bluuebunny/crossref_metadata_2025 huggingface dataset:
The Paraclinoid Carotid Artery: Anatomical Aspects of a Microneurosurgical Approach
Authors: Knosp Engelbert , Müller Gerd , Perneczky Axel
Published: May 2010

The paraclinoid area is investigated anatomically for possible microneurosurgical approaches to the C3 segment of the internal carotid artery and to structures in the vicinity of the anterior siphon knee. Removal of the anterior clinoid process reveals a tight connective tissue ring that fixes the internal carotid artery to the surrounding osseous structures at the point of its transdural passage. Transection of this fibrous ring opens a microsurgical pathway to the carotid C3 segment. The artery is surrounded by a loose connective tissue layer that allows blunt preparation along the C3 segment, without compromising the cranial nerves and without damaging venous compartments of the cavernous sinus. This approach provides neurosurgical access to paraclinoidal aneurysms, to partly intracavernous aneurysms, and to carotid-ophthalmic aneurysms, allowing control of the proximal aneurysm neck and of the parent artery itself. In cases of tumors involving the medial sphenoid ridge, the apex of the orbit, or the cavernous sinus, the pericarotid connective tissue can serve as a guide layer for access along the internal carotid artery.
Distal Ulnar Neuropathy from Carpal Ganglia: A Clinical and Electrophysiological Study
Authors: Cavallo Michele , Poppi Massimo , Martinelli Paolo , Gaist Giulio
Published: May 2010

The clinical and electrophysiological observations in two cases of distal ulnar neuropathy from carpal ganglia are reported. In the first case, the ganglion was compressing the ulnar nerve just proximal to its division; in the second case, the ganglion was compressing the deep branch of the ulnar nerve just at its origin. In both cases, both axonal degeneration and segmental demyelination were present. A clinical classification of the compression syndromes of the deep ulnar branch is proposed.
Tuberculoma of the Ulnar Nerve: Case Report
Authors: Nucci Francesco , Mastronardi Luciano , Artico Marco , Ferrante Luigi , Acqui Michele
Published: May 2010

A peripheral nerve tuberculoma, the third on record, involved the ulnar nerve, as did the other two. This case report is followed by a discussion of the pathogenesis and diagnosis of this lesion. Its pathogenesis is unclear. Direct infection from a tuberculous sister was disproved, and infection via a local wound is highly unlikely. A previous, silent form of tuberculosis seems to have been the cause.
Successful Surgical and Anesthetic Management of Vein of Galen Aneurysm in a Neonate in Congestive Heart Failure
Authors: Matjasko Jane , Robinson Walker , Eudaily Daniel
Published: May 2010

A 12-day-old infant in intractable cardiac failure due to a vein of Galen malformation was treated successfully with serial ligation of the majority of the vessels feeding the malformation. Despite some residual vascular supply to the malformation, the congestive heart failure has disappeared and growth and development have been normal over a 3-year follow-up period.
Lymphocytic Adenohypophysitis: Clinical, Radiological, and Magnetic Resonance Imaging Characterization
Authors: Levine Steven N. , Benzel Edward C. , Fowler Marjorie R. , Shroyer John V. , Mirfakhraee Mansour
Published: May 2010

Lymphocytic adenohypophysitis is a rare nonneoplastic cause of a pituitary mass. We report the case of an 18-year-old woman who presented with complaints of headaches and visual disturbances after an otherwise uncomplicated pregnancy and delivery. She had an elevated serum prolactin level and a pituitary mass visualized by magnetic resonance imaging (MRI). The tissue removed by transsphenoidal resection was an inflammatory mass composed of lymphocytes, plasma cells, and moderate fibrosis surrounding islands of hyperplastic lactotrophs. This is the first case of lymphocytic adenohypophysitis visualized by MRI. As in this case, lymphocytic adenohypophysitis is frequently confused with a prolactin-secreting pituitary tumor before operation and pathological examination of the tissue. The clinical characteristics and radiological features of and an approach to managing patients with lymphocytic adenohypophysitis are reviewed and discussed.
Computed Tomography of the Postoperative Intervertebral Disc and Lumbar Spinal Canal : Investigation of Twenty - five Patients after Successful Operation for Lumbar Disc Herniation
Authors: Montaldi Stefano , Fankhauser Heinz , Schnyder Pierre , de Tribolet Nicolas
Published: May 2010

Twenty-five patients with good outcome after operation for lumbar disc herniation underwent unenhanced computed tomography (CT) and plain radiography of the lumbar spine before, 5 to 7 days after, and 6 lo 7 weeks after the operation to define the radiological features ofthe postoperative disc and spinal canal. After operation, the center of the disc appears hypodense. The anterior and lateral borders remain sharply delimited, but in 44% of the cases the posterior border shows an image suggesting the persistence of disc herniation. In 84% of the cases, there are major changes in the spinal canal with complete occlusion of the extradural space on the operated side by a heterogeneous material the attenuation value of which ranged between those of cerebrospinal fluid and disc. The outline of the dural sac and of the nerve root is lost. This aspect did not significantly change between the 1st and the 6 th postoperative week, except for the disappearance of any air within the canal and a slight movement on the dural sac toward the operated side. From these major radiological modifications found in asymptomatic postoperative patients, it is concluded that positive CT in patients with the failed back surgery syndrome has limited value. Myelography is preferred as the primary neuroradiological investigation.
Structural Mechanics of the Blowout Fracture: Numerical Computer Simulation of Orbital Deformation by the Finite Element Method
Authors: Takizawa Hideo , Sugiura Kazuaki , Baba Motoki , Tachisawa Takayuki , Kadoyama Shigeru , Kabayama Toshio , Ohno Hitoshi , Fuseya Youko
Published: May 2010

Blowout fractures most frequently involve the orbital floor. The contour of the orbit has been postulated as one of the factors responsible for this phenomenon, but only a few studies have been carried out. The present study was planned to determine the effect of the contour of the orbit when intraorbital pressure is raised to simulate the hydraulic mechanism of blowout fracture. The profile of the orbit was estimated from five dry human skulls, and the measurements were approximated to frame models. The deformation of these models by raised intraorbital pressure was calculated by computer simulation using the finite element method. In all ofthe orbital models, the deformation of the orbital floor was significantly greater than that of the roof. These findings verified that the orbital roof has a higher resistance than the floor against raised intraorbital pressure. We suspect that this resistance is due to the arched shape of the orbital roof, whereas the floor is rather flat.
Septation in Syringomyelia and Its Possible Clinical Significance
Authors: Lederhaus Scott C. , Pritz Michael B. , Pribram Henry F. W.
Published: May 2010

A 3-year-old boy with a septated syrinx and several other dysraphic features is presented. The literature regarding the cause, diagnosis, and pathology of septation in syringomyelia is reviewed. This case raises two points. First, the septated pattern may be associated with an elevated pressure in the syrinx. Second, despite the septations, the syrinx may communicate freely.
Multiple Thoracic Disc Herniations: Case Report
Authors: Shikata Jitsuhiko , Yamamuro Takao , Iida Hirokazu , Kashiwagi Naoya
Published: May 2010

Multiple thoracic disc herniation is rare, and one of the main problems in its treatment has been the lack of accuracy in diagnostic tests. Now, with the advent of computed tomographic scanning with metrizamide in the subaraehnoid space, the accuracy has been greatly improved. With computed tomographic scanning, the type and level of the lesion can be demonstrated, even when the myelographic study is unclear. Our report describes the case of a 38-year-old man with multiple thoracic intervertebral disc herniation, who also exhibited symptoms of spinal cord compression. Computed tomographic metrizamide myelography clearly showed anterior compression of the spinal cord due to disc herniation at T5-T6, T6-T7, T7-T8, T8-T9, and T9-T10. Removal ofthe herniated discs was followed by interbody fusion using autogenous bone grafts, and excellent results were obtained.
Distal Anterior Choroidal Artery Aneurysm: Intraoperative Localization and Treatment
Authors: Knuckey Neville W. , Epstein Mel H. , Haas Richard , Sparadeo Frank
Published: May 2010

Distal anterior choroidal artery aneurysms with intraventricular hemorrhage are rare and difficult to treat. We report the case of a 46-year-old woman with a left distal anterior choroidal artery aneurysm presenting as a typical subaraehnoid hemorrhage from which she had no focal neurological signs. Because the aneurysm was located within the dominant deep temporal lobe, we used intraoperative computed tomography to guide a probe to the aneurysm to allow minimal dissection. This is the first report of a successfully treated distal anterior choroidal artery aneurysm. Reports of this unusual aneurysm and methods of approaching deep temporal lesions are reviewed.
Anaplastic Astrocytomas Associated with Previous Radiotherapy: Report of Three Cases
Authors: Dierssen G. , Alvarez G. , Figols J.
Published: May 2010

In a group of 132 patients with malignant astrocytomas treated between 1971 and 1983, there were 3 patients who had received radiotherapy to the head several years before developing the glioma. The cases are described, and the evidence supporting the view that the gliomas might be radiation-induced is discussed.
Bilateral Cholesterol Granuloma of the Skull Base: Case Report and Review of the Literature
Authors: Gamache Francis W. , McLure Thomas , Deck Michael , Linstrom Christopher
Published: May 2010

A unique case of bilateral cholesterol granuloma of the skull base and its treatment is presented. Cholesteatoma, a pathological entity often confused with cholesterol granuloma, is differentiated from cholesterol granuloma. Cholesterol granuloma is not rare. This tumor seems to derive from an inflammatory process at the skull base that results in bony erosion surrounding a cyst wall of inflammatory tissue. Neurological abnormalities reflect the location of the tumor in relation to the brain stem. Radiographically, the cyst wall enhances with the administration of i.v. contrast agent, and the center of the lesion is isodense with brain on computed tomography, unlike cholesteatoma. Magnetic resonance imaging characteristics are currently being defined. At operation, cholesterol granuloma consists primarily of a viscous fluid within a capsule of inflammatory tissue. Treatment requires establishing a pathway for drainage of the granuloma. The advantages of transsphenoidal, transclival drainage of such lesions are outlined.
Intraoperative Ventricular Puncture
Authors: Paine Jonathan T. , Batjer H. Hunt , Samson Duke
Published: May 2010

Modem neuroanesthetic techniques frequently provide the neurosurgeon with adequate brain relaxation for an atraumatic frontotemporal or transylvian dissection. Circumstances such as recent subarachnoid hemorrhage with brain edema and acute hydrocephalus can mandate significant frontal lobe retraction before access to cerebrospinal fluid (CSF) drainage from the basal cisterns is gained. A simple technique can give the “early” aneurysm surgeon reliable access to the frontal horn of the lateral ventricle for intraoperative drainage of CSF before brain retraction.
Zygomaticotemporal Approach to the Basis Cranii and Basilar Artery
Authors: Neil-Dwyer Glenn , Sharr Michael , Haskell Richard , Currie David , Hosseini Massoud
Published: May 2010

When using the zygomaticotemporal approach, one removes the whole of the zygomatic bone with its attachment to the masseter muscle, allowing a lower and more anterior approach to the interpeduncular cistern along the inferomedial surface of the temporal lobe. Minimal brain retraction is required to give an excellent view of the bifurcation of the basilar artery and of the suprasellar region. (Neurosurgery 23:20-22, 1988)
Regrowth Patterns of Glioblastoma Multiforme Related to Planning of Interstitial Brachytherapy Radiation Fields
Authors: Bashir R. , Hochberg F. , Oot R.
Published: May 2010

Recognition of the local nature of glioblastoma has generated an increasing interest in treatment using radioactive implants (interstitial brachytherapy). A key issue in such implantation is the configuration of the radiation field in relation to the resected tumor. In particular, should radiation be provided to the area from which the tumor has been resected? To clarify this issue, we evaluated patterns of tumor regrowth into this resected area in 62 patients. Three patterns of computed tomographic scan-documented tumor regrowth were recognized: preferential (regrowth to refill the resected area only), circumferential (regrowth into the resected area and previously uninvolved contiguous brain) and away (local regrowth into noncontiguous brain, sparing the surgical bed). Regrowth of the tumor 6.3 to 6.8 months after resection was seen in 59 of 62 patients (95.2%). Preferential regrowth was seen in 32 of 62 patients (51.6%), and circumferential regrowth was seen in 27 of 62 patients (43.5%). Regrowth away was seen in 3 of 62 patients (4.8%). Radiation fields planned for interstitial brachytherapy must adequately include the resected area because of the high incidence of tumor regrowth into that area.
Acute Traumatic Atlas Fractures: Management and Long Term Outcome
Authors: Hadley Mark N. , Dickman Curtis A. , Browner Carol M. , Sonntag Volker K. H.
Published: May 2010

Fractures of the 1st cervical vertebra (C1) represent 7% of all acute cervical spine fractures. Isolated atlas fractures are most commonly bilateral or multiple fractures through the ring of C1. Frequently (44% of cases), the atlas will be fractured in combination with the axis. Treatment of isolated C1 fractures should be governed by the rules of Spence. The treatment of combination C1-C2 fractures is dictated by the type and severity of the C2 fracture. Experience with 57 cases of acute atlas fractures is reviewed. Nonoperative external immobilization was used in 53 patients (with 1 failure), and early surgical wiring and fusion were performed in 4 patients. The long term outcome from an atlas fracture is good (median follow-up, 40 months).
Thoracic Intervertebral Disc Herniations: Diagnostic Value of Magnetic Resonance Imaging
Authors: Blumenkopf Bennett
Published: May 2010

Thoracic disc herniation is relatively rare and frequently poses a challenge in clinical diagnosis. These protrusions have been categorized into two major anatomical types and three main clinical syndromes. A number of characteristic radiographic features have been reported. Recently, magnetic resonance imaging (MRI) has gained popularity as a neurodiagnostic imaging tool. A series of nine cases of thoracic intervertebral disc herniation is reported. The clinical aspects of the cases are discussed, and the potential value of spine MRI for thoracic disc herniation diagnosis is emphasized.
Microsurgical Anatomy of the Posterior Fossa Cisterns
Authors: Matsuno Haruo , Rhoton Albert L. , Peace David
Published: May 2010

The microsurgical anatomy of the posterior fossa cisterns was examined in 15 cadavers using 3× to 40× magnification. Liliequist's membrane was found to split into two arachnoidal sheets as it spreads upward from the dorsum sellae: an upper sheet, called the diencephalic membrane, which attaches to the diencephalon at the posterior edge of the mamillary bodies, and a lower sheet, called the mesencephalic membrane, which attaches along the junction of the midbrain and pons. Several other arachnoidal membranes that separate the cisterns were identified. These include the anterior pontine membrane, which separates the prepontine and cerebellopontine cisterns; the lateral pontomesencephalic membrane, which separates the ambient and cerebellopontine cisterns; the medial pontomedullary membrane, which separates the premedullary and prepontine cisterns; and the lateral pontomedullary membrane, which separates the cerebellopontine and cerebellomedullary cisterns. The three cisterns in which the arachnoid trabeculae and membranes are the most dense and present the greatest obstacle at operation are the interpeduncular and quadrigeminal cisterns and the cisterna magna. Numerous arachnoid membranes were found to intersect the oculomotor nerves. The neural and vascular structures in each cistern are reviewed.
Direct Puncture of the Cavernous Sinus for Obliteration of a Recurrent Carotid-Cavernous Fistula
Authors: Teng Michael Mu Huo , Guo Wan-Yuo , Lee Liang-Shong , Chang Tsuen
Published: May 2010

The authors report direct transcutaneous puncture of the cavernous sinus through an intact orbit for embolization of a recurrent carotid-cavernous fistula (CCF) after 10 prior operations. The fistula was obliterated completely with this technique. No significant complication was noted except temporary ptosis for about 2 months. When other approaches are difficult or impossible, this technique can be an alternate way to treat a recurrent CCF after a trapping procedure.
Intracranial Phycomycosis: Case Reports
Authors: Tang Lok-Ming , Ryu Shan-Jin , Chen Tong-Jong , Cheng Shaw-Yi
Published: May 2010

Cerebral phycomycosis is a rare disease. We describe two patients with unusual features of focal intracranial phycomycosis: a diabetic patient with chronic epidural abscess and a healthy individual with an isolated intracerebral abscess. Biopsy established the diagnosis in both patients. Treatment was successful in the patient with intracerebral abscess.
Spinal Subependymoma Presenting as an Extramedullary Tumor: Case Report
Authors: Matsumura Akira , Hori Akira , Spoerri Otto
Published: May 2010

A rare case of cervicothoracic subependymoma in a 25-year-old man is described. The tumor appeared as an extramedullary mass lesion, but a discrete, less well-demarcated portion was observed in the lateral part of the cord at the T2 level. Previous reports of spinal subependymomas are reviewed, and nosological possibilities of extramedullary presentation are discussed.
Giant Cell Tumor of the Skull: Case Report
Authors: Henderson Bruce T. H. , Whitwell Helen
Published: May 2010

The case of a 16-year-old girl with giant cell tumor involving the occipital bone is described. The radiological and pathological findings are detailed, followed by a discussion of the literature.
Unusual Clinical Presentation of a Presumed Pineal Germinoma with Two Disseminated Lesions
Authors: Nakano Shinichi , Uehara Hisao , Kinoshita Kazuo
Published: May 2010

We report a case of a presumed pineal germinoma in a 28-year-old man. Although the pineal body, the presumed primary lesion, was small, there were two disseminated tumors, one in the posterior fossa and the other in the left parietal region. The initial symptom was cerebellar ataxia. These two disseminated tumors had attachments to the inferior surface of the cerebellar tentorium and the dura mater of the parietal convexity, respectively, and they were fed by external carotid artery branches, like meningiomas. Neither angiography nor magnetic resonance imaging could provide the differential diagnosis between germinoma and meningioma. Computed tomographic scanning revealed slight enlargement of the pineal body suggestive of a germinoma.
Isolated Hypoglossal Nerve Palsy Due to Metastatic Germinoma in the Neck: A Ventriculoatrial Shunt-related Complication
Authors: Woo Edmund , Yu Yuk-Ling
Published: May 2010

A 12-year-old boy with suprasellar germinoma was treated with a right-sided ventriculoatrial shunt at diagnosis. He subsequently developed a metastatic neck mass that presented with an isolated right hypoglossal nerve palsy. Radiological investigations showed a vascular tumor and thrombosis of the right internal jugular vein. It is hypothesized that thrombosis at the venous inflow channel allowed local proliferation of the tumor cells that exited from the intracranial cavity via the shunt.
Magnetic Resonance Imaging in the Diagnosis and Treatment of Lhermitte-Duclos Disease (Dysplastic Gangliocytoma of the Cerebellum)
Authors: Reeder Ralph F. , Saunders Richard L. , Roberts David W. , Fratkin Jonathan D. , Cromwell Laurence D.
Published: May 2010

Lhermitte-Duclos disease is a rare disorder characterized by a slowly enlarging mass lesion in the cerebellum. The pathophysiology of the disease is poorly understood, but recent reports have suggested that a clinically significant mass may recur many years after total gross removal of the tumor. Computed tomography and angiography have been relatively insensitive in imaging the tumor either at presentation or during the postoperative period. The authors present three patients with histologically proven Lhermitte-Duclos disease who have undergone magnetic resonance imaging (MRI). In the first case, preoperative T1- and T2-weighted images clearly demonstrated the location and extent of the lesion, which was verified at operation. In the other two cases, only postoperative images were obtained. These demonstrated the extent of residual tumor and indicate a high probability of lesion expansion during periods of 4 and 10 years, respectively. We conclude that MRI is an important tool in both the diagnosis and the treatment of patients with Lhermitte-Duclos disease.
Facial Nerve Palsy Secondary to a Dural Cavernous Angioma of the Middle Cranial Fossa Eroding the Tegmen Tympani
Authors: Pozzati Eugenio , Giuliani Giuliano , Ferracini Romano , Gaist Giulio
Published: May 2010

A patient with a dural cavernous angioma of the middle cranial fossa eroding the tegmen tympani and causing an isolated palsy of the facial nerve is presented. The rarity of this lesion is stressed, as are the peculiar clinical findings and the magnetic resonance imaging.
Transient Late Magnetic Resonance Imaging Changes Suggesting Progression of Brain Stem Glioma: Implications for Entry Criteria for Phase II Trials
Authors: Longee Darryl C. , Friedman Henry S. , Djang William T. , Halperin Edward , Schold Clifford S. , Oakes Jerry W.
Published: May 2010

An 8-year-old boy was treated with irradiation (66 Gy) for a brain stem glioma. Five months after the completion of radiotherapy, magnetic resonance imaging demonstrated apparent tumor progression despite the patient's neurological improvement. The child continued to improve, with subsequent radiographic evidence of tumor regression, without additional therapeutic intervention. The evaluations of response and recurrence of brain tumors as well as entry criteria for Phase II studies are discussed.
Transoral Removal of Missile Fragments from the C1-C2 Area: Report of Four Cases
Authors: Mangiardi John R. , Alleva Michael , Dynia Richard , Zubowski Robert
Published: May 2010

Low velocity firearm damage to the upper cervical spine without neurological deficit occurs infrequently. Four cases of gunshot fragments involving the anterior elements of C1 and C2 are presented. In all four cases, the fragments were removed via a transoral approach without neurological complications or mechanical instability.
Prolonged Therapeutic External Ventricular Drainage: A Prospective Study
Authors: Chan Kwan-Hon , Mann Kirpal S.
Published: May 2010

Over a 2½-year period, 34 patients underwent therapeutic external ventricular drainage with a valve-regulated system. The mean duration of drainage was 16 days. There was no incidence of ventricular infection, nor was there blockage of the ventricular catheter requiring revision. Eventually, 13 patients required ventriculoperitoneal shunts. All survivors remained free from complications after more than 6 months of follow-up. The system proved safe and reliable in patients requiring prolonged ventricular drainage.
Cavernous Malformations of the Spinal Cord
Authors: McCormick Paul C. , Michelsen Jost W. , Post Kalmon D. , Carmel Peter W. , Stein Bennett M.
Published: May 2010

Six patients with intramedullary cavernous malformations of the spinal cord are presented. Four men and two women presented with acute, subacute, or episodic signs and symptoms of spinal cord dysfunction, ranging in duration from 3 days to 25 years. All patients underwent operative resection of the malformation. Complete removal was achieved in five patients. Neurological function either stabilized or improved postoperatively in all patients; follow-up ranged from 4 to 84 months. The increasing awareness of the propensity for recurrent hemorrhage, clinical features, and resectability of these malformations are discussed.
Treatment of Extraneural Metastatic Medulloblastoma with a Combination of Cyclophosphamide, Adriamycin, and Vincristine
Authors: Chamberlain Marc C. , Silver Pamela , Edwards Michael S. B. , Levin Victor A.
Published: May 2010

Seven patients with extraneural metastases from medulloblastoma were treated with a combination of cytoxan, adriamycin, and vincristine (CAV). None of the patients had evidence of active neural axis disease. All patients with bone metastases responded with a reduction in bone pain and improvement on the radionuclide bone scan. One patient presenting with lymph node metastases showed initial reduction in the size of the palpable nodes. In this group, the median time to the development of extraneural metastasis was 18 months from the time of original diagnosis of central nervous system medulloblastoma. The median duration of response to CAV, after extraneural metastasis, was 17 months (4-65 months). Four of seven patients died of disease-related causes, one patient presumed well was lost to follow-up, and two of seven are still without evidence of active disease at 37 and 65 months. The combination of CAV is well tolerated and provides reasonably good palliation for extraneural medulloblastoma.
Unruptured Cerebral Arteriovenous Malformations Presenting with Intracranial Hypertension
Authors: Barrow Daniel L.
Published: May 2010

Two cases of unruptured pial arteriovenous malformations (AVMs) presenting with intracranial hypertension and papilledema are reported. In the absence of previous hemorrhage or associated hydrocephalus, such a manifestation of pial AVMs is quite unusual. Both patients experienced prompt and sustained resolution of papilledema after surgical removal of the malformation. One case was complicated by the normal perfusion pressure breakthrough phenomenon postoperatively. The pathophysiology of intracranial hypertension associated with unruptured pial AVMs and the relationship to pseudotumor cerebri are discussed.
Surgical Excision of a Cavernous Hemangioma of the Rostral Brain Stem: Case Report
Authors: Ondra Stephen L. , Doty James R. , Mahla Michael E. , George Eugene D.
Published: May 2010

A 23-year-old pregnant woman presented with sudden diplopia, ataxia, hemiparesis, and headache secondary to a brain stem hemorrhage. Magnetic resonance imaging (MRI) revealed a hematoma associated with a probable cavernous hemangioma of the rostral brain stem. In this report, we discuss the MRI findings leading to the preoperative diagnosis, as well as the surgical techniques involved in the successful resection.
Cavernous Sinus Syndrome as the Presentation of Malignant Lymphoma: Case Report and Review of the Literature
Authors: Delpassand Ebrahim S. , Kirkpatrick Joel B.
Published: May 2010

Cavernous sinus syndrome (CSS) is an unusual presentation of malignant lymphoma. We report a patient with lymphoma that presented with CSS, and we review the literature on nine other reported cases. Sharp retroorbital pain, paresthesia around the orbit, and complete 6th nerve palsy were dominant presenting symptoms. In all cases, the tumor developed on the right side. The computed tomographic scan was abnormal in only two of the nine patients during the early stages of the disease. The dominant histological type was large cell lymphoma. The mean age of the patients was 45 years. The mean survival time after the first presenting symptom was 8.7 months. Two of the reported patients as well as our patient had disseminated disease, which became evident at autopsy.
Tension Pneumocephalus after Transsphenoidal Surgery: Case Report
Authors: Altinörs Nur , Arda Nuri , Kars Zafer , Türker Ayhan , Şenveli Engin , Çepoğlu Cengiz , Çinar Nusret
Published: May 2010

The authors present a patient who underwent transsphenoidal surgery for a pituitary adenoma and afterward developed late, severe rhinorrhea and tension pneumocephalus. The patient was treated conservatively.
Presentation and Management of Pediatric Chiari Malformations without Myelodysplasia
Authors: Dyste Gregg N. , Menezes Arnold H.
Published: May 2010

Chiari malformations without myelodysplasia are rarely diagnosed in the pediatric age group. With current neurodiagnostic techniques, however, they are being seen more frequently. Unfortunately, the prognosis is not clear because publications have included a number of different entities, used a variety of surgical approaches, and lacked long term follow-up. Sixteen patients younger than 20 years were treated for Chiari malformations (without myelodysplasia) between 1975 and 1985. The average age was 11 years, and the average duration of symptoms was 20 months. The common symptoms were isolated motor weakness (56%), pain (37.5%), and sensory loss (25%). Frequently seen signs were motor deficit (81%), sensory loss (50%), scoliosis (50%), and cranial nerve palsy (50%). The surgical procedures used were foramen magnum decompression (3 transoral clivus odontoid resections and 15 posterior fossa decompressions with dural grafting), alteration of cerebrospinal fluid (CSF) pathways at the cervicomedullary junction (plugging the foramen cecum and a 4th ventricle to subarachnoid shunt with posterior fossa decompression), and ventriculoperitoneal shunting (2 cases). In follow-up, 37.5% of the patients are asymptomatic, 50% are improved, and 12.5% are stable after an average follow-up period of 43 months. The asymptomatic group was younger (9.3 years) and had a shorter symptom duration (7.2 months) than both the improved (11.9 years, 16.4 months) and the stable groups (15 years, 20 months). Optimal outcome depends on complete evaluation of the abnormal CSF pathways and bony abnormalities at the craniovertebral junction. Operation is then directed toward correction of these abnormalities as delineated radiographically. Of our patients, 87.5% have at least shown improvement, which has been long term in all cases.
Thrombosed Arteriovenous Malformations: A Type of Occult Vascular Malformation
Authors: Ebeling John D. , Tranmer Bruce I. , Davis Kathleen A. , Kindt Glenn W. , DeMasters B. K.
Published: May 2010

Thrombosed arteriovenous malformations (AVMs) are the predominant type of occult vascular malformation and do not seem to differ significantly in clinical or radiographic presentation from other types of occult vascular malformations. Thrombosed AVMs and occult vascular malformations occasionally present with symptoms secondary to subacute or occult hemorrhage that requires operation. The histopathology of thrombosed AVMs and occult vascular malformations does not seem to have prognostic significance. Five patients with histologically verified thrombosed AVMs are reported. Two patients had previous incomplete resection of histologically proven thrombosed AVMs and presented with recurrence and bleeding. Two patients presented with seizures and headaches, and one patient presented with hemiparesis and headache. All histology specimens had evidence of hemorrhage. The pathological findings of these lesions seem variable; two specimens contained a mixture of cavernous angioma and AVM. Two previously resected lesions had been defined histologically as thrombosed AVMs. Successful excision of the lesions was accomplished in four patients, and one patient had stereotactic biopsy. The magnetic resonance imaging characteristics of lesions seem to add a degree of specificity over computed tomography and angiography. We have found that the literature poorly describes the natural history and histology of these lesions. Conservative management for seizures and headaches due to thrombosed AVMs may not be warranted because of a propensity for hemorrhage and recurrence.
Relief of Lumbar Canal Stenosis Using Multilevel Subarticular Fenestrations as an Alternative to Wide Laminectomy: Preliminary Report
Authors: Young Steven , Veerapen Richard , O'Laoire Sean A.
Published: May 2010

We describe an operative approach to lumbar canal stenosis which, unlike laminectomy, takes into account the segmental pathology of the disease. At each level involved, a bilateral subarticular fenestration is performed under high magnification. The medial third of each facet joint is first removed with an air-powered drill; then the remaining two-thirds of the joint is undercut with the drill to allow a generous fenestration in the thickened ligamentum flavum and adjacent laminae. All tissue responsible for neural compression is removed, but the spinous processes, interspinous ligaments, and much of the facet joints and laminae are preserved. Spinal stability is maintained and, because tissue disruption is minimized, postoperative discomfort is usually reduced, promoting early mobility and reduced hospital stay. The operation is described in detail, and the results of operation in 32 patients are assessed. The follow-up periods now range from 17 to 58 months. Of 23 patients who presented with neurogenic claudication, 14 (61%) obtained complete relief and 7 (30%) improved significantly. The mean hospital stay was 9 days (range, 4 to 17 days).
Spontaneous Postoperative Normalization of Growth Hormone Levels in Two Patients with Acromegaly Not Cured by Transsphenoidal Surgery
Authors: Landolt A. M. , Froesch E. R. , König M. P.
Published: May 2010

Postoperative persistence of elevated growth hormone (GH) levels in patients with acromegaly usually suggests residual adenoma tissue secreting GH and is an indication for further treatment. In rare cases, spontaneous normalization of serum GH levels in patients with acromegaly has been reported to occur as a consequence of intratumoral hemorrhage (pituitary apoplexy). We report two patients in whom persisting acromegaly was documented 1 and 2 weeks, respectively, after transsphenoidal operation and who experienced spontaneous normalization of GH levels. In one patient, this favorable outcome was found 1.5 years after the operation and followed a pregnancy. The other patient, whose GH values normalized 3 months after operation, had received preoperative treatment with a new, long-acting somatostatin analog.
Rhinocerebral Mucormycosis with Extension to the Posterior Fossa: Case Report
Authors: Soloniuk Donald S. , Moreland Douglas B.
Published: May 2010

A 25-year-old man with juvenile onset diabetes presented with rhinoorbital mucormycosis. He was treated aggressively with orbital extirpation and amphotericin B. Six months later, he presented with posterior fossa extension of the mucormycosis.
Cerebrospinal Fluid Eosinophilia and Sterile Shunt Malfunction
Authors: Traynelis Vincent C. , Powell Randell G. , Koss William , Schochet Sydney S. , Kaufman Howard H.
Published: May 2010

Cerebrospinal fluid (CSF) eosinophilia is a rare finding most often associated with central nervous system inflammatory processes, including parasitic, bacterial, and mycotic infections. It has also been seen as an allergic phenomenon. We present two cases of CSF eosinophilia occurring concurrently with sterile shunt malfunction. We speculate that CSF eosinophilia in our patients might have resulted from an allergic response to a foreign material such as suture, surgical glove powder, hair, cotton fibers, antibiotics, or silicone rubber. The incidence of sterile CSF eosinophilia after shunting is not known. Information concerning the role of eosinophilia in the development of shunt malfunctions is also lacking. An increased awareness of this possibility and further investigation are warranted.
Carotid-Anterior Cerebral Artery Anastomosis with Aneurysm: Case Report and Review of the Literature
Authors: Odake Genya
Published: May 2010

A ruptured aneurysm at the origin of the bilateral pericallosal arteries with an anomalous anterior cerebral artery was found in a 56-year-old man. The abnormal solitary anterior cerebral artery arose from the intracranial proximal internal carotid artery, passed underneath the ipsilateral optic nerve, and turned upward at the midline as a common trunk of the bilateral pericallosal arteries. Subarachnoid hemorrhage recurred 15 days postoperatively, and the patient did poorly. The 20 published cases of this rare anomaly (an infraoptic course of the anterior cerebral artery with a low bifurcation of the internal carotid artery) are reviewed. This anomaly should be referred to by the descriptive term “carotid-anterior cerebral artery anastomosis.” It is frequently associated with aneurysms.
Combined Treatment of Osteosarcoma of the Spine
Authors: Sundaresan Narayan , Rosen Gerald , Huvos Andrew G. , Krol George
Published: May 2010

We reviewed the clinical features and results of treatment in 24 patients with osteogenic sarcoma of the spine treated over a 35-year period. There were 14 male and 10 female patients 13 to 71 years old. The tumor arose de novo in 13 patients and was secondary to other conditions in 11. All patients presented with pain, and 16 (67%) had neurological deficits. Patients were divided into two treatment groups. Thirteen patients treated from 1949 to 1977 usually underwent limited tumor resection and external radiation therapy. The second group, 11 patients treated from 1978 to 1984, underwent more aggressive surgical resection and received combination chemotherapy as well as local rediation to the tumor bed. In the second group, there were 5 long term survivors, and only 1 patient developed metastatic disease while on therapy. Failure to obtain local control was the major cause of treatment failure. Complete surgical resection of the tumor by spondylectomy and combination chemotherapy offer the best prospect for cure of osteogenic sarcoma of the spine.
Intralesional Infusion of Lymphokine-activated Killer (LAK) Cells and Recombinant Interleukin-2 (rIL-2) for the Treatment of Patients with Malignant Brain Tumor
Authors: Merchant Randall E. , Merchant Lynn H. , Cook Sallie H. S. , McVicar Daniel W. , Young Harold F.
Published: May 2010

Twenty patients with supratentorial, intracerebral lesions defined by computed tomographic scan or magnetic resonance imaging were treated by surgery and adoptive immunotherapy with lymphokine-activated killer (LAK) cells and recombinant Interleukin-2 (rIL-2, Cetus). Seventeen patients had glioblastoma, two had high-grade oligodendroglioma, and one patient had two metastatic sarcoma lesions. LAK cells were produced from blood mononuclear cells (MNC) obtained by 2 to 3 leukapheresis procedures and cultured (2.5 × 106 MNC/ml) 3 to 5 days with 1000 units rIL-2/ml. Although LAK cells could be produced from MNC of all patients, those taking steroids or with a low Karnofsky functional status generated, on average, suboptimal LAK cell activity. Age, sex, and serum anticonvulsant levels do not seem to influence a patient's ability to produce LAK cells in vitro. For therapy, cultured MNC (1-15 × 109) containing LAK cells were suspended in saline containing 106 units rIL-2 and injected into tissue surrounding the tumor cavity during craniotomy. For 3 days after their operations, patients received 106 units rIL-2 into the tumor cavity through an Ommaya reservoir. The treatment protocol was tolerated well by all patients, although they all experienced some degree of headache, fever, or lethargy that cleared within a few days of the last rIL-2 injection. When computed tomographic (CT) scans were obtained soon after treatment, areas of low density suggested a greater-than-normal extent of edema around the operative site. At the present time, CT scans indicate that the tumors of seven patients have recurred with an average disease-free interval of 25 ± 6 weeks. Eight patients have remained alive and free of tumor for at least 6 months after surgery and immunotherapy. LAK cell plus rIL-2 immunotherapy for brain tumors is safe and may be efficacious against minimal tumor burden.
Abdominal X-ray and Pathological Findings in Distal Unishunt Obstruction
Authors: Le Roux Peter , Berger Mitchel , Benjamin Denis
Published: May 2010

A new x-ray finding suggesting distal obstruction of the Unishunt is described. Fusiform swelling of the distal slit valve (“pantaloon sign”) seen on an abdominal x-ray film was associated with surgically proven distal shunt obstruction in 8 of 10 patients. No patient with a normally functioning (n = 67) or proximally malfunctioning shunt (n = 6) displayed this abnormality. This finding in association with clinical and computed tomographic evidence of shunt malfunction can direct surgical revision to the appropriate site. The pathology of distal shunt malfunction is also reviewed.
Ventriculopleural Shunts for Hydrocephalus: A Useful Alternative
Authors: Jones Robert Francis Clifford , Currie Bruce George , Kwok Bernard Chi Tack
Published: May 2010

From 1969 to 1979, ventriculopleural shunts were inserted in 29 children with progressive hydrocephalus. A standard Pudenz pump with a Raimondi catheter was used for all but 1 child for whom a Holter valve was used. The shunt functioned adequately in 7, but in 18 it had to be changed as a result of symptomatic pleural effusion. From 1979 to 1982, a further series of 52 other patients received ventriculopleural shunts, and these cases have recently been reviewed. The apparatus used was a Portnoy ventricular catheter or a medium or high pressure Heyer Schulte pump with an antisiphon device and a Salmon distal catheter. Three patients developed a shunt infection. One died with a functioning shunt. Four catheters became blocked by adhesions, and in only 1 patient was a peritoneal shunt substituted as a result of symptomatic effusion.
Presentation of Type I Chiari Malformation after Head Trauma
Authors: Mampalam Thomas J. , Andrews Brian T. , Gelb Douglas , Ferriero Donna , Pitts Lawrence H.
Published: May 2010

An unusual case of Type I Chiari malformation that became symptomatic after closed head injury is reported. The patient manifested transient upper extremity weakness, persistent lower cranial nerve dysfunction, and cerebellar signs that slowly resolved. Magnetic resonance images showed tonsillar ectopia but no displacement of the brain stem or syringomyelia. Type I Chiari malformation should be included in the differential diagnosis of patients who present with upper extremity weakness, lower cranial nerve palsies, or cerebellar signs after trauma.
Intramedullary Dermoid Tumor Diagnosed with the Assistance of Magnetic Resonance Imaging
Authors: Graham Donald V. , Tampieri Donatella , Villemure Jean-Guy
Published: May 2010

Intramedullary dermoid tumors are unusual. Traditional methods of diagnosing spinal tumors have included clinical suspicion, plain roentgenography, myelography, and computed tomography. A case of intramedullary tumor provisionally diagnosed preoperatively by traditional methods and specifically as dermoid tumore with the assistance of magnetic resonance imaging is presented. Diagnosis and treatment of spinal dermoid tumors with an emphasis on magnetic resonance imaging is discussed.
Respiratory Distress Caused by Migration of Ventriculoperitoneal Shunt Catheter into the Chest Cavity: Report of a Case and Review of the Literature
Authors: Gaudio Roberto , De Tommasi Antonio , Occhiogrosso Michele , Vailati Giacomo
Published: May 2010

A case is reported in which the peritoneal catheter of a ventriculoperitoneal shunt migrated into the chest cavity causing an hydrothorax. The three similar cases drawn from the literature are reported.
Metastatic Liposarcoma of the Brain with Response to Chemotherapy: Case Report
Authors: Haft Harold , Wang George C.
Published: May 2010

Metastatic liposarcomas to the brain are rare. The authors describe a patient with a 20-year history of liposarcoma originating in the thigh and metastatic to the brain 18 years later. The brain metastasis was removed by surgery. Nine months later, the patient developed metastases to the retroperitoneum and liver. At that same time, she had recurrent brain metastasis. She was then treated with chemotherapy. The abdominal mass shrank considerably in the beginning, and the recurrent brain metastases totally disappeared. The patient eventually succumbed to widespread liposarcoma. Autopsy revealed extensive liposarcoma involving the retroperitoneum, liver, and lung, but no trace of tumor was found in the brain.
Late Appearance of a Radiodense Lesion at the Site of an Irradiated Metastasis: Neuropathological Findings
Authors: Schnittker Joseph B. , Thomas Harvey G. , Johns Robert D. , Shin Kyu H. , Clark Arthur W.
Published: May 2010

The appearance of contrast-enhancing computed tomographic (CT) lesions at the site of an irradiated brain tumor often has sinister implications. We present the case of a 43-year-old woman who received cranial irradiation as treatment for cerebral metastases from lung cancer. Follow-up radiographic studies revealed complete tumor regression; however, 26 months after treatment, enhanced CT scanning showed a radiodense nodule at the site of one of the previous metastatic deposits. Neuropathological examination of the surgically excised tissue identified benign reactive changes only. The natural history of irradiated brain lesions is discussed.
Positron Emission Tomography in the Detection of Malignant Degeneration of Low-Grade Gliomas
Authors: Francavilla Thomas L. , Miletich Robert S. , Di Chiro Giovanni , Patronas Nicholas J. , Rizzoli Hugo V. , Wright Donald C.
Published: May 2010

The management of low-grade gliomas represents a challenge to the physician as a significant proportion may undergo malignant degeneration to a high-grade tumor. We present the positron emission tomography (PET) scans, using [18F] fluorodeoxyglucose (FDG), of 12 patients who have histological and/or clinical evidence of malignant degeneration of a low-grade glioma. Each scan displays a focal area of hypermetabolism similar to that of malignant gliomas which arise de novo. Three patients also underwent PET scanning prior to malignant degeneration. When the initial scan is compared with the postmalignant degeneration study, a difference in tumoral glucose uptake can be recognized. A region previously shown to be hypometabolic develops focal hypermetabolism as malignant changes evolve. This study displays the utility of FDG-PET in the evaluation of malignant degeneration of low-grade gliomas. The knowledge that a neoplasm has altered its biological behavior may influence subsequent therapeutic options. If these findings can be confirmed in larger series and by other investigators, it is possible that FDG-PET may be adopted as one of the diagnostic tools for guiding the management of low-grade gliomas.