bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional Improvement after Spinal Surgery for the Dysraphic Malformations
Authors: Linder Martin , Rosenstein Jacob , Sklar Frederick H.
Published: May 2010

Spinal surgery for the various dysraphic malformations is generally indicated to arrest disease progression. The results of the present study suggest that certain clinical conditions and presentations are associated with an exceptionally good surgical prognosis. Sixty-nine procedures were done in 55 patients. The diagnoses included hydromyelia and tethered cord related to diastematomyelia, lipoma, lipomeningocele, previous operation, and thickened filum terminale. The operative results were evaluated for significant functional neurological and urological improvement, as well as for the relief of pain. Pain relief was achieved in 92% of patients with preoperative pain. Significant functional return was seen in 67% of hydromyelia patients. On the other hand, surgical treatment of tethered cord caused improvement in 24% (lipoma) to 46% (thickened filum and diastematomyelia). These results suggest that patients with hydromyelia and patients with a dysraphic malformation and pain have an excelient prognosis after operation. A re-evaluation of the indications for surgery for these patients may be necessary.
Spinal Extrathecal Hemangiolipomas: Report of Two Cases and Review of the Literature
Authors: Padovani Roberto , Tognetti Francesco , Speranza Stefano , Pozzati Eugenio
Published: May 2010

Two cases of a rare entity, spinal extrathecal hemangiolipoma, are presented. The clinical and histological features of the tumor are discussed, with particular attention to the uncommonly sudden onset of symptoms in one patient. Complete neurological recovery was exhibited by one patient after excision of the lesion, whereas only a partial recovery was achieved in the other case. The pathogenetic aspects of hemangiolipomas and the literature dealing with the previously reported 12 cases are reviewed.
Treatment of Bilateral Spontaneous Carotid-Cavernous Fistula by Hamby's Method Combined with an Extracranial-Intracranial Bypass Procedure
Authors: Eguchi Tsuneyoshi , Mayanagi Yoshiaki , Hanamura Tetsu , Tanaka Hideki , Ohmori Kitaroh , Takakura Kintomo
Published: May 2010

A case of bilateral spontaneous carotid-cavernous fistula is presented. Hamby's operation combined with extracranial-intracranial (EC/IC) bypass with a long vein graft was performed on both sides. The feasibility and precautions of using a long vein graft for the EC/IC bypass are discussed.
The So-Called Cavernous Sinus: A Review of the Controversy and Its Implications for Neurosurgeons
Authors: Taptas John N.
Published: May 2010

The so-called cavernous sinus is a venous pathway, an irregular network of veins that is part of the extradural venous network of the base of the skull, not a trabeculated venous channel. This venous pathway, the internal carotid artery, and the oculomotor cranial nerves cross the medial portion of the middle cranial fossa in an extradural space formed on each side of the sella turcica by the diverging aspects of a dural fold. In this space the venous pathway has only neighborhood relations with the internal carotid artery and the cranial nerves. The space itself must be distinguished from the vascular and nervous elements that it contains. The revision of the anatomy of this region has not only theoretical interest but also important clinical implications.
Photocoagulation of Cerebral Arteriovenous Malformations and Arterial Aneurysms with the Neodymium: Yttrium-Aluminum-Garnet or Argon Laser: Preliminary Results in Twelve Patients
Authors: Fasano Victor Aldo , Urciuoli Rosa , Ponzio Roberto Maria
Published: May 2010

Six arteriovenous malformations (AVMs) and five arterial aneurysms (AAs) were treated with either argon or neodymium:yttrium-aluminum-garnet laser irradiation; one AVM was treated with both. All AVMs were occluded completely, leaving adjacent tissue untouched and preserving the regional vascularization. Photocoagulation produced varying effects on AAs: in one case an intraoperative rupture was sealed, in two cases the volume of an ectasia was reduced when the bleeding and thinner areas were coagulated, and in one case a saccular aneurysm was progressively and completely obliterated while the patency of the parent artery was preserved. These preliminary results are satisfactory; more experience will indicate how and when these new techniques can replace traditional ones or be used in combination with them.
Cerebrospinal Fluid Hydromechanics in Adult Patients with Benign Noncommunicating Hydrocephalus: One-Hour Test Shunting and Balanced Cerebrospinal Fluid Infusion test to Select Patients for Intracranial Bypass Operation
Authors: Magnæs Bjørn
Published: May 2010

Cerebrospinal fluid (CSF) pressure and absorption were determined in 12 patients with benign noncommunicating hydrocephalus. An extracorporeal communication of plastic tubing between the ventricular system and the lumbar subarachnoid space was established to imitate the hydromechanical condition after an intracranial bypass operation. This extracorporeal shunt, which in effect was an externalized Torkildsen shunt, served first as a test shunt for 1 hour and then as a route for the constant rate CSF infusion test. The total CSF absorptive capacity was thus determined under a condition of balanced CSF pressure between the proximal and distal compartment. Four patients, whose tests showed normal CSF pressure and absorption, were selected for intracranial bypass operation. Follow-up examination showed a normal clinical condition, reduction of the ventricular system, normal CSF pressure, and normal CSF absorption in all 4 patients. The other 8 patients, whose tests indicated impaired CSF absorption, were treated by ventriculoatrial shunting. The tests were valid in selecting patients for intracranial bypass operation.
Neurocutaneous Masson's Vegetant Intravascular Hemangioendothelioma
Authors: Nagib Mahmoud G. , Sung Joo Ho , Seljeskog Edward L.
Published: May 2010

Since first described, Masson's vegetant intravascular hemangioendothelioma (VIH) has been recognized in various locations. The neurocutaneous dissemination of the lesions in our case represent a unique characteristic. The histopathological and radiological similarities between VIH and malignant lesions are stressed.
Anterior or Posterior Approach to the Cervical Spine: An Anatomical and Radiographic Evaluation and Comparison
Authors: Raynor Richard B.
Published: May 2010

Both the anterior and the posterior approaches are used in the treatment of cervical radiculopathy. An evaluation of the advantages and limitations of each method as compared to the other was made in isolated cervical spine segments. With a posterior approach, a quarter to a half of the facet joint must be removed to unroof the neural foramen. Anterior osteophytes in the region of the uncovertebral joint are difficult to reach from posteriorly unless they are very large. Using an anterior approach the amount of root decompression is easily overestimated. The lateral limits of the decompression must be beyond direct visualization to equal that obtained posteriorly. Osteophytes in the region of the uncovertebral joints are easily reached. Because some roots leave the dural tube a significant distance above the interspace, a soft disc fragment may migrate out of the interspace and behind the body to compress the root. This fragment may be missed from the anterior approach unless the root anatomy is evaluated carefully. X-ray films were taken at each step of the surgical procedures and were compared. A final set was taken using radiopaque markers to identify key structures. Plain x-ray films of the cervical spine reflect few if any of the anatomical alterations accomplished by operation. Oblique x-ray films do not visualize the entrance of the anatomical foramen, and osteophytes seen on this view may be well anterior in the neural canal.
Clinical Indications for Computer-assisted Myelography
Authors: Barrow Daniel L. , Wood James H. , Hoffman James C.
Published: May 2010

Computer-assisted myelography (CAM) is a technique in which computed tomography (CT) is combined with the intrathecal administration of metrizamide to demonstrate the spinal cord and surrounding structures. This retrospective study of 139 CAMs performed at Emory University Hospital included 125 CAMs that were preceded by routine metrizamide myelography (secondary CAM). The remaining 14 CAMs were primary studies without concomitant myelography. These CAMs and conventional myelograms were reviewed to provide indications for the use of CAM as a replacement for other radiodiagnostic studies or as an adjunct to radiological diagnosis. Eighty-one CAMs (58%) were positive for some pathological process. Of the 69 secondary CAMs demonstrating a pathological condition, 46 (67%) revealed some aspect of the lesion not apparent on routine metrizamide myelography. In no case with positive myelography was CAM negative. However, conventional myelography often added valuable diagnostic information. Although high resolution CT has allowed limited visualization of the spinal cord. CAM is often indicated for cases in which diagnosis requires more definition of cervicomedullary, extradural, intradural, extramedullary, and intramedullary lesions. Our clinical review found CAM to be extremely useful in the diagnostic evaluation of pathological conditions involving the spine and spinal cord and suggests clinical indications for the use of CAM based upon selected illustrative cases. Furthermore, CAM seemed to be superior to other radiological procedures in certain instances, such as in cases of spinal dysraphism and in the evaluation of lesions at the foramen magnum. Until more experience is obtained using spinal CT and CAM, CAM should not replace myelography altogether. The present study indicates that, rather than replacing conventional CT and myelography, CAM should be used as a primary study in situations where it has been shown to be superior and as a complementary study when other neurodiagnostic examinations are equivocal or nondiagnostic.
Althesin in the Management of Head Injuries
Authors: Mcllhany Michael , Rapport Richard , Dunn Robert , Namazie Mohamed , Delilikan Alex
Published: May 2010

The aggressive treatment of major craniocerebral trauma has received recent attention. Barbiturate administration has been beneficial in some cases of sustained, uncontrolled intracranial hypertension. One major disadvantage of pentobarbital narcosis is the long half-life of the drug (15 to 48 hours). We have used Althesin, an intravenous steroid anesthetic (alfaxalone and alfadolone acetate; Glaxo Laboratories Ltd., Greenford, Middlesex, England), in eight seriously head-injured patients. Althesin combines the theoretical advantages of pentobarbital in the management of head trauma with almost immediate reversibility (serum half-life, 1.6 minutes). Raised intracranial pressure and clinical outcome seem to be influenced favorably and the side effects are negligible when the drug is administered by continuous intravenous infusion over several days. Further study of this compound in the management of head trauma seems warranted.
Arachnoid Cyst of the Fourth Ventricle Manifesting Normal Pressure Hydrocephalus
Authors: Korosue Kazuyoshi , Tamaki Norihiko , Fujiwara Kiyoshi , Matsumoto Satoshi
Published: May 2010

The authors report a patient with the syndrome of normal pressure hydrocephalus who had an arachnoid cyst in the 4th ventricle. Ventriculoperitoneal shunting followed by removal of the cyst resulted in a complete recovery.
Arachnoiditis Presenting as a Cervical Cord Neoplasm: Two Case Reports
Authors: Bose Bikash , Myers Donald L. , Osterholm Jewell L.
Published: May 2010

Neurological evaluation supplemented by myelography has been highly successful in diagnosing spinal cord tumors. Our experience shows that a widening of the cord on myelography is not always diagnostic of spinal cord tumors. Two patients who presented clinically with evidence of spinal cord tumor and had a widening of the cord on myelography were found to have severe cervical arachnoiditis without any evidence of intrinsic cord abnormality. Hence, cervical arachnoiditis should be considered in the differential diagnosis of spinal cord tumor on myelography.
Penetration of Nafcillin, Methicillin, and Cefazolin into Human Brain Tissue
Authors: Frame Peter T. , Watanakunakorn Chatrchai , McLaurin Robert L. , Khodadad Ghahreman
Published: May 2010

To determine the penetration of the antistaphylococcal antibiotics, nafcillin, methicillin, and cefazolin, into brain tissue, we gave to each of 27 patients undergoing craniotomy and brain biopsy one of the antibiotics in a 2-g intravenous infusion just before operation. At the time of brain tissue removal (30 to 225 minutes after the start of the infusion). a serum specimen was obtained, and tissue and serum were assayed for antibiotic concentration. Eleven of 13 brain specimens contained detectable nafcillin concentrations between 0.36 and 11 μg/g of tissue (mean. 2.7 μg/g for all 13 specimens). Fourteen of 18 brain tissue specimens contained detectable methicillin concentrations between 0.56 and 5.0 μg/g of tissue (mean, 2.0 μg/g for all 18 specimens). Ten of 11 brain tissue specimens contained detectable cefazolin concentrations between 2.0 and 40 μg/g of tissue (mean, 10.6 μg/g for all 11 specimens). Each antibiotic penetrated “abnormal” brain tissue better than “relatively normal” brain tissue. Because nafcillin is more active against Staphylococcus aureus, we conclude that nafcillin is preferable to methicillin for the therapy of central nervous system staphylococcal infections. Cefazolin achieves higher brain tissue concentrations than the penicillins, but has not been clinically evaluated for the therapy of central nervous system infections.
Large and Giant Paraclinoid Aneurysms: Surgical Techniques, Complications, and Results
Authors: Heros Roberto C. , Nelson Paul B. , Ojemann Robert G. , Crowell Robert M. , DeBrun Gerard
Published: May 2010

Twenty-five patients with giant (>25 mm in diameter) and 9 patients with large (15 to 25 mm in diameter) aneurysms of the internal carotid artery in the ophthalmic or paraophthalmic region are reviewed. In 23 of these patients the aneurysm was clipped directly. There was 1 death in this group, and none of the survivors had disabling neurological complications outside the visual system. The other 11 patients were treated by a trapping procedure or by either common carotid ligation or internal carotid ligation in the neck. Of the 5 patients treated by internal carotid ligation preceded by an extracranial to intracranial bypass graft, 3 developed embolic complications, which in 1 patient resulted in death. One of the 4 patients treated by ligation of the common carotid artery died 1 year later from a recurrent subarachnoid hemorrhage. Of the total group, 18 patients had visual loss preoperatively as a result of aneurysmal compression; in 10 the vision was improved by operation, in 3 it was made worse, and in 2 it was unchanged. In another patient the vision continued to deteriorate slowly after common carotid occlusion, and the other 2 patients died postoperatively before vision could be assessed. The complications in the patients are described and analyzed in detail. Maneuvers found to be of value in the direct approach to these lesions are described. Of these, exposure of the internal carotid artery in the neck for temporary occlusion during clipping and thorough drilling of the anterior clinoid process and unroofing of the optic canal were particularly helpful. The literature on indirect methods of treatment by carotid occlusion with and without bypass graft is reviewed with special reference to the complications and effectiveness of each alternative. Based on this review of the literature and our experience, a treatment scheme is suggested for these aneurysms depending on their mode of presentation.
Tension Pneumocephalus after Posterior Fossa Craniotomy
Authors: Toung Thomas , Donham Robert T. , Lehner Anthony , Alano Jean , Campbell James
Published: May 2010

Four cases of tension pneumocephalus after either posterior fossa craniotomy or translabyrinthine resection of acoustic neuroma with or without nitrous oxide anesthesia are described. Three of the operations were performed with the patient in the sitting position, and one was done with the patient in the lateral position. Of the three cases operated in the sitting position, no nitrous oxide was used at any time during anesthesia in one. Two patients failed to regain consciousness after the termination of anesthesia, and the other two developed the sudden onset of neurological symptoms 1 to 1.5 hours after the operation. In all cases computed tomography disclosed a large subdural collection of air. Re-exploration of the surgical wound or twist drill aspiration of the subdural air resulted in prompt recovery of neurological status in three patients, whereas the other patient's neurological status improved gradually without any specific treatment. The role played by nitrous oxide, the mechanisms by which air enters the intracranial space, the contributory factors, and the predisposing surgical conditions of tension pneumocephalus are reviewed and discussed. Dependent drainage of the cerebrospinal fluid, especially in a patient with coexisting hydrocephalus, seems to be the most important factor for the development of this complication.
Early Operation for Ruptured Intracranial Aneurysms
Authors: Yamamoto Isao , Hara Makoto , Ogura Koichiro , Suzuki Yoshio , Nakane Toshichi , Kageyama Naoki
Published: May 2010

The relationship between the results of early operation for ruptured intracranial aneurysms (72 cases) and the preoperative computed tomographic (CT) findings was studied. There was a correlation among the surgical results, the development of symptomatic vasospasm, and high density on the preoperative CT scan, particularly the presence of a localized, thick layer in the subarachnoid space. However, no relationship was found between the occurrence of ventricular enlargement and the preoperative CT findings. Cisternal or ventricular drainage might contribute to an uncomplicated postoperative course for patients with severe subarachnoid clot shown on the preoperative CT scan.
Long Term Results of Stereotactic Thalamotomy for Cerebral Palsy
Authors: Broggi G. , Angelini L. , Bono R. , Giorgi C. , Nardocci N. , Franzini A.
Published: May 2010

A group of 33 patients (between 10 and 30 years old and with average intelligence) underwent stereotactic surgery for abnormal movements due to cerebral palsy. Neurological, neurofunctional, and neuropsychological examinations were performed pre- and postoperatively. The length of follow-up ranged between 1 and 4 years. The clinical results are reported and discussed in relation to the targets, the side of the lesion, and the clinical picture. Our data show that better results are obtained in patients with tremor and hyperkinesias; dystonia is improved to a lesser extent, whereas spasticity tends to recur. Operation is more effective for patients with unilateral signs than for patients with bilateral symptoms. The clinical results are stable in time, and the side effects fade away after a few months.
Dural Sinus Pressure as Related to Neurosurgical Positions
Authors: Iwabuchi Takashi , Sobata Eiji , Suzuki Mikio , Suzuki Shigeharu , Yamashita Masao
Published: May 2010

Taking advantage of the exposure of dural sinuses during craniotomies, we measured confluens sinuum pressure by direct catheterization. The influence of various surgical positions and of other factors on confluens sinuum pressure was studied. When the upper half of the body was raised, the confluens sinuum pressure decreased to reach zero at + 25º when the angle was +90º, a marked negative pressure of −12.7 ± 3.0 cm H2O (mean ± SD) was observed in adults. In children under 6 years of age, however, such negative pressure was not observed even at an angle of +90º. The confluens sinuum pressure was 2.7 ± 0.6 cm H2O with the patient in the reverse jackknife position (supine position with the upper and lower halves of the body elevated ca. 20º), 3.0 ± 0.8 in the sea lion position (prone position with the upper and lower halves of the body elevated ca. 20º and with the neck hyperextended), 5.8 ± 0.9 in the prone position, and 5.9 ± 1.7 in the supine position. In the supine and the sitting positions, the confluens sinuum pressure was elevated well enough by jugular compression to prevent air embolism. Positive pressure respiration did not raise the confluens sinuum pressure. The pressure of the jugular bulb measured by percutaneous direct puncture did not always reflect the confluens sinuum pressure, probably because subcutaneous hematoma produced an effect similar to that of jugular compression.
Traumatic Posterior Atlantoaxial Dislocation without Neurological Deficit: Case Report
Authors: Jamshidi Saied , Dennis Michael W. , Azzam Charles , Karim Najmaldin
Published: May 2010

A case is presented in which a patient sustained a closed head injury with subsequent acute subdural hematoma and delayed posterior dislocation of the atlas without fracture of the odontoid process and with an intact C-1 arch. The subdural hematoma was treated operatively. The atlas dislocation was managed with closed reduction without manipulation and subsequent posterior fusion of C-1, C-2, and C-3. The patient was intact neurologically on admission and remained so throughout his hospitalization.
Choroid Plexus Papilloma of the Third Ventricle: Case Report and Review of the Literature
Authors: Gradin Wesley C. , Taylon Charles , Fruin Alan H.
Published: May 2010

Choroid plexus papilloma (CPP) is a rare intraventricular neoplasm occurring primarily in the lateral ventricles of children and the 4th ventricle of adults. We describe the third reported case of a cystic CPP of the 3rd ventricle and review the pertinent literature.
Real-Time Ultrasonography: A Useful Tool in the Evaluation of the Craniectomized, Brain-injured Patient
Authors: Ostrup Richard , Bejar Raul , Marshall Lawrence
Published: May 2010

Real-time ultrasonography is being used increasingly to establish the diagnosis of and serially assess intraventricular hemorrhage and hydrocephalus in neonates. The procedure requires an open fontanel because scatter from the bone occurs from direct application of the transducer to the skull and bone density precludes satisfactory imaging. With an adult, under circumstances where a bone flap is left out after intracranial procedures and the patient's clinical status is such that the patient cannot be transferred for computed tomographic scanning, real-time ultrasonography allows a safe, noninvasive, bedside demonstration of ventricular size, degree of shift of midline structures, and intraparenchymal and intraventricular lesions.
Spontaneous Seeding of Medulloblastoma: Results of Cerebrospinal Fluid Cytology and Arachnoid Biopsy from the Cisterna Magna
Authors: Tomita Tadanori , McLone David G.
Published: May 2010

Five children with cerebellar medulloblastoma underwent cytological study for neoplastic cells in the cerebrospinal fluid (CSF) from the lateral ventricle and cisterna magna and biopsy of the arachnoid of the cisterna magna before the manipulation of a medulloblastoma. In all cases, seeding of neoplastic cells was present in the CSF or arachnoid of the cisterna magna, whereas the ventricular fluid was negative for neoplastic cells. This study suggests that medulloblastoma seeds spontaneously into the subarachnoid space, thus supporting the need for postoperative whole neuraxis radiation.
Computed Tomographic Guidance Stereotaxis in the Management of Intracranial Mass Lesions
Authors: Apuzzo Michael L.J. , Sabshin James K.
Published: May 2010

A prototype Brown-Roberts-Welles stereotactic instrument has been used as both a diagnostic and a therapeutic surgical adjunct in cases of intracranial mass lesions. Eighty-three procedures (142 point placements) required computerized guidance stereotaxy. The unit accomplished point intracranial access with an accuracy of greater than 1 mm. Pathological processes included a variety of neoplasms (56 cases), strokes (7 cases), and infections (20 cases) affecting deep regions of the cerebral hemispheres, the ventricular system, the cerebellum, and the rostral brain stem. Procedures were undertaken with the patient under local anesthesia for biopsy (300 point specimens), culture, evacuation, aspiration, endoscopic excision, and implantation of radioisotopes. The techniques and instrumentation for each of these procedures are described. Procedural objectives were satisfactorily accomplished with no mortality and an overall complication rate of 4%. Recovery of tissue specific to establish a histological diagnosis or the etiological factors related to each disease process was realized in 94% of the cases. These results were obtained with scanner utilization times averaging 15 minutes and procedurally related patient recovery periods of less than 4 hours. The value and adaptability of the instrumentation and techniques are illustrated, and potential future applications are discussed.
Pediatric Brain Stem Tumors: Radiographic, Pathological, and Clinical Correlations
Authors: Berger Mitchel S. , Edwards Michael S. B. , LaMasters David , Davis Richard L. , Wilson Charles B.
Published: May 2010

A retrospective analysis of the case histories of 21 pediatric patients (ages, 2.5 to 18 years) with a histologically proven diagnosis of brain stem glioma was performed to determine whether patterns of radiographic appearance could be correlated with pathology. Based on the computed tomographic or pneumoencephalographic appearance of the tumor at the time of clinical diagnosis, tumors were divided into four types: central intrinsic (Type I), central exophytic expansion into the 4th ventricle (Type II), eccentric exophytic expansion not involving the 4th ventricle (Type III), and both eccentric and central exophytic expansion (Type IV). Regardless of the radiographic classification, all patients except one, who harbored a well-differentiated astrocytoma in the area of the pons, had an anaplastic astrocytoma (n = 14 or a glioblastoma mutiforme (n = 6). There was no appreciable difference in survival between patients with either tumor histology. The presence of a cystic component did not affect survival. High resolution computed tomographic scans, with reconstructed images of the posterior fossa, can predict the presence and location of brain stem tumors and associated cysts and probably the histological nature of the tumor.
Thoracic Disc Herniation: Operative Approaches and Results
Authors: Sekhar Laligam N. , Jannetta Peter J.
Published: May 2010

In a series of 12 cases of thoracic disc herniation operated upon at the University of Pittsburgh, 4 different operative approaches were used. These included laminectomy in 2 early cases, posterolateral extrapleural operation in 5 cases, transthoracic operation in 3 cases, and transpedicular operation in 2 cases. The relative merits of the various approaches are discussed in this paper. The clinical presentation, radiological features, and follow-up data are also presented. Precise preoperative radiological diagnosis was essential in planning the operative strategy. The posterolateral and transpedicular approaches were both satisfactory, but the former had some advantages over the latter. With a mean follow-up period of 5 years, 5 patients were cured, 5 were improved, and 1 was unchanged. One patient was worse due to coexistent amyotrophic lateral sclerosis.
Early Correction of Orbicularis Oculi Paralysis with an Encircling Silicone Prosthesis
Authors: Jelks Glenn W. , Ransohoff Joseph
Published: May 2010

Fifteen patients with paralysis of the 7th and 5th nerves or the 7th nerve alone were treated with an encircling silicone prosthesis. There has been no serious ocular complication observed over the last 3 years. The prosthesis has been removed in 9 of the 15 patients in whom good 7th nerve recovery has occurred. In the remaining 6 patients, the prosthesis is being well tolerated.
Embolization of a Superficial Temporal Artery to Middle Cerebral Artery Bypass: Case Report
Authors: Conley Frances K.
Published: May 2010

This case history of a man with bilateral carotid artery occlusions presents angiographic documentation of the embolization of a superficial temporal-middle cerebral artery bypass. The embolic source was thrombotic and/or atheromatous debris that had collected in the persistent stump of one of the occluded internal carotid arteries.
Pineal Region Meningioma: Report of Two Cases and Literature Review
Authors: Piatt Joseph H. , Campbell Gerald A.
Published: May 2010

The case histories of two patients with pineal region meningiomas are presented. Comparable cases reported previously in the literature are reviewed. A characterization of the clinical features of this lesion is formulated and compared with the clinical appearance of patients with other types of pineal masses. This characterization is placed in perspective by a brief discussion of the diagnostic evaluation of patients with pineal region tumors.
Chiari Malformation Presenting in Adults: A Surgical Experience in 127 Cases
Authors: Joseph Levy Walter , Mason Laura , Hahn Joseph F.
Published: May 2010

We reviewed 127 patients who were operated upon for adult presentation Chiari malformation and made six conclusions: (a) The clinical examination remains crucial in the diagnosis. (b) The surgical anatomy is highly varied. (c) Syrinxes can be missed on preoperative contrast studies. (d By a conservative grading system, we determined that 46%; of the patients improved during long term follow-up. One-quarter deteriorated over the long run in spite of any treatment. (e) The overall results did not differ whether the treatment was plugging of the central canal plus decompression or decompression alone. (f) In patients with progression, plugging of the central canal obtained superior results. A review of the literature shows that the natural history of this complex disease process has not been established. This history is needed to identify the course of what may be several important factors that lead to the pathological condition in this disease.
Expanding Bolt for Anterior Cervical Spine Osteosynthesis: Technical Note
Authors: Lesoin Francis , Jomin Michel , Viaud Christian
Published: May 2010

Presented is the design of an expanding bolt for use in the osteosynthesis of cervical spine injuries.
Cerebral Edema Associated with Meningiomas
Authors: Gilbert Joseph J. , Paulseth Erik J. , Coates Robert K. , Malott David
Published: May 2010

The cerebral edema, as judged by computed tomographic scan, associated with supratentorial meningiomas was assessed in 55 cases. No relationship to the occurrence or the degree of edema could be established with respect to meningioma location, histological type, tumor vascularity, cellularity, number of mitotic figures, necrosis, calcification, or cortical invasion. The larger the meningioma, the more likely the presence of and the severity of cerebral edema. The edema is a significant factor in the occurrence of clinical signs and symptoms. A biopsy of cerebral cortex and white matter underlying a transitional meningioma in a patient with associated cerebral edema demonstrated perivascular astrocytic end-feet swelling in the cortex and considerable extracellular fluid in the white matter. The ultrastructural appearance is similar to that seen with primary and metastatic brain tumors and with experimental vasogenic cerebral edema.
Bromocriptine Treatment of Prolactin-secreting Tumors: Surgical Implications
Authors: Weiss Martin H. , Wycoff Robert R. , Yadley Richard , Gott Peggy , Feldon Steven , Feldon Steven
Published: May 2010

Ten of 19 patients with Stage III-IV prolactin-secreting tumors experienced significant reduction in the size of the tumor when treated with therapeutic doses of bromocriptine. Those tumors that responded favorably to preoperative pharmacological manipulation were found to have an improved surgical cure rate. These preliminary data suggest that a preoperative effort to reduce the size of large prolactin-secreting tumors may result in significant improvement of our surgical ventures.
Successful Treatment of Primary Central Nervous System Lymphomas with Chemotherapy after Osmotic Blood-Brain Barrier Opening
Authors: Neuwelt Edward A. , Balaban Edward , Diehl Jan , Hill Suellen , Frenkel Eugene
Published: May 2010

Three patients with primary central nervous system (CNS) lymphoma have had major tumor regression with multiagent chemotherapy given in association with reversible blood-brain barrier opening used to enhance drug delivery to the tumor. In addition, in one patient barrier modification was carried out in the posterior fossa by mannitol infusion into the vertebral artery without untoward effects, an approach not heretofore accomplished. Computed tomographic (CT) studies documented that discontinuation of steroids rapidly effected an increase in the delivery of contrast agent to the tumor. CT monitoring of the degree of barrier modification showed tumor nodules and tumor size not apparent on the control scans, thereby providing additional evidence of the existence of a blood-brain barrier in CNS tumors. These studies further show that drug (contrast) delivery to the tumor, as well as to the surrounding barrier, is enhanced after reversible blood-brain barrier modification. Finally, chemotherapy administered by this approach resulted in defined, objective tumor responses in these three patients.
Experience with the Suction-Irrigation Technique in the Management of Spinal Epidural Infection
Authors: Garrido Eddy , Rosenwasser Robert H.
Published: May 2010

Nine patients with spinal epidural infection were managed with the suction-irrigation technique with excellent healing of the incision by primary intention in every case. The patients have been followed for 3 to 40 months. One patient developed a subcutaneous stitch abscess, which was treated by removal of the suture material. The surgical technique is described.
Bilateral Facet to Spinous Process Fusion: A New Technique for Posterior Spinal Fusion after Trauma
Authors: Cahill David W. , Bellegarrigue Roberto , Ducker Thomas B.
Published: May 2010

A variety of options exist for the treatment of fracture/dislocation of the cervical spine, including prolonged traction immobilization, immobilization in an external device, and open surgical fusion. In cases of facet dislocation and flexion/compression injuries, the authors have found that surgical fusion is the most useful. However, in cases of facet fracture or disruption of the posterior neural arch, routine interspinous wiring techniques do not provide adequate rotational stability and may allow postsurgical redislocation before bony fusion. For these cases, a new technique using bilateral facet to spine wire loops has been developed. In the 25 cases reported here, the technique provided excellent stability against anterior horizontal displacements and rotational dislocations despite unilateral or bilateral facet fracture or disruption of the posterior neural arch.
Acrylic Stabilization of the Cervical Spine for Neoplastic Disease: Evolution of a Technique for Vertebral Body Replacement
Authors: Chadduck William M. , Boop Warren C.
Published: May 2010

The resection of collapsed cervical vertebral bodies affected by malignant lytic lesions often requires innovative methods for stabilization. Over the years, immediate stabilization of the cervical spine has been achieved with acrylic bridges, preformed metallic placement bodies, fibular strut grafts, and other aids. Because acrylic bonds poorly to adjacent bony structures, techniques to assure the adequate fixation of an acrylic bridge between resected vertebral bodies are needed. The possible progression of disease in adjacent bone prompts us to maximize the amount of internal fixation with rods or pins to assure stability. Lasting stability has become more important as the longevity of cancer patients has been increased by multimodality therapy. We report our technique for treating cancer patients with acrylic and pin fixation of the cervical spine after vertebral body excision by the anterior route. Certain modifications of the technique may have advantages over previously reported procedures. Our series of six cases demonstrates the evolution of a technique that allows relatively rapid and easy decompression of the cervical spinal cord and provides immediate stability of the cervical spine. Our indications and contraindications for this procedure are also discussed.
Scarring around Cervical Epidural Stimulating Electrode
Authors: Reynolds Arden F. , Shetter Andrew G.
Published: May 2010

Scarring around the electrically stimulating electrodes has been of concern since dorsal column stimulation was introduced. This concern resurfaced in the days of cerebellar electrodes and, with the advent of epidural stimulating techniques for the control of pain and spasticity, it again arises as a potential problem. We present a patient who underwent the placement of a C-2-C-4 electrode to treat torticollis; 3 months later, a mild spastic quadriparesis developed and the stimulation became ineffective. At reexploration, dense scar surrounded the electrode and confined the cervical spinal cord. With microdissection techniques, the scar was removed from the dura mater and the dura began to pulsate freely. The quadriparesis reversed. Examination of the scar tissue microscopically showed linearly arrayed fibroblastic nuclei, and we are uncertain whether the exuberant fibroblastic response is a response to electrical stimulation, the materials used in the electrode, or some technical aspects of the operation.
Pneumocephalus Secondary to Spontaneous Bronchial-Subarachnoid Fistula
Authors: Swaid Swaid N. , Windham Thomas L. , Morawetz Richard B.
Published: May 2010

We describe a patient in whom pneumocephalus appeared spontaneously, resulting from a communication between the bronchial tree and the thoracic subarachnoid space in association with squamous cell carcinoma of the lung. The communication was demonstrated by myelography and obliterated surgically. A review of the literature is included.
Glioblastoma Multiforme after Radiotherapy for Acromegaly
Authors: Piatt Joseph H. , Blue James M. , Schold S. Clifford , Burger Peter C.
Published: May 2010

A case of glioblastoma multiforme that occurred 14 years after radiotherapy for acromegaly is presented. The striking correspondence between the anatomy of the tumor and the geometry of the radiation ports is suggestive of a causal relationship. Previously reported cases of radiation-associated glioma are reviewed, and a brief appraisal of the evidence for induction of these lesions by radiation is presented. The differentiation of radiation-associated neoplasms from radionecrosis is also discussed.
Posterior Dural Arteriovenous Malformations in Infancy
Authors: Albright Leland A. , Latchaw Richard E. , Price Robert A.
Published: May 2010

A 23-month-old infant with an extensive dural arteriovenous malformation (AVM) developed a heart murmur and cardiomegaly. The AVM involved the occipital and suboccipital dura mater and the tentorium, bilaterally. We embolized the AVM with Gelfoam and polyvinyl alcohol particulates, subtotally resected it, and embolized residual vessels with isobutyl cyanoacrylate, In spite of this extensive therapy, the malformation was not totally eradicated and an occipital pial AVM developed. This infant and the eight infants with posterior dural AVMs reported previously emphasize the difficulty of eradicating these lesions in infancy. We contrast the clinical features and therapy of infants and adults with posterior dural AVMs. Infants develop heart failure and cranial bruits beacause of arteriovenous shunts, whereas adults complain of headache and intracranial bruits. Infants need therapy to prevent progressive heart failure, intracranial hypertension, and perhaps cerebral ischemia. Ligation of arterial tributaries is inadequate therapy for these lesions. Embolization and resection of the malformation, when feasible, offers the best chance of curing posterior dural AVMs with extensive arterial tributaries.
Multicentric Glioma as a Cause of Multiple Cerebral Lesions
Authors: Chadduck William M. , Roycroft David , Brown Michael W.
Published: May 2010

Two new cases of multicentric glioblastoma are presented to re-emphasize the needs (a) to consider this diagnosis in patients with multiple intracerebral lesions suggesting metastases or abscesses and (b) to consider prompt biopsy of accessible lesions in these patients.
Role of Multiple Cerebral Microthrombosis in Symptomatic Cerebral Vasospasm: With a Case Report
Authors: Suzuki Shigeharu , Suzuki Mikio , Iwabuchi Takashi , Kamata Yoshimasa
Published: May 2010

In our studies of the pathogenesis of cerebral vasospasm, we have been emphasizing that microthrombosis may play an important role in the induction of cerebral ischemic symptoms or cerebral infarction. In this report, multiple microthrombi are demonstrated histologically to be a major cause of cerebral infarction in the autopsied brain of a 63-year-old woman who died from typical cerebral vasospasm that occurred after the rupture of an anterior communication artery aneurysm. We discuss the significance of thrombus formation and subarachnoid perivascular acidosis in vasospasm.
Congenital Extradural Cyst of the Orbital Optic Nerve: Case Report
Authors: Celli Paolo , Palma L. , Palatisky E.
Published: May 2010

A rare congenital arachnoid cyst of the orbital optic nerve affecting a 5-year-old boy is described and the relevant literature is reviewed. On the basis of the macro- and microscopic features of the reported case, an analogy is suggested between the observed optic nerve cyst and the extradural arachnoid cyst of the spinal canal, Moreover, the hypotheses put forward to explain the pathogenesis of spinal extradural arachnoid cysts may also account for the exceptional appearance of a similar cyst in the orbital portion of the optic nerve.
Spontaneous Saphenous Neuralgia
Authors: Luerssen Thomas G. , Campbell Robert L. , Defalque Ray J. , Worth Robert M.
Published: May 2010

Six patients representing seven cases of spontaneous (nontraumatic) saphenous neuralgia secondary to entrapment of the nerve in the subsartorial canal are presented. All patients complained of medial knee and leg pain. Clinical findings included tenderness over the subsartorial canal and sensory changes in the cutaneous distribution of one or both terminal branches of the saphenous nerve. The diagnosis was confirmed by saphenous nerve block in all cases. All patients were treated operatively, which resulted in symptomatic improvement. All six patients initially underwent external neurolysis; however, three patients required saphenous neurectomy for recurrent symptoms. Saphenous neuralgia should be considered in the differential diagnosis of medial lower extremity pain.
Management of Hydrocephalus Secondary to Intraventricular Hemorrhage in the Preterm Infant with a Subcutaneous Ventricular Catheter Reservoir
Authors: McComb Gordon J. , Ramos Angela D. , Platzker Arnold C. G. , Henderson Diane J. , Segall Hervey D.
Published: May 2010

To control hydrocephalus resulting from massive intraventricular hemorrhage in premature neonates with respiratory distress syndrome, we inserted a specially designed low profile subcutaneous ventricular catheter reservoir (reservoir) by the 12th day of life (average; range, 3 to 30 days) in 20 neonates whose mean birth weight was 1110 ± 270 g (28.7 ± 1.6 weeks of gestation). The reservoir was repeatedly aspirated over 10 to 48 days. No cerebrospinal fluid infection, reservoir obstruction, or breakdown of the skin overlying the reservoir occurred. Serial computed tomographic scans documented control of the hydrocephalus and an increase in the thickness of the cortical mantle of the survivors. No mortality was associated with placement of the reservoir or its subsequent conversion, if necessary, to a ventriculoperitoneal shunt. However, only 7 of the 20 infants survived. On follow-up 3 to 5 years later, 2 of the 7 have normal intellectual and motor development. Two infants are normal intellectually, but have a motor deficit. The remaining 3 patients have both significant intellectual and motor developmental delay. The use of the reservoir is offered as a safe and effective alternative to repeated ventricular punctures, external ventricular drainage, or initial shunting. Aggressive management of hydrocephalus secondary to intraventricular hemorrhage may improve neurological function in some surviving neonates.
Intracerebral Aspergillus Abscess: Case Report
Authors: Klein H. J. , Richter Hans-Peter , Schachenmayr Walter
Published: May 2010

Intracranial aspergillosis is rare and often fatal. The authors report the successful treatment of a right temporal intracerebral aspergillus abscess.
Persistent Trigeminal Artery with Internal Carotid Artery Occlusion
Authors: Lewis Van L. , Cail Wayne S.
Published: May 2010

A patient with a persistent trigeminal artery and occlusion of the internal carotid artery is presented. The development and protective hemodynamic significance of this persistent embryological anastomosis are briefly discussed.
Fatal Complication of the “Bonnet Bypass”: Case Report
Authors: Garrido Eddy , Freed Michael H.
Published: May 2010

A patient with transient ischemic attacks and an occluded right common carotid artery underwent a left superficial temporal artery to right middle cerebral artery vein graft (bonnet bypass). One week after operation, minor trauma to the scalp caused avulsion of the anastomosis and a massive fatal acute subdural hematoma. The mechanism of the vascular avulsion and precautions to be taken to avoid such problems in other patients undergoing this procedure are discussed.
Spinal Extradural Benign Synovial or Ganglion Cyst: Case Report and Review of the Literature
Authors: Pendleton Bruce , Carl Barton , Pollay Michael
Published: May 2010

A lumbar spinal extradural ganglion cyst is reported, and the world literature on spinal ganglion cysts is reviewed. The clinical presentation, findings, etiology, and pathogenesis of these lesions are discussed.
Metastatic Renal Cell Carcinoma Mimicking a Meningioma
Authors: Killebrew K. , Krigman M. , Mahaley M. S. , Scatliff J. H.
Published: May 2010

We report a patient with renal cell carcinoma metastatic to the left trigone, which mimicked an intraventricular meningioma. The metastasis was recognized 13 years after removal of the primary tumor, a longer disease-free interval than any previously reported cases with brain metastases of renal cell carcinoma. The patient is now free of disease 4 years after resection and 17 years after the discovery of the primary tumor. Metastatic disease should be considered in all patients with prior resection of renal cell carcinoma who experience the onset of neurological disease, even after a prolonged disease-free interval. Long term survival is observed after the resection of solitary metastases, particularly if these appear after a prolonged disease-free interval.
An Unusual Late Complication of Acrylic Spinal Fusion: Case Report
Authors: Jordan Steve E. , Bremer Alfonso M. , Nguyen Tai Q.
Published: May 2010

The authors report an unusual complication after posterior cervical spine fusion utilizing methyl methacrylate and metallic pins. Eight months postoperatively, the patient noticed a subcutaneous foreign body in the right side of the neck. Radiographic and operative findings confirmed the clinical impression of migration of one of the metallic pins.