bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraoperative evaluation of cerebral hemodynamics using directional Doppler technique
Authors: Nornes Helge , Grip Arne , Wikeby Per
Published: May 2009

✓ The use of a pulsed echo Doppler technique during surgery for cerebral arteriovenous malformation is described. The equipment and the methods employed are presented. The main advantages are easy determination of flow direction and pattern of the vasculature involved, allowing a precise discrimination between inflow and outflow channels. Deep-seated malformations, not visible at the brain surface, can be located with the Doppler technique. The ultrasound probe was placed on the brain surface with a slight pressure on the intact pia mater. The precise direction and depth of the malformation could be determined in relation to the recording site. This facilitated the planning of cortical incisions, identification of vessels involved, and the vascular procedure to be employed.
Scoliosis and hydrocephalus in myelocele patients
Authors: Hall Peter , Lindseth Richard , Campbell Robert , Kalsbeck John E. , Desousa Alonso
Published: May 2009

✓ Developmental scoliosis is a common cause of increasing disability and deformity in long-term myelocele survivors, and is believed to result from a paralytic collapsing spine. The possible etiological role of compensated hydrocephalus and hydromyelia was assessed by determining the effect of ventricular shunting on 11 myelocele patients with developmental scoliosis. After successful shunting, one patient with a 47° curve continued to deteriorate. Three cases with curves greater than 60° were stabilized for short periods, but eventually required spinal fusion. Seven cases with curves less than 55° were improved from a mean scoliosis of 29° to 13° during a 20-month follow-up period. Several patients had pre-existing shunts that were found to be non-functional on shuntogram. These findings suggest that the spinal complications of hydrocephalus may be more common than previously recognized in myelocele patients and that advanced developmental scoliosis may be avoided by early recognition and ventricular shunting.
Early diagnosis of delayed posttraumatic intracerebral hematomas
Authors: Diaz Fernando G. , Yock Douglas H. , Larson David , Rockswold Gaylan L.
Published: May 2009

✓ Nine cases of delayed posttraumatic intracerebral hematomas (DTICH) were found retrospectively among 656 patients with closed head injuries admitted to the Hennepin County Medical Center in a 12-month period. All cases had severe head injuries sustained with the head in motion. The interval from cranial injury to diagnosis of DTICH by computerized tomography (CT) varied from 8 hours to 13 days. Eight patients were comatose on admission, three had focal seizures, and three had focal findings. The diagnosis was made on repeat CT scans obtained because of the development of focal findings in four cases, lack of improvement in four cases, and general neurological deterioration in one case. Four patients had initially negative CT scans. Four demonstrated only extracerebral hematomas on initial CT scan. One patient showed intracerebral hematoma on the initial scan followed by new hematomas on repeat study. The cases presented are discussed in light of pertinent literature.
Subependymal giant-cell astrocytoma
Authors: Sima Anders A. F. , Robertson David M.
Published: May 2009

✓ A 13-year-old boy presented with an obstructive left lateral intraventricular mass. Pathological examination revealed a subependymal giant-cell astrocytoma. Further clinical investigation confirmed the diagnosis of tuberous sclerosis. Ultrastructural examination confirmed previously reported features of this tumor. Tumor cells containing large dense granulated bodies and dense-core vesicles, not previously described in this tumor, were identified.
Subdural hematoma in an adult following a blast injury
Authors: Murthy J. M. K. , Chopra J. S. , Gulati D. R.
Published: May 2009

✓ A case is reported of chronic subdural hematoma in a civilian who was injured when a pipe exploded while being cleaned by air blasting. The literature regarding the pathogenesis of blast injury is reviewed.
Fenestrated basilar artery with an associated saccular aneurysm
Authors: Hoffman William F. , Wilson Charles B.
Published: May 2009

✓ A patient who presented with a subarachnoid hemorrhage was found to have a saccular aneurysm arising from the proximal basilar artery. The aneurysm was bilobed, directed anteriorly and inferiorly, and associated with a proximal fenestrated segment of the basilar artery.
Transsphenoidal hypophysectomy for disseminated carcinoma of the prostate gland
Authors: Tindall George T. , Payne Nettleton S. , Nixon Daniel W.
Published: May 2009

✓ Transsphenoidal microsurgical hypophysectomy was performed in 53 men with disseminated carcinoma (Stage IV) of the prostate gland. The mean age was 64.8 years. Forty-three of the 53 men had severe pain due to their disease. Significant pain relief was obtained following hypophysectomy, usually within 24 hours, in 39 (91%) of these 43 patients. Objective remission occurred in 16 (36%) of 45 patients in whom the follow-up review was adequate to make this decision. Although dramatic, pain relief was not permanent in every patient. Four patients died in the early postoperative period, and in one, death was directly related to the operative procedure. Significant complications included partial diabetes insipidus in 40 cases (75.5%), and cerebrospinal fluid leaks in six (11.3%).

The authors conclude that hypophysectomy is an appropriate operation in patients with disseminated carcinoma of the prostate gland, particularly when pain is a significant feature of the illness. Further, the transsphenoidal microsurgical approach appears to be the operative procedure of choice for performing hypophysectomy.
Prospective study of 100 lumbosacral discectomies
Authors: Weir Bryce K. A.
Published: May 2009

✓ A prospective study of 100 patients undergoing discectomy was carried out. The neurological findings were documented preoperatively and at 1 month and 1 year postoperatively. The clinical and radiological data were analyzed with respect to significant associations. There were no complications. At a minimum of 1 year postoperatively, 63% of patients had complete relief of back pain and 73% had complete relief of leg pain. A discriminant analysis equation was derived which assessed the relative significance of factors as determinants of outcome. A method is given for estimating whether a patient will have a good or a poor outcome following the discectomy. Factors shown to be of significance should be recorded in prospective series to allow for comparison as to the efficacy of different methods of treatment. The results are better than those described for chemonucleolysis.
Physiological study of presumed ventralis intermedius neurons in the human thalamus
Authors: Ohye Chihiro , Narabayashi Hirotaro
Published: May 2009

✓ Unitary or a group of unitary responses recorded extracellularly in the rostral part of the thalamic sensory nucleus during the course of thalamotomy for parkinsonian and other kinds of tremor were studied. They were the first sensory neurons encountered in the frontocaudal approach of the stereotaxic needle to the therapeutic target at the lower border of the ventralis intermedius nucleus. The spike discharges, isolated from high neural noise background, responded to passive and/or active movement of joint or muscle on the contralateral extremity but never to light tactile stimuli. In five cases, electrical stimulation of the corresponding peripheral nerves elicited the same spike discharge at short and fixed latency of about 12 msec. Weak electrical stimulation given to each thalamic point produced paresthetic or electric sensation around the receptive field, and stronger stimulation induced tremor-like movement in the area involving the receptive field. Finally, a small coagulation lesion in this thalamic point resulted in immediate relief of tremor without any sensory deficit.

From these findings, the possibility is considered that in the human, this particular thalamic zone could be the ventralis intermedius nucleus, which is separable from the surrounding nuclei and is related to tremor mechanism.
Spinal chordomas
Authors: Sundaresan Narayan , Galicich Joseph H. , Chu Florence C. H. , Huvos Andrew G.
Published: May 2009

✓ A series of 54 patients with spinal chordomas were treated at Memorial Sloan-Kettering Cancer Center between 1949 and 1976. Thirty-six lesions were located in the sacrococcygeal region and 18 involved the vertebral column at a higher level. The male to female ratio was 35:19. Vertebral chordomas generally occurred in a younger age group. Our radiological findings suggest that there is marked soft-tissue extension anterior to the vertebral column at the time of initial diagnosis. Eleven of 18 vertebral chordomas and 10 of 36 sacral chordomas were found to have disseminated metastases during their course. Analysis of the various modes of therapy reveals that the median survival for both groups is approximately 6 years. However, the 5-year survival for the sacrococcygeal group was 66% as opposed to 50% for the vertebral group. Radiation therapy produced significant palliation but objective evidence of tumor regression was difficult to assess. Chemotherapy in a small number of patients did not have any effect on the tumor. With the advent of computerized tomography scanning, further studies should be done to document the response of this tumor to radiation therapy.
The evaluation of seizure disorders by computerized tomography
Authors: McGahan John P. , Dublin Arthur B. , Hill Richard P.
Published: May 2009

✓ A series of 150 patients with seizure disorders was analyzed in detail. Older individuals (over the age of 65 years) with a short duration of seizure activity at the time of computerized tomography (CT) examination (less than 6 months), associated with specific neurological findings and focal seizures secondarily generalized, produced the highest number of intracranial CT abnormalities. Relationships between CT, electroencephalography (EEG), and other diagnostic procedures and pertinent historical and neurological findings are discussed.
The use of computerized tomography in the diagnosis of cerebral hydatid cysts
Authors: Özgen Tuncalp , Erbengi Aykut , Bertan Vural , Saǧlam Süleyman , Gürçay Özdemir , Pirnar Tuǧrul
Published: May 2009

✓ Eleven cases of cerebral hydatid cyst, diagnosed by computerized tomography (CT), are presented. The importance of CT in minimizing the possibility of accidentally tapping or tearing the cyst membrane is stressed. Repeat CT scanning after removal of the cyst revealed atrophy in the affected hemisphere.
Clearance of macromolecular and particulate substances from the cerebrospinal fluid system of the rat
Authors: Mann J. Douglas , Butler Albert B. , Johnson Richard N. , Bass Norman H.
Published: May 2009

✓ Arachnoid villi in the intracranial dural sinuses constitute the principal sites for absorption of proteins and particulates from the cerebrospinal fluid (CSF) system. Although arachnoid villi in the rat are morphologically less complex than those found in other mammals, their resistance to CSF outflow, as assessed by a graded series of constant flow manometric infusions, is similar to that found in other species. Moreover, inulin and polystyrene beads, when infused into the spinal subarachnoid space of rats, are rapidly cleared from the CSF system into intracranial dural sinuses. Inulin appeared in sinus blood 3 minutes after onset of infusion and reached concentrations 26 times greater than those found in the systemic circulation; particulate matter in the form of 0.5-µm polystyrene beads showed similar efflux characteristics. Hence, the CSF system of the rat is functionally similar to that found in other mammalian species, with arachnoid villi constituting a major efflux route for clearance of macromolecular and particulate substances.
Effect of vasodilators and myelotomy on recovery after acute spinal cord injury in rats
Authors: Rivlin Alex S. , Tator Charles H.
Published: May 2009

✓ The effect of papaverine, nitroprusside, or myelotomy on the recovery of spinal cord function was studied in rats after acute cord-compression injury. Spinal cord recovery was measured by a quantitative method of clinical assessment previously developed in our laboratory. Neither papaverine nor nitroprusside improved recovery of cord function. Dorsal midline myelotomy extending anteriorly as far as the central canal did not produce significant improvement (p > 0.05). However, when the myelotomy extended completely through the cord in the anteroposterior plane significant improvement (p < 0.01) was obtained.
Effects of dexamethasone on tumor-induced brain edema and its distribution in the brain of monkeys
Authors: Yamada Kazuo , Bremer Alfonso M. , West Charles R.
Published: May 2009

✓ A human choriocarcinoma was successfully adapted to grow in the brain of monkeys (Macaca mulatta), thus providing a model of tumor-induced brain edema. Four animals were given dexamethasone (3 mg/kg/day) during 3 to 5 days after the onset of clinical signs, and the other five received no treatment for the same period. Tissue water and electrolyte content of treated and untreated animals were compared in cortex and white matter at various distances from the edge of the tumor. In untreated animals, 67.9% and 23.6% swelling was detected in adjacent and remote white matter, respectively, but only 11.8% swelling was noted in adjacent cortex. In animals treated with dexamethasone these percentages of swelling were improved to 32.4% and 11.9% in the corresponding white matter, and to 4.9% in adjacent cortex. The electrolyte changes shown in edematous brain of control animals also demonstrated significant improvement in the dexamethasone-treated group. Tissue radioactivity of 3H-dexamethasone at 60 minutes after intravenous injection was high in the periphery of tumor, adjacent cortex, and white matter, but low in the center of tumor, remote cortex, and white matter. The sites with high concentrations of dexamethasone also showed significant improvement of brain edema after dexamethasone treatment, suggesting that dexamethasone may act directly at these loci.
Heifetz clip failure
Authors: Dujovny Manuel , Kossovsky Nir , Kossowsky Ram , Haines Stephen , Maroon Joseph C.
Published: May 2009

✓ A metallurgical analysis of a fractured Heifetz aneurysm clip is described. The authors assign the failure to a stress-corrosion mechanism.
Acute hydrocephalus and death one month after non-surgical treatment for acute cerebellar hemorrhage
Authors: Brillman Jon
Published: May 2009

✓ Acute cerebellar hemorrhages, treated medically with subsequent complete recovery, have been designated “benign cerebellar hemorrhages.” Ordinarily, acute cerebellar hemorrhage does require early surgical intervention and reported surgical mortality is relatively low (17%) in awake patients with this lesion. Clinical studies have shown that, after a period of approximately 2 weeks, the predicted mortality for this disorder becomes less than the operative mortality, and patients are then expected to recover. The author reports a case, with serial computerized tomography scanning, in which deterioration and death occurred 4 weeks after acute cerebellar hemorrhage. It is concluded that surgical intervention should be considered early in the clinical course of all cases of acute cerebellar hemorrhage.
Subdural spinal fungal granuloma due to Candida tropicalis
Authors: Kumar Sushil , Kaza Ramachandra C. , Tandon Arun , Nayar Mohini
Published: May 2009

✓ A case is reported in which spinal cord compression was caused by granulation tissue due to Candida tropicalis infection.
Long-term neuropsychological outcome of closed head injury
Authors: Levin Harvey S. , Grossman Robert G. , Rose James E. , Teasdale Graham
Published: May 2009

✓ Long-term recovery from severe closed head injury was investigated in predominantly young adults whose Glasgow Coma score was 8 or less at the time of admission. Of the 27 patients studied (median follow-up interval of 1 year), 10 attained a good recovery, 12 were moderately disabled, and five were severely disabled. In contrast to previous studies suggesting that intellectual ability after severe closed head injury eventually recovers to a normal level, our findings showed that residual intellectual level, memory storage and retrieval, linguistic deficit, and personal social adjustment corresponded to overall outcome. All severely disabled patients and several moderately disabled patients exhibited unequivocal cognitive and emotional sequelae after long follow-up intervals. Analysis of persistent neuropsychological deficit in relation to neurological indices of acute injury severity demonstrated the prognostic significance of oculovestibular deficit.
Detailed monitoring of the effects of mannitol following experimental head injury
Authors: Brown Frederick D. , Johns Lydia , Jafar Jafar J. , Crockard H. Alan , Mullan Sean
Published: May 2009

✓ The experimental model of a cerebral missile injury developed by Crockard was used in three groups of Rhesus monkeys treated with mannitol. One group received mannitol 15 minutes after being injured with a BB pellet at 90 m/sec impact. Another group was wounded identically, but mannitol treatment was delayed until 1 hour after injury. The last group was wounded with the missile traveling at 180 m/sec, and mannitol was started 15 minutes after trauma. The data were contrasted with the results from the original model. After receiving mannitol, all groups showed marked improvement in mean blood pressure, cerebral perfusion pressure, cerebral blood flow, and cerebral metabolic rate of oxygen consumption out of proportion to the degree of reduction in intracranial pressure (ICP). The authors conclude that the therapeutic value of mannitol may, in some injuries, be directly related to its effects on blood flow and metabolism, as well as to its better known effects upon ICP.
Early and late results of intracranial direct surgery of anterior communicating artery aneurysms
Authors: Hori Shigeaki , Suzuki Jiro
Published: May 2009

✓ During the 14-year period up to September, 1975, 346 patients with a single anterior communicating artery aneurysm, including eight with unruptured aneurysms, were operated on by direct intracranial procedures. There was an early operative mortality of 5.5%. Follow-up studies, an average of 3 years 11 months after surgery, revealed that about 85% of the survivors, excluding those who could not be followed, had regained their working capacity, and that the late mortality and morbidity rates were 9.6% and 2.0%, respectively. The rationale for performing the intracranial operation and factors influencing postoperative results are discussed, with particular emphasis on the techniques for accurate treatment of aneurysms that help to prevent postoperative rebleeding and therefore give better overall surgical results.
Transient ischemic attacks due to increased platelet aggregation and adhesiveness
Authors: Al-Mefty Ossama , Marano Gary , Rajaraman Srinivasan , Nugent G. Robert , Rodman Nathaniel
Published: May 2009

✓ The authors report 22 cases of transient ischemic attacks (TIA's) manifested by amaurosis fugax or hemiparesis or paresthesia of less than 24 hours' duration. None of the patients demonstrated 1) evidence of atherosclerotic cerebral vascular disease on angiography, 2) evidence of intracranial lesion on brain scan, 3) cardiac source of emboli, 4) arteritis or collagen disease, or 5) history of migraine. The only abnormalities found to explain the TIA's were abnormally increased platelet adhesiveness and/or aggregation. All of these patients were followed from 1 to 5 years, and had repeated coagulation studies. Treatment with antiplatelet drugs showed an excellent clinical response with associated decrease in platelet adhesiveness and aggregation. Discontinuance of the antiplatelet drug resulted in a recurrence of the TIA's which coincided with an increase in aggregation and adhesiveness. In two cases the platelet morphology was studied by transmission and scanning electron microscopy. It appears that there is a specific group of patients with TIA's in whom the sole cause of the attack is an abnormality of platelet function. For these people there is a specific therapy and a method of monitoring the treatment.
Prolactin suppression of leukocyte chemotaxls in vitro
Authors: Harris Robert D. , Kay Neil E. , Seljeskog Edward L. , Murray Kenneth J. , Douglas Steven D.
Published: May 2009

✓ Leukocyte chemotaxis in vitro was studied for cells from patients with pituitary adenomas. Leukocytes obtained preoperatively from two of three patients with elevated serum prolactin levels demonstrated chemotaxic alterations described in other malignant disease. Statistically significant suppression of chemotaxis occurred in the leukocytes of four of 12 specimens from normal donors at concentrations of 1000 ng/ml, and in four of eight specimens at 2000 ng/ml of prolactin in preincubation media. Thus prolactin concentration may influence the motility of leukocytes. The variable neoplastic behavior of morphologically similar pituitary adenomas may, in part, reflect a neurohormonally altered host response to the presence of these lesions.
Empty sella and rhinorrhea
Authors: García-Uría José , Carrillo Rafael , Serrano Pilar , Bravo Gonzalo
Published: May 2009

✓ The association of an empty sella with rhinorrhea is an unusual finding. Of 29 cases of empty sella observed by the authors, eight underwent surgery for rhinorrhea. None of the patients showed clinical evidence of increased intracranial pressure or hydrocephalus. Seven were cases of primary empty sella, the eighth was an acromegalic patient, who had received radiotherapy 4 years before. Except for this patient, the others showed no clinical signs of a previous tumor. In the surgical treatment of these patients, the authors used both the transfrontal and transsphenoidal approaches. In spite of generally accepted good results following surgical closure of this type of fistula, four patients needed more than one operation. The fistula closed in only three of them; in the last patient rhinorrhea persisted after three operations.
Cerebral hemodynamic changes during plateau waves in brain-tumor patients
Authors: Matsuda Masayuki , Yoneda Shunichi , Handa Hajime , Gotoh Hiroshi
Published: May 2009

✓ The plateau wave, one of the wave forms observed in patients with increased intracranial pressure, has previously been extensively investigated, but its pathophysiological aspect is as yet unclear. The authors undertook a study of cerebral hemodynamic changes while the plateau waves were observed in five brain-tumor patients. Although the number of cases studied was small, a remarkable decrease in cerebrovascular resistance was seen in all patients during the plateau waves. It is suggested that the plateau waves are caused by a marked cerebral vasodilatation. The present results support the thesis that cerebral blood volume is increased during the plateau waves. The plateau waves are closely related to the intrinsic vasomotor control of cerebral circulation, and can occur as long as cerebral vasodilating ability is maintained, irrespective of the existence of cerebral autoregulation.
Motion of bones and volume changes in the neurocranium after craniectomy in Crouzon's disease
Authors: Rune Bodil , Selvik Göran , Kreiborg Sven , Sarnäs Karl-Victor , Kågström Erik
Published: May 2009

✓ Craniectomy was performed on a boy with Crouzon's disease at 22 months of age. Metallic implants (tantalum balls, 0.5 mm in diameter) were inserted in the calvaria during surgery, and the child was examined postoperatively by roentgen stereometry at intervals of about 100 days (total observation time, 309 days). The thyroid radiation dose was 250 µGy for one examination. The effect of craniectomy was recorded with a high degree of accuracy in terms of motion of bones and volume changes in the calvaria. Expansion occurred almost entirely through motion of free bone flaps in the frontal region, while a linear craniectomy in the region of the sagittal suture caused small changes. The rate of expansion decreased rapidly and stabilization was recorded about 250 days after surgery.
Estrogen-receptor protein in intracranial meningiomas
Authors: Donnell Mark S. , Meyer Glenn A. , Donegan William L.
Published: May 2009

✓ The increased frequency of meningiomas in women compared with men, and the rapidly progressive course of these tumors in pregnant patients suggest that hormones may be involved in this disease. Tumor tissue from six patients with meningiomas was analyzed for estrogen-receptor protein. Two patients had tumors with very high concentrations of this protein, approaching that found in hormonally sensitive breast carcinoma. The biochemical and possible clinical significance of these findings is discussed.
Depressed skull fracture in the neonate
Authors: Saunders Brian S. , Lazoritz Stephen , McArtor Robert D. , Marshall Paul , Bason William M.
Published: May 2009

✓ The authors describe three cases of neonatal depressed skull fracture that were elevated by means of an obstetrical vacuum extractor. In one case, a transparent breast pump shield replaced the metal vacuum extractor cup, permitting direct observation as the depression was elevated. Neonatal depressed skull fractures not associated with neurological signs may be safely elevated without surgery using the obstetrical vacuum extractor.
Dural-cortical anastomosis in pial arteriovenous malformation
Authors: Waga Shiro , Morikawa Atsunori , Kojima Tadashi
Published: May 2009

✓ A patient is reported with a purely pial arteriovenous malformation (AVM) supplied from the posterior parietal artery. The prominent middle meningeal artery contributed to opacification of the angular branches distal to the AVM, but did not contribute to the AVM. After total removal of the AVM, the angular branches became opacified from the middle cerebral artery. Review of the literature suggests that hypertrophied dural arteries which do not contribute to the AVM's but which do opacify the cortical branches distal to the AVM's are rare.
Subdural tension pneumocephalos
Authors: Lunsford L. Dade , Maroon Joseph C. , Sheptak Peter E. , Albin Maurice S.
Published: May 2009

✓ Two patients developed subdural tension pneumocephalus after undergoing posterior fossa surgery performed in the sitting position. The mechanism for entry of air into the intracranial compartment is analogous to the entry of air into an inverted soda-pop bottle. As the fluid pours out, air bubbles to the top of the container. We have thus referred to this as the “inverted pop-bottle syndrome.” Computerized tomography provided prompt diagnosis and confirmed brain displacement. Twist-drill aspiration of the air resulted in improvement in both patients, although one patient subsequently died from an intracerebellar hemorrhage. Tension pneumocephalus appears to be another potential complication of posterior fossa surgery in the sitting position. This condition is easily diagnosed and treated, and should be considered whenever a patient fails to recover as expected following posterior fossa surgery.
Factors influencing future progress in neurosurgery
Authors: Ward Arthur A.
Published: May 2009

✓ The ever-widening horizons in the neurosciences are noted by the author. Maintenance of the bridges between research and clinical practice will result in improved therapy. Research interest is expanding, and involvement by neurosurgeons and neurosurgical training programs is vital for future progress. Techniques are required to evaluate and assess new surgical procedures that evolve from research endeavors.
The nature of posttraumatic epilepsy
Authors: Caveness William F. , Meirowsky Arnold M. , Rish Berkeley L. , Mohr Jay P. , Kistler J. Philip , Dillon J. Daniel , Weiss George H.
Published: May 2009

✓ The development, recession, and residua of posttraumatic epilepsy follow natural laws that are imperfectly defined. However, studies from World War I, World War II, the Korean conflict, and the Vietnam War demonstrate the following patterns: 1) The onset of seizures is significantly related to local brain destruction and its location, and to diffuse brain damage, reflected by alteration in consciousness. 2) The incidence of seizures has remained the same from one war to another, in spite of marked improvement in patient transport, surgical techniques, medical management, and the prophylactic use of anticonvulsants in Vietnam. 3) After injuries incurred in combat and support activities, the onset of new cases of epilepsy rises sharply, with approximately 5% having a seizure in the first week, 10% in the first 3 months, 16% in the first 6 months, 23% in the first year, 29% in the first 2 years; after that there is a low, but protracted rate of new cases of epilepsy. 4) Those cases that occur in the first week are less influenced by the agent of injury or local brain damage, thereafter there is a sharp divergence with the more extensive injuries providing the greater number of patients with seizures. 5) In the population at risk, 65% to 75% never have a seizure. In those that do, the development varies in degree, adjudged from frequency of seizures. The latter ranges from a single seizure to a number that defies an accurate count. 6) As new patients with seizures accumulate, earlier patients cease having seizures. Within 5 to 10 years, one-half of the patients have ceased having seizures, with or without therapy. Half of the remainder, about 8% of the injured, have intractable seizures. 7) While there is a clear correlation between severity of injury and onset of seizures, there is no correlation between severity of injury and cessation of attacks. However, there is a correlation between the attack frequency and persistence of seizures. 8) From the preceding, two principal determinants are evident: the constitutional tendency toward seizures (probably a multifactorial genetic trait), and the brain damage. In onset of seizures, both play a part, the constitutional factor apparently determining severity of attacks. In cessation or persistence of seizures, the constitutional factor plays the dominant role.
Intraoperative evaluation of cerebral hemodynamics using directional Doppler technique
Authors: Nornes Helge , Grip Arne , Wikeby Per
Published: May 2009

✓ The use of a pulsed echo Doppler technique during procedures for occlusion of intracranial aneurysms is described. Saccular aneurysms can be located with reference to probe position and depth setting. Tracings of intra-aneurysmal flow are presented, and the characteristic flow pattern is discussed. Special emphasis has been placed on the parent artery flow, particularly the effect of lumen reduction on flow velocity. Results of flow velocity studies on the cognate (direct) and collateral flow in the middle cerebral artery and the proximal anterior cerebral artery are presented and discussed.
Monitoring of cortical excitability during induced hypotension in aneurysm operations
Authors: Eisenberg Howard M. , Turner John W. , Teasdale Graham , Rowan Jack , Feinstein Robert , Grossman Robert G.
Published: May 2009

✓ The electrical excitability of the cortex was monitored during craniotomy in 10 patients with ruptured aneurysms, to test their ability to tolerate hypotensive anesthesia. Excitability was assessed by measuring the direct cortical response, a response evoked and recorded from the surface of the brain. Previous animal experiments had shown that this response can be used as an index of cerebral blood flow. In the 10 patients the response progressively declined as the blood pressure was lowered and increased when the pressure was restored. Observation of the direct cortical response during aneurysm operations is a practical method for evaluating the electrophysiological responsiveness of the cortex during hypotension, and the authors suggest that decreases in the amplitude of the response are related to decreases in local cerebral blood flow.
Neurological prognosis after traumatic quadriplegia
Authors: Maynard Frederick M. , Reynolds Glenn G. , Fountain Steven , Wilmot Conal , Hamilton Richard
Published: May 2009

✓ Between January, 1974, and December, 1976, 123 patients with traumatic quadriplegia were admitted to the California Regional Spinal Cord Injury Care System. The spinal cord injury resulted from gunshot wounds in five, from a stab wound in one, from neck injuries with no bone damage seen on x-ray studies in 10, and from fracture dislocations of the cervical spine in 107. One-year follow-up information was available on 114 patients. Neurological impairment using the Frankel classification system was compared at 72 hours postinjury to the 1-year follow-up examination. Fifty of 62 patients with complete injury at 72 hours were unchanged at 1 year. Five of these 62 patients had developed motor useful function in the legs or became ambulatory by 1 year, but all had sustained serious head injuries at the time of their trauma making initial neurological assessment unreliable. Ten percent of all cases had combined head injury impairing consciousness. Among 103 cognitively intact patients, none with complete injury at 72 hours were walking at 1 year. Of patients with sensory incomplete function at 72 hours postinjury, 47% were walking at 1 year; 87% of patients with motor incomplete function at 72 hours postinjury were walking at 1 year. Spinal surgery during the first 4 weeks postinjury did not improve neurological recovery. A method of analyzing neurological and functional outcomes of spinal cord injury is presented in order to more accurately evaluate the results of future treatment protocols for acute spinal injury.
Craniopharyngiomas in childhood
Authors: Shapiro Kenneth , Till Kenneth , Grant D. Norman
Published: May 2009

✓ The authors review 60 children who presented with craniopharyngiomas. Patients were treated by either 1) cyst aspiration followed by deep x-ray therapy (DXT), 2) radical excision, 3) incomplete tumor excision, or 4) incomplete excision followed by DXT. Symptomatic clinical recurrence signified failure of treatment. Of the patients treated by cyst aspiration and DXT, 50% experienced recurrence (mean time after treatment, 4.4 years), while recurrences occurred in 23% undergoing radical excision (mean time, 2.4 years). Symptomatic recurrences occurred in 78% treated by incomplete removal only (mean time, 2.2 years). No recurrences have occurred in seven patients whose incomplete removal was followed by DXT. The authors conclude that radical excision is most likely to produce survival free of recurrence. When radical excision is not possible, DXT appears to provide an additional effect on preventing tumor regrowth. Characteristics of craniopharyngiomas favoring radical excision are also discussed.
Studies of experimental cervical spinal cord transection
Authors: Tibbs Phillip A. , Young Byron , McAllister R. G. , Todd Edward P.
Published: May 2009

✓ Regional cerebral blood flow (CBF) was measured by the microsphere technique in anesthetized, mechanically ventilated dogs before and after cervical laminectomy in four (control group), or cervical laminectomy followed by cervical cord transection (CCT) at the C-6 level in six (experimental group). No significant differences in arterial pH, pO2 or pCO2 were observed between control and experimental dogs. Baseline values for mean arterial pressure (MAP) were also similar in the two groups, but MAP fell in all experimental dogs after CCT (p < 0.025). At 120 minutes after CCT, three of the six dogs had an MAP > 60 torr (66 ± 4 torr), and in three the MAP was < 50 torr (45 ± 3 torr). Regional CBF in cortical gray matter, white matter, and medulla did not change significantly after CCT in dogs with MAP > 60 torr. The CBF fell significantly at 120 minutes after CCT in all regions sampled in the dogs with MAP < 50 torr (p < 0.025). At 30 and 120 minutes after CCT, cerebellar blood flow fell significantly in all experimental animals (p < 0.05).

These findings indicate that, despite hypotension and sympathetic denervation of cerebral vessels, CBF in cortical gray matter, white matter, and medulla is maintained at normal levels after CCT by autoregulation as long as MAP exceeds 60 torr. Decreased cerebellar blood flow in the experimental group suggests redistribution of CBF after CCT with relative preservation of flow to gray matter, white matter, and medulla. Reduced CBF in the acutely cord-injured patient with significant hypotension (MAP < 60 torr) may simulate or complicate coexistent head injury.
Selective traumatic infarction of the human anterior hypothalamus
Authors: Rudelli Raul , Deck John H. N.
Published: May 2009

✓ A case of assault with bilateral manual avulsion of the eyes was followed by highly selective infarction of the anterior hypothalamus. The hypothalamic infarction occurred as a result of avulsion of part of the optic chiasm together with the anterior perforating arteries passing through it. Following this assault, symptoms of hypothalamic dysfunction included altered thermoregulation, alternating diabetes insipidus, and inappropriate antidiuretic hormone (ADH) secretion, altered patterns of sleep and arousal, and changing cardiac arrhythmias. The case casts light upon the vascular supply of the human hypothalamus and on the degree of localization existing for various hypothalamic functions.
Uveitis and cerebral reticulum-cell sarcoma (large-cell lymphoma)
Authors: Rosenbaum Thomas J. , MacCarty Collin S. , Buettner Helmut
Published: May 2009

✓ A patient with a peculiarly refractory uveitis and vitritis was later found to have an infiltrative mass lesion of the posterior portion of the corpus callosum. The histopathological diagnosis of reticulum-cell sarcoma (large-cell lymphoma) was made after study of vitreous tissue obtained by pars plana vitrectomy of the right eye. Intraocular involvement with cerebral reticulum-cell sarcoma has been reported previously.
Tetraplegia secondary to cervical sarcoidosis
Authors: Engle Edward A. , Cooney F. Donald
Published: May 2009

✓ This is the report of a case of vertebral sarcoidosis causing collapse of cervical vertebrae with resulting tetraplegia. The patient was successfully treated by decompression and subsequent anterior removal of the invaded three vertebral bodies, followed by an autologous bone graft.
Reconstruction of the atlas and axis with wire and acrylic after metastatic destruction
Authors: Nagashima Chikao , Iwasaki Takahi , Okada Keiichi , Sakaguchi Arata
Published: May 2009

✓ The authors describe a method of C1–2 reconstruction by means of wires and acrylic in a patient with metastatic destruction from carcinoma of the rectum. A huge upper cervical tumor together with involved bone had been removed at an earlier operation.
Agenesis of parietal bones with restoration of the cranial vault
Authors: Sela Mordechai , Sahar Abraham , Lewin-Epstein Jacob
Published: May 2009

✓ Complete agenesis of both parietal bones was found as a single anomaly in an otherwise healthy boy. The defect in the cranial vault was restored with preformed methyl methacrylate onlay plates.
Surgical removal of bilateral papillomas of the choroid plexus of the lateral ventricles with resolution of hydrocephalus
Authors: Gudeman Steven K. , Sullivan Humbert G. , Rosner Michael J. , Becker Donald P.
Published: May 2009

✓ The authors report a patient with bilateral papillomas of the choroid plexus of the lateral ventricles with documentation of cerebrospinal fluid (CSF) hypersecretion causing hydrocephalus. Special attention is given to the large volume of CSF produced by these tumors (removal of one tumor reduced CSF outflow by one-half) and to the fact that CSF diversion was not required after both tumors were removed. Since tumor removal alone was sufficient to stop the progression of hydrocephalus, we feel that this case supports the concept that elevated CSF production by itself is sufficient to cause hydrocephalus in patients with papillomas of the choroid plexus.
Surgical postoperative bleeding associated with aspirin ingestion
Authors: Merriman Edward , Bell William , Long Donlin M.
Published: May 2009

✓ Two patients are reported in whom repeated postoperative hematomas appeared to be secondary to aspirin-induced platelet defect. Routine bleeding and clotting studies will not demonstrate this platelet-induced coagulopathy. A previous history of massive aspirin ingestion makes such a coagulopathy a serious consideration, but the platelet defect may occur with small doses of aspirin. Such aspirin ingestion should be viewed with great concern by the neurosurgeon. The defect is treatable by platelet transfusion.
Chemotherapy as an adjunct in the initial management of cerebellar medulloblastomas
Authors: Venes Joan L. , McIntosh Sue , O'Brien Richard T. , Schwartz Allen D.
Published: May 2009

✓ Eight consecutive children with biopsy-proven cerebellar medulloblastoma were treated with a combination of whole neuraxis radiation and prolonged chemotherapy using vincristine and cyclophosphamide. There was no evidence of tumor recurrence in the follow-up period, which ranged from 16 months to 7 years and 8 months following diagnosis. Morbidity associated with this regimen has been infrequent and easily reversible.
Neurosurgical desmoid tumors
Authors: Friede Reinhard L. , Pollak Anita
Published: May 2009

✓ Four neurosurgical tumors of desmoid appearance are presented, along with a brief review of the differential diagnoses of intracranial or spinal fibromatous or desmoid lesions. Two of the tumors were identified as extremely collagenized meningiomas by their typical fine structure. The classification of the other two tumors remains uncertain, but they were thought to belong to the family of desmoid tumors.
Regional cerebral blood flow and oxygen utilization in superficial temporal-middle cerebral artery anastomosis patients
Authors: Grubb Robert L. , Ratcheson Robert A. , Raichle Marcus E. , Kliefoth Arthur B. , Gado Mokhtar H.
Published: May 2009

✓ Regional cerebral blood flow (rCBF) and regional cerebral oxygen utilization (rCMRO2) were measured before and after surgery in nine patients undergoing a superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis to bypass cerebrovascular lesions not amenable to extracranial operative procedures. The objective of these studies was to determine whether measurements of this type could provide objective criteria for surgery as well as assess the effect of surgery. The preliminary data, although limited, suggest that measurements of regional cerebral hemodynamics and metabolism in these patients before and after surgery provide valuable data upon which to develop criteria and assess results. For example, 1) a significant depression of rCBF and rCMRO2 in patients in whom a major cerebral infarction has not occurred, or 2) relative preservation of rCMRO2 despite depressed rCBF seem to be favorable indications for establishing a functioning STA-MCA anastomosis. In such patients, STA-MCA anastomosis can be followed by a return of rCBF and rCMRO2 to virtually normal levels. Relatively normal rCBF and rCMRO2 in the presence of an occluded internal carotid artery in asymptomatic patients indicates satisfactory collateral circulation and is probably a contraindication to surgery.
Intracranial aneurysms associated with arteriovenous malformations
Authors: Suzuki Jiro , Onuma Takehide
Published: May 2009

✓ Nine cases of intracranial aneurysm associated with cerebral arteriovenous malformation (AVM) were found in a total of 140 patients with cerebral AVM (6.4%). Radical operation was performed for both angioma and aneurysm in eight cases and for aneurysm only in one case. The suitability of surgical treatment of both aneurysm and angioma is discussed.
Nonvolumetric methods of detecting impaired intracranial compliance or reactivity
Authors: Wilkinson Harold A. , Schuman Nancy , Ruggiero John
Published: May 2009

✓ The authors have attempted to find a clinically reliable method of measuring intracranial pressure (ICP) compliance or reactivity that does not require volumetric manipulation. An analysis was undertaken of ICP, pulse widths and of the presence or absence of B waves, both experimentally in dogs and clinically in postoperative human patients. In both dogs and humans, ICP pulse width generally increased with increasing ICP and with increasing intracranial mass, and definitely increased with systolic arterial blood pressure. Nonetheless, ICP pulse width commonly failed to increase with increasing cerebral reactivity, and low ICP pulse width measurements were at times recorded in distinctly pathological situations.

From the clinical study it was found that B waves were encountered more commonly in patients with increased ICP or increased ICP pulse width. However, the correlation between B waves alone or in combination with increased ICP or ICP pulse width and quantitative measurements of ICP reactivity was not significant. Mean reactivity and the range of reactivity measurements were almost identical in patient groups with and without B waves. For the time being the “ICP reserve test” remains the most accurate, the safest, and the most clinically useful method of quantitating ICP reserve.
Thoracic myelopathy caused by osteophytes of the articular processes
Authors: Marzluff Joseph M. , Hungerford G. Douglas , Kempe Ludwig G. , Rawe Stephen E. , Trevor Richard , Perot Phanor L.
Published: May 2009

✓ Compression of the spinal cord or nerve roots resulting from degenerative spondylosis is commonly seen in the cervical or lumbar region, but it has not previously been described in the thoracic region. Despite this, the authors believe that the syndrome is not rare. They describe four cases, three of which were seen at one institution within 2 years. Decompression of the spinal cord by removal of the osteophytes may produce gratifying results, even when symptoms have been present for years. The syndrome should be considered in any patient who has a thoracic myelopathy and radiological evidence of spondylosis.
Analysis and measurement of some sources of variability in experimental spinal cord trauma
Authors: Molt James T. , Nelson Louis R. , Poulos Dennis A. , Bourke Robert S.
Published: May 2009

✓ Experiments were performed on anesthetized cats to determine whether the variability that is common in experimental spinal cord injuries produced by the weight-drop technique can be reduced if a more accurate determination of the actual intensity of the insult to the cord is measured. In addition, determinations of the contribution of such variables as mass of drop-weight, impounder diameter, and animal weight to variability were made. It was found that of the three measures of intensity readily available from a strain gauge transducer, impulse (change in momentum of drop-weight) showed the highest correlation with the histologically determined extent of the lesion. It was shown that the mass of the drop-weight had a significant effect on lesion size even when the gram × centimeter quantification of the injury was constant. Animal weight and impounder diameter did not make a significant contribution to the variability of injury as determined by low-power microscopy.
The effect of topical application of antibiotics on the cerebral cortex
Authors: Garretson Henry D. , Reid Kenneth H. , Shields Christopher B. , Noonan John D.
Published: May 2009

✓ A common complication of intrathecal sepsis is the development of clinical seizure activity. However, some of the newer, commonly used antibiotics may have epileptogenic and electrocortical depressant effects when applied topically to the cerebral cortex. Epileptogenic characteristics of these antibiotics may be masked by the known tendency for intracranial sepsis to produce both early and late clinical seizure problems. In this experimental study, electrocortical spike activity was produced by penicillin, methicillin, cephalothin, carbenicillin, colistimethate, and neomycin, and electrocortical depression was caused by tobramycin and gentamicin. A mixed picture was found with neomycin and carbenicillin.