bluuebunny/crossref_metadata_2025 huggingface dataset:
Cottonoid as an acoustical marker for intraoperative ultrasound scanning
Authors: Voorhies Rand M. , Bell William O. , Patterson Russel H. , Gamache Francis W.
Published: May 2009

✓ The authors demonstrate the use of cottonoid as a marker for ultrasound localization of a subcortical tumor.
Intracranial and systemic effects of osmotic and oncotic therapy in experimental cerebral edema
Authors: Albright A. Leland , Latchaw Richard E. , Robinson Alan G.
Published: May 2009

✓ Experiments were carried out to compare the effectiveness of oncotic and osmotic therapy in dogs with experimental cerebral edema caused by a left parietal cold lesion. Animals were divided into five groups and treated for 6 hours with either crystalloid (control group), or mannitol, albumin, furosemide, or albumin/furosemide (treatment groups). The cerebral effects of therapy were evaluated by intracranial pressure (ICP) measurements and by postmortem evaluations of water content, using computerized tomography (CT) density measurements and wet-dry weight measurements. The ICP was significantly reduced by all treatments except albumin alone, and was reduced equally by mannitol, furosemide, and albumin/furosemide. The CT density of the lesion area was significantly increased by all treatments. The density of the contralateral nonlesioned hemisphere was significantly increased by all treatments except albumin. The water content of the lesion area was significantly decreased by all treatments; water content of the opposite hemisphere was not significantly reduced. The systemic effects of therapy were evaluated by measuring net fluid balance, wedge pressures, hematocrits, free water clearance, and vasopressin. Negative fluid balance without an increase in hematocrit or in vasopressin secretion occurred only in dogs treated with albumin/furosemide. Such oncodiuretic therapy seems to cause normovolemic dehydration and to have cerebral effects similar to mannitol and furosemide, without their undesirable systemic effects.
Noninvasive detection of intracranial vascular lesions using an electronic stethoscope
Authors: Sekhar Laligam N. , Wasserman Jack F.
Published: May 2009

✓ Using an electronic stethoscope, the authors have attempted noninvasive detection of intracranial aneurysms, arteriovenous malformations (AVM's), and carotid cavernous fistulas in 45 patients. A microphone of older design and a newly designed horn-coupled probe microphone were used to record the sound signals emanating from the cranium. A trigger pulse recorded by another microphone placed over the carotid area or the precordium was used to time the intracranial signals. The sound signals were converted to electrical signals, amplified, filtered, and analyzed using fast Fourier transformation to give plots of amplitude versus frequency of the signals. A spike at a certain frequency or a bruit over a band of frequencies was considered a positive finding. The records of 18 of the patients were not satisfactory for analysis, mainly due to external noise interference. Eight of 11 aneurysm patients with satisfactory recordings emitted resonant spikes, turbulent bruits, or combinations of the two. The other three records were negative. Four patients with AVM's and two with carotid cavernous fistulas exhibited broad-band bruits representing turbulent flow. Neither spikes nor bruits were demonstrable in three patients with brain tumors or in seven patients without intracranial vascular lesions. Experimental vein pouch aneurysms were also induced in two dogs. Recordings from these animals revealed resonant spikes. The limitations and scope of electronic stethoscope audiometry are discussed.
The effects of raised ICP on lymph flow in the cervical lymphatic trunks in cats
Authors: Love James A. , Leslie Ronald A.
Published: May 2009

✓ Lymph was collected from cervical lymphatic trunks of anesthetized cats under conditions of normal cerebrospinal fluid (CSF) pressure and again when the CSF pressure was elevated by infusing artificial CSF into the subarachnoid space at the cisterna magna. There was an immediate increase in lymph flow on initiation of the CSF infusion, but this increase was not maintained although the CSF infusion continued. Lymph protein concentrations fell when the CSF infusion started and remained depressed while the infusion of CSF continued. It is postulated that under steady-state conditions much of the CSF leaving the subarachnoid space via the cranial nerves enters the capillaries from the extravascular spaces, and that large molecules from the CSF, such as proteins, return to the blood via the lymphatic system.
Effect of intravenous lidocaine on experimental spinal cord injury
Authors: Kobrine Arthur I. , Evans Delbert E. , LeGrys David C. , Yaffe Lyn J. , Bradley Mark E.
Published: May 2009

✓ A series of experiments was conducted to study the effect of systemic intravenous administration of lidocaine on neurological recovery after acute experimental spinal cord injury in cats. The spinal cord was injured by the rapid inflation of an epidural balloon at T-6. The physiological integrity of the spinal cord ceased within 2 seconds in all animals, as demonstrated by acute disappearance of the somatosensory evoked response (SER). There was essentially no return of the SER in the five untreated animals when monitored for 4 hours post-injury. All of the pathological specimens from these animals revealed severe central cord hemorrhage. Intravenous lidocaine was begun 15 minutes after the injury in five animals. Three of these animals had significant return of the SER. The pathological specimens from the lidocaine-treated animals revealed either mild or moderate central cord hemorrhage. The results of this experiment suggest that systemic lidocaine administration has a significant beneficial effect in the treatment of acute spinal cord injury.
Delayed onset of Lhermitte's sign following head and/or neck injuries
Authors: Chan Richard C. , Steinbok Paul
Published: May 2009

✓ The authors report four patients who suffered the delayed onset of Lhermitte's sign following head and/or neck trauma with no significant neurological deficits. The average onset from the time of the injury was 2½ months. In all patients, there was a full range of movement of the cervical spine with no tenderness and no neurological deficits. Myelography was performed in three of the four patients and was normal. The duration of Lhermitte's sign ranged from 4 months to 1 year (mean 8 months). Complete recovery occurred in all cases. The pathogenesis, differential diagnosis, and management of patients with Lhermitte's sign are discussed.
Lumbar nerve root compression by synovial cysts of the ligamentum flavum
Authors: Abdullah Adel F. , Chambers Robert W. , Daut Dennis P.
Published: May 2009

✓ Synovial cysts of the ligamentum flavum, measuring 1 cm in diameter, caused compression of the lumbar nerve roots in four patients. The authors discuss the association of these cysts with advanced focal spondylosis, and speculate on their etiology.
Intracranial extension of inflammatory pseudotumor of the orbit
Authors: Kaye Andrew H. , Hahn Joseph F. , Craciun Atanase , Hanson Maurice , Berlin A. Jan , Tubbs Raymond R.
Published: May 2009

✓ Orbital pseudotumors are inflammatory lesions of the orbit of unknown etiology, which initially mimic an orbital neoplasm. Involvement of the other orbit is uncommon, and extension into the paranasal sinus rare. Intracranial extension of pseudotumor of the orbit is previously unreported. This is a case report of a patient with pseudotumor of the orbit with intracranial extension. The literature of the subject is reviewed.
Hangman's fracture with complete dislocation of C-2 on C-3
Authors: Roda José M. , Castro Alberto , Blázquez Martin G.
Published: May 2009

✓A patient with a complete fracture-dislocation of C-2 on C-3 without dysfuncton of the spinal cord is presented. The patient was treated conservatively, and immobilization resulted in good alignment of the cervical spine and solid healing of the fracture.
Neoplastic cerebral aneurysm from lung cancer
Authors: Kochi Nobuo , Tani Eiichi , Yokota Masayuki , Nakaya Yasuhiro
Published: May 2009

✓ A 56-year-old man with lung cancer developed a massive intracerebral hematoma resulting from rupture of a small neoplastic aneurysm in a cortical branch of the left posterior temporal artery. Histologically, undifferentiated squamous cells formed an embolus in the aneurysm and destroyed the aneurysm wall. No tumor mass was evident around the aneurysm.
Granulomolecular hypertrophy of the cerebellum (Lhermitte-Duclos disease)
Authors: Di Lorenzo Nicola , Lunardi Pierpaolo , Fortuna Aldo
Published: May 2009

✓ The clinical features and pathology of granule cell hypertrophy of the cerebellum (Lhermitte-Duclos disease) are described in a 30-year-old man. The patient, who underwent successful surgery, is the eighth reported survivor of this disease. Whether the disease is neoplastic or dysplastic is still unknown, but the lesion has growth potential, and consequently the proper treatment is surgical resection. A cerebrospinal fluid shunt was only temporarily effective in this case.
Intrasellar hydatid cyst
Authors: Özgen Tunçalp , Bertan Vural , Kansu Tülay , Akalin Sema
Published: May 2009

✓ The authors report a case of hypopituitarism due to a cystic lesion in the sella turcica which was revealed by neuroradiological investigations. A hydatid cyst was found and removed by the transsphenoidal route. The transsphenoidal approach avoided intracranial spillage of fertile daughter cyst and scolices.
The metabolic response to severe head injury
Authors: Clifton Guy L. , Robertson Claudia S. , Grossman Robert G. , Hodge Susan , Foltz Richard , Garza Cutberto
Published: May 2009

✓ Caloric expenditure and nitrogen balance were measured in 14 steroid-treated comatose head-injured patients acutely and up to 28 days after injury. During this period patients were fed with a continuous enteral infusion of a formula containing 2 Kcal/cc and 10 gm nitrogen/liter. Indirect calorimetry was carried out for 102 patient-days. The mean resting metabolic expenditure (RME) for nonsedated nonparalyzed patients was 138% ± 37% of that expected for an uninjured resting person of equivalent age, sex, and body surface area. Nitrogen excretion was measured for 135 patient-days. The mean excretion was 20.2 ± 6.4 gm/day. The mean protein caloric contribution was 23.9% ± 6.7% and was greater than 25% for six patients, compared to normal values of 10% to 15%. Despite hyperalimentation, positive nitrogen balance for any 3-day period was achieved in only seven patients, and required replacement of 161% to 240% of RME with enterally administered formula. Head-injured patients had a metabolic response similar to that reported for patients with burns of 20% to 40% of the body surface.
Beagle puppy model of intraventricular hemorrhage
Authors: Ment Laura R. , Stewart William B. , Duncan Charles C. , Scott David T. , Lambrecht Richard
Published: May 2009

✓ The newborn beagle puppy has been demonstrated to provide a good model for neonatal intraventricular hemorrhage (IVH). A study was designed to determine if indomethacin can prevent IVH, and if indomethacin would produce changes in local cerebral glucose utilization (LCGU). By computerized random design, newborn beagle puppies were pretreated with either indomethacin (a known inhibitor of prostaglandin synthetase) or saline, and then assigned either to receive a hemorrhagic hypotension/volume reexpansion insult or to receive no insult. Pretreatment with indomethacin produced a marked drop in the incidence of IVH as well as significant alterations in the blood pressure responses to the hemorrhagic hypotension/volume reexpansion insult. Carbon-14 autoradiography was used to determine LCGU: no alterations were demonstrated in cerebral metabolism in uninjured pups pretreated with indomethacin compared to saline-pretreated animals. In addition, although the hemorrhagic hypotension/volume reexpansion insult produced marked alterations in LCGU in both groups of traumatized pups, indomethacin prevented the changes in LCGU in the germinal matrix and white matter that were found in the saline-pretreated animals.
Blood-brain barrier disruption in immature Fischer 344 rats
Authors: Bullard Dennis E. , Bigner Darell D.
Published: May 2009

✓ Methods for transiently disrupting the blood-brain barrier (BBB) which are consistent with survival are described for immature Fischer 344 rats weighing 40 to 99 gm. A catheter was retrogradely inserted into the external carotid artery to the level of the bifurcation. Perfusion of 1.4 M mannitol or 1.6 M arabinose, at a rate of 0.01 to 0.1 ml/sec for 30 seconds, resulted in transient BBB disruption as measured by Evans blue dye (EBD) staining. Higher flow rates or perfusion with 10% to 30% dimethyl sulfoxide were associated with a mortality rate ranging from 0% to 44%. Perfusion with 0.9% sodium chloride or intrafemoral artery perfusion with 1.4 M mannitol did not disrupt the BBB. Optimum BBB disruption as measured by EBD staining was achieved with 1.6 M arabinose at 0.026 ml/sec for 30 seconds, at which time all of the 42 experimental animals had BBB disruption; all of the animals so treated survived 2 weeks following perfusion. This technique will allow the efficacy of delivering chemotherapeutic agents following BBB disruption to be tested in several of the more commonly used small-animal models for brain-tumor research.
The value of computerized tomography in aneurysmal subarachnoid hemorrhage
Authors: Gurusinghe Nihal T. , Richardson Alan E.
Published: May 2009

✓ Of 256 patients with aneurysmal subarachnoid hemorrhage, 131 underwent computerized tomographic (CT) scanning within 7 days of the ictus. These scans were analyzed in order to assess the quantity of blood in the main subarachnoid cisterns and cerebral fissures. The method of quantification used recognized the horizontal and vertical components of the largest clot visible on the CT scan and expressed this as the “CT score.” Angiographic vasospasm was assessed and graded, based on reduction in the caliber of the major cerebral vessels. The CT score was then compared to 1) the incidence of angiographic vasospasm, 2) the clinical course, and 3) the eventual outcome. Of the patients who showed no blood on the initial CT scan, 87% were admitted in good clinical grades, whereas among patients with higher CT scores the number admitted in poor clinical grades increased. The degree of angiographic vasospasm did not relate as closely as the CT score to the clinical grade on admission or to the subsequent clinical course.

The final outcome was assessed on follow-up review, and those acquiring neurological deficits from ischemic neurological dysfunction (IND) were identified. Ninety percent of patients with no blood on the CT scan (CT score 0) had a good outcome, while 5% sustained the effects of IND. The incidence of IND gradually increased with a rise in the CT score until, with scores of 8 and above, 90% of patients suffered the ill effects of IND. The CT score proved to be a simple yet accurate prognostic indicator of the outcome of IND.
β-Endorphin-like immunoreactivity increases in human lumbar cerebrospinal fluid following routine metrizamide myelography
Authors: Rachlin Jacob R. , Fessler Richard G. , Duda Eugene E. , Brown Frederick D. , Fang Victor , Mullan Sean
Published: May 2009

✓ Much interest has recently been focused on the possible role of the endogenous opiates in the perception of pain in humans. Several investigators have examined the levels of these substances in human cerebrospinal fluid (CSF) in attempts to identify the mechanisms by which electrical stimulation of the brain might induce analgesia. Most of these CSF samples were collected at the time of ventriculography or myelography. In the present study, the levels of β-endorphin in the CSF of 22 patients undergoing myelography were examined before and after the injection of a contrast agent. β-Endorphin increased an average of 356% (p < 0.0005) 15 to 20 minutes following the injection of contrast material into the lumbar subarachnoid space. Thus, routine myelography may have a profound effect on the levels of β-endorphin measured by radioimmunoassay in human CSF, and great care must be taken in interpreting the significance of changes seen in β-endorphin levels in CSF collected from patients at the time of myelography or ventriculography. The effect of the injection of contrast material on β-endorphin immunoreactivity must be distinguished from the postulated effects of any analgesia-inducing therapy.
Disseminated hematogenous metastases from a pineal germinoma in an infant
Authors: Howman-Giles Robert , Besser Michael , Johnston Ian H. , Da Silva Merle
Published: May 2009

✓ A pineal germinoma in a 9-month-old boy is described. After surgical resection and cerebrospinal fluid diversionary shunting, the child developed hematogenous metastases which showed marked increased uptake on radionuclide gallium-67 scans.
Cavernous hemangioma of the optic canal
Authors: Costa e Silva Izabel , Symon Lindsay
Published: May 2009

✓ Cavernous hemangioma is the most frequent orbital tumor in adults. It has so far not been described in an intracanalicular situation. Two such cases recently encountered are presented, and the literature is reviewed. The clinical, radiological, neurophysiological, surgical, and pathological findings from the two cases are described.
Dural involvement in sinus histiocytosis with massive lymphadenopathy
Authors: Trudel Michel
Published: May 2009

✓ An unusual case of an isolated histioproliferative lesion arising from the basal dura of the left middle cranial fossa is described. The presence of lymphophagocytosis suggests that this represents an extra-nodal, intracranial form of sinus histiocytosis with massive lymphadenopathy.
Traumatic middle meningeal arteriovenous fistula caused by three-point skull fixation
Authors: Inagawa Tetsuji , Takeda Tetsuji , Taguchi Haruyoshi , Kamiya Kazuko , Yamada Tohru
Published: May 2009

✓ Traumatic middle meningeal arteriovenous (AV) fistulas usually occur as rare complications of head injury. An unusual case of a middle meningeal AV fistula is presented which resulted from three-point fixation with a skull clamp to stabilize the head during surgery for an anterior communicating artery aneurysm.
Outcome 1 year after SAH from cerebral aneurysm
Authors: Ropper Allan H. , Zervas Nicholas T.
Published: May 2009

✓ A group of 112 consecutive patients who initially had no neurological deficits after subarachnoid hemorrhage (SAH) was followed intensively for at least 1 year. Ninety-four were in neurological Grade I or II (Hunt and Hess classification) on arrival. A hundred patients underwent late surgery but, despite excellent surgical results, major morbidity and mortality rates were observed related to preoperative complications. In the preoperative period, 14 (13%) rebled, 41 (37%) had symptomatic cerebral vasospasm, and 24 (21%) had hydrocephalus that required treatment. Of the 100 surgical patients, 73 were in Grade I or II, 26 in Grade III, and one in Grade IV. Six patients had intraoperative neurological complications, and two had delayed postoperative cerebral infarction. Six patients died during hospitalization, but only one as a result of operation. Six others died during the year following discharge of causes unrelated to the operation. The ultimate functional outcome at 1 year of these initially good-risk patients was poor. Only 46% were fully recovered, and 25% reported emotional or psychological disturbances that interfered with their daily lives. Forty-four percent could return to their previous jobs or a comparable position, and 20% obtained lesser employment. Management mortality at 1 year was 11%, and morbidity related to persistent neurological deficits (mainly strokes from vasospasm) was 20%. Thus, management mortality and morbidity at 1 year was 31%, and the number of patients returning to useful life was disappointing. The authors support the suggestion by previous workers that an analysis of at least the 6-month and perhaps the 1-year outcome (especially management mortality for all patients) provides the most important parameter for judging outcome and comparing different management protocols for SAH.
Response of chronic experimental cerebral vasospasm to methylprednisolone and dexamethasone
Authors: Chyatte Douglas , Sundt Thoralf M.
Published: May 2009

✓ The authors have previously demonstrated that high-dose methylprednisolone (30 mg/kg intravenously every 8 hours) prevents severe chronic vasospasm in dogs. In the present study, lesser doses of methylprednisolone (15 mg/kg intravenously every 8 hours) and dexamethasone (0.1 mg/kg intravenously every 8 hours), although better than no treatment at all, were significantly less effective than the higher dose of methylprednisolone. These data suggest that methylprednisolone can prevent chronic experimental vasospasm from occurring only when given in high doses (30 mg/kg).
Pulmonary embolism in neurosurgical patients: diagnosis and treatment
Authors: Di Ricco Giorgio , Marini Carlo , Rindi Maurizio , Ravelli Vitale , Lutzemberger Lodovico , Tusini Giorgio , Giuntini Carlo
Published: May 2009

✓ Pulmonary embolism was suspected in 45 neurosurgical patients who were treated between January, 1980, and December, 1981. Hypoxemia with respiratory alkalosis and sudden tachycardia gave rise to this suspicion more often than any other sign or symptom. Perfusion lung scanning confirmed the presence of pulmonary embolism in 23 of these cases. A retrospective analysis of the clinical course of these 23 patients suggested that one or more previous episodes of pulmonary embolism had occurred in 16 cases (69.6%), and had been either overlooked or misdiagnosed. Treatment was started immediately after diagnosis. Twenty-one patients were given heparin; however, two could not be treated because of contraindication to using anticoagulant drugs. Two patients died during treatment. The 21 surviving patients were assessed and 11 of them submitted again to perfusion lung scanning 1 week after diagnosis: 14 had improved, but seven did not show significant changes either clinically or on perfusion lung scanning. Nine treated patients developed hemorrhage, but it was readily controlled. In two of the nine patients, hemorrhage involved the surgical area. It is stressed that pulmonary embolism may be suspected and diagnosed in neurosurgical patients at an early stage. Heparin may be given and the survival rate appears to be better than previously reported figures.
Cerebellar medulloblastoma in adults
Authors: Hughes Peter G.
Published: May 2009

✓ From 1960 through 1981, 15 patients with cerebellar medulloblastoma, aged 16 years or over, were referred for irradiation following surgery. All patients received craniospinal irradiation; three patients received adjuvant chemotherapy. Five-year and 10-year survival rates of 63% and 38%, respectively, were obtained. The main cause of treatment failure was tumor recurrence in the posterior fossa. All local recurrences presented late, none developing within the first 3 years. One patient suffered systemic disease. The prognosis following relapse was poor. One patient achieved a prolonged remission following further surgery and radiotherapy, but died of treatment-related complications. The majority of the survivors are free of major deficit. One patient developed paraplegia 10 years after treatment. The possible risk of late damage to the hypothalamic-pituitary axis is discussed.
Cerebrospinal fluid shunt infection
Authors: Walters Beverly C. , Hoffman Harold J. , Hendrick E. Bruce , Humphreys Robin P.
Published: May 2009

✓ A retrospective study of the management of patients with infected cerebrospinal fluid (CSF) shunts was undertaken, covering the 20 years from 1960 to 1979, inclusive, and involving 222 patients with 267 infections. The data were analyzed with emphasis on influences surrounding treatment choice and subsequent outcome. Treatment was classified into three major categories: medical management (antibiotics alone), surgical management (antibiotics plus operative removal of the infected shunt), and no treatment (ranging from admission and observation only to shunt revision), the diagnosis of shunt infection having been missed. Results showed surgical treatment to be more efficacious than medical or no treatment, with a higher rate of initial cure, and lower morbidity and mortality rates.

Also examined were the relationships among clinical presentation, infection rate, and results of specimens sent for culture, and initial treatment. The definitive nature of initial treatment was revealed to be directly proportional to the aggressiveness of microbiological investigation. This latter aspect was related to clinical presentation, with shunt malfunction being the least recognized symptom of shunt infection. Patients presenting with blocked shunts were less likely to receive therapy appropriate for infection than any other group, leading to the conclusion that shunt malfunction may be more specific to infection than heretofore believed.
Hemodynamically significant stenosis of the internal carotid artery treated with endarterectomy
Authors: Vorstrup Sissel , Engell Hans Christian , Lindewald Helle , Lassen Niels Alexander
Published: May 2009

✓ Repeated cerebral blood flow (CBF) measurements with xenon-133 inhalation and single photon emission tomography were performed in a patient suffering a minor stroke with subsequent orthostatic-provoked transient ischemic attacks (TIA's). Angiography revealed a thread-like internal carotid artery and an occluded external carotid artery on the side of the ischemic neurological symptoms. Computerized tomography and technetium-99m-pertechnetate brain scintigraphy 2 weeks after stroke were both normal. Before reconstructive vascular surgery, resting CBF showed a hypoperfused area corresponding to the clinical symptoms. Diamox (acetazolamide, 1 gm) increased CBF by 24% in the unaffected hemisphere, whereas even a slight decrease in flow (“steal”) was seen in the maximally affected region. In contrast, theophylline (220 mg) reduced CBF in the unaffected hemisphere and caused a slight increase in the previously maximally hypoperfused area (“inverse steal”). After surgery, the flow pattern practically normalized and the TIA's disappeared.

The CBF measurements before surgery and also after the injection of the vasoactive drugs indicated that focal hemodynamic insufficiency elicited the TIA's, and pointed at a low mean arterial blood pressure of about 35 mm Hg in the affected hemisphere. The perioperative finding of a mean blood pressure in the internal carotid artery of 31 mm Hg on the symptomatic side confirmed that the brain tissue had a severely reduced perfusion pressure. On clamping the artery, a stump pressure of 22 mm Hg and electroencephalogram flattening was noted, so a temporary internal shunt was inserted. The findings demonstrate that preoperative CBF measurements, including studies of the regional vasoreactivity, may identify patients with hemodynamic TIA's. These patients are at particular risk of developing cerebral ischemia during carotid endarterectomy, as any further compromise of the inflow may precipitate frank ischemia.
An unusual complication of Dura Film as a dural substitute
Authors: Ongkiko Carlos M. , Keller Jeffrey T. , Mayfield Frank H. , Dunsker Stewart B.
Published: May 2009

✓ Two cases are presented in which the patients developed an unusual complication following the use of an artificial dural substitute, silicone-coated Dacron (Dura Film). Both patients had undergone removal of a tumor and involved dura. The first patient developed a very thick connective-tissue capsule of the graft material which simulated a recurrent tumor. The second patient developed an acute hemorrhage initially thought to be an acute subdural hematoma beneath the artificial dura 9 weeks after tumor removal and implantation of the graft. A review of the literature and proposed mechanisms of these complications are presented.
Use of cryoprecipitate coagulum to control tumor-bed bleeding
Authors: Kennedy J. Gerald , Saunders Richard L.
Published: May 2009

✓ The case is presented of a 44-year-old woman who underwent reoperation under cardiac standstill for a recurrent left sphenoid wing meningeal hemangiopericytoma. Because of persistent accumulations of clot with clinical deterioration and shift on computerized tomography scanning, the patient was returned to the operating suite twice. At the second reoperation, hemostasis was finally achieved through the instillation of admixed cryoprecipitate, calcium, and activated thrombin.
New steel device for occipitocervical fixation
Authors: Cantore Giampaolo , Ciappetta Pasquale , Delfini Roberto
Published: May 2009

✓ A new steel device for occipitocervical fixation is described. The system is easily and quickly applied, and affords a stronger and more secure means of attachment of the steel wires than using the occipital bone alone.
BCNU solubility and toxicity in the treatment of malignant astrocytomas
Authors: Layton Patricia B. , Greenberg Harry S. , Stetson Philip L. , Ensminger William D. , Gyves John W.
Published: May 2009

✓ Administration of BCNU into the carotid artery as treatment for malignant astrocytomas has produced retinal and brain toxicity. It is unclear whether the BCNU diluent, ethanol, is the cause of the toxicity, but the elimination of the ethanol is an attractive possibility. Clinically, decreasing the ethanol from 2.0 ml/100 mg BCNU to 0.75 ml/100 mg BCNU resulted in a marked decrease in eye toxicity. To simulate this clinical situation, three 500-mg solutions of BCNU, ethanol, and saline were prepared, decreasing the ethanol concentration from 3.0 ml to 2.0 ml to 0.75 ml/100 mg BCNU. The amount of BCNU recovered in vitro after simulated clinical administration of the three solutions decreased from 84.9% to 38.3% as the diluent decreased. Therefore, drug delivery at a fixed BCNU dose will decrease with the amount of ethanol diluent used. The clinical decrease in eye toxicity must be partly attributed to a decrease in the amount of BCNU delivered to the retina. Simulated administration of a solution of 500 mg BCNU/150 ml of 5% dextrose in water (D5W) gave 83.7% BCNU recovery. The D5W gives solubility comparable to that provided by 3.0 ml ethanol to each 100 mg BCNU, and its use eliminates ethanol as a potential retinal and brain toxin.
Early aneurysm operation and outcome in two remote Scandinavian populations
Authors: Vapalahti Matti , Ljunggren Bengt , Säveland Hans , Hernesniemi Juha , Brandt Lennart , Tapaninaho Antti
Published: May 2009

✓ The Kuopio University Clinic is the neurosurgical referral center for a population of 930,000 inhabitants in central Finland while the Lund University Clinic is the neurosurgical referral center for a population of 1.46 million inhabitants in southern Sweden. The incidence of aneurysmal subarachnoid hemorrhage (SAH) is approximately 19/100,000/year in central Finland and approximately five/100,000/year in southern Sweden. During the calendar year 1982, 69 patients with a ruptured supratentorial aneurysm were admitted in Lund, and 71 such patients were admitted in Kuopio. Thirty-nine patients in neurological Grades I to III (according to Hunt and Hess) underwent early aneurysm operation in Lund, and 46 such patients were operated on within a week after SAH in Kuopio. In the combined series of 85 Grade I to III patients with aneurysm operation within a week after rupture, 78% made a good recovery; the morbidity rate was 14%, and the mortality rate was 8%.
Subarachnoid hemorrhage in childhood and adolescence
Authors: Hourihan Margaret D. , Gates Peter C. , McAllister Victor L.
Published: May 2009

✓ The authors have reviewed 167 cases of subarachnoid hemorrhage (SAH) occurring in patients aged 20 years and younger in a 23-year period. The modes of presentation and etiology of SAH are similar in childhood and adolescence and in the adult population, but there was a different incidence of the specific pathology producing the bleeding in this series. Twenty-six percent of cases were due to bleeding arteriovenous malformations, 52% were due to ruptured aneurysms, and in 19% no cause was found. Aneurysms in this young age group differed in several important respects from those in the adult population: there was a male predominance, a higher incidence of internal carotid bifurcation aneurysms was seen, and multiple aneurysms were encountered less commonly.
Intraventricular hemorrhage in the premature rabbit pup
Authors: Coulter David M. , LaPine Tim , Gooch W. Manford
Published: May 2009

✓ The authors used the premature rabbit model to examine the pathophysiology of intraventricular hemorrhage (IVH). They studied the brains of 167 control animals, of 45 animals after a hypertensive insult, of three animals after a bolus infusion of normal saline, and of 10 animals after both insults. In none of the brains was IVH identified. Limited reproducibility may restrict the use of this animal model.
Von Hippel-Lindau syndrome with microscopic hemangioblastomas of the spinal nerve roots
Authors: Ismail Sezgin Mehmet , Cole Gillian
Published: May 2009

✓ The authors describe a case of von Hippel-Lindau syndrome diagnosed at autopsy in a 49-year-old woman. She died suddenly following hemorrhage from a cerebellar hemangioblastoma. Other autopsy findings included a retinal hemangioblastoma, an adrenal pheochromocytoma, and a clear-cell renal tumor. The case was distinguished by the unexpected finding of multiple microscopic hemangioblastomas of the spinal nerve roots. The case is discussed with emphasis on the incidence of spinal hemangioblastomas in von Hippel-Lindau syndrome.
Intracranial sparganosis: an uncommon infection
Authors: Anders Karl , Foley Kevin , Stern W. Eugene , Brown W. Jann
Published: May 2009

✓ The first case of intracranial sparganosis to be reported from the United States is presented. The patient, a 27-year-old woman, complained of focal seizures involving the right lower extremity. A left parietal parasagittal craniotomy was performed, and a granuloma containing a sparganum was excised from the parietal lobe. The clinical and pathological features of sparganosis are reviewed. Only five cases of intracranial sparganosis have previously been described.
Giant cystic cavernoma in a child
Authors: Khosla Virender K. , Banerjee Ashru K. , Mathuriya Suresh N. , Mehta Saroj
Published: May 2009

✓ A totally cystic giant cavernous hemangioma is described in a 3-year-old girl. The clinical presentation and computerized tomography findings were both unique. The patient was successfully treated by surgery.
Vertebral trephine: a new instrument for anterior cervical fusion
Authors: Mann Kirpal S.
Published: May 2009

✓ A simple yet versatile instrument for anterior cervical fusion is described.
Percutaneous flexible bipolar epidural neuroelectrode for spinal cord stimulation
Authors: Kaschner Alfred G. , Sandmann Wilhelm , Larkamp Heinz
Published: May 2009

✓ This article describes a new flexible bipolar neuroelectrode which is inserted percutaneously into the epidural space for segmental spinal cord stimulation. This electrode was used in experiments with dogs and monkeys for recording cortical somatosensory evoked potentials in order to identify intraoperative spinal cord ischemia during periods of aortic occlusion.
Effect of selective inhibitor of thromboxane A2 synthetase on cerebral vasospasm after early surgery
Authors: Tani Eiichi , Maeda Yukio , Fukumori Toyokazu , Nakano Masaru , Kochi Nobuo , Morimura Tatsuo , Yokota Masayuki , Matsumoto Tsuyoshi
Published: May 2009

✓ The authors report the results of inhibition of thromboxane A 2 synthetase in 49 consecutive patients with subarachnoid hemorrhage (SAH). These unselected Grade I to IV patients all had a ruptured aneurysm of the anterior circle of Willis, and were operated on within 72 hours after SAH. Twenty-seven patients were treated postoperatively by an intravenous infusion of sodium(E)-3-[4-(3-pyridylmethyl)-phenyl]-2-propenoate (OKY-1581), a selective inhibitor of thromboxane A2 synthetase, at 5 µg/kg/min for 10 to 14 days, and the remaining 22 patients did not receive this drug. Both groups of patients had similar age distribution and preoperative neurological conditions. A suggestive but statistically insignificant improvement was found in postoperative angiographic vasospasm, ischemic symptoms, and overall outcome in the group receiving OKY-1581. The incidence of low-density areas on the postoperative computerized tomography scans was significantly decreased in patients treated with OKY-1581 infusion.
The false fontanel
Authors: Harbaugh Robert E. , Saunders Richard L.
Published: May 2009

✓ In the neonate, palpation of the anterior fontanel is recognized as a simple and reliable means for estimating intracranial pressure. With closure of the fontanel this aspect of the clinical examination is lost. The authors report a series of 15 shunted infants and children in whom a false fontanel was created by making a 2-cm craniectomy in the right parietal region and excising the underlying internal pericranium. This produces a cranial opening which, like the anterior fontanel, can be used for palpation and real-time ultrasound imaging of the brain. By removing the internal pericranium, reossification of the defect is delayed by more than 12 months. Sparing the dura propria avoids the risks of cerebrospinal fluid leak or brain herniation into the cranial window. This procedure is reported to be simple, reliable, and of value in assessing shunt function in hydrocephalic infants and young children. An illustrative case report is presented.
Congenital hemihypertrophy and abnormalities of the cerebral vasculature
Authors: Fischer Edwin G. , Strand Roy D. , Shapiro Frederic
Published: May 2009

✓ Two patients are described with congenital hemihypertrophy and vascular abnormalities of the brain on the side of the hypertrophy and in the posterior fossa. The abnormalities observed included giant aneurysm, capillary hemangioma, and arteriovenous malformation. Vascular anomalies in the affected limbs are common in congenital hemihypertrophy, and neurological abnormalities and hypertrophy of the brain have been reported. The presence of vascular abnormalities of the brain in this condition may provide an opportunity to further the understanding of the development of cerebrovascular malformations.
Multiple cranial nerve palsies due to a hyperextension injury to the cervical spine
Authors: Rosa Louis , Carol Mark , Bellegarrigue Roberto , Ducker Thomas B.
Published: May 2009

✓ The case of a patient with multiple bilateral cranial nerve palsies and spinal cord sparing secondary to a stable hyperextension injury to C-1 is presented.
Radiation-induced cerebellar chondrosarcoma
Authors: Bernstein Mark , Perrin Richard G. , Platts Marjorie E. , Simpson William J.
Published: May 2009

✓ The authors report a case of chondrosarcoma arising in the cerebellum 16 years after treatment of a cerebellar malignant astrocytoma by subtotal resection and irradiation. It is thought that the chondrosarcoma arising within the intracranial cavity was a probable consequence of previous ionizing radiation.
Chiasmal osteoma following tuberculous meningitis
Authors: Maitland Charles G. , Pcsolyar Dale W. , Morris William J. , Ragsdale Bruce D.
Published: May 2009

✓ Clinical and radiological signs of a chiasmal lesion developed in a man 25 years after successful treatment of tuberculous meningitis. Surgical exploration and pathological examination demonstrated a mature chiasmal osteoma. The bony growth may have been a sequela of the prior infection.
Return of function after intracranial suture of the trochlear nerve
Authors: Grimson Baird S. , Ross Mark J. , Tyson George
Published: May 2009

✓ An excellent functional result was obtained after microsuture of a trochlear nerve which was inadvertently divided during the course of a craniotomy. Successful intracranial suture of this nerve has not previously been reported. Ophthalmoscopic detection of excyclotorsion of the eye on the side of the trochlear nerve palsy is discussed, along with its value in the differential diagnosis of acquired vertical diplopia.
Shunt fluid examination: risks and benefits in the evaluation of shunt malfunction and infection
Authors: Noetzel Michael J. , Baker Roy P.
Published: May 2009

✓ A combined retrospective and prospective study was designed to assess the efficacy of shunt fluid examination in the evaluation of shunt malfunction and/or infection, and to ascertain the complication rate associated with this procedure. Ninety-one patients with shunts for the treatment of hydrocephalus underwent a total of 209 diagnostic shunt “taps.” Of 72 instances of mechanical obstruction documented at surgery, 70 were correctly identified by abnormal shunt fluid dynamics, either an opening cerebrospinal fluid (CSF) pressure in excess of the expected valve pressure or absent flow of fluid. The organisms responsible for 12 of 13 shunt-related infections were correctly isolated on initial and all subsequent shunt fluid cultures obtained prior to the institution of appropriate antibiotics. With one infection, a bacterial pathogen was not identified until the third tap. In all instances in which lumbar or ventricular CSF, blood, or wound cultures disclosed an organism, shunt fluid cultures also identified the agent. In addition, these procedures were less reliable. No complications occurred during or immediately following any of the shunt taps. Long-term consequences were assessed in 53 patients with an average follow-up period of 26 months. Some shunt systems subsequently required revision and two infections were documented. The uniformly long interval between the shunt fluid examination and these complications makes it unlikely that the taps contributed to the development of malfunction or infection. Shunt fluid examination appears to be a simple, benign, and yet accurate means of diagnosing shunt malfunction and/or shunt-related infection.
Lambdoid synostosis
Authors: Hinton David R. , Becker Laurence E. , Muakkassa Kamel F. , Hoffman Harold J.
Published: May 2009

✓ The microscopic development of the normal lambdoid suture was studied in autopsy specimens from 19 normal subjects ranging in age from 20 weeks' gestation to 60 years. The cellular activity at the suture varied considerably with age; however, maximal activity was seen in specimens approximately 3 months of age. There were several unusual features, including a high incidence of cartilaginous differentiation and the presence of intrasutural Wormian bones. Forty-one specimens from 37 patients with isolated lambdoid synostosis were also studied pathologically. Only three cases showed bone union across the suture, which appears to be a result of closure rather than fusion as in other synostoses. The remainder of the cases showed varying degrees of increased cellular proliferation at the suture line, resulting in exaggerated and prolonged sutural activity. Morphologically, this produced increased interdigitation and fibrous adhesion between the suture margins.
Lambdoid synostosis
Authors: Muakkassa Kamel F. , Hoffman Harold J. , Hinton David R. , Hendrick E. Bruce , Humphreys Robin P. , Ash Judith
Published: May 2009

✓ Seventy-four patients with premature union of the lambdoid suture were treated at The Hospital for Sick Children during the years 1972 through 1982. Lambdoid synostosis is considered to be a rare form of craniosynostosis, but this is more likely due to lack of recognition rather than to infrequent occurrence. The skull deformity resulting from lambdoid synostosis is often mistakenly attributed to positional molding rather than to actual synostosis. When the lambdoid suture closes, the occiput on the involved side is flat, the forehead on the same side tends to bulge forward, and the ear on this side adopts a low and forward position. Skull x-ray films may demonstrate obliteration of the lambdoid suture, but more frequently one sees sclerosis along one edge of the closing suture. Radionuclide bone scanning will show increased activity during the active phase of union and decreased or absent activity once union has occurred. Craniectomy performed during the neonatal period will correct the deformity and provide for normal cranial growth. Delay in surgery beyond 6 months will frequently necessitate a more extensive cranial repair.
Central nervous system mesenchymal chondrosarcoma
Authors: Harsh Griffith R. , Wilson Charles B.
Published: May 2009

✓ Local recurrence developed 6 years after the initial resection of an intraspinal meningeal tumor that originally was thought to be an angioblastic meningioma. Histological review of the pathology led to a change of that diagnosis to one of mesenchymal chondrosarcoma. The recurrent vascular tumor was embolized, then totally excised. Because this tumor had malignant features, the patient received irradiation and chemotherapy. No evidence of regrowth has been observed during a period of more than 4 years. Mesenchymal chondrosarcomas of the central nervous system and their treatment are reviewed.
Rupture of a giant basilar aneurysm after saphenous vein interposition graft to the posterior cerebral artery
Authors: Heros Roberto C. , Ameri Ali M.
Published: May 2009

✓ A patient with a giant aneurysm of the top of the basilar artery presented with severe progressive symptoms of brain-stem compression. There was inadequate collateral circulation to the upper basilar system. She underwent exploration of the aneurysm and, after it was found to be impossible to clip, a tourniquet was placed on the basilar artery for future occlusion with the patient awake. A saphenous vein graft was interposed between the left external carotid and the left posterior cerebral arteries. The previously unruptured aneurysm bled fatally 36 hours after surgery, just before intended occlusion of the basilar artery.
Intra-arterial BCNU chemotherapy for treatment of malignant gliomas of the central nervous system
Authors: Greenberg Harry S. , Ensminger William D. , Chandler William F. , Layton Patricia B. , Junck Larry , Knake James , Vine Andrew K.
Published: May 2009

✓ Because of the rapid systemic clearance of BCNU (1,3-bis-(2-chloroethyl)-1-nitrosourea), intra-arterial administration should provide a substantial advantage over intravenous administration for the treatment of malignant gliomas. Thirty-six patients were treated with BCNU every 6 to 8 weeks, either by transfemoral catheterization of the internal carotid or vertebral artery or through a fully implantable intracarotid drug delivery system, beginning with a dose of 200 mg/sq m body surface area. Twelve patients with Grade III or IV astrocytomas were treated after partial resection of the tumor without prior radiation therapy. After two to seven cycles of chemotherapy, nine patients showed a decrease in tumor size and surrounding edema on contrast-enhanced computerized tomography scans. In the nine responders, median duration of chemotherapy response from the time of operation was 25 weeks (range 12 to more than 91 weeks). The median duration of survival in the 12 patients was 54 weeks (range 21 to more than 156 weeks), with an 18-month survival rate of 42%. Twenty-four patients with recurrent Grade I to IV astrocytomas, whose resection and irradiation therapy had failed, received two to eight courses of intra-arterial BCNU therapy. Seventeen of these had a response or were stable for a median of 20 weeks (range 6 to more than 66 weeks). The catheterization procedure is safe, with no immediate complication in 111 infusions of BCNU. A delayed complication in nine patients has been unilateral loss of vision secondary to a retinal vasculitis. The frequency of visual loss decreased after the concentration of the ethanol diluent was lowered.