bluuebunny/crossref_metadata_2025 huggingface dataset:
Reticulin stain in differentiating astrocytomas from neurilemmomas on frozen sections
Authors: Kepes John J. , Morantz Robert A. , England Anna Marie
Published: May 2009

✓ The authors recommend the use of a reticulin stain for frozen sections to differentiate between astrocytomas and neurilemmomas during surgery. This technique was first described for the diagnosis of pituitary adenomas.
Reduction of postoperative lumbar hemilaminectomy pain with Marcaine
Authors: Mullen John B. , Cook Wesley A.
Published: May 2009

✓ A technique is described using intraoperative infiltration of paravertebral musculature with Marcaine, a long-acting local anesthetic. This has resulted in a marked reduction of postoperative pain following lumbar disc surgery.
Surgical hemostasis
Authors: Owen Charles A. , Bowie E. J. Walter
Published: May 2009

✓ Every surgical procedure taxes the hemostatic defenses of the patient. If his hemostatic mechanism is sound, he is unlikely to have a bleeding problem during or after an operation, unless, of course, a suture or clip slips off. Two classes of patients do present bleeding problems to the surgeon. One group has a pre-existing bleeding tendency, the other acquires it during or after the operation.

The recognition of patients with severe hemostatic disabilities, such as hemophilia, presents no problem since the patient is aware of the disease. The mild bleeder is less likely to be detected by screening tests than by adroit questioning. The major hemostatic defect that may develop during an operation, or shortly thereafter, is disseminated intravascular coagulation. This syndrome, always secondary, may accompany shock, mismatched blood transfusion, septicemia, or extensive malignancy. Its prevention or early recognition is much easier than treatment after circulating platelets and some coagulation factors have been consumed and fibrinolysis is destroying fibrin and fibrinogen.
Some observations on aneurysms of the proximal internal carotid artery
Authors: Punt Jonathan
Published: May 2009

✓ The author reports on 41 aneurysms of the proximal internal carotid artery (PICA) demonstrated in 36 patients with subarachnoid hemorrhage. The patients included a striking preponderance of women, and there was a high incidence of multiple aneurysms. In cases with multiple aneurysms the PICA aneurysm was usually found incidentally, a more distal aneurysm on the internal carotid artery being the source of hemorrhage. An infundibulum at the origin of a posterior communicating artery was unusually common in these patients. The origin of the ophthalmic artery is proposed as the angiographic landmark of the level at which the internal carotid artery penetrates the dura mater.
Effect of nonsteroid anti-inflammatory drugs on subarachnoid hemorrhage in dogs
Authors: White Richard P. , Hagen A. Ainsworth , Robertson James T.
Published: May 2009

✓ The effects of two long-acting anti-inflammatory agents on behavioral changes and cerebral vasospasm were evaluated in a canine model of chronic subarachnoid hemorrhage (SAH). The agent with the longest half-life, sudoxicam, clearly reduced both the incidence and the magnitude of the vasospasm, and prevented the usual behavior changes caused by the simulated SAH. The results obtained with the other agent, naproxen, suggested that it was better than the administration of saline. These agents were studied because of reports indicating that prostaglandins and thromboxane may play a role in the pathogenesis of the effects of SAH and because the nonsteroid anti-inflammatory agents exert pharmacological effects by reducing an excessive synthesis of these lipids. The findings suggest that some of these agents may afford an alternative treatment for the deleterious consequences of SAH.
The anatomy of the so-called “articular nerves” and their relationship to facet denervation in the treatment of low-back pain
Authors: Bogduk Nikolai , Long Don M.
Published: May 2009

✓ Dissections of the dorsal rami of L1–5 were performed in human cadavers, and the course of the dorsal rami, their branches, and the innervation of the zygapophyseal joints in the lumbar region were specifically studied. At the L-1 through L-4 levels, the dorsal rami divide into medial and lateral branches within the intertransverse ligaments. Each medial branch runs across the root of the adjacent superior articular process. At the caudal edge of the process, the branch turns medially beneath the mammillo-accessory ligament. Beneath the mammillo-accessory ligament, medial branches occur that innervate the adjacent zygapophyseal joint, and distal zygapophyseal branches arise at the laminar level to innervate the next lower joint. The L-5 dorsal ramus runs along a groove between the ala of the sacrum and its superior articular process. At the caudal edge of the articular process, the ramus divides into medial and lateral branches, and the medial branch supplies the L5—S1 articulation.
Protective effects of steroids on the cortico-microcirculation injured by cold
Authors: Soejima Tohru , Yamamoto Y. Lucas , Meyer Ernst , Feindel William , Hodge Charles P.
Published: May 2009

✓ Early microcirculatory changes after focal cold injury of the cerebral cortex were examined in dogs with and without steroids by serial fluorescein angiography of the brain (FAB), by measurement of the diameter of epicerebral vessels, and by measurement of cerebral blood flow with the clearance method using krypton-85 and xenon-133. Changes in the transcerebral vessels were examined by x-ray projection microangiography.

Within 30 minutes of the injury, the cortical area injured by a temperature of −65° C showed a reduction in blood flow of 60%. When treated with steroids and while still at the same temperature, blood flow was reduced by only 35%. Serial FAB revealed slowing and arrest of flow in the epicerebral microcirculation which could be noted first in the small veins, then in the medium-sized veins and small arteries. Fluorescein dye leaked from the epicerebral vessels, around the small veins, then around larger veins and small arteries. Some leakage of dye from medium-sized arteries was noted 2 hours after injury. This sequence of slowing and arrest of the microcirculation, with exit of dye from intact arterial vessels, identified here for the first time in relation to a cortical freezing lesion, may help to explain the development of later brain edema which spreads widely in the subcortical white matter. After steroids, improvement of the microcirculation was present as defined by cortical blood flow, fluorescein angiography, and x-ray projection microangiography.
Acute occlusion of the posterior spinal vein
Authors: Doppman John L. , Girton Mary , Popovsky Mark A.
Published: May 2009

✓ The posterior spinal vein was occluded with silicone in seven rhesus monkeys, and locally resected in one. There were no neurological findings associated with acute venous obstruction of the cord. Follow-up arteriography revealed diversion of venous outflow into the anterior spinal venous system. Histology revealed gliosis associated with demyelinization confined to the posterior columns.
Intracranial pressure in the normal monkey while awake and asleep
Authors: Gücer Gündüz , Viernstein Lawrence J.
Published: May 2009

✓ Intracranial pressure (ICP) was recorded continuously by telemetry in seven normal monkeys trained to eat, sleep, and live in a primate chair. Electroencephalography, electromyography, and blood pressure were also measured by conventional means. During wakefulness and all stages of sleep except desynchronized sleep, the ICP record showed small short-term variations in pressure. However, during desynchronized sleep, the mean ICP rose on the average to 170 ± 6 mm H2O above the ICP levels in the other states of sleep, and the pulsation pressure variation increased by a factor of three. The episodes occurred 10 ± 2 times during the night and lasted for 6.8 ± 1.4 minutes, during which the average systemic blood pressure decreased by 19 ± 1.6 mm Hg. These ICP waves occurring during desynchronized sleep resemble the plateau waves described by Lundberg, but are of smaller magnitude and they appear to be a normal characteristic of sleep in the macaque monkey. Bilateral sympathectomy of the superior cervical ganglia in four of the monkeys did not alter significantly the duration, amplitude, or frequency of occurrence of the ICP waves during desynchronized sleep.
Congenital astrocytoma presenting with intracerebral hematoma
Authors: Rothman Steven M. , Nelson James S. , DeVivo Darryl C. , Coxe William S.
Published: May 2009

✓ A massive left intracerebral hematoma was surgically evacuated from a 2-week-old infant. Pathological examination showed that the hemorrhage had developed within a fibrillary astrocytoma. Neonatal intracerebral hemorrhage should raise the question of congenital tumor because such a hemorrhage in this age group is rarely the result of trauma, bleeding diathesis, or vascular malformation.
Enlarging histoplasmomas following treatment of meningitis due to Histoplasma capsulatum
Authors: Allo Maria D. , Silva Joseph , Kauffman Carol A. , Dicks Robert E.
Published: May 2009

✓ This report describes a case in which an intracranial histoplasmoma was successfully treated with surgical removal and amphotericin B. This is the third reported case of its kind. The authors discuss problems of preoperative diagnosis in a patient with depressed cell-mediated immunity, and no evidence of extracerebral dissemination.
Excision of a brain-stem epidermoid cyst
Authors: Weaver Edgar N. , Coulon Richard A.
Published: May 2009

✓ An intra-axial epidermoid cyst of the brain stem is presented. X-ray studies revealed a mass within the brain stem; computerized tomography showed the mass to be cystic. The epidermoid cyst was successfully removed surgically. Six months after operation the patient is stable with sixth and seventh nerve palsies but resolution of right spastic hemiparesis.
Relation of cerebral blood flow to neurological status and outcome in head-injured patients
Authors: Obrist Walter D. , Gennarelli Thomas A. , Segawa Hiromu , Dolinskas Carol A. , Langfitt Thomas W.
Published: May 2009

✓ Noninvasive studies of regional cerebral blood flow (CBF) were performed on 36 head-injured patients in varying degrees of coma, using the intravenous xenon-133 method. Serial examinations, averaging four per patient, were begun during the acute phase of illness and continued until death or recovery of normal consciousness. Comparison of the initial and final studies revealed that CBF declined to very low levels in all nine patients who died, and remained subnormal in a patient with persistent vegetative state. In contrast, 25 of 26 patients who recovered consciousness showed increases in blood flow.

Because of the presence of both reduced and elevated blood flows on the initial study, CBF was not predictive of outcome. Absolute or relative hyperemia, observed in nine acute cases, was associated with either diffuse cerebral swelling (observed on computerized tomography) or recovery from systemic shock. Cerebral metabolic studies in hyperemic patients yielded a very low oxygen uptake and arteriovenous oxygen difference, indicating that the high blood flow was a true “luxury perfusion.” When instances of presumed luxury perfusion were excluded, CBF was positively correlated with level of consciousness, assessed on a four-point coma scale.
Failure of high-dose steroid therapy to influence intracranial pressure in patients with severe head injury
Authors: Gudeman Steven K. , Miller J. Douglas , Becker Donald P.
Published: May 2009

✓ While corticosteroids in standard neurosurgical dosage do not appear to influence recovery from severe head injury or elevated intracranial pressure (ICP), some reports claim that a much higher dose is effective. A resultant hypothesis is that an abrupt increase in corticosteroid dosage in patients with severe head injury should cause a detectable reduction in ICP and in cerebral elastance within 48 hours. To test this hypothesis, 20 consecutive patients with severe head injury, 12 of whom had had surgical decompression of mass lesions, were studied. All patients were artificially ventilated, and had continuous monitoring of ICP and intermittent testing of elastance by measurement of the volume-pressure response (VPR). For the first 12 hours after admission, patients received methylprednisolone, 40 mg every 6 hours. The dose was then increased abruptly by giving a single dose of 2 gm and 500 mg every 6 hours for the next 24 hours, then tapering rapidly. No significant change in ICP or VPR could be detected after 24 or 48 hours of high-dose steroid therapy. Of the 20 patients, 50% had good recovery or were moderately disabled, 15% were severely disabled or vegetative, and 35% had died. The course of ICP and the outcomes in these patients were not significantly different from those observed in a previous group of 262 patients managed in the same way for the high-dose regimen. There was, however, a high incidence of gastric hemorrhage (50%) and of hyperglycemia with glucosuria (85%) in these 20 patients. These negative results in patients with head injury stand in marked contrast to our experience of the benefit of methylprednisolone in patients with brain tumors.
Definition of cellular immune responses to brain antigens in human head trauma
Authors: Apuzzo Michael L. J. , Sheikh Khalid M. A. , Heiden James S. , Weiss Martin H. , Kurze Theodore
Published: May 2009

✓ Cellular immune responses to brain antigens in patients with head injury were studied by applying the leukocyte adherence inhibition (LAI) assay. The investigation was conducted in three phases. 1) In the initial phase, evaluation of a series of 22 test and 25 control cases obtained at random during a 2- to 6-week time frame following a traumatic event indicated significant non-adherence of leukocytes (NAL) in 77% of the test group and 20% of the control group in the presence of brain antigen. 2) In a second phase, a larger test population was divided into four groups of different posttraumatic intervals. This study measured NAL in the presence of normal heart or normal brain antigen. Assays revealed an initial significant NAL in the presence of both antigens; however, after the first week following injury the majority of cases manifested significant NAL only with brain antigen. These values of NAL persisted over a 6- to 8-week period. 3) As a final phase of investigation, analysis of a sequential series of assays in 12 patients over a 90-day period indicated significant NAL in the presence of brain antigen within the first week of injury, this was followed by a drop in NAL in most of the cases. Studies at 7 to 60 days posttrauma demonstrated significant NAL with brain antigen alone, with a subsequent drop by 90 days. These observations are interpreted to represent sensitization of leukocyte subgroups to brain proteins that are immunologically recognized following the traumatic event.
Cerebrospinal fluid cytology after subarachnoid hemorrhage
Authors: Ito Umeo , Inaba Yutaka
Published: May 2009

✓ A method is described which has been found capable of detecting subarachnoid hemorrhage (SAH) up to 15 to 17 weeks after its occurrence. The episode of SAH was confirmed by bloody and/or xanthochromic cerebrospinal fluid (CSF) at the time of SAH onset. In this study, 47 samples of lumbar CSF from diagnostically confirmed SAH patients were used. The CSF cells were collected onto slides and stained with May-Gruenwald-Giemsa or Perl's reagent. Iron-positive cells were detected at 1 week, increased by 4 to 6 weeks to 8.5% of total nucleated cells, and decreased to 1% by 15 to 17 weeks. All 27 samples obtained at 2 to 9 weeks after SAH showed iron-positive cells. No iron-positive cells (false-negative samples) were noted in 25% (one of four) of samples obtained during the first week, and in 33% (one of three) of samples obtained 10 to 12 weeks and 15 to 17 weeks after SAH. Of the total samples (37) obtained within 17 weeks after SAH, 8.1% (three of 37) were false negative. No iron-positive cells were detected in samples obtained later than 21 weeks after the SAH episode (10 samples).
Cervical myelopathy caused by developmental stenosis of the spinal canal
Authors: Epstein Joseph A. , Carras Robert , Hyman Roger A. , Costa Sergio
Published: May 2009

✓ The authors present six patients with myelopathy caused by developmental stenosis of the cervical spine. Hyperextension injuries precipitated the onset of symptoms in two patients, aged 19 and 20 years. In four, 41 to 69 years of age, symptoms were gradual in onset, progressing to severe disability. X-ray films revealed narrowing of the dorsoventral diameter of the spinal canal to as little as 1.0 cm. The myelograms showed widening of the cord in the transverse plane strongly suggestive of an intramedullary tumor. A unique finding was maldevelopment with flattening of the neural arch often hidden by the posterior portions of the articular facets when seen in the lateral views. These patients showed no significant evidence of spondylosis, arthrosis, or any of the structural stigmata usually observed in cervical spondylotic myelopathy. When indicated, decompressive laminectomy is the treatment of choice.
Total removal of a parasagittal meningioma of the posterior third of the sagittal sinus and its repair by autogenous vein graft
Authors: Hakuba Akira , Huh Choon Woong , Tsujikawa Satoshi , Nishimura Shuro
Published: May 2009

✓ Total removal is reported of a parasagittal meningioma that invaded the lateral wall and lateral recess of the posterior third of the superior sagittal sinus. The operation was performed by using a silicone rubber non-collapsible tube with an inflatable balloon cuff at each end for the bypass of the sinus blood, and entailed repair of the defect in the sinus wall by a saphenous vein graft. The clinical results and angiographic findings are presented.
Myelocystocele with cerebellar heterotopia
Authors: Suneson Anders , Kalimo Hannu
Published: May 2009

✓ The authors describe a case with well differentiated cerebellar tissue contained in a hydromyelic dilation of the spinal cord, that is, myelocystocele, in connection with a cervicothoracic meningocele. The embryology is discussed.
Atypical fibrous histiocytoma of the thoracic spine
Authors: Guarnaschelli John J. , Wehry Susan M. , Serratoni Frank T. , Dzenitis Andrievs J.
Published: May 2009

✓ A 14-year-old boy presented with mid-thoracic pain, leg weakness, and bladder dysfunction. Plain x-ray films and bone scan were normal whereas myelography demonstrated an extradural mass extending from T-2 to T-5. Exploration revealed a large tumor adherent to dura and bone. Pathological verification of an atypical fibrous histiocytoma prompted the report of this rare tumor of the vertebral column.
Counter-pressure microfork for intracranial vascular anastomosis
Authors: Heifetz Milton D.
Published: May 2009

✓ A technique is described using a counter-pressure device in suturing for superficial temporal-middle cerebral artery anastomoses.
Intraspinal tumors in children
Authors: DeSousa Alonso L. , Kalsbeck John E. , Mealey John , Campbell Robert L. , Hockey Arthur
Published: May 2009

✓ The authors have presented 81 children with intraspinal tumors, all less than 16 years of age. The clinical features indicated that gait disturbance, pain, and sphincter disturbance are the most prominent complaints. Reflex changes, paralysis, and sensory impairment are the most frequent physical findings. Cerebrospinal fluid protein was recorded in 47 patients and was abnormal in 34. Spine radiography was abnormal in 58% of the patients. Seventy of the patients had myelography, and it was diagnostic in 67. Surgery was performed on 79 patients, with a 2.5% operative mortality (30 days postsurgery). Of the 49 patients who are alive, 91.5% are able to walk. Mean follow-up period was 8.5 years.

The authors document the benign course of the intramedullary astrocytomas and suggest an approach to their treatment. They encourage an aggressive approach to metastatic intraspinal tumors. The iatrogenic origin of some epidermoid tumors is noted. The importance of early diagnosis and treatment of the intraspinal tumors in children is emphasized.
Localization in somatic sensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation
Authors: Woolsey Clinton N. , Erickson Theodore C. , Gilson Warren E.
Published: May 2009

✓ This paper reports and illustrates in figurine style results obtained by electrical stimulation of the cortex in 20 patients and by recording of cortical evoked potentials (EP's) in 13 of these patients, whose surgery required wide exposure of the Rolandic or paracentral regions of the cortex. This study is unique in that cutaneous receptive fields related to specific cortical sites were defined by mechanical stimulation, as is done in animals, in contrast to electrical stimulation of peripheral nerves at fixed sites, as in scalp EP recordings. Observations were made on pre- and postcentral gyri, on the second somatic sensory-motor area, on the supplementary motor area, and on the supplementary sensory area. In two patients with phantom limb pain, the pain was elicited in one on stimulation of the postcentral arm area, and in the other on stimulation of the supplementary sensory leg area. Surgical removal of these areas had the immediate effect of abolishing the phantoms and the pain. Long-term follow-up review was not possible. In one patient with severe Parkinson's disease, stimulating currents subthreshold for the elicitation of movement resulted in disappearance of tremor and rigidity for short periods after stimulation of the precentral gyrus. The possible patterns of organization of the human pre- and postcentral areas are considered and compared with those of the chimpanzee and other primates. In patients in whom data from pre- and postcentral gyri were adequate, it appeared that the precentral face-arm boundary is situated 1 to 2 cm higher than the corresponding postcentral boundary.
Morphological changes associated with chronic cerebellar stimulation in the human
Authors: Robertson Lee T. , Dow Robert S. , Cooper Irving S. , Levy Laurence F.
Published: May 2009

✓ The histopathology associated with chronic cerebellar stimulation is described for three human cerebellum and brain-stem specimens obtained at autopsy. The specimens were from three severely epileptic patients who received cerebellar stimulation at 10 Hz for 6½ to 15 months. The electrode arrays were completely encapsulated with loose connective tissue that included a proliferation of capillaries, an infiltration of lymphocytes, and an occasional macrophage. The capsule of one of the specimens was tightly adherent to the underlying cerebellar cortex, which may have been caused by some trauma during the surgical placement of the electrodes. Severe injury of the cerebellar cortex was generally confined to between 1 and 2 mm directly beneath the electrode array, and included thinning of the molecular layer, and loss of most Purkinje cells, interneurons, and associated fibers. Abnormal Purkinje cell dendritic patterns and loss of climbing fibers were evident 3 to 4 mm from the cortical surface. At a depth of 5 to 6 mm, there was no distinction from the nonstimulated areas. However, in all specimens the most severe changes, including a complete loss of the neuropil, were evident at the caudal border of the electrode array underlying the connecting wires. A calculation of the amount of severe and very severe neuronal damage for two specimens revealed that 1.2% and 3.1% of the total cortical surface was injured by this neuroprosthesis. Neuropathological changes were also evident in the dentate nucleus and the brain stem. Areas of the dentate nucleus that were close to regions of very severe cortical damage showed marked degenerative changes. Retrograde degeneration was evident primarily within the caudal portion of the medial accessory olivary nucleus.
Anterior cervical discectomy and interbody fusion
Authors: Shima Toshio , Keller Jeffrey T. , Alvira Mariano M. , Mayfield Frank H. , Dunsker Stewart B.
Published: May 2009

✓ This study evaluates the histological and histochemical changes and osteogenicity of Synthos (tricalcium phosphate ceramic) implanted in the cervical intervertebral space. The cervical vertebrae from C-3 to C-6 were exposed in 20 dogs, and discectomy was performed at the third and fifth spaces. A dowel of Synthos was inserted into the third space, and a piece of fresh autologous graft from the humerus was inserted into the fifth space. The animals were divided into five groups with four animals in each. Four animals were sacrificed at each of 3, 6, 12, 18, and 22 weeks after the procedure. The C-3 to C-6 vertebrae were removed en bloc. One-half of each specimen was processed for histological examination of bone development, while the other half was processed for the two-color fluorescent labeling technique of Suzuki and Matthews for determination of osteogenesis at the time of operation and sacrifice. Various degrees of compression of the Synthos dowel were noted, with anterior and/or posterior displacement of the implant in 70% of the cases. Results indicate that the Synthos implant was biochemically and biomechanically unacceptable for the purposes of this investigation.
Effect of impounder contact area on experimental spinal cord injury
Authors: Gerber Arthur M. , Corrie W. Stephen
Published: May 2009

✓ The spinal cords of two groups of dogs were subjected to 500 gm-cm impacts using two different configurations of impounders. The impounders varied only in area of contact with the dural surface. All other parameters were kept constant. With one impounder all of the dogs injured were totally paraplegic. The impounder consistently producing total paraplegia straddled the entire width of the dorsal surface of the spinal cord in a manner corresponding to the posterior arch of a vertebra. The injury produced with this impounder is not only consistently reproducible but bears a closer resemblance to clinical injury such as anterior vertebral dislocation than that produced with a smaller impounder.
Iatrogenic carotid-cavernous fistula following Fogarty catheter thromboendarterectomy
Authors: Eggers Frank , Lukin Robert , Chambers A. Alan , Tomsick Thomas A. , Sawaya Raymond
Published: May 2009

✓ A case of iatrogenic carotid-cavernous fistula secondary to a Fogarty catheter thrombectomy is presented. The literature and seven previously reported cases are reviewed.
Detection of cryptic vascular malformations by computerized tomography
Authors: Terao Hideo , Hori Tomokatsu , Matsutani Masao , Okeda Riki
Published: May 2009

✓ Two cases of cryptic vascular malformation that were not demonstrated by cerebral angiography were detected by computerized tomography. One of these patients had a cavernous angioma in the fourth ventricle with recurrent subarachnoid hemorrhages, and the other harbored a small arteriovenous malformation and intracerebral hematoma. The usefulness and limitations of computerized tomography in the identification of cryptic vascular malformations are discussed.
High cervical spinal cord compression by an enterogenous cyst
Authors: Fabinyi Gavin C. A. , Adams Judith E.
Published: May 2009

✓ A case of enterogenous cyst causing compression of the spinal cord at C-1 is presented. The clinical course and radiological and histological findings are discussed.
Iliac crest fracture after removal of two bone plugs for anterior cervical fusion
Authors: Reale Fabio , Gambacorta Domenico , Mencattini Giorgio
Published: May 2009

✓ A case is reported in which the iliac crest fractured following removal of two bone plugs. The plugs had been removed for use in a double cervical vertebral body fusion operation by the method of Cloward.
Cerebellar ganglioglioma
Authors: Mørk Sverre J. , Berg-Jensen Martin , Haugen Åge
Published: May 2009

✓ This report presents clinicopathological documentation of a nerve-cell tumor in the right cerebellar hemisphere in a young woman. The nomenclature and some other aspects of tumors containing neuronal cells are discussed.
Abnormal origin of the posterior inferior cerebellar artery
Authors: Fankhauser Heinz , Kamano Shuji , Hanamura Tetsu , Amano Kazuyoshi , Hatanaka Hiroshi
Published: May 2009

✓ Posterior inferior cerebellar arteries originating from the vertebral arteries between the axis and the atlas were demonstrated angiographically in a 12-year-old boy. The patient presented with tetraparesis of sudden onset after a gymnastic exercise. There was no recognizable trauma.
Synergism between BCNU and irradiation in the treatment of anaplastic gliomas
Authors: Steinbok Paul , Mahaley M. Stephen , U Raymond , Zinn Douglas C. , Lipper Stan , Mahaley Jane L. , Bigner Darell D.
Published: May 2009

✓ The therapeutic effects of irradiation, BCNU, or combined irradiation and BCNU were studied in the avian sarcoma virus (ASV)-induced glioma model in rats. Whole-head orthovoltage radiation therapy was given in six equal fractions over 2 weeks, and BCNU was administered intraperitoneally as a single dose of 10 mg/kg. Two series of experiments were performed in order to duplicate the results. In Series 1, the median survival times of the experimental groups, in days after randomization, were as follows: control group (no treatment), 69; group receiving 2000 rads, 84 (p < 0.05); group receiving BCNU, 80.5 (p < 0.1); and group receiving 2000 rads + BCNU, 112 (p < 0.001). In Series 2, the median survival times were: control group, 73.5; group receiving 2300 rads, 85 (p < 0.01); group receiving BCNU, 92.5 (p < 0.025); and group receiving 2300 rads + BCNU, 123.5 (p < 0.001). In both series, combined therapy was significantly better than either radiation or BCNU alone. This is the first time that a synergistic effect of BCNU and irradiation has been reported in an in vivo brain-tumor model and supports the clinical use of this combination in the treatment of malignant gliomas.
Experimental delayed radiation necrosis of the brain
Authors: Martins Albert N. , Severance Ralph E. , Henry James M. , Doyle Thomas F.
Published: May 2009

✓ The authors have designed an experiment to detect a hitherto unrecognized interaction between high doses of the glucocorticoid, dexamethasone, and brain irradiation. Eighteen juvenile male rhesus monkeys received 1800 rads to the whole brain in 8.5 minutes. For 1½ days before and 10½ days after the irradiation, nine animals received approximately 2.9 mg/kg/day of dexamethasone intramuscularly in addition to irradiation, while the remaining nine animals served as the control group and received saline. All animals eventually developed a progressive neurological syndrome, and died of delayed radiation necrosis of the brain. The two groups were compared with regard to latency to onset of clinical signs, survival time, and number, distribution, and location of lesions of radionecrosis. Large doses of dexamethasone did not alter the susceptibility of the primate brain to delayed radiation necrosis. Detailed morphological study of the radionecrotic lesions supports the hypothesis that most, if not all, of the lesions develop as the consequence of injury to blood vessels.
Malignant pineal region tumors
Authors: Neuwelt Edward A. , Glasberg Mark , Frenkel Eugene , Clark W. Kemp
Published: May 2009

✓ Eight patients with primary malignant pineal tumors have been seen at this institution over the past 6 years; six of them underwent definitive surgical exploration. Complete gross microsurgical excision of well encapsulated tumors was possible in four of these patients. In two cases of pineal germinomas, a biopsy and a subtotal resection were carried out because of the known radiosensitivity of this tumor. These six surgical patients all received postoperative craniospinal radiation and continue to do well up to 6 years postoperatively. Two nonoperative patients were initially treated at other institutions by ventriculoperitoneal shunt and radiation and were the only ones to develop metastatic disease. One patient had metastasis of her pineoblastoma to her unirradiated spinal canal and the other patient had metastasis of his germinoma to the peritoneum. The former patient was quadriplegic on admission, although her pineal tumor was no longer visible on computerized tomography (CT), and she died of pneumonia. The latter patient's tumor secreted the beta chain of human chorionic gonadotropin (HCG). This patient's massive metastatic tumor burden completely regressed as determined by body CT scan and HCG levels after four courses of chemotherapy with bleomycin, vinblastine, and cis-platinum. In 20 patients with lesions of the pineal region, craniotomy was associated with only one death (a patient with metastatic adenocarcinoma). Thus, microsurgery for pineal tumors provides either a reasonably safe potential for complete tumor extirpation and possible cure, or a tissue diagnosis which is necessary for appropriate therapeutic planning for radiotherapy and/or chemotherapy. The traditional therapeutic approach of empiric radiotherapy without a tissue diagnosis for pineal lesions may no longer be warranted.
Results of microsurgical management of intracranial aneurysms
Authors: Nornes Helge , Wikeby Per
Published: May 2009

✓ This paper presents the results of a total of 468 aneurysm operations performed on a consecutive series of 463 patients in an 8-year period, using microsurgical techniques. About two-thirds of the patients were operated on within the first 2 weeks after hemorrhage. The postoperative mortality was 4.5%. A good result was obtained in 74.5% of cases, and a fair result in 11.8%, whereas 9.2% were permanently disabled. Hypothermia was used in 142 operations, and 326 were carried out under induced hypotension. Immediate and late results of surgery are discussed with reference to selection of patients, timing of surgery, and the anesthetic and operative procedures.
Microvascular embolization of cerebral arteriovenous malformations
Authors: Mullan Sean , Kawanaga Henry , Patronas Nicholas J.
Published: May 2009

✓ A useful variation of an established technique is described for embolization of cerebral arteriovenous malformations. Silastic sponge emboli that fit into No. 16, 17, and 18 stub adapters are passed through standard-sized transfemoral catheters. Of 28 treated patients, obliteration was regarded as very successful in 16. Partial success was achieved in four. Eight were regarded as failures because the reticulum was too large for these microemboli.
Subclavian steal syndrome
Authors: Bohmfalk George L. , Story Jim L. , Brown Willis E. , Marlin Arthur E.
Published: May 2009

✓ Intraoperative vertebral artery blood flow was measured in two patients with symptomatic subclavian steal syndrome, before and after proximal end-to-side vertebral to common carotid artery transposition. This confirmed retrograde flow in the vertebral artery before transposition, and antegrade flow after transposition. The measured flow rates were compared to values in other series involving different operative procedures for correction of symptomatic subclavian steal. The greatest mean antegrade flow rates in the vertebral artery were restored by proximal end-to-side vertebral to common carotid artery transposition.
Endothelial lesions after temporary clipping
Authors: Richling Bernd , Griesmayr Gottfried , Lametschwandtner Alois , Scheiblbrandner Wolfgang
Published: May 2009

✓ The effect of temporary clipping on the arterial endothelium of rats was examined with scanning electron microscopy. The opening pressure of four Heifetz clips was modified by changing the springs. Four different clip forces (20, 35, 45, and 65 gm), four periods of clipping (10, 30, 60, and 180 minutes), and three vessel diameters (smaller than 1 mm, 1.1 to 1.3 mm, and 1.4 to 2 mm) were compared. Different grades of endothelial damage were observed. On gross examination the damage involved a detachment of endothelium and the adherence of platelets to the subendothelial tissue. The duration of clipping seemed to be of more importance than the clip force, whereas the vessel diameter had no recognizable influence.
Minimum vascular occlusive force
Authors: Dujovny Manuel , Wakenhut Norman , Kossovsky Nir , Gomes Carl W. , Laha Ranjit K. , Leff Louis , Nelson Debra
Published: May 2009

✓ A mathematical analysis of the minimum occlusion force necessary to occlude small vessels based on the parametric influence of blood pressure, vessel diameter, clamp width, and vessel shape after clamping was performed. The results were confirmed by in vivo experimentation with 60 rat aortas (of 1.8 to 2.4 mm caliber) using a variable-force clamp gauge developed in our laboratory. Experimental and theoretical results differed by only 3 gm. Scanning electron microscopy revealed that the initial changes in the endothelium occurred in smaller radii of curvature. Increased pressure resulted in gross morphological changes across the vessel. The minimum occlusion force (as determined by the variable-force clamp gauge) produced only minimal endothelial damage.
Acute intracranial hypertension and auditory brain-stem responses
Authors: Nagao Seigo , Roccaforte Peter , Moody Robert A.
Published: May 2009

✓ Changes in auditory brain-stem responses (BER's) and somatosensory evoked responses (SER's) were investigated to correlate mass volume, intracranial pressure, and neurological dysfunction in mass-induced intracranial hypertension in cats. As the intracranial pressure was raised by expansion of a supratentorial balloon, the late components of the SER's were suppressed first, followed by the early components of the SER's, then Wave V and Wave IV of the BER's, in that order. This suggests that the nonspecific reticular projections are most vulnerable to compression ischemia, and the specific somatosensory pathways are the next most vulnerable. Neural activity of the auditory pathways in the upper brain stem was also gradually suppressed, but less so than that of the somatosensory pathways. After complete transtentorial herniation, in spite of immediate mass evacuation, the function of the somatosensory pathways was greatly impaired, often irreversibly. The neural activity of the auditory pathways in the upper brain stem revealed progressive recovery during a 3-hour period. The measurements of BER Wave V is thought to be useful in predicting transtentorial herniation.
Congenital anastomosis between the vertebral artery and internal carotid artery in the neck
Authors: Parkinson Dwight , Reddy Venkatesha , Ross R. T.
Published: May 2009

✓ A rare case of anastomosis between the vertebral artery and the internal carotid artery in the neck of a patient with an anterior communicating artery aneurysm is reported.
Treatment of intraoperative middle cerebral artery occlusion with pentobarbital and extracranial-intracranial bypass
Authors: Lawner Pablo M. , Simeone Frederick A.
Published: May 2009

✓ A patient with a meningioma of the medial sphenoid wing underwent inadvertent intraoperative occlusion of the middle cerebral artery. Neurological deficit and infarction were presumably prevented by immediate administration of pentobarbital followed by extracranial-intracranial bypass.
Posterior fossa xanthogranuloma
Authors: Vaquero Jesús , Leunda Guillermo , Cabezudo José M. , de Juan Manuel , Herrero José , Bravo Gonzalo
Published: May 2009

✓ A large subdural xanthogranuloma was removed from the posterior fossa of a 53-year-old woman with symptoms of Hand-Schüller-Christian disease. Two additional masses with similar density on computerized tomography were found in the hypothalamus and in the choroid plexus of the right lateral ventricle.
Direct surgical treatment of giant intracranial aneurysms
Authors: Hosobuchi Yoshio
Published: May 2009

✓ The author has operated on 40 patients with giant intracranial aneurysms, using various surgical approaches. Giant aneurysms predominated in females (3:1) and were most common in the age group 30 to 60 years. Patients presented with subarachnoid hemorrhage (17), visual disturbance (18), chronic headache (14), transient or progressive hemispheric deficit (6), seizure (2), dementia (2), and cerebrospinal fluid rhinorrhea (1). Giant aneurysms were located at the carotid artery (25), the basovertebral artery (8), the anterior communicating artery (5), and the middle cerebral artery (2). Eight of 40 patients had one or more other aneurysms and/or associated arteriovenous malformations. Aneurysms were treated with intramural thrombosis (21), neck occlusion (7), trapping (10), proximal parent artery ligation (1), and aneurysmorrhaphy (1). After as much as 8 years of follow-up, 32 patients (80%) showed complete or marked improvement in signs and symptoms; two patients (5%) had a poor recovery. There were six surgical mortalities (15%).

Giant aneurysms can be treated with respectable results if the surgeon selects the technique best suited to the particular aneurysm. In general, neck occlusion, trapping, and aneurysmorrhaphy are best for giant aneurysms of the anterior circulation, and intramural thrombosis is best for those of the posterior circulation. Extra- and intracranial vascular anastomotic techniques are also of value. For success, a flexible approach is essential.
Hyperemic and ischemic problems of surgical treatment of arteriovenous malformations
Authors: Mullan Sean , Brown Frederick D. , Patronas Nicholas J.
Published: May 2009

✓ Three patients with arteriovenous malformations are described who showed signs of massive hyperemia in the vascular territory of the normal brain proximal to arterial ligation. One additional patient had evidence of ischemia of the brain in the territory distal to ligation (steal), and in another both mechanisms were considered as operative hazards.
Possible role of the erythrocyte in causing prolonged cerebral vasospasm
Authors: Ozaki Nobuyuki , Mullan Sean
Published: May 2009

✓ Contractile activity of the various fractions of fresh and incubated blood was studied in vitro using the isolated canine basilar artery. Of the various fractions of fresh blood, significant contraction was induced by serum, but moderate contraction was induced by platelet-rich plasma and lysed red cells, while intact red cells and platelet-poor plasma had no significant activity. The contractions induced by serum and platelet-rich plasma were blocked by phenoxybenzamine, while those induced by lysed red cells were not. Whereas serum and platelet-rich plasma lost their contractile activity after 24 hours of incubation, lysed red cells retained activity up to 7 days after incubation. Biochemical analysis of the hemolysate by means of Sephadex column chromatography revealed that the contractile substance(s) possessed a molecular weight above 5000. These results suggest the possibility that the above substance(s) may play a role in prolonged cerebral vasospasm.
Dynamics of cerebral edema
Authors: Aarabi Bizhan , Long Donlin M.
Published: May 2009

✓ Brain edema was produced in cats by a standardized cortical freezing lesion. With a careful microsurgical technique, the injured cortex was removed as a single piece, either immediately after induction or at 2, 4, or 8 hours after lesion production. The injured brain was either discarded or replaced in its bed. Brain edema and the defect in the blood-brain barrier were assessed by determining percent dry weight, increase in volume of white matter, and spread of Evans' blue by planimetry. The results indicate that 1) if the lesion is removed immediately after production, formation of the expected vasogenic brain edema is completely abolished; 2) replacement of the frozen brain is unable to induce significant increase in permeability of the surrounding blood-brain barrier or a significant amount of brain edema; and 3) if the lesion is removed at 2, 4, or 8 hours with or without replacement, advancement of the edema front and increase in the amount of edema is stopped. It appears that an intact vascular bed is necessary for the extracellular fluid component of brain edema, and that no edemagenic factors exist within the injured brain in this model that influence either the production or propagation of the increased extracellular fluid volume.
Communicating hydrocephalus as a cause of aqueductal stenosis
Authors: Nugent G. Robert , Al-Mefty Ossama , Chou Sam
Published: May 2009

✓ Eleven cases of presumed aqueductal stenosis with onset of symptoms after the first decade were reviewed. Ten patients had complete occlusion and one a high-grade stenosis. In 10, the dilated lateral ventricles caused a marked inferior displacement of the third ventricle. Postshunting diagnostic studies on six of these patients revealed ascent of the third ventricle, and in three of these the aqueduct was shown to be patent. It appears that in some cases of advanced communicating hydrocephalus the descending third ventricle kinks or pinches shut the aqueduct, adding an obstructive component which accelerates the clinical picture. The mechanism and clinical features of this process are discussed.
Experimental acute balloon compression of the spinal cord
Authors: Kobrine Arthur I. , Evans Delbert E. , Rizzoli Hugo V.
Published: May 2009

✓ Acute balloon compression of the thoracic spinal cord for 15, 7, 5, 3, and 1 minute in monkeys caused immediate disappearance of the spinal evoked response and complete focal ischemia of the compressed segment in all animals. Only the animals in the 1-minute group, however, demonstrated return of the evoked response. These data, coupled with data from previous experiments of slow balloon compression of the spinal cord and spinal cord ischemia, suggest that the major pathological substrate for neural dysfunction after balloon compression of the spinal cord, be it acute or slow, is physical injury of the neural membrane, irrespective of blood flow changes. These findings also suggest that the ability of that membrane to recover is related to rapidity and length of time of compression. Focal changes in blood flow do not appear to be significant in this mechanism.
Acute intracranial hypertension and auditory brain-stem responses
Authors: Nagao Seigo , Roccaforte Peter , Moody Robert A.
Published: May 2009

✓ Movement of the upper brain stem (inferior colliculus) was correlated with the alterations in the amplitude of wave V of the auditory brain-stem responses (BER's) during supratentorial brain compression in cats. In vivo observation of the brain stem and postmortem inspection show that suppression of the amplitude of BER wave V reflects the extent of caudal displacement of the inferior colliculus. Marked suppression of the amplitude of BER wave V (approximately 30% of control) correlates with the beginning of transtentorial herniation, and complete suppression of the wave V indicates complete transtentorial herniation of the brain-stem and supratentorial structures. The BER wave V is thought to be a sensitive index of caudal movement of the upper brain stem due to transtentorial herniation.
Posttraumatic vertigo
Authors: Jacobs George B. , Lehrer Joel F. , Rubin Robert C. , Hubbard John H. , Nalebuff Donald J. , Wille Rosanne L.
Published: May 2009

✓ Posttraumatic vertigo may be an accompanying symptom associated with concussion and with the post-concussion state. It is possible, however, that these symptoms are related to perilymphatic fistulas and are not the direct result of cerebral concussion. Although many fistulae heal spontaneously, patients with persistent vertigo and fluctuating hearing loss following head trauma may have associated defects in the perilymphatic channels with fistulas in the region of the oval or round windows. This paper presents results of surgical repair in three patients with fistulas. Surgical intervention becomes much more urgent when sensory neural hearing loss has occurred acutely or has developed during the course of illness.