bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of an Item Bank for a Computerized Adaptive Test of Activity in Children With Cerebral Palsy
Authors: Haley Stephen M. , Fragala-Pinkham Maria A. , Dumas Helene M. , Ni Pengsheng , Gorton George E. , Watson Kyle , Montpetit Kathleen , Bilodeau Nathalie , Hambleton Ronald K. , Tucker Carole A.
Published: May 2009

Background: Contemporary clinical assessments of activity are needed across the age span for children with cerebral palsy (CP). Computerized adaptive testing (CAT) has the potential to efficiently administer items for children across wide age spans and functional levels.

Objective: The objective of this study was to examine the psychometric properties of a new item bank and simulated computerized adaptive test to assess activity level abilities in children with CP.

Design: This was a cross-sectional item calibration study.

Methods: The convenience sample consisted of 308 children and youth with CP, aged 2 to 20 years (X=10.7, SD=4.0), recruited from 4 pediatric hospitals. We collected parent-report data on an initial set of 45 activity items. Using an Item Response Theory (IRT) approach, we compared estimated scores from the activity item bank with concurrent instruments, examined discriminate validity, and developed computer simulations of a CAT algorithm with multiple stop rules to evaluate scale coverage, score agreement with CAT algorithms, and discriminant and concurrent validity.

Results: Confirmatory factor analysis supported scale unidimensionality, local item dependence, and invariance. Scores from the computer simulations of the prototype CATs with varying stop rules were consistent with scores from the full item bank (r=.93–.98). The activity summary scores discriminated across levels of upper-extremity and gross motor severity and were correlated with the Pediatric Outcomes Data Collection Instrument (PODCI) physical function and sports subscale (r=.86), the Functional Independence Measure for Children (Wee-FIM) (r=.79), and the Pediatric Quality of Life Inventory–Cerebral Palsy version (r=.74).

Limitations: The sample size was small for such IRT item banks and CAT development studies. Another limitation was oversampling of children with CP at higher functioning levels.

Conclusions: The new activity item bank appears to have promise for use in a CAT application for the assessment of activity abilities in children with CP across a wide age range and different levels of motor severity.
Relationship between intracranial hemodynamics and microdialysis markers of energy metabolism and glutamate-glutamine turnover in patients with subarachnoid hemorrhage
Authors: Samuelsson Carolina , Howells Timothy , Kumlien Eva , Enblad Per , Hillered Lars , Ronne-Engström Elisabeth
Published: May 2009

Object

The aim of this study was to explore the relationship between hemodynamics (intracranial and systemic) and brain tissue energy metabolism, and between hemodynamics and glutamate (Glt)-glutamine (Gln) cycle activity.

Methods

Brain interstitial levels of lactate, pyruvate, Glt, and Gln were prospectively monitored in the neurointensive care unit for more than 3600 hours using intracerebral microdialysis in 33 patients with subarachnoid hemorrhage (SAH). Intracranial pressure (ICP), mean arterial blood pressure, and cerebral perfusion pressure (CPP) were recorded using a digitalized system.

Results

Interstitial Gln and pyruvate correlated with CPP (r = 0.25 and 0.24, respectively). Intracranial pressure negatively correlated with Gln (r = −0.29) and the Gln/Glt ratio (r = –0.40). Levels of Gln and pyruvate and the Gln/Glt ratio were higher and levels of Glt and lactate and the lactate/pyruvate ratio were lower during periods of decreased ICP (≤ 10 mm Hg) as compared with values in periods of elevated ICP (> 10 mm Hg). In 3 patients, a poor clinical condition was attributed to high ICP levels (range 15–25 mm Hg). When CSF drainage was increased and the ICP was lowered to 10 mm Hg, there was an instantaneous sharp increase in interstitial Glt and pyruvate in these 3 patients.

Conclusions

Increasing interstitial Gln and pyruvate levels appear to be favorable signs associated with improved CPP and low ICP. The authors suggest that this pattern indicates an energy metabolic situation allowing augmented astrocytic energy metabolism with accelerated Glt uptake and Gln synthesis. Moreover, their data raised the question of whether patients with SAH and moderately elevated ICP (15–20 mm Hg) would benefit from CSF drainage at lower pressure levels than what is usually indicated in current clinical protocols.
The use of recombinant activated factor VIIa in coagulopathic traumatic brain injuries requiring emergent craniotomy: is it beneficial?
Authors: McQuay Nathaniel , Cipolla James , Franges Eleanor Z. , Thompson Gregory E.
Published: May 2009

Object

The role of recombinant activated factor VII (rFVIIa) in traumatic brain injury (TBI) has not been well established. This study evaluates the outcomes of using rFVIIa as first-line therapy in patients with a severe TBI requiring emergent craniotomy that are coagulopathic.

Methods

The authors retrospectively reviewed patients admitted between 2003 and 2006 to a Level I trauma center with a severe TBI requiring an emergency craniotomy. Eighteen patients with coagulopathy that was corrected using rFVIIa were identified. Variables evaluated included age, injury severity score, head abbreviated injury score, Glasgow Coma Scale score, international normalized ratio, time to operation, operative procedure, thromboembolic events, and death.

Results

The cohort consisted of 18 patients, predominantly male (55.6%) with a mean age of 80.5 years. The most common mechanism of injury was a fall. Coagulopathy was due to premorbid anticoagulants in 50% of the cohort. Time from admission to operation was 130 minutes. Coagulopathy reversal was complete in all 18 cases (100%). A high mortality rate (55.6%) was attributed to a high incidence of withdrawal of care (50%). The incidence of thromboembolic events was low (5.6%). Survivors, when compared with nonsurvivors, had a > 3-fold increase in postoperative Glasgow Coma Scale score for similar preoperative scores. A good functional outcome was achieved in 75% of survivors with a mean follow-up period of 4.2 months.

Conclusions

The use of rFVIIa in the correction of coagulopathy in patients having sustained severe TBI requiring emergency craniotomy appears to be safe and effective even among the elderly. This allows a shorter transit time to craniotomy. Its effects on mortality and long-term neurological outcome requires further investigation prospectively.
Treatment of traumatic brain injury in mice with bone marrow stromal cell–impregnated collagen scaffolds
Authors: Qu Changsheng , Xiong Ye , Mahmood Asim , Kaplan David L. , Goussev Anton , Ning Ruizhuo , Chopp Michael
Published: May 2009

Object

This study was designed to investigate new ways of delivering human marrow stromal cells (hMSCs) to the injured brain by impregnating them into collagen scaffolds in a mouse model of traumatic brain injury (TBI).

Methods

Eight C57BL/6 J mice were injured with controlled cortical impact and received transplantation into the lesion cavity of 0.3 × 106 hMSCs impregnated into 3D porous collagen scaffolds. Additional experimental groups of 8 mice each received scaffolds implanted alone into the lesion cavity, hMSCs administered alone intracerebrally or intravenously, or saline injected into the lesion core. All treatments were performed 7 days after TBI. Spatial learning was measured using a modified Morris water maze test, and brain tissue samples were processed for histopathological analysis.

Results

The results showed that hMSC-impregnated scaffolds were more effective than hMSCs administered alone (either intravenously or intracerebrally) in improving spatial learning, reducing lesion volume, and increasing vascular density after TBI.

Conclusions

Collagen scaffolds populated with hMSCs may be a new way to reconstruct injured brain tissue and improve neurological function after TBI.
Clinical implications of intraoperative infrared brain surface monitoring during superficial temporal artery–middle cerebral artery anastomosis in patients with moyamoya disease
Authors: Nakagawa Atsuhiro , Fujimura Miki , Arafune Tatsuhiko , Sakuma Ichiro , Tominaga Teiji
Published: May 2009

Object

Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). Symptomatic cerebral hyperperfusion is a potential complication of this procedure, but its treatment is contradictory to that for ischemia. Because intraoperative techniques to detect hyperperfusion are still lacking, the authors performed intraoperative infrared monitoring in moyamoya disease using a novel infrared imaging system.

Methods

During superficial temporal artery–middle cerebral artery anastomosis in 25 patients (26 hemispheres) with moyamoya disease, the authors monitored the brain surface temperature intraoperatively with the IRIS-V infrared imaging system. The average gradation value change (indicating temperature change) was calculated using commercial software. Magnetic resonance imaging, MR angiography, and N-isopropyl-p-[123I]iodoamphetamine SPECT studies were performed routinely before and within 10 days after surgery.

Results

Patency of bypass, detailed local hemodynamics, and changes in cortical surface temperature around the anastomosis site were well recognized by the IRIS-V infrared imaging system in all cases. In the present study, 10 patients suffered transient neurological symptoms accompanied by an increase in CBF around the anastomosis site, recognized as symptomatic hyperperfusion. The increase in temperature was significantly higher in these patients. Intensive blood pressure control was undertaken, and free-radical scavengers were administered. No patient in the present study suffered a permanent neurological deficit.

Conclusions

Although the present method does not directly monitor surface CBF, temperature rise around the anastomosis site during surgery might be an indicator of postoperative hyperperfusion. Prospective evaluation with a larger number of patients is necessary to validate this technique.
The results of resection after stereotactic radiosurgery for brain metastases
Authors: Kano Hideyuki , Kondziolka Douglas , Zorro Oscar , Lobato-Polo Javier , Flickinger John C. , Lunsford L. Dade
Published: May 2009

Object

Radiosurgery for brain metastasis fails in some patients, who require further surgical care. In this paper the authors' goal was to evaluate prognostic factors that correlate with the survival of patients who require a resection of a brain metastasis after stereotactic radiosurgery (SRS).

Methods

During the last 14 years when surgical navigation systems were routinely available, the authors identified 58 patients who required resection for various brain metastases after SRS. The median patient age was 54 years. Prior adjuvant treatment included whole-brain radiation therapy alone (17 patients), chemotherapy alone (9 patients), both radiotherapy and chemotherapy (10 patients), and prior resection before SRS (8 patients). The median target volumes at the time of SRS and resection were 7.7 cm3 (range 0.5–24.9 cm3) and 15.5 cm3 (range 1.3–81.2 cm3), respectively.

Results

At a median follow-up of 7.6 months, 8 patients (14%) were living and 50 patients (86%) had died. The survival after surgical removal was 65, 30, and 16% at 6, 12, and 24 months, respectively (median survival after resection 7.7 months). The local tumor control rate after resection was 71, 62, and 43% at 6, 12, and 24 months, respectively. A univariate analysis revealed that patient preoperative recursive partitioning analysis classification, Karnofsky Performance Scale status, systemic disease status, and the interval between SRS and resection were factors associated with patient survival. The mortality and morbidity rates of resection were 1.7 and 6.9%, respectively.

Conclusions

In patients with symptomatic mass effect after radiosurgery, resection may be warranted. Patients who had delayed local progression after SRS (> 3 months) had the best outcomes after resection.
Angiofibroma of the middle cranial fossa
Authors: Iyer G. Vasudeva , Vaishya N. D. , Bhaktaviziam A. , Taori G. M. , Abraham Jacob
Published: May 2009

✓ The rare occurrence of angiofibroma as a primary intracranial tumor in the middle cranial fossa is reported in a young woman, and related reports are reviewed.
Vertex epidural hematoma treated by twist drill aspiration
Authors: Bonner John T. , Ward Arthur A.
Published: May 2009

✓ A case of vertex epidural hematoma was satisfactorily diagnosed and treated by twist drill aspiration. It is suggested that this method may occasionally be preferable to craniotomy for this lesion.
Abnormal brain scans in patients with cerebral arterial spasm
Authors: Wilkins Robert H. , Wilkinson Robert H. , Odom Guy L.
Published: May 2009

✓ Six cases are presented to show that the intracranial arterial spasm accompanying subarachnoid hemorrhage can be associated with an abnormal brain scan beginning 1 to 3 weeks after the onset of the spasm. The scan abnormality gradually disappears over a few months, and is presumably due to cerebral infarction.
Chronic spontaneous spinal epidural hematoma
Authors: Boyd Harry R. , Pear Bertram L.
Published: May 2009

✓ Two cases of spontaneous chronic spinal epidural hematoma are reported. Epidural hematoma in the region of the spinal cord produces dramatic signs of cord compression leading to early diagnosis and treatment, while epidural hemorrhage in the region of the cauda equina is insidious in its onset and tends to become chronic before definite treatment is undertaken.
Circulatory effects of moderately and severely increased intracranial pressure in the dog
Authors: Gonzalez Norberto C. , Overman John , Maxwell John A.
Published: May 2009

✓ Anesthetized dogs were subjected to elevated intracranial pressure (ICP) of 60 and 100 mm Hg. At 60 mm Hg, decreases in heart rate and arterial blood pressure were observed associated with an increase in femoral blood flow that suggested vasodilation in the somatic areas. Cardiac output showed little change. Subsequent elevation of ICP to 100 mm Hg was followed by an increase in arterial blood pressure; cardiac output increased, and femoral flow increased still further. Since resistance to flow did not change, the hypertension was thought to be due to an increase in flow rather than peripheral resistance. An increase in heart rate was associated with the elevation in cardiac output; the fact that femoral blood flow increased proportionately more than cardiac output suggested a redistribution of blood flow. The changes in peripheral blood flow and in cardiac output were associated with a decrease in the arteriovenous oxygen (A–VO2) difference. No signs of tissue hypoxia were observed; specifically there was no significant change in the lactate-to-pyruvate ratio; the changes in A–VO2 difference were correlated with changes in flow and the product of the two variables, namely, oxygen consumption, remained unchanged. The data show that experimental elevation of ICP restricted to moderate levels is followed by hemodynamic changes suggesting peripheral vasodilation, and that when an increase in blood pressure then occurs, it is due to an increase in blood flow despite the decrease in peripheral resistance.
Partial agenesis of the corpus callosum simulating a neoplasm
Authors: Banerjee Timir , Sayers Martin P.
Published: May 2009

✓ A case of partial agenesis of the corpus callosum is reported. The differential diagnosis is discussed and the significance of correlating clinical signs with the angiographic findings in the lateral view is emphasized.
Benign tumors of the cerebral dural sinuses
Authors: Browder Jefferson , Browder Ann , Kaplan Harry A.
Published: May 2009

✓ During an anatomical study of 295 cerebral dural sinuses obtained from cadavers, polypoid nodules were found in the superior sagittal sinus in two specimens. In 23 additional specimens, similar but smaller nodules were encountered in the transverse sinuses. The polyps in the superior sagittal sinuses were of sufficient size to cause a dilatation of the sinuses at the level of the masses. The histological evidence indicates their origin to be Pacchionian granulations.
Communication of hydromyelic cavity with the fourth ventricle shown by combined Pantopaque and air myelography
Authors: James Hector E. , Schut Luis , Pasquariello Patrick P.
Published: May 2009

✓ A 3-year-old child who had had respiratory and feeding difficulties at birth was admitted because of respiratory distress and stridor. Radiological evaluation with Pantopaque and air myelography revealed an Arnold-Chiari malformation associated with extensive hydromyelia and communication between the fourth ventricle and the hydromyelic cavity.
Fracture-dislocation of the cervical spine with ankylosing spondylitis
Authors: Osgood Carroll , Martin Louis G. , Ackerman Elliott
Published: May 2009

✓ Two cases of cervical fracture-dislocation causing neurological deficits in patients with ankylosing spondylitis are presented. Review of the literature shows that these patients have a higher incidence of neurological deficits (70%) than comparable patients without ankylosing spondylitis (44%). Predisposing factors and treatment are discussed.
Stereotaxic coagulation of a paraventricular arteriovenous malformation
Authors: Cahan Leslie D. , Rand Robert W.
Published: May 2009

✓ Stereotaxic coagulation of a single feeding vessel to a deeply situated arteriovenous malformation is described. The procedure involves stereotaxic positioning of a coagulating electrode to the arterial supply of the malformation. The placement is guided by intraoperative angiography. Although the coagulation did not immediately affect the feeding vessel, a postoperative angiogram obtained 1 month later demonstrated elimination of the major abnormalities in the malformation.
Pressure indicating bag for monitoring intracranial pressure
Authors: Numoto Mitsuo , Wallman James K. , Peardon Donaghy R. M.
Published: May 2009

✓ A new, simple, accurate, and inexpensive device for monitoring intracranial pressure, the Pressure Indicating Bag, is described. It is adaptable to both manual and automatic use.
Metastatic glioma associated with hypercalcemia
Authors: Cooper Paul R. , Budzilovich Gleb N. , Berczeller Peter H. , Lieberman Abraham , Battista Arthur
Published: May 2009

✓ Two cases of metastatic glioma with hypercalcemia are presented. Elevated serum calcium secondary to metastatic central nervous system tumors may be more common than is generally supposed, and the symptoms of hypercalcemia may be mistaken for those of increased intracranial pressure.
Carotid-cavernous sinus fistula treated by intravascular occlusion with a balloon catheter
Authors: Markham James W.
Published: May 2009

✓ The author reports two cases of fistula of the carotid-cavernous sinus successfully treated by intraluminal occlusion with a balloon catheter. The fistulas have remained obliterated for 3 years, and no reactions have occurred in either case from the indwelling intra-arterial catheter.
A telescopic ventriculoatrial shunt that elongates with growth
Authors: Wise Burton L.
Published: May 2009

✓ A ventriculoatrial (VA) shunt catheter has been developed, based on a double telescopic principle, that elongates during longitudinal growth of the child. It is implanted in patients by a technique similar to that used for other VA shunts, with minor modifications. Radiopaque markers on the expandable portion of the shunt allow radiographic measurement of the “growth” of the shunt. These shunts have been implanted in 18 children with hydrocephalus; in 15 they continue to function, a duration of from 1 to 4 years. In eight this was the initial shunt, while in 10 others the telescopic shunt was implanted at the time of revision of a standard shunt. One additional special model was implanted directly in the auricle by thoracotomy and is functioning over 5 months later. This type of shunt may largely eliminate the need for prophylactic lengthening of VA shunts during growth and prevent the problem of distal shunt obstruction due to growth.
Traumatic vertebral-carotid-jugular arteriovenous aneurysm
Authors: Rothman Stephen L. G. , Pratt A. G. , Kier E. Leon , Allen William E.
Published: May 2009

✓ The authors report a patient with a traumatic vertebral-carotid-jugular arteriovenous aneurysm diagnosed by rapid sequence selective angiography.
Exposure of the anterior part of the circle of Willis in the dog
Authors: Hori Shigeaki , Himwich Williamina A.
Published: May 2009

✓ A technique for exposing the vessels in the anterior part of the circle of Willis in the dog is described. Some of the physiological and anatomical characteristics of the anterior communicating and the anterior cerebral arteries are discussed.
Modifiable inexpensive electrodes for transcutaneous stimulation
Authors: Lentini Richard , Davis Ross , Goldstein Jeff
Published: May 2009

✓ The materials and methods for making improved transcutaneous nerve stimulation electrodes are described.
Multiple sclerosis
Authors: Rose Augustus S.
Published: May 2009

✓ The author presents a review of multiple sclerosis, and summarizes the present knowledge of the disease in relation to cause, pathogenesis, pathophysiology, and treatment. He stresses the inconsistency between the central nervous system pathology and the occurrence of signs and symptoms.
Leptomeningeal cysts associated with traumatic cerebrospinal fluid rhinorrhea
Authors: Front Dov , Beks Jan W. F. , Penning Lourens
Published: May 2009

✓ Nine instances of traumatic leptomeningeal cysts associated with rhinorrhea are described. The authors believe that the consequences of head trauma are responsible for both the rhinorrhea and the formation of leptomeningeal cysts, and that the scintigraphic demonstration of a leptomeningeal cyst may help in diagnosis when no overt rhinorrhea is present.
High-speed angiography of experimental head injury
Authors: Shatsky Stanley A. , Evans Delbert E. , Miller Frederick , Martins Albert N.
Published: May 2009

✓ Cineangiograms were performed at 1000 frames/sec in anesthetized rhesus monkeys during 4 meters/sec impact head injuries. Impacts that did not fracture the skull resulted in rapid transient movements of intracranial arteries. Lateral blows distorted the ipsilateral middle cerebral artery and reversibly displaced the anterior cerebral artery across the midline. Occipital blows distorted the peripheral branches of the middle and posterior cerebral arteries, and produced marked stretching of extracranial vessels. These data indicate that most of the intracranial movements hypothesized as etiological in brain injury occur in the first milliseconds following trauma. This technique makes possible quantitative measurement of these intracranial events and so may aid in the understanding of brain injury.
Subdural hematoma secondary to metastatic dural carcinomatosis
Authors: Leech Richard W. , Welch F. Tod , Ojemann George A.
Published: May 2009

✓ A case is reported in which bilateral subdural hematomas were caused by metastatic adenocarcinoma in the subdural membranes. This diffuse dural carcinomatosis was associated with widespread intravascular tumor growth and a marked vascular and fibrous proliferation, interpreted as a tumor-induced angiodesmoplasia. The hematomas resulted from separation and hemorrhage into this highly vascular abnormal areolar layer of the dura.
Pontine cyst presenting as trigeminal pain
Authors: Mortara Richard H. , Markesbery William R. , Brooks William H.
Published: May 2009

✓ The clinical, operative, and autopsy findings associated with a large, solitary, benign cyst of the pons and cerebellar peduncles that simulated a neoplasm of the fifth cranial nerve are described. The cyst manifested itself clinically by fifth cranial nerve signs and symptoms alone. A developmental origin is suggested for this nonneoplastic cyst.
Benign osteoblastoma of the skull
Authors: Williams Ronald N. , Boop Warren C.
Published: May 2009

✓ A case of benign osteoblastoma involving the skull is reported and the radiological, pathological, and clinical features of this tumor discussed. Benign osteoblastoma should be considered in the differential diagnosis of skull tumors because of its favorable response to conservative excision.
Progression of partial experimental injury to peripheral nerve
Authors: Kline David G. , Hudson Alan R. , Hackett Earl R. , Bratton Bert R.
Published: May 2009

✓ Isometric measurements of muscle contraction in response to single as well as tetanic volleys of supramaximal stimuli were recorded from the limbs of 32 monkeys with noninjured or partially lacerated tibial nerves. Nerve action potentials (NAP) and muscle action potentials (MAP) were also determined at intervals varying from 1 hour to 52 weeks after injury. Limbs with mobilized noninjured nerve sustained small but definite decreases in muscle contraction strength particularly if the interval between operations was brief. Partially lacerated nerves had immediate averaged decreases in single twitch and supramaximal contraction strengths of 32.8% and 30.4% despite maintenance of NAP velocity. One week following injury, muscle contraction had decreased by another 21.6% and 19.7% respectively while NAP velocity was decreased by 18.5%. Measurements were also reduced at 2, 4, and 8 weeks and to a lesser degree at 12 weeks; at 24 and 36 weeks, muscle contraction was less than preinjury data but not when compared to recordings 15 minutes after injury. Values recorded at 52 weeks reflected partial reinnervation of Achilles musculature. Studies over a 24-hour period following partial laceration demonstrated significant further decreases in muscle power by 8 hours. The authors conclude that nerve activity following partial laceration fluctuates as function diminishes during the early hours to weeks following injury.
Neurological and pathological effects of second lumbar spondylectomy and spinal column shortening in the dog
Authors: Yturraspe Daniel J. , Lumb William V. , Young Stuart , Gorman Harry A.
Published: May 2009

✓ The second lumbar vertebra was surgically removed from 10 dogs, and the shortened vertebral column was stabilized by internal fixation with two types of plastic plates. Shortening of the spinal column was usually not associated with detectable loss of function or neurological deficit. Histological lesions, however, included widely disseminated axonal degeneration, gliosis, and atrophy of spinal nerve roots in the surgical area. The spinal cord adapted to shortening of the vertebral column by becoming intrinsically shorter, rather than by being displaced within the spinal canal.
Transfemoral embolization of an external carotid-cavernous fistula
Authors: Pugatch Robert D. , Wolpert Samuel M.
Published: May 2009

✓ The authors report a case of spontaneous carotid-cavernous fistula in which transfemoral arterial embolization under fluoroscopic control resulted in immediate occlusion of the fistula and dramatic resolution of the patient's signs and symptoms.
Effect of respiratory movement on cerebrospinal fluid dynamics in hydrocephalic infants with shunts
Authors: Yamada Hiroshi , Tajima Masataka , Nagaya Masahiro
Published: May 2009

✓ The authors report a study of the effect of respiratory movement on intracranial, auricular, and intraperitoneal cerebrospinal fluid (CSF) pressure in hydrocephalic infants with shunts. Postoperative intraventricular pressures were also recorded for comparison. The intraventricular, right auricular, and intraperitoneal pressures rose during expiration and dropped during inspiration; the pressure changes were most marked while the infants were crying or straining. All pressures dropped simultaneously at the time of inspiration, but the auricular pressure was most significantly affected. It dropped to −100 to −200 mm H2O when the patients cried, while intraventricular and intraperitoneal pressures remained above 0 mm H2O. The postoperative intracranial pressures were in accord with these results; the pressures after ventriculoatrial shunt were significantly lower than those after ventriculoperitoneal shunt when the same pressure valves were used.
Comparison of intervertebral disc disease treatment by chymopapain injection and open surgery
Authors: Watts Clark , Hutchison Gary , Stern Jack , Clark Kemp
Published: May 2009

✓ Chymopapain chemonucleolysis was performed on 100 patients with primary lumbar intervertebral disc disease. The results were compared with those of 174 patients who underwent laminotomy, foraminotomy, and discectomy. Primary lumbar intervertebral disc disease was arbitrarily divided into degenerative, complex, previous surgical, and simple disc syndromes. No difference was seen between chemonucleolysis and surgery in the first three divisions; between 55% and 60% of patients responded successfully to treatment. In the simple disc division 89% of the surgical and 60% of the chemonucleolysis patients had successful results.
Radical one-stage correction of craniofacial anomalies
Authors: Epstein Fred J. , Wood-Smith Donald , Converse John M. , Benjamin M. Vallo , Becker Melvin H. , Ransohoff Joseph
Published: May 2009

✓ The authors present their experience in the surgical treatment of 66 patients with craniofacial anomalies, and discuss selection of patients, surgical technique, complications, and results.
Giant cell tumors of the calvaria
Authors: Arseni Constantin , Horvath Lenke , Maretsis Mlhail , Carp Nlcolae
Published: May 2009

✓ The authors report and discuss four rare cases of primary, giant cell tumor of the cranial vault, a usually benign tumor that develops in young patients and has an extremely low rate of latent malignancy. The authors believe the preferred treatment to be total surgical removal of the tumor; only in rare cases of malignancy when the tumor is impossible to remove totally should this be combined with radiotherapy. Associated minor trauma played only a tumor-revealing role and was not involved in the etiology.
Bilateral giant carotid-ophthalmic aneurysms
Authors: Garcia-Bengochea Francisco , Deland Frank H.
Published: May 2009

✓ The authors describe a patient with bilateral giant aneurysms of the internal carotid artery in the region of the ophthalmic artery. This case illustrates the feasibility of successful intracranial surgical treatment for this unusual combination.
Vernix caseosa meningitis and laryngeal stridor in an infant with myelomeningocele
Authors: Correa-Restrepo Alvaro , Robertson Charlene , Rozdilsky Bohdan
Published: May 2009

✓ The authors present the case of an infant with laryngeal stridor, apneic spells, and an open lumbar myelomeningocele; granulomatous vernix caseosa meningitis was found at autopsy. They suggest that chemical meningitis which also involved the cranial nerves might be held partly responsible for the laryngeal stridor.
Convexity leptomeningeal cysts diagnosed by scinticisternography
Authors: Front Dov , Defesche Hubert F.H.G. , Oen Thian Siang , Beks Jan W.F. , Penning Lourens
Published: May 2009

✓The scintigraphic diagnosis of eight convexity leptomeningeal cysts is described; the cysts appear as a local collection of abnormal radioactivity, best seen at 48 hours. The correlation of the scintigraphic findings with clinical, radiological, and operative findings is discussed.
Threshold for pain from anterolateral quadrant stimulation as a predictor of success of percutaneous cordotomy for relief of pain
Authors: Mayer David J. , Price Donald D. , Becker Donald P. , Young Harold F.
Published: May 2009

✓ A sensitive quantitative index for predicting optimal electrode position in percutaneous anterolateral cordotomy was determined by electrical stimulation through the lesioning electrode. If the threshold for pain elicited by the stimulation electrode was less than 300 µA, a 5-sec radiofrequency lesion of 50 mA would produce complete contralateral analgesia with no weakness. When the pain threshold exceeded 300 µA, incomplete or no analgesia would result with the standard single lesion. The results further suggested that the fibers in the anterolateral quadrant that transmit pain are discretely rather than diffusely localized.
Cervical spondylolysis with spondylolisthesis
Authors: Prioleau George R. , Wilson Charles B.
Published: May 2009

✓ The authors describe a case in which cervical spondylolysis was found at multiple levels with spondylolisthesis and associated neurological deficits. Radiographic findings and the absence of history of trauma suggest a congenital etiology.
Vasospastic dystrophy of the hand
Authors: Bender John L.
Published: May 2009

✓ The author reports a patient with a history of left arm pain and wasting of the hand who had absent radial and ulnar pulses. Sympathectomy restored the arterial circulation to the hand with nearly complete return of function.
Primary osteogenic sarcoma of the brain
Authors: Jacques Skip , Freshwater Donald B. , Shelden C. Hunter
Published: May 2009

✓ The authors report a case of primary osteogenic sarcoma of the brain. Negative autopsy findings, complete bone radiographs, and bone-scanning techniques were consistent with a primary tumor focus in the right temporoparietal region of the brain. The authors suggest an origin from a primitive multipotential mesenchymal cell.
Method of needle immobilization for ventriculography
Authors: Strother Charles M. , Newton Thomas H.
Published: May 2009

✓ The authors describe a method of needle immobilization for ventriculography, which minimizes cerebral trauma incident to ventriculograms.
Glioma of the jugular foramen
Authors: Lee Seung H. , Osborn Morris A. , Buchheit William A.
Published: May 2009

✓ A case is presented of a jugular foramen syndrome caused by an ectopic glioma. Treatment was by intracapsular removal through a suboccipital craniectomy.
Juxtasellar hyperostosis of non-meningiomatous origin
Authors: Lee K. Francis , Whiteley William H. , Schatz Norman J. , Edeiken Jack , Lin Shu-ren , Tsai Fong-Young
Published: May 2009

✓ Seven patients are described who had juxtasellar hyperostosis with visual disturbance secondary to non-meningiomatous lesions. Two had chromophobe adenomas, one craniopharyngioma, one carcinoma of the sphenoid sinus, one a thrombosed aneurysm of the intracavernous portion of the internal carotid artery, one epidermoidoma of the orbit, and one chondroblastoma of the anterior clinoid process. The diagnosis of meningioma was entertained initially on the basis of hyperostosis plus visual impairment. Careful evaluation of hyperostosis is essential for correct diagnosis of meningioma, according to our experience. Suprasellar meningiomas almost invariably produce irregular hyperostosis of the planum sphenoidale, often associated with serration and blistering. Sphenoid meningioma, when it is sclerotic, always shows thickening or expansion of the sphenoid wings. Therefore, in the absence of typical meningiomatous hyperostosis, one can readily differentiate non-meningiomatous hyperostosis from true meningioma.
Angiographic demonstration of a cerebral venous angioma
Authors: Preissig Randall S. , Preissig Sandra H. , Goree John A.
Published: May 2009

✓ This patient presented with a cerebral venous angioma in which the angiographic findings were suggestive of a malignant brain tumor; the true nature of this lesion was documented at surgery. The diagnostic features of this case are discussed.
Brain-cutting device for correlation of brain scan and autopsy sections
Authors: Shipps Fred C. , D'Agostino Anthony , Raaf John
Published: May 2009

✓ The authors describe a frame with guides to facilitate accurate correlation of the planes of brain-specimen sections with computerized axial tomography brain scans.
Systemic candidiasis and endophthalmitis in neurosurgical patients
Authors: Cushman Arthur R. , Friedman Gerald , Capsavage John
Published: May 2009

✓ Three cases of systemic candidiasis in neurosurgical patients are presented. Two of the three patients also had endophthalmitis. All of the cases were treated with broad-spectrum antibiotics and glucocorticoids prior to the appearance of candidiasis. The authors stress the high susceptibility of neurosurgical patients to opportunistic infections of this type.
Proximal occlusion of the dominant anterior cerebral artery for anterior communicating aneurysm
Authors: Choudhury Abdur R.
Published: May 2009

✓ Twenty-seven patients with ruptured and one with symptomatic unruptured anterior communicating aneurysms were treated by proximal clip occlusion of the dominant anterior cerebral artery. These patients have been followed for 2 to 4½ years and the results evaluated. The operation carried a very low mortality rate (3.5%) and a relatively low morbidity. There was no instance of recurrent hemorrhage during the study period. Clinical and preoperative angiographic criteria for selection of patients and the timing and technique of surgery are discussed.
Characteristics of human optic gliomas in tissue culture
Authors: Martuza Robert L. , Kornblith Paul L. , Liszczak Theodore M.
Published: May 2009

✓ Nine human optic gliomas were examined in tissue culture. Typically, growth from the explants revealed well differentiated bipolar cells with abundant 9 to 10 nm fibers similar to those observed in the surgical specimens. Multinucleation was rare except for one culture, which had as many as 20 nuclei arranged in a palisading fashion along the periphery of some of the cells. Degenerative changes of the 9 to 10 nm fiber bundles with the production of amorphous electron-dense deposits were observed both in vivo and in vitro, and were thought to represent the formation of Rosenthal fibers. A distinctive feature of some of the optic gliomas was the ability of their long, thin cellular processes to form fibrous tangles in tissue culture. The correlation of these fibrous tangles in culture with Rosenthal fibers in vivo is still uncertain.
A new surgical approach to the treatment of coronal synostosis
Authors: Raimondi Anthony J. , Gutierrez Francisco A.
Published: May 2009

✓ The authors describe a surgical technique for the treatment of unilateral coronal synostosis, which they have carried out successfully in 16 children. Frontal craniotomy, removal of the lesser wing of the sphenoid, orbital unroofing, and removal of the entire orbital rim are recommended as essential elements of cranioorbital reconstruction in the treatment of plagiocephaly.
“Congenital” plexiform neurofibroma of the occipital scalp
Authors: Ohaegbulam Samuel C.
Published: May 2009

✓ An occipital scalp tumor first noted in a Nigerian girl during the first month of her life gradually increased in size and 13 years later measured 20 × 16 × 17 cm. A skull film revealed a 2 × 4-cm skull defect underneath the tumor over the lambdoid suture. Complete excision of the tumor was achieved although it was adherent to the dura of the transverse sinus. It was histologically confirmed to be plexiform neurofibroma. There were no other signs of von Recklinghausen's neurofibromatosis.
Superficial temporal-middle cerebral artery anastomosis associated with glioblastoma multiforme
Authors: Cusick Joseph F. , Komacki Senichiro , Choi Hongyung
Published: May 2009

✓ The authors report a case in which glioblastoma multiforme was intimately associated with a surgical anastomosis of the superficial temporal artery to a branch of the middle cerebral artery.
Transsphenoidal chiasmapexy for correction of posthypophysectomy traction syndrome of optic chiasm
Authors: Decker Robert E. , Carras Robert
Published: May 2009

✓ Postoperative improvement occurred as a result of transsphenoidal chiasmapexy in a patient with posthypophysectomy visual loss. Traction injury of the optic chiasm may have been caused by a deficient diaphragma sellae and inadequate packing and repair of the sella floor. A cartilaginous seal is recommended.
Intracanalicular meningioma with normal tomography
Authors: Susac John O. , Martins Albert N. , Whaley Robert A.
Published: May 2009

✓ A middle-aged woman presented with the typical symptoms and signs of a compressive optic nerve lesion. Plain skull films, tomography of the optic canals, and selective angiography with magnification and subtraction were normal. Computerized transaxial tomography clearly showed the tumor, which was a meningioma of the optic nerve sheath. At surgery the tumor was found within the optic canal with intracranial and orbital extensions. It was strictly intradural and did not involve the surrounding bone at any point. This case documents the fact that an intracanalicular meningioma may be associated with normal tomograms of the optic canal.
A nerve stimulator for the cerebellopontine angle
Authors: Morgan Charles W. , Jannetta Peter J.
Published: May 2009

✓ A fine-tipped bipolar nerve-stimulator probe has been developed and has proved especially useful in intracranial surgery of the cranial nerves.
Computerized tomography as a possible aid to histological grading of supratentorial gliomas
Authors: Tchang Stanley , Scotti Guiseppe , Terbrugge Karel , Melançon Denis , Bélanger Gary , Milner Curt , Ethier Romeo
Published: May 2009

✓ Computerized tomography (CT) is shown to be very helpful in demonstrating the presence and extent of supratentorial gliomas, particularly in combination with intravenous injection of contrast material. Certain specific density patterns were found to exist and enabled us to differentiate with confidence the low-grade gliomas from the glioblastomas. Overlapping did occur, however, as was to be expected, since histological proof was sometimes obtained by needle biopsy with its inherent doubt as to true tumor representation. Future CT techniques such as sequential scanning after intravenous injection of contrast material may further increase the usefulness of CT scans in the diagnosis and therapeutic approach to the patient with a suspected glioma.
Iatrogenic failure of a ventriculoperitoneal shunt
Authors: Gerber Arthur M.
Published: May 2009

✓ A previously undescribed cause of ventriculoperitoneal shunt malfunction is presented. Limitation of abdominal excursion by a spica cast used to correct congenital hip dislocation reduced cerebrospinal fluid flow through a shunt. This easily correctable cause of “shunt failure” nearly resulted in replacement of a working shunt.
Ocular bobbing with superior cerebellar artery aneurysm
Authors: Sherman David G. , Salmon James H.
Published: May 2009

✓ A teen-age girl became comatose after the sudden onset of headache. Initial angiography did not reveal the site of bleeding. The subsequent onset of ocular bobbing directed attention to the region of the pons. Repeated angiography showed an aneurysm of the superior cerebellar artery. At surgery, the fundus of the aneurysm was adherent to the pons and there was a small hematoma within the pons. Ocular bobbing is rare, but is most commonly seen in association with destructive lesions of the pontine tegmentum, and is a useful localizing sign.
Spinal subarachnoid hemorrhage during myelography
Authors: Rice John F. , Shields Christopher B. , Morris Charles F. , Neely Byron D.
Published: May 2009

✓ Neoplasms of the conus medullaris and cauda equina have been shown to cause subarachnoid hemorrhage (SAH). In such instances, the hemorrhage has been the presenting symptom. A patient with a neurofibroma at T12—L1 experienced spinal SAH during myelography for suspected lumbar disc disease. The roentgenograms showing the lesion itself first and the subarachnoid clot subsequently may be unique. The cause of hemorrhage in this patient may have been the shearing of bridging capsular veins because of diminished cerebrospinal fluid pressure below the almost obstructing lesion.
Interrelationship of aneurysm clips and vascular tissue
Authors: Rosenbaum Thomas J. , Sundt Thoralf M.
Published: May 2009

✓ Various straight-jawed aneurysm clips were tested for occluding capabilities on a vascular tissue model. Occluding pressures varied markedly among the clip styles and were altered by changes in the lumen and tissue composition of the model. Mechanical characteristics are highly variable between clip styles, but fall within a narrow range for clips of a similar style. The complex interplay of the unique aspects of clip design and force generated by the spring in conjunction with tissue characteristics and precise clip placement upon the tissue are major variables in the apparent ability of a particular clip to occlude the neck of an aneurysm.
Experience with multiloculated brain abscesses
Authors: Stephanov Stephan
Published: May 2009

✓ The author reports his experience with 10 consecutive multiloculated brain abscesses diagnosed by computerized tomography and successfully treated by excision (primary or early secondary) or repeated aspiration.
Altered blood flow and secondary injury in experimental spinal cord trauma
Authors: Senter Howard J. , Venes Joan L.
Published: May 2009

✓ A modification of the hydrogen clearance technique was used to study blood flow in the dorsolateral funiculus of traumatized thoracic spinal cord in cats. The results of this study show that ischemia occurred in all animals both at the level of trauma, and 1 cm below the site of trauma. There was, however, a period of over 1 hour after trauma during which blood flow was maintained at both sites. This investigation not only confirms the presence of ischemia in the lateral funiculus of the injured spinal cord but suggests that a period of time exists in the posttraumatic period during which pharmacological intervention may alter the ischemic response and possibly prevent secondary injury resulting from the ischemia.
Hemangioma calcificans
Authors: DiTullio Michael V. , Stern W. Eugene
Published: May 2009

✓ A middle-aged woman, with a previous history of medically suppressed absence attacks, presented with mild changes in mental status and a skull film demonstrating several areas of mottled, granular, intracranial calcifications. These lesions, although readily visible on computerized tomography, appeared avascular during the course of cerebral angiography. At the time of surgery the masses, which were densely calcified and generally circular, demonstrated numerous areas of superficial, white, verrucous excrescences. Microscopic, pathological evaluation confirmed the diagnosis of hemangioma calcificans. The literature describing this rare entity is briefly reviewed.
Principles of pain management
Authors: King Robert B.
Published: May 2009

✓ Information that contributes to our understanding of the processes that participate in the perception of and responses to pain has expanded rapidly in the last decade. Much of this information and many clinical observations demand new conceptual frameworks within which to modify and expand classical teachings of pain pathways and mechanisms. In this brief review, some of these new dimensions are considered. The limited references serve as an introduction to more comprehensive original and review material.
A new method for testing the force of clips for aneurysms or experimental spinal cord compression
Authors: Dolan Eugen J. , Tator Charles H.
Published: May 2009

✓ A new method is described for the determination of force-distance curves for aneurysm clips. A dissecting microscope with a goniometer eyepiece was used to determine the angle between the clip blades as various forces were applied to open the clip. The cosine law was then used to calculate the force-distance curves. The method allows accurate characterization of different clips and is especially useful for the early detection of clip weakening.
Posttraumatic meningitis due to ampicillin-resistant Hemophilus influenzae
Authors: Bryan Charles S. , Jernigan Floyd E.
Published: May 2009

✓ Two men who sustained skull fractures secondary to blunt head trauma developed meningitis due to Hemophilus influenzae type b. The isolates in both cases were resistant to ampicillin but susceptible to chloramphenicol. Based on this experience and recent epidemiological trends, it is suggested that chloramphenicol, rather than penicillin G, might be the initial therapy of choice for posttraumatic meningitis when no micro-organisms are recognized on Gram-stained smears of the cerebrospinal fluid.