bluuebunny/crossref_metadata_2025 huggingface dataset:
Familial os odontoideum
Authors: Morgan Michael K. , Onofrio Burton M. , Bender Claire E.
Published: May 2009

✓ A familial asymptomatic os odontoideum with a Klippel-Feil type II fusion of C-2 and C-3 is reported. The pattern of inheritance within this family is consistent with that of autosomal dominance. The index case, a 16-year-old boy, was studied with plain cervical spine x-ray films, lateral cervical tomography in flexion and extension, fluoroscopic evaluation of the subluxation, and magnetic resonance (MR) imaging of the spine in flexion and extension. In spite of the subluxation noted on flexion and extension, there was no evidence of cord compression on MR imaging. The etiology and management of this condition are discussed.
Spinal meningioma arising from a lumbar nerve root
Authors: Ng Thomas H. K. , Chan Kwan Hon , Mann Kirpal S. , Fung Ching F.
Published: May 2009

✓ A case is reported of cauda equina compression from an intradural meningioma arising from the L-5 nerve root in a young man.
Chemotherapy as the initial treatment of spinal cord compression due to disseminated neuroblastoma
Authors: Sanderson I. R. , Pritchard Jon , Marsh Henry T.
Published: May 2009

✓ During a 12-month trial period, all children attending the Hospitals for Sick Children, London, England, for management of spinal cord compression due to disseminated neuroblastoma were given chemotherapy as initial treatment rather than radiotherapy or laminectomy. Response to treatment was evaluated by a neurosurgeon as well as by oncologists. Four children were treated in this way and all made a full recovery of spinal cord function.
Recanalization of spinal arteriovenous malformations following embolization
Authors: Hall Walter A. , Oldfield Edward H. , Doppman John L.
Published: May 2009

✓ Recently, therapeutic embolization has been advocated as the treatment of choice for arteriovenous malformations (AVM's) of the spine. However, no study has established lasting benefit from this procedure or determined the incidence of recanalization, as occurs with cerebral AVM's. In this study, six patients were followed periodically after complete obliteration of their AVM's by particulate embolization was shown by immediate arteriography. The study group included three men (aged 59 to 72 years) with spinal dural arteriovenous (AV) fistulas and three women (aged 27 to 38 years) with intramedullary glomus-type spinal cord AVM's. The patients were treated by embolization with 100- to 1000-µm diameter polyvinyl alcohol particles. Clinical improvement, most commonly manifesting as increased lower-extremity strength, occurred in all patients after embolization. However, recurrent symptoms, including weakness, numbness, and urinary incontinence, occurred within 2 and 8 months in two of the three patients with dural AV fistulas and within 2 months in two of the three patients with glomus AVM's, prompting radiological reevaluation. Spinal arteriography revealed recanalization of the AV fistulas and spinal AVM's in five patients. Magnetic resonance (MR) imaging demonstrated a signal-void area caused by intramedullary AVM's. This area disappeared after embolic occlusion, but recurred after delayed recanalization, indicating restored flow through the AVM.

Embolization provides only temporary treatment for many spinal AVM's. After embolic occlusion, delayed reassessment with arteriography and/or MR imaging is indicated, particularly if the symptoms persist or recur. Surgical excision of spinal AVM's provides the only therapeutic means to eliminate flow through the AVM permanently in most patients, and should be considered the treatment of choice when feasible.
Presence and significance of NK cells in glioblastomas
Authors: Vaquero Jesús , Coca Santiago , Oya Santiago , Martínez Roberto , Ramiro Josefa , Salazar Francisco G.
Published: May 2009

✓ A monoclonal antibody against the surface marker IOT-10 of natural killer (NK) cells was used to investigate the presence of these cells in a series of 25 glioblastomas. In 40% of the tumors, IOT-10-positive NK cells were found in small numbers scattered among the tumor cells. The presence of IOT-10-positive NK cells was not related to the degree of lymphocytic infiltration in the tumor as demonstrated by hematoxylin and eosin staining, nor did it appear to influence the survival time of the patients studied.
Treatment of vein of Galen aneurysmal malformation
Authors: Lasjaunias Pierre , Rodesch Georges , Pruvost Phillippe , Laroche Françoise Grillot , Landrieu Pierre
Published: May 2009

✓ The authors report the case of a vein of Galen aneurysmal malformation in a 1-year-old baby presenting with an enlarging head. The lesion was a direct arteriovenous fistula in a dilated vein of Galen and was treated by complete embolization in one session. Four months after occlusion of the shunt, the ectatic vein of Galen and torcular were normal, and the head circumference had stabilized. This case serves as an opportunity to emphasize the quality of results that can be obtained with endovascular techniques. Proper analysis of the vein of Galen angioarchitecture allows planning for appropriate treatment with the lowest possible risk of morbidity and mortality.
Transvenous copper wire insertion for dural arteriovenous malformations of cavernous sinus
Authors: Takahashi Akira , Yoshimoto Takashi , Kawakami Kiyoshi , Sugawara Takayuki , Suzuki Jiro
Published: May 2009

✓ Therapeutic embolization by means of transvenous copper wire insertion was performed in five patients with dural arteriovenous malformations (AVM's) of the cavernous sinus. In each case, angiograms had shown that the AVM's were supplied from both internal and external carotid arteries, which was thought to render complete transarterial embolization difficult. A No. 2.5 French Teflon catheter was introduced into the affected cavernous sinus through the superior ophthalmic or internal jugular vein with the aid of a flexible mini guide wire. Copper wires were pushed by the guide wire into the cavernous sinus until the disappearance or a sufficient decrease in the arteriovenous shunt was noted. The patients' symptoms resolved or improved without any severe complications. Angiography revealed complete disappearance of the lesion immediately after treatment in three cases and follow-up angiography taken within 8 months showed no arteriovenous shunt in any patient. This method is a promising treatment for dural AVM's when conventional transarterial embolization is thought to be difficult.
William Osler and “the special field of neurological surgery”
Authors: Canale D. J.
Published: May 2009

✓ Harvey Cushing's paper, “The special field of neurological surgery,” published in the Bulletin of The Johns Hopkins Hospital in 1905, constitutes a recognized milestone in the establishment of neurological surgery as a separate surgical specialty in the United States. The main point the author wishes to make here is that the very special friendship of Sir William Osler, influencing, encouraging, stimulating Cushing at the particular time that it did (1901 to 1905), was probably the primary positive influence that made it possible for Cushing to achieve specialization in neurological surgery and to make his considerable contribution in this field.
Early changes of intracranial pressure, perfusion pressure, and blood flow after acute head injury
Authors: Pfenninger Ernst G. , Reith Andreas , Breitig Dieter , Grünert Ad , Ahnefeld Friedrich W.
Published: May 2009

✓ The present study examines intracranial pressure (ICP), cerebral perfusion pressure (CPP), and cerebral circulation immediately after experimental head injury in an animal model. The underlying systemic hemodynamic changes were also observed. To produce a standardized head injury, a fluid-percussion device was applied to the dura at the midline of 10 piglets. Seven other nontraumatized animals served as a control group. Hemodynamic parameters as well as ICP and CPP were recorded on-line, one value every 1.4 seconds. Cerebral blood flow (CBF) and cerebral vascular resistance (CVR) were measured three times using a microsphere technique. Immediately after head injury, the traumatized animals showed a sudden increase in ICP, with a maximum of 40 torr at 3 to 5 minutes, while there was a pronounced decrease in CPP from 85 to 40 torr. The CBF in the various brain areas fell from 55 to 22 ml/min/100 gm within 5 minutes after the impact, and CVR increased to 300% of control values within 90 minutes. The findings of this study demonstrated that cerebral circulation is critically jeopardized within a few minutes after trauma. This, in combination with a subsequent increase in CVR, makes the early development of ischemic brain damage very likely. In traumatized patients, treatment prior to hospital admission must therefore be directed at prevention of this fatal course.
Moyamoya-like disease associated with a lenticulostriate region aneurysm
Authors: Grabel Jordan C. , Levine Mitchell , Hollis Peter , Ragland Ronald
Published: May 2009

✓ A case of moyamoya-like disease associated with an intracerebral hemorrhage and an unusual aneurysm is reported. The patient's clinical status and the initial and follow-up angiographic appearance of the aneurysm are presented. The etiology of the moyamoya phenomenon and of associated aneurysms is discussed.
Magnetic resonance imaging in myelocystoceles
Authors: Peacock Warwick J. , Murovic Judith A.
Published: May 2009

✓ Two cases of terminal myelocystocele, a rare localized cystic dilatation of the caudal spinal central canal, are reviewed. Magnetic resonance imaging is a useful diagnostic tool for its evaluation. Terminal myelocystocele consists of the following: a myelocystocele which contains a “trumpet-like” flaring of the distal spinal cord central canal and thus is partially lined by ependymal tissue; a meningocele or dilated subarachnoid space located around the myelocystocele, which bulges into the subcutaneous region; and fibrolipomatous tissue surrounding the two cysts. This condition is usually associated with abnormalities of the vertebral column and sacrum as well as compression of the spinal cord and meningocele by a fibrous band. There is a possible relationship of the myelocystocele to teratogens such as loperamide HCl and retinoic acid, although the exact etiology of this entity is not known.
Treatment of spontaneous cerebrospinal fluid leak with epidural blood patch
Authors: Rupp Stephen M. , Wilson Charles B.
Published: May 2009

✓ A case of spontaneous cerebrospinal fluid (CSF) leak from a sacral nerve root sleeve is reported. The leak resulted in CSF hypotension, which failed to resolve with prolonged bed rest. An epidural blood patch using autologous blood placed percutaneously via the caudal canal was successful in treating the problem.
Vascular malformations of the brain stem
Authors: Chyatte Douglas
Published: May 2009

✓ Vascular malformations of the brain stem are unusual lesions that may pose a diagnostic and therapeutic challenge. Seven patients with vascular malformations involving the brain stem were evaluated; six were treated surgically, with complete obliteration of the lesion in five patients. In five patients symptoms developed only after a hemorrhage had occurred, and three of these suffered a rebleed before appropriate treatment was given. Angiography failed to demonstrate lesions in three cases, which did not appear to protect from repeat hemorrhage since two of the three rebled. There were no operative deaths, and no patients were made permanently worse after surgery. Useful recovery occurred commonly after appropriate treatment and appeared to be possible even in patients who had suffered a catastrophic neurological deficit at the time of presentation. These data indicate that surgical removal of the lesion may be warranted in some patients with symptomatic brain-stem vascular malformation.
Radiation therapy in the management of low-grade supratentorial astrocytomas
Authors: Shaw Edward G. , Daumas-Duport Catherine , Scheithauer Bernd W. , Gilbertson David T. , O'Fallon Judith R. , Earle John D. , Laws Edward R. , Okazaki Haruo
Published: May 2009

✓ The records of 167 patients with grade 1 or 2 supratentorial pilocytic astrocytomas (41 patients), ordinary astrocytomas (91 patients), or mixed oligoastrocytomas (35 patients) diagnosed between 1960 and 1982 are retrospectively reviewed. The extent of surgical tumor removal was gross total or radical subtotal in 33 patients (20%) and subtotal or biopsy only in the remaining 134 patients (80%). Postoperative radiation therapy was given to 139 (83%) of the 167 patients, with a median dose of 5000 cGy (range 600 to 6500 cGy).

Multivariate analysis revealed that a pilocytic histology was the most significant prognostic variable associated with a good survival. The 5- and 10-year survival rates were, respectively, 85% and 79% for the 41 patients with pilocytic astrocytomas compared to 51% and 23% for the 126 patients with ordinary astrocytomas or mixed oligoastrocytomas. Postoperative irradiation did not appear to be associated with improved survival times in the patients with pilocytic astrocytomas; however, in the 126 patients with ordinary astrocytomas or mixed oligoastrocytomas, those who received “high-dose” radiation (≥ 5300 cGy) had significantly better survival times than those who received “low-dose” radiation (< 5300 cGy) or surgery alone. The 5- and 10-year survival rates were, respectively, 68% and 39% for the 35 patients receiving high-dose radiation, 47% and 21% for the 67 receiving low-dose radiation, and 32% and 11% for the 19 treated with surgery alone.

The survival rate was poor for the 23 patients with ordinary astrocytomas and oligoastrocytomas who underwent gross total or radical subtotal tumor removal (14 of whom were also irradiated): 52% at 5 years and 21% at 10 years, with 19 of 23 patients developing tumor progression and dying 1 to 12 years postoperatively. In contrast, all 10 patients with pilocytic astrocytomas who had gross total or radical subtotal tumor removal alone were long-term survivors, with follow-up periods of about 4 to 25 years.
Chemonucleolysis versus discectomy: a randomized multicenter trial
Authors: van Alphen H. August M. , Braakman Reinder , Bezemer P. Dick , Broere Gijs , Berfelo M. Willem
Published: May 2009

✓ A randomized clinical trial was carried out to compare the results of open discectomy with those of chemonucleolysis in 151 patients suffering from a disc herniation at L4–5 or L5–S1. All patients fulfilled strict entry criteria; 78 patients underwent open discectomy and 73 were subjected to chemonucleolysis.

An increase in radicular pain immediately after treatment was encountered in 16 patients (22%) in the chemonucleolysis group, as compared to none in the discectomy group. The efficacy of discectomy appeared to be definitely superior to that of chemonucleolysis. Within a follow-up period of 1 year, 18 patients (25%) required open discectomy following failed chemonucleolysis; two patients (3%) in the discectomy group needed a second operation. Open discectomy following previous chemonucleolysis was successful in only 44% of cases. Comparison of the final results of the two modes of treatment 12 months after the last intervention (including second treatment) did not reveal any significant differences.

The duration of the preoperative symptoms, the level of disc herniation, and the leakage of contrast medium out of the disc appeared to be of no relevance to the final outcome. The complication rates in both treatment groups were low.
Anterior cervical debridement and strut-grafting for osteomyelitis of the cervical spine
Authors: Stone James L. , Cybulski George R. , Rodriguez Justo , Gryfinski Martin E. , Kant Ravi
Published: May 2009

✓ A retrospective review of the surgical experience in treating 18 patients with osteomyelitis of the cervical spine is reported. The patients ranged in age from 20 to 60 years and all complained of neck pain upon admission. Ten patients had a prior history of intravenous drug abuse, three had previously suffered penetrating injuries of the neck, and one had an extraspinal site of osteomyelitis. Bacteria were isolated in 13 cases and tuberculosis in three. Neurological abnormalities were present in over one-half of the patients, consisting of myelopathy (nine cases) or radiculopathy (four cases). Plain cervical spine films and polytomography demonstrated vertebral and end-plate destruction, spinal instability, and increased paravertebral soft-tissue shadow in all cases. Computerized tomography and, more recently, magnetic resonance imaging have proven helpful in detecting bone involvement and the presence of epidural extension associated with cervical osteomyelitis. The risk of vertebral body collapse, kyphosis, and myelopathy in the osteomyelitic cervical spine has standardized the management of this problem in this institution to consist of skeletal traction, needle aspiration or blood culture for organism identification, anterior cervical debridement, autogenous iliac graft fusion, and intravenous administration of antibiotics. Spinal stability and neurological improvement were achieved in all 18 patients.
Halo vest versus spinal fusion for cervical injury: evidence from an outcome study
Authors: Bucholz Richard D. , Cheung K. Charles
Published: May 2009

✓ The indications for surgical fusion, as opposed to halo fixation, in the management of cervical spine injury are still unclear. At St. Louis University Medical Center a conservative protocol has been adopted to treat almost all cervical spine fractures with halo fixation. To determine what factors have contributed to failure of halo fixation, the records and radiographs of all patients with cervical spine injuries who were treated at that institution between 1984 and 1986 were reviewed. During this interval, 124 patients were treated, consisting of 93 men and 31 women between 6 and 94 years old. Of these, 15 (12%) had cervical fusion without preoperative halo device application. This group included eight patients with old injuries and delayed diagnosis, three with nonreducible locked facets, and four with miscellaneous indications. The remaining 109 patients were treated with halo vests. Four died before completing the 3-month standard treatment. Of those completing the treatment, 48 had C1–2 level injuries and 57 had C3–T1 level injuries. Sixteen patients (15%) failed their halo treatments and required surgical fusion: eight while still in halo fixation and eight after they had completed treatment with a halo device. Failure of halo treatment was indicated by recurrent dislocation in 13 patients and increased neurological deficit in three. Thirteen of the patients who failed treatment had C3–T1 injuries and three had C1–2 injuries. Of 27 patients with odontoid fractures, only two (7.4%) failed halo fixation. There were no failures in 11 patients with hangman's fractures. Of the 57 patients with C3–T1 injuries, 13 (23%) failed treatment, nine of whom had locked or “perched” facets. The factors causing failure of halo fixation were analyzed. The overall success rate was 85%, suggesting that the halo vest can be used to treat most patients with cervical spine injuries. Under certain circumstances (in the presence of old injuries, difficult reduction, or locked or “perched” facets), surgery may be indicated to avoid unnecessary delay in definitive management.
A dose-response study of dexamethasone in a model of spinal cord compression caused by epidural tumor
Authors: Delattre Jean Yves , Arbit Ehud , Thaler Howard T. , Rosenblum Marc K. , Posner Jerome B.
Published: May 2009

✓ In order to assess the clinical and biological effects of glucocorticoids in the therapy of epidural spinal cord compression, the T8–10 epidural space of 50 rats was implanted with Walker 256 tumor. The rats were studied 10 to 20 days later when they became paraparetic. The regional blood-spinal cord transport constant (K, a function of the blood-spinal cord barrier) of 14Carbon-labeled aminoisobutyric acid was measured with quantitative autoradiography 6 hours after intravenous injection of low-dose (0.1 mg/kg), intermediate dose (1 mg/kg), and high-dose (10 mg/kg) dexamethasone. The effects of dexamethasone in these doses on the clinical signs and water content of the compressed cord were also evaluated 40 hours after treatment began. The K factor increased 730% in compressed compared with noncompressed spinal cords (p < 0.001). Dexamethasone induced a dose-related reduction of both K (p = 0.007) and water content of the compressed cord (p < 0.0001). Stabilization or, more rarely, improvement of weakness at 24 and 40 hours posttreatment correlated with the dose of dexamethasone (r = 0.88, p < 0.001). This study demonstrates that dexamethasone has a dose-related beneficial clinical effect associated with an improvement of blood-spinal cord barrier breakdown and a reduction of the water content of the compressed cord. This study supports the use of high-dose dexamethasone for the initial treatment of epidural spinal cord compression.
Intradiploic arachnoid cysts
Authors: Weinand Martin E. , Rengachary Setti S. , McGregor Douglas H. , Watanabe Itaru
Published: May 2009

✓ Two patients are presented in whom cranial arachnoid cysts developed as diverticuli of the arachnoid membrane through small defects in the dura mater, eroded through the inner table, expanded within the diploe, and eroded the outer table of the skull. Based on observations at the time of surgery and the histological examination of these lesions, it is proposed that they are congenital in origin. Previously reported cases of “traumatic arachnoid cyst without fracture,” “intradiploic cerebrospinal fluid fistula,” and “middle fossa pitholes” appear to represent the same pathological process as the lesions reported in this paper. It is proposed that “intradiploic arachnoid cyst” is the most appropriate term by which these lesions should be described.
Randomized trial of three chemotherapy regimens and two radiotherapy regimens in postoperative treatment of malignant glioma
Authors: Shapiro William R. , Green Sylvan B. , Burger Peter C. , Mahaley M. Stephen , Selker Robert G. , VanGilder John C. , Robertson James T. , Ransohoff Joseph , Mealey John , Strike Thomas A. , Pistenmaa David A.
Published: May 2009

Within 3 weeks of definitive surgery, 571 adult patients with histologically confirmed, supratentorial malignant gliomas were randomly assigned to receive one of three chemotherapy regimens: BCNU (1,3-bis(2-chloroethyl)-1-nitrosourea) alone, alternating courses (every 8 weeks) of BCNU and procarbazine, or BCNU plus hydroxyurea alternating with procarbazine plus VM-26 (epipodophyllotoxin). Patients accrued in 1980 and 1981 were to receive 6020 rads of whole-brain radiotherapy concurrent with the first course of chemotherapy. Patients accrued in 1982 and 1983 were randomly assigned to receive either whole-brain irradiation as above, or 4300 rads of whole-brain radiotherapy plus 1720 rads coned down to the tumor volume. The data were analyzed for the total randomized population and separately for the 510 patients, termed the “Valid Study Group (VSG),” who met protocol eligibility specifications (including central pathology review), 80% of whom had glioblastoma multiforme. The median survival times from time of randomization for the three chemotherapy groups of the VSG ranged from 11.3 to 13.8 months, and 29% to 37% of the patients survived for 18 months (life-table estimate); the differences between these groups were not statistically significant. Survival differences between the radiotherapy groups were small and not statistically significant. It is concluded that, for malignant glioma, giving part of the radiotherapy by coned-down boost is as effective as full whole-brain irradiation, and that multiple-drug chemotherapy as outlined in this protocol conferred no significant survival advantage over BCNU alone.
Transcranial resection of tumors of the paranasal sinuses and nasal cavity
Authors: Blacklock J. Bob , Weber Randal S. , Lee Ya-Yen , Goepfert Helmuth
Published: May 2009

✓ Combined cranial and facial procedures for resection of malignancies of the paranasal sinuses and nasal cavity have been used with variable success and complication rates in the last 25 years. A series of nine patients undergoing 10 exclusively transcranial procedures for these tumors is presented, and an effective technique for reconstruction without free tissue transfer is described. The patients in this series suffered no major complications, and all have remained free of disease during the short follow-up period. The technique described in this report offers the advantage of wide exposure, symmetrical approach to the superstructures of the face and orbits, the potential for resection of a large portion of the anterior cranial floor, and substantial reconstruction which is a major factor in avoiding complications.
Unenhanced and gadolinium-DTPA-enhanced MR imaging in postoperative evaluation in pediatric brain tumors
Authors: Dickman Curtis A. , Rekate Harold L. , Bird C. Roger , Drayer Burton P. , Medina Marjorie
Published: May 2009

✓ Gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA) is a chelated paramagnetic contrast agent under clinical trial for use in magnetic resonance (MR) imaging. The increased signal intensity following the intravenous infusion of contrast medium may improve the ability of MR imaging to delineate tumors. The use of this method in 15 pediatric patients with suspected brain-tumor recurrence was analyzed. All 15 patients underwent postoperative Gd-DTPA-enhanced MR imaging, and residual tumor was demonstrated in nine of them. Based on the findings of the enhanced MR studies, four patients had additional surgery, two underwent radiation therapy, and one was given immunotherapy. Continued surveillance was recommended for the remaining eight patients. In all cases the enhanced MR imaging studies were superior to the unenhanced studies in regard to the qualitative and quantitative assessment of the residual tumor. Gadolinium-DTPA-enhanced MR imaging appears to be a safe and effective means of providing an accurate postoperative assessment of residual disease in pediatric brain-tumor patients. It is as effective as contrast-enhanced computerized tomography and has the sensitivity and anatomic resolution provided by MR imaging. The most useful role of this agent was in the postoperative period, in assessing the adequacy of surgical resection. This technique is recommended as the procedure of choice in the postoperative assessment and long-term surveillance of patients with brain tumors.
Improved outcome prediction based on CSF extrapolated creatine kinase BB isoenzyme activity and other risk factors in severe head injury
Authors: Hans Pol , Albert Adelin , Franssen Colette , Born Jacques
Published: May 2009

✓ The present study of 43 patients with severe head injury shows that outcome prediction can be markedly improved by combining an appropriate marker of the degree of initial brain damage and other risk factors. The patients were classified into three groups according to their actual outcome after 6 months: death (22 patients); persistent vegetative state or severe disability (eight patients); and moderate disability or good recovery (13 patients). By applying stepwise logistic discriminant analysis to the patients' data, five significant risk factors were selected: degree of neurological damage assessed by cerebrospinal fluid (CSF) extrapolated creatine kinase BB isoenzyme activity, Glasgow-Liege Coma Scale score, age, incidence of thoracic injury, and intracranial pressure (ICP). Extrapolated creatine kinase BB activity had the highest prognostic ability (67%). Uncontrollable elevated ICP proved to be systematically associated with death, whereas its absence was not necessarily indicative of a favorable outcome. The combination of the five variables yielded a total prognostic efficiency of 91%. The percentages of correctly predicted patients for the three outcome groups were, respectively, 100%, 50%, and 100%. Thus, half of the persistently vegetative and severely disabled patients were identified by the selected factors.
Relationship between compliance and resistance to outflow of CSF in adult hydrocephalus
Authors: Tans Joseph T. J. , Poortvliet Dick C. J.
Published: May 2009

✓ Resistance to outflow of cerebrospinal fluid (Rcsf) was determined by constant flow infusions and pressure-volume index (PVI) using bolus infusions in 114 patients with various types of hydrocephalus. A clear correlation was found between PVI and Rcsf and, to a lesser degree, between these two parameters and baseline pressure. The PVI was not related to patient's age, duration of disease, type of hydrocephalus, or ventricular size, indicating that the relationship between PVI and Rcsf was genuine and not caused by patient selection. It is concluded that, in adult hydrocephalus, compliance is not an independent parameter but chiefly determined by Rcsf.
Cerebral blood flow and metabolism in severely head-injured children
Authors: Muizelaar J. Paul , Marmarou Anthony , DeSalles Antonio A. F. , Ward John D. , Zimmerman Richard S. , Li Zhongchao , Choi Sung C. , Young Harold F.
Published: May 2009

✓ The literature suggests that in children with severe head injury, cerebral hyperemia is common and related to high intracranial pressure (ICP). However, there are very few data on cerebral blood flow (CBF) after severe head injury in children. This paper presents 72 measurements of cerebral blood flow (“CBF15”), using the 133Xe inhalation method, with multiple detectors over both hemispheres in 32 children aged 3 to 18 years (mean 13.6 years) with severe closed head injury (average Glasgow Coma Scale (GCS) score 5.4). In 25 of the children, these were combined with measurements of arteriojugular venous oxygen difference (AVDO2) and of cerebral metabolic rate of oxygen (CMRO2). In 30 patients, the first measurement was taken approximately 12 hours postinjury. In 18 patients, an indication of brain stiffness was obtained by withdrawal and injection of ventricular cerebrospinal fluid and calculation of the pressure-volume index (PVI) of Marmarou. The CBF and CMRO2 data were correlated with the GCS score, outcome, ICP, and PVI.

Early after injury, CBF tended to be lower with lower GCS scores, but this was not statistically significant. This trend was reversed 24 hours postinjury, as significantly more hyperemic values were recorded the lower the GCS score, with the exception of the most severely injured patients (GCS score 3). In contrast, mean CMRO2 correlated positively with the GCS score and outcome throughout the course, but large standard deviations preclude making predictions based on CMRO2 measurements in individual patients. Early after injury, there was mild uncoupling between CBF and CMRO2 (CBF above metabolic demands, low AVDO2) and, after 24 hours, flow and metabolism were completely uncoupled with an extremely low AVDO2. Consistently reduced flow was found in only four patients; 28 patients (88%) showed hyperemia at some point in their course. This very high percentage of patients with hyperemia, combined with the lowest values of AVDO2 found in the literature, indicates that hyperemia or luxury perfusion is more prevalent in this group of patients. The three patients with consistently the highest CBF had consistently the lowest PVI: thus, the patients with the most severe hyperemia also had the stiffest brains. Nevertheless, and in contrast to previous reports, no correlation could be established between the course of ICP or PVI and the occurrence of hyperemia, nor was there a correlation between the levels of CBF and ICP at the time of the measurements. The authors argue that this lack of correlation is due to: 1) a definition of hyperemia that is too generous, and 2) the lack of a systematic relationship between CBF and cerebral blood volume. The implications of these findings for therapeutic modes of controlling ICP in children, such as hyperventilation and the use of mannitol, are discussed.
Cerebral blood flow and metabolism in severely head-injured children
Authors: Muizelaar J. Paul , Ward John D. , Marmarou Anthony , Newlon Pauline G. , Wachi Akihiko
Published: May 2009

✓ Autoregulation of cerebral blood flow (“CBF15”) was tested in a series of 26 pediatric patients (mean age 13.2 years) with severe head injury (average Glasgow Coma Scale (GCS) score 5.5) in the acute stage. A baseline 133Xe CBF measurement was performed and then repeated, after blood pressure was increased by 29% with intravenous phenylephrine or decreased by 26% with intravenous trimethaphan camsylate. Correlations were made between CBF and clinical condition, outcome, time after injury, intracranial pressure (ICP), and pressure-volume index (PVI) changes, and the site of injury (hemispheres, diencephalon, or brain stem). The site of injury was determined with multimodality evoked potential measurements. Autoregulation was intact in 22 (59%) of 37 measurements. There was no correlation with GCS score, outcome, time after injury, site of injury, or way of testing (decreasing or increasing blood pressure). Autoregulation was statistically significantly more often impaired when CBF was either below normal −2 standard deviations (SD) (reduced flow) or above normal +2 SD (absolute hyperemia). In cases with intact autoregulation, mean ICP decreased from 17.5 to 15.0 mm Hg with higher blood pressure and increased from 19.0 to 21.3 mm Hg with lower blood pressure. When PVI was measured during the blood pressure manipulations, it was found to change in a direction opposite to the ICP change. The consequences of these findings in the management of ICP problems with blood pressure control are discussed.
Radiation-induced intracranial malignant gliomas
Authors: Shapiro Scott , Mealey John , Sartorius Carl
Published: May 2009

✓ The authors present seven cases of malignant gliomas that occurred after radiation therapy administered for diseases different from the subsequent glial tumor. Included among these seven are three patients who were treated with interstitial brachytherapy. Previously reported cases of radiation-induced glioma are reviewed and analyzed for common characteristics. Children receiving central nervous system irradiation appear particularly susceptible to induction of malignant gliomas by radiation. Interstitial brachytherapy may be used successfully instead of external beam radiotherapy in previously irradiated, tumor-free brain, and thus may reduce the risk of radiation necrosis.
Intracerebral drug delivery in rats with lesion-induced memory deficits
Authors: Howard Matthew A. , Gross Alan , Grady M. Sean , Langer Robert S. , Mathiowitz Edith , Winn H. Richard , Mayberg Marc R.
Published: May 2009

✓ Pharmacological treatments directed at increasing cortical acetylcholine activity in patients with Alzheimer's disease have largely been disappointing, perhaps because denervated areas of brain may not be exposed to adequate amounts of drug. A new method has been developed to enable localized intracerebral delivery of neurotransmitter substances using a polymeric drug delivery system. Microspheres of a polyanhydride sebacic acid copolymer were impregnated with bethanechol, an acetylcholinesterase-resistant cholinomimetic. Twenty rats received bilateral fimbria-fornix lesions, producing cholinergic denervation of the hippocampus and marked impairment in spatial memory. The animals were trained for 2 weeks to run an eight-arm radial maze, after which they received bilateral intrahippocampal implants of saline (five rats), blank polymer (five rats), or bethanechol-impregnated polymer (10 rats). Following implantation, spatial memory was assessed by radial-maze performance testing for 40 days. Untreated lesioned rats showed persistently poor spatial memory, entering maze arms with near random frequency. Similarly, animals treated with saline and blank polymer did not improve after implantation. Rats treated with bethanechol-impregnated microspheres, however, displayed significant improvement within 10 days after implantation; this improvement persisted for the duration of the experiment (p < 0.05, Student's t-test). Histological analysis of regional acetylcholinesterase staining showed widespread loss of activity throughout the hippocampus bilaterally in all animals. The microsphere implants were visible within the hippocampus, with minimal reactive changes in surrounding brain. It is concluded that intracerebral polymeric drug delivery successfully reversed lesion-induced memory deficits, and has potential as a neurosurgical treatment method for Alzheimer's disease and other neurodegenerative disorders.
Imaging of brain tumors using peripheral benzodiazepine receptor ligandss
Authors: Black Keith L. , Ikezaki Kiyonobu , Toga Arthur W.
Published: May 2009

✓ Peripheral benzodiazepine receptor ligands were utilized to selectively image intracerebrally implanted C6 gliomas, RG-2 gliomas, and Walker 256 metastatic tumors by means of quantitative autoradiography. Intravenous injections of 3H-PK11195 (1-(2-chlorophenyl)-N-methyl-N-(1-methylpropyl)-3-isoquinoline carboxamide) or 3H-flunitrazepam in combination with clonazepam revealed high densities of peripheral benzodiazepine binding in glial tumors, with less binding in metastatic tumors. Peripheral binding was displaced by preadministration of excess PK11195. Topographical correlation was excellent between areas of histologically verified tumor and high densities of peripheral benzodiazepine binding. The choroid plexus, ependyma, and pineal gland also showed a moderate level of binding, but there was little binding in other normal brain structures or necrotic tissue. Binding densities were three- to fivefold higher in C6 glial tumors compared to normal cortex. Injection of 3H-flunitrazepam alone, which binds to both central and peripheral receptors, had the advantage of showing normal anatomic structures in addition to a clear definition of tumor topography. The potential value of peripheral benzodiazepine ligands in selectively imaging brain tumors in man with positron emission tomography is discussed.
The effect of cerebrospinal fluid pressure on dural venous pressure in young rats
Authors: Jones Hazel C. , Gratton Julie A.
Published: May 2009

✓ In order to study cerebrospinal fluid (CSF) absorption across the dural sinus wall, the effect of CSF pressure (recorded from the cisterna magna) on dural venous pressure (recorded from the transverse sinus) was investigated in groups of rats at 2, 10, 20, and 31 days after birth and in adulthood. At normal resting pressures there was no positive pressure gradient between the CSF and sinus venous blood in 2-, 10-, and 20-day-old rats, but in 31-day-old and adult rats there was a positive gradient of 16 and 12 mm H2O, respectively. A series of constant-rate infusions of artificial CSF was made into the cisterna magna, and subsequent plateaus in both CSF and venous blood were recorded. The gradient of a plot of plateau pressure against infusion rate gave the overall resistance to absorption of the CSF for each age group, which was higher in 2- and 10-day-old rats than at three older ages. The effect on dural venous pressure was age-related, with the largest increase at 2 days, the smallest at 20 days, and no effect at 31 days or in adults. The pressure difference between CSF and sinus blood has been used to calculate resistance to absorption across the sinus wall. This showed that the high overall resistance to drainage in young rats can be largely accounted for by the rise in sinus pressure. It is concluded that drainage of CSF into the sinuses is greatly restricted in young animals.
A pneumatized anterior clinoid mimicking an aneurysm on MR imaging
Authors: Gean Alisa D. , Pile-Spellman John , Heros Roberto C.
Published: May 2009

✓ The advent of magnetic resonance (MR) imaging has marked a new era in neuroimaging — particularly in terms of diminishing the need for more invasive diagnostic procedures. A cautionary note should be sounded, however, about an important limitation of standard spin-echo MR studies. Two patients were referred for angiography because MR imaging indicated the presence of a “paraclinoid aneurysm.” In retrospect, these findings were due instead to a pneumatized anterior clinoid. Angiography could have been avoided had this pitfall been recognized, and had a gradient-echo flow-imaging protocol been utilized. This latter approach (which does not replace spin-echo imaging) is more sensitive to flowing blood and thus allows differentiation of an air space from a nonthrombosed aneurysm.
Foramen magnum syndrome from pseudogout of the atlanto-occipital ligament
Authors: Ciricillo Samuel F. , Weinstein Philip R.
Published: May 2009

✓ The authors report a case of progressive foramen magnum syndrome due to deposits of calcium pyrophosphate dihydrate crystals, which caused reactive hypertrophy in the posterior longitudinal ligament at C-1 and in the transverse ligament of the atlas in an 84-year-old woman. This is the first reported case of symptomatic pseudogout in this anatomic location. Rapid neurological recovery followed transoral decompression of the cervicomedullary junction.
CT infusion scanning for the detection of cerebral aneurysms
Authors: Newell David W. , LeRoux Peter D. , Dacey Ralph G. , Stimac Gary K. , Winn H. Richard
Published: May 2009

✓ Computerized tomography (CT) infusion scanning can confirm the presence or absence of an aneurysm as a cause of spontaneous intracerebral hemorrhage. Eight patients who presented with spontaneous hemorrhage were examined using this technique. In five patients the CT scan showed an aneurysm which was later confirmed by angiography or surgery; angiography confirmed the absence of an aneurysm in the remaining three patients. This method is an easy effective way to detect whether an aneurysm is the cause of spontaneous intracerebral hemorrhage.
Nonoperative treatment of spinal epidural infections
Authors: Mampalam Thomas J. , Rosegay Harold , Andrews Brian T. , Rosenblum Mark L. , Pitts Lawrence H.
Published: May 2009

✓ Spinal epidural infections were diagnosed before the onset of neurological deficits in six patients and treated nonsurgically. The diagnosis was based on the clinical presentation and on the results of myelography and computerized tomography scanning. Positive cultures were obtained from blood in all six patients, from aspiration of a paraspinous infection in two, and from a skin abscess and a pulmonary empyema in one patient each. Staphylococcus aureus was the causative organism in five cases. All patients were treated with intravenous antibiotics and remained neurologically intact throughout the course of treatment. Five patients have had no recurrence of their symptoms. One patient eventually required surgery for persistent discitis.
Immunomagnetic separation of infiltrating T lymphocytes from brain tumors
Authors: Bosnes Vidar , Hirschberg Henry
Published: May 2009

✓ Tumor-infiltrating lymphocytes (TIL's) were isolated from human glioma biopsy specimens by immunomagnetic separation using T cell-specific monoclonal antibodies coupled to paramagnetic beads, and were expanded in culture with feeder cells and interleukin-2 (IL-2). The infiltrating cells from five of seven patients proliferated in culture. When tested after 2 to 3 weeks of culture, virtually all of the cells stained with antibodies against the CD2 and CD3 antigens. Most cells also expressed human leukocyte antigen class II molecules, while varying percentages of cells stained with antibodies against the IL-2 receptor and the CD4 and CD8 antigens. The cytotoxicity of the cultured TIL's against autologous and allogeneic glioma cells and the K562 and Daudi cell lines was measured and compared with that of lymphokine-activated killer (LAK) cells from the same patients. None of the TIL's showed significant cytotoxicity against these targets, whereas LAK cells lysed all of the targets.
Protective effect of the iron chelator deferoxamine on cold-induced brain edema
Authors: Ikeda Yukio , Ikeda Kiyomi , Long Donlin M.
Published: May 2009

✓ Oxygen free radicals such as superoxide radical and iron-catalyzed hydroxyl radical generated by the superoxide system have been implicated in the genesis of brain edema. Therefore, deferoxamine (DFO), an iron chelator, could potentially be used to treat brain edema. To examine this hypothesis, vasogenic brain edema was produced in 48 cats by a cortical freezing lesion. The animals were separated into three groups: Group 1 comprised 14 cats that received no DFO and were sacrificed at 6 or 24 hours; Group 2 consisted of 12 cats that were treated with DFO (50 mg/kg/ml, intravenously) at 15 minutes before the lesion was made and 60 minutes later and were sacrificed at 6 or 24 hours; and Group 3 included 12 cats that were treated with DFO (50 mg/kg/ml, intravenously) at 15 minutes after the lesion was produced and 60 minutes later and were sacrificed at 6 or 24 hours. The effect of DFO on arterial blood pressure was also studied in the remaining 10 cats.

Brain water content in eight sampling areas was measured by the specific gravity method. Blood-brain barrier disruption was assessed by spread of Evans blue dye with planimetry. Specific gravity values at 6 and 24 hours were significantly higher in Group 2 than in Group 1 animals. Areas of Evans blue dye extravasation at 6 and 24 hours were significantly reduced in Group 2 relative to Group 1. Group 3 cats showed improvement in specific gravity values and Evans blue extravasation at 6 hours, but not at 24 hours. The iron chelator DFO prevented early development of brain edema; thus, this oxygen free radical scavenger may provide a foundation for a new therapy for brain edema.
Ultrastructure of the human posttraumatic syrinx
Authors: Reddy Kesava K. V. , Del Bigio Marc R. , Sutherland Garnette R.
Published: May 2009

✓ Although posttraumatic syringomyelia is a well-established clinicopathological entity, there is a paucity of information on the ultrastructural features of this condition. This study documents the light and electron microscopic features of posttraumatic syringes obtained from two patients who underwent surgical cordectomy. The syringes were lined largely by cell processes of astrocytes. Small regions near the caudal end were lined by flattened ependymal cells that lacked surface specializations. These were thought to represent remnants of the central canal ependyma. The ultrastructural appearance of the syrinx was similar to that of the communicating syringomyelia as well as the periventricular changes that accompany hydrocephalus. The authors conclude that the changes represent the nonspecific sequelae of a distensile force within the syrinx cavity.
Mucinous cysts of the pituitary stalk
Authors: Panagopoulos Kanaris P. , Jolesz Ferenc A. , El-Azouzi Mustapha , Black Peter McL.
Published: May 2009

✓ This report describes two cases of a mucinous cyst (Rathke's cleft cyst) in the pituitary stalk: the first was found in a 29-year-old woman 5 years following pregnancy and the second in a 30-year-old woman 6 years after pregnancy. The presenting symptoms are analyzed and the diagnosis is discussed, with emphasis on the role of magnetic resonance imaging.
Vascularized fibular graft to replace resected cervical vertebral bodies
Authors: Freidberg Stephen R. , Gumley Graham J. , Pfeifer Bernard A. , Hybels Roger L.
Published: May 2009

✓ Use of a vascularized free fibular graft is described as a method of replacing excised cervical vertebrae when severe instability is present. The vascularized bone graft heals more rapidly and with greater strength than a nonvascularized autogenous graft.
Sparganosis of the brain
Authors: Anegawa Shigetaka , Hayashi Takashi , Ozuru Katsuyasu , Kuramoto Shinken , Nishimura Kenichi , Shimizu Takashi , Hirata Mizuki
Published: May 2009

✓ A rare case of cerebral sparganosis occurring in a 7-year-old boy is reported. Since his clinical symptoms fluctuated and diagnostic evaluation demonstrated multiple lesions, he was examined for a parasitic infection. Emphasis is placed on the difficulties involved in diagnosing cerebral sparganosis.