bluuebunny/crossref_metadata_2025 huggingface dataset:
Mononuclear cell infiltration in central portions of human astrocytomas
Authors: Hitchcock Edward R. , Morris Christine S.
Published: May 2009

✓ The mononuclear cell infiltration in the central portion of human low- and high-grade astrocytomas has been examined using monoclonal antibodies to cell surface differentiation antigens. There was no significant difference between the number of T cells, B cells, or macrophages. The OKT8+(suppressor/cytotoxic) T cell population was the major lymphocyte subset in the infiltrates. There was, however, indirect evidence for a proportion of the total OKT8+cells being natural killer cells. Overall, there was a significant difference in the number of macrophages compared to the total lymphoid cell population. Several cell types seem to play an equal role in the cellular and humoral immune response within the center of the tumors, as distinct from that occurring at the periphery.
In situ characterization, clonogenic potential, and antitumor cytolytic activity of T lymphocytes infiltrating human brain cancers
Authors: Miescher Sylvia , Whiteside Theresa L. , de Tribolet Nicolas , von Fliedner Vladimir
Published: May 2009

✓ Mononuclear cells infiltrating human brain tumors were isolated from seven of nine surgical biopsy specimens. These cells were small T11+,T3+lymphocytes that did not express DR antigens or the receptor for interleukin-2. In addition, large granular lymphocytes were recovered from two of these tumors. The clonogenic potential of tumor-infiltrating lymphocytes (TIL's) was assessed by limiting-dilution analysis (LDA) using a microculture system that permits proliferation of virtually 100% of normal peripheral blood T lymphocytes (PBL-T's).

In comparison to normal and autologous PBL-T's, TIL's had a strikingly reduced proliferative potential revealed by a decrease in the frequency of proliferating T lymphocyte precursors calculated by LDA. On average, only one of every 100 T cells from TIL's was able to proliferate, as compared to one of every two or all of the T cells from the patient's peripheral blood or from normal donors. Furthermore, the TIL populations showed depressed proliferative responses to the lectins phytohemagglutinin and concanavalin A and to the phorbol ester 12-0-tetradecanoyl-phorbol-13-acetate. Clonal analysis performed on the proliferating microcultures from three tumors demonstrated that the majority of these clones possessed cytolytic activity against various tumor cell targets. Among clones tested for cytolytic activities with glioma cells, four lysed cultured autologous tumor cells, and the specific lysis was > 50% in all cases. Numerous clones with natural killer (NK)-like activity were obtained from two TIL preparations, and the frequency of cytolytic T lymphocyte precursors with NK-like activity was determined for one of these preparations and was found to be higher than that in the patient's peripheral blood. Glioma cells grown in culture and then mixed with normal peripheral blood lymphocytes (PBL's) were capable of inhibiting the PBL's response to lectins. This inhibitory property may account in part for the observed poor clonogenicity of TIL's from brain tumors. Nevertheless, nearly all proliferating clones displayed cytotoxicity against either autologous or allogeneic tumor cell targets and may imply selective accumulation of cytolytic effector cells at the tumor site.
Effects of the 21-aminosteroid U74006F on posttraumatic spinal cord ischemia in cats
Authors: Hall Edward D.
Published: May 2009

✓ The ability of a single intravenous dose of the 21-aminosteroid U74006F to affect the development of posttraumatic spinal cord ischemia was examined in pentobarbital-anesthetized cats. After surgical preparation, each animal received a 300 gm-cm contusion injury to the exposed L-3 vertebral segment, followed by a single bolus injection of vehicle or U74006F (3 or 10 mg/kg) at 30 minutes postinjury. Spinal cord white matter blood flow (SCBF) was measured by hydrogen clearance in the dorsolateral funiculus in the center of the injured segment before and at various times up to 4 hours after injury. In vehicle-treated cats, there was a progressive decline in SCBF over the course of the experiment. By 4 hours postinjury, SCBF had decreased from a preinjury value of 15.9 ± 2.4 ml/100 gm/min (mean ± standard error of the mean) to 5.8 ± 0.8 ml/100 gm/min, representing a decline of 63.5%. In contrast, the SCBF measured 4 hours postinjury in cats that were treated with a single 10-mg/kg dose of U74006F was 13.6 ± 1.7 ml/100 gm/min (p < 0.001 vs. vehicle). Animals that received a 3-mg/kg intravenous dose of U74006F displayed a drop in SCBF equal to that of vehicle-treated cats. However, when a 3-mg/kg dose of U74006F was given to four vehicle-treated cats at the end of the experiment, a partial reversal of ischemia was recorded. Blood flow increased within 30 minutes from a mean of 4.5 ± 0.8 to 7.4 ± 1.0 ml/100 gm/min or an increase of 64.4% (p < 0.05). This rather surprising effect of U74006F in reversing posttraumatic ischemia once it has developed significantly is not shared by a 30-mg/kg intravenous dose of methylprednisolone sodium succinate (MP), although MP has previously been shown to attenuate the posttraumatic drop in SCBF when given before the SCBF drop occurs. The mechanism of action of U74006F in antagonizing posttraumatic ischemia development is believed to involve the ability of the compound to inhibit iron-dependent lipid peroxidation in central nervous system tissue.
Intraventricular varix causing hemorrhage
Authors: Roda José M. , Bencosme José , Isla Alberto , Blázquez Martín G.
Published: May 2009

✓ A case of a cerebrovascular varix located in the right lateral ventricle is reported. The patient suffered intraventricular and subarachnoid hemorrhages. The intraventricular varix was coagulated and excised.
Water-soluble contrast medium for intraoperative evaluation of anterior cervical discectomy
Authors: Walker Joseph , Gillespie Ritchie , Davis John , Dawson William
Published: May 2009

✓ When anterior cervical discectomy is performed for either “hard” or “soft” cervical disc herniation using either the Cloward approach or simple discectomy, it is often difficult to confirm intraoperatively the adequacy of the lateral, superior, and inferior margins of the dissection. Placement of a nonionic contrast material, iohexol, into the disc space before obtaining anteroposterior and lateral x-ray spine films can indicate the adequacy of the margins of dissection of the soft disc or bone ridge to prevent a poor operative result.
Unusual spinal cord enlargement related to intramedullary hemangioblastoma
Authors: Solomon Robert A. , Stein Bennett M.
Published: May 2009

✓ In a series of 60 intramedullary spinal cord tumors, there were eight cases of hemangioblastoma. Seven of these eight patients displayed evidence of diffuse spinal cord enlargement over multiple levels at a considerable range beyond the actual location of the tumor. One patient had a large intramedullary cyst that accounted for only part of the enlargement, and one had multiple tumor nodules. Six other patients had no obvious explanation for the diffuse cord enlargement.

This phenomenon of extensive spinal cord enlargement appears to be unique to this type of tumor and not related to multiple tumors or extensive cyst formation. The cord enlargement seems to be related to edema and congestion of the spinal cord, perhaps secondary to the vascular shunt present in the hemangioblastomas. The possible pathophysiology and clinical importance of this observation is discussed.
Posterior cervical reconstruction with methyl methacrylate cement and wire: a clinical review
Authors: Whitehill Richard , Cicoria Anthony D. , Hooper William E. , Maggio William W. , Jane John A.
Published: May 2009

✓ The charts and radiographs of 20 patients who were treated for traumatic cervical instability by the Department of Neurosurgery at the University of Virginia by means of posterior reconstruction with methyl methacrylate cement and fixation wires were reviewed by the Department of Orthopaedic Surgery. Based primarily on radiographic criteria, it was found that posterior reconstruction failed to rigidly immobilize the underlying unstable motion segments in 11 patients. Four of these patients required additional surgery to correct postoperative instability. Based on this experience, cement and wire reconstructions are now recommended only when: 1) they can be limited to one cervical level; 2) No. 18 fixation wire is used; 3) wiring is performed from a facet on one side to the adjacent spinous processes; and 4) autogenous bone graft is added to the posterior elements on the side of the midline opposite the cement and wire.
Effect of posttraumatic hypoventilation on cerebral energy metabolism
Authors: Andersen Bruce J. , Unterberg Andreas W. , Clarke Geoff D. , Marmarou Anthony
Published: May 2009

✓ Cerebral energy metabolism was studied in cats subjected to fluid-percussion brain trauma followed immediately by 30 minutes of controlled hypoventilation for the purpose of simulating a more realistic model of human head injury. The cerebral blood flow (CBF) and cerebral metabolic rates of oxygen (CMRO2) and glucose (CMRGl) were measured, with simultaneous phosphorus-31 magnetic resonance spectroscopy quantifications of cerebral tissue pH, phosphocreatine (PCr), and inorganic phosphate (Pi). Hypoventilation alone did not produce marked changes in CMRGl, tissue pH, or PCr:Pi ratios. When hypoventilation was combined with trauma, marked alterations in CBF, CMRGl, PCr:Pi ratio, and tissue pH were seen, indicating relative ischemia. The alterations of cerebral energy metabolism produced by combining trauma and hypoventilation are more severe than those caused by fluid-percussion trauma alone, and may provide a more realistic model of human head injury.
Cavernous hemangioma of Meckel's cave
Authors: Fehlings Michael G. , Tucker William S.
Published: May 2009

✓ A case of a cavernous hemangioma located within Meckel's cave and involving the gasserian ganglion is described in a patient presenting with facial pain and a trigeminal nerve deficit. Although these lesions have been reported to occur in the middle fossa, this is believed to be the first case of such a vascular malformation arising solely from within Meckel's cave.
A four-wall orbital decompression for dysthyroid orbitopathy
Authors: Stranc Mirek , West Michael
Published: May 2009

✓ A new surgical technique is described for the relief of the ocular manifestations of dysthyroid orbitopathy. Surgical decompression of the orbit was reserved for patients who failed to respond to medical treatment. Eleven patients (nine women and two men) were followed for periods from 3 to 48 months. Visual loss was the commonest presentation and the main indication for surgery. All patients had failed to respond to medical therapy, consisting of steroid and/or radiation therapy. Three patients had previously undergone orbital decompressions with limited success. Six patients had preoperative visual acuity of worse than 20/200. Preoperative exophthalmos ranged from 24 to 35 mm (normal 16 mm). The orbits were approached by a bifrontal scalp flap with exposure of the temporal and infratemporal fossae. The orbital roof was approached transcranially. The posterior wall of the frontal sinus was removed together with the mucous lining. To maximize the decompression, the periosteum surrounding the orbital contents was incised, allowing the contents to prolapse through the newly created windows into the maxillary antrum, temporal fossa, anterior cranial fossa, and nose. During the past 3 years, 22 orbits in 11 patients have been decompressed by this technique. Symptomatic relief was obtained in all but one patient who still had significant exophthalmos with keratitis, but did have a dramatic improvement in vision. The decrease in exophthalmos ranged from 1 to 13 mm (mean 7 mm). The most dramatic improvement was in vision, with postoperative acuity of 20/20 to 20/30 in all but two patients. There were no deaths and no major morbidity.
Thallium-201 tumor/cardiac ratio estimation of residual astrocytoma
Authors: Mountz James M. , Stafford-Schuck Kathy , McKeever Paul E. , Taren James , Beierwaltes William H.
Published: May 2009

✓ Treatment of high-grade astrocytoma includes surgery, chemotherapy, and various methods of irradiation. Radiation therapy usually results in necrosis and edema around the primary tumor site. Contrast-enhanced computerized tomography (CT) and standard radionuclide imaging techniques are unable to reliably distinguish recurrent tumor from necrosis or edema since these images depict localization of contrast material or tracer, which primarily depends on blood-brain barrier breakdown. Thallium-201 (201Tl) appears to incorporate into viable tumor cells more rapidly than into normal brain cells. This report describes a new method to quantify the uptake of 201Tl in the tumor: the tumor-to-cardiac uptake ratio (T/C). Twenty-three 201Tl brain scans were performed on eight patients to differentiate recurrent viable high-grade astrocytoma from posttherapy changes. Planar images of the head and heart were obtained in order to calculate the ratio of tumor counts to cardiac counts. This ratio represents a numerical estimation of 201Tl uptake in the brain tumor relative to cardiac counts and is expressed as the T/C index. The T/C index correlated well with the clinical course in all eight patients. In general, however, CT suggested more extensive regrowth of tumor than the actual clinical status suggested. In one patient's course of radiological monitoring, tumor recurrence was detected by means of 201Tl imaging four months prior to its appearance on CT. In conclusion, when performed serially, the T/C index can provide an accurate estimate of residual tumor burden or recurrence, and detect and quantify viable tumor during therapy.
A clinical comparison of subarachnoid catheters to ventriculostomy and subarachnoid bolts: a prospective study
Authors: Mollman H. Dennis , Rockswold Gaylan L. , Ford Sandra E.
Published: May 2009

✓ A subarachnoid catheter (SAC) technique of continuous intracranial pressure (ICP) monitoring is presented and compared to intraventricular catheters (IVC's) and subarachnoid bolts (SAB's) in 40 neurosurgical patients. Thirty-one patients were monitored simultaneously with SAC's and IVC's and nine patients with SAC's and SAB's, and the ICP waveforms and measurements were compared. The duration of monitoring ranged from 15 hours to 11 days, and the initial ICP from 2 to 117 torr. A total of 42 SAC's were placed; two that entered brain parenchyma were redirected. One SAC placement was associated with an intracerebral hematoma. There were no infections. For the 31 patients with SAC's and IVC's, there were 2706 pairs of ICP measurements with a mean difference of −0.12 torr and a standard deviation of 5.29 torr. The waveforms from the SAC's and IVC's were indistinguishable. For the nine patients with SAC's and SAB's, there were 773 pairs of ICP measurements with a mean difference of 1.24 torr and a standard deviation of 32.83 torr. The SAB waveforms were of varying quality and all dampened with time. The paired t-test (ts) demonstrated no statistically significant difference between SAC's and IVC's (ts = −1.19). An analysis of variance demonstrated the scatter of the measurements obtained from SAB's to be 38.5 times that of SAC's, p < 0.00005. The SAB is shown to be relatively inaccurate with a wide range of variance, while the SAC is demonstrated to be an accurate, reliable, and safe method of continuous ICP measurement and an acceptable alternative to ventriculostomy.
Effect of removal of the endothelium on vasocontraction in canine and rabbit basilar arteries
Authors: Nakagomi Tadayoshi , Kassell Neal F. , Sasaki Tomio , Lehman R. Michael , Torner James C. , Hongo Kazuhiro , Lee Joung H.
Published: May 2009

✓ The effect of endothelium removal on the contractile responses to KCl, hemoglobin, serotonin (5-HT), norepinephrine (NE), prostaglandin (PG)F2α, PGD2, and PGE2was investigated in canine and rabbit basilar arteries by an isometric tension-recording method. In canine basilar arteries, endothelium removal elevated the dose-response curves to 5-HT, PGF2α, and PGD2, and PGE2, but not to KCl, hemoglobin, or NE. In rabbit basilar arteries, on the other hand, removal of the endothelium elevated the dose-response curves to 5-HT, NE, PGF2α, and PGD2, but not to KCl or hemoglobin. Neither contractile nor inhibitory response was elicited by PGE2in rabbit basilar arteries. Contraction induced by 5-HT and NE following endothelium removal had a much more pronounced effect in rabbit basilar arteries than in canine basilar arteries.

These results suggest that, following endothelium removal, abolition of the spontaneous release of endothelium-derived relaxing factor is the most probable mechanism of the enhanced vasocontraction. Since endothelial damage results from subarachnoid hemorrhage, the aforementioned mechanism of vasocontractile enhancement may play a role in the pathogenesis of cerebral vasospasm.
Aneurysms of the basilar artery treated with circulatory arrest, hypothermia, and barbiturate cerebral protection
Authors: Spetzler Robert F. , Hadley Mark N. , Rigamonti Daniele , Carter L. Philip , Raudzens Peter A. , Shedd Steven A. , Wilkinson Elizabeth
Published: May 2009

✓ Complete circulatory arrest, deep hypothermia, and barbiturate cerebral protection are efficacious adjuncts in the surgical treatment of selected giant intracranial aneurysms. These techniques were utilized in seven patients, one with a large and six with giant basilar artery aneurysms; four had excellent results, one had a good result, one had a fair outcome, and one died. The rationale for the use of complete cardiac arrest with extracorporeal circulation, hypothermia, and barbiturate cerebral protection is outlined. The surgical and anesthetic considerations are reviewed. The perioperative morbidity and long-term results support the use of these techniques in selected patients with complex intracranial vascular lesions.
Subependymal giant-cell astrocytoma in children
Authors: Chow Chung W. , Klug Geoffrey L. , Lewis Elizabeth A.
Published: May 2009

✓ The authors describe five cases of subependymal giant-cell astrocytoma in children in which many clinical, histological, immunohistochemical, and ultrastructural features typical of this tumor were present. However, prominent focal necrosis and mitoses, features usually associated with high-grade tumors, were seen in all cases. Despite the presence of necrosis and mitoses, clinical follow-up studies have revealed a lack of aggressive tumor behavior after surgery alone. The discrepancy between the histological and clinical features in these cases is emphasized so that excessive treatment of a basically low-grade tumor may be avoided. Mast cells were seen in all five cases, often in large numbers.
Peritoneal drainage of chronic subdural hematomas in older patients
Authors: Probst Charles
Published: May 2009

✓ Most patients with chronic subdural hematoma are successfully treated with trephination and external drainage. However, hematomas with thick membranes may persist or recur, needing reoperation or major surgery such as craniotomy with membranectomy. In 14 patients aged over 60 years, internal peritoneal drainage of the hematoma by a low-pressure shunt system proved to be a reliable method of treatment with the following advantages: rapid neurological improvement; immediate postoperative mobilization; little stress for the patient; no recurrence; disappearance of the membranes; and slow and well-tolerated cerebral reexpansion without hypotension. Successful use of this method has been reported previously in children, but not in adults.
Pre-irradiation internal carotid artery BCNU in treatment of glioblastoma multiforme
Authors: Bashir Rifaat , Hochberg Fred H. , Linggood Rita M. , Hottleman Kathleen
Published: May 2009

✓ High-dose 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) infusion into the internal carotid artery following cranial irradiation in the treatment of glioblastoma multiforme is accompanied by evidence of leukoencephalopathy in a significant number of patients. In an attempt to avoid this problem, a phase I trial was performed using intracarotid BCNU infusion before irradiation. Twenty-eight patients with grade III/III astrocytoma (World Health Organization Classification, equivalent to Kernohan grade IV) received a 400-mg infusion of BCNU into the infraophthalmic carotid artery. The treatment was repeated every 4 weeks for a total of four cycles prior to cranial irradiation (5500 to 6000 cGy). The major toxic sequelae included nausea and vomiting (24%), decreased visual acuity (14%), transient cerebral ischemia (3.5%), and thrombocytopenia (3.5%). Fatal leukoencephalopathy occurred in two patients. The median survival time was 37 weeks for all evaluable patients and 56+ weeks for those completing the protocol. The tumor response to drug infusion as judged by computerized tomography (CT) was complete in 22% of patients and partial in 22%; 56% showed no CT tumor response.

Pre-irradiation intracarotid artery BCNU benefits a very small group of patients with grade III/III astrocytoma. The associated severe leukoencephalopathy makes this mode of therapy unacceptable for a phase III trial.
Autotransplantation of the superior cervical ganglion into the brain
Authors: Itakura Toru , Kamei Ichiro , Nakai Kunio , Naka Yutaka , Nakakita Kazuo , Imai Harumichi , Komai Norihiko
Published: May 2009

✓ The superior cervical ganglion (SCG) of rats was transplanted into their own parietal cortex. Four weeks after implantation, catecholamine histofluorescence revealed many transplanted catecholamine cells in the cortex. However, no fibers extended from the transplanted tissue to the cerebral cortex. In a second group of rats which had been pretreated with 6-hydroxydopamine (a specific neurotoxin to the catecholamine neuron), some showed extension of catecholamine fibers to the cerebral cortex.

To simulate an animal model of Parkinson's disease, MPTP (1-methyl-4-phenyl-1,2,5,6-tetrahydropyridine) was administered to five monkeys. Two weeks after MPTP administration, dopamine terminals in the caudate nucleus disappeared. After autotransplantation of the SCG into the caudate nucleus of these monkeys, many of the transplanted SCG cells extended axons beyond the graft into the caudate nucleus. These results show that transplanted SCG cells survived well in the brain. Under special circumstances, such as a shortage of catecholamine in the brain, implanted SCG cells extended their axons into the brain. It is suggested that autotransplantation of SCG grafts may be a new therapy for Parkinson's disease.
An easily replaceable intracranial catheter
Authors: Lehman Ralph A. W.
Published: May 2009

✓ Replacement of a catheter draining an intracranial cyst or a ventricle can be difficult if the fluid space has collapsed. An intracranial catheter which can be safely and accurately exchanged is described. The catheter also offers an advantage during the original placement if the fluid cavity to be drained has a thick wall.
Glycerol rhizolysis for treatment of trigeminal neuralgia
Authors: Young Ronald F.
Published: May 2009

✓ Percutaneous retrogasserian glycerol instillation was performed under local anesthesia for treatment of trigeminal neuralgia in 162 patients. A simplified technique that did not involve cisternography was used. Initial pain relief was achieved in 146 patients (90.1%). Recurrent pain was noted in 27 patients (18.5%) and was more frequent (50%) in patients who had undergone surgical treatments prior to glycerol injection than in those who had no previous surgical treatment (12.3%). A second glycerol injection was carried out in nine patients and a third injection in two patients. The follow-up period extended from 6 to 67 months and 77.8% of patients are totally pain-free after one or more glycerol injections. Another 8.6% experienced good pain relief with the addition of small doses of pharmacological agents. Thus, 140 (86.4%) of the original 162 patients experienced satisfactory pain control following glycerol rhizolysis.

Initial sensory loss on the face occurred in 117 patients (71.6%) but at last follow-up examination only 46 patients (28%) experienced mild orofacial hypalgesia and 13 patients (8%) noted analgesia. The corneal reflex was absent in three patients (1.8%) and reduced in five (3.1%). No patients noted corneal ulceration or anesthesia dolorosa. Percutaneous retrogasserian glycerol rhizolysis offers a rapid, safe, reliable, and relatively inexpensive surgical approach to treatment of trigeminal neuralgia.
Prophylactic parenteral antibiotics in clean neurosurgical procedures: a review
Authors: Dempsey Robert , Rapp Robert P. , Young Byron , Johnston Sarah , Tibbs Phillip
Published: May 2009

✓ Clean surgical procedures carry a risk of postoperative wound infection that is less than 5% in most hospitals. The use of prophylactic antibiotic agents in clean neurosurgical cases is controversial, and the neurosurgical literature through 1980 contains no controlled clinical trials to study its effectiveness in such cases. A report of 1732 consecutive procedures without a single postoperative wound infection in patients receiving systemic gentamicin, vancomycin, and streptomycin irrigation fluids is often quoted by neurosurgeons; however, these results have not yet been duplicated by others. Since 1980, there have been several controlled trials that support the use in clean neurosurgical cases of prophylactic antibiotics, including the vancomycin/gentamicin/streptomycin regimen and the first-generation cephalosporins. A report in 1986 of 1602 cases without a primary wound infection supports the use of a single perioperative dose of cefazolin. A review of causative organisms in postoperative wound infections demonstrates the preponderance of Gram-positive pathogens. Therefore, when antibiotic prophylaxis is indicated, adequate Gram-positive bacterial coverage, including protection against Staphylococcus infection, is required. With consideration of the present data, the cost of antibiotic therapy, and the danger of drug toxicity, a short perioperative regimen of cefazolin as prophylaxis is preferred in clean neurosurgical cases.
Effects of calcium antagonists on intracerebral penetrating arterioles in rats
Authors: Takayasu Masakazu , Bassett John E. , Dacey Ralph G.
Published: May 2009

✓ There is no direct information on the effect of calcium antagonists on intracerebral penetrating arterioles, which are responsible for a significant part of total cerebrovascular resistance. In a study on rats, the effects of four calcium antagonists (diltiazem, verapamil, nifedipine, and nimodipine) on isolated intracerebral penetrating arterioles with mean resting diameters (± standard error of the mean) of 52.3 ± 3.0 µm were investigated. Vessel diameters were monitored in vitro by means of a video microscope dimensional analyzer under constant transmural pressure (60 mm Hg) after cannulation. Each calcium antagonist produced maximal dilation of about 50% (diltiazem 46.4% ± 5.6%, verapamil 53.1% ± 6.0%, nifedipine 46.9% ± 6.1%, and nimodipine 47.1% ± 5.4%) with varied sensitivity (median effective dose (ED50): diltiazem 1.52 × 10−6 M, verapamil 1.08 × 10−7 M, nifedipine 8.65 × 10−9 M, and nimodipine 1.62 × 10−9 M). Dilation effects persisted for a significantly longer time after washout with calcium antagonists such as diltiazem (15.5 ± 1.8 minutes), nifedipine (19.0 ± 3.9 minutes), and nimodipine (30.0 ± 1.6 minutes) than after washout with adenosine (8.5 ± 1.0 minutes). It appeared that the magnitude of vasodilation was greater and the duration of dilation after washout longer in intracerebral penetrating arterioles than that reported for pial arterioles, although sensitivity to each calcium antagonist was quite similar to that reported for larger cerebral arteries. These data provide a possible explanation for the apparent disparity between clinical efficacy and angiographically determined vessel diameter when patients with cerebral vasospasm are treated with calcium antagonists. These agents may have a greater effect on intracerebral penetrating arterioles than on angiographically visible larger arteries.
Intervertebral disc space cyst simulating a recurrent herniated nucleus pulposus
Authors: Grabel Jordan C. , Davis Raphael , Zappulla Rosario
Published: May 2009

✓ The case presented is of a patient with an intervertebral disc space cyst producing recurrent radicular pain following microdiscectomy in the lumbar region. Difficulties with the preoperative diagnosis of this and other recurrent radicular syndromes are discussed, and a review of the relevant literature is presented.
Cushing Oration, 1988: Law and medicine: conflict or collaboration?
Authors: Dickson Brian
Published: May 2009

✓ Doctors and lawyers share the common goal of pursuit of the welfare of the patient and client. Even where litigation brings physicians into conflict with the law, collaboration must be our guide. The standard of care is defined by reference to the expertise of the medical profession. The need for informed consent is based upon the moral and ethical values our professions share. In assessing fair compensation, legal rules are shaped by the need to make the lives of the injured and disabled bearable, again an ethical value we hold in common. The nature of our day-to-day tasks and the methods we employ may be different, but we must never lose sight of the fact that the interests of society can only be met if we work closely together.
Ventral paraclinoid carotid aneurysms
Authors: Nutik Stephen L.
Published: May 2009

✓ A series of 15 patients with 17 ventral paraclinoid carotid artery aneurysms is presented. With this type of aneurysm the neck is at or just distal to the level of the ophthalmic artery and proximal to the posterior communicating artery on the ventral surface of the carotid artery. There is a high incidence of female patients and multiple aneurysms. At surgery, the aneurysms are hidden by the anterior clinoid process and often have an intracavernous component. The neck of the aneurysm is usually intradural and can be clipped.
Angiographically occult arteriovenous malformations
Authors: Ogilvy Christopher S. , Heros Roberto C. , Ojemann Robert G. , New Paul F.
Published: May 2009

✓ Eight cases of histopathologically proven arteriovenous malformations (AVM's) which were not visualized on angiography are presented. As is typical with these lesions, most of the patients in this series presented with hemorrhage, seizures, or episodic or progressive neurological symptoms suggestive of a neoplasm. The diagnosis of angiographically occult AVM was highly suspected preoperatively in each case based on the combination of computerized tomography (CT) and magnetic resonance (MR) findings. The CT scans in all cases showed moderately hyperdense lesions which enhanced mildly or moderately in a nonhomogeneous pattern with administration of contrast material. The MR image showed one or more bright areas interspersed with areas of low or absent signal peripherally or centrally on both T1- and T2-weighted images. The AVM was totally excised in seven patients and partially excised in one patient, with favorable results in all. The clinical management and differential diagnosis of angiographically occult AVM's are discussed. In patients with a clinical course and radiological studies suggestive of an occult AVM, removal of the lesion, if accessible, should be performed in order to rule out a neoplasm and prevent subsequent hemorrhage and progression of symptoms.
Meningiomas and hemorrhagic diathesis
Authors: Oka Kazunari , Tsuda Hiroko , Kamikaseda Kazufumi , Nakamura Ryuji , Fukui Masashi , Nouzuka Youko , Sueishi Katsuo
Published: May 2009

✓ The physical act of operating on 13 patients with meningiomas was studied for its effect on the fibrinolytic system. Fibrinolytic abnormalities, mainly due to an increase of plasma fibrinolytic activity, appeared in three patients prior to, during, or after surgery. These patients demonstrated hemorrhagic diathesis in the operative wounds which was associated with a consumptive coagulopathy, namely, an increase of fibrin/fibrinogen degradation product concentration and a decrease of fibrinogen concentration in plasma. Antiplasmin agents (gabexate and tranexamic acid) were effective in minimizing loss of blood during and after the operation. Abnormal hyperfibrinolysis seems to play a role in hemostatic difficulties in patients undergoing surgery for meningioma.
Late neurological changes following traumatic spinal cord injury
Authors: Piepmeier Joseph M. , Jenkins N. Ross
Published: May 2009

✓ Sixty-nine patients with traumatic spinal cord injuries were evaluated for changes in their functional neurological status at discharge from the hospital, and at 1 year, 3 years, and 5+ years following injury. The neurological examinations were used to classify patients' spinal cord injury according to the Frankel scale. This analysis revealed that the majority of improvement in neurological function occurred within the 1st year following injury; however, changes in the patients' status continued for many years. Follow-up examinations at an average of 3 years postinjury revealed that 23.3% of the patients continued to improve, whereas 7.1% had deteriorated compared to their status at 1 year. An examination at an average of 5+ years demonstrated further improvement in 12.5%, with 5.0% showing deterioration compared to the examinations at 3 years. These results demonstrate that, in patients with spinal trauma, significant changes in neurological function continue for many years.
In vitro cytolysis of primitive neuroectodermal tumors of the posterior fossa (medulloblastoma) by lymphokine-activated killer cells
Authors: George Richard E. , Loudon William G. , Moser Richard P. , Bruner Janet M. , Steck Peter A. , Grimm Elizabeth A.
Published: May 2009

✓ Short-term stimulation of nonantigen-primed peripheral blood mononuclear leukocytes with interleukin-2 generates a population of oncolytic effectors designated “lymphokine-activated killer” (LAK) cells. These LAK cells express potent lytic activity against a wide spectrum of fresh or cultured autochthonous (patient's own) and allogeneic (unrelated) tumors, yet specifically spare normal tissues. In this study, cells derived from primitive neuroectodermal tumors of the posterior fossa (PNET-PF) were examined for their sensitivity to LAK cytolysis utilizing anin vitro4-hour chromium-51-release assay. Five early-passage cell lines, derived from primary PNET-PF, demonstrated significant sensitivity to LAK cell cytolysis. Lysis was equally effective in culture medium and cerebrospinal fluid. Three freshly excised PNET-PF exhibited similar susceptibility to lysis by autochthonous LAK cells. Greatly increased expansion of LAK cell cultures could be achieved by short-term stimulation with monoclonal anti-CD3 antibodies in addition to interleukin-2 activation. These findings constitute the preliminaryin vitrofoundations for potential intrathecal adoptive immunotherapy of PNET-PF with LAK cells.
Ergonomic considerations in the design of neurosurgery instruments
Authors: Núñez German , Kaufman Howard
Published: May 2009

✓ Surgical instruments should be designed to optimize control and interact with tissues or other objects while avoiding surgeon fatigue, muscle spasms, tissue ischemia, and injuries. Several well-established ergonomic criteria can be used in the design of instruments. Analysis of some commonly used bone biting instruments reveal how they violate these criteria. The thoughtful redesign of instruments using these principles is recommended.
Trapping of giant basilar trunk aneurysms
Authors: Kashiwagi Shiro , Tew John M. , van Loveren Harry R. , Thomas Geoffrey
Published: May 2009

✓ Two cases of successful trapping of giant basilar trunk aneurysms are presented. The aneurysms were trapped by clipping the basilar artery distal to the anterior inferior cerebellar arteries and proximal to the superior cerebellar arteries. The outcome was excellent in both cases. In the treatment of giant basilar trunk aneurysms, trapping the involved segment of the basilar artery is an effective way to obliterate and decompress the aneurysm. Preoperative assessment of potential collateral vascular supply, operative technique, and the efficacy of intraoperative monitoring are discussed.
Retrolabyrinthine transsigmoid approach to basilar trunk and vertebrobasilar artery junction aneurysms
Authors: Giannotta Steven L. , Maceri Dennis R.
Published: May 2009

✓ A retrolabyrinthine transsigmoid approach was employed successfully in three patients with vertebrobasilar aneurysms. The major benefits of this technique include a relatively shallow depth of exposure, lack of brain stem retraction, and simplicity as compared to traditional and some recently proposed methods. All three patients have returned to their previous activities.
CSF leukotriene C4 following subarachnoid hemorrhage
Authors: Paoletti Pietro , Gaetani Paolo , Grignani Guido , Pacchiarini Lucia , Silvani Vittorio , Rodriguez y Baena Riccardo
Published: May 2009

✓ Leukotrienes derive from arachidonic acid metabolism via the lipoxygenase pathway and modulate several cellular events. In the central nervous system, leukotrienes are mainly synthesized in the gray matter and in vascular tissues. Their production is enhanced in ischemic conditions and in experimental subarachnoid hemorrhage (SAH). Previous studies have indicated the ability of the leukotrienes C4 and D4 to constrict arterial vessels in vivo and in vitro and have suggested their involvement in the pathogenesis of cerebral arterial spasm. In the present study, the authors measured lumbar and cisternal cerebrospinal fluid (CSF) levels of leukotriene C4 in 48 patients who had suffered aneurysmal SAH. In 12 of the cases, symptomatic and radiological spasm was evident. The mean lumbar CSF level of immunoreactive-like activity of leukotriene C4 (i-LTC4) was significantly higher (p < 0.005) than in control cases, while the cisternal CSF level was higher than the lumbar mean concentration (p < 0.005). Patients presenting with vasospasm had significantly higher levels of i-LTC4 compared to patients without symptomatic vasospasm.

This is the first report concerning monitoring of i-LTC4 levels in the CSF after SAH. The results of this study suggest that: 1) metabolism of arachidonic acid via the lipoxygenase pathway is enhanced after SAH; 2) the higher cisternal CSF levels of i-LTC4 may be part of the biological response in the perianeurysmal subarachnoid cisterns after the hemorrhage; and 3) the higher CSF levels of i-LTC4 in patients presenting with vasospasm suggest that a relationship exists between this compound and arterial spasm and/or reflect the development of cerebral ischemic damage.
Ten-year survival among patients with supratentorial astrocytomas grade III and IV
Authors: Salford Leif G. , Brun Arne , Nirfalk Sigrid
Published: May 2009

✓ The Swedish Cancer Registry, in a linkage with the Swedish Registry of Statistics, was used to trace all patients operated on in Southern Sweden for histopathologically verified malignant primary central nervous system tumors during the years 1958 to 1975. Patients surviving 10 years after the operation were identified, and their original surgical specimens were reexamined. Six (0.5%) of 1147 patients were shown to have survived for between 12 and 28 years after surgery for supratentorial astrocytomas grade III and IV. All six patients are in good condition, without signs of tumor recurrence. The only obvious common denominator for the survivors is their youth at operation. Three patients were 7 to 11 years old at surgery, and none was older than 38 years. It is concluded that a cure may be possible in exceptional patients with the “incurable” astrocytoma grade III and IV.
Hydroxylapatite: an adjunct to cranial bone grafting
Authors: Matukas Victor J. , Clanton Jerald T. , Langford Keith H. , Aronin Patricia A.
Published: May 2009

✓ Hydroxylapatite is a dense pure ceramic material which has been used extensively in the reconstruction of atrophic maxillary and mandibular ridges. The authors describe a technique for the use of hydroxylapatite in combination with grafting of bone, either autogenous or from the bone bank, to restore contour to cranial defects. The use of hydroxylapatite in combination with bone grafting for contour restoration is recommended, as attempts to place the material directly on dura were not successful.
Quantification of thermal asymmetry
Authors: Uematsu Sumio , Edwin David H. , Jankel William R. , Kozikowski Joseph , Trattner Michael
Published: May 2009

✓ The use of thermography in evaluating nerve injury is based on the presence of temperature asymmetries between the involved area of innervation and the corresponding area on the opposite side of the body. However, interpretation of the thermographic image has been troubled by subjectivity. This paper describes a computer-calculated method of collecting data that eliminates subjective biases. Comprehensive normative data are presented on the degree of thermal asymmetry in the human body.

The degree of thermal asymmetry between opposite sides of the body (ΔT) is very small. For example, the value of AT for the forehead (mean ± standard deviation) was 0.18° ± 0.18°C, for the leg it was 0.27° ± 0.2°C, and for the foot it was 0.38° ± 0.31°C. These values were reproducible in both short- and long-term follow-up measurements over a period of 5 years. The ΔT's reported here were obtained from 40 matched regions of the body surface of 90 asymptomatic normal individuals. These values can be used as a standard in assessment of sympathetic nerve function, and the degree of asymmetry is a quantifiable indicator of dysfunction.
Current reporting of responsiveness in acute cerebral disorders
Authors: Starmark Jan-Erik , Holmgren Eddy , Stålhammar Daniel
Published: May 2009

✓ One hundred sixty-six papers published in seven neurosurgical journals from 1983 through 1985 have been surveyed to determine the methods used for assessment of overall patient responsiveness in acute cerebral disorders (coma grading). Fifty-one different coma scales or modifications were found. The Glasgow Coma Scale (GCS) sum score (that is, the sum of the scores of the individual eye, verbal, and motor scales) dominated (54%), and was used in 73 (76%) of 96 of the head-injury studies; in 56 (77%) of these 73 studies it was the single method of grading neurological status. The GCS sum score was used in 16 (23%) of 70 studies in patients with other etiologies. The Hunt and Hess scale was used in 26 (57%) of 46 reports of patients with subarachnoid hemorrhage.

In 31 (55%) of the 56 studies of head injuries using the GCS alone, it was not obvious if the 12- or 13-grade scale was used. In 13 studies (23%) no reference to methodological investigations was made. In 44 papers (79%) the handling of untestable features, such as intubation or swollen eyes, was not reported. In the 56 studies using the GCS alone, coma was defined in many different ways and in 22 studies the definition of coma was not specified. In 63% of reports, the GCS sum score scale was combined in one to five groups of scores and this was done in 32 different ways. No information was available to describe the procedure of data aggregation or the reliability of the 13-grade GCS sum score.

The lack of standardization makes it unnecessarily difficult to perform valid comparisons between different series of patients. Since the GCS sum score is the most widely used scale, it is suggested that the reporting of the GCS sum score should be standardized regarding pseudoscoring, coma definition, and use of combined scores. Further studies on the reliability of the GCS sum score are needed.
In situ fixation of the spinal cord using microwave radiation
Authors: Gower David J. , Hollman Carol , Lee K. Stuart , Tytell Michael
Published: May 2009

✓ Due to its investiture with bone, the spinal cord can be difficult to study anatomically and histologically. Tissue degradation during immersion fixation or mechanical trauma during extraction of unfixed tissue often produces confusing artifacts. Perfusion fixation eliminates many of these problems, but it is a slow, tedious, and technically demanding procedure. This report demonstrates that microwave irradiation of the spinal cord before its removal from the spine is a rapid and easy method of tissue fixation with an absence of artifacts comparable to that with perfusion fixation.
Experimental retrograde adriamycin trigeminal sensory ganglionectomy
Authors: Kato Seiya , Yamamoto Teiji , Iwasaki Yuzo , Niizuma Hiroshi , Nakamura Tadashi , Suzuki Jiro
Published: May 2009

✓ Direct destruction of the sensory ganglion or its root, by either surgical transection or injection of phenol, has been employed as preferred treatment for a variety of neuralgic pain syndromes. In this report, the suicide axoplasmic transport of adriamycin is described as a novel approach to sensory ganglionectomy. When injected into a branch of the trigeminal nerve in the cat, adriamycin was swiftly transported by way of retrograde axoplasmic flow to the sensory neurons parental to the injected nerve, where adriamycin-specific autofluorescence was observed. Trigeminal sensory evoked potentials became unobtainable 24 to 48 hours after injection of adriamycin in concentrations of 1% to 10%. The sensory neurons underwent subacute degeneration within a week due to the delayed action of adriamycin, and consequently the primary afferents degenerated in a restricted projection field of the brain-stem trigeminal sensory nuclei. These results indicate that retrograde axoplasmic transport of adriamycin is a unique approach to noninvasive sensory ganglionectomy with strict, albeit simple, safe targeting of sensory neurons and little likelihood of regeneration.
A new dural elevator for use during removal of the sphenoid wing
Authors: Kobayashi Shiro , Andrews Brian T. , Pitts Lawrence H. , Nakazawa Shozo
Published: May 2009

✓ A new dural elevator is described that simultaneously lifts and retracts the dura from the frontal and temporal surfaces of the sphenoid wing, allowing safe removal of this structure during pterional craniotomy.
Utilization of resources for the maintenance of excellence in neurological surgery
Authors: Garretson Henry D.
Published: May 2009

✓ In order to maintain the highest standards of care, neurosurgeons commit significant monies and time to continuing education. Significant time is devoted to national and regional organizations that work to assure standards for neurosurgical training, certification, and patient care. The continued increase in the sum of these efforts, both in money and time, indicates that a more efficient approach will be necessary in the future if neurosurgery and neurosurgeons are not to be overwhelmed or standards compromised.
Prognostic implications of the proliferative potential of low-grade astrocytomas
Authors: Hoshino Takao , Rodriguez Luis A. , Cho Kyung G. , Lee Kyu S. , Wilson Charles B. , Edwards Michael S. B. , Levin Victor A. , Davis Richard L.
Published: May 2009

✓ The proliferative potential of low-grade astrocytomas was estimated in 47 patients. Each patient received an intravenous infusion of bromodeoxyuridine (BUdR), 150 to 200 mg/sq m, at the time of craniotomy to label cells in deoxyribonucleic acid (DNA) synthesis; the percentage of S-phase cells, or BUdR labeling index (LI), of each tumor was determined immunohistochemically. In 29 patients (60%), the tumors had BUdR LI's of less than 1%, indicating a slow growth rate; only three (10%) of these patients died of recurrent tumor during a follow-up period of up to 3½ years. In contrast, of the 18 patients (40%) whose tumors had BUdR LI's of 1% or more, 12 (67%) had a recurrence and nine died during the same follow-up period. These results show that the proliferative potential, as reflected by the BUdR LI, is an important prognostic factor that separates low-grade astrocytomas into two groups and provides a more scientific rationale for selecting treatment for individual patients.