bluuebunny/crossref_metadata_2025 huggingface dataset:
Short vein grafts for cerebral revascularization
Authors: Little John R. , Furlan Anthony J. , Bryerton Bernadine
Published: May 2009

✓ Experience with the use of a short saphenous vein bypass graft for cerebral revascularization is reviewed. Twenty patients with symptomatic atherosclerotic occlusive disease underwent a total of 21 bypass procedures. Cerebral revascularization was performed using a short (5 to 10 cm) saphenous vein graft (SVG) extending from the superficial temporal artery (STA) trunk anterior to the ear in 19 bypasses, or from the occipital artery (OA) immediately behind the mastoid process to the posterior temporal or angular branch of the middle cerebral artery (MCA) in two bypasses. The early patency rate for the SVG bypasses was 90%. Two of the four patients with SVG occlusion were found to have substantial resolution of a severe inaccessible internal carotid artery stenosis that was present preoperatively. Filling of multiple major branches of the MCA through the SVG was seen in 90% of patients on late postoperative conventional angiography. The STA trunk or proximal OA was consistently found to be enlarged on the late studies. None of the patients had recurrence of cerebral transient ischemic attacks. The procedure may be useful as a primary means of cerebral revascularization or as an alternative approach when a scalp artery cannot be used because of its small size, severity of arteriosclerotic changes (a common occurrence), or damage during its dissection. Cerebral blood flow studies suggest that the use of a short SVG has a more favorable effect upon the cerebral circulation than the conventional bypass procedure.
Cerebrospinal fluid shunt infections
Authors: Forward Kevin R. , Fewer H. Derek , Stiver H. Grant
Published: May 2009

✓ The authors have reviewed the clinical manifestations and therapy of hydrocephalus shunt infections in 32 patients with a total of 35 shunt infections. These 35 infections accounted for 43 hospital admissions. First infections usually developed within 2 months following surgery. At the time of diagnosis, 89% of patients were febrile. Fever and cough as a symptom complex characterized the initial clinical presentation in six of 19 episodes of infection complicating ventriculoatrial (VA) shunts, as compared with none of 21 episodes in which infection complicated ventriculoperitoneal (VP) shunts. Seven of 21 infectious episodes occurring in patients with VP shunts in situ were associated with significant abdominal pain and tenderness. These patients usually had no other clinical features to suggest shunt infection. Both of these symptom complexes often led to delays in diagnosis and treatment. Causative organisms included Staphylococcus epidermidis in 21, Staphylococcus aureus in seven, Gram-negative aerobic bacilli in seven, diphtheroids in five, Streptococcus species in four, and anaerobes in three. Five infections were polymicrobial in nature. Positive blood cultures were seen in 13 of 17 infectious episodes complicating VA shunts, as compared with only three of 13 other infections. When the shunt was completely removed, with or without replacement, all 13 patients were cured. When intravenous antibiotics were administered in conjunction with incomplete shunt removal, only eight of 15 courses resulted in cure. Intraventricular antibiotics were administered in four patients and all were cured. Therapy of shunt infections with parenteral antibiotics and incomplete shunt removal is associated with an unacceptably high failure rate.
Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results
Authors: Ciric Ivan , Mikhael Michael , Stafford Thomas , Lawson Lawrence , Garces Rafael
Published: May 2009

✓ The authors have reported on 108 patients with pituitary macroadenomas (measuring 2 cm in at least one diameter) who underwent 117 transsphenoidal operations and five craniotomies, and were followed for periods ranging from 6 months to 14 years. Vision improved in 90% of the patients. Gross total tumor removal with no evidence of residual tumor tissue demonstrable on the postoperative computerized tomography scan was accomplished in 41% of cases. However, gross total tumor removal is not synonymous with complete tumor removal. Endocrine cure was possible in 25% of prolactin-secreting and 20% of growth hormone-secreting adenomas. The incidence of recurrence was 12%, with the majority occurring from 4 to 8 years postoperatively. Both the tumors with suprasellar extension of more than 2 cm and the hard fibrotic tumors had a higher recurrence rate. Postoperative administration of radiation therapy has been associated with a significantly lower recurrence rate than when this therapy was withheld. Transsphenoidal surgery of pituitary macroadenomas confined to the extra-arachnoid space is associated with a relatively small number of complications. The operative technique used in this series is described.
Intra-arterial ACNU therapy for malignant brain tumors
Authors: Yamashita Junkoh , Handa Hajime , Tokuriki Yasuhiko , Ha Young Soo , Otsuka Shin-Ichi , Suda Kinya , Taki Waro
Published: May 2009

✓ The authors examined the growth rate of mouse 203 glioma cells in vitro and found it to be markedly inhibited after exposure to ACNU for 5 minutes at a drug concentration of 100 µg/ml. Rats that had undergone intracranial implantation of T1 neurogenic tumor were treated by 5 mg/kg of ACNU administered either intravenously or intra-arterially. The median survival times for the control animals and the animals undergoing intravenous or intracarotid administration of ACNU were 23, 29, and 46 days, respectively. The difference in survival time between the intravenous and intracarotid administration groups was statistically significant (p < 0.01) when examined by the Cox-Mantel test.

In a clinical trial, 17 patients with glioblastoma were treated by ACNU, eight intravenously and nine by the intra-arterial route. The drug was given in doses of 2 to 3 mg/kg at least twice before and twice after a course of postoperative radiotherapy. Intra-arterial administration was performed over a period of 5 minutes under local anesthesia. The median postoperative survival time for the patients in the intra-arterial group was 12.5 months, compared with 9.0 months for those in the intravenous group. The survival rate for the intra-arterial group was slightly higher, although statistically not significant, probably because the number of cases was small. The degree of thrombocytopenia due to ACNU tended to be less marked in the intra-arterially treated patients. The theoretical advantages of the intra-arterial administration of ACNU are discussed.
Cardiovascular response to severe head injury
Authors: Clifton Guy L. , Robertson Claudia S. , Kyper Kathy , Taylor Addison A. , Dhekne Ramesh D. , Grossman Robert G.
Published: May 2009

✓ The cardiovascular, pulmonary, and metabolic responses to severe head injury were studied clinically in the acute phase after severe head injury with the object of determining if a common response was present and, if so, its significance in the management of the patients' intracranial and systemic physiological states. Cardiac output, pulmonary capillary wedge pressure, arterial blood pressure, arterial and mixed venous blood gases, and arterial and mixed venous epinephrine (E) and norepinephrine (NE) levels were measured serially in 15 patients during the first 3 days after injury. A hyperdynamic state was found, characterized by increased cardiac output, cardiac work, moderate hypertension, tachycardia, decreased or normal systemic and pulmonary vascular resistance, increased pulmonary shunting, and increased oxygen delivery and utilization. Arterial E and NE levels correlated well with the cardiac output, cardiac work, blood pressure, heart rate, oxygen delivery, and oxygen utilization but not with vascular resistance or pulmonary shunt. The magnitude of the hyperdynamic state did not correlate with intracranial pressure, Glasgow Coma Scale score, or computerized tomography findings. It is concluded that a hyperdynamic cardiovascular state occurs after severe head injury, and that it is mediated in part by sympathetic nervous activity. The significance of this state for systemic management of patients with head injury is discussed.
Treatment of hypertension associated with head injury
Authors: Robertson Claudia S. , Clifton Guy L. , Taylor Addison A. , Grossman Robert G.
Published: May 2009

✓ Arterial hypertension that occurs after severe head injury is characterized by elevation of systolic blood pressure, tachycardia, increased cardiac output, normal or decreased peripheral vascular resistance, and increased circulating catecholamines. The effects of two drugs used in the management of hypertension, propranolol and hydralazine, on these indices of cardiovascular function were examined in six head-injured patients. Both drugs effectively normalized blood pressure. However, hydralazine increased heart rate by 30%, cardiac index by 49%, left cardiac work by 21%, and pulmonary venous admixture by 53%, and was responsible for an increase in intracranial pressure or decreased compliance in two patients. Hydralazine produced no consistent change in arterial catecholamines. In contrast, propranolol decreased heart rate by 21%, cardiac index by 26%, left cardiac work by 35%, pulmonary venous admixture by 15%, and oxygen consumption by 18%. Propranolol decreased arterial epinephrine levels by 48% and norepinephrine levels by 28%. Propranolol appears to be a useful antihypertensive drug in the hyperdynamic head-injured patient because it normalizes blood pressure and the underlying hemodynamic abnormalities both by its beta-adrenergic blocking action and by decreasing circulating levels of catecholamines.
Cerebrospinal fluid myelin basic protein in hydrocephalus
Authors: Sutton Leslie N. , Wood James H. , Brooks Benjamin R. , Barrer Stephen J. , Kline Mitchell , Cohen Steven R.
Published: May 2009

✓ Immunoreactive myelin basic protein (MBP) levels were measured in cerebrospinal fluid (CSF) samples taken from 57 patients with active hydrocephalus (age range 3 weeks to 60 years). Of these patients, 28 (49%) had elevated MBP values (> 4.5 ng/ml). Elevated MBP levels were found in 44% of patients with congenital hydrocephalus, 75% of patients with posttraumatic hydrocephalus, 80% of patients with normal-pressure hydrocephalus, and 83% of patients with porencephaly. Also associated with abnormal MBP levels was the ventricular size as measured by computerized tomography scanning (χ2: p < 0.05): 36% of the patients with small ventricles (ventricle:brain ratio 0 to 0.4:1) had elevated MBP in the CSF, whereas 61% of those with moderate ventricles (0.41 to 0.6:1 ratio) and 100% of those with large ventricles (0.61 to 0.85:1 ratio) had abnormal values. Only 33% of those with maximal hydrocephalus (0.86 to 1.0:1 ratio) had elevated MBP levels, perhaps because of dilution effects. In three patients in whom CSF was obtained simultaneously by ventricular and lumbar punctures, the ventricular fluid had a consistently higher concentration of MBP, suggesting a cerebral origin. It is concluded that active hydrocephalus produces significant periventricular demyelination, probably as the result of mechanical stretching.
Spinal cord arteriovenous malformations with significant intramedullary components
Authors: Cogen Philip , Stein Bennett M.
Published: May 2009

✓ Few neurosurgeons have stressed the occurrence, manifestations, and resectability of intramedullary spinal arteriovenous malformations (AVM's). In six of 17 patients in the authors' series of operable spinal AVM's, the lesions had major intramedullary components. Three of these six patients presented with subarachnoid hemorrhage, and all had catastrophic neurological deficits which gradually improved. The hemorrhages appeared to originate from large venous varices lying adjacent to the intramedullary portion of the AVM. The mechanism explaining the sudden neurological deficit in the other three patients was presumed to be thrombosis within the venous varices associated with their AVM's. The reliability of the various radiographic procedures in identifying the intramedullary components of these AVM's is discussed. These malformations may be removed totally with a high degree of safety using microsurgical techniques. The postoperative course in this series of patients was gratifying in terms of improvement of neurological deficits. Postoperative angiography was not performed on all of these patients. However, the follow-up period averaged 5 years.
Trigeminal neuralgia treated by radiofrequency coagulation
Authors: Latchaw John P. , Hardy Russell W. , Forsythe Sarah B. , Cook Allan F.
Published: May 2009

✓ Ninety-six patients underwent percutaneous radiofrequency coagulation (RC) of the Gasserian ganglion for relief of trigeminal neuralgia between 1973 and 1978. Fifty-two percent of patients who were followed for 5 years were free of recurrence after a single RC procedure. Factors predicting clinical results were sought from initial historical and demographic data. Age, sex, duration of illness, and previous response to medication were unrelated to outcome. Patients previously treated by open surgery appeared to receive less benefit from subsequent RC. The RC procedure seemed more effective in the treatment of patients with classical tic douloureux than in those with atypical features. The degree of sensory loss created by RC was associated with the clinical outcome. Patients acquiring dense sensory deficits demonstrated a reduced risk of recurrence (p = 0.006): 25% of patients with dense sensory loss and 55% of those with a partial deficit developed a recurrence by 5 years, whereas all patients without initial sensory loss suffered a recurrence by 5 years.
The cutting-edged microvascular needle
Authors: Pagnanelli David M. , Naradzay Jerome F. X. , Pait T. Glenn , Rizzoli Hugo V. , Kobrine Arthur I.
Published: May 2009

✓ The authors have compared the vascular endothelial damage caused by blunt-tipped microvascular needles as reported previously with that of sharp cutting-edged needles of comparable size. The same four distinct vascular lesions were found with cutting-edged needles as with the blunt-tipped needles. Even though one experimenter made all of the lesions, and all of the tissue was handled in the same fashion, there was much variation in the extent of the intimal damage. Overall, cutting-edged needles produced slightly less intimal tearing and platelet aggregation than blunt-tipped needles, but the difference was not striking.
Intradural chordoma without bone involvement: nuclear magnetic resonance (NMR) appearance
Authors: Mapstone Timothy B. , Kaufman Benjamin , Ratcheson Robert A.
Published: May 2009

✓ This paper presents a rare case of intradural chordoma which involved the pons but had no radiological or surgical evidence of bone involvement. The appearance of this tumor on nuclear magnetic resonance imaging is presented.
Squamous cell carcinoma arising in a suprasellar epidermoid cyst
Authors: Lewis Anthony J. , Cooper Perry W. , Kassel Edward E. , Schwartz Michael L.
Published: May 2009

✓ A case is presented in which a squamous cell carcinoma developed in an intracranial epidermoid cyst. The patient was a 54-year-old woman with a 3-year history of depression and amblyopia; no focal findings were noted and she was diagnosed as having psychiatric disorders. On her final admission she showed clinical evidence of a rapidly growing intracranial mass. Computerized tomography (CT) identified a right parasellar and temporal lesion which was then incompletely removed. The literature on primary intracranial squamous cell carcinoma is reviewed, and the role of CT scanning in preoperative diagnosis of this lesion is discussed.
Use of metrizamide for percutaneous cordotomy
Authors: Batzdorf Ulrich , Bentson John R.
Published: May 2009

✓ Demonstration of the anterior surface of the spinal cord is an important step in performing a percutaneous cordotomy. Metrizamide has been found to be a superior agent for this purpose, permitting visualization of the cord shadow in the anteroposterior as well as the lateral projection, and thereby also enabling the surgeon to visualize displacement of the spinal cord during the procedure. Tissue impedance and spinal cord stimulation techniques are used in conjunction with metrizamide. No adverse effects have resulted from the use of this technique.
Pure alpha subunit-secreting pituitary tumors
Authors: Klibanski Anne , Ridgway E. Chester , Zervas Nicholas T.
Published: May 2009

✓ The authors describe six patients with pituitary macroadenomas hypersecreting only the alpha subunit of the glycoprotein hormones. These patients had been previously diagnosed as having “non-functioning chromophobe adenomas.” All of the patients had visual field abnormalities and partial hypopituitarism. The elevated serum alpha concentrations showed a variable response to stimulation by thyrotropin-releasing hormone, and could not be suppressed by thyroid hormone administration. Immunological, gel chromatographic, and immunocytochemical studies documented that only the alpha subunit was present. Following pituitary surgery and radiotherapy, serum alpha levels decreased. These patients represent a new subset of functioning pituitary tumors. Determination of alpha subunit concentration is useful in managing some patients with pituitary tumors previously thought to have non-functioning chromophobe adenomas.
Pathophysiology of periventricular tissue changes with raised CSF pressure in cats
Authors: Rosenberg Gary A. , Saland Linda , Kyner Walter T.
Published: May 2009

✓ Intraventricular pressure (IVP) is increased in the early stages of acute hydrocephalus. Pressure falls, however, when compensatory routes for cerebrospinal fluid (CSF) absorption develop. In order to better understand the pathophysiology of acute hydrocephalus, the authors performed ventriculocisternal perfusions on adult cats with outflow pressures maintained at either −5, 20, or 40 cm H2O. Cerebral blood flow (CBF) was determined by the iodoantipyrine method. Penetration of an extracellular marker, horseradish peroxidase (HRP), was visualized histologically. Capillary transfer of radiolabeled molecules from CSF to blood was measured by steady-state tissue clearance. Increased IVP had several effects: 1) significant reduction in mean CBF in the periventricular white matter; 2) penetration of the HRP into deep white matter; and 3) prolongation of steady-state tissue clearance half-time for (14C)-ethylene glycol in the caudate nucleus. Reduced blood flow to periventricular white matter and impaired molecular clearance in the caudate nucleus may contribute to the clinical symptoms in acute hydrocephalus.
Effects of methylprednisolone on peritumoral brain edema
Authors: Yamada Kazuo , Ushio Yukitaka , Hayakawa Toru , Arita Norio , Yamada Noriko , Mogami Heitaro
Published: May 2009

✓ Peritumoral brain edema was produced by intracerebral transplantation of Walker 256 tumor in rats. Local cerebral blood flow (LCBF), local cerebral glucose utilization (LCGU), and capillary permeability were studied in untreated and methylprednisolone-treated rats by quantitative autoradiography. In the untreated group, LCBF and LCGU were widely depressed in the cortex and deep structures of the hemisphere ipsilateral to the tumor. In the methylprednisolone-treated animals, LCBF and LCGU were significantly better than in the untreated animals. Capillary permeability was highly increased in the viable part of the tumor in the untreated animals. In the methylprednisolone-treated group, capillary permeability of the tumor was significantly lower than that in the untreated group. These results may suggest that increase in capillary permeability of the tumor is the major source for edema fluid production, and that methylprednisolone improves brain edema by decreasing capillary permeability of the tumor. Decrease in edema fluid formation may result in restoration of blood flow and glucose metabolism in the adjacent brain tissue, and may improve clinical symptoms and signs.
Scanning electron microscope study of human arachnoid villi
Authors: D'Avella Domenico , Cicciarello Rocco , Albiero Francesca , Andrioli Giancarlo
Published: May 2009

✓ The functional morphology of human arachnoid villi obtained from surgical biopsy specimens has been studied by scanning electron microscopy (SEM). On SEM examination, the villi appeared to be distended, as if functioning normally. The endothelial cells constituting the cerebrospinal fluid (CSF)-blood interface were covered by numerous microvilli, uniformly oriented along the major axis of the villus. Examination for cell-to-cell contact revealed only occasional areas of tight adherence between adjacent endothelial cells, while widened intercellular spaces were frequently observed. Generally corresponding to the apex of the villus, points of emergence of endothelium-lined hollow structures were identified; these may represent apical openings of open pathways from the subarachnoid space to the venous system. Ultrastructural arrangements consistent with a closed system of CSF reabsorption were also observed. Large cells maximally distended and protruding into the sinus lumen were commonly seen; these were interpreted as the result of the formation of giant vacuoles within the endothelium covering the villus.

This study has provided ultrastructural evidence for both closed and open systems of CSF reabsorption. Ultrastructural findings, such as gaps between endothelial cells and tubule-like endothelium-lined structures as previously identified in animals and observed in man by transmission electron microscopy, were demonstrated in human biopsy specimens by SEM.
The long-term outcome in patients with multiple aneurysms
Authors: Winn H. Richard , Almaani Waled S. , Berga Sarah L. , Jane John A. , Richardson Alan E.
Published: May 2009

✓ The proper treatment of multiple and incidental aneurysms remains controversial because the long-term result of different modes of management is unclear. This report evaluates the long-term outcome (follow-up period averaged 7.7 years) in 182 patients with multiple aneurysms who suffered a subarachnoid hemorrhage (SAH) to document the incidence of late bleeding. Of the 182 patients, 132 were treated by bed rest and 50 by surgery (craniotomy) directed at only the ruptured aneurysm. Seventy of the patients with bed rest were alive after 6 months. Twenty-one of these conservatively treated patients (30%) suffered a late hemorrhage, which is equal to the previously reported average yearly rebleed rate (3%) with a single aneurysm of the anterior circulation. There was no evidence that a previously intact aneurysm had ruptured in SAH patients treated with bed rest, indicating that late hemorrhage was due to rerupture from the original aneurysm. Patients who were hypertensive and who had a large aneurysm had an increased risk of late rehemorrhage. A linear discriminant analysis was developed to predict late rebleeding. The fate of intact aneurysms was evaluated by following patients with multiple aneurysms treated by craniotomy directed only at the ruptured aneurysm. Of the 50 craniotomy patients, 38 were alive after 6 months. In this group, the minimal risk of rupture of an intact aneurysm is approximately 1% per year. The presence of hypertension increased the risk of late hemorrhage. In conclusion, patients with multiple untreated aneurysms managed by bed rest have a late rehemorrhage rate equal to that observed in patients with a single cerebral aneurysm; the data indicate that rupture of intact aneurysms is not insignificant.
The first human stereotaxic apparatus
Authors: Picard Claude , Olivier Andre , Bertrand Gilles
Published: May 2009

✓ The first human stereotaxic apparatus was probably built in London, England, around 1918 to the specifications of Aubrey Mussen, a neuroanatomist and neurophysiologist who had worked with Clarke. The recent acquisition by the Montreal Neurological Institute of Mussen's original apparatus prompts this report on the salient points of his career, and summary of his early contributions to stereotaxy.
Comparison of outcome in two series of patients with severe head injuries
Authors: Gelpke Geert Jan , Braakman Reinder , Habbema J. Dik F. , Hilden Jørgen
Published: May 2009

✓ A comparison is made between the outcome distributions of two Dutch series of patients with severe head injuries. Both series are taken from the same study and cover the same period (1974 to 1977). There is a large difference in survival rate between the series: 45% versus 63%. The authors present a possible method for assessing the influence of differences in initial severity of injury on outcome. It is estimated that, of the 18% difference in survival rate, 10.5% is due to differences in severity of injury on admission. The remaining 7.5% difference in survival rate is not explained, but may have been caused by unmeasured variations in the initial determination of severity of injury or by differences in effectiveness of management. The higher survival rate was achieved at the center with the more conservative management regimen. An evaluation of recent literature suggests that reports that do not find aspects of “aggressive” management beneficial are more reliable in comparing series than are those that claim improved outcome after aggressive therapy.
Intracranial volume-pressure relationship in man
Authors: Tans Joseph Th. J. , Poortvliet Dick C. J.
Published: May 2009

✓ Pressure-volume indices (PVI's) were determined for a heterogeneous group of 40 patients who underwent continuous monitoring of ventricular fluid pressure (VFP). The main purpose was to investigate the relationship between VFP and PVI and to establish the significance of the measured PVI values. Determinations of PVI appear to be useful only when baseline VFP is under 20 mm Hg, maximum VFP is under 30 mm Hg, A-waves are absent, and B-waves do not occur numerously. The authors advocate starting with 1-ml bolus infusions, and then, when the resulting pressure rise exceeds 4 mm Hg, additional bolus infusions can be omitted. Results indicate that 13 ml and 10 ml are the key values for the PVI. A PVI of less than 13 ml indicates the need for either reduction of VFP and improvement of compliance or intensive monitoring of both the VFP and the volume-pressure relationship; if the PVI is below 10 ml, anti-hypertensive treatment is almost always necessary. Values of PVI's between 13 and 18 ml, although pathological, usually have no therapeutic consequences.
Effects of prostacyclin and indomethacin on experimental delayed cerebral vasospasm
Authors: Fukumori Toyokazu , Tani Eiichi , Maeda Yukio , Sukenaga Atsuhiko
Published: May 2009

✓ Isolated canine basilar artery contracted by prostaglandin E2, hemoglobin, or serum was relaxed in a dose-dependent manner by the addition of 10−8M to 10−6M prostacyclin (PGI2), and was scarcely relaxed by 10−9M PGI2. In other studies, intravenous administration of PGI2 (25 or 75 ng/kg/min), indomethacin (4 mg/kg), or indomethacin (4 mg/kg) plus PGI2 (25 ng/kg/min) failed to reverse angiographic delayed vasospasm produced in vivo in the canine basilar artery by an intracisternal injection of blood. In addition, no significant increase occurred in mean values of regional cerebral blood flow (rCBF) with any treatments, and mean rCBF difference in dogs treated by PGI2 infusion at 25 ng/kg/min was 2.5 ± 1.2 ml/100 gm/min and only significantly increased (p < 0.01). Mean arterial blood pressure was significantly reduced by PGI2 infusion at 25 (p < 0.05) or 75 ng/kg/min (p < 0.005).
Consequences of dural defects acquired in infancy
Authors: Winston Ken , Beatty Robert M. , Fischer Edwin G.
Published: May 2009

✓ Four infants underwent craniectomy for craniosynostosis and subsequently developed an expanding cranial defect with herniation of brain. All four had an unrepaired laceration of the dura. The pathophysiology of this entity and of the growing fracture of childhood are discussed, and a unified interpretation of the consequences of unrepaired dural defects is proposed.
Distraction rod stabilization in the treatment of metastatic carcinoma
Authors: Cusick Joseph F. , Larson Sanford J. , Walsh Patrick R. , Steiner Robert E.
Published: May 2009

✓ Stabilization of the spinal column with Harrington distraction rods and acrylic fusion was the primary form of treatment in a select group of patients with metastatic carcinoma of the spinal column. Clinical criteria included patients in poor general medical condition with intractable pain originating from metastatic tumor involvement in the ventral components of the thoracic or upper lumbar spinal column and minimal evidence or absence of spinal cord compression. After stabilization, pain relief was almost total and sustained, and neurological status generally remained unchanged from preoperative findings without any evidence of improvement of preexisting abnormalities or occasions of rapid neurological deterioration. This form of spinal stabilization may offer significant relief of debilitating pain, lessen the risk of pathological fracture-dislocation of the thoracic or upper lumbar vertebral column, and reduction in the local compressive effects on the spinal cord caused by ventrally situated metastatic tumor.
Unilateral hydrocephalus secondary to congenital atresia of the foramen of Monro
Authors: Wilberger James E. , Vertosick Frank T. , Vries John K.
Published: May 2009

✓ Unilateral hydrocephalus is an uncommon entity which results from obstruction at the level of the foramen of Monro. It is usually brought about by tumors or inflammatory conditions. Congenital maldevelopment of the foramen of Monro is an often postulated, yet never proven, cause of unilateral ventricular enlargement. A case of unilateral hydrocephalus secondary to congenital atresia of the foramen of Monro is presented to document the occurrence of this condition.
A cannula for use in ultrasonically guided biopsies of the brain
Authors: Rubin Jonathan M. , Dohrmann George J.
Published: May 2009

✓ The authors describe a cannula that has been modified to improve its visibility during ultrasonically guided biopsies of the brain. To enhance the echogenicity of the tip of the cannula, six parallel rings, 0.25 to 0.30 mm deep and 0.40 to 0.50 mm apart, were etched into the tip of the cannula. The cannula was also lengthened to approximately 19 cm to permit its unencumbered passage through any biopsy guidance device that may be employed. Detailing the precise location of the tip of the biopsy cannula is most important. The tip of this modified probe is much more echogenic and hence more easily seen ultrasonically than it would be otherwise, both in vivo and in vitro. This modified cannula is useful in any ultrasonically guided intracranial biopsy procedure.
An experimental study of the acute stage of subarachnoid hemorrhage
Authors: Kamiya Ken , Kuyama Hideyuki , Symon Lindsay
Published: May 2009

✓ A baboon model of subarachnoid hemorrhage (SAH) has been developed to study the changes in cerebral blood flow (CBF), intracranial pressure (ICP), and cerebral edema associated with the acute stage of SAH. In this model, hemorrhage was caused by avulsion of the posterior communicating artery via a periorbital approach, with the orbit sealed and ICP restored to normal before SAH was produced. Local CBF was measured in six sites in the two hemispheres, and ICP monitored by an implanted extradural transducer. Following sacrifice of the animal, the effect of the induced SAH on ICP, CBF, autoregulation, and CO2 reactivity in the two hemispheres was assessed. Brain water measurements were also made in areas of gray and white matter corresponding to areas of blood flow measurements, and also in the deep nuclei.

Two principal patterns of ICP change were found following SAH; one group of animals showed a return to baseline ICP quite quickly and the other maintained high ICP for over an hour. The CBF was reduced after SAH to nearly 20% of control values in all areas, and all areas showed impaired autoregulation. Variable changes in CO2 reactivity were evident, but on the side of the hemorrhage CO2 reactivity was predominantly reduced. Differential increase in pressure lasting for over 7 minutes was evident soon after SAH on the side of the ruptured vessel. There was a significant increase of water in all areas, and in cortex and deep nuclei as compared to control animals.
The prognostic value of computerized tomography in comatose head-injured patients
Authors: van Dongen Krijn J. , Braakman Reinder , Gelpke Geert Jan
Published: May 2009

✓ In a series of 121 comatose head-injured patients, computerized tomography (CT) scans were obtained at various intervals after onset of coma. The scans were classified without knowledge of previous scans or of the patient's clinical state, and predictions as to outcome at 1 year were made based on clinical features and CT findings. The state of the basal cisterns as seen on CT scans proved to be a very powerful prognosticator. Subsets of features with the greatest prognostic weight were selected systematically for CT features, clinical features, and for a combination of CT and clinical features. With these features, probability statements were made about death or survival at 1 year. The quality of the predictions was established by comparing them with actual outcome. The percentage of accurate predictions was markedly higher with a combination of clinical and CT features than with clinical or CT features alone.
Cranial chordomas in children and young adults
Authors: Wold Lester E. , Laws Edward R.
Published: May 2009

✓ A series of 12 surgically treated and pathologically proven cranial chordomas presenting in children and young adults is reviewed. These rare tumors occur in relation to the path of the primitive notochord; four were parasellar, six were mid-clival, and two were inferior clival in location. Pathological evaluation revealed five of the tumors to have a significant chondroid component. Follow-up studies ranging from 1 month to 21 years revealed that eight patients were alive, all of whom had received radiation therapy following surgery.
Choroid plexus papillomas and human choroid plexus
Authors: Matsushima Toshio
Published: May 2009

✓ Choroid plexus papillomas and mature human choroid plexus were studied by light and electron microscopic techniques. The mature choroid plexus has three types of cells: Type I cells are cuboidal or columnar cells and line the villi; Type II cells are flat cells lining connective tissue adjacent to neural tissue; and Type III cells are flat cells lining crypts in connective tissue. The cells of benign papillomas were similar to the fully developed Type I cells. The cells of a malignant papilloma were similar to the underdeveloped-appearing Type III cells. A variant malignant papilloma had well differentiated mucus-secreting cells resembling goblet cells.
Prolactinoma of pituitary with associated amyloid-like substances
Authors: Kuratsu Jun-ichi , Matsukado Yasuhiko , Miura Masaki
Published: May 2009

✓ A prolactin-secreting pituitary adenoma containing amyloid substance was studied by light and electron microscopy. The tumor was found in a 32-year-old woman who presented with a short history of amenorrhea and galactorrhea. Pituitary adenoma containing amyloid substance is a very rare entity, and the implications of this association are discussed. Previous reports, suggesting that mesenchymal cells or hormone-secreting tumor cells in pituitary adenomas produce amyloid substances, are reviewed.
Management of carotid-cavernous fistulas by surgery combined with interventional radiology
Authors: Tress Brian M. , Thomson Kenneth R. , Klug Geoffrey L. , Mee Roger R. B. , Crawford Bruce
Published: May 2009

✓ Two cases of carotid-cavernous fistulas were successfully treated by standard interventional radiology techniques after otherwise inaccessible vessels were surgically exposed. In the first case, an internal carotid artery (ICA), which had previously been ligated as part of an attempted surgical “entrapment” procedure, was recanalized to permit passage of a detachable balloon catheter to the fistula, resulting in its obliteration. In the second case, an enlarged superior ophthalmic vein was exposed and isolated to facilitate retrograde catheterization of the cavernous sinus and obliteration of a dural fistula between the ICA and the cavernous sinus by steel Gianturco coils. The methods and complications of both procedures are discussed.
An approach to a basilar aneurysm above the bifurcation of the internal carotid artery
Authors: Kobayashi Shigeaki , Sugita Kenichiro , Nakagawa Fukuo
Published: May 2009

✓ The authors report a case of a basilar artery aneurysm approached by the transsylvian route; the aneurysm was successfully clipped through the space distal to the carotid bifurcation and between the frontal and temporal lobes. This approach is useful when the internal carotid artery is short, sclerotic, and difficult to mobilize. Special care should be taken when retracting perforating arteries and the posterior communicating artery.
Moyamoya syndrome in only one of two identical twins
Authors: Tanghetti Bruno , Capra Ruggero , Giunta Filippo , Marini Giovanni , Orlandini Alberto
Published: May 2009

✓ The authors describe moyamoya syndrome in only one of two identical twins. The clinical and angiographic data suggest that it may be an acquired form, but the cause of the pathology remains obscure.
Microprocessor-controlled scanning micromanipulator for carbon dioxide laser surgery
Authors: Dagan Jacob , Robertson Jon H. , Clark W. Craig
Published: May 2009

✓ A microprocessor-controlled scanning device for use in carbon dioxide laser surgery is described. This device increases the speed of dissection, allows the surgeon to keep both hands in the operative field, and thereby decreases the fatigue associated with manual control of the micromanipulator used in a surgical laser system.
Transantral transsphenoidal approach to the pituitary
Authors: Hoyt Thomas E. , Turnbull Frederick M. , Kusske John A.
Published: May 2009

✓ The authors describe the technique of a transantral transsphenoidal approach to the sella turcica. The advantages and potential complications are discussed. This procedure may also be applicable when dealing with tumors of the skull base and orbits.
Transsphenoidal treatment of non-neoplastic intrasellar cysts
Authors: Baskin David S. , Wilson Charles B.
Published: May 2009

✓ Thirty-eight patients underwent transsphenoidal microsurgical treatment of non-neoplastic intrasellar cysts: 36 had cyst drainage and biopsy of the cyst wall, and in two the cyst was totally removed. Surgical morbidity was 8%. The mean follow-up time was 46.3 months; 100% patient follow-up evaluation was achieved. Sixteen female patients (mean age 24.6 years) had pars intermedia cysts: 88% had menstrual irregularities, 63% had galactorrhea, 31% had headache, and 56% had hyperprolactinemia. Within these groups, menstrual cycles returned in 86%, galactorrhea ceased in 90%, headaches resolved in 80%, and serum prolactin levels were restored to normal in 66%. Eight females and three males had Rathke's cleft cysts (mean age 34.0 years): of these 11 patients, 91% had headaches and 18% had hyperprolactinemia; of the eight females, 63% had amenorrhea and 63% had galactorrhea. Within these groups, serum prolactin levels normalized in 50%, and 80% noted reduced headache. Of the females, 80% had return of menses and 50% noted cessation of galactorrhea. Six males and two females had arachnoid cysts (mean age 42.2 years): 50% had headaches; 50% were asymptomatic. Preoperatively, 50% of these patients had hypothyroidism and 25% had adrenal hypofunction. Postoperatively, 75% of patients with headache noted improvement, and 33% of patients with abnormal thyroid function had normal function. Adrenal function did not improve. Three patients had an intrasellar cysticercosis cyst, epidermoid cyst, and postoperative cyst, respectively. All had evidence of partial hypopituitarism; none improved postoperatively. The results indicate that different types of pituitary cysts produce different clinical syndromes, and suggest that simple transsphenoidal drainage and partial removal of the cyst wall can provide safe and effective therapy.
Cerebral arteriovenous malformations
Authors: Luessenhop Alfred J. , Rosa Louis
Published: May 2009

✓ To address the problems of surgical risk versus natural risk associated with cerebral arteriovenous malformations (AVM's), and the role of the intravascular operative approach, the authors have assessed a 20-year experience with 450 patients. Results of direct surgery in 90 patients indicate that for the smaller AVM's (Grades I and II), mortality and morbidity rates are lower than a reasonably projected natural risk. Hence, these patients are candidates for surgery in most instances. However, for more extensive AVM's (Grades III and IV), consideration of anticipated future years of exposure to natural risk and the location of the AVM in the brain are necessary for determining operability. In general, neither seizures nor incipient focal neurological dysfunction alone are indications for surgery, and the risks of disability or death from hemorrhage after the fifth decade of life are probably less than the surgical risks by present operative techniques. Considering the usual age of patients at the time of diagnosis, it is estimated that surgical risk is currently less than the natural risk for about 65% to 70% of all AVM patients.

The categories of AVM's in which the angiographic effectiveness of the intravascular approach is the greatest correspond to the same categories of AVM's that can be surgically removed with low risk. The intravascular approach is most useful for management of large AVM's causing progressive neurological dysfunction or as a preliminary step to surgery in selected cases in which access to major feeding arteries is difficult. The authors believe that the future of the intravascular approach should be directed toward transforming large inoperable AVM's into operable ones, but that the overall capability for this with acceptable risk is uncertain at present.
Musical murmurs in human cerebral arteries after subarachnoid hemorrhage
Authors: Aaslid Rune , Nornes Helge
Published: May 2009

✓ A transcranial ultrasonic method for the recording of murmurs from cerebral vessels is described. Using the new approach the authors have observed musical murmurs of pure tone quality in 15 patients with increased flow velocities in the cerebral arteries after spontaneous subarachnoid hemorrhage (SAH). The frequency range of the pure tones was from 140 to 820 Hz, corresponding to flow velocities between 73 and 215 cm/sec. The musical murmurs occurred as a transitional state between silent flow and the well known phenomenon of bruit. They were observed between the 4th and the 20th day after SAH. The most likely cause of the musical murmur is a periodic shedding of vortices in the cerebral arteries, commonly referred to as “a von Kármán vortex street.” Clinically the presence of musical murmurs indicated that pathologically increased blood velocities were present in the artery under investigation. This probably reflected the degree of spasm.
Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound
Authors: Aaslid Rune , Huber Peter , Nornes Helge
Published: May 2009

✓ The use of an ultrasonic transcranial Doppler technique for noninvasive evalution of cerebral vasospasm is described. Middle cerebral arteries (MCA's), classified as spastic on angiography, demonstrated blood-flow velocity between 120 and 230 cm/sec. The flow velocities in these arteries had a clear inverse relationship to the diameter as measured from angiograms in 38 patients with recent subarachnoid hemorrhage. This relationship in the proximal anterior cerebral artery (ACA) was found to be more complicated to assess, due to the collateral channels in the anterior part of the circle of Willis. The authors conclude, however, that the new method of measuring vasospasm will also detect spasm in the ACA if it has a hemodynamically significant effect upon flow resistance.
Successful radical removal of an intracranial meningioma in 1835 by Professor Pecchioli of Siena
Authors: Giuffrè Renato
Published: May 2009

✓ In 1835, Pecchioli, Professor of Surgery and Operating Medicine at the University of Siena, removed a “fungus of the dura mater” (meningioma). The lesion was a large ulcerated cranial outgrowth at the level of the right sinciput, which at operation proved to originate from the dura mater and to be eroding the bone. Surgery was radical. The patient recovered and attended for follow-up review several times in the course of 30 months, always fit and with no sign of recurrence. This procedure was later selected for the competition for the chair of Surgery at the University of Paris in 1840. In 1847, Pecchioli summarized his surgical material spanning 16 years' activity, including neurosurgical operations.
Morbidity, mortality, and quality of life following surgery for intracranial meningiomas
Authors: Chan Richard C. , Thompson Gordon B.
Published: May 2009

✓ The authors report 257 patients who underwent 338 craniotomies for the removal of meningiomas. The average duration of observed survival was 9.0 years, while that with acceptable quality of life was 8.3 years. Multiple factors including the size and location of tumors, the degree of tumor excision, the histological features, and the preoperative condition of the patients are important in both duration of survival and quality of life following surgery for intracranial meningiomas. Computerized tomography permits early diagnosis and is invaluable in follow-up assessment. It allows for recognition of small recurrent tumors, and offers a better opportunity for complete removal and, subsequently, a longer duration of reasonable survival. Radiation therapy may prolong survival time in patients with malignant meningiomas, but it fails to delay further tumor recurrences following its delivery to patients with recurrent tumors. There are multiple predisposing factors responsible for the development of postoperative seizures. These include tumor recurrence involving highly functional anatomical areas of the brain, history of preoperative seizures, and intraoperative factors such as excessive brain retraction and the sacrifice of major draining or bridging veins. Intraoperative complications may be decreased by using osmotic diuretics and subarachnoid drains, meticulous dissection, and with the increased awareness and preservation of the important venous structures.
Cervical spondylotic myelopathy treated by single-stage multilevel anterior decompression
Authors: Mann Kirpal S. , Khosla Virender K. , Gulati Des R.
Published: May 2009

✓ Fifty patients suffering from advanced cervical spondylotic myelopathy were surgically treated to eliminate compression of the cord. All disc protrusions demonstrated by positive-contrast myelography that measured larger than 1.5 mm were excised. Each patient was operated on in a single-stage procedure by anterior discectomy, without bone fusion, for protrusions between 2 and 4 mm, and by vertebral trephination and intercorporeal iliac bone-graft fusion for protrusions larger than 4 mm. There were no serious complications. Improvement by one clear disability grade (as defined by the authors) was observed in 36% of the cases, by two grades in 56%, and by three grades in 8%. No patient showed an improvement of four grades. During a follow-up period varying from 2 to 5 years, none of the patients showed clinical evidence of progression of myelopathy; however, 44% of patients showed definite radiological evidence of progression of cervical spondylosis. This indicates that myelopathy may be arrested and may regress, but the process of cervical spondylosis continues unabated in almost half of the cases.