bluuebunny/crossref_metadata_2025 huggingface dataset:
Intervertebral Disc Infection after Lumbar Chemonucleolysis: Report of a Case
Authors: Zeiger Evan H. , Zampella Edward J.
Published: May 2010

Intervertebral disc space infection can be a serious and disabling complication of any procedure that affords entry for bacteria into the susceptible disc space. Most disc space infections occur after cervical or lumbar laminectomies. Discitis has been reported after myelography, lumbar puncture, paravertebral injection, and obstetrical epidural anesthesia. A case of septic discitis occurring after intradiscal therapy with chymopapain is presented. Patients who return for evaluation of recurrent spinal pain after chemonucleolysis, especially those with paravertebral muscle spasm, should be evaluated for the possibility of disc space infection by obtaining an erythrocyte sedimentation rate, peripheral white count, differential cell count, and plain roentgenograms. Radionuclide bone scans, although not specific, may provide further objective evidence leading to the diagnosis of an intervertebral disc space infection.
Magnetic Resonance Imaging in the Evaluation of Low Attenuation Lesions on Computed Tomography
Authors: Bucci Michael N. , Black Keith L. , Venes Joan L. , Latack Joseph T.
Published: May 2010

Computed tomography has proven invaluable in the assessment of intracranial mass lesions. Low attenuation lesions can, however, present diagnostic difficulties. We report three cases where magnetic resonance imaging was beneficial in clarifying solid versus cystic intracranial lesions.
Bilateral Upper Extremity Paralysis (Bell's Cruciate Paralysis) from a Gunshot Wound to the Cervicomedullary Junction
Authors: Marano Stephen R. , Calica Arnold B. , Sonntag Volker K. H.
Published: May 2010

Cruciate paralysis is characterized by midline involvement of the rostral portion of the pyramidal decussation, resulting in paralysis of the upper extremity without lower extremity involvement. The neuroanatomical basis is the more rostral and medial decussation of the upper extremity motor fibers in the medulla compared with the more caudal and lateral decussating fibers of the lower extremity at the lower boundary of the cervicomedullary junction. We believe this to be the first reported case of Bell's cruciate paralysis caused by a gunshot wound to this region. The neuroanatomical basis and the mechanisms that produce this unique clinical entity are discussed.
Transoral Unilateral Facetectomy in the Management of Unilateral Anterior Rotatory Atlantoaxial Fracture/Dislocation: A Case Report
Authors: Schmidek Henry H. , Smith Donald A. , Sofferman Robert A. , Gomes Francisco B.
Published: May 2010

An unusual case of unilateral anterior rotatory atlantoaxial fracture/dislocation with neurological deficit is presented. The injury could not be reduced by skeletal traction, but was successfully reduced by partial facetectomy at C-1, C-2 accomplished through a transoral exposure of the atlantoaxial region combined with labiomandibularglossotomy. To the best of our knowledge, this is the first instance of an injury of this type to be so managed. The details of the operative procedure are described, and the subject of rotatory atlantoaxial dislocation is reviewed.
Postradiation Sarcoma Involving the Spine
Authors: Sundaresan Narayan , Huvos Andrew G. , Krol George , Hughes James E. O. , Cahan William G.
Published: May 2010

Postradiation sarcomas arising many years after treatment of cancer are long term sequelae of therapy. We describe the clinical features, radiographic findings, and results of treatment in 13 patients with such sarcomas encountered over a 6-year period. Of these patients, 9 had bone sarcomas and the remaining 4 had paraspinal tumors arising from adjacent soft tissue and nerve. The primary cancer for which radiation was given included Hodgkin's disease (4 patients), breast cancer (2 patients), cervix cancer (2 patients), and a variety of others (5 patients). The latent interval to the occurrence of the second neoplasm varied from 6 to 30 years (median, 10 years) after treatment of the original tumor. Despite aggressive treatment, the overall prognosis was poor. The median survival was 8 months, with only 3 surviving more than 2 years. Although rare, postradiation sarcoma should be considered in the differential diagnosis of patients presenting with late onset of spinal pain or neurological symptoms after clinical remission of an original cancer.
Administration of Intraspinal Morphine Sulfate for the Treatment of Intractable Cancer Pain
Authors: Shetter Andrew G. , Hadley Mark N. , Wilkinson Elizabeth
Published: May 2010

A total of 24 patients with intractable cancer pain were evaluated as candidates for spinal morphine therapy. Temporary trials were carried out with bolus injections of preservative-free morphine sulfate via percutaneously inserted epidural catheters. Fourteen patients felt that pain relief was sufficient to warrant long term morphine application, and permanent drug delivery systems were implanted. These consisted of an Ommaya reservoir and an epidural spinal catheter in 6 patients and an Infusaid pump with either an epidural or subarachnoid spinal catheter in 8 patients. Pain relief with these systems was felt to be excellent in 7 patients, good in 4 patients, and fair in 3 patients. There was a statistically significant reduction in supplemental narcotic use between the pre- and postoperative periods (P < 0.001). Median survival after operation was 3.0 months (mean, 5.0 months), with a range of 1 to 23 months. Tolerance was seen in all patients regardless of the mode of drug delivery, but it occurred more quickly with bolus injections than with continuous infusion (statistically significant difference, P < 0.05). A persistent cerebrospinal fluid fistula developed in 1 patient; this required wound revision. No other serious complications or episodes of respiratory depression occurred. We conclude that intraspinal morphine sulfate is a beneficial treatment option for cancer patients in whom pain has become debilitating and unresponsive to oral or parenteral narcotic regimes.
Hyperglycemia-induced Hemichoreoathetosis: The Presenting Manifestation of a Vascular Malformation of the Lenticular Nucleus
Authors: Vincent Frederick M.
Published: May 2010

A 72-year-old diabetic woman developed paroxysmal hemichoreoathetosis during an episode of nonketotic hyperglycemia. The movement disorder abated as the blood glucose normalized. A computed tomographic scan revealed a vascular malformation involving the lenticular nucleus on the side contralateral to the dyskinesia. Hyperglycemia has rarely been reported to cause episodic dyskinesias, but there have been no prior reports of patients with striatal vascular abnormalities in whom hyperglycemia seemingly caused a transient movement disorder.
Successful Combination Chemotherapy (Cisplatinum, Vinblastine, and Bleomycin) against Peritoneal Dissemination of Intracranial Germ Cell Tumor
Authors: Kumura Eiji , Arita Norio , Hayakawa Toru , Ushio Yukitaka , Nakata Hiroyuki , Murasawa Akira , Mogami Heitaro , Ikezoe Junpei , Minami Yuzo
Published: May 2010

We found combination chemotherapy with cisplatinum, vinblastine, and bleomycin (PVB therapy) effective in the treatment of a patient with a pineal germ cell tumor with peritoneal dissemination. The metastatic complication may have been attributable to the ventriculoperitoneal shunt tube. After the first course of PVB therapy, the disseminated tumors were decreased in size; no residual tumors were detected after the third course by laparoscopic examination, computed tomographic scanning, or echogram. Our results suggest that combined PVB therapy is effective in the treatment of extraneural metastasis from intracranial germ cell tumors. (18:802-804, 1986)
Delayed Epidural Hemorrhage in Hypotensive Multiple Trauma Patients
Authors: Bucci Michael N. , Phillips Timothy W. , McGillicuddy John E.
Published: May 2010

Despite the availability of high resolution computed tomography, severely head-injured patients often present diagnostic dilemmas. An initially negative computed tomographic scan in the presence of severe multiple trauma does not predict an uncomplicated course. Early repeat scanning should be considered. We present three cases of delayed epidural hemorrhage in multiple trauma patients who initially were hypotensive secondary to hypovolemia. Possible etiologies for the hemorrhage as well as a list of indications for repeat scanning in the posttraumatic period are discussed.
Subdural Electrodes for Seizure Focus Localization
Authors: Rosenbaum Thomas J. , Laxer Kenneth D. , Vessely Michael , Smith W. Brewster
Published: May 2010

Fifty patients with medically refractory partial seizure disorders have undergone subdural electrode placement for seizure focus localization. Standard scalp telemetry recordings of ictal events had failed to demonstrate accurately the site of seizure onset, and these patients were considered candidates for telemetry with intracerebral depth electrodes. Excellent recordings of interictal and ictal events were obtained, and localization of the epileptogenic focus was derived from recordings made during spontaneously occurring seizures. Electrocorticograms were monitored for up to 21 days. The recordings enabled a surgical decision to be made in 43 of 50 cases (86%). Thirty patients have subsequently undergone cortical excision of their foci with good results. Subdural electrode recordings are a significant addition to the armamentarium of the neurosurgeon attempting to localize surgical seizure foci, offering a low morbidity procedure as an alternative to depth electrode implantation.
Charcot's Spine with Neurological Deficit: Computed Tomography as an Aid to Treatment
Authors: Raynor Richard B.
Published: May 2010

A patient with Charcot's disease of the lumbar spine presented with weakness of one extremity. Myelographic and x-ray film studies indicated stenosis and compression due to degenerative changes. Although decompression and fusion were considered, computed tomographic scans indicated the wide extent and location of the destructive changes. Nonoperative treatment was elected because of the high risk of fusion failure and instability.
Glioblastoma Occurring after Radiation Therapy for Meningioma: Case Report and Review of Literature
Authors: Zuccarello Mario , Sawaya Raymond , deCourten-Myers Gabrielle
Published: May 2010

A 32-year-old man developed an intracranial glioblastoma multiforme 10 years after irradiation for an incompletely resected convexity meningioma. The association of these two tumors is exceedingly rare. Therefore, we propose that this is a case of radiation-induced glioma and review the evidence supporting this view.
Brain Abscess Due to Haemophilus aphrophilus: Possible Canine Transmission
Authors: Abla Adnan A. , Maroon Joseph C. , Slifkin Malcolm
Published: May 2010

A 58-year-old patient developed progressive right hemiparesis and a hemisensory loss. Computed tomography demonstrated a lesion in the left frontoparietal region with ring enhancement. A craniotomy was performed and an abscess was removed, which on culture grew Haemophilus aphrophilus. The same organism was isolated from the patient's poodle dog but not from three other poodles of family members. This, along with previous reports, suggests that the poodle may be a vector in the transmission of this organism, which rarely may cause a brain abscess.
Subarachnoid Hemorrhage in the Presence of a Cerebral Arteriovenous Malformation and an Intraventricular Oligodendroglioma: Case Report
Authors: Martinez-Lage Juan F. , Poza Máximo , Esteban Juan A. , Sola Joaquin
Published: May 2010

The authors report a case of a ventricular oligodendroglioma associated with a cortical arteriovenous malformation. The patient presented with subarachnoid hemorrhage. Computed tomographic scan showed an intraventricular hyperdense lesion, mimicking a hematoma. Angiography revealed a superficial arteriovenous malformation in the right parietal lobe, unrelated to ventricular cavities. Both lesions were treated during the same operation. The diagnostic difficulties and the significance of this uncommon association are discussed.
Posterolateral Approach and Anterior Spinal Canal Recalibration in Severe Spinal Injury Affecting T-12, L-1: A Study of Seven Cases
Authors: Richaud Jacques , Boetto Sergio , Lazorthes Yves
Published: May 2010

The authors present seven cases of spinal trauma at the T-12-L-1 level with severe spinal canal stenosis secondary to compressive, anterior discocorporeal lesions. Associated neurological disorders were of varying severity. Six cases were investigated by computed tomography, which enabled the degree of thoracolumbar spinal canal stenosis to be determined. In all cases, the surgical procedure involved rectification of spinal deformity, with an initial unilateral posterolateral approach permitting anterior spinal canal recalibration, either by impaction of protrusive fragments or ablation of ejected disc fragments. The stabilization was in all cases achieved by complimentary bilateral plates using Roy-Camille material, associated with posterolateral arthrodesis by grafting with reconstruction of the articulopedicular structure. The functional spinal result was excellent in all cases, and recalibration was verified by tomography. In those cases showing neurological deficiency, good and early recovery was attributable to the suppression of spinal canal stenosis. The application of this posterolateral approach for severe lesions of the thoracolumbar junction seems to represent, in all cases of recent lesions, an alternative to the anterior or combined methods, which present widely recognized difficulties at the thoracoabdominal junction.
Coincidental Pituitary Adenoma and Parasellar Meningioma: Case Report
Authors: Yamada Kenji , Hatayama Takashi , Ohta Masahiro , Sakoda Katsuaki , Uozumi Tohru
Published: May 2010

We report a patient who had pituitary adenoma and parasellar meningioma coincidentally, with neither irradiation nor a history of head injury. Preoperative computed tomographic (CT) scan had shown a large intrasellar mass with ringlike enhancement; in contact with this mass, another well-enhanced mass had been shown. Histopathologically, the intrasellar mass was diagnosed as chromophobic pituitary adenoma and the other mass as meningotheliomatous meningioma. We present clinical, radiological, and histopathological findings and discuss previously reported cases of coincidental pituitary adenoma and meningioma without irradiation. This is the first case report since the advent of CT that pituitary adenoma and parasellar meningioma in contact with each other could be clearly demonstrated by CT.
Postoperative Oculomotor Palsy Due to Vasospasm in a Patient with a Ruptured Internal Carotid Artery Aneurysm: A Case Report
Authors: Kudo Tadashi
Published: May 2010

Postoperative oculomotor palsy is not uncommon in patients with aneurysm, but delayed postoperative peripheral oculomotor palsy due to vasospasm has not been reported. This paper presents such a patient. Oculomotor palsy was successfully treated with volume therapy. The importance of recognizing this entity and initiating appropriate treatment for vasospasm as soon as possible in order to prevent permanent deficit is emphasized.
Chronic Subperiosteal Hematoma of the Skull in an Adult: A Case Report
Authors: Palatinsky Emanuel , Liccardo Giovanni , Di Lorenzo Nicola
Published: May 2010

A unique case of chronic subperiosteal hematoma of the skull in an adult is reported. The possible pathogenetic mechanisms involved in the slowly progressive enlargement of the lesion are discussed.
Neurogenic Pulmonary Edema Associated with Ruptured Intracranial Aneurysm: Case Report
Authors: Yabumoto Michio , Kuriyama Tsuyoshi , Iwamoto Munehisa , Kinoshita Tatsuyuki
Published: May 2010

A case of ruptured distal anterior cerebral artery aneurysm associated with neurogenic pulmonary edema is presented. It is suggested that this association should not be accepted as a “taboo” for radical intervention followed by a proper management of ventilation with positive end-expiratory pressure to maintain the anesthetic condition. Cardiorespiratory control is essential in cases of pulmonary edema with ruptured aneurysm. Decompression and evacuation of blood clot surrounding the hypothalamus could subdue the hyperadrenosympathetic discharge that may cause neurogenic pulmonary edema.
Anterior Approach and Osteosynthesis for Recent Fractures of the Pedicles of the Axis
Authors: Lesoin F. , Pellerin P. , Villette L. , Jomin M.
Published: May 2010

The authors report their experiences using the anterior approach and osteosynthesis for recent fractures of the pedicles of the axis in eight patients. They describe the transcervical transclival approach and osteosynthesis and discuss the advantages of and indications for this approach. (Neurosurgery 19:374-377, 1986)
Further Experience Utilizing the Gildenberg Technique for Computed Tomography-guided Stereotactic Biopsies
Authors: Bullard Dennis E. , Osborne Dennis , Burger Peter C. , Nashold Blaine S.
Published: May 2010

Initial experience using the Gildenberg technique for computed tomography-guided stereotactic biopsies is reviewed. Of 50 patients, adequate tissue was obtained in 49. In one patient, the stereotactic frame was unable to reach the selected biopsy site. In 32 of 49 patients, the diagnosis was obtained with one biopsy: in the remainder, two to five samples were required. In 4 cases, a subsequent craniotomy was performed: these provided similar histopathological tissue and in no case was the diagnosis altered. The lesions were categorized by CT as ring-enhancing lesions (REL), enhancing lesions with surrounding low density (ELLD), and low density lesions with and without peripheral areas of enhancement. Of the REL, 21 of 23 were primary tumors. Of the ELLD, 5 of 13 were primary tumors: the remainder had a wide spectrum of disease. Of the low density lesions without enhancement, 6 were primary tumors and 1 was an inflammatory process. Three patients had low density lesions with peripheral areas of enhancement and proved to have malignant primary tumors. The remaining patients had multiple lesions with both primary and metastatic disease. Twelve RELs were biopsied in multiple sites. An accurate diagnosis was best obtained by performing the first biopsy in the enhancing rim with additional biopsies as needed in the low density center. Homogeneous lesions could be biospied with target selection based upon a primary regard for safety rather than imaging characteristics. Three patients had transiently increased hemiparesis and one had a transient decrease in level of consciousness after biopsy. There were no patients with long-term morbidity in this series. From our experience, we believe this technique offers a safe, accurate, and relatively inexpensive alternative for performing-CT-guided intracranial biopsies.
Lumbar Synovial or Ganglion Cysts
Authors: Kjerulf Terrell D. , Terry Daniel W. , Boubelik Richard J.
Published: May 2010

Most reports regarding synovial cysts of the spinal canal have been presentations identifying an unusual pathological entity that is to be included in the differential diagnosis of cauda equina compression syndromes. Most of the 26 cases reported represent isolated examples of this pathological process. We present five cases of lumbar synovial cysts encountered in our practice in the past 8 years. Patients with lumbar synovial cysts do not demonstrate any predictable clinical picture. They may present with a unilateral sciatica or neurogenic claudication. Lumbar extension is usually restricted, whereas flexion is full. Mechanical signs of nerve root entrapment or lumbosacral plexus irritation are unimpressive. Neurological deficits are usually mild, if present. Radiological findings include degenerative spondylosis, spondylolisthesis, and a rounded posterolateral extradural mass of low attenuation value adjacent to a facet shown on computed tomographic scan. The etiology of lumbar synovial cysts is not known. Histological findings of myxoid degeneration, microcystic change, calcification, and hemosiderin deposits suggest that chronic microtrauma with occasional focal hemorrhage may play a major role in the etiology of the cysts. With resection of the cyst, the postoperative course is usually uneventful. Recurrences have not yet been encountered in our patients.
Congenital Supratentorial and Infratentorial Peripheral Neurogenic Tumor: A Clinical, Ultrastructural, and Immunohistochemical Study
Authors: Moss David S. , Haines Stephen J. , Leonard Arnold S. , Dehner Louis P.
Published: May 2010

Congenital neoplasms of the central nervous system are extremely rare, although they have been well documented since the earliest reports from the mid-19th century. Medulloblastoma, other primitive neuroectodermal tumors, and various types of gliomas have comprised the majority of cases. This report describes a highly unusual infratentorial and supratentorial tumor presenting as a scalp mass in a neonate who experienced in utero distress. The supratentorial mass extended through a defect in the skull to the parietooccipital lobe, and the infratentorial aspect involved the 9th and 10th cranial nerves in the region of the cerebellopontine angle. A complex spindle cell neoplasm incorporating peripheral nerve sheath and vascular characteristics was further characterized by electron microscopy and immunohistochemistry. Based upon these studies, the tumor was interpreted as a congenital schwannoma with divergent vascular differentiation. The child has been tumor-free for approximately 2 years after the initial operative procedure.
Late Intracranial Metastasis from Esthesioneuroblastoma: Case Report and Review of the Literature
Authors: Rodas Raul A. , Erkman-Balis Bayzar , Cahill David W.
Published: May 2010

Review of the literature reveals much disparity regarding the incidence, natural history, and survival rate in patients harboring esthesioneuroblastoma (olfactory neuroblastoma). The metastatic tendencies of this tumor have been highly variable in the literature. and reported intracranial involvement has been via local extension from the tumor's origin near the cribiform plate. Our present case describes a metastasis of esthesioneuroblastoma to the right parietal cortex and meninges in a patient without evidence of local recurrence after combined surgical and radiation therapy 5 years previously. The broad spectrum of biological behavior of this tumor, and its response to various therapies are discussed. The immunohistochemical and ultrastructural features of this unusual tumor are also presented. Recommendations are made for the management of these patients, including regular serial neurological examinations, serial computed axial tomography or magnetic resonance imaging of the head and neck, and, in the initial management, chemotherapy.
Fusiform Basilar Artery Aneurysm in a 33-Month-Old Child
Authors: Little John R. , Larkins Mark V. , LÜders Hans , Hahn Joseph F. , Erenberg Gerald
Published: May 2010

A 33-month-old girl presented with acute subarachnoid hemorrhage from a ruptured multilobulated fusiform aneurysm of the midbasilar artery. This rare lesion was treated surgically by occluding the basilar artery. Intraoperative brain stem auditory evoked potential and somatosensory evoked potential monitoring results did not change with basilar artery occlusion, suggesting that the occlusion would be tolerated. However, the amplitudes of brain stem auditory evoked potential Waves III-V to right ear stimulation were transiently reduced during left pontine retraction during the aneurysm exposure. The patient made a complete clinical recovery.
Models of Spinal Cord Injury: Part 2
Authors: Harvey Kushner , Ronald S. Markowitz , Alan Mechanic , Perry Black
Published: May 2010

A mathematical model was constructed to predict motor performance in rats for 8 weeks after spinal cord injury. The model is based on experimental data generated from an investigation of the static-load technique of inducing cord injury and was derived using multiple linear regression. The regression coefficients for weight of the injury-producing load were statistically significant (P < 0.001), and it was found that the weight of the load contributes over 95% of the posttrauma motor deficit, whereas the time duration of the load resting on the cord contributes less than 5% to the deficit. Sex, pretrauma motor performance, and pretrauma body weight are insignificant covariates. The model may be used to establish expected motor deficits and to derive dose-response curves.
Reactive Gliosis Simulating Butterfly Glioma: A Neuroradiological Case Study
Authors: Craig Cazenave , Steven Reid , Chat Virapongse , Stephen Hunter
Published: May 2010

Reactive gliosis was found in a 40-year-old man who presented with intractable seizures thought to be due to a malignant neoplasm. Although two separate lesions located bilaterally in the frontal lobes were evident on the computed tomographic scan, a connection between these lesions along the fibers of the corpus callosum was clearly demonstrated on T2-weighted magnetic resonance images. The unusual radiological appearance of this gliosis, which simulated a malignant butterfly glioma on magnetic resonance imaging (MRI), is reported. Because MRI is still a new modality, its images should be interpreted with judicious caution.
Case-Control Study of Clinical Outcome after Aneurysmal Subarachnoid Hemorrhage
Authors: Brott Thomas , Mandybur Thaddeus I.
Published: May 2010

The clinical and neuropathological features of 84 nonsurvivors of aneurysmal subarachnoid hemorrhage (consecutive autopsy series) were compared with those of 51 survivors (consecutive clinical series). The groups differed significantly in the type of bleeding: 58% of the nonsurvivors had massive subarachnoid hemorrhage (MSAH) compared to 10% of the survivors (P < 0.00001); 54% of the nonsurvivors had intraventricular hemorrhage (IVH) compared to 29% of the survivors (P < 0.008); 45% of the nonsurvivors had intracerebral hematoma (ICH) compared to 8% of the survivors (P < 0.00001). Only 1 of the 19 patients with both MSAH and ICH survived. The incidence of cerebral infarction was similar in nonsurvivors (31%) and survivors (29%). In the absence of associated MSAH, IVH, or ICH, cerebral infarction was uncommon (11%). Documented in-hospital rebleeding was uncommon in nonsurvivors (13%) and survivors (2%). Admission neurological status did not predict outcome independent of the extent of the initial bleeding. Comparison of the two groups suggests that the type and extent of initial bleeding are the most important determinants of mortality in aneurysmal subarachnoid hemorrhage.
Inflammatory Lesions of the Basal Ganglia and Thalamus: Review of Twenty-one Cases
Authors: Bhatia Ravi , Tandon Prakash , Misra Nalini Kant
Published: May 2010

We report a series of 21 patients with basal ganglia and thalamic granulomas or abscesses treated over 7 years. Among them, 15 were tubercular, 5 were pyogenic, and 1 was fungal. Pyogenic abscesses, usually hematogenous, also occurred secondary to osteomyelitis of the skull and chronic otitis media. The fungal abscess developed in a nonimmunocompromised patient with no intercurrent malignancy. Evidence of tuberculosis elsewhere in the body was detected in only 7 patients with tuberculomas. The computed tomographic (CT) image morphology characterizing an abscess or a tuberculoma was present in all except 2 patients with tuberculomas. The fungal abscess resembled a malignant glioma. The only hospital mortality occurred in a deeply unconscious patient with a thalamic pyogenic abscess. A 12-month or longer follow-up in 16 patients showed that 3 continued to be handicapped neurologically, and 2 died 13 and 16 months later, respectively. We conclude that inflammatory lesions at these sites are not uncommon and that CT scans are diagnostic in the great majority. Doubtful diagnosis merits stereotactic aspiration or biopsy of the lesion. Satisfactory results follow adequate medical therapy.
Superficial Temporal Artery to Proximal Middle Cerebral Artery Anastomosis: Clinical and Angiographic Long Term Results
Authors: Collice Massimo , Arena Orazio , Fontana Romero A.
Published: May 2010

Anastomosis of the superficial temporal artery (STA) with a proximal segment of the middle cerebral artery (MCA) has been proposed as a new cerebral revascularization technique alternative to the conventional bypass on the cortical surface. We introduced this procedure in our surgical practice in 1982 for patients with internal carotid artery (ICA) aneurysms not suitable for direct repair in whom occlusion of the ICA is considered necessary. One patient died because a conventional STA-MCA bypass did not prevent a major stroke caused by a therapeutic ICA occlusion. We are reporting our surgical technique and the immediate and long term clinical and angiographic results in five cases operated on during the period June 19, 1982, through January 19, 1983. The early and late patency rates were good. No neurological complications were observed after the bypass procedure or during a 3-year follow-up period. In our opinion, the use of proximal segments of the MCA as recipient arteries for supratentorial revascularization is a good alternative to the use of cortical surface arteries and, in selected cases, could be the first choice technique.
Subarachnoid Hemorrhage with Normal Cerebral Angiography: A Prospective Study on Sellar Abnormalities and Pituitary Function
Authors: Bjerre Per , Henrik VidebÆk , JÖrgen Lindholm
Published: May 2010

Ten consecutive patients with subarachnoid hemorrhage (SAH) of unknown cause were examined for sellar abnormalities and pituitary dysfunction. The diagnosis of SAH rested on a typical history and the demonstration of blood in the cerebrospinal fluid (computed tomography (CT), lumbar puncture). Initial CT and four-vessel angiography were performed in all patients, and five had repeat angiography. Endocrinological assessment was done after the initial angiography, and abnormal findings from this first study were reassessed 3 months later. The follow-up study included a high resolution CT scan of the sellar region. One patient had panhypopituitarism. Insufficient growth hormone secretion alone or combined with a low plasma concentration of estradiol or testosterone was found in another seven patients. The sella was ballooned or enlarged in three patients, and four patients had at follow-up a partly empty sella. A spontaneous development of a partly empty sella from an adenoma with suprasellar extension was observed in the patient with panhypopituitarism. This patient had experienced pituitary apoplexy with resulting SAH. Based on sellar enlargement, an empty sella, and pituitary dysfunction, this pathogenesis was suggested in another three patients. Our findings suggest that hemorrhagic necrosis in a pituitary adenoma may be an important cause of SAH with normal angiography.
Interstitial Brachytherapy of Malignant Brain Tumors Using Computed Tomography-guided Stereotaxis and Available Imaging Software: Technical Report
Authors: Coffey Robert J. , Friedman William A.
Published: May 2010

The implantation of radioactive sources into malignant intraaxial brain tumors, interstitial brachytherapy, is a theoretically attractive treatment for these nearly uniformly fatal lesions. Optimal application of this treatment modality requires careful preoperative planning, computer-assisted dosimetry, and computed tomography-guided stereotactic implantation of the isotope-bearing catheters. A method is presented by which available computed tomographic imaging software can be used with a standard radiotherapy treatment planning computer and the Brown-Roberts-Wells stereotactic system for preoperative imaging, dosimetry planning, and brachytherapy catheter insertion. Dedicated computer facilities are not required, making this method available to any neurosurgeon with access to a current generation computed tomographic scanner.
Meningioma Associated with Aneurysm and Subarachnoid Hemorrhage: Case Report and Review of the Literature
Authors: Bloomgarden Gary M. , Byrne Thomas N. , Spencer Dennis D. , Heafner Michael D.
Published: May 2010

A patient presented with spontaneous subarachnoid hemorrhage after a prolonged episode of coughing. A preoperative computed tomographic (CT) scan confirmed subarachnoid hemorrhage, but demonstrated no other lesion. Arteriography revealed an ophthalmic artery aneurysm. Operation revealed the aneurysm to be intracavernous without sign of prior rupture; however, a small hemorrhagic meningioma was removed from the ipsilateral anterior clinoid process. In this case, coincidental meningioma and aneurysm presented as a subarachnoid hemorrhage secondary to tumor hemorrhage. The follow-up of cases of subarachnoid hemorrhage with negative arteriography with sequential CT scans is discussed.
Cerebrospinal Fluid Fistula Involving the Sphenoid Sinus
Authors: Christie Martin
Published: May 2010

A case of posttraumatic delayed cerebrospinal fluid fistula from the middle cranial fossa to a lateral extension of the sphenoid sinus is reported. The advantages in demonstrating this unusual set of circumstances by computerized tomography are discussed.
Benign Osteoblastoma of the Clivus Removed by a Transoral Approach: Case Report
Authors: Di Lorenzo Nicola , Palatinsky Emanuel , Bardella Lia , Maleci Alberto
Published: May 2010

A case of benign osteoblastoma of the lower clivus is reported. The clinical and radiological features and the surgical rationale for the transoral approach are briefly discussed.
Hemodynamic Method to Predict Whether Hunterian Ligation of the Basilar Artery Will Lead to Thrombosis of Basilar Bifurcation Aneurysms
Authors: Chang Jack , Roach Margot R.
Published: May 2010

In some cases, basilar artery aneurysms cannot be repaired surgically and the basilar artery is occluded near the neck of the aneurysm to stop flow into the aneurysm. After the operation, the aneurysm can fill only by flow through the posterior communicating arteries (PCoAs). Hemodynamically, if the flow were the same in both PCoAs and there were no phase lag in the pressures, there would be no pressure gradient for flow to go across the neck of the aneurysm and therefore the aneurysm would thrombose. We have assumed that the diameter of the artery is roughly proportional to the flow that goes through it chronically. We measured the diameters of the PCoAs in 25 patients who had hunterian ligation of the basilar artery. We also measured the maximal width, height, and depth of the aneurysms on angiograms obtained before and after operation. Eleven aneurysms thrombosed completely and had a diameter ratio of > 0.6; 10 aneurysms thrombosed partially and had a diameter ratio of 0.46 ˜ 1.0; 4 aneurysms did not change and had a diameter ratio of <0.45. The ratio of the sizes of the PCoAs pre- and postoperatively was comparable in most cases, so we believe that it is possible to predict reasonably accurately from this simple measurement whether the aneurysm is likely to thrombose if the basilar artery is ligated.
New Kneeling Attachment and Cushioned Face Rest for Spinal Surgery
Authors: Ray Charles D.
Published: May 2010

Surgical frames, kneeling attachments, and special operating tables for lumbar spinal surgery are designed to promote good positioning, lower the intraabdominal pressure, and reduce epidural bleeding. The frame reported here fulfills these objectives and produces either lumbar spinal extension to reduce paraspinal muscle tension or mild flexion to distract the neural arches. The new frame unit is made of lightweight fiberglass and aluminum, weighing only 14 lb (6.5 kg), and utilizes the hydraulic elevator pump of the operating table as a means to raise or lower the frame. Thus, adjusting the horizontal plane of the lumbar spine requires no separate crank system. The anterior tibial cushions, lying in hemicylindrical troughs, and the ergonomically designed cushions for chest and buttocks improve the distribution of body weight. A new, fully adjustable, cushioned face rest is used to maintain the neck in a neutral position, with the patient placed fully face-down.
Autogeneic Skull Bone Grafts to Reconstruct Large or Complex Skull Defects in Children and Adolescents
Authors: Edwards Michael S. B. , Ousterhout Douglas K.
Published: May 2010

Autogeneic split or free skull bone grafts harvested at the time of operation were used to repair large or complex skull defects in 19 children; in 2 children, autogeneic fresh rib grafts were also used. Follow-up examinations for periods of 1 and 7 years showed that the use of autogeneic grafts is superior to the use of materials such as acrylic or metals for cranioplasty in children.
Direct Delivery of Medication into a Brain Tumor through Multiple Chronically Implanted Catheters
Authors: Bouvier Guy , Penn Richard D. , Kroin Jeffrey S. , Beique Rene , Guerard Marie Jose
Published: May 2010

A recurrent malignant glioma was treated with cisplatin delivered directly into the tumor. The drug was delivered via 68 small catheters distributed evenly throughout the tumor area. Each catheter was connected to an osmotic minipump that delivered 0.5 ml of drug solution each hour for 10 days. There were no side effects from the catheter implantation, chemotherapy, or catheter removal. Although the chemotherapy halted progression of the tumor, it recurred, and the patient died 6 months after treatment.
Diagnostic Value of Computed Tomography in Recurrent Pain after Discectomy
Authors: Schell Gerald R. , Modesti Luciano M. , Cacayorin Edwin D.
Published: May 2010

Intravenously enhanced computed tomography (CT) was used in patients in whom the differential diagnosis between recurrent herniated disc and postoperative scar was considered. Enhanced CT images demonstrated postoperative herniated discs more accurately than clinical criteria, myelography, or plain or postmetrizamide CT. The scar tissue shows contrast enhancement, but recurrent disc herniation does not. Therefore, contrast-enhanced CT is considered to be a valuable aid in distinguishing between recurrent disc herniation and hypertropic scar formation.
Successful Removal of Air Gun Bullets from the Third Ventricle
Authors: Kojima Tadashi , Waga Shiro , Kubo Yoshichika , Shimizu Takeo
Published: May 2010

A patient with air gun bullets in the 3rd ventricle associated with delayed ventricular hemorrhage is presented. Through an anterior transcallosal approach, the surgeon successfully removed the bullets without any significant permanent sequelae.
Acute Brain Swelling during Evacuation of Subdural Hematoma Caused by Delayed Contralateral Extradural Hematoma: Report of Two Cases
Authors: Meguro Kotoo , Kobayashi Eiki , Maki Yutaka
Published: May 2010

Two patients experienced severe brain swelling during the evacuation of acute subdural hematomas. Postoperative computed tomographic (CT) scans revealed delayed extradural hematomas on the sides opposite the subdural hematomas. Extradural bleeding occurred in the area of the fractured skull. One patient improved neurologically after evacuation of the extradural hematoma, and the other was not operated because he was moribund. Drilling exploratory burr holes in the fractured area may have been a better strategy than awaiting a postoperative CT scan. The reduction of intracranial pressure after the removal of subdural hematoma was postulated to be the most important factor contributing to the formation of the extradural hematoma.
Factors Affecting Survival of Children with Malignant Gliomas
Authors: Al-Mefty Ossama , Al-Rodhan Nayef R. F. , Phillips Robert L. , El-Senossi Mohammed , Fox John L.
Published: May 2010

Forty-four patients (23 male and 21 female, aged 2 to 20 years (mean, 9.6)), harboring pathologically proven malignant glioma (Grades III and IV) were treated between 1976 and 1985. Tumor sites included the cerebral hemisphere (26 patients), thalamus (6 cases), brain stem (7 cases), and the cerebellum (5 cases). All patients underwent operation and initial treatment with steroids. Irradiation was given in 35 patients; 3 had adjuvant chemotherapy. At the time of study, 22 were deceased. The longest period of follow-up was 65 months. Survival curves were calculated from the date of the first visit to the date of the last evaluation or death. The mean survival times were 30 months for all patients, 14 months for cerebellar cases, 17 months for brain stem cases, 26 months for thalamic cases, and 33 months for cerebral hemisphere cases. However, the differences between mean survival times were not statistically significant. The patient's age was the single most significant factor, with those 5 to 10 years old having the worst survival curve (P= 0.0036). Irradiation was associated with an improved mean survival time (34 vs. 19 months); however, this was not statistically significant (P= 0.15). Girls had shorter mean survival times than boys (16.5 vs. 37 months, P= 0.0511). Otherwise, there was no clinical or radiological factor that indicated a better prognosis. This was also confirmed by x2analyses comparing 72 factors between patients with more than 24 months of survival and those with less than 24 months of survival. In particular, tumor size (greater or less than 5 cm), the presence of neurological deficits, the level of consciousness, increased intracranial pressure, hydrocephalus, calcium or cyst on a computed tomographic scan, and histological grading (III or IV) showed no significant correlations.
Stereotactic Resection of Juvenile Pilocytic Astrocytomas of the Thalamus and Basal Ganglia
Authors: McGirr Stephen J. , Kelly Patrick J. , Scheithauer Bernd W.
Published: May 2010

Six patients with juvenile pilocytic astrocytomas of the thalamus or basal ganglia underwent seven computer-assisted stereotactic laser craniotomies with complete or nearly complete removal of the tumor in all cases. The tumor was located in the right basal ganglia in one patient, the left basal ganglia in one patient, and the left thalamus in four patients. Postoperative assessment of the completeness of tumor removal was confirmed by contrast-enhanced computed tomographic scanning within the first 2 weeks after operation. None of the patients was neurologically worse after the procedure, and five were improved. The duration of follow-up ranged from 6 months to 3.5 years. In this group of patients, the computer-assisted, stereotactically guided resection of these deeply located, benign tumors was accomplished with no morbidity or mortality.
Transcallosal Parafornicial Approach for Third Ventricle Tumors: Neuropsychological Consequences
Authors: Petrucci Ralph J. , Buchheit William A. , Woodruff Guy C. , Karian John M. , DeFilipp Gary J.
Published: May 2010

Five adult patients with 3rd ventricle tumors underwent a transcallosal intraventricular parafornicial approach. Pre- and postoperative cognitive reviews were conducted on all patients. Each review consisted of: (a) a standardized neuropsychological battery, (b) mental status reviews, (c) specific tests for disconnection, and (d) a personality variable, where possible. Computed tomography and magnetic resonance imaging are also presented. The three patients with colloid cysts and the two with oligodendrogliomas showed no significant postoperative cognitive deficits compared to the preoperative review. These additional subtle neuropsychometric measures, along with the methodological advantage of preoperative review, support a parafornicial approach where indicated to preserve cognitive abilities.
Malignant Meningioma within the Third Ventricle: A Case Report
Authors: Strenger Scott W. , Huang Yun Peng , Sachdev Ved P.
Published: May 2010

A case of a malignant meningioma within the 3rd ventricle is presented. Although malignant transformation of meningiomas has been described, occurrence within the ventricular system is extremely rare.
Intracarotid Chemotherapy with 1,3-Bis-(2-chloroethyl)-1-nitrosourea (BCNU) in 5% Dextrose in Water in the Treatment of Malignant Glioma
Authors: Johnson David W. , Parkinson David , Wolpert Samuel M. , Kasdon David L. , Kwan Eddie S. K. , Laucella Michael , Anderson Mary L.
Published: May 2010

After radiotherapy, 20 patients, 18 with documented progression of malignant glioma and 2 with Grade II astrocytoma, received a total of 52 courses of intracarotid 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) at a dose of 150 mg/m2 dissolved in 5% dextrose in water. The patients were treated at 6-week intervals for a maximum of five courses of chemotherapy per patient. Response to treatment was analyzed on computed tomographic scans by measuring the volume of the enhancing tumor and any central low density. From these data, tumor doubling times ranging from 110 to 968 days were obtained. An 11 to 60% reduction in enhancing tumor volume was noted in 8 patients, 2 of whom had a greater than 50% decrease in tumor volume. One patient had no change in tumor volume 110 weeks after the initiation of BCNU chemotherapy. Four patients had tumor in more than one vascular territory; tumor growth was arrested in the perfused territory, but continued in the nonperfused area. In 1 of the 4 patients, tumor also grew along a shunt catheter tract and spread over the surface of the ipsilateral hemisphere. One patient developed clinically asymptomatic leukoencephalopathy after five courses of BCNU. Two patients had postradiation leukoencephalopathy before BCNU treatment. Seventeen patients had peritumoral low density with mass effect after BCNU; thus, the true incidence of BCNU-related leukoencephalopathy could not be determined. All patients experienced transient unilateral orbital pain during the infusion and scleral erythema that lasted for several hours afterward. Loss of vision was noted in 2 patients, although it seemed to be related to the therapy in only 1 patient. In our group of patients, there was no significant myelosuppression or indication of other systemic toxicity.
Thoracic Spondylosis: An Unusual Cause of Myelopathy
Authors: Smith Douglas E. , Godersky John C.
Published: May 2010

Narrowing or stenosis of the spinal canal may result in myelopathy, radiculopathy, and neurogenic claudication. Degenerative changes, or spondylosis, are the most common causes of these symptoms throughout the spinal axis, but these changes are encountered least frequently in the thoracic region. The pathological changes consisting of laminar, articular process, and ligamentum flavum hypertrophy, with a variable degree of disc degeneration, are the same in the thoracic spine as the changes found in the lumbar and cervical regions. We present seven patients with symptomatic thoracic spondylosis evaluated over the past 4 years. Spinal computed tomography readily defined the abnormality. A predilection for the T10-T-12 levels is evident. The prognosis for at least partial recovery is good, even in those with long-standing disease and severely impaired function. The previous literature concerning this unusual cause of thoracic compression is reviewed, and the differential diagnostic possibilities are discussed.
Multiple Intraparenchymal Brain Plasmacytomas with Spontaneous Intratumoral Hemorrhage
Authors: Husain Muhammad M. , Metzer Steven W. , Binet Eugene F.
Published: May 2010

The case of a patient with two intraparenchymal brain plasmacytomas without cranial or dural attachment and with intratumoral hemorrhage is presented. Computed tomographic (CT) findings are described. Autopsy revealed two discrete intraparenchymal plasmacytomas with intratumoral hemorrhage, one cerebral and one cerebellar. There have been few case reports of brain plasmacytoma without cranial or dural attachment, and this case of multiple such intracranial, intraparenchymal plasmacytomas with hemorrhage is certainly unique. Intratumoral hemorrhage with intracranial plasmacytoma is extraordinarily rare. The literature of intracranial involvement with myeloma and plasmacytoma and the CT appearance of intracranial plasmacytoma are surveyed.