bluuebunny/crossref_metadata_2025 huggingface dataset:
A safe technique for the precise localization of carotid-cavernous fistula during balloon obliteration
Authors: Cares Herbert L. , Roberson Glen H. , Grand Walter , Hopkins L. Nelson
Published: May 2009

✓ The authors report a technique to precisely localize a fistulous opening in the carotid artery. The patient is heparinized and a Prolo catheter is introduced into the internal carotid artery and inflated distal to the approximate site of the fistula. Heparinization allows the balloon to be inflated long enough to obtain and analyze high-quality angiography film without fear of thromboembolism generated by the temporary balloon occlusion. Contrast material injected through the Prolo catheter proximal to the balloon reveals a small segment of cavernous carotid artery between the inflated balloon distally and the fistula proximally. The venous structures are now only faintly opacified and cannot obscure the morbid anatomy of the exact fistulous tear in the carotid artery. If the balloon is placed exactly opposite to the site of the fistula, a standing, stagnant column of dye forms a cast of the cavernous, petrous, and cervical carotid artery. Once the fistula is localized with this method, it may be obliterated by any therapeutic means preferred. If the Prolo catheter is used for intraluminal occlusion, then a transfemoral contralateral carotid angiogram is done before the heparin is reversed to confirm that the balloon has not been placed proximal to the fistula.
Pituitary adenomas in childhood and adolescence
Authors: Richmond Isabelle L. , Wilson Charles B.
Published: May 2009

✓ This report describes a group of 25 children and adolescents with biopsy-proven pituitary adenomas. They were found in 33% of patients encountered in our recent study of 74 parasellar tumors detected in patients under 20 years old. Earlier detection accounts for this apparent increase in frequency. This interpretation is supported by the rarity of signs of intracranial hypertension at presentation, as well as decreased incidence and severity of visual failure. More than 70% of patients have evidence of pituitary hypersecretion at presentation. Increased awareness of these endocrinological signs as well as improved hormonal assays facilitate both diagnosis and management. Hypopituitarism is rare; the important exception is suppression of gonadotrophic function that is known to occur early in the natural history of intrasellar pituitary adenomas.

The low incidence of suprasellar and extrasellar extension is documented by both radiographic and operative findings. Transsphenoidal resection was employed in 92% of patients, with an estimated total resection in 73% of cases. Follow-up studies show a high quality of survival; no patient has severe neurological deficit and less than half of them require replacement therapy. The recurrence rate is 8%. Our findings do not support a previous report that pituitary adenomas in this age group are frequently extrasellar and invasive.
Microsurgical anatomy of the distal anterior cerebral artery
Authors: Perlmutter David , Rhoton Albert L.
Published: May 2009

✓ The microsurgical anatomy of the distal anterior cerebral artery (ACA) has been defined in 50 cerebral hemispheres. The distal ACA, the portion beginning at the anterior communicating artery (ACoA), was divided into four segments (A2 through A5) according to Fischer. The distal ACA gave origin to central and cerebral branches. The central branches passed to the optic chiasm, suprachiasmatic area, and anterior forebrain below the corpus callosum. The cerebral branches were divided into cortical, subcortical, and callosal branches. The most frequent site of origin of the cortical branches was as follows: orbitofrontal and frontopolar arteries, A2; the anterior and middle internal frontal and callosomarginal arteries, A3; the paracentral artery, A4; and the superior and inferior parietal arteries, A5. The posterior internal frontal artery arose with approximately equal frequency from A3 and A4 and the callosomarginal artery. All the cortical branches arose more frequently from the pericallosal than the callosomarginal artery. Of the major cortical branches, the internal frontal and paracentral arteries arose most frequently from the callosomarginal artery. The distal ACA of one hemisphere sent branches to the contralateral hemisphere in 64% of brains. The anterior portions of the hemisphere between the 5-cm and 15-cm points on the circumferential line showed the most promise of revealing a recipient artery of sufficient size for an extracranial-intracranial artery anastomosis. The distal ACA was the principal artery supplying the corpus callosum. The recurrent artery, which arose from the A2 segment in 78% of hemispheres, sent branches into the subcortical area around the anterior limb of the internal capsule.
Assessment of the effects of cingulate gyrus lesions by neuropsychological techniques
Authors: Long Charles J. , Pueschel Katherine , Hunter Samuel E.
Published: May 2009

✓ Nineteen psychiatric patients undergoing bilateral cryogenic cingulate cortex lesions were extensively evaluated pre- and postoperatively with objective measures of intelligence, higher cortical functions, memory, and emotional status. Following surgery the patients as a group revealed no significant deterioration of functions; rather, they demonstrated improvement that could be interpreted as the result of decline in anxiety. Investigations of individual patients revealed that the overall test performance was improved in 13 and substantially unchanged in three, whereas three demonstrated some decline in performance. These results were discussed in terms of the characteristics of the changes across the various tests.
Postoperative epidural hematoma as a complication of anterior cervical discectomy
Authors: Hoi Sang U , Wilson Charles B.
Published: May 2009

✓ In three cases, anterior cervical discectomy was complicated by acute postoperative paraplegia secondary to epidural hematomas at the operative sites. Prompt evacuation of the hematomas was followed by recovery in each instance. The source of bleeding was an arterial arcade that may be encountered during the course of removing the posterior longitudinal ligament. As a result of this experience, the authors suggest steps to be taken to avoid this uncommon complication.
Teratomatous cyst of the spinal canal
Authors: Rosenbaum Thomas J. , Soule Edward H. , Onofrio Burton M.
Published: May 2009

✓ A search of the English literature revealed 46 cases of primary intraspinal teratomas, of which 22 were teratomatous cysts of the spinal cord. To clarify the confusion regarding this rare lesion, the definition, origin, presentation, and histological features of the lesion are discussed. An additional case is presented.
Metastatic melanoma simulating subdural hematoma
Authors: Palmer F. John , Poulgrain Anthony P.
Published: May 2009

✓ Metastatic melanoma tends to be found in subcortical white matter and this localization may produce clinical or radiological features that are unusual in metastatic disease. A case is described that closely simulated a subdural hematoma both clinically and radiologically.
Diffuse cerebrospinal gliomatosis
Authors: Kawano Nobuyuki , Miyasaka Yoshio , Yada Kenzoh , Atari Hideo , Sasaki Kenichi
Published: May 2009

✓ A case of diffuse cerebrospinal gliomatosis is presented, with widespread involvement of the brain, cranial nerves, and spinal cord. This case showed a far more extensive distribution of tumor cells than previously reported cases of gliomatosis cerebri. The clinical picture and oncogenesis of gliomatosis cerebri is briefly discussed.
Surgery of the carpal tunnel
Authors: Eboh Noel , Wilson Donald H.
Published: May 2009

✓ The authors describe a modified technique for surgery of the carpal tunnel. The primary cause of the carpal tunnel syndrome is the same as other entrapment neuropathies: an enlarged nerve within a tight tunnel. Electrical studies have shown that the area of compression is in the middle of the tunnel. Treatment is surgical: a palmar incision, which begins at the wrist medial to the palmaris longus, to avoid damage to the sensory branch of the median nerve; and section of the retinaculum from the exit of the tunnel toward the entrance.
Cerebral angiography of the rat
Authors: Ikeda Kimiyuki
Published: May 2009

✓ An open technique of right retrograde brachial arteriography of the rat is described. With the aid of magnification radiography, this method permits high quality examinations of the extracranial and intracranial circulations. The muscular branches of the brachial artery are preserved at the initial study to allow repeat examination. A four-vessel study is also attainable by injection of contrast material immediately after death of the animal.
A method for surgical management of focal epilepsy, especially as it relates to children
Authors: Goldring Sidney
Published: May 2009

✓ A method of surgical management for intractable epilepsy is described. The essential features are: 1) all surgical manipulation is carried out under general, rather than local, anesthesia; 2) the sensorimotor region is readily identified in the anesthetized patient by recording cortical sensory evoked responses; and 3) the epileptogenic focus is localized by extraoperative electrocorticography via indwelling epidural electrode arrays, localization deriving from recordings made during spontaneously occurring clinical seizures. Cases are presented to demonstrate that: 1) in some instances, recording of sensory evoked responses is the only means of sensorimotor localization in both the awake and anesthetized patient, and 2) spontaneous and electrically induced electroencephalographic seizure activity may provide false localization of the focus, the correct localization requiring recordings made during spontaneous clinical seizures. The outcome of surgery and the various epileptogenic lesions encountered are described. A good result has been achieved in 61% of patients followed 1 to 10 years. When the results obtained in children are analyzed alone, 70% have benefited from surgery.
Cervical myeloradiculopathy caused by arthrotic hypertrophy of the posterior facets and laminae
Authors: Epstein Joseph A. , Epstein Bernard S. , Lavine Leroy S. , Carras Robert , Rosenthal Alan D.
Published: May 2009

✓ Five patients with typical cervical myeloradiculopathy caused by focal cervical spinal stenosis are presented. Dorsal intrusions into the spinal canal by hypertrophied apophyseal joints and thickened laminae resulted in cord and nerve root compression. Minor spondylotic changes were present in the floor of the spinal canal. Laminar decompression with foraminotomy and facetectomy relieved the patients of their symptoms. An anterior approach should not be considered in the management of this disorder. Our findings of severe apophyseal arthrosis with lesser degrees of associated spondylosis are similar to those described in anatomical studies by other authors. While uncommon, myelopathy caused by dorsal compression of the spinal cord and nerve roots deserves specific mention so that therapy can be directed to the proper quadrants of the spinal canal wherein the significant pathology is located.
Management of recurrent CSF rhinorrhea of the middle and posterior fossa
Authors: Spetzler Robert F. , Wilson Charles B.
Published: May 2009

✓ The authors review 39 patients with cerebrospinal fluid (CSF) leaks originating from the middle or posterior fossa. They evaluate the usefulness of preoperative investigative procedures, including cisternal radionuclide scanning and the deliberate increase of intracranial pressure. The results in this series emphasize the important role that abnormal CSF dynamics play in the recurrence of problematic cases of rhinorrhea or otorrhea. The following guidelines are recommended by the authors on the basis of their recent experience: 1) if hydrocephalus is present, if the cisternogram is abnormal, or if the CSF leak is intermittent and slight, the initial treatment should be insertion of a lumboperitoneal shunt; 2) if the leak is localized in the sellar or parasellar area, a transsphenoidal approach to obliterate the leak is advised; 3) if the CSF leak originates through a dural opening into the middle ear, an intracranial repair is indicated.
Determination of cerebrospinal fluid shunt function with water-soluble contrast medium
Authors: Savoiardo Mario , Solero Carlo L. , Passerini Angelo , Migliavacca Franco
Published: May 2009

✓ Determination of cerebrospinal fluid shunt patency with water-soluble contrast medium is a simple, rapid, reliable, and safe technique. Since September, 1974, the authors performed 113 examinations. With the Spitz-Holter valve, only the atrial catheter can be studied, but, with the Pudenz valve and with the shunting devices that have a double-dome reservoir, both the proximal and the distal catheter can be visualized. Through the ventricular catheter a full ventriculographic study can be made, demonstrating ventricular size, malposition of the catheter, and the lesion that caused the hydrocephalus, or its evolution. The problem of collapsed ventricles, in which clinical and “manual” evaluation of the flushing device can give misleading findings, is emphasized. The injection of the atrial or peritoneal catheter in the pathological cases demonstrated its blockage, level of disconnection, malposition, sleeve, or cyst formation. Computerized tomography has only slightly decreased the number of these studies: when the ventricles are large, the examination with water-soluble contrast medium is still needed to demonstrate the exact level of malfunction. This demonstration has decreased the number of the total revisions or complete changes of shunting systems, eliminating some unnecessary changes of normally functioning catheters.
South American blastomycosis presenting as a posterior fossa tumor
Authors: Araujo João C. , Werneck Lineu , Cravo Marco A.
Published: May 2009

✓ An unusual case of infection of the central nervous system by Paracoccidioides braziliensis, presenting as posterior fossa tumor, is discussed and the pertinent literature reviewed.
Basilar-middle meningeal arterial anastomosis
Authors: Waga Shiro , Okada Masahiko , Yamamoto Yoshisuke
Published: May 2009

✓ A rare case of basilar-middle meningeal arterial anastomosis is reported. Pertinent literature is reviewed and an embryological explanation of this anastomosis is discussed.
Eosinophilic granuloma of the base of the skull
Authors: Miller Carole , Lloyd Thomas V. , Johnson John C. , Hunt William E.
Published: May 2009

✓ The authors present an unusual case of eosinophilic granuloma arising in the region of the foramen rotundum.
Pulmonary edema following fatal aneurysm rupture
Authors: Weir Bryce K.
Published: May 2009

✓ A retrospective clinico-pathological analysis of 78 cases of fatal subarachnoid hemorrhage (SAH) was carried out: 71% had a pathological diagnosis of pulmonary edema (PE), and of these 31% had a clinical diagnosis of PE. Patients with pathological PE were younger and died sooner after their SAH than those without. The incidence of PE fell with the passage of time following SAH, while the occurrence of pneumonia and embolism increased. There were hypoxemia and hypocapnia in both groups, more severe in the group that had pathological PE. The pathophysiology of neurogenic PE is discussed and possible therapeutic approaches indicated.
A simple gravimetric technique for measurement of cerebral edema
Authors: Marmarou Anthony , Poll Werner , Shulman Kenneth , Bhagavan Hemmige
Published: May 2009

✓ A simple method was developed for the laboratory preparation of gradient columns of specific gravity used in measurement of brain-tissue water. By this automated technique, virtually linear and repeatable density gradients were obtained from which values of tissue specific gravity could be determined. The specific gravity of both solid and fresh cortex and white matter from adult cats was measured and converted to units of percent water per gram tissue using conversion factors derived for this purpose and applicable to studies of brain edema.
Lumbar phlebography in the diagnosis of disc herniations
Authors: Roland Jean , Treil Jacques , Larde Dominique , Picard Luc , Manelfe Claude
Published: May 2009

✓ The authors report their experience with 240 cases with lumbar phlebography in the diagnosis of lumbar disc herniations. The normal radiological anatomy and the radiological signs of disc herniations are described. Indications for phlebography are given, and the reliability of this test is compared with that of myelography performed with water-soluble agents.
Spinal evoked potentials in the primate: Neural substrate
Authors: Cusick Joseph F. , Myklebust Joel , Larson Sanford J. , Sances Anthony
Published: May 2009

✓ Summated responses evoked by peripheral nerve stimulation were recorded from electrodes located in the epidural and subdural spaces anterior and posterior to the monkey spinal cord. Segmental microsurgical resection of the dorsal columns both at the thoracic and cervical levels resulted in total obliteration of the response recorded rostral to these lesions. Isolated segmental dorsal column preservation did not significantly alter response latency or wave form recorded at the rostral electrodes. Bilateral cervical dorsolateral column resection also resulted in no discernible alterations of these responses. These data indicate that spinal evoked potentials recorded from levels rostral to their root entry zones arise almost exclusively from the dorsal columns.
Chemotherapy of recurrent medulloblastoma with combined procarbazine, CCNU, and vincristine
Authors: Crafts David C. , Levin Victor A. , Edwards Michael S. , Pischer Tana L. , Wilson Charles B.
Published: May 2009

✓ Seventeen patients with recurrent medulloblastoma were treated with a combination of three drugs: procarbazine, CCNU, and vincristine (PCV). Tumor recurrence was documented at varying periods following surgery and radiotherapy. Among 16 evaluable patients, ten showed a response to PCV on the basis of subjective neurological improvement and a decrease in tumor size by radiological criteria. Five patients were designated as having stable disease on the basis of no change in neurological status and tumor size. One patient showed uninterrupted progression of disease. The median time to progression for all patients was 45 weeks.

Significant myelotoxicity, exacerbated by prior spinal irradiation, compromised therapy. After an initial response, it was often necessary to reduce the higher doses of CCNU and procarbazine that caused concomitant bone-marrow toxicity; as a consequence of the lowered doses, tumor progression was then frequently observed. The authors conclude that PCV is an effective form of palliative therapy for recurrent medulloblastoma.
Spinal epidural venous angioma causing foraminal enlargement and erosion of vertebral body
Authors: Decker Robert E. , Augustin Winston San , Epstein Joseph A.
Published: May 2009

✓ A case history of a segmental epidural venous angioma is presented. Findings included foraminal enlargement and vertebral body erosion. Routine computerized tomography with contrast enhancement should be helpful in diagnosis of vascular anomalies in patients with radicular symptoms.
Traumatic cerebrospinal fluid-lymphatic fistula
Authors: Kozic Zelimir , Zingesser Lawrence H.
Published: May 2009

✓ A case is presented of lymphatic intravasation of Pantopaque during myelography in a patient with a gunshot injury to the sacrum.
Hematoma of the quadrigeminal plate
Authors: Torre Emanuele La , Delitala Alberto , Sorano Vincenzo
Published: May 2009

✓ The authors report a case in which a hematoma of the quadrigeminal plate resulted from the rupture of a “cryptic” arteriovascular malformation (AVM) fed by the artery of the quadrigeminal plate. The AVM was symptomatic before rupturing and this clinical feature, associated with the lack of angiographic demonstration, led to the erroneous preoperative diagnosis of a tumor. In retrospect, the only finding that might have suggested the correct diagnosis was the beaded appearance on the ventriculogram of the aqueduct due to blood clots into this fluid space.
Persistent hypoglossal artery and persistent trigeminal artery presenting with posterior fossa transient ischemic attacks
Authors: Stern Jack , Correll James W. , Bryan Nick
Published: May 2009

✓ Two patients, one with a persistent hypoglossal artery and the other with a persistent trigeminal artery, presented with transient ischemic attacks in the distribution of the posterior fossa. Both had stenosis and ulcerative plaques at the carotid bifurcation. Their symptoms were successfully relieved after carotid endarterectomy.
Detachable balloon and calibrated-leak balloon techniques in the treatment of cerebral vascular lesions
Authors: Debrun Gérard , Lacour Pierre , Caron Jean-Pierre , Hurth Michel , Comoy Jean , Keravel Yves
Published: May 2009

✓ Of the cerebral vascular lesions that can be treated with intravascular detachable balloon techniques, carotid-cavernous sinus fistulas and vertebro-vertebral fistulas have the best results. The great advantage of this technique is that the cerebral blood flow can usually be preserved after the occlusion of the fistula. The authors report 17 posttraumatic carotid-cavernous sinus fistulas successfully treated with preservation of the carotid blood flow in 12 cases. None of the patients died, and the morbidity was limited to one case of third nerve palsy. The treatment of aneurysms by this method is, however, much more difficult and dangerous. Of 14 cases treated, seven good results were obtained. Two patients died and two had a poor outcome. The embolization of certain brain angiomas with calibrated-leak balloons using bucrylate promises to be important in the future.
Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve
Authors: Hardy David G. , Rhoton Albert L.
Published: May 2009

✓ Compression and distortion of the trigeminal nerve by a tortuous and elongated superior cerebellar artery (SCA) is postulated to be a frequent cause of trigeminal neuralgia. This theory and the use of operative therapy in which the offending arterial loop is separated from the trigeminal nerve has created a need for more detailed information on the relationship of the SCA and the trigeminal nerve. In order to meet this need, 50 trigeminal nerves and the adjacent SCA were examined in 25 adult cadavers. Twenty-six of the 50 nerves examined had a point of contact with the SCA, but it was uncommon for the arterial contact to produce distortion of the nerve. In six instances, the contact was at the pontine entry zone of the trigeminal nerve, the site of arterial compression postulated to be associated with trigeminal neuralgia. Four trigeminal nerves (8%) had a point of contact with the anterior inferior cerebellar artery (AICA). The fact that large arteries are commonly in contact with the trigeminal nerve is important not only because of the controversial relationship of neurovascular contact to trigeminal neuralgia, but because of the possibility that major vessels may be encountered and injured during rhizotomy and other posterior fossa operations on the trigeminal nerve.
Tissue cultures from cerebrospinal fluid specimens in the study of human brain tumors
Authors: Black Peter M. , Callahan Liane V. , Kornblith Paul L.
Published: May 2009

✓ The authors report a study in which 109 cerebrospinal fluid (CSF) specimens from patients with varying neurological disorders were incubated in tissue culture medium for 1, 3, and sometimes 7 days. Strict criteria for malignancy were applied to cells found at these intervals. In 35 patients with verified central nervous system neoplasms, eight cases had malignant cells and 11 others had “doubtful” cells by tissue-culture analysis. Thirty-three of these cases were also examined with standard millipore cytological techniques: six had malignant cells and four had “doubtful” cells. Of 50 cases with inflammatory or other non-neoplastic conditions, cells were cultured in 13. None was considered malignant by our criteria. Tissue culture of CSF has several potential benefits. Even with stringent criteria, it is possible to demonstrate the presence of unequivocally malignant cells in CSF by tissue culture. The systemic application of such criteria may eventually increase the positive identification of malignancies. Further, since these cells are growing, the degree of malignancy may be more accurately determined by a study of growth in culture. Such a study could not be done by conventional methods. Finally, tissue culture can help to guide therapy in certain instances in which a surgical biopsy cannot be obtained.
Experimental dysraphism in the rat
Authors: Smith Michael T. , Wissinger John P. , Smith Carol Grace , Huntington Howard W.
Published: May 2009

✓ An experimental treatment that results in dysraphic lesions in rat embryos was studied to gain insight into the origin of such lesions. Pregnant rats given 100,000 units of vitamin A by gavage tube on gestational Days 8, 9, and 10 produced abnormal litters, and 50% of the embryos had exencephaly and/or spina bifida. Study of these embryonic lesions revealed hyperplasia of neural tube tissue that extended laterally to the edge of an epidermal defect. The epidermal defect consisted of the absence of fetal epidermis over the hyperplastic neural tissue. At no stage in development was embryonic hydrocephalus noted. In fact, the central canals of the embryos with malformations were poorly developed and smaller than those of control embryos. Results with this model indicate that the malformations arise through a process of overgrowth and hyperplasia and not from embryonic hydrocephalus. Continued work with this and other models is required to delineate new mechanisms and to offer alternative postulates for the origin of dysraphic lesions.
Intracerebral hemorrhage due to ruptured venous aneurysm
Authors: Tyson George W. , Jane John A. , Strachan W. Ellis
Published: May 2009

✓ Documented rupture of venous aneurysms associated with arteriovenous fistulas is uncommon, and reports of the formation and rupture of venous aneurysms that are not associated with fistulas are distinctly rare. One case is presented in which spontaneous rupture of a saccular aneurysm on a vessel draining an arteriovenous fistula produced an intracerebral hematoma. A second case is described in which fatal intracerebral hemorrhage was produced by a traumatic aneurysm of an otherwise normal superficial cerebral vein.
Computerized tomographic definition of mesencephalic hematoma with evacuation through pedunculotomy
Authors: Humphreys Robin P.
Published: May 2009

✓ A 10-year-old boy, who presented with symptoms of a progressive hemorrhagic stroke, had suffered a spontaneous midbrain hematoma. The extent of the clot was detailed by computerized tomography and the lesion was surgically removed through pedunculotomy.
Intradural sacral nerve root metastasis mimicking herniated disc
Authors: Hirsh Leonard F. , Finneson Bernard E.
Published: May 2009

✓ Spinal tumors may mimic herniated discs but the neurological findings and radiographs usually indicate the correct diagnosis. A case of metastasis to the S-1 intradural nerve rootlets is reported, with symptoms closely simulating a herniated disc. The correct diagnosis could not be made preoperatively in spite of clinical suspicion of a tumor.
Double-blind evaluation of chemonucleolysis for herniated lumbar discs
Authors: Martins Albert N. , Ramirez Archimedes , Johnston James , Schwetschenau P. Robert
Published: May 2009

✓ Sixty-six patients with symptomatic herniated lumbar discs refractory to the usual conservative management were allocated at random into one of two treatment groups according to a double-blind protocol: 31 received chymopapain intradiscally (chemonucleolysis) and 35 received a placebo intradiscally. Symptoms remained significantly improved 1 year or more after injection for 55% of those treated with chymopapain and for 46% of those treated with placebo. The difference is not statistically significant. However, to discard chemonucleolysis on the basis of this one small clinical trial may be premature. Since continuing controversy has re-established a climate in which another double-blind study of chemonucleolysis is ethically feasible and scientifically desirable, we favor additional clinical trials under a tightly controlled protocol to help resolve the issue.
Regional spinal cord blood flow in rats after severe cord trauma
Authors: Rivlin Alex S. , Tator Charles H.
Published: May 2009

✓ Spinal cord blood flow (SCBF) was measured in 12 albino rats following acute cord injury produced by the extradural clip compression technique. Severe injury was produced with the clip compressing the cord with a force of 180 gm for 5 minutes, an injury previously shown to produce a severe functional deficit. Regional SCBF was measured 15 minutes, 2 hours, and 24 hours after injury by the 14C-antipyrine autoradiographic technique and a scanning microscope photometer. At 15 minutes and 2 hours, white and gray matter blood flow was severely diminished, and, at 24 hours, there was only minimal improvement. Focal decreases in blood flow were seen in white and gray matter for a considerable distance proximal and distal to the site of cord trauma. Thus, it has been confirmed in this model that severe cord compression injury produces severe posttraumatic ischemia in the cord which lasts for at least 24 hours.
Prophylaxis of postmyelogram headaches
Authors: Gutterman Paul , Bezier Honorio S.
Published: May 2009

✓ One hundred patients undergoing myelography received prophylactic autologous epidural blood patches to prevent postmyelogram headache. The results indicate a significant reduction in the incidence and severity of this problem compared to a control group, without any significant side effects.
Fibrosarcoma of the scalp
Authors: Chaudhari A. Basit , Ladapo Foluso , Duncan Josbert T. K.
Published: May 2009

✓ A parieto-occipital scalp tumor, noted in a Nigerian boy during the first month of his life, gradually increased in size, and after two attempts at partial removal there was a rapid increase in its size. When he was 17 years old, it measured 21 × 17 × 16 cm. There was no underlying skull defect. Complete excision of the tumor was achieved, and on histological examination it was found to be a fibrosarcoma, The patient was given a course of radiotherapy following wound healing. He remained well for 5½ months but then had manifestations of small local recurrence and distant metastases that responded only minimally to another course of radiotherapy combined with cancer chemotherapy.
Subarachnoid hemorrhage secondary to ruptured aneurysms in infants
Authors: Grode Marshall L. , Saunders Myles , Carton Charles A.
Published: May 2009

✓ Two infants with subarachnoid bleeding from middle cerebral artery aneurysms are presented, with detailed case histories.
Hemangiopericytoma of the spinal canal
Authors: Harris Darrell J. , Fornasier Victor L. , Livingston Kenneth E.
Published: May 2009

✓ Hemangiopericytoma is a vascular neoplasm consisting of capillaries outlined by an intact basement membrane that separates the endothelial cells of the capillaries from the spindle-shaped tumor cells in the extravascular area. These neoplasms are found in soft tissues but have rarely been shown to involve the spinal canal. This is a report of three such cases. Surgical removal of the tumor from the spinal canal was technically difficult. A high risk of recurrence has been reported but in these three cases adjunctive radiotherapy appeared to be of benefit in controlling the progression of the disease. These cases, added to the six cases in the literature, confirm the existence of hemangiopericytoma involving the vertebral column with extension into the spinal canal. This entity should be included in the differential diagnosis of lesions of the spinal canal. The risk of intraoperative hemorrhage should be anticipated.
Isolated histiocytosis X of the hypothalamus
Authors: Tibbs Phillip A. , Challa Venkata , Mortara Richard H.
Published: May 2009

✓ Failure to consider histiocytosis X in the differential diagnosis of hypothalamic masses may lead to inappropriate empirical radiotherapy. This report concerns a case of histiocytosis X of the hypothalamus, unassociated with systemic histiocytic lesions, in which early biopsy allowed specific therapy with subsequent total regression of the lesion.
Modification of intracranial aneurysm clip
Authors: Shahbabian Set , Mayfield Frank H.
Published: May 2009

✓ A modification of the Mayfield aneurysm clip is described which is thought to decrease the chance of slippage of the clip, mainly in the case of large-necked and atherosclerotic aneurysms.
The outcome with aggressive treatment in severe head injuries
Authors: Marshall Lawrence F. , Smith Randall W. , Shapiro Harvey M.
Published: May 2009

✓ The authors have analyzed the hospital course and outcome in 100 consecutive patients with severe head injuries who either on admission or within 24 to 48 hours of their hospitalization were not verbally responsive, and not able to follow commands. All were treated in a uniform manner. Operative intervention was performed immediately in patients with significant extracerebral hematomas or large superficial intracerebral hematomas. Intracranial pressure (ICP) was monitored in all, and in 55 patients treatment with a combination of dexamethasone, hyperventilation (PaCO2 of 25 to 28 mm Hg), mannitol, normothermia, and controlled systemic arterial pressure was required for intracranial hypertension (ICP > 15 mm Hg). In 25 patients whose ICP remained significantly elevated (ICP > 40 mm Hg for 15 minutes or more), high-dose pentobarbital therapy was used to lower the ICP. Forty-five patients recovered with no or minimal neurological deficit, and returned to their pre-injury occupation (good recovery). Fifteen patients are moderately disabled, four are severely disabled, and eight remain in a persistent vegetative state. The mortality rate was 28%. The favorable outcome in this series suggests that early aggressive surgical treatment, successful control of intracranial hypertension, and careful attention to medical complications can improve the outcome in patients with severe head injuries.
Neurovascular relationships of the sphenoid sinus
Authors: Fujii Kiyotaka , Chambers Steven M. , Rhoton Albert L.
Published: May 2009

✓ The increasing use of the transsphenoidal approach to sellar tumors has created a need for more detailed information about the neurovascular relationships of the sphenoid sinus. To better define this anatomy, 25 sphenoid sinuses were examined in cadavers, with attention to the neural and vascular structures in the lateral wall of the sinus. Three structures produced prominent bulges into the lateral wall of the sinus; they were 1) the optic nerves, 2) the carotid arteries, and 3) the maxillary branches of the trigeminal nerve. Over half of these structures had a bone thickness of less than 0.5 mm separating them from the sphenoid sinus, and in a few cases, they were separated by only sinus mucosa and dura.

1) The optic canals protruded into the superolateral part of the sphenoid sinus in all except one side of one specimen. In 4% of the optic nerves, only the optic sheath and sinus mucosa separated the nerves from the sinus, and in 78%, less than a 0.5-mm thickness of bone separated them. 2) The carotid arteries produced a prominent bulge into the sphenoid sinus in all but one side of one specimen. In 8% of the carotid arteries there were areas where no bone separated the artery and the sinus. 3) The maxillary branches of trigeminal nerves bulged into the inferolateral part of the sphenoid sinus in all except one side of two specimens. One side of one specimen had no bone, and 70% had less than a 0.5-mm thickness of bone separating the nerve from the sinus. The importance of these findings in transsphenoidal surgery is reviewed.
Surgical treatment of distal anterior cerebral artery aneurysms
Authors: Yoshimoto Takashi , Uchida Keita , Suzuki Jiro
Published: May 2009

✓ Between June, 1961, and September, 1975, the authors operated on 60 patients with aneurysms of the anterior cerebral artery distal to the anterior communicating artery (ACoA) by a direct intracranial approach. It is of utmost importance in the treatment of aneurysms to have control of the parent artery of the aneurysm. This makes it easier and safer to approach the aneurysm neck and to handle possible premature aneurysm rupture. The aneurysms were classified into two types, ascending and horizontal. Aneurysms arising from the origin of the ACoA and including the entire portion of the knee of the corpus callosum were designated as aneurysms of the ascending portion, whereas aneurysms beyond the genu were designated as aneurysms of the horizontal portion. For aneurysms of the ascending portion, bifrontal craniotomy was considered the safest approach. For aneurysms of the horizontal portion, a small parasagittal craniotomy was determined to be sufficient.
Combined neurilemmoma and angioma
Authors: Kasantikul Vira , Netsky Martin G.
Published: May 2009

✓ Eight cases are described of intracranial and peripheral neoplasms composed of mixed neurilemmoma and hemangioma. It is proposed that ectomesenchyme can differentiate into neurilemmoma and angioma. The latter may be related to recently described angiogenetic factors, or to developmental factors as in rare cases of arterial angiomas. The angiomatous part may be common, but has often been overlooked. The presence of abnormal vessels, whether in kind or in number, helps explain various biological features of neurilemmoma. These vessels frequently bleed within the tumor, which results in the characteristic hemosiderin-laden macrophages. Bleeding may also occur into the cerebrospinal fluid (CSF) to create xanthochromia. The frequent increase in CSF protein in cases of neurilemmoma is attributed to transudation of serum from abnormal vessels. Less commonly, bleeding may be sufficient to cause subarachnoid hemorrhage. The dense collagen usually associated with these angiomas accounts for the relative infrequence of major hemorrhages.
Intraventricular administration of amikacin for complicated Gram-negative meningitis and ventriculitis
Authors: Wirt Timothy C. , McGee Zell A. , Oldfield Edward H. , Meacham William F.
Published: May 2009

✓ Four pediatric neurosurgical patients with Gram-negative meningitis and ventriculitis were treated with parenteral and intraventricular amikacin, a new aminoglycoside. The organisms infecting these patients were resistant to multiple antimicrobial drugs but were sensitive to amikacin. Treatment was continued for 14 days after cerebrospinal fluid cultures became negative. All four patients were cured and have demonstrated no nephrotoxicity, ototoxicity, or evidence of persistent infection on follow-up examination.
Computerized tomography and pathological correlation in cystic meningiomas
Authors: Becker Dennis , Norman David , Wilson Charles B.
Published: May 2009

✓ Meningiomas have been reported to have associated areas of surrounding low density on computerized tomography (CT). These low-density areas may represent edema, widened subarachnoid spaces, loculated cerebrospinal fluid, demyelination, or adjacent tumor. Two cases are presented in which this adjacent area of low density represented a tumor cyst. Recognition is important as the CT appearance of these lesions may simulate a metastatic tumor.
Treatment of carotid-cavernous fistulas by cavernous sinus occlusion
Authors: Mullan Sean
Published: May 2009

✓ The author reports the occlusion of 33 carotid-cavernous fistulas in 31 patients using thrombogenic techniques. In one patient the carotid artery had been occluded previously, in one it was occluded deliberately, and with 31 fistulas it was preserved. There was no mortality and virtually no morbidity.
Experimental assessment of phenoxybenzamine in cerebral vasospasm
Authors: White Richard P. , Huang Shang-Po , Hagen A. Ainsworth , Robertson James T.
Published: May 2009

✓ The effect of phenoxybenzamine (PBZ) on cerebral vasospasm of the basilar artery induced by the injection of 2 ml of blood into the cisterna magna of dogs was assessed in chronic experiments. The presence of vasospasm was documented arteriographically. In one group of animals, 12 mg/kg of PBZ was given intravenously 2 hours before the intracisternal injection of blood to ascertain whether this drug would prevent the development of vasospasm for 24 hours. In another group of animals a 10−2M solution of PBZ was given intracisternally 15 minutes after vasospasm was produced, and again 24 hours afterward, to determine if the drug would reverse an existing spasm. These drug-treated animals were compared with controls which were treated with saline alone. The results indicate that the drug treatment was not statistically superior to saline in any of the groups studied. The finding that saline injected into the cisterna magna reversed the cerebral vasospasm illustrates the importance of this procedure in evaluating effectiveness of drugs and confirms the original observation that washing the cerebrospinal fluid with saline can terminate an experimentally induced vasospasm. Moreover, the fact that intracisternal injections of saline were more effective when given soon after the establishment of vasospasm than when injected 24 hours afterward supports the conclusion of others that the pathogenesis of cerebral vasospasm changes with time. The results also indicate that the presence of cerebral vasospasm in some animals did not prevent the return of normal behavior.
Individual variability in cortical localization of language
Authors: Ojemann George A.
Published: May 2009

✓ Individual variability in the localization of language, as measured by object-naming, was assessed for left lateral peri-Sylvian cortex with a multi-sample technique of stimulation mapping at a constant current. This study was performed during craniotomy under local anesthesia in 10 patients with medically intractable epilepsy and the usual pattern of left brain dominance for language. A high degree of variability in the exact location of naming was present. Only one area, a small portion of the third frontal convolution immediately in front of the motor strip, showed naming changes in all patients in whom it was sampled. This area is considerably smaller than the classical Broca's area. Elsewhere in language cortex, including all parts of the posterior language area, there was considerable individual variability. Because of this, the classical model of language localization is an inaccurate basis for establishing the risk of aphasia in surgical therapy of dominant hemisphere peri-Sylvian lesions in this and related patient populations. Rather, that risk should be assessed from the individual localization of language, established by the multisample technique of stimulation mapping.
Total removal of acoustic neurinomas
Authors: Zlotnik Ephraim I. , Sklyut Iosif A. , Smeyanovich Arnold F. , Stolkarts Iosif Z.
Published: May 2009

✓ The authors analyze the results of total removal of acoustic neurinomas in 120 patients operated on between January, 1967, and January, 1976. The facial nerve was preserved after surgery in 65 patients (54.2%). The use of microsurgical techniques in the last 3 years of study permitted preservation of the seventh nerve in 26 of 35 operated patients (74.3%). Of 103 patients examined postoperatively, 96 retained their full or partial capacity for work (93.2%). Ten patients (8.3%) died after surgery. In the last 3 years, 35 patients were operated on without a single death.
Craniofacial growth following experimental craniosynostosis and craniectomy in rabbits
Authors: Persson K. Maurits , Roy William A. , Persing John A. , Rodeheaver George T. , Winn H. Richard
Published: May 2009

✓ Premature fusion of the coronal suture was produced in 9-day-old rabbits by immobilization of the suture area bilaterally with methyl-cyanoacrylate adhesive. The effects of suture fusion and its surgical release on suture growth and on skull morphology were evaluated by radiographic cephalometry. Immobilization resulted in significant changes in the angular dimensions in the vault toward an anteroposterior shortening. No permanent deformity was observed in the angular relationship between the cranial base and the facial skeleton. Craniectomy at 30 days, when a skull deformity had been established, resulted in rapid separation of the bones at the suture site which returned the deformed skull to a normal configuration by 90 days of age. Surgical removal of a normal suture in a control group also resulted in accelerated separation of the bones at the excised suture site, but it was less than after removal of an immobilized suture. The experimental data indicate that premature fusion of rapidly growing sutures results in consistent skull deformity. Early release of the fusion, when this is the primary abnormality, will result in spontaneous correction of the deformity.
Loss of autoregulation and posttraumatic ischemia following experimental spinal cord trauma
Authors: Senter Howard J. , Venes Joan L.
Published: May 2009

✓ Blood flow in the dorsolateral funiculus of the cat thoracic spinal cord was studied after severe experimental cord injury, using a modification of the hydrogen clearance technique. Autoregulation was intact during the initial 60 to 90 minutes after cord injury, but was then lost coincident with the onset of ischemia. The data suggest that the ischemic response to spinal cord injury is mediated both by the loss of autoregulation and by relative vasoconstriction of the resistance vessels. Therapeutic intervention aimed at maintaining perfusion during the early posttraumatic period may prove of value in reversing or limiting some elements of dysfunction due to the secondary injury of ischemia.
Alteration of posttraumatic ischemia in experimental spinal cord trauma by a central nervous system depressant
Authors: Senter Howard J. , Venes Joan L. , Kauer John S.
Published: May 2009

✓ Blood flow after severe experimental injury to the thoracic spinal cord was studied in cats, using a modification of the hydrogen clearance technique. Gamma hydroxybutyrate, a central nervous system depressant, was shown to markedly alter the ischemic response to injury if given during the early posttraumatic period. Other vasoactive drugs investigated had no effect on posttraumatic ischemia. Therapeutic intervention during the early posttraumatic period aimed at increasing blood flow while decreasing the metabolic requirements of the injured cord may prove of value in reversing or limiting some elements of long-tract dysfunction due to the secondary ischemic insult.
Pathology of an arachnoid cyst
Authors: Krawchenko John , Collins George H.
Published: May 2009

✓ Accidental death brought to autopsy a 19-year-old girl with an asymptomatic arachnoid cyst which had expanded from the region of the interpeduncular cistern so as to replace the third ventricle and extend into both lateral ventricles. Associated with this expansion was a significant degree of hydrocephalus, compression of the walls of the lateral ventricle, and obliteration of the normal structures of the floor of the third ventricle. The histological structure of the cyst wall and its relationship to the normal arachnoid are defined and found to consist of a reduplication of the normal arachnoid membrane resulting in a space within the arachnoid tissue. It is suspected but not proven that the cyst was congenital, resulting from an abnormality in development. Some suggestions are offered regarding the mechanism for its enlargement.
Vasospasm following transcranial removal of large pituitary adenomas
Authors: Mawk John R. , Ausman James I. , Erickson Donald L. , Maxwell Robert E.
Published: May 2009

✓ The authors report three cases of cerebral vascular spasm following transfrontal removal of large pituitary neoplasms. One patient awakened from surgery hemiparetic, but has since recovered. A second patient developed hemiparesis with confusion on the fifth postoperative day and eventually died. The third patient developed hemiplegia on the tenth postoperative day, but recovered completely. Vascular spasm was documented angiographically in all three cases. Possible mechanisms underlying this unusual complication are discussed.