion (Group I), 5 with bilateral ICA occlusion (Group II), 4 with inaccessible ICA stenosis proximal to the ophthalmic artery (OA) (Group III), 2 with ICA stenosis distal to the OA (Group IV), 3 with ICA occlusion distal to the OA (Group V), 2 with MCA stenosis (Group VI), and 2 with MCA occlusion (Group VII). Five patients undergoing craniotomy for an asymptomatic saccular aneurysm were used as controls. Mean RAP (MRAP) was measured by ophthalmodynamometry (ODM) and was expressed as a ratio of the mean systemic arterial blood pressure (i.e., MRAP/MSAP). The mean MRAP/MSAP for combined Groups I, II, and III with ICA occlusion proximal to the OA was significantly lower than both the control group (P = 0.0001) and the combined Groups IV, V, VI, and VII with occlusive lesions distal to the OA (P = 0.0001). Six patients in Groups I and II with venous stasis retinopathy had a mean MRAP/MSAP of 0.18 + 0.11. Mean cortical artery pressure (MCAP) was measured by inserting a 26 gauge needle into a small cortical artery and was expressed as the MCAP/MSAP ratio. Mean MCAP/MSAP was less than 0.50 for all groups except Group III. The mean MCAP/MSAP for combined Groups IV, V, VI, and VII was significantly lower than in combined Groups I, II, and III (P = 0.02). RAP measured by ODM was moderately predictive of CAP in patients with an occlusive lesion of the ICA proximal to OA (r = 0.50). The degree of correlation was highest for those patients with a very low MCAP/MSAP (i.e., <0.25) ratio (r = 0.74). These findings indicate that ODM may be helpful in identifying patients with severe cerebral hypoperfusion secondary to ICA occlusive disease proximal to the OA.
Comparison among Three Methods of Intracranial Pressure Recording
Authors: North Brian , Reilly Peter
Published: May 2010

Fluid-coupled recording systems are the most popular method of recording intracranial pressure (ICP), but they can be prone to blockage and infection. A series of 378 recordings of ICP was analyzed to identify complications and cases in which recording had to be discontinued prematurely because of catheter blockage. Three different methods of ICP recording were used: a ventricular catheter, a Richmond screw, and a subdural catheter. Richmond screws became blocked more often (16%) than subdural catheters (2.7%) or ventricular catheters (2.5%). Complications of infection and intracerebral hemorrhage were observed mostly in the ventricular catheter patients. Of these three methods, a subdural catheter is the preferred method of recording ICP.
Bilateral Carotid Siphon Involvement in Giant Cell Arteritis
Authors: Vincent Frederick M. , Vincent Tish
Published: May 2010

A 60-year-old woman with inadequately treated giant cell arteritis developed an acute unilateral ischemic optic neuropathy associated with bilateral carotid artery and orbital bruits. Angiography demonstrated vascular changes compatible with arteritis localized to the cavernous and petrous segments of both internal carotid arteries. After treatment with high dose steroids, the bruits disappeared.
Reversal of Fixed Pupils after Spontaneous Intraventricular Hemorrhage with Secondary Acute Hydrocephalus: Report of Two Cases Treated with Early Ventriculostomy
Authors: Hochman Seth M.
Published: May 2010

Rapid reversal of fixed pupils, complete external 3rd nerve ophthalmoplegia, and coma occurred after early ventricu-lostomy in two hypertensive male patients with spontaneous intraventricular hemorrhage and secondary acute hydro-cephalus. Putative pathophysiology of fixed pupils secondary to transtentorial herniation from obstructive hydrocephalus is discussed. Cases such as the present ones are unsettling because they are exceptions to the usually reliable negative prognosis indicated by fixed puplis. Nonetheless, it is important to report these cases to delineate which patients with this important clinical sign may benefit from aggressive management.
Choroid Plexus Papilloma with Chondroma: Case Report
Authors: Salazar Jorge , Vaquero Jesùs , Aranda Ignacio F. , Menèndez Josefa , Jimenez Dolores M. , Bravo Gonzalo
Published: May 2010

The authors report the successful total removal of a rare intracranial tumor in the right lateral ventricle of a 15-year-old girl with epileptic seizures. Histopathological examination showed a benign tumor formed by mature cartilage and choroid plexus papilloma. From our review of the literature, a mixed tumor with these histological features has not been reported previously in this location. The diagnosis, surgical approach, etiology, and prognosis of this lesion are discussed.
Case Report: Childhood Cerebellopontine Angle Teratoma Associated with Congenital Hydrocephalus
Authors: Waters David C. , Venes Joan L. , Katrina Zis
Published: May 2010

A case of childhood teratoma in the cerebellopontine angle associated with shunted congenital hydrocephalus is presented. The need for detailed computed axial scanning with and without contrast in congenital hydrocephalus not associated with intraventricular hemorrhage or myelodysplasia is emphasized.
Computed Tomography-based Stereotactic Third Ventriculostomy: Technical Note
Authors: Kelly Patrick J. , Goerss Stephan , Kall Bruce A. , Kispert David B.
Published: May 2010

This report describes a computed tomography-based computer-assisted stereotactic technique for performing 3rd ventriculostomy. The procedure has been performed on seven patients with acquired obstructive hydrocephalus of various etiologies. None of these patients have yet required shunting. (18:791–794, 1986)
Anterior Cerebral Artery Reconstruction
Authors: Yokoh Akira , Ausman James I. , Dujovny Manuel , Diaz Fernando G. , Berman S. Kim , Sanders James , Mirchandani Haresh G.
Published: May 2010

Anterior cerebral artery end-to-end, end-to-side, and side-to-side anastomoses and grafting procedures including bypass and interposition using segments of the posterior cerebral artery harvested from the same specimen were performed. The reconstruction procedures were accomplished experimentally with the A1 and A2 segments of the anterior cerebral artery. the recurrent artery of Heubner (RAH), and the orbitofrontal and frontopolar arteries in end-to-end or end-to-side anastomosis to the A1 segment. Side-to-side anastomoses between both A2 or A3 segments were completed without difficulty. We utilized the anatomical and experimental reconstruction data in the performance of three surgical procedures for aneurysms in this area. An A1 to A2 end-to-end anastomosis, an A2 to A2 end-to-side anastomosis, and an end-to-end anastomosis of the RAH were performed with no technical difficulties or complications. This study shows the feasibility of these microvascular reconstruction procedures in the anterobasal part of the interhemisphere, where cerebral aneurysms frequently develop.
Craniotomy versus Transsphenoidal Excision of Large Pituitary Tumors: The Usefulness of Magnetic Resonance Imaging in Guiding the Operative Approach
Authors: Snow Robert B. , Lavyne Michael H. , Lee Benjamin C. P. , Morgello Susan , Patterson Russell H.
Published: May 2010

Fifteen patients with large pituitary tumors were studied with computed tomography (CT) and magnetic resonance imaging (MRI). CT was performed using General Electric 8800 and 9800 scanners (General Electric Co., Medical Systems Division, Milwaukee, Wisconsin). MRI was performed utilizing a Technicare superconducting scanner (Technicare, Cleveland, Ohio) at 0.5 tesla. Based on the operative findings, the tumors were divided into two groups. Tumors in Group 1 (n = 12) were described by the surgeon as soft or partially necrotic and easily removed by suction and curettage. Tumors in Group 2 (n = 3) were firm and required sharp dissection or the laser for removal. The tumors were divided into four categories based on MRI signal: (a) isointense with surrounding brain on spin echo (SE) 30 and SE 90, (b) increased signal intensity on SE 30 and SE 90, (c) decreased signal intensity on SE 30 and increased signal intensity on SE 90, and (d) isointense signal on SE 30 and increased signal intensity on SE 90. All three of the firm tumors were isointense with brain on MRI appearance. The tumor consistency (firm vs. soft) was not differentiable on CT scan. The transsphenoidal approach is less satisfactory than craniotomy in cases of firm, fibrous pituitary tumors. Based on our preliminary data, if the MRI signal in the tumor is isointense, then the surgeon should be prepared to deal with a fibrous tumor and might elect a transcranial rather than a transsphenoidal approach.
Intracranial Rupture of a Pressure Monitoring Transducer: Technical Note
Authors: Gentleman Douglas , Mendelow David A.
Published: May 2010

A solid state catheter tip transducer was used to measure intracranial pressure. During calibration, air escaped into the subdural space. Ways of recognizing and preventing this complication are discussed.
Primary Ewing's Sarcoma of the Base of the Skull
Authors: Steinbok Paul , Flodmark Olof , Norman Margaret Grace , Chan Ka Wah , Fryer Christopher John Hugh
Published: May 2010

The authors report a case of primary Ewing's sarcoma of the petrous bone. The radiological features, including the computed tomographic sean and angiographic findings, are described in detail.
Candida albicans Shunt Infection: Report of Two Cases
Authors: Gower David J. , Crone Kerry , Alexander Eben , Kelly David L.
Published: May 2010

Infection of cerebrospinal fluid shunts with Candida albicans is reported in two patients. Scanning electron microscopy in one case demonstrates the relationship of the Candida hyphae to the white blood cells and to silicone plastic. A review of 10 previously reported cases of Candida shunt infection indicates that the infection usually follows a major bacterial infection or direct contamination or occurs spontaneously, Previous therapy has usually involved removal of the shunt, and the role of parenteral antifungal therapy is still unclear. Overall mortality to date is 25%.
Perineurioma: A Benign Peripheral Nerve Tumor
Authors: Tranmer Bruce I. , Bilbao Juan M. , Hudson Alan R.
Published: May 2010

A unique benign peripheral nerve tumor, called a perineurioma, is described in this report. Light and electron microscopy and immunohistochemistry indicate that this tumor was derived from the perineurial cell. We discuss the ultrastructure, histogenesis, and management of this neoplasm.
Surgical Approaches for the Correction of Metopic Synostosis
Authors: Delashaw J. B. , Persing John A. , Park T.S. , Jane John A.
Published: May 2010

Premature closure of the metopic suture results in a deformity ranging from a minor variation to a severe cosmetic deformity. The three principal abnormalities comprising metopic synostosis are trigonocephaly secondary to the restriction of growth of both frontal bones, deficient lateral supraorbital rims, and hypotelorism. Seventeen of 18 patients evaluated for metopic synostosis had surgical correction of their anomalies. For a minor degree of prominence at the metopic suture, a bicoronal flap followed by shaping at the suture with a shaping burr was sufficient and yielded favorable cosmetic results. A more extensive procedure for cosmetic resolution of trigonocephaly and hypotelorism was required for those patients with more pronounced deformities. In patients with moderate to severe metopic synostosis, the following procedures were important in achieving excellent cosmetic results: (a) a bicoronal subgaleal flap down to the supraorbital rims with preservation of continuity of pericranium with an intact periorbita; (b) bifrontal craniotomy with complete removal of the metopic suture; (c) dural plication in midline to achieve an immediate aesthetically pleasing contour; d) removal or remodeling of the supraorbital rims and nasion with replacement of the remodeled frontal bone anteriorly in order to rebuild the orbital rim and release the supraorbital bar from the anterior cranial base; and e) securement of the bifrontal bones anteriorly and laterally, but not posteriorly, to allow further anterior and lateral displacement of the supralateral orbital margin.
Inaccurate Pressure Readings for Subarachnoid Bolts
Authors: Miller Jimmy D. , Bobo Hunt , Kapp John P.
Published: May 2010

The subarachnoid bolt has been used extensively to monitor intracranial pressure in a variety of conditions. We have had two patients who had subarachnoid bolts in place that were thought to be functional in whom evidence of increased pressure was present. In one case, the patient had Reye's syndrome with seizure activity, decerebrate posturing, fixed and dilated pupils, and cardiac arrest. Although autopsy revealed evidence of cerebellar and uncal herniation, verifying the presence of pressure cones, the subarachnoid bolt pressure was never elevated and had a good wave form. In the other case, the patient developed an epidural hematoma postoperatively while a subarachnoid bolt was in place. The subarachnoid bolt was measuring pressures of less than 15 mm Hg with a good wave form despite clinical and, subsequently, computed tomographic evidence of an evolving mass. The use of a pressure monitor such as the subarachnoid bolt should not replace frequent clinical assessment of the patient.
Metamorphopsia and Permanent Cortical Blindness after a Posterior Fossa Tumor
Authors: Brau Ricardo H. , Lameiro Juan , Llaguno Alousius V. , Rifkinson Nathan
Published: May 2010

A case of posterior fossa tumor associated with supratentorial symptoms is presented. The pattern of symptoms that developed after operation follow the description of metamorphopsia. The condition progressed to permanent cortical blindness. Tumoral vasospasm is suggested as a possible etiological mechanism for the clinical picture.
Spontaneous Hemorrhage in a Mixed Glioma of the Cerebellum: Case Report
Authors: Specht C.S. , Pinto-Lord C. , Smith T.W. , DeGirolami U. , Suran E. , Marshall P.C. , Davidson R.I.
Published: May 2010

An 8-year-old boy presented in coma and was found to have a massive posterior fossa hemorrhage on computed tomographic scan. Autopsy disclosed a large cerebellar hematoma within a mixed glioma containing both juvenile pilocytic astrocytoma and oligodendroglioma. It is postulated that the hemorrhage originated from the oligodendroglial component of the tumor.
Multiple Peripheral Aneurysms of the Posterior Inferior Cerebellar Artery
Authors: Beyerl Brian D. , Heros Roberto C.
Published: May 2010

Peripheral aneurysms of the posterior inferior cerebellar artery (PICA) are rare. The authors describe a case in which five distinct peripheral aneurysms of the PICA were diagnosed and microsurgically clipped while preserving the parent vessel. One of the aneurysmal sacs was excised and examined pathologically, and no evidence of an infectious etiology was found. The surgical approach to peripheral PICA aneurysms is discussed and the literature concerning these unusual aneurysms is reviewed.
Delayed Intracerebral Hemorrhage after Ventriculoperitoneal Shunting
Authors: Snow Robert B. , Zimmerman Robert D. , Devinsky Orrin
Published: May 2010

A rare complication of ventriculoperitoneal shunting is presented. In this case, a moderate-sized intracerebral hemorrhage (3 to 5 cm in maximal diameter) occurred 1 week after operation for idiopathic hydrocephalus in a 43-year-old woman. The patient recovered fully without operative intervention. No other case of delayed intracerebral hemorrhage after a ventricular shunting procedure was found in a review of the literature. The presumed mechanism in the present case is delayed erosion of a cerebral blood vessel by the ventricular catheter.
Entrapped Lumbar Nerve Root in Pseudomeningocele after Laminectomy: Report of Three Cases
Authors: Hadani Moshe , Findler Gideon , Knoler Nahshon , Tadmor Rina , Sahar Abraham , Shacked Itzchak
Published: May 2010

The authors report three patients with symptomatic postlaminectomy pseudomeningocele. At operation a loop of a nerve root was found to be trapped within the dural defect. All three patients exhibited a delayed onset of radicular symptoms and signs after disc surgery. The pseudomeningocele was demonstrated by computed tomography and myelography, but the entrapped root could be identified only at operation. (Neurosurgery 19:405-407, 1986)
Enchondroma of the Cervical Spine
Authors: Willis Brian K. , Heilbrun Peter M.
Published: May 2010

Enchondroma is a benign cartilaginous tumor rarely found in the vertebral column. The authors report a case of a 24-year-old woman with upper extremity paresthesias and weakness secondary to bony destruction of multiple vertebral bodies by an enchondroma. The tumor was treated by block excision of the involved vertebral bodies followed by placement of a bone graft.
Distal Cervical Carotid Dissection after Carotid Endarterectomy: A Complication of Indwelling Shunt?
Authors: Loftus Christopher M. , Dyste Gregg N. , Reinarz Stephen J. , Hingtgen William L.
Published: May 2010

Technical factors and surgical techniques in carotid endarterectomy remain a controversial subject. The use of an indwelling arterial shunt has theoretical advantages in assuring intraoperative hemispheric perfusion and affording a more relaxed surgical environment. There has been little clinical demonstration, however, of superior results with carotid shunting. Although champions of routine shunting argue that it is a benign protective intervention, the possibilities of distal embolization or intimal disruption exist. The authors report a case of cervical carotid dissection far distal to the operative site that they postulate resulted from intimal disruption after routine shunt placement. This devastating complication from an otherwise benign procedure prompts reconsideration of the benefits and risks of routine shunt placement.
Bilateral Hearing Loss after Unilateral Removal of an Acoustic Neuroma by the Suboccipital Approach: Case Report
Authors: Chovanes George I. , Buchheit William A.
Published: May 2010

Contralateral hearing loss is a very rare complication of acoustic neuroma surgery. A case of immediate postoperative contralateral hearing loss is reported. Possible causes and the pertinent literature are reviewed.
Intramedullary Neurilemomas of the Spinal Cord: Report of Two Cases and Review of the Literature
Authors: Ross Donald A. , Edwards Michael S. B. , Wilson Charles B.
Published: May 2010

Two patients harboring intramedullary neurilemomas of the spinal cord are presented. Published reports of these rare lesions and possible mechanisms of their origin are reviewed. Based on the authors' experience and review of the literature, they think that the treatment of choice for these rare lesions is laminectomy and resection and that intraoperative frozen section diagnosis is essential. Incorrect interpretation of the biopsy material that suggests an original diagnosis of infiltrating glioma, perhaps because a neurilemoma was not expected, has made second operations necessary.
Acute Subdural Hematoma with Rapid Resolution in Infancy: Case Report
Authors: Nagao Takeki , Aoki Nobuhiko , Mizutani Hiroshi , Kitamura Koichi
Published: May 2010

An infant who suffered acute subdural hematoma due to minor head trauma twice in a short period is presented. Each subdural hematoma, showing high density on computed tomographic scanning, resolved with unusual rapidity, resulting in full recovery after nonsurgical management. The mechanism of this rapid resolution of each hematoma was thought to be participation of cerebrospinal fluid secondary to a tearing of the arachnoid membrane.
Auditory Brain Stem Responses in the Prognosis of Late Postconcussional Symptoms and Neuropsychological Dysfunction after Minor Head Injury
Authors: Schoenhuber Rudolf , Gentilini Massimo
Published: May 2010

Thirty patients suffering from minor head injury were examined with auditory brain stem responses (ABR), neuropsy-chological tests for assessment of higher nervous functions, and a questionnaire on postconcussional symptoms. Comparison of the 6 patients with altered ABR with the other 24 showed no statistical difference in either the number of long-lasting postconcussional symptoms or the scores on neuropsychological tests. Subclinical brain stem involvement as shown by ABR does not seem to correlate with impaired mental function or symptoms of the postconcussion syndrome. This greatly limits the use of ABR in forensic medicine.
Orbital Schwannomas: Report of Nine Cases and Review of the Literature
Authors: Cantore Giampaolo , Ciappetta Pasquale , Raco Antonino , Lunardi Pierpaolo
Published: May 2010

The authors report 9 cases of orbital schwannoma out of a total of 148 orbital tumors operated. The computed tomography (CT) scan is considered superior to other methods used in the radiological work-up of endoorbital tumors because, in addition to being noninvasive, it gives direct visualization of the lesion and more precise localization both with respect to the muscular cone and tridimensionally. Unfortunately, preoperative diagnosis is not always possible solely on the basis of the CT scan because the enhancement of the tumor is not constant, thus making differential diagnosis with meningioma and cavernous angioma problematic. In addition, CT enables the surgeon to choose the best route for tumor removal. Operative results are good and are influenced by the use of microsurgical techniques.
Postoperative Extradural Hematomas: Computed Tomographic Survey of 1105 Intracranial Operations
Authors: Fukamachi Akira , Koizumi Hidehito , Nagaseki Yoshishige , Nukui Hideaki
Published: May 2010

We reviewed the computed tomographic findings after 1055 intracranial operations to determine the incidence of postoperative extradural hematomas. There were 11 medium and 5 large hematomas after 1055 operations (1.0%). Ten of the 16 hematomas were operated upon (10/1055, 0.9%). Four of the 10 hematomas were seen after 278 brain tumor removals (1.4%), another four after 190 aneurysmal operations (2.1%), one after 14 intracerebral hematoma removals (7.1%), and the last one after 251 ventricular shunting or drainage procedures (0.4%). In 4 of the 10 operated hematomas, sites were regional, in five sites were adjacent, and in one the site was distant. All of the five adjacent hematomas extended downward from a lower rim of the operative locus. Causes were analyzed in the three types of the hematomas. In case of the regional hematomas, the causes were incomplete hemostasis of the dura mater or the bone in all four patients, nonperformance of central stay sutures in three, systemic hypertension in one, and hypofibrinogenemia in one. In the adjacent hematomas, we could find dural separation at an edge of craniotomy in all five patients, abrupt collapse of the brain in all, ventricular dilatation in two, and systemic hypertension during immediate postoperative period in two. In one distant hematoma, ventricular dilatation and ventricular shunting procedure were themselves thought to be the causal factors.
Reactivation of Herpesvirus in Neurosurgical Patients
Authors: Nabors Michael W. , Francis Carolyn K. , Kobrine Arthur I.
Published: May 2010

The authors are presenting seven patients who had operations between July 1984 and July 1985 and who developed herpes infections postoperatively. Four of the patients developed their infections in a dermatomal distribution that correlated with the nerve roots manipulated at operation. A spectrum of localized herpes reactivation is demonstrated in this series. The use of corticosteroids and other associated variables are discussed. Like reactivation of herpes simplex after trigeminal nerve operation, we believe reactivation of herpes simplex and herpes zoster can occur in operation of the cervical, thoracic, or lumbosacral spine.
Carotid Endarterectomy after Recent Stroke: Preliminary Observations in Patients Undergoing Early Operation
Authors: Pritz Michael B.
Published: May 2010

Three patients with recent stroke underwent carotid endarterectomy 1, 4, and 8 days after the onset of maximal symptoms. In each case, computed tomography (CT) demonstrated recent cerebral infarction and cerebral arteriography showed high grade cervical carotid stenosis. No patient developed worsened neurological symptomatology, intracerebral hemorrhage, or vasomotor paralysis. These results suggest that carotid endarterectomy, if indicated, can be performed safely after acute stroke under certain conditions. These criteria include the following: (a) normal level of consciousness, (b) relatively small cerebral infarction without mass effect on CT, and (c) meticulous control and monitoring of systemic blood pressure during the perioperative period. These initial observations suggest that a specific subgroup of patients with recent cerebral infarction may be able safely to undergo carotid endarterectomy shortly after diagnosis.
Impact of Myelography on the Radiotherapeutic Management of Malignant Spinal Cord Compression
Authors: Calkins Alison R. , Olson Margaret A. , Ellis James H.
Published: May 2010

From December 1981 through August 1984, 24 patients with spinal cord compression syndrome due to epidural neoplasms were evaluated for radiotherapy with clinical examination, radiographs of the spine, and myelography. All plain films were reviewed, and mock radiotherapy fields designed using specific criteria for margins. The same patients were reviewed a second time considering the additional information provided by myelography. The initial treatment fields were found to be inadequate in 69% of the patients. Even in patients with discrete bony lesions, the results of myelography affected the treatment 45% of the time. A history of previous spinal irradiation significantly influenced port design in only 1 of the 7 patients who had received previous radiotherapy. Although invasive, myelography is essential in planning the treatment of spinal cord compression.
Symptomatic Progressive Ventriculomegaly in Hydrocephalics with Patent Shunts and Antisiphon Devices
Authors: McCullough David C.
Published: May 2010

The antisiphon device (ASD) was designed to prevent excessive negative intracranial pressure and overdrainage with cerebrospinal fluid shunts. It has been recommended for prevention of slit ventricles and extreme shunt dependency. It was used by the author in 40 children and young adults who had low pressure headaches or were judged to be at risk for the development of subdural hematomas because of extreme hydrocephalus, relatively fixed head size, or tall stature. Nine patients encountered problems with adverse symptoms in spite of shunt patency. Four had alarming neurological symptoms of coma or severe headaches after incorporation of ASDs in ventriculoperitoneal shunt systems. With patients in the horizontal position, shunt patency was documented but computed tomography revealed progressive ventriculomegaly when they were kept erect. Symptoms abated and ventricular size diminished after conversion to proximal medium pressure diaphragm or spring-ball valve systems without ASDs. Because long shunt systems with ASDs require adequate hydrostatic columns to initiate flow when patients are erect, it is theorized that such symptoms could have been prevented by placing ASDs farther downstream from the cerebral ventricles.
Primary Leptomeningeal Glioma Mimicking an Acoustic Neuroma: Case Report with Review of the Literature
Authors: Sceats James D. , Quisling Ronald , Rhoton Albert L. , Ballinger William E. , Ryan Patrick
Published: May 2010

Primary leptomeningeal gliomas are rare. Historically, they have been found in the spinal canal more frequently; however, in the recent literature nearly all have been found within the cranium. In the only cadaveric study of leptomeningeal glial nests, the most frequent site was the medulla and pons. Until now, no leptomeningeal glioma has been found at this site. We report what we believe to be the first such case mimicking an acoustic neuroma.
Functional Recovery after Decompressive Operation for Thoracic and Lumbar Spine Fractures
Authors: Edward C. Benzel , Sanford J. Larson
Published: May 2010

A series of 105 operative cases of thoracic and lumbar spine trauma is presented. All patients underwent an anterior decompression and fusion via the lateral extracavity approach with or without an accompanying posterior internal stabilization procedure (modified Weiss springs or Harrington distraction rods). All patients were allowed to plateau neurologically before reconstructive spine surgery was performed. The patient's neurological grade at the time of surgery and after recovery was assessed according to a seven-grade scale presented herein. None of the 34 patients with a motor and sensory complete myelopathy recovered any function below the level in injury. Of the 10 motor-complete patients with some sensory perception, 4 improved neurologically; however, only 1 of these improved to a state of limited ambulation. The rest remained nonambulatory. Of the 33 patients with significantly disabling incomplete motor and sensory myelopathies, 17 improved to a level of minimal neurological deficit; only 3 patients were left nonambulatory. Of the 21 patients whose physical finding demonstrated a minimal neurological deficit preoperatively, 17 recovered to a normal neurological state. Seven patients were neurologically normal preoperatively and were unchanged postoperatively. Reconstruction of the spine with an anterior decompression and an accompanying stabilization procedure, when appropriate, leads to a better neurological outcome than that expected with either a conservative, nonoperative approach or an operative posterior stabilization approach.
Neurological Deficit after Carotid Infusion of Cisplatin and 1,3-Bis(2-chloroethyl)-1-nitrosourea (BCNU) for Malignant Glioma: An Analysis of Risk Factors
Authors: John P. Kapp , Robert A. Sanford
Published: May 2010

The records of 24 patients with malignant gliomas treated with carotid infusion of cisplatin and 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) are reviewed for risk factors that might suggest the development of a permanent neurological deficit after infusion. Permanent neurological deficits were seen with doses of cisplatin as low as 69 mg/m2, although doses as high as 100 mg/m2 were tolerated by other patients. All 3 patients who developed permanent neurological deficits received fixed doses of cisplatin of 150 mg and supplied only 2 major intracranial branches from the infused carotid artery. In none of these patients was a filter used in the infusion line. Other risk factors identified in 2 of the 3 patients were diffuse neoplasm involving the region of the internal capsule and the use of an infusion pump rather than a pulsatile bolus infusion technique. The development of a permanent neurological deficit appeared unrelated to the dose of BCNU within the range utilized, and preinfusion administration of corticosteroids did not prevent neurological deficit. These possible risk factors should be considered in the future development of protocols for arterial infusion therapy of malignant gliomas.
Epilepsy after Operation for Aneurysms
Authors: Sbeih I. , Tamas L. B. , O'Laoire S. A.
Published: May 2010

The authors reviewed 100 consecutive survivors of aneurysm operations and identified 3 patients who developed postoperative epilepsy. The use of prophylactic phenytoin in the first 67 cases did not seem to influence the patient's risk of developing epilepsy. It is concluded that with present microneurosurgical techniques the risk of postoperative epilepsy is small and unselective use of phenytoin prophylaxis should be reconsidered.
Spinal Cord Tumors Presenting with Neural Tube Defects
Authors: Gregorios Jocelyn B. , Green Barth , Page Larry , Thomsen Sharon , Monforte Hector
Published: May 2010

Two primary lumbosacral tumors arising at the site of neural tube defects are presented. One was a teratoma diagnosed in an infant with myelomeningocele. The other was an ependymoma that developed in an adult with meningocele. It is postulated that these cases represent a neoplastic transformation of heterotopic primordial elements that have been incorporated within the defect, supporting the view that overgrowth of neural tissue may be the result rather than the cause of neural tube deformity. Such rare occurrences may be due to interaction between intrauterine teratogenic factors and familial predisposition in affected patients.
Aneurysms of the Posterior Cerebral Artery: Report of Ten Cases
Authors: Chang Han Soo , Fukushima Takanori , Takakura Kintomo , Shimizu Tsuneo
Published: May 2010

Ten cases of posterior cerebral artery (PCA) aneurysm are presented. There were 13 aneurysms in the 10 patients: 6 saccular, 5 fusiform, 1 broad-based, and 1 giant fusiform serpentine aneurysm. Eight patients underwent operation: clipping for 2 saccular aneurysms, trapping for 1 saccular and 3 fusiform aneurysms, and coating for 2 fusiform or broad-based aneurysms. Microsurgical cerebral revascularization techniques were attempted in 2 cases: after a fusiform aneurysm had been excised, end-to-end anastomosis of the residual two ends of the PCA was performed and, after a giant serpentine aneurysm had been trapped, the superficial temporal artery was anastomosed transcortically to the distal PCA. Two patients died before operation because of rebleeding and vasospasm. Postoperative neurological deficits include contralateral hemiparesis, homonymous hemianopsia, hemihypesthesia, and ipsilateral 3rd nerve palsy. Our results suggest that, despite the good collateral circulation of the PCA, some ischemic events may occur after trapping procedures and that cerebral revascularization techniques may have some benefit in the treatment of unclippable aneurysms in this region.
Anaplastic Ganglioglioma in an Infant: Case Report and Review of the Literature
Authors: Hall Walter A. , Yunis Eduardo J. , Albright Leland A.
Published: May 2010

A 6-month-old girl had a gradually increasing head circumference. A preoperative computed tomographic (CT) scan of the head revealed an enhancing calcified partially cystic right frontal mass that was removed through a right frontotemporal craniotomy. On microscopic examination, the tumor was composed of sheets of neurons in a glial background alternating with highly cellular anaplastic areas. The diagnosis of anaplastic ganglioglioma was made. The child has done well for the 20 months since the operation without any evidence of tumor recurrence on subsequent CT scans. Because of the immaturity of the child's developing central nervous system, we have elected not to initiate radiotherapy at this time. The pertinent literature regarding gangliogliomas is reviewed.
Unusual Posterior Fossa Dural Arteriovenous Malformation in a Neonate: Case Report
Authors: Ross Donald A. , Walker Joseph , Edwards Michael S. B.
Published: May 2010

We report the case of an infant born with an unusual posterior fossa dural arteriovenous malformation that was supplied by the entire intracranial circulation. The lesion caused hydrocephalus and congestive heart failure that led to the infant's death.
Early Repair of Myelomeningocele and Simultaneous Insertion of Ventriculoperitonal Shunt: Technique and Results
Authors: Hubballah Malek Y. , Hoffman Harold J.
Published: May 2010

During the years 1975 to 1985, 10 patients underwent simultaneous repair of myelomeningocele and insertion of a ventriculoperitoneal shunt at the Hospital for Sick Children in Toronto. The technique for carrying out these procedures in the same operative setting will be described. None of the patients developed shunt infections or myelomeningocele repair breakdown in the follow-up period of 1 to 9 years. One patient died 9 days after operation secondary to aspiration. The remaining patients underwent neuropsychological testing during their follow-up periods and over 70% were found to have normal or slightly below normal intelligence and psychosocial development. The technique of simultaneous repair of a myelomeningocele and insertion of a ventriculoperitoneal shunt in infants with a myelomeningocele and concomitant hydrocephalus overt at birth is safe and should be carried out to decrease the risk of myelomeningocele repair breakdown and cerebrospinal fluid leak in such patients.
Brain Abscess Complicating the Use of a Halo Orthosis
Authors: Goodman Michael L. , Nelson Paul B.
Published: May 2010

We report a case of brain abscess complicating the use of a halo orthosis in the treatment of a cervical spine injury suffered during wrestling. Four previous brain abscesses complicating the use of halo orthoses have been reported. All cases of abscess have been associated with overlying infection at the site of pin insertion. Our case and at least one of those previously reported may have been related to tightening of the halo pins after placement. Serious spine injuries occur rarely in wrestlers and are associated with the use of illegal holds and maneuvers in which one athlete is thrown to the mat. The pathophysiology and radiographic appearance of a unilateral facet dislocation are reviewed.
Intramedullary Melanotic Schwannoma of the Cervicomedullary Junction
Authors: Solomon Robert A. , Handler Michael S. , Sedelli Robert V. , Stein Bennett M.
Published: May 2010

We report a case of a patient with an intramedullary tumor of the cervicomedullary junction. At operation, the tumor was noted to be highly pigmented, and pathological study demonstrated that the tumor was a melanotic schwannoma. Both intramedullary schwannomas and melanotic schwannomas in any location in the body are exceedingly rare. This is the first reported case of an intramedullary melanotic schwannoma of the central nervous system. The possible origin of this tumor is discussed.
Multiple Oncotic Intracranial Aneurysms and Cardiac Metastasis from Choriocarcinoma: Case Report and Review of the Literature
Authors: Seigle J. M. , Caputy Anthony J. , Manz Herbert J. , Wheeler Christine , Fox John L.
Published: May 2010

Ten cases of oncotic intracranial aneurysms from choriocarcinoma have been reported previously. We report an eleventh case with four aneurysms secondary to metastatic choriocarcinoma. These aneurysms seemed to arise from cephalic embolization of neoplastic tissue from an implant of choriocarcinoma in the left ventricle of the heart.
Ectopic Pituitary Gland Simulating a Suprasellar Tumor
Authors: Colohan A. R. T. , Grady M. S. , Bonnin J. M. , Thorner M. O. , Kovacs K. , Jane J. A.
Published: May 2010

A case report of ectopic pituitary gland in the suprasellar region of a normal 39-year-old woman with persistent headaches is presented. The embryological development of the pituitary gland is briefly reviewed, with a discussion of the relevant literature. No previous report of normal pituitary tissue in a suprasellar location in the absence of tumor could be found.
Visual Hallucinations Associated with Pituitary Adenoma
Authors: Ram Zvi , Findler Gideon , Gutman Itzhak , Tadmor Rina , Sahar Abraham
Published: May 2010

Visual hallucinations were the presenting symptom in three patients with pituitary adenoma. One patient reported only simple unformed hallucinations, which are a well-documented phenomenon occurring in lesions compressing the optic nerves and chiasm. The other two patients, however, experienced complex formed visual hallucinations believed to be of the release type. No evidence of seizure activity responsible for the hallucinations was found; the mechanism producing them is discussed with correlation to operative findings and electrophysiological studies.
Isolated Central Nervous System Angiitis First Presenting as Spontaneous Intracranial Hemorrhage
Authors: Biller José , Loftus Christopher M. , Moore Steven A. , Schelper Robert L. , Danks Kelly R. , Cornell Steven H.
Published: May 2010

Two cases of isolated central nervous system angiitis presenting as spontaneous intracranial hemorrhage are reported. The usefulness and limitations of cortical/leptomeningeal biopsy in this condition is described. Emphasis is placed on the clinical awareness of this unusual association to ensure early recognition and prompt management with immunosuppressive therapy.