bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic Trial of Intravenous Nimodipine in Patients with Established Cerebral Vasospasm after Rupture of Intracranial Aneurysms
Authors: Jan Michel , Buchheit Fernand , Tremoulet Michel
Published: May 2010

The therapeutic efficacy of intravenous nimodipine to treat the syndrome of delayed ischemic deterioration or vasospasm after subarachnoid hemorrhage caused by a ruptured aneurysm was investigated in a randomized, double-blind, placebo-controlled multicenter study. A total of 188 patients (nimodipine (N) = 102, placebo (P) = 86) were enrolled in the study, both pre- and postoperatively, within 24 hours of clinical deterioration connected with vasospasm or within 24 hours of arteriography that identified vasospasm. After 61 patients were excluded for not meeting study criteria or for protocol violation, the results were supported by 127 validated case reports: 73 patients received intravenous treatment with nimodipine, and 54 were given placebo. Analysis of the main criterion of efficacy, the number of deaths and of patients with severe deficit related to vasospasm alone, showed a significant statistical difference (N = 8 (19%), P = 17 (49%), P = 0.01). The risk of death or disability was reduced by 66% in the treated group. Analysis of this criterion by type of inclusion (clinical or angiographic) also showed a significant reduction in the clinical group (P = 0,05), but there was no difference in the angiographic group. The risk of mortality connected with vasospasm was reduced by 82%, but analysis by group showed that there was no significant difference for those patients included on clinical criteria, whereas mortality was reduced to a much greater extent in the angiographic group. These results demonstrate the therapeutic efficacy of nimodipine in reducing secondary ischemic brain damage in patients already suffering from angiographic vasospasm or delayed ischemic deterioration.
Localized Hypertrophic Mononeuropathy Involving the Tibial Nerve
Authors: Iyer Vasudeva G. , Garreston Henry D. , Byrd Ryland P. , Reiss Steven J.
Published: May 2010

Localized hypertrophic neuropathy (LHN) is a disorder of unknown cause that presents with progressive, predominantly motor weakness in the distribution of a single nerve, with the histological appearance of the “onion bulb” formation. Because of its rarity, the condition is often ignored in the differential diagnosis of mononeuropathy. We report a case of LHN involving the posterior tibial nerve and review the literature.
Angiographic Examination and Surgical Treatment of Bow Hunter's Stroke
Authors: Hanakita Junya , Miyake Hidenori , Nagayasu Shinji , Nishi Shyogo , Suzuki Takanori
Published: May 2010

Anatomically, the vertebral artery courses through six foramina transversaria of the cervical vertebrae, passing through the groove on the surface of the arch of the atlas and then penetrating the dura mater. Because of this anatomical course, the vertebral arteries are often affected by head motion. Stenotic change of the vertebral artery can occur at the atlantoaxial level in head rotation. Such a special type of stroke was named “bow hunter's stroke” by Sorensen. We report three cases of bow hunter's stroke and discuss the angiographic examinations. As surgical treatment, we performed partial transversectomy of the atlas vertebra, with favorable results. The usefulness of this surgical procedure is discussed.
Primary Intraosseous Malignant Meningioma of the Skull: Case Report
Authors: Lee Wei-Hwa , Tu Yen-Chang , Liu Ming-Yin
Published: May 2010

Primary intraosseous meningioma of the skull is rare. This report describes a 61-year-old man who was treated by craniectomy 3 times for a repeatedly recurrent primary intraosseous malignant meningioma. Transmission electron microscopy revealed interdigitation of cytoplasmic processes, microfilaments, and distinct desmosomal structures. Immunocytochemical studies of cultured cells showed strong expression of vimentin and weakly positive staining for S-100 protein. Primary intraosseous malignant meningioma should be considered in the differential diagnosis of massive solitary osteolytic lesions of the skull.
Sleep Apnea and the Chiari I Malformation: Case Report
Authors: Levitt Philip , Cohn Martin A.
Published: May 2010

The authors report the case of an ambulatory patient who presented with sleep apnea episodes of the central and obstructive types and an associated Chiari Type I malformation. The central episodes stopped and the obstructive episodes decreased markedly after decompression. The improvement in the so-called obstructive episodes was unexpected and indicates that they may have been on a central basis.
Dysembryoplastic Neuroepithelial Tumor: A Surgically Curable Tumor of Young Patients with Intractable Partial Seizures
Authors: Daumas-Duport Catherine , Scheithauer Bernd W. , Chodkiewicz Jean-Paul , Laws Edward R. , Vedrenne Claude
Published: May 2010

This report concerns the clinicopathological features of 39 cases of a morphologically unique and surgically curable group of neuroepithelial tumors associated with medically intractable partial complex seizures. All were supratentorial and characterized by intracortical location, multinodular architecture, and heterogeneity in cellular composition. The constituent cells included astrocytes, oligodendrocytes, and neurons. Because neuronal atypia was often inapparent, the tumors superficially resembled mixed oligoastrocytomas. The term “dysembryoplastic neuroepithelial tumor” (DNT) is proposed for these distinctive lesions, the clinicopathological features of which suggest a dysembryoplastic origin. With the exception of the occurrence of headaches in 2 patients, partial complex seizures were the exclusive symptom. Age at onset of symptoms ranged from 1 to 19 years (mean 9 years). In addition to the chronic nature of the seizures (range, 2 to 18 years; mean, 9 years), one-third of the patients showed radiological features, such as focal cranial deformity, indicating that the tumors had an early onset and were of long standing. In most cases, computed tomography showed a “pseudocystic,” well-demarcated, low density appearance associated in some cases with focal contrast enhancement (18%) or calcific hyperdensity (23%). The tumor involved the temporal lobe in 24 patients (62%), the frontal lobe in 12 (31%), and the parietal and/or occipital lobe in 3 cases. Although tumor removal was considered incomplete or subtotal in 17 patients (44%), long term follow-up (range, 1 to 18 years; mean, 9 years) showed neither clinical nor radiological evidence of recurrence in any patient. Comparison of the survival data of the 13 subjects who had undergone postoperative radiotherapy with 26 who had not indicated that radiation therapy was of no obvious benefit. The identification of DNT has therapeutic and prognostic implications because aggressive therapy can be avoided, thus sparing these young patients the deleterious long term effects of radio- or chemotherapy.
Photodynamic Therapy of Malignant Brain Tumors: Clinical Results of, Difficulties with, Questions about, and Future Prospects for the Neurosurgical Applications
Authors: Perria Carlo , Carai Martino , Falzoi Antonello , Orunesu Giuseppe , Rocca Antonio , Massarelli Giovannino , Francaviglia Natale , Jori Giulio
Published: May 2010

Photodynamic therapy (PDT) has been applied in a variety of oncological fields with good results. In neurosurgery, the clinical series are limited and the number of treated patients is not statistically significant. This work examines the results of PDT performed in our clinic and discusses some difficulties and causes of failure of this method in neurosurgical patients. Eight patients with malignant brain tumors underwent PDT. All had been treated previously by operation and radiation therapy and one patient had also received chemotherapy. At 24 hours after the i.v. injection of hematoporphyrin (5 mg/kg body weight), the tumor was removed as radically as possible and the residual tumor bed was exposed to either 630-nm light from an argon-dye laser or 600- to 680-nm light isolated from the emission of a quartz-halogen lamp. The type of sensitizer, the irradiation methods, and the peculiarities of glial tumors are examined as possible causes of failure. The longer survivals of some patients with glial tumors treated by PDT may make this treatment suitable when traditional therapies fail.
Outcome of Aneurysmal Subarachnoid Hemorrhage in a Hospital Population: A Prospective Study Including Early Operation, Intravenous Nimodipine, and Transcranial Doppler Ultrasound
Authors: Seiler Rolf W. , Reulen Hans J. , Huber Peter , Grolimund Peter , Ebeling Uwe , Steiger Hans J.
Published: May 2010

A total of 153 consecutive patients with proven aneurysmal subarachnoid hemorrhages (SAHs) admitted immediately after diagnosis regardless of clinical condition were managed according to the same protocol. The initial evaluation included computed tomography (CT), transcranial Doppler ultrasound (TCD), angiography-CT, and/or angiography. Intravenous nimodipine (2 mg/hour) was started after confirmation of the diagnosis. The timing of operation was determined individually according to age, clinical course, and CT and TCD findings. Twenty-one Grade V patients treated with intensive care and ventriculostomy died or did not improve within 24 hours after SAH. Three patients with life-threatening intracerebral hematomas underwent emergency operation. Operation was early in 55 good risk patients and late in 57 patients because of poor initial grade, late admission, or logistic reasons. Seventeen patients had no operation because of old age, persistent poor clinical condition, medical complication, or lethal rebleeding before operation. In the total series, 90 patients (59%) made a full recovery, the overall morbidity rate was 14% (21 of 153 cases), and the mortality rate was 27% (42 of 153). Postoperative mortality including emergency evacuation of hematomas was 7.8% and mortality after elective operation was 6.2%. The causes of disability and death were the initial effect of the hemorrhage in 25 patients (16.3%), rebleeding in 15 (9.8%), delayed cerebral infarction in 8 (5.2%), surgical complications in 7 (4.5%), hydrocephalus in 4 (2.6%), and medical complications in 4 (2.6%).
Perioperative Lumbar Injection of Ringer's Lactate Solution in Chronic Subdural Hematomas: A Series of 100 Cases
Authors: Grisoli F. , Graziani N. , Peragut J. C. , Vincentelli F. , Fabrizi A. P. , Caruso G. , Bellard S.
Published: May 2010

A series of 100 patients underwent surgical treatment for chronic subdural hematomas between 1979 and 1987. The procedure consisted of craniectomy with a 30-mm trephine, irrigation and drainage of the hematoma, laceration of the outer and inner membranes, and lumbar intrathecal injection of Ringer's lactate solution for immediate cerebral reexpansion (average injection, 130 ml). This technique gave the following results: 2% mortality, 2% moderate morbidity, and 96% recovery. The recovery of the patients was rapid, and good outcome was achieved in Grade 3 and Grade 4 cases (Markwalder's classification).
Dysautoregulation in Patients with Ruptured Aneurysms: Cerebral Blood Flow Measurements Obtained during Surgery by a Temperature-controlled Thermoelectrical Method
Authors: Tenjin Hiroshi , Hirakawa Kimiyoshi , Mizukawa Norihiko , Yano Ichiro , Ohta Tsutomu , Uchibori Mikio , Hino Akihiko
Published: May 2010

We used a temperature-controlled thermoelectrical method, induced hypotension, and CO2 inhalation to obtain cerebral blood flow (CBF) measurements during surgery for investigation of the state of brain vasoreactivity in subarachnoid hemorrhage patients. The study included 11 patients who underwent 12 operations for ruptured intracranial aneurysms. The CBF data were analyzed to investigate the neurological state, presence or nonpresence of vasospasm, timing of the operation, and outcome of each patient. Autoregulation disturbance, in terms of reaction to hypotension, was consistently seen in patients in poor neurological states, and this disturbance was correlated with poor outcome. This simple monitoring system, used during emergency operations for ruptured aneurysm, was useful in predicting outcome.
Computed Tomography of Epidural Fibrosis after Discectomy: A Comparison between Symptomatic and Asymptomatic Patients
Authors: Cervellini Patrizio , Curri Decio , Volpin Lorenzo , Bernardi Lorenzo , Pinna Vittore , Benedetti Antonio
Published: May 2010

The evaluation of patients with symptoms recurrent after disc surgery is a difficult diagnostic problem. The most common causes are recurrent herniation and postoperative scarring; routine x-ray and myelographic differentiation between herniation and scarring is difficult or impossible. High resolution computed tomography (CT) has shown some results in the evaluation of postoperative patients, but the role of epidural fibrosis in failed back surgery syndrome (FBSS) is not clear. Some knowledge of the “normal” CT physiological healing and scarring after disc surgery is necessary. We scanned 20 asymptomatic operated patients and 20 patients with recurrent sciatic nerve pain after disc surgery who did not have bony stenosis, recurrent disc herniation, or other causes of FBSS. Our observations showed no important differences in the fibrosis demonstrated by CT between symptomatic and asymptomatic patients. The degree and type of fibrosis are not related to recurrent symptoms.
Brachytherapy in the Treatment of Recurrent Solitary Brain Metastases
Authors: Heros Deborah O. , Kasdon David L. , Chun Mison
Published: May 2010

Conventional therapy for solitary brain metastases includes radiotherapy and surgical resection in selected cases. Often, however, the metastasis recurs and limits the quality of life and survival of the patient. Once the metastasis recurs, therapeutic options are limited. Brachytherapy delivers a high total dose of radiation to a localized area, allowing reirradiation at the time of recurrence. Three patients with recurrent brain metastases treated with iridium-192 implants are presented; two of these patients had breast carcinoma and one had malignant melanoma. The implants allowed long term survival in the two patients with recurrent metastatic breast carcinoma. Unfortunately, the patient with melanoma did not respond to the brachytherapy and died within 7 months of implantation. The approaches to treatment to metastatic brain tumors and the rationale for using brachytherapy are discussed.
Selective Neurotomy of the Tibial Nerve for Treatment of the Spastic Foot
Authors: Sindou Marc , Mertens Patrick
Published: May 2010

One of the most frequent neurological sequelae seen by the specialist in rehabilitation is the spastic foot. Spasticity in the foot may be responsible for abnormal posture and painful or trophic disturbances impairing standing and walking. This disability can be corrected by a simple neurosurgical procedure, the selective tibial neurotomy. In this procedure, one sections the tibial nerve branches to the muscles sustaining spasticity, i.e, the soleus and/or the gastrocnemius nerves for equinus and ankle clonus or the posterior tibialis branch for varus and the flexor fascicles for tonic flexion of the toes. After microsurgical dissection of each tibial nerve branch at the lower part of the popliteal region and their identification with bipolar electrostimulation, the selected branches are partially sectioned under the operating microscope. The present series consists of 62 operations performed in 53 patients, 9 bilaterally and 44 unilaterally. Operation obtained complete suppression of the disabling spasticity that had been present for 2 to 17 years (4 on average), total pain relief, and consequently improvement of the residual voluntary movements (by achieving a better balance between agonist and antagonist muscles) in 51 of the 62 spastic feet (i.e., 82% of the cases). For all of these patients, the beneficial effects were long-lasting over the 1- to 10-year follow-up (3 years on average). Selective neurotomy of the tibial nerve should be considered only after failure of intensive prolonged kinestherapy and of all available medical treatment. It must take place, however, before the onset of irreversible articular disturbances and musculotendinous retractions, which require complementary orthopedic corrections.
Slit Ventricle Syndrome with Aqueduct Stenosis: Third Ventriculostomy as Definitive Treatment
Authors: Reddy K. , Fewer H. D. , West M. , Hill N. C.
Published: May 2010

Slit ventricle syndrome is a poorly understood entity characterized by features of raised intracranial pressure and small ventricles in shunt-dependent hydrocephalics. Five patients with this syndrome were treated with antisiphon devices, high pressure shunts, or subtemporal decompression, but continued to be symptomatic. Third ventriculostomy, performed as a last resort in these patients, gave encouraging results. The patient data, operative approach, and perliminary results are presented here.
Extracranial Posterior Inferior Cerebellar Artery Aneurysm Causing Isolated Intraventricular Hemorrhage: A Case Report
Authors: Ruelle Antonio , Cavazzani Paolo , Andrioli Giancarlo
Published: May 2010

The authors report the unusual case of an aneurysm arising on an extracranial loop of the left posterior inferior cerebellar artery (PICA). The computed tomographic scan showed an isolated hemorrhage in the lateral ventricles, and the lesion was recognized 1.5 cm below the foramen magnum at the level of the atlas. The literature concerning peripheral PICA aneurysms is reviewed and the clinical and radiological features of these lesions are discussed. A tendency for subarachnoid bleeding from distal PICA aneurysm ruptures to spread into the ventricular system is suggested. The diagnosis of distal PICA aneurysm should also be considered in cases of isolated intraventricular hemorrhage without obvious parenchymal or subarachnoid hemorrhage. The need for four-vessel angiography when studying patients suffering from a subarachnoid hemorrhage is stressed.
Oligodendroglial Proliferative Abnormality Associated with Arteriovenous Malformation: Report of Three Cases with Review of the Literature
Authors: Nazek M. , Mandybur T. I. , Kashiwagi S.
Published: May 2010

A peculiar nonneoplastic oligodendroglial proliferative abnormality associated with cerebral arteriovenous malformations (AVMs) was present in three patients. Histological examination of biopsy material revealed dense oligodendroglial tissue reminiscent of oligodendroglioma in the white matter adjoining the AVMs. Careful consideration of clinical and pathological features suggested that the evidence was insufficient to qualify the lesion as truly neoplastic (oligodendroglioma); rather, a tissue collapse or a hamartomatous proliferation could be considered to be its cause. The literature contains 14 instances of various vascular malformations associated with primary brain tumors, 5 of which were diagnosed as oligodendrogliomas. It is possible, however, that some of the cases reported in the literature constitute oligodendroglial abnormality similar to that observed in our cases rather than genuine oligodendrogliomas. Attention is drawn to this interesting and prognostically important phenomenon.
Distribution of 10B after Infusion of Na210B12H11SH into a Patient with Malignant Astrocytoma: Implications for Boron Neutron Capture Therapy
Authors: Finkel Gerald C. , Poletti Charles E. , Fairchild Ralph G. , Slatkin Daniel N. , Sweet William H.
Published: May 2010

If a sufficient concentration of the stable isotope 10B is introduced into a neoplasm, radiation therapy can be effected by short-range heavy charged particles from the disintegration of 10B by slow neutrons. Brain tumors were irradiated postoperatively by Hatanaka and co-workers in Japan using a 1 to 2 hour intraarterial infusion of 10B-enriched Na2B12H11SH (Na210B12H11SH) before exposure of the tumor-bearing area of the brain to slow neutrons from a 100 kilowatt nuclear reactor. The clinical outcome of such boron neutron capture therapy has been favorably impressive in some patients, but its efficacy in brain tumors needs improvement. In our study, a terminally ill patient with malignant astrocytoma was infused intravenously with Na210B12H11SH for 25 hours. The postmortem distribution of 10B in unfixed, frozen, tumor-bearing brain and spinal cord tissues was studied by comparing representative cryostat sections of these specimens with neutron-induced heavy charged particle radiographs of the same sections. Preferential accumulation of 10B was observed in the tumor, with relatively little accumulation of 10B in the parenchyma of the central nervous system.
Transoral Approach to Extradural Lesions of the Lower Clivus and Upper Cervical Spine: An Experience of 19 Cases
Authors: Di Lorenzo Nicola
Published: May 2010

An experience with 19 cases of transoral exposure of the lower clivus and ventral aspect of the upper cervical spine is presented. The spectrum of pathological entities in this series includes malformative, neoplastic, and spondylotic conditions. The report is designed to focus upon some points of overall surgical management of patients treated by the transoral approach, with emphasis on management of postoperative instability, and to underline the discrepancy in the prognosis of congenital and acquired disorders, in terms of mortality, morbidity, and long-term results.
Craniopharyngiomas: Fluctuation in Cyst Size Following Surgery and Radiation Therapy
Authors: Constine Louis S. , Randall Stephen H. , Rubin Philip , McDonald Joseph
Published: May 2010

Patients with craniopharyngiomas who demonstrate cyst enlargement after surgery and radiation are often presumed to be treatment failures. Therapeutic approaches in various centers include repetitive cyst aspirations, surgical reexcision, and instillation of cytotoxic agents such as methotrexate, 32P, or 198Au. Each intervention has associated severe or even lethal side effects. Not all patients with craniopharyngioma who have cystic enlargement after primary therapy require an intervention, as demonstrated by 4 patients recently managed in the University of Rochester Medical Center. Since 1978, when computed tomography was routinely in use, we have managed 11 patients with craniopharyngiomas who were treated with surgery followed by radiation therapy. Three of these patients demonstrated post-irradiation enlargement of the residual cystic component followed by a decrease in size without surgical intervention. An additional patient showed cystic growth followed by stabilization of size. It is noteworthy that the cyst enlarged within the first 5 months after radiation therapy in the 3 patients who subsequently demonstrated a diminution in the size of their cysts. This suggests that the mechanism for cyst formation remained intact and subsequently abated because of a radiation-induced lesion. We conclude that after treatment with surgery and radiation therapy, the cystic component of craniopharyngiomas may increase and, without intervention, subsequently decrease in size. Thus, in the asymptomatic patient who demonstrates cystic growth soon after primary therapy, close observation alone may be warranted.
Spinal Cord Stimulation for Relief of Chronic Pain in Vasospastic Disorders of the Upper Limbs
Authors: Robaina Francisco J. , Dominguez Manuel , Díaz Manuel , Rodriguez José L. , de Vera José A.
Published: May 2010

Eleven patients with chronic pain due to severe vasospastic disorders in the upper limbs were treated with cervical spinal cord stimulation. In 8 patients the pain was due to reflex sympathetic dystrophy in the late stage of the disease, and 3 patients had severe idiopathic Raynaud's disease. The mean follow-up for both groups was 27 months. A total of 10 patients (90.9%) had good or excellent results. Thermographic and plethysmographic changes were observed in both groups. There seems to be a very close relationship between the increase of blood flow and the amount of pain relief achieved. In an attempt to quantify the intensity of pain, the visual analog scale and McGill Pain Questionnaire were used, Stimulation proved to be harmless, with no mortality and very low morbidity. The latter centered around local infection and displacement of the electrodes. No objective changes occurred in trophic alterations such as bone decalcification and ankylosis, but there were improvements in the alterations in the nails and skin. In the reflex sympathetic dystrophy group, the amount of pain relief achieved enabled most patients to undergo subsequent physiotherapy and rehabilitation. In severe cases of reflex sympathetic dystrophy and idiopathic Raynaud's disease, spinal cord stimulation is an alternative treatment that can be used as primary therapy or as secondary therapy after unsuccessful sympathectomy or sympathetic blocks.
Intracranial Arteriovenous Malformation: Relationship between Clinical Factors and Surgical Complications
Authors: Batjer H. Hunt , Devous Michael D. , Seibert G. Burton , Purdy Phillip D. , Bonte Frederick J.
Published: May 2010

Serious morbidity and hyperemic states continue to complicate the treatment of certain intracranial arteriovenous malformations (AVMs). Clinical and radiographic characteristics of 62 patients treated over 3 years were analyzed to determine if hyperemic complications (HCs) (defined as unusual perioperative edema or hemorrhage) and outcome could be predicted. Twenty-five (40%) of the patients were less than 30 years old, 28 (45%) were between 30 and 50, and 9 (15%) were more than 50. A history of hemorrhage was found in 48%, and 34% presented with progressive deficits. Thirteen (21%) developed evidence of HCs; 51 (82%) ultimately had a good outcome, 4 (6%) had a poor outcome, and 7 (11%) died. The incidence of HCs was higher in patients whose AVMs recruited perforating vessels (53%) than those without (7%) (P < 0.001). The presence of preoperative angiographic steal carried a 35% risk of HCs whereas its absence carried a 13% risk (P < 0.05). The sum of the diameters of the feeding vessels was also predictive P < 0.05). Outcome was clearly age-related: good outcome was achieved in 92% of the patients less than 30 years old, 86% of those 30 to 50, and 44% of patients older than 50 (P < 0.05). Left hemispheric AVMs showed less morbidity than right (P < 0.05) as did those without perforating vessel recruitment (P < 0.07). HCs had a dramatic impact on outcome with 92% of patients without HCs having good outcome and 46% of those with HCs recovering well (P < 0.001).
De Novo Aneurysm Formation Following Carotid Ligation: Case Report and Review of the Literature
Authors: Dyste Gregg N. , Beck David W.
Published: May 2010

The authors report a patient with an aneurysm of the carotid siphon who underwent ligation of the cervical carotid artery. Six years after this procedure, the patient suffered a subarachnoid hemorrhage from an apparent de novo aneurysm. Pertinent literature is reviewed to determine the incidence of this occurrence, and congenital arteriosclerotic and hemodynamic factors causing aneurysm enlargement are discussed.
Association of von Recklinghausen's Neurofibromatosis and Aqueduct Stenosis
Authors: Şenveli Engin , Altinörs Nur , Kars Zafer , Arda Nuri , Türker Ayhan , Çinar Nusret , Yalniz Zeki
Published: May 2010

We present 6 patients with a definite diagnosis of von Recklinghausen's neurofibromatosis. All of them had aqueductal stenosis and hydrocephalus requiring surgical intervention because of clinical signs of increased intractranial pressure confirmed by pressure measurements.
Klüver-Bucy Syndrome in a Child with Bilateral Arachnoid Cysts: Report of a Case
Authors: Rossitch Eugene , Oakes W. Jerry
Published: May 2010

Klüver-Bucy syndrome is an uncommon constellation of behavioral abnormalities resulting from bilateral temporal lobe damage. The syndrome is rare in adults and even less commonly seen in children. In this paper we present a child with Klüver-Bucy syndrome and bilateral temporal arachnoid cysts.
Lumbar Synovial Cysts: Report of Eleven Cases
Authors: Eyster E. Fletcher , Scott William R.
Published: May 2010

Over the past 18 months we have encountered 11 cases of symptomatic lumbar synovial cysts. This experience occurred during a period during which some 1,800 lumbar computed tomographic scans were done. The apparent increased incidence of these lesions is most likely due to the increased diagnostic ability made possible by the advent of high-resolution computed tomography and magnetic resonance imaging. This is a report and discussion of our 11 cases with a review of the literature. There is nothing distinctive in the physical findings or in the histories of our patients, but we have found, as have others, that high-resolution computed tomographic scanning and magnetic resonance imaging significantly enhance the diagnosis of such lesions.
Cordectomy for Syringobulbo-Myelia with Sleep Apnea Secondary to a Spinal Extramedullary Tumor: Case Report
Authors: Tokoro Kazuhiko , Chiba Yasuhiro , Yagishita Saburo , Kunimi Yumiko
Published: May 2010

The case of a 40-year-old man with syringobulbo-myelia secondary to an unresectable spinal extramedullary tumor is described. Fifteen years previously, the patient had undergone a laminectomy of T8 through T12 for a “benign” spinal cord tumor at another hospital and had become paraplegic; the tumor (neurinoma) had been neglected for 12 years. Magnetic resonance imaging demonstrated a large thoracolumbar spinal tumor with syringobulbo-myelia. Polysomnography showed central-, peripheral-, and mixed-type sleep apneas. After the failure of an attempted syringoperitoneal shunt, cordectomy at the level of T6 was performed with a good result. The mechanisms of the formation of syringomyelia and sleep apnea secondary to a caudal spinal extramedullary tumor are discussed.
Decision Analysis: A Tool of the Future: An Application to Unruptured Arteriovenous Malformations
Authors: Fisher Wink S.
Published: May 2010

Overwhelming and confusing data regarding the natural history of arteriovenous malformations can confound physicians attempting to advise patients whether surgery of unruptured arteriovenous malformations is indicated. Decision analysis is a new mathematical tool that allows physicians to compare options in such patients. With the use of a simple office computer, a software program was devised to compare surgical versus conservative options in a hypothetical 25-year-old man. The computer model weights the important considerations of patient age, mortality and morbidity rates of the physician performing the surgery, rebleeding from the arteriovenous malformation, and patient desires, using the Markov process. When mortality and morbidity rates are reasonable, the mathematical process supports surgical intervention in the hypothetical patient. Patient guidelines for older patients and future plans for the model using grading systems are discussed.
Stereotactic Biopsy in the Diagnosis of Brain Masses: Comparison of Results of Biopsy and Resected Surgical Specimen
Authors: Chandrasoma Parakrama T. , Smith Maurice M. , Apuzzo Michael L. J.
Published: May 2010

We report the pathological accuracy of image-directed stereotactic brain biopsy in 30 patients who had mass lesions of the brain and subsequently underwent resection of the mass. The histological diagnosis at stereotactic biopsy was appropriate for direction of clinical management in 28 of 30 patients. Correlation between the stereotactic and resection diagnoses was exact in 19 of 30 cases. These included 11 of 12 nonastrocytic neoplasms and 8 of 13 astrocytic neoplasms. Correlation was imperfect in 9 of 30 cases, but not to the extent of having significant clinical impact. These included 2 cases of anaplastic astrocytoma that were upgraded to glioblastoma multiforme, 2 cases of astrocytoma that had a significant oligodendroglial component, and 5 non-neoplastic lesions that were reported on biopsy as showing nonspecific reactive changes. In 2 of 30 patients, the stereotactic biopsy was not accurate. This included one patient who had glioblastoma multiforme whose stereotactic biopsy showed only necrotic tissue. Serious diagnostic error that resulted in clinical mismanagement occurred in one patient who had a pineal germinoma that had large areas of granulomatous inflammation at which the stereotactic biopsy was directed. This study provides evidence that, with careful target placement, stereotactic biopsy can provide biopsy material that represents the entire lesion with an accuracy that is sufficient for clinical management.
Intraoperative Measurement of Cerebral and Tumor Blood Flow with Laser-Doppler Flowmetry
Authors: Arbit E. , DiResta G. R. , Bedford R. F. , Shah N. K. , Galicich J. H.
Published: May 2010

A new technique, laser-Doppler flowmetry, has been used intraoperatively to measure blood flow responses in normal brain tissue and brain tumor to blood pressure and arterial blood gas alterations. We have observed that blood flow is reduced in most cerebral tumors, and that most tumors retain the normal response to changes in arterial blood gas; however, these responses are varied. One group of tumors in our study demonstrated an autoregulatory capacity; a second behaved passively—that is, blood flow changes followed blood pressure—while a third showed no response.
Impairment of Vertebral Artery Flow Caused by Extrinsic Lesions
Authors: George Bernard , Laurian Claude
Published: May 2010

In a consecutive series of 71 cases of extrinsic lesions involving the vertebral artery (VA), 51 patients presented with external compression of this vessel. The compressive agents included 34 tumors, 4 osteophytes, 5 fibrous bands, 4 traumatic lesions, 2 neural elements, and 2 infectious processes. The main site was the second portion of the VA (C2-C6) (30 of 51 patients). Compression always induced at least significant stenosis, and in 8 patients caused complete occlusion. The compression was either permanent (44 patients) or intermittent (7 patients). Symptoms were observed in 11 patients, including 2 with permanent deficits. Surgical release of compression was performed each time symptoms could be explained by a reduction in VA flow and also when the compressing agent needed to be removed, as in the cases involving tumors. VA decompression was achieved by direct approach in 37 patients, by reduction and fixation of a traumatic dislocation in 2 patients, and by distal revascularization in 4 patients. Medical treatment or roentgenotherapy was used in the other patients. Results were excellent in all but 2 patients, who died from traumatic and ischemic lesions, respectively. Therefore, it seems important to identify external causes of compression of the VA for two reasons: 1) to suppress symptoms of vertebrobasilar insufficiency when their relation to VA compression is clearly established, and 2) to remove compressive agents like turnors safely while preserving the VA.
The Principles of Bony Spinal Fusion
Authors: Kaufman Howard H. , Jones Eric
Published: May 2010

Bony fusion is frequently required for anatomical reconstruction and stabilization of the spine. This review discusses bone structure, healing after fracture, and bony fusion, including the use of autografts and allografts. Research should be done on preparation of the bed, the nature and quantity of bone to be used, and how best to immobilize the spine.
Aneurysmal Bone Cyst of the Thoracic Spine: Treatment by Excision and Segmental Stabilization with Luque Rods
Authors: Cybulski George R. , Anson John , Gleason Thomas , Homsi M. F. , Reyes Marc G.
Published: May 2010

Preoperative radiological evaluation with magnetic resonance imaging and computed tomography was valuable in planning the surgical management of a destructive lesion of the posterior elements of the thoracic spine that was causing spinal cord compression in an 18-year-old woman. Preoperative recognition of bilateral involvement of the pedicles in addition to the laminae and spinous process led to use of prophylactic segmental stabilization of the spine with Luque rods after successful excision of an aneurysmal bone cyst. This case provides an example of the usefulness of computed tomographic scanning and magnetic resonance imaging in assessing the distribution and location of vertebral tumor and its potential effect on spinal stability. The efficacy of combining radical excision with stabilization for treatment of aneurysmal bone cysts of the spine is emphasized.
Magnetic Resonance Imaging of Symptomatic Rathke's Cleft Cyst: Report of a Case
Authors: Wagle V. G. , Nelson D. , Rossi A. , Uphoff D.
Published: May 2010

A case of symptomatic Rathke's cleft cyst is described. In spite of the intrasellar component and radiological and clinical evidence of involvement of the pituitary gland, the sella turcica was minimally involved. MRI afforded optimal visualization and localization of the intra- and suprasellar components vis-à-vis the pituitary gland, optic chiasm, infundibular stalk, and carotid arteries.
Use of Stimulation Mapping and Corticography in the Excision of Arteriovenous Malformations in Sensorimotor and Language-Related Neocortex
Authors: Burchiel Kim J. , Clarke Hadley , Ojemann George A. , Dacey Ralph G. , Winn H. Richard
Published: May 2010

The excision of an arteriovenous malformation (AVM) located within eloquent neocortex presents a formidable neurosurgical challenge. Compromise of the vascular supply to normal surrounding brain or surgical trauma to essential neighboring neocortex may result in unacceptable postoperative neurological morbidity. In addition, successful removal of these lesions without the benefit of intraoperative corticography may leave in situ areas of highly epileptogenic brain, resulting in continued epilepsy. In this report, we describe eight patients who underwent craniotomy and excision of AVMs at our institutions. Six of these lesions were located in the dominant (left) hemisphere, and two were on the right. All patients underwent preoperative testing with Amytal administered via the carotid artery (Wada test). Subsequently, the patient was placed under local anesthesia, and we performed a craniotomy. Electrocorticography was used to identify epileptogenic brain in the region of the AVM and to establish after-discharge thresholds to electrical stimulation. Stimulation-mapping techniques were then used to delineate critical motor, sensory, and language areas. Trial occlusion of feeding vessels was also carried out to document postocclusion neurological deterioration, if any. At a later time, a second procedure was performed under general anesthesia to excise the lesion and any epileptogenic foci, using the cortical maps derived earlier. Using these techniques, it was possible to effect complete excision of these lesions in seven of eight patients without causing additional neurological deficits.
Early Carotid Endarterectomy after Cerebral Infarction
Authors: Little John R. , Moufarrij Nazih A. , Furlan Anthony J.
Published: May 2010

The objective of the study was to review our recent experience with carotid endarterectomy performed within 30 days of completed cerebral infarction and to evaluate the role of computed tomographic (CT) scanning in the decisionmaking process. Twenty-seven of 302 operations (9%) were carried out during the 30-day time period. The mean interval between cerebral infarction and surgery was 14 days. Angiography revealed severe stenosis (>75%) of the internal carotid artery in 19 patients. Severe stenosis with deep ulceration found in 6 patients and moderate stenosis (i.e., 50-75%) with deep ulceration was found in 2 patients. CT scans showed recent infarction in 4 patients and an old subcortical lacune in 2 patients. Twenty-two patients were neurologically stable with mild deficits and showed normal results on a CT scan performed 24 hours or more after the ischemic event. These patients underwent early cerebral angiography and carotid endarterectomy without permanent morbidity or mortality. Two patients with moderate stable neurological deficits and findings of recent infarction on CT scans had uneventful postoperative courses. Five patients who were neurologically unstable underwent surgery. The 2 patients with repeated transient ischemic attacks and normal findings on CT scans had uneventful postoperative courses. Two of the three patients with progressive neurological deficits and CT findings of recent cerebral infarction experienced extension of their infarcts after surgery. One of these patients died. Our personal experience, together with a review of previous reports, indicated that patients who have minimal residual neurological deficits and whose CT scans show normal findings are at low surgical risk, perhaps approaching that of patients with transient ischemic attacks. The surgical risk is high in patients with progressive neurological deficits and CT scan findings of recent cerebral infarction. Patients with moderate, stable neurological deficits and CT scan findings of recent cerebral infarction appear to carry an intermediate surgical risk.
Erroneous Measurement of Intracranial Pressure Caused by Simultaneous Ventricular Drainage: A Hydrodynamic Model Study
Authors: Wilkinson Harold A. , Yarzebski Jorge , Wilkinson Edward C. , Anderson Frederick A.
Published: May 2010

Intracranial pressure (ICP) is often measured from intraventricular catheters, a technique that allows therapeutic drainage of ventricular cerebrospinal fluid (CSF) as an aid in controlling ICP and circumventing obstruction. Drainage of CSF simultaneously with ongoing ICP measurement has been advocated as safe and efficient, and devices are commercially available to permit this practice; however, this concept has been seriously challenged, based on clinical observations. The inaccuracy induced by simultaneous CSF drainage and ICP monitoring is quantitated in this report in a mechanical brain model using a standard ventricular catheter. The following conclusions have been confirmed: 1) rapid CSF drainage induces a severe artifactual reduction in measured ICP, more extreme at higher pressures; 2) calibrated slower rates of CSF drainage produce a severe, although less immediate, reduction in measured ICP; 3) severe artifact appears even in the presence of continuous CSF outflow, so a system that measures ICP only in the presence of CSF flow does not prevent artifact; 4) with simultaneous CSF drainage, measured ICP is determined more by the outflow pressure setting than by actual brain pressure; 5) Since ICP elevation of 25 to 30 mm Hg blocks CSF production, even slow fluid drainage at high pressures should ultimately lead to ventricular collapse and severe artifact.
Determination of Irreversible Ischemia by Xenon-Enhanced Computed Tomographic Monitoring of Cerebral Blood Flow in Patients with Symptomatic Vasospasm
Authors: Yonas Howard , Sekhar Laligam , Johnson David W. , Gur David
Published: May 2010

In patients with subarachnoid hemorrhage, delayed neurological deficits, often followed by infarction, are believed to result from ischemia caused by vasospasm. Cerebral blood flow (CBF) data have been useful in predicting the risk of vasospasm in these patients and in distinguishing those deficits caused by vasospasm. Although CBF thresholds for infarction have been established in animals, few clinical studies have correlated CBF values with neurological symptoms and infarction. To assess the sensitivity to ischemia provided by xenon-enhanced computed tomography (Xe/CT) of CBF and to define the clinical significance of specific values that it measures, we compared the clinical, CT, and Xe/CT findings on CBF in 51 patients with subarachnoid hemorrhage caused by ruptured aneurysms. Each patient had 1 to 6 Xe/CT studies. Fourteen patients had symptomatic vasospasm. In all 14, the first post deficit Xe/CT study found abruptly reduced CBF, either regionally or globally. In 9 of these 14 patients, flow values fell below 15 ml/100 g/min in 2 or more adjacent 2-cm cortical regions of interest, and in all 9, concurrent follow-up CT scans showed infarction in these regions. Eight of the 9 had paralysis and a severe sensory deficit. No patient whose CBF remained above 18 ml/100 g/min developed infarction. The blood flow studies caused neither significant complications nor neurological deterioration. The Xe/CT CBF method appears very sensitive to the early detection of symptomatic vasospasm. In most patients with subarachnoid hemorrhage, this noninvasive technique can replace angiography to delineate the location and severity of vasospasm, and may be useful in predicting the development of infarction.
Surgical Treatment of Tumors in the Anterior Skull Base Using the Transbasal Approach
Authors: Arita Norio , Mori Shintaro , Sano Mitsumasa , Hayakawa Toru , Nakao Kazutami , Kanai Nobuhiro , Mogami Heitaro
Published: May 2010

Five patients with tumors in the anterior skull base were surgically treated using the transbasal approach, which permits removal of the tumor, repair of the dura mater, and reconstruction of the skull base in a one-stage procedure. By using autologous materials for the bone graft and pedunculated pericranial flap for the reconstruction, the intracranial structures are separated from the air-filled nasal and paranasal cavities. No postoperative complications such as wound infection and leakage of cerebrospinal fluid were encountered. The use of this surgical technique makes it possible to extirpate brain tumors that heretofore have been considered unresectable.
Efficacy of Antibiotic Prophylaxis in Clean Neurosurgical Operations
Authors: Haines Stephen J.
Published: May 2010

Four controlled trials and one case control study have presented data supporting the efficacy of perioperative administration of antibiotics in reducing the rate of infection following clean neurosurgical procedures. Their results are, for the most part, consistent with uncontrolled studies reported since 1980. Taken together, these studies clearly and consistently demonstrate the value of perioperative antibiotic prophylaxis in clean neurosurgical operations.
Traumatic Extradural Hematoma of the Cervical Spine
Authors: Garza-Mercado Román
Published: May 2010

An example of a traumatic extradural hematoma of the cervical spine that occurred in a 32-year-old man who suffered from chronic ankylosing spondylitis is reported. Progressive sensory and motor deficit ensued some 3 hours after the patient fell from a standing position. The patient landed on his back, striking his head on the floor. After being helped up, he was able to walk unassisted to a nearby chair, where he sat down until his left lower extremity—and shortly afterwards, the right one—became numb and weak. On admission, the patient was found to have tetraparesis that was more pronounced in the lower extremities and associated with incomplete sensation to pinprick at level T7-T10. He also had painless distention of the urinary bladder. After a few hours, the weakness in his limbs increased and his sensory level rose to C5 bilaterally. A horizontal diastatic fracture across the vertebral body of C7 was discovered on plain x-ray films of the spine, and an extradural hematoma extending dorsally from C5 to T1 was revealed by emergency magnetic resonance imaging. After an emergency decompressive cervical laminectomy and removal of the clot, the patient rapidly regained complete neurological function, except with regard to both the urinary bladder and the rectum, which remained abnormal for almost 7 weeks after the operation.
Growth of Prolactinoma despite Lowering of Serum Prolactin by Bromocriptine
Authors: Kupersmith Mark J. , Kleinberg David , Warren Floyd A. , Budzilovitch Gleb , Cooper Paul
Published: May 2010

Four patients with macroprolactinomas treated with bromocriptine had tumor growth and visual loss despite marked reduction in their serum prolactin levels. Explanations for this dissociation of tumor growth and prolactin measurement might include noncompliance. Patients treated with bromocriptine require periodic examination by computed tomographic scan or magnetic resonance imaging and neuro-ophthalmological evaluation in addition to monitoring of serum prolactin.