bluuebunny/crossref_metadata_2025 huggingface dataset:
The abducens nerve
Authors: Nathan Hilel , Ouaknine Georges , Kosary Isaac Z.
Published: May 2009

✓ The authors describe the origins and course of the sixth cranial nerve in 62 cadaver or autopsy cases and describe three patterns. In Pattern 1 the nerve originates and runs all its way as a single trunk. In Pattern 2 it originates as a single trunk, but splits into two branches in the subarachnoid space, while in Pattern 3 it originates as two separate trunks. In both Patterns 2 and 3 the trunks perforate the dura mater independently and enter the cavernous sinus by passing one above and the other below the petrosphenoidal ligament. In the sinus the two trunks fuse into a single trunk which then continues to the lateral rectus muscle. The practical neurological importance of these variations is discussed.
Encephalopathy associated with occult neuroblastoma
Authors: Berg Bruce O. , Ablin Arthur R. , Wang Winfred , Skoglund Rayburn
Published: May 2009

✓ The authors report four cases of occult neuroblastoma in children with the striking clinical findings of opsoclonus, myoclonus, and ataxia. The diagnostic value of plain roentgenograms of the chest and abdomen or an intravenous pyelogram is emphasized. Assays for vanillyl mandelic acid and cystathionine may be of value. The clinical course and pathogenesis of encephalopathies due to neuroblastoma are discussed.
Experimental study of relation of fever to cerebral edema
Authors: Clasen Raymond A. , Pandolfi Sylvia , Laing Iris , Casey Donald
Published: May 2009

✓ The effect of hyperthermia on the development of the cerebral edema associated with cryogenic lesions was studied in monkeys. Exposure to a body temperature of near 104°F for a period of only 2 hours increased the edema by 40%. This effect was independent of the hypertensive action of hyperthermia but was intensified when the latter was present. It is suggested that, in human diseases known or thought to be associated with cerebral edema, fever should be vigorously treated.
The experimental effect of direct electrical current on intracranial arteries and the blood-brain barrier
Authors: Fox John L. , Yasargil M. Gazi
Published: May 2009

✓ Direct electrical current (DC) was applied to the basilar artery of 20 dogs and the circle of Willis of five monkeys. The artery was in contact with microsurgical forceps acting as the monopolar electrode. The DC currents from 0 to 1 mA were used at voltages of 0 to 3 V with observable effect noted at levels above 0.5 mA at 1 V. Neither negative (−) nor positive (+) DC caused vasoconstriction unless the initial and terminal current change occurred too rapidly causing a stimulus pulse. Both − and + DC caused focal vasodilatation of the artery made spastic by needle puncture or topical 10% barium chloride (BaCl2). This dilatation was more rapid (30 to 60 sec) and more pronounced with −DC current. Angiography confirmed extreme focal dilatation lasting at least 4 days after −DC application. This appears to be secondary to the known production of hydroxyl (OH−) ions at the cathode and possibly hydrogen (H+ or H3O+) ions at the anode during electrolysis. We hypothesize that smooth muscle protein bonds are affected. The effects of DC on the systemic arteries also are described.

Also studied were the effects of similar DC on brain cortical microvasculature of 10 dogs and on the systemic arteries of 50 rats. It was discovered that not only did + DC cause the well-known local coagulation phenomena but also both − and + DC caused formation of micro-emboli with resulting occlusion of arterioles. These phenomena, which could be seen only under the operating microscope, occurred after a decomposition potential of about 1 V was reached. We theorize this was due to the formation of denatured protein and alkali-hematin at the − pole secondary to the formation of OH− ions during electrolytic reduction and due to formation of denatured protein and acid-hematin at the + pole secondary to the formation of H+ ions during electrolytic oxidation. For reasons not yet clear there was an acute breakdown in the blood-brain barrier to fluorescein around the negative pole but not around the positive pole.
Dynamic pressure-flow relationships of brain blood flow in the monkey
Authors: Early Calvin B. , Dewey Richard C. , Pieper Heinz P. , Hunt William E.
Published: May 2009

✓ Pressure-flow data are presented for the brain vascular bed in the rhesus monkey. These data are obtained at fixed levels of vasomotor tone. Resultant flow curves are called the “dynamic pressure-flow relationships” (DPFR). In the experimental model, arterial pressures are oscillated with a sinusoidal pump at frequencies exceeding the vasomotor response lag time. The resultant DPFR curves are discussed. A model is presented to show that changes in vasomotor tone cause a vertical shift of the DPFR. Changes in vascular bed resistance cause a change in the slope of the DPFR (▵P/▵F).
Lymph node metastasis as first manifestation of glioblastoma
Authors: Dolman Clarisse L.
Published: May 2009

✓ An enlarged parotid lymph node excised from a young woman contained malignant cells. Three weeks later she developed signs of a brain tumor and died despite irradiation. Autopsy revealed a large frontal lobe glioblastoma multiforme which had infiltrated the dura. The lymph node, which had been the first manifestation of disease, contained identical tumor tissue.
Metastasis of bronchogenic carcinoma to acoustic neurinoma
Authors: LeBlanc Raymond A.
Published: May 2009

✓ An example of bronchogenic carcinoma metastasizing to an acoustic neurinoma is described. The two other comparable cases reported are discussed and the eight other cases of extracranial-to-intracranial spread of tumor noted.
Angiographic visualization of fatal hemorrhage from a cerebral arteriovenous malformation
Authors: McLennan James E. , Rosenbaum Arthur E. , Hedley-Whyte E. Tessa , Tischler Arthur S. , Scott R. Michael
Published: May 2009

✓ The authors report and discuss a rare angiographic demonstration of extravasation of contrast material from a ruptured arteriovenous malformation.
Acute spinal subdural hematoma
Authors: Zilkha Albert , Nicoletti John M.
Published: May 2009

✓ A case of an acute posttraumatic spinal subdural hematoma is presented. Complete neurological recovery followed surgical evacuation.
Adjustable microvascular clamp for cerebrovascular surgery
Authors: Peters Norman , Ommaya Ayub K.
Published: May 2009

✓ A lightweight adjustable double microvascular clamp is described that requires only one adjustment before application for anastomosis of arteries.
Surgical treatment of arterial aneurysms of the vertebrobasilar circulation
Authors: Chou Shelley N. , Ortiz-Suarez Humberto J.
Published: May 2009

✓ Twenty patients with basilar bifurcation aneurysms and subarachnoid hemorrhage were treated surgically as a consecutive series irrespective of preoperative grading. There were six fatalities; eight of the survivors have done well while six are in poor condition.

The authors also report a series of 13 surgical cases of posterior fossa aneurysm not located at the basilar bifurcation, three on the posterior cerebral artery, five on the basilar trunk, and five on the vertebral origin of the posterior inferior cerebellar artery. There were two operative deaths and one late death due to pulmonary embolism. The other 10 have had good results.
Intraparenchymal arteriovenous malformations with predominant external carotid artery contribution
Authors: Dahl Raymond E. , Kline David G.
Published: May 2009

✓ Arteriovenous malformations located within cerebral parenchyma are usually supplied by intracranial vessels. An extracranial blood supply to these lesions is rare. The authors report their experience with two such cases and discuss the 21 comparable reports.
Dispersion of central nervous system tumors
Authors: Batzdorf Ulrich , Gold Vivian
Published: May 2009

✓ The phenomenon of tumor dispersion through cerebrospinal fluid is discussed in relation to observations made in tissue cultures of human central nervous system tumors. Satellite colony formation was observed in cultures of tumors that tend to spread through the CSF. Abnormalities of the tumor cell surface, particularly a reduction of cell-to-cell adhesiveness, probably are important. Although mechanical factors contribute to the formation of both CSF metastases and in vitro satellites, they do not offer a sufficient explanation for these phenomena.
Reliability of technicians in computerized and standard A-mode midline echoencephalography
Authors: Brisman Ronald , Buchanan Darrell S. , Rosegay Harold
Published: May 2009

✓ A prospective controlled study was done to evaluate technician reliability in measuring midline cerebral shifts by computerized (Midliner) and standard A-mode echoencephalography. Thirteen of 16 (81%) verified shifts were correctly predicted by the Midliner, while only five of 14 (36%) shifts were correctly noted by the standard echoencephalograms. Two false negatives occurred with 2 mm Midliner shifts. The computerized echoencephalogram is a simple and effective instrument for determining midline shifts even when used by minimally trained paramedical personnel, but its reliability is limited when it shows a 1.5 to 2 mm shift or an unsatisfactory tracing.
Stimulation of internal capsule for relief of chronic pain
Authors: Adams John E. , Hosobuchi Yoshio , Fields Howard L.
Published: May 2009

✓ The severe spontaneous pain associated with lesions of the central nervous system has been successfully suppressed by electrical stimulation of the posterior limb of the internal capsule. The physiological basis for this result is not understood but the authors's hypothesis is that the pain suppression is due to stimulation of parietal corticofugal inhibitory fibers.
Sequential morphological changes at the site of carotid endarterectomy
Authors: French Barry N. , Rewcastle N. Barry
Published: May 2009

✓ Nineteen carotid arteries were examined post mortem after endarterectomy had been performed from 1 hour to 11 years previously. The sequential morphological changes at the endarterectomy site were divided into acute, reparative, and mature phases. All nine occluded arteries thrombosed during the acute phase postoperatively. The degree of medial necrosis, acute inflammation and adventitial exposure was more marked in these thrombosed acute phase arteries. By 30 days new intima covered the endarterectomy site and thereafter thrombosis was not seen. Avoidable technical errors led to thrombosis of three arteries. Anticoagulation after surgery may reduce the incidence of postoperative thrombosis. Recurrent symptomatic atheroma occurred in two cases at the original endarterectomy site 16 months and 11 years after operation.
Treatment of postangiographic hemiplegia with vasopressors
Authors: Wernick Shelley , Sugar Oscar
Published: May 2009

✓ Postangiographic hemiplegia can be successfully treated with vasopressors. A case is presented and the method of treatment discussed and analyzed.
Epidural empyema following thoracic extradural block
Authors: Ferguson John F. , Kirsch Wolff M.
Published: May 2009

✓ An unusual case of epidural sepsis with subsequent paraparesis following the placement of a thoracic epidural catheter for the maintenance of a postoperative analgesic block is reported. The hazards of this technique are reviewed.
Spinal fluid-venous fistula: a mechanism for intravascular Pantopaque infusion during myelography
Authors: Lin Paul M. , Clarke Joseph
Published: May 2009

✓ Two cases of intravascular infusion of Pantopaque occurring during myelography are reported. Cerebrospinal fluid-venous fistula is described as the mechanism of escape of Pantopaque from the subarachnoid space into a venous plexus and as a possible explanation of postspinal intracranial hypotension.
Surgical treatment of vascular lesions in the brain stem
Authors: Chou Shelley N. , Erickson Donald L. , Ortiz-Suarez Humberto J.
Published: May 2009

✓ The authors report the total surgical removal of five vascular lesions of the brain stem, three hemangioblastomas and two arteriovenous malformations. One patient died; among the others, the quality of survival is excellent. Factors favoring surgical removal of such lesions are discussed.
Congenital scalp defects: aplasia cutis congenita
Authors: Kosnik Edward I. , Sayers Martin P.
Published: May 2009

✓ The authors discuss the rare lesion of congenital scalp defect, both partial and full thickness. The majority occur in children who are otherwise normal, but a few are seen in children who have many concomitant anomalies. A high percentage of the multiple anomaly cases were found to have trisomy 13–15. Etiology of these lesions is not clear, but there seems to be an inherited component. Treatment of otherwise normal children is conservative for the smaller lesions, with excision and primary closure when possible for the larger ones.
Chronic subdural hematoma in adults
Authors: Fogelholm Rainer , Heiskanen Olli , Waltimo Olli
Published: May 2009

✓The relationship of age to clinical and pathological findings was analyzed in 109 adult patients operated on because of chronic subdural hematoma. A well-formed membrane on the inner and outer surface of the hematoma was used as the criterion for chronicity of the hematoma. Younger patients had more evidence of increased intracranial pressure; older patients had more evidence of mental deterioration and pyramidal tract lesions. The interval from trauma to operation was shorter in the young patients. The thickness of the hematoma as measured from angiograms increased with the age of the patient. The cause of this difference is discussed.
Follow-up comparison of hydrocephalus with and without myelomeningocele
Authors: Shurtleff David B. , Kronmal Richard , Foltz Eldon L.
Published: May 2009

✓ A series of 454 hydrocephalic patients with and without myelomeningocele and with and without treatment is reviewed. The survival rates for hydrocephalus alone and for hydrocephalus with myelodysplasia are comparable. The authors reach the conclusion that treatment of the hydrocephalic process and its complications is the most critical therapeutic consideration. Mental retardation is the major unalterable cause for failure to develop independence; some lesser emotional causes can be modified by encouragement. Repeated reassessment of the patient's condition and adjustment are important. Before treatment is started parents or guardians should be fully informed of the child's future potential for independent life and mental development.
Late results of radical excision of craniopharyngiomas in children
Authors: Katz Edward L.
Published: May 2009

✓ The results of radical surgical excision of craniopharyngiomas in children operated on by Dr. Donald Matson beginning in 1950 are presented. The patients are analyzed in regard to survival and quality of survival. While 22 of 34 children so treated at the initial operation are presently alive and tumor-free, high mortality and morbidity followed in cases where reoperation was performed. Properly treated endocrinological deficits need not be a serious problem, but persistent hyperosmolality carried a grave prognosis. No predictive criteria are yet available to determine which tumors are amenable to radical surgical excision.
Neonatal craniopharyngioma
Authors: Azar-Kia Behrooz , Krishnan Uttamapalayam R. , Schechter Mannie M.
Published: May 2009

✓ The authors report a case of craniopharyngioma in a newborn infant. Marked hydrocephalus of the fetal head was recognized in the Pelvimetric roentgenograms of the mother and massive suprasellar calcification was seen in the plain skull films.
Chronic subdural hematoma simulating transient cerebral ischemic attacks
Authors: Melamed Eldad , Law Slvan , Reches Avinoam , Sahar Abraham
Published: May 2009

✓ A patient is presented in whom chronic subdural hematoma simulated transient ischemic attacks. The neurological manifestations were those of recurrent, transient episodes of expressive dysphasia preceded by focal sensory deficit. Various pathophysiological mechanisms which could have caused the unusual clinical picture are briefly considered.
Review of basic concepts of cell kinetics as applied to brain tumors
Authors: Hoshino Takao , Wilson Charles B.
Published: May 2009

✓ The authors review and discuss the basic concepts of cell kinetics as applied to brain tumors. Uncontrolled growth of a neoplasm represents an expanding tumor cell population. Four growth parameters characterize the behavior of a neoplastic population: cell cycle time, growth fraction, tumor doubling time, and cell loss. The concept of provisionally nondividing cells explains the disparity between cell cycle time and tumor doubling time. Human gliomas, like many non-neural solid tumors, contain variable proportions of actively proliferating and nonproliferating tumor cells; this ratio is expressed by the growth fraction. The major kinetic difference between glioblastomas and differentiated astrocytomas resides in their respective growth fractions, in all likelihood an inherent biological characteristic of each tumor. Glioblastoma proliferates at a rapid rate, and only a high rate of cell loss prevents this tumor from doubling its volume in less than 1 week. The selection of drugs and design of drug schedules for treatment of glioblastomas should be made with the knowledge that 60% to 70% of the cells in this tumor are resting (nonproliferating). If experience with other solid tumors is any guide, judicious selection and combined use of drugs according to kinetically sound schedules will produce more effective chemotherapy of brain tumors.
Radiofrequency percutaneous Gasserian ganglion lesions
Authors: Onofrio Burton M.
Published: May 2009

✓ Percutaneous radiofrequency ablation of the Gasserian ganglion or posterior root, or both, was performed in 140 patients. Of the 135 patients with trigeminal neuralgia, satisfactory analgesia was achieved in 121. Postoperative complications included unintentional first-division analgesia (10), transient sixth-nerve palsy (1), neuroparalytic keratitis (2), and anesthesia dolorosa (2). The phenomenon of facial blush may be helpful in avoiding unwanted first-division analgesia. In four of five patients with other forms of neuralgia, the procedure did not relieve pain; the fifth patient experienced significant relief from pain due to carcinoma of the mandible.
Effect of delayed local cooling on experimental spinal cord injury
Authors: Thienprasit Phudhiphorn , Bantli Heinrich , Bloedel James R. , Chou Shelley N.
Published: May 2009

✓ The authors report studies indicating that delayed local cooling is effective in minimizing the neurological deficits of experimental spinal cord injury in cats. Cortical evoked responses were useful in predicting the neurological outcome; untreated animals whose evoked response disappeared for 6 hours failed to recover whereas all treated animals in the same group recovered dramatically. Decompression by laminectomy alone proved ineffective. Possible explanations for the therapeutic effects of cooling and the significance of the delay are briefly discussed.
Vasogenic edema following acute and chronic spinal cord compression in the dog
Authors: Griffiths Ian R.
Published: May 2009

✓ The T-13 spinal cord segment of dogs was compressed both acutely and chronically by means of a balloon catheter. The vascular permeability to protein was assessed using Evans blue albumin (EBA), and the dorsal column evoked potential recorded to monitor conduction failure. With acute compression sufficient to cause conduction failure there was a marked leakage of EBA from the intermediate gray matter, which spread into the dorsolateral white matter. The degree of edema was similar whether the compression was maintained or released. Chronic compression maintained over 4 to 5 hours did not increase vascular permeability, but following release of compression leakage of EBA occurred in the same cord locations observed with leakage from acute compressions. This increased permeability following release of chronic compression may result from reactive hyperemia. Dorsal column conduction returned after the release of both acute and chronic compression. The extravasated EBA was present both in the extracellular space and within cells. The results and their clinical application are discussed.
Use of 6-hydroxydopamine to create lesions in catecholamine neurons in rats
Authors: Mendez Jorge S. , Finn Billie W.
Published: May 2009

✓ The authors report experiments in rats with 6-hydroxydopamine (6-OHDA), a chemical agent used for creating lesions in catecholamine neurons. Stereotaxic injection of 6-OHDA into the compact zone of the substantia nigra induced degeneration of the nigrostriatal dopamine (DA) system, confirmed by histology and histochemistry of the substantia nigra and by dopamine determinations in the neostriatum. These observations closely mimic those found in Parkinson's disease. In the experimental model a rotatory behavior is induced by DA agonists; this response has been used to test drugs for potential therapeutic use and also in basic studies of the extrapyramidal system. This technique may be useful in developing other experimental models for neurosurgical problems involving catecholamine pathways.
Catecholamine levels in the injured spinal cord of monkeys
Authors: Bingham W. George , Ruffolo Robert , Friedman Stewart J.
Published: May 2009

✓ The authors report a study of catecholamine levels in the spinal cords of monkeys following a 300 gm-cm blow to the midthoracic spinal cord. There was a progressive decrease in norepinephrine (NE) activity as a first-order process with a half-life of 6.4 hours. The NE activity in injured tissue never exceeded control levels, which remained unchanged both above and below the injured segment. Dopamine activity remained unchanged in the injured tissue as well as in control segments above and below the area of trauma for the first hour.
Cervical spine injuries in infants
Authors: Gaufin Lynn M. , Goodman Stanley J.
Published: May 2009

✓ The authors point out the unique anatomical and therapeutic considerations involved in injuries of the cervical spine and cord in infants. The special problems encountered in the treatment of such patients are illustrated by three cases, a “Hangman's” fracture, a C6–7 fracture-dislocation, and an acute quadriparesis associated with dysgenesis of the posterior elements of C1–3.
Results of treatment of intracranial aneurysms by wrapping and coating
Authors: Mount Lester A. , Antunes J. Lobo
Published: May 2009

✓ The authors report the results of treatment of 58 intracranial aneurysms by wrapping with muscle or muslin gauze, and/or coating with Selverstone plastic material. They conclude that reinforcement with muscle is of little value, but that muslin gauze and plastic produced satisfactory results.
Incidence of postoperative deep vein thrombosis in neurosurgical patients
Authors: Joffe Stephen N.
Published: May 2009

✓ This preliminary report on the use of 125I-fibrinogen and Doppler ultrasound techniques for the diagnosis of postoperative deep vein thrombosis (DVT), shows that neurosurgical patients are at considerable risk. The DVT was often asymptomatic, bilateral, and extended into the more proximal veins.
Spinal cord compression due to extramedullary hematopoiesis in homozygous thalassemia
Authors: Luyendijk Wlllem , Went Lodewijk , Schaad Hans D.G.
Published: May 2009

✓ The authors report a case of homozygous thalassemia in which a mass of hematopoietic tissue in the vertebral canal caused spastic paraparesis. Surgical removal of the tissue plus radiotherapy were successful. The pathological findings indicated direct extension of hematopoietic tissue from the adjacent bone marrow into the epidural space of the vertebral canal.
Maduromycosis of the brain
Authors: Natarajan Murugesan , Balakrishnan Devarajulu , Muthu Aloysius K. , Arumugham Kallady
Published: May 2009

✓ A rare case of a gas-containing brain abscess due to verified maduromycosis is described. Blackish material over the abscess cavity revealed the fungal elements. The pus from the abscess contained Streptococcus hemolyticus and Klebsiella organisms.
Pituitary hemangioblastoma in a patient with von Hippel-Lindau disease
Authors: Dan Noel G. , Smith Dermer E.
Published: May 2009

✓ A case of von Hippel-Lindau disease is described in which a pituitary hemangioblastoma was present as well as a cerebrovascular anomaly.
Effects of mannitol and steroid therapy on intracranial volume-pressure relationships in patients
Authors: Miller J. Douglas , Leech Peter
Published: May 2009

✓ The intracranial volume-pressure response was measured in 61 patients undergoing continuous monitoring of intraventricular pressure. This test, which determines the increase in intracranial pressure induced by an addition of 1 ml in ventricular CSF volume in 1 second, yields information concerning spatial compensation in patients with intracranial space-occupying processes. On the basis of variability tests, a change in volume-pressure response of 2 mm Hg/ml was accepted as significant. Pronounced enlargement of the ventricles interferes with the test. In patients with intracranial hypertension, intravenous mannitol (0.5 gm/kg) and intramuscular betamethasone (26 mg) both reduce the volume-pressure response significantly more than they reduce intracranial pressure. This suggests that these agents favorably alter the configuration of the volume-pressure curve.
Increase in cerebral perfusion pressure by arterial hypertension in brain swelling
Authors: Matakas Frank , Waechter Rainer v. , Knüpling Reent , Potolicchio Samuel J.
Published: May 2009

✓ Brain swelling was produced in monkeys and cats by the inflation of an epidural balloon against the parietal lobe. Resulting changes in intracranial pressure (ICP) were correlated to variation in systemic arterial pressure (SAP). Intracranial perfusion pressure (ICPP) defined as the difference between SAP and ICP, was found to vary with the degree of arterial hyper- and hypotension. The relationship between SAP and ICP can be explained by an existing equilibrium between extramural pressure and vessel wall circumferential tension. A positive perfusion pressure can exist in brain swelling as long as vessel wall tension is preserved and the degree of expanding brain tissue volume is held below certain limits.
Relief of pain by transcutaneous stimulation
Authors: Loeser John D. , Black Richard G. , Christman Amalia
Published: May 2009

✓ A series of 198 patients with chronic pain of diverse etiology was carefully analyzed for epidemiologic and descriptive factors which might influence the response to transcutaneous stimulation. The overall series included 12½% with long-term success, and 68% with partial or short-term relief. There were no consistent specific diagnoses, or epidemiologic or descriptive factors that made good results from stimulation predictable. Stimulation of the painful area itself was not always necessary for pain relief. Favorable responses to transcutaneous stimulation were usually correlated with the continued existence of significant sensory input from the painful region. The authors conclude that transcutaneous stimulation is a valuable therapeutic modality for some patients with chronic pain.
Experimental intracerebral movement of electron microscopic tracers of various molecular sizes
Authors: Milhorat Thomas H. , Davis Donald A. , Hammock Mary K.
Published: May 2009

✓ The authors demonstrate that, while the intracerebral movement of proteins and other relatively large molecules is restricted by tight junctions of endothelia and epithelia of the brain, calcium ion penetrates these barriers and moves between the blood and CSF cavities by extracellular pathways. Mechanisms underlying CSF formation are considered on the basis of this anatomical continuity of the vascular, extracellular, and CSF compartments of the brain for very small molecules.
Steroid-induced remission in spinal canal reticulum cell sarcoma
Authors: Clarke Patrick R. R. , Saunders Michael
Published: May 2009

✓ The authors record the case histories of two patients originally diagnosed as having the Guillain-Barré syndrome, who responded to steroid therapy and were subsequently shown to have reticulum cell sarcomas. The dangers of attaching significance to steroid-induced remissions are stressed.
Injection of chymopapain into intervertebral discs
Authors: Onofrio Burton M.
Published: May 2009

✓ The author presents an evaluation of 72 patients given intradiscal chymopapain as the treatment for symptoms related to ruptured intervertebral disc. The rationale, criteria for patient selection, risks, and results are described. The author believes that this early follow-up suggests that chymopapain may have a place in the treatment of symptomatic disc protrusions and extrusions.
Inadequacies and hazards of chymopapain injections as treatment for intervertebral disc disease
Authors: Sussman Bernard J.
Published: May 2009

✓ The author reviews laboratory and clinical reports that lead him to believe that chymopapain does not specifically dissolve the nucleus pulposus and is toxic for vascular and neural tissue.
Transverse axial tomography of the spine
Authors: Jacobson Robert E. , Gargano Fredie P. , Rosomoff Hubert L.
Published: May 2009

✓ The authors describe the technique of transverse axial tomography of the spine and give a detailed description of the axial anatomy of the normal lumbar spine from L-4 to the sacrum. They demonstrate a specific repetitive pattern of intraosseous and articular segments, and stress the importance of the articular processes in shaping the vertebral canal and the intervertebral foramina. The authors believe axial tomography to be a simple, noninvasive radiological technique that allows cross-sectional visualization of the vertebral canal and articular processes in the living patient.
Bifrontal decompressive craniectomy in the management of head trauma
Authors: Venes Joan L. , Collins William F.
Published: May 2009

✓ Retrospective analysis of 13 patients who had bifrontal decompressive craniectomy for the management of posttraumatic cerebral edema shows a significant decrease in expected mortality, but severe morbidity in the survivors. Only one patient returned to the pretrauma level of neurological function, No correlation could be found between the quality of survival and the neurological or operative findings. The need for more accurate prognostic criteria in the evaluation of severely head-injured patients is discussed.
Management of carotid-ophthalmic aneurysms
Authors: Guidetti Beniamino , La Torre Emanuele
Published: May 2009

✓ The authors present 26 cases of carotid-ophthalmic aneurysms that were surgically treated. Contrary to the opinion that these aneurysms, which often are of giant size, must be treated conservatively or by common carotid ligation, the authors favor radical surgery, believing that carotid ligation does not provide assurance against the risk of rebleeding, and frequently is associated with failure to restore useful vision. Often these aneurysms have a neck more suitable for ligation than shown by angiography, since a giant aneurysm may overlap the carotid artery in the angiogram. Preoperative criteria and some details of radical treatment are discussed.
Surgical embolization of cerebral arteriovenous malformations through internal carotid and vertebral arteries
Authors: Luessenhop Alfred J. , Presper John H.
Published: May 2009

✓ The authors describe the clinical results of surgical embolization in 55 patients with large cerebral arteriovenous malformations. Follow-up intervals ranged from 2 months to 14 years, averaging 4½ years. The authors believe the procedure is safe in properly selected patients and is useful as a preliminary to direct surgical excision. It relieves associated headaches, and usually reverses or stabilizes a progressive neurological deficit. The potential for seizures probably is not altered. The incidence of hemorrhage following embolization is low for patients with no previous history of hemorrhage; however, the procedure does not reduce the likelihood of recurrence in patients with a prior history of hemorrhage.
Contrecoup skull fractures
Authors: Hirsch Charles S. , Kaufman Benjamin
Published: May 2009

✓ The authors describe the frequency, pathological features, and significance of contrecoup fractures of the anterior cranial fossae, which occur commonly when falls with occipital or temporal impacts cause fatal head injuries.
Microsurgical anatomy of the jugular foramen
Authors: Rhoton Albert L. , Buza Robert
Published: May 2009

✓ The authors conducted an autopsy study of 50 jugular foramina and surrounding tissue, using the dissecting microscope. Anatomical findings from this study are presented.
Value of sequential postoperative brain scans in patients with anaplastic gliomas
Authors: Leonard John R. , Witherspoon Lynn R. , Mahaley Moses S. , Goodrich Jack K.
Published: May 2009

✓ The authors analyze the postoperative course of 30 patients with anaplastic supratentorial gliomas to evaluate the usefulness of sequential brain scanning as an adjunct to clinical neurological examinations in the early detection of tumor recurrence. The correlation between sequential scanning and clinical evaluation was excellent; no examples of divergent results were seen. With the exception of scans made very early in the postoperative period or when postoperative scalp flap infections were present, initial postoperative scans were easily interpreted in terms of both the superficial (postcraniotomy) and parenchymal changes. The specific type of postoperative therapy (radiation therapy, chemotherapy, or both) could not be correlated with whether scan or examination ultimately changed first. However, analysis of original tumor location revealed that while sequential postoperative scanning offered no advantage over repetitive neurological examinations in the detection of recurrent tumor in the neurologically dominant left hemisphere, scan changes preceded examination changes in eight of 17 cases involving tumors of the neurologically nondominant right hemisphere.
Adverse reactions to intrathecal saline injection for control of pain
Authors: Lucas John T. , Ducker Thomas B. , Perot Phanor L.
Published: May 2009

✓ The authors report the results of a questionnaire regarding the use of hypertonic saline for the control of pain. Of 2105 patients so treated, nearly 11% had an adverse temporary symptom or sign, reported as an untoward reaction; slightly over 1% suffered a significant morbidity, of which paraplegia or quadriplegia was by far the most common, and two patients died (0.1%).
Metal prosthesis of the cervical vertebra
Authors: Ono Keiro , Tada Koichi
Published: May 2009

✓ The authors successfully used a newly-devised metal prosthesis anchored by acrylic cement in four patients with cervical spinal tumor. Two of these patients suffered incomplete quadriplegia due to epidural infiltration of the tumor and required laminectomy. Severe neck pain was relieved in all cases, and neurological improvement was maintained until death.
Penetrating gunshot wounds of the cervical spine in civilians
Authors: Heiden James S. , Weiss Martin H. , Rosenberg Alan W. , Kurze Theodore , Apuzzo Michael L. J.
Published: May 2009

✓ The authors present a series of 38 civilian patients with cervical gunshot injuries, and compare neurological recovery in patients with complete lesions and patients with incomplete lesions according to whether therapy was surgical or nonsurgical. In patients with incomplete injury, ultimate recovery was a function of the initial injury more than surgical or nonsurgical therapy; nor did patients with complete lesions show significant change in outcome with either mode of therapy. Cord pathology at laminectomy rarely provided a clue about neurological recovery, and dural decompression did not alter neurological outcome. The authors conclude that the sole indication for routine surgical intervention appears to be progressive neurological deficit.
Intracranial hydatid cysts
Authors: Kaya Umur , Özden Beyhan , Türker Kiraç , Tarcan Bülent
Published: May 2009

✓ The authors report 17 cases of intracranial hydatid cyst out of 500 brain tumors seen in 20 years, and analyze clinical, investigative, diagnostic, and operative findings.
Carotid-cavernous sinus fistula presenting as a posterior fossa mass
Authors: Bartlow Bruce , Penn Richard D.
Published: May 2009

✓ The authors report a case in which trigeminal neuralgia and hearing loss developed 14 years after a severe head injury. Arteriography demonstrated a carotid-cavernous sinus fistula producing a large venous mass in the posterior fossa.
Evolution of a primary intrasellar germinomatous teratoma into a choriocarcinoma
Authors: Giuffrè Renato , Di Lorenzo Nicola
Published: May 2009

✓ A case of intrasellar teratoma with a germinal structure in a 10-year-old girl is described. A few months after intracranial surgery the tumor differentiated into a choriocarcinoma and finally spread to multiple cerebral, pulmonary, and renal metastases. In the course of choriocarcinomatous evolution, very high urinary levels of luteinizing gonadotropin (HCG) developed, but there was no clinical or anatomical evidence of precocious puberty.
The third circulation revisited
Authors: Milhorat Thomas H.
Published: May 2009

✓ The author reviews modern information concerning the formation, flow, and functions of the cerebrospinal fluid. Particular attention is given to the lymphatic-like features of the third circulation and to its importance as an internal milieu for nervous tissue.
Scanning electron microscopy of the ventricular system in normal and hydrocephalic rabbits
Authors: Page Robert B.
Published: May 2009

✓ The author used the scanning electron microscope to study the ependyma in six control rabbits and six rabbits made hydrocephalic by infusion of silicone oil into the cisterna magna. The ependymal lining of the third ventricle, head of the caudate nucleus, superior angle of the caudate, and atrium of the lateral ventricle was examined. In the hydrocephalic animals, clusters of cilia emanating from the ependyma over periventricular white matter become separated; the author believes this is secondary to ingrowth of new ependymal cell processes covered with microvilli. The addition of these cells to the ependymal surface permits ventricular dilatation without ependymal disruption and provides more surface containing microvilli, presumably capable of increased transventricular fluid transfer. No such changes occur over gray matter masses since their surfaces are not deformed by moderate ventricular dilatation. The morphological alterations in the ependyma that occur in moderate hydrocephalus do not appear to be simply manifestations of ependymal destruction but rather suggest a modification in its function from that of a surface capable of propelling cerebrospinal fluid to one capable of increased transfer of transventricular fluid. As hydrocephalus progresses, compensation may fail because of the relative decrease in microvilli so that the cell surface provides a less efficient mechanism for absorption.
Continuous intraventricular cerebrospinal fluid pressure recording in hydrocephalic children during wakefulness and sleep
Authors: Rocco Concezio Di , McLone David G. , Shimoji Takeyoshi , Raimondi Anthony J.
Published: May 2009

✓ Continuous 24-hour recordings of intracranial pressure and electroencephalographic activity were made on five hydrocephalic children in whom, in the resting wakefulness state, the intracranial pressure (ICP) was considered normal. An increase in both the mean ICP and its oscillations related to cardiac systole was recorded during slow-wave sleep. Further episodic increases, up to a factor of 7 compared to wakefulness values, occurred during sleep. In three patients it was possible to correlate such episodic increases to the rapid eye movement phases of sleep. The authors discuss these phenomena and their possible implication in the progression of hydrocephalus.
Experimental effects of steroids and steroid withdrawal on cerebrospinal fluid absorption
Authors: Johnston Ian , Gilday David L. , Hendrick E. Bruce
Published: May 2009

✓ The authors studied the effects on cerebrospinal fluid (CSF) absorption of chronic administration and acute withdrawal of steroids in dogs. CSF absorption was measured by determining the amount of isotope (indium 111DTPA) recovered over a 4-hour period after injection into the cisterna magna. Resistance to CSF absorption was estimated by determining rates of flow of Ringer's lactate infusion into the cisterna magna over a range of pressure gradients between CSF and sagittal sinus. Steroid withdrawal was associated with a marked reduction in CSF absorption and an increase in resistance to CSF flow. Dogs on steroids also showed reduced CSF absorption although the reduction was not statistically significant when compared with controls. The results are discussed in terms of possible mechanisms of action of steroids on CSF absorption, the etiology of the benign intracranial hypertension syndrome and the use of steroids in the control of intracranial hypertension.
Sinus pericranii
Authors: Ohta Tomio , Waga Shiro , Handa Hajime , Nishimura Shuro , Mitani Tetsumi
Published: May 2009

✓ Five cases of sinus pericranii are presented, four congenital and one traumatic. All five cases were successfully treated with extirpation and reinforcement with Gelfoam and silk thread over the skull openings. The literature on this rare symptom-complex is reviewed and a new definition of sinus pericranii proposed.
Thrombectomy of the middle cerebral artery
Authors: Zlotnik Ephraim I.
Published: May 2009

✓ A case is described in which thrombectomy of the middle cerebral artery by way of one of its side branches successfully restored blood flow in the artery and resulted in marked regression of neurological disturbances.
Ultrasound determination of cerebrospinal fluid shunt patency
Authors: Flitter Marc A. , Buchheit William A. , Murtagh Frederick , Lapayowker Marc S.
Published: May 2009

✓ A technique employing a Doppler ultrasound flowmeter in determining cerebrospinal fluid shunt patency is described. The technique has proven to be a valuable aid in the evaluation of the patient in whom shunt function is in question.
Memory clip for intracranial aneurysm surgery
Authors: Iwabuchi Takashi , Suzuki Shigeharu , Ebina Kunihiko , Honma Toshio
Published: May 2009

✓ The authors have devised a malleable V-shaped removable clip with mechanical memory effect or shape memory. This clip is easily removed by heating part of it to 79° to 107°C, causing the closed clip to return to its original V shape.
Method for measuring brain tissue pressure
Authors: Clark Robert M. , Capra Norman F. , Halsey James H.
Published: May 2009

✓ The authors report a method for measuring total local brain tissue pressure (BTP) using a miniature catheter transducer stereotaxically introduced into the white matter of the cat's cerebrum. Quantitative rapid phasic pressure changes were satisfactorily demonstrated. Due to some drift of baseline of the transducers and inability to perform in vivo calibration, reliable long-term quantitative pressure measurements sometimes could not be studied. The BTP from each cerebral hemisphere and the cisternal pressure (CP) were monitored during alterations of pCO2 and systemic blood pressure, and distilled H2O injection prior to and after right middle cerebral artery (MCA) ligation. The catheter transducers functioned well on chronic implantation for up to 6 weeks. Compared to the chronically implanted catheters, acutely implanted catheters responded identically except for drift. The response of intracranial pressure and CP to MCA occlusion, alterations in pCO2, and systemic blood pressure were similar. No BTP gradients appeared in response to MCA ligation, hypercapnia, hypertension, or progressive swelling of the resulting infarction.
Experimental cervical myelopathy
Authors: Gooding Michael R. , Wilson Charles B. , Hoff Julian T.
Published: May 2009

✓ The authors report experiments designed to test the effect of regional ischemia induced by selective vascular ligations and anterior compression of the cervical cord at two adjacent segments (C-4, C-5) in the same dog. They conclude that local ischemia of the cervical cord, caused by local deformation, when superimposed on a regional reduction in spinal cord blood flow, accounts for the myelopathy of cervical spondylosis whether produced experimentally in animals or occurring naturally in man.
Isotope cisternography and ventriculography in congenital anomalies of the central nervous system
Authors: Glasauer Franz E.
Published: May 2009

✓ The author discusses the value of isotope cisternography and ventriculography in the diagnosis of a variety of congenital anomalies of the central nervous system (CNS) associated with either hydrocephalus or a disturbance in cerebrospinal fluid (CSF) flow and absorption. In sincipital encephaloceles the techniques demonstrate CSF communication with the anomalous sac and the frequently associated hydrocephalus with occipital lesions. In porencephaly and cerebral agenesis, the isotope demonstrates ventricular reflux and remains in the cystic dilatation indicating abnormal CSF absorption; isotope ventriculography also reveals a delayed CSF absorption and the possible sites of CSF obstruction in Arnold-Chiari malformations and Dandy-Walker syndrome. In addition to their differential diagnostic value isotope studies can be a helpful guide in the choice of the proper surgical treatment of some CNS anomalies.
Catecholamine content of cerebral tissue after occlusion or manipulation of middle cerebral artery in cats
Authors: Cohen Harold P. , Waltz Arthur G. , Jacobson Ronald L.
Published: May 2009

✓ The authors determined by fluorimetry the norepinephrine-epinephrine content (NE-E) of cerebral tissue from 38 cats, to ascertain whether constriction of hypersensitive arterial vessels by vasoactive agents in ischemic cerebral tissue could cause extension of cerebral infarcts and worsening of neurological deficits. Twenty-three cats had the left middle cerebral artery (MCA) occluded transorbitally, and 10 cats had sham operations. Five cats had only the surgical procedures necessary for obtaining tissue; mean NE-E content was 0.30 µg/gm (SD = 0.041). For the other 33 cats, including those with sham operations, values were variable, ranging from 0.07 to 0.60 µg/gm. Low values usually were obtained for ischemic hemispheres 24 hours and 7 days after MCA occlusion, but at other times values could be high or low on either side. Many factors unrelated to tissue damage, including arterial manipulation, influence the catecholamine content of cerebral tissue.
Mechanisms of contractile response of cerebral artery to externally-applied fresh blood
Authors: Simeone Frederick A. , Vinall Philip
Published: May 2009

✓ The authors report and analyze the in vitro contractions of fresh bovine cerebral artery on exposure to blood. The vessel does not contract significantly until blood clots on its surfaces; the contraction begins at the moment of clotting and is maintained as long as extracellular calcium is available. Comparative studies with vasoconstrictor amines suggest that serotonin, liberated from platelets by the clotting process, is responsible for this contraction and that the adherent clot itself concentrates the serotonin on the surface of the vessel. This contraction persists throughout the “viability” of the in vitro preparation, approximately 10 hours. Serotonin is capable of producing this sustained contraction by increasing smooth muscle cell membrane permeability to extracellular calcium, which in turn activates native actinomycin.
Craniosynostosis
Authors: Foltz Eldon L. , Loeser John D.
Published: May 2009

✓ The authors review the embryopathology and clinical manifestations of craniosynostosis and analyze a series of 27 children. The operative procedure of linear craniectomy and immediate cranioplasty is described and evaluated. Since few children with craniosynostosis have neurological deficits that can be ascribed to the skull anomalies, surgery to prevent neurological complications is only rarely justified. However, it is often possible to ameliorate the cosmetic deformity in many of these patients if operative intervention is undertaken in early infancy.