bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathways for orofacial pain sensation in the trigeminal brain-stem nuclear complex of the Macaque monkey
Authors: Young Ronald F. , Ferryman Kent M.
Published: May 2009

✓ Eleven Macaque monkeys underwent a variety of lesions in the trigeminal afferent system; namely, tractotomy, rhizotomy, and radiofrequency destruction of various components of the bulbospinal trigeminal nuclear complex. Behavioral responses were evaluated before and after the lesions using a quantitative paradigm which measured lever-pressing in response to electrical stimulation of the dental pulp or facial skin, and by assessing adversive responses to facial cutaneous and intraoral pin-scratch.

Thresholds for lever-pressing in response to cutaneous facial stimulation were elevated by tractotomy, elevated further by a combination of tractotomy and rhizotomy of the seventh, ninth, and 10th cranial nerves and cervical dorsal roots C1–3, and maximally elevated by complete radiofrequency destruction of the trigeminal nucleus caudalis. These lesions also abolished adversive responses to cutaneous facial pin-scratch. None of these lesion combinations, however, altered lever-pressing responses to dental pulp stimulation. Radiofrequency destruction of the trigeminal nuclei principalis, oralis, and interpolaris caused elevations of lever-pressing thresholds in response to dental pulp stimulation, and also smaller but statistically significant elevations on cutaneous electrical stimulation. Mild reductions in adversive responses to cutaneous pin-scratch were also produced by these rostral nuclear lesions, suggesting analgesia.

The experiments suggest that primary afferent fibers for dental pain perception travel only in the trigeminal nerve and that these fibers relay via the trigeminal brain-stem nuclei principalis, oralis, and interpolaris. Primary afferent fibers for cutaneous facial pain perception travel in the trigeminal, facial, glossopharyngeal, and vagus nerves, and the upper cervical dorsal and ventral roots, and these afferents relay mainly in the trigeminal nucleus caudalis.
Politics and health: an emerging technology
Authors: Rosenzweig Robert M.
Published: May 2009

✓ A political scientist examines the worlds of advanced medicine and the modern research university. Both elements are affected by the growth in the role of government. Central government had sharply limited powers early in this century, but by the middle third their powers were enlarged, particularly in the spheres of the economy and social welfare. The last third of the century will reveal what the governed want of the government. The scientific and technological aspects of World War II plunged the universities into the limelight as the main producers of vital knowledge and as objects of national policy. This power of knowledge expanded from national security to public health and welfare. Governmental patronage fostered basic medical research and revolution in biology. With advanced research there marched advanced training. America's leading research universities became stronger and flourished for a few decades, to be confronted suddenly by a shift in government priorities. Governmental fiscal support has dwindled while governmental regulation has increased.

The medical profession passed from an early position of opposing the role of government to a position in which it paid inadequate attention to the adverse consequences of the systems that were adopted. Physicians who practice in a variety of settings have a variety of interests which account for the division within the profession. In a political setting it is advantageous and more important to have a clear view of central common interests. The speaker's advice to his colleagues in education is applicable to medicine, to act now in a manner to serve as a model for a vision of a “plausible future.” The measure of success in the future depends upon the ability to preserve those values, practices, and habits of mind that account for our value to society. The primacy of scholarly judgments over political judgments is not always easy to achieve in dealings with governments.
Surgical management of suprasellar meningioma
Authors: Symon Lindsay , Rosenstein Jacob
Published: May 2009

✓ A consecutive series of 101 cases of suprasellar meningioma has been reviewed. Most of the patients were between 40 and 60 years of age, and women predominated in all age groups. Visual impairment was the most common admitting complaint and visual field defect the most common finding. Symmetrical visual field defects were noted in 22 cases, while the remaining 79 cases had either asymmetrical binocular involvement or only monocular defects. All patients underwent craniotomy with the operating microscope being used in 33 cases. Mortality and partial resection rates were lower and overall outcome was better in patients with tumors 3 cm or less in size and a duration of symptoms of 2 years or less. Use of the operating microscope also appeared to lower the mortality rate and improve the overall outcome; however, no effect on postoperative visual improvement was noted.
Etoposide-induced blood-brain barrier disruption
Authors: Spigelman Melvin K. , Zappulla Rosario A. , Johnson James , Goldsmith Stanley J. , Malis Leonard I. , Holland James F.
Published: May 2009

✓ The intracarotid infusion of the anti-neoplastic compound, etoposide, has been shown to exert a dose-dependent effect on blood-brain barrier (BBB) permeability. Etoposide, however, is formulated in a complex solvent solution containing alcohol, Tween 80, polyethylene glycol 300, and citric acid. To investigate the contribution of the solvent solution to BBB disruption, the authors studied Sprague-Dawley rats after the internal carotid artery infusion of the solvent solution with and without the addition of etoposide. Experiments were performed at four doses of drug and/or solvent. Disruption of the BBB was evaluated qualitatively by the appearance of the systemically administered dye, Evans blue, in the cerebral hemispheres and quantitatively by the ratio of gamma counts of the technetium-labeled chelate of diethylenetriaminepentaacetic acid (99mTc-DTPA) in the ipsilateral:contralateral hemisphere. Significant barrier opening was obtained in all four groups of animals infused with solvent plus etoposide. In the corresponding groups of rats infused with the solvent solution alone, BBB disruption was markedly lower. Only in the group infused with the largest dose of solvent was the hemispheric ratio of 99mTc-DTPA significantly different from saline-infused animals. Each of the groups with solvent plus etoposide had 99mTc-DTPA ratios significantly different from the control group. Intracarotid infusion and subsequent BBB disruption were well tolerated by the animals receiving either solvent alone or solvent and etoposide. Disruption of the BBB secondary to the intracarotid infusion of etoposide is primarily caused by the drug itself and not by the solvent solution.
A model for predicting delayed intracranial hypertension following severe head injury
Authors: Klauber Melville R. , Toutant Steven M. , Marshall Lawrence F.
Published: May 2009

✓ A graph is presented for predicting delayed intracranial hypertension (intracranial pressure (ICP) greater than 30 mm Hg) for severely head-injured patients, based on a logistic regression model. Data gathered during the first 24 hours of patient observation are used to predict patient status during the subsequent 48 hours. The best predictor out of 10 factors analyzed was the peak ICP level during the first 24 hours (p < 0.0001). Other predictors used in the final model were the presence of hypotension (p = 0.045) and abnormal ventricles — defined as ventricles which were either absent, small, or enlarged (p = 0.086). Error rates of 24% and 20% were obtained initially and by means of a separate cross-validation group, respectively. Use of a conservative cut point (25% estimated chance of developing excess ICP) for designating high-risk patients provided a procedure with sensitivity of 86% to 89% for the two groups.
Influence of stimulus location and limb position on motor responses in the comatose patient
Authors: Barolat-Romana Giancarlo , Larson Sanford J.
Published: May 2009

✓ Motor responses to standardized stimuli were evaluated in 18 comatose patients with abnormal motor reactions. Painful stimuli were applied to three areas: the supraorbital, sternal, and medial aspects of the arm. Stimulations were carried out with the upper limbs first flexed and then extended. The initial position of the arm significantly influenced the posturing pattern. With the arm initially flexed there was a significantly higher percentage of abnormal flexor reactions, and the opposite occurred with the arm initially extended. Supraorbital stimulation yielded a significantly higher number of extensor responses. Arm stimulation, instead, caused a higher percentage of abnormal flexor reactions. When painful stimulation was applied to an arm initially flexed, the percentage of extensor responses was extremely low. Conversely, supraorbital stimulation with the arms extended yielded the highest percentage of extensor responses.

The study shows that, within the frame of abnormal motor responses, the same patient can exhibit different reactions according to the site of stimulation and initial position of the upper extremities. These patterns are fairly constant and should be borne in mind in the evaluation of comatose patients.
Human umbilical artery for microvascular grafting
Authors: Yeh Hwa-shain , Keller Jeffrey T. , Brackett Kim A. , Frank Edmund , Tew John M.
Published: May 2009

✓ As microvascular surgery has developed, the necessity for smaller arterial prostheses of less than 2 mm in internal diameter (ID) has increased markedly. Glutaraldehyde-stabilized human umbilical arteries with 1.5 to 2.0 mm ID are smaller than any other graft material currently available. This study was designed to determine whether this graft material has potential clinical application for microanastomosis.

Twenty male albino rats, each weighing 400 to 500 gm, were used in this study. The abdominal aorta was exposed and a 3- to 4-mm segment was resected. A 10-mm interposition graft of glutaraldehyde-stabilized human umbilical artery was implanted by end-to-end anastomosis. The patency of the grafts was determined by repeated operative exploration at intervals of 1 week, and 1, 3, 9, and 12 months. Two grafts were found to be occluded each time at the 1-, 3-, and 9-month explorations. At each exploration time, five rats were sacrificed and histopathological studies conducted. All five remaining grafts were patent at 12 months.

There was no evidence of endothelial proliferation on the luminal surface of the patent grafts as determined by scanning electron microscopy. The luminal surface and underlying region consisted of an amorphous proteinaceous-like material. Significant degeneration of the vessel wall was noted in all grafts surviving over 9 months. Central necrosis surrounded by a chronic inflammatory process that extended to and included the adventitia was observed in the occluded grafts. While the patency demonstrated was good, the tissue changes noted in the walls of the grafts indicate that further study is necessary before this material can be used as a graft in humans.
Increase of β-endorphin levels in cerebrospinal fluid but not in plasma in patients with cerebral infarction
Authors: Furui Tomoo , Satoh Kyoko , Asano Yoshio , Shimosawa Sadashi , Hasuo Michiaki , Yaksh Tony L.
Published: May 2009

✓ β-Endorphin was measured in cerebrospinal fluid (CSF) and plasma in patients with cerebral infarction at acute (4 to 48 hours) and chronic (1 month) stages. Only CSF samples obtained in the acute stage showed β-endorphin values that were statistically higher than those measured in a control population. This finding suggests that infarction at its acute stage gives rise to an increased release of β-endorphin. Such a mechanism is consistent with the possibility that the reported therapeutic effect of naloxone in cerebral ischemic lesions may result in part from the antagonism of the centrally released endorphin, β-endorphin.
Accessory cerebral ventricle of the occipital lobe
Authors: Hori Akira , Bardosi Attila , Tsuboi Koji , Maki Yutaka
Published: May 2009

✓ Small separated accessory ventricles in the occipital lobe were observed in 21.3% of 404 patients, as seen by computerized tomogram. There was no significant preponderance in regard to sex or laterality. The accessory ventricles were clinically not significant. As seen at autopsy, accessory ventricles were found in the subcalcarine white matter, posterior to the occipital horn of the lateral ventricle, in 29.5% of 200 “normal” brains. Again, there were no significant sex and laterality differences. Accessory ventricles were never found in brains of fetuses or newborn babies. The youngest child in whom an accessory ventricle was found was 1 month old. No accessory ventricles were larger than 1 cm in diameter; they were slit-like, triangular or oval in shape. Histologically, they showed subtotal loss of the ependymal layer, subependymal gliosis, and/or fibrosis, and, in some cases, hyalinofibrotic capillary degeneration. Electron microscopy of the remaining ependymal cells in the accessory ventricle showed marked atrophy. Accessory ventricles are formed at the tip of the occipital horn postnatally through the expansion of the deep calcarine fissure, increase in brain volume in the region, and subsequent fusion of the mediolateral ventricular walls.
Brain sarcoma of meningeal origin after cranial irradiation in childhood acute lymphocytic leukemia
Authors: Tiberin Pascal , Maor Esther , Zaizov Rina , Cohen Ian J. , Hirsch Menachem , Yosefovich Tovi , Ronen Jacov , Goldstein Jed
Published: May 2009

✓ The authors report their experience with an unusual case of intracerebral sarcoma of meningeal cell origin in an 8½-year-old girl. This tumor occurred 6½ years after cranial irradiation at relatively low dosage (2200 rads) had been delivered to the head in the course of a multimodality treatment for acute lymphocytic leukemia. The tumor recurred approximately 10 months after the first surgical intervention. Macroscopic total excision of the recurrent growth followed by whole-brain irradiation (4500 rads) failed to eradicate it completely and local recurrence prompted reoperation 18 months later. This complication of treatment in long-term childhood leukemia survivors is briefly discussed, as well as the pathology of meningeal sarcomas.
Solitary primary intracranial extracerebral glioma
Authors: Shuangshoti Samruay , Kasantikul Vira , Suwanwela Nitaya , Suwanwela Charas
Published: May 2009

✓ A case is presented of a solitary primary extracerebral mixed glioma occurring in the right suprasellar and parasellar region of a 49-year-old woman who had bilateral temporal hemianopsia for 3 months. At craniotomy, the well demarcated outline and extracerebral location of the tumor suggested that it was a meningioma. However, its gliomatous nature was confirmed by identification of glial fibrillary acidic protein (GFAP) in the tumor cells. Review of nine reported solitary primary intracranial extracerebral gliomas, including the present case, revealed that they tended to occur in the third to fifth decades of life, in patients with an average age of 42½ years, and without sexual predilection. All were supratentorial with a tendency to be situated in the vicinity of the Sylvian fissure. Only the glioma in the present case was at the cranial base. They were diagnosed as three astrocytomas, two glioblastomas, two oligodendrogliomas, one astroblastoma, and one mixed glioma. A suggestion is made that all these gliomas arose primarily from heterotopic neuroglia in the leptomeninges.
Anterior sacral meningocele with an unusual presentation
Authors: Quigley Matthew R. , Schinco Frank , Brown J.Thomas
Published: May 2009

✓ A case of familial anterior sacral meningocele associated with a dermoid tumor is reported. This patient presented with recurrent aseptic meningitis. The role of computerized tomography following metrizamide myelography in the diagnosis of this lesion is discussed.
A dowel inserter for anterior cervical interbody fusion
Authors: Brandt Lennart , Ljunggren Bengt
Published: May 2009

✓ The authors describe a new instrument for placement of bone dowels in procedures for anterior cervical interbody fusion.
A decade of pituitary microsurgery
Authors: Wilson Charles B.
Published: May 2009

✓ The author reviews his experience with surgical treatment of 1000 pituitary tumors, the majority of which were endocrine-active. The criteria of grading, the microsurgical technique used, and the postoperative results are presented. The mortality rate was 0.2% overall, with no deaths in the group of 774 patients with endocrine-active adenomas.
Enterogenous intraspinal cysts
Authors: Agnoli Agnolo L. , Laun Albrecht , Schönmayr Robert
Published: May 2009

✓ The authors have reviewed the literature and recorded the distinguishing features of intraspinal enterogenous cysts. There are no characteristic clinical findings or history associated with this disease. These congenital space-occupying lesions frequently go undiagnosed, and the patient may be treated for many years as a case of multiple sclerosis. The teratogenic “determination period” is decisive for the development of anomalies affecting one, two, or all three of the germinal layers. All of these cysts belong to the same group, and their structure is an expression of the differing determination periods. The various theories about their etiology are discussed. True intraspinal enterogenous cysts are usually found in the cervical region. After careful operative removal, the prognosis is favorable.
Pain relief from dorsal root entry zone lesions made with argon and carbon dioxide microsurgical lasers
Authors: Powers Stephen K. , Adams John E. , Edwards Michael S. B. , Boggan James E. , Hosobuchi Yoshio
Published: May 2009

✓ Argon and carbon dioxide microsurgical lasers were used to produce lesions in the dorsal root entry zone (DREZ) experimentally in six cats and surgically in 21 patients who had denervation pain syndromes. The technique of producing lesions, the histological and physiological changes seen in the cat spinal cord, and the results of treatment in the clinical series are discussed. Lesions were produced within the DREZ without new involvement of the dorsal column system or corticospinal tract in all but one patient. Based on their subjective evaluation, two-thirds of the patients were relieved of more than 50% of their preoperative pain. These experimental results and clinical experience suggest that the argon and carbon dioxide lasers effectively produce localized microsurgical lesions in the DREZ. The concept that an abnormality involving either neurons in the substantia gelatinosa or internuncial fibers in Lissauer's tract is responsible for pain in patients with primary sensory nerve deafferentation is discussed.
Surgical reconstruction of the proximal vertebral artery
Authors: Diaz Fernando G. , Ausman James I. , de los Reyes Raul A. , Pearce Jeffrey , Shrontz Carl , Pak Hooshang , Turcotte Jean
Published: May 2009

✓ The authors have reviewed their experience in the management of 55 patients admitted to Henry Ford Hospital with symptoms of vertebrobasilar insufficiency and associated proximal vertebral artery stenosis or occlusion. In 48 patients, the symptoms occurred as multiple repeated events, five of which resulted in permanent deficits. The remaining seven patients had single events, four of which caused permanent deficit. These patients had been treated unsuccessfully with antiplatelet agents (37 cases) and with anticoagulant drugs (15 cases) before surgery. Most patients had multiple angiographic abnormalities, including bilateral vertebral stenosis in 19 cases, unilateral vertebral stenosis and contralateral occlusion in 18, unilateral vertebral hypoplasia and contralateral stenosis in 10, subclavian artery stenosis with steal in seven, and bilateral vertebral artery occlusion in one case. Posterior communicating arteries could not be demonstrated angiographically in 18 patients. Thirty-four patients had associated stenotic or occlusive lesions of the internal carotid artery. Forty-eight underwent a vertebral-to-carotid artery transposition. Of these, 18 had an associated carotid endarterectomy and seven had a vertebral artery endarterectomy immediately before the transposition. Two patients had saphenous vein grafts, one from the subclavian and one from the common carotid artery to the vertebral artery. Other surgical procedures included vertebral artery ligation in one case, transposition of the vertebral artery to the thyrocervical trunk in two cases and to the subclavian artery in one case, and endarterectomy of the origin of the vertebral artery in one case. All but two patients had complete resolution of their symptoms: one had persistent dizziness and the other had syncopal episodes. Complications included transient Horner's syndrome (30 cases) which became permanent in four cases, vocal cord paralysis (three cases), elevated hemidiaphragm without respiratory difficulty (two cases), and superficial wound infection (one case). There were no deaths.

Although the presentation of patients with vertebrobasilar insufficiency is generally characteristic, we believe that a specific diagnosis can be established only by angiographic means. Anticoagulants have been used to alleviate symptoms in some cases but are ineffective in solving the primary hemodynamic problem. Surgical reconstruction of the affected area deserves further evaluation in the management of these patients.
Intracranial dissecting aneurysms of the posterior circulation
Authors: Berger Mitchel S. , Wilson Charles B.
Published: May 2009

✓ Dissecting aneurysms of the intracranial posterior circulation are unusual lesions that affect otherwise healthy young adults, are difficult to diagnose and manage, and carry a high morbidity and mortality rate. Headache in the suboccipital-posterior cervical region is the most common presenting symptom. The dissection usually occurs between the intima or internal elastic lamina and the media; subadventitial dissection does occur and accounts for the infrequent finding of subarachnoid hemorrhage. A deficit in the inner layers of the vessel is the proposed source of dissection. The angiographic features are inconsistent, although an irregularly narrowed arterial segment with proximal and/or distal dilatation are typical findings. Depending on the location of the dissection, the surgical options are: ligation, trapping, or reinforcement of exposed abnormal portions of the vessel. Anticoagulation therapy is not indicated in the management of this lesion.
Comparison of various methods for delivering radiolabeled monoclonal antibody to normal rat brain
Authors: Bullard Dennis E. , Bourdon Mario , Bigner Darell D.
Published: May 2009

✓ Different methods were evaluated for delivering iodine-125 monoclonal antibodies (Mab's) to the central nervous system in 40- to 99-gm Fischer rats. By evaluating interhemispheric, interregional, and brain:blood ratios of Mab's, the efficacy of intracarotid (IC) or intravenous (IV) administration of Mab's with and without prior IC perfusion with 0.9% NaCl (normal saline, NS), 1.4 M mannitol, or 1.6 M arabinose, or of femoral artery perfusion with 1.4 M mannitol was evaluated. No difference was seen between IC and IV administration of Mab's with or without prior perfusion. Intracarotid perfusion with hyperosmolar agents was required to disrupt the blood-brain barrier (BBB) and to significantly elevate brain levels of Mab's. The brain and blood levels of Mab's were elevated in all regions of the brain following hyperosmolar BBB disruption. However, the levels were significantly higher in the ipsilateral hemisphere, with cross-over occurring primarily in the vascular distribution of the contralateral anterior cerebral artery. Intracarotid hyperosmolar perfusion produced 450% to 500% increases in ipsilateral and 240% to 280% increases in contralateral hemispheric brain:blood Mab ratio levels compared to those achieved with NS perfusion. For IC perfusion of mannitol or arabinose, flow rates ranging from 0.017 to 0.052 ml/sec were equally effective in disrupting the BBB. Insignificant morbidity and mortality rates were noted up to 2 weeks following BBB disruption. Additional ligation of major extracranial branches of the external and internal carotid arteries prior to IC perfusion did not result in a selective increase in hemispheric Mab levels. Temporally, following hyperosmolar BBB disruption, brain:blood Mab ratios remained elevated bilaterally at 7 days after Mab delivery, with the ipsilateral hemispheric levels remaining significantly elevated compared with the contralateral hemispheric levels until Day 5, when the ratio returned to the nonperfused range. Catheterization was required in the small animals and was performed under magnification in 10 to 20 minutes, with less than an 8% overall morbidity and mortality. The methodology developed should prove helpful in delivery of Mab's or other agents in rat tumor models and experimental models for other disease entities.
Therapeutic trial of hypercarbia and hypocarbia in acute experimental spinal cord injury
Authors: Ford Ronald W. J. , Malm David N.
Published: May 2009

✓ Hypocarbia, normocarbia, or hypercarbia was maintained for an 8-hour period beginning 30 minutes after acute threshold spinal cord injuries in cats. No statistically significant differences in neurological recovery or histologically assessed tissue preservation were found among the three groups of animals 6 weeks after injury. No animal recovered the ability to walk. It is concluded that maintenance of hypercarbia or hypocarbia during the early postinjury period is no more therapeutic than maintenance of normocarbia. Mortality rates and tissue preservation data suggest, however, that postinjury hypocarbia may be less damaging than hypercarbia.
Tic convulsif: results in 11 cases treated with microvascular decompression of the fifth and seventh cranial nerves
Authors: Cook Bruce R. , Jannetta Peter J.
Published: May 2009

✓ The syndrome of tic convulsif consists of ipsilateral concurrent trigeminal neuralgia and hemifacial spasm. Since Cushing's 1920 description of this syndrome in three patients, 37 additional cases have been reported in the world literature. Of the 15 with adequate operative descriptions, 10 had vascular abnormalities and five had tumors. The authors report 11 cases of tic convulsif treated by microvascular decompression of both the fifth and seventh cranial nerves. At operation, 21 of 22 nerves were found to have root entry zone vascular compression. One trigeminal nerve was considered normal. One seventh nerve had a tumor displacing the anterior inferior cerebellar artery into its root entry zone. The average follow-up period in this series was 6 years 2 months (range 1 to 8½ years). Eight patients (73%) were pain-free, two (18%) had frank recurrences, and one (9%) had mild discomfort. Eight patients (73%) were totally free of facial spasm, and two others (18%) had only a trace of residual spasm. These results are comparable to those achieved by treating the individual syndromes with microvascular decompression. Therefore, microvascular decompression of both the fifth and seventh cranial nerves is recommended as the treatment of choice in tic convulsif.
Surgical treatment of glossopharyngeal neuralgia and pain from cancer of the nasopharynx
Authors: Giorgi Cesare , Broggi Giovanni
Published: May 2009

✓ The outcome is summarized for 14 cases operated on for glossopharyngeal neuralgia, with both open and percutaneous rhizotomy techniques, between 1960 and 1984. Four patients, all with primary neuralgia, underwent open surgery. Pain disappeared, leaving only a ninth nerve deficit in all but one patient; in that patient, paroxysms of pain recurred after 3 years, mediated by the nervus intermedius. Five other patients with idiopathic neuralgia and five patients with pain secondary to carcinoma underwent percutaneous procedures. Seven patients who had retrogasserian percutaneous rhizotomy for associated trigeminal neuralgia were also pain-free. No mortality or morbidity resulted from either type of procedure.
Occipital neuralgia and the C1–2 arthrosis syndrome
Authors: Ehni George , Benner Benjamin
Published: May 2009

✓ Occipital neuralgia syndromes have been ascribed to a great many pathological alterations, some demonstrable and some hypothetical. Recently, occipital neuralgia has been attributed to developmental and posttraumatic lesions in the cervicocranial junction region, with the nerve roots at C-1 and C-2 considered to be the principal pain pathways. The authors describe a series of seven patients with an upper neck and occipital pain syndrome due to unilateral degenerative disease (arthrosis) of a C1–2 lateral articulation. Two of the cases are presented in detail. This disease is demonstrable by radiography through the open mouth by isotope bone scanning, and by computerized tomography scanning. Temporary relief may be obtained by anesthetic and steroid injection, and permanent relief achieved by C-2 dorsal rhizotomy.
Radiation-induced cerebral meningioma: a recognizable entity
Authors: Rubinstein Abraham B. , Shalit Mordechai N. , Cohen Mathias L. , Zandbank Uri , Reichenthal Eli
Published: May 2009

✓ The authors retrospectively analyzed the clinical and histopathological findings in 201 patients with intracranial meningiomas operated on in the period 1978 to 1982. Forty-three of the patients (21.4%) had at some previous time received radiation treatment to their scalp, the majority for tinea capitis. The findings in these 43 irradiated patients were compared with those in the 158 non-irradiated patients. Several distinctive clinical and histological features were identified in the irradiated group, which suggest that radiation-induced meningiomas can be defined as a separate nosological subgroup.

The use of irradiation in large numbers of children with tinea capitis in the era prior to the availability of griseofulvin may be responsible for a significantly increased incidence of intracranial meningiomas.
Subdural hematomas of the posterior fossa in normal-weight newborns
Authors: Hernansanz José , Muñoz Francisco , Rodríguez Daniel , Soler Concepción , Principe Carlos
Published: May 2009

✓ Two cases are reported of subdural hematoma of the posterior fossa in normal-weight full-term newborn infants. The most salient factors in these cases were the lack of specific symptoms and signs indicating the nature and location of the lesion, the importance of computerized tomography for diagnosis, and the good results obtained with early surgical treatment.
Spontaneous spinal subarachnoid hemorrhage and subdural hematoma
Authors: Swann Karl W. , Ropper Allan H. , New Paul F. J. , Poletti Charles E.
Published: May 2009

✓ Two patients with spontaneous spinal subarachnoid hemorrhage are presented to emphasize the clinical and radiological features of this uncommon illness. Both had severe back pain at the onset. One patient had a subdural hematoma that compressed the conus medullaris and cauda equina, and was drained percutaneously; the other had clots in the subarachnoid space. The cerebrospinal fluid showed a polymorphonuclear pleocytosis that simulated septic meningitis. Complete spinal angiography failed to reveal a cause for the hemorrhages.
Avascular necrosis of bone following short-term dexamethasone therapy for brain edema
Authors: Fast Avital , Alon Malvina , Weiss Shmuel , Zer-Aviv Freddy R.
Published: May 2009

✓ The authors present a case of avascular necrosis of both femoral and humeral heads which developed after short-term steroid treatment for brain edema. Avascular necrosis of bone may develop after short-term as well as after maintenance steroid therapy. Early diagnosis with bone scanning and management may in some cases prevent joint destruction.
Surgical experiences with giant intracranial aneurysms
Authors: Symon Lindsay , Vajda Janos
Published: May 2009

✓ A series of 35 patients with 36 giant aneurysms is presented. Thirteen patients presented following subarachnoid hemorrhage (SAH) and 22 with evidence of a space-occupying lesion without recent SAH. The preferred technique of temporary trapping of the aneurysm, evacuation of the contained thrombus, and occlusion of the neck by a suitable clip is described. The danger of attempted ligation in atheromatous vessels is stressed. Intraoperatively, blood pressure was adjusted to keep the general brain circulation within autoregulatory limits. Direct occlusion of the aneurysm was possible in over 80% of the cases. The mortality rate was 8% in 36 operations. Six percent of patients had a poor result. Considerable improvement in visual loss was evident in six of seven patients in whom this was a presenting feature, and in four of seven with disturbed eye movements.
Dissecting aneurysm of the vertebral artery
Authors: Shimoji Takeyoshi , Bando Kuniaki , Nakajima Keiji , Ito Kazufumi
Published: May 2009

✓ Seven cases of dissecting aneurysm of the vertebral artery, all appearing to be of fusiform type, are reported. Clinically, all seven cases initially showed symptoms of subarachnoid hemorrhage; however, three of these were associated with Wallenberg's syndrome. The characteristic angiographic findings in these cases were: 1) retention of contrast medium in the aneurysm; 2) the presence of a true (vertebral artery) and false (arterial wall) lumen in the late arterial and/or venous phase; and 3) irregular arterial narrowing proximal and/or distal to the aneurysm. Autopsy findings of one patient supported the angiographic findings. Recently, reports of fusiform aneurysms associated with subarachnoid hemorrhage have been increasing. As dissecting aneurysms are found in the fusiform group, it is very important to analyze serial angiograms in order to choose a method of surgical treatment.
Localization of function in the excision of lesions from the sensorimotor region
Authors: Gregorie Erik M. , Goldring Sidney
Published: May 2009

✓ A method is described which utilizes the recording of somatosensory evoked responses and cortical stimulation to localize the sensorimotor area under general anesthesia. It has been used in 31 patients who had lesions located in or near the somatosensory or motor gyri. Twenty-six of these patients had a tumor, and the remaining five had a tuberculoma, cysticercoid cyst, thrombosed arteriovenous malformation, cystic infarct, and astrocytic proliferation, respectively. Case histories of selected patients are briefly reported to demonstrate how the method can be used to improve the safety of surgical excisions in the sensorimotor area. The neurological results are discussed in relation to recent physiological studies, demonstrating multiple and spatially separate, sensory and motor representations of the body in the somatosensory and motor gyri.
Deep vein thrombosis and pulmonary emboli in neurosurgical patients: a review
Authors: Swann Karl W. , Black Peter McL.
Published: May 2009

✓ This review examines the incidence, natural history, diagnosis, prophylaxis, and management of deep vein thrombosis (DVT) and pulmonary embolism (PE) in neurosurgical patients. Recent studies estimate the incidence of postoperative DVT detected by fibrinogen scanning in neurosurgical patients to be 29% to 43%. Specific factors that enhance the risk of venous thromboembolism include previous DVT, surgery, immobilization, advanced age, obesity, limb weakness, heart failure, and lower extremity trauma. Clinical diagnosis of venous thromboembolism is unreliable but can be augmented by noninvasive screening tests such as iodine-125-fibrinogen scanning, Doppler ultrasonography, and impedance plethysmography. As prophylactic measures, mini-dose heparin and external pneumatic compression of the legs have decreased the incidence of DVT in clinical studies of neurosurgical patients. However, no prophylactic measure has been convincingly shown to prevent PE in neurosurgical patients. Thrombi involving the popliteal, deep femoral, and iliac veins appear most likely to cause significant PE. Anticoagulation therapy constitutes standard management of DVT and PE; however, in neurosurgical patients the potential for precipitating intracranial or intraspinal hemorrhage may necessitate vena caval interruption. This appears to be an effective alternative to anticoagulation.
Transuncodiscal approach to dumbbell tumors of the cervical spinal canal
Authors: Hakuba Akira , Komiyama Masaki , Tsujimoto Takeshi , Ahn Myung Soo , Nishimura Shuro , Ohta Tomio , Kitano Hideki
Published: May 2009

✓ A combined anterior and lateral approach to the anterior cervical spinal canal with fusion was performed on five patients with cervical dumbbell-shaped tumors. The procedure consists of anterior discectomy and ipsilateral uncectomy, and removal of the posterolateral corners and posterior transverse ridges of the upper and lower vertebral bodies at the level of the tumor. In the case of a large tumor in the spinal canal, additional removal of a limited segment from the lateral part of the vertebral body was performed. The bone defect was filled with a T-shaped iliac bone graft. Two vertebral bodies were fused in each case. The highest level of the operation was C-2 and the lowest was T-1. The authors believe that any cervical dumbbell-shaped tumor below the C-2 level can be removed via an anterolateral approach as long as no more than three levels of the spine are involved.
The role of the prostacyclin-thromboxane system in cerebral vasospasm following induced subarachnoid hemorrhage in the rabbit
Authors: Chan Richard C. , Durity Felix A. , Thompson Gordon B. , Nugent Robert A. , Kendall Marie
Published: May 2009

✓ Subarachnoid hemorrhage (SAH) was induced in 50 rabbits by injecting 1.25 cc/kg of autologous, well heparinized, fresh arterial blood into the cisterna magna, followed by suspending the animals in a head-down position at 30° for 15 minutes. The animals were evenly divided into five groups: a control group, or groups receiving post-SAH prostacyclin (PGI2), carbacyclin, thromboxane A2 (TXA2) synthetase inhibitor (OKY-1581), or nutralipid. Radiographic vertebrobasilar arterial spasm was demonstrated on the 3rd day post-SAH in the control animals. This was decreased in the prostacyclin and the carbacyclin groups and was absent in the OKY-1581 and the nutralipid groups. Cerebral blood flow (CBF) measurements on the 4th day post-SAH using the xenon-133 technique failed to reveal any significant difference between the prostacyclin, the carbacyclin, and the control groups, but flows in the nutralipid and the OKY-1581 groups were significantly higher. There was a good correlation between the clinical status and the CBF. Intracytoplasmic vacuolation and detachment of the vascular endothelium, seen ultrastructurally, may account for the impaired synthesis of prostacyclin. Exogenous prostacyclin and carbacyclin decreased vasospasm but failed to improve cerebral perfusion. OKY-1581 blocked the synthesis of the potent vasoconstrictor, TXA2, which is not only formed during platelet aggregation but also induces platelet aggregation. Nutralipid contains linolenic acid, a precursor of eicosapentaenoic acid (EPA), which is more potent in inhibiting platelet aggregation and in blocking TXA2 production. The various fatty acid constituents of nutralipid bind to albumin and thereby shorten the half-life of TXA2.
Diagnosis of superior sagittal sinus thrombosis by computerized tomography
Authors: d'Avella Domenico , Russo Antonio , Santoro Giuseppe , Pandolfo Nicola , Cafarelli Franco , De Blasi Francesco , Eugenio del Vivo Romeo
Published: May 2009

✓ Superior sagittal sinus thrombosis was diagnosed on computerized tomography (CT) scanning and was subsequently confirmed by angiography in two patients. Small ventricles and filling defects occurring within the sinus (the empty triangle sign) appeared to be highly suggestive of superior sagittal sinus thrombosis, and the association was confirmed angiographically. Potential pitfalls in the CT diagnosis of local obstruction of cerebral venous outflow are described and correlated with the natural history of the disease. The need for improved awareness of the CT appearance of occlusive disease of the dural venous sinuses is stressed.
Exposure of the posterior wall during end-to-side vascular anastomosis
Authors: Guity Afrassiab , Young Paul H. , Smith Kenneth R.
Published: May 2009

✓ An atraumatic technique for exposing the posterior wall during an end-to-side anastomosis is described.
Relationship between hemispheric cerebral blood flow, central conduction time, and clinical grade in aneurysmal subarachnoid hemorrhage
Authors: Rosenstein Jacob , Dah-Jium Wang Alexander , Symon Lindsay , Suzuki Mikio
Published: May 2009

✓ The relationship between central conduction time (CCT) and hemispheric cerebral blood flow (CBF) has been examined in 20 patients presenting with subarachnoid hemorrhage. A total of 63 combined CCT/CBF recordings were performed at various times throughout the hospital course of these patients, and the findings were correlated to clinical status. The initial-slope index of the CBF (CBFisi) was found to correlate well with clinical grade, and a gradation in flow was noted between the different neurological grades. Patients in Grades I and II (Hunt and Hess classification) had the highest flows (mean CBFisi = 47.2 ± 8.1); Grade III patients had intermediate flows (mean CBFisi = 39.6 ± 7.8); and Grade IV patients had the lowest flows (mean CBFisi = 32.0 ± 6.4).

While CCT tended to become increasingly prolonged with worsening grade, a significant difference could not be demonstrated between Grade I, II, and III patients. Only when Grade IV status was reached was the CCT significantly prolonged. When CBFisi and CCT were examined, a threshold relationship was noted between CBFisi and CCT prolongation. At flow values above 30, little change was noted in CCT, and CCT remained in the normal range. However, at flow values below 30, CCT became increasingly prolonged as blood flow diminished. The degree of CCT prolongation appeared to be directly proportional to the degree of blood flow diminution at flows below threshold.
Regional CBF, intraventricular pressure, and cerebral metabolism in patients with ruptured intracranial aneurysms
Authors: Voldby Bo , Enevoldsen Erna M. , Jensen Finn T.
Published: May 2009

✓ Regional cerebral blood flow (rCBF), cerebral metabolic rate of oxygen (CMRO2), intraventricular pressure, and lactate/pH levels in the cerebrospinal fluid (CSF) were measured in 38 patients with ruptured intracranial aneurysms between the 3rd and 13th day after subarachnoid hemorrhage (SAH). Angiography was performed following the rCBF study and the degree of vasospasm was measured on the angiograms. The patients were graded clinically according to the system of Hunt and Hess. Cerebral vasospasm significantly influenced rCBF: global reductions and focal changes (ischemia, hyperemia, and tissue peaks) were commonly associated with vasospasm. Patients with severe diffuse spasm always had global ischemia (21 ± 5 ml/100 gm/min), and cerebral infarctions were demonstrated subsequently, The CMRO2 was more reduced than rCBF, indicating an uncoupling between flow and metabolism. This relative luxury perfusion was associated with CSF lactic acidosis and intracranial hypertension. The arteriovenous difference of oxygen was equally reduced in all categories of patients, probably due to the primary insult of SAH. The CMRO2 decreased concomitantly with arterial caliber, indicating a secondary impairment of cerebral metabolism due to vasospasm.
Dorsal root entry zone lesions for post-amputation pain
Authors: Saris Stephen C. , Iacono Robert P. , Nashold Blaine S.
Published: May 2009

✓ Chronic pain following an amputation may involve the stump, the phantom limb, or both. Operations such as rhizotomy, cordotomy, stump revision, and dorsal column stimulation have been unsuccessful in treating this condition. This study evaluates the effectiveness of dorsal root entry zone (DREZ) coagulation for this pain problem. The authors studied 22 patients with amputations due to trauma, gangrene, or cancer. All developed post-amputation pain, underwent a DREZ procedure, and were followed from 6 months to 4 years after surgery. Overall, only eight (36%) of these 22 patients had pain relief. However, good results were obtained in six (67%) of nine patients with phantom pain alone, and in five (83%) of six patients with traumatic amputations associated with root avulsion. Poor results were obtained in patients with both phantom and stump pain, or stump pain alone. The DREZ procedure has a limited, but definite, place in the treatment of post-amputation pain.
Brain tissue pressure in focal cerebral ischemia
Authors: Iannotti Fausto , Hoff Julian T. , Schielke Gerald P.
Published: May 2009

✓ Twenty-three anesthetized cats underwent permanent middle cerebral artery occlusion in a study of the relationships of regional cerebral blood flow, ventricular fluid pressure, brain tissue pressure, and ischemic edema formation. A pressure gradient of 8 mm Hg developed between ischemic tissue and normally perfused tissue during a 4-hour observation period after occlusion. Brain water accumulated as tissue pressure rose, while blood flow in the same area fell. The data suggest, but do not prove, that ischemic brain edema causes tissue pressure to rise focally, and that blood flow to the ischemic zone is compromised further by the resultant hydrostatic pressure gradient.
Neuropathological changes related to the transorbital application of ethyl 2-cyanoacrylate adhesive to the basal cerebral arteries of cats
Authors: Smith Thomas W. , DeGirolami Umberto , Crowell Robert M.
Published: May 2009

✓ The long-term toxic effects of ethyl 2-cyanoacrylate adhesive were evaluated histologically in 25 cats. Fresh medical- or commercial-grade adhesive was introduced transorbitally into the subarachnoid space in the vicinity of the right middle cerebral artery. Three sham-operated animals served as controls. The animals were sacrificed at intervals ranging from 2 days to 6 months. For both medical- and commercial-grade adhesive, neuropathological examination disclosed acute and chronic granulomatous inflammation of the meninges and evidence of severe vascular damage, including vessel wall necrosis, inflammation, thrombosis, and occasionally hemorrhage. Most animals showed cerebral infarcts of variable size in the territories of distribution of the basal arteries which were in contact with adhesive. The results of this study show that ethyl 2-cyanoacrylate is capable of producing severe arterial and parenchymal damage. The risk of its deleterious effects should be weighed against its potential benefits. Clinical experience would suggest that ethyl 2-cyanoacrylate can be used in difficult situations as long as care is taken to protect the brain and local blood vessels.