bluuebunny/crossref_metadata_2025 huggingface dataset:
Reoperation after lumbar intervertebral disc surgery
Authors: Law Jay D. , Lehman Ralph A. W. , Kirsch Wolff M.
Published: May 2009

✓ This retrospective study includes 53 patients who underwent reoperation after failure of lumbar disc surgery to relieve pain. All patients had leg pain before reoperation, which was successful in 28% of cases. Most clinical features, such as persistence or mode of recurrence of pain, radicular quality of pain, positive straight-leg raising, and myelographic root sleeve defects, were not helpful in predicting successful and unsuccessful reoperations. However, a significantly larger percentage of women than men had successful reoperations. Patients who had past or pending compensation claims, who had sensory loss involving more than one dermatome, or who failed to have myelographic dural sac indentations resembling those caused by a herniated disc did poorly with reoperation. A very convincing myelographic defect appears to be needed to justify reoperation at a previously unoperated location. Excision of scar alone or dorsal rhizotomy was of no avail in these cases.
Congenital inclusion dermoid cyst of the anterior fontanel
Authors: Glasauer Franz E. , Levy Laurence F. , Auchterlonie William C.
Published: May 2009

✓ An unusual type of dermoid cyst is reported in 10 African infants. In these cases a soft, cystic mass located over the anterior fontanel was noted shortly after birth and gradually enlarged. The cyst had no intracranial extension and was easily excised intact. The clinical and x-ray findings of the cyst are described and compared with the usual dermoids. The histology and the contents of the cyst are detailed and some peculiarities of this lesion pointed out.
Embolization of cerebral vessels with inflatable and detachable balloons
Authors: Laitinen Lauri , Servo Antti
Published: May 2009

✓ The authors describe an inflatable and detachable rubber balloon for embolization of cerebral or spinal vessels.
Intracranial pressure changes induced by sodium nitroprusside in patients with intracranial mass lesions
Authors: Cottrell James E. , Patel Katie , Turndorf Herman , Ransohoff Joseph
Published: May 2009

✓ Because of the ability of sodium nitroprusside (SNP) to dilate cerebral blood vessels, intracranial pressure (ICP) should increase with its use. In patients with vascular intracranial tumors following SNP (0.01%) infusion, ICP increased from 14.58 ± 1.85 to 27.61 ± 3.33 torr (p > 0.0005) and cerebral perfusion pressure decreased from 89.32 ± 3.5 to 43.23 ± 4.60 torr (p < 0.0005) when the mean arterial pressure had reduced by 33%. These results suggest that SNP not be used in patients with raised ICP unless previous measures have been taken to improve intracranial compliance.
A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics
Authors: Marmarou Anthony , Shulman Kenneth , Rosende Roberto M.
Published: May 2009

✓ A mathematical model of the cerebrospinal fluid (CSF) system was developed to help clarify the kinetics of the intracranial pressure (ICP). A general equation predicting the time course of pressure was derived in terms of four parameters: the intracranial compliance, dural sinus pressure, resistance to absorption, and CSF formation. These parameters were measured in the adult cat, and the equation was tested by comparing experimental and calculated values of the time course of pressure in response to volume changes. The theoretical and experimental results were in close agreement, and the role of each parameter in governing the dynamic equilibrium of the ICP was determined. From this analysis, dynamic tests were developed for rapid measurement of CSF formation, absorption resistance, and the bulk intracranial compliance. These techniques are applicable to clinical settings, providing data that are useful in characterizing the physiological mechanisms responsible for raised ICP and assessing changes induced by therapy.
Long-term follow-up review of patients with acute and subacute subdural hematomas
Authors: Rosenørn Jarl , Gjerris Flemming
Published: May 2009

✓ The authors present 149 patients suffering from acute (112) and subacute (37) subdural hematomas admitted during the 10-year period 1965 to 1974, with a follow-up period of 2 to 12 years. During the time of observation, 104 patients died and 45 survived; 73% of the patients with acute and 27% with subacute subdural hematomas died. Of the patients with an acute subdural hematoma, 11% went back to work, as against 32% of those with subacute subdural hematomas. The 5-year survival rate was 28% in patients with acute and 76% in patients with subacute subdural hematomas.
Intracranial air on computerized tomography
Authors: Osborn Anne G. , Daines Jonathan H. , Wing S. Douglas , Anderson Robert E.
Published: May 2009

✓ Intracranial gas may be epidural, subdural, subarachnoid, parenchymal, or intraventricular. Intracranial air can be easily diagnosed and its location correctly assessed by computerized tomography. Potentially serious complications of intracranial air, such as tension pneumocephalus, can be rapidly and accurately identified, facilitating appropriate clinical therapy.
A comparison of radiographic methods of diagnosing constrictive lesions of the spinal canal
Authors: Post M. Judith Donovan , Gargano Fredie P. , Vining Donald Q. , Rosomoff Hubert L.
Published: May 2009

✓ With the advent of computerized tomography (CT), a new method of visualizing the spinal canal in cross-section has been created. Before the introduction of CT scanning, evaluation of the cross-sectional anatomy of the spinal canal was accomplished chiefly by the Toshiba unit. This study compares these two forms of tomography and discusses their relative effectiveness in diagnosing constrictive lesions of the spinal canal.
Experimental neurogenic pulmonary edema in cats
Authors: Hoff Julian T. , Nishimura Merry
Published: May 2009

✓ Hemorrhagic pulmonary edema was produced consistently in 19 of 20 anesthetized, paralyzed, ventilated cats when intracranial pressure (ICP) was raised for 30 minutes by intraventricular infusion of mock CSF to 150 mm Hg in 14, or 200 mm Hg in six. However, under identical conditions, except that ICP was raised to only 100 mm Hg, three of seven animals did not develop hemorrhagic edema of the lungs and the remaining four had spotty hemorrhage. Thirteen control animals with normal ICP had normal lungs. Gravimetric lung water analysis by Pearce's method confirmed gross and microscopic appearance of hemorrhagic pulmonary edema. Extravascular lung water (p < 0.05) and lung blood (p < 0.05) were significantly greater than control values when ICP was raised to or exceeded 150 mm Hg. Despite hemorrhagic edema, pulmonary gas exchange (O2, CO2) remained unaffected.

This animal model allows quantitative measurement of neurogenically-mediated hemorrhagic edema of the lungs before gas exchange is impaired. The model may facilitate clarification of the pathogenesis of neurogenic pulmonary edema and, consequently, refine evaluation of therapy.
Arterial blood gases during raised intracranial pressure in anesthetized cats under controlled ventilation
Authors: Jennett Sheila , Hoff Julian T.
Published: May 2009

✓ In anesthetized paralyzed cats ventilated with air, blood gases were analyzed repeatedly before and during episodes of raised intracranial pressure (ICP). The ICP was raised by infusion via the lumbar subarachnoid or intraventricular route, and increases were maintained for at least 30 minutes. A minor degree of hypoxemia commonly developed, but was always associated with hypercapnia; normoxia was restored by increasing the ventilation sufficiently to restore normocapnia. Relative under-ventilation is thus liable to develop if the minute volume is maintained constant when ICP is raised, probably because of increased metabolic rate which may be associated with a rise in temperature; there is no evidence to implicate more obscure causes of hypoxemia in this circumstance. Pulmonary hemorrhage and edema were found post mortem in nine of 20 animals, but only two of these had developed greater hypoxemia than could be accounted for by under-ventilation. Phrenic electroneurograms were recorded, and respiratory activity was shown to persist during prolonged periods of cerebral ischemia.
Microanatomy of the optic canal
Authors: Maniscalco Jack E. , Habal Mutaz B.
Published: May 2009

✓ The human optic canal, an intricate anatomical structure with several normal variations, was studied in 83 individual cadaver specimens. The landmarks and dimensions of the adjacent structures were noted and correlated with surgical exposure of the area. The transorbital-ethmoidal route for extracranial decompression of the optic canal was also studied.
Fascicular nerve allograft evaluation
Authors: Levinthal Robert , Brown W. Jann , Rand Robert W.
Published: May 2009

✓ Orthotopic whole-nerve and fascicular nerve grafts were transplanted between inbred rats with known histocompatibility antigen structure. In general, the whole sciatic nerves demonstrated a graded rejection response dependent upon the degree of tissue histocompatibility differences. The fascicular grafts, however, had evidence of greatly decreased rejection and no stigma of a graded response dependent on degree of variability of tissue typing. Limitations of the experiment are outlined, and the possible avenues of further research are briefly discussed.
Anaerobic spinal epidural abscess
Authors: Guerrero Isabel C. , Slap Gail Barsky , MacGregor Rob Roy , Lawner Pablo , Ruggeri Sebastian , Gennarelli Thomas
Published: May 2009

✓ An acute spinal epidural abscess is reported from which a pure growth of the anaerobe Fusobacterium necrophorum was isolated. The mode of infection and pathogen makes it unique. The literature concerning the bacteriology of epidural abscess and the implications of anaerobic epidural infection are discussed.
Intracranial extracerebral brain heterotopia
Authors: Marubayashi Tohru , Matsukado Yasuhiko
Published: May 2009

✓ The authors describe a case of intracranial heterotopic brain located on the medial one-third of the left sphenoid ridge, and enveloped in a huge cystic cavity. The heterotopic brain was resected successfully with satisfactory clinical results. The resected brain was 8 × 4 × 3 cm in diameter, of 7 or 8 months gestational age, and consisted of cerebrum, brain stem, and cerebellum. Anatomical and cytoarchitectural findings of the heterotopic brain are presented.
Intradiploic epidermoid cyst of the occipital bone with torcular obstruction
Authors: Rengachary Setti , Kishore Pulla R. S. , Watanabe Itaru
Published: May 2009

✓ The authors describe a patient with a giant occipital intradiploic epidermoid cyst with compression of the torcular and other posterior fossa structures.
Carotid paraclinoid aneurysms with intradural origin and intracavernous location
Authors: Nutik Stephen
Published: May 2009

✓ Five cases of a congenital berry aneurysm of the internal carotid artery with origin partially intradural and fundus mainly intracavernous are presented. Angiography does not allow a precise definition of the amount of aneurysm that is intradural, a fact of importance when planning treatment of these cases. However, the angiographic features are characteristic of the type and suggest that these aneurysms be grouped together as a separate entity.
Moyamoya disease associated with aneurysm
Authors: Kodama Namio , Suzuki Jiro
Published: May 2009

✓ Five cases of moyamoya disease associated with aneurysm are reported. In three cases, the aneurysms were located at the peripheral portion of the posterior choroidal artery, and in two at the basilar artery. Based on these cases, the symptoms and mechanisms of formation of aneurysms in moyamoya disease are discussed.
Cerebellar hemorrhage in adults
Authors: Little John R. , Tubman David E. , Ethier Roméo
Published: May 2009

✓ A series of 10 adult patients with cerebellar hemorrhage diagnosed by computerized tomography (CT) is described. Hypertension was the most common etiological factor, accounting for 70% of the cases. The clinical presentation appeared to fall into two basic groups. The first group (60% of the cases) ran a progressive course with early brain-stem compression. The second group had a benign course with findings of focal cerebellar dysfunction. The CT findings reflected the two clinical categories. The scans of Group 1 patients revealed a large hematoma (≥ 3 cm) and substantial ventricular dilatation. In contrast, scans of Group 2 patients demonstrated a small hematoma (< 3 cm) without ventricular dilatation. Use of CT scanning allowed the accurate differentiation of cerebellar hemorrhage from primary brain-stem and intraventricular hemorrhage. The findings of the CT investigations proved very helpful in defining appropriate therapy.
Variations in response of human brain tumors to BCNU in vitro
Authors: Kornblith Paul L. , Szypko Paula E.
Published: May 2009

✓ A microtiter assay was used to study the sensitivity of 24 cultured human astrocytomas to the chemotherapeutic agent 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU). The tumor cell lines tested originated from patients who were being treated with postoperative chemotherapy within the past 24 months. At a dose level comparable to the maximum in vivo therapeutic dose level, 18 of the 24 cell lines tested showed a significant response to the drug. If in vitro response can eventually be correlated with clinical response, this microtiter assay could help to form a basis for planning more specific chemotherapeutic treatment.
The effect of intracarotid infusion of dexamethasone and 5-hydroxytryptamine on cerebral blood flow and metabolism in baboons
Authors: Mendelow A. David , Eidelman Benjamin H. , McCalden Thomas A.
Published: May 2009

✓ The effect of intracarotid infusion of dexamethasone on cerebral blood flow and cerebral oxygen utilization was measured in baboons using the xenon-133 clearance technique. The cerebrovascular response to intracarotid infusion of 5-hydroxytryptamine (5-HT) was then determined during simultaneous infusion of the steroid. Infusion of dexamethasone alone and infusion with 5-HT produced no significant change in cerebral blood flow or cerebral oxygen utilization when compared to baseline values. The study indicates that neither dexamethasone nor 5-HT with dexamethasone modify cerebral blood flow when infused via the internal carotid artery.
Malignant astrocytoma following radiotherapy of a craniopharyngioma
Authors: Sogg Richard L. , Donaldson Sarah S. , Yorke Craig H.
Published: May 2009

✓ A 9-year-old schoolgirl received 6007 rads to the suprasellar region for craniopharyngioma. Five years later, a malignant astrocytoma developed in the right temporal lobe. We cite clinical and experimental evidence to support our suspicion that the glioma may have been induced by radiation.
Infantile retrocerebellar cyst with immature neural tissue
Authors: Walsh John , Gilles Floyd H. , Welch Keasley
Published: May 2009

✓ A retrocerebellar cyst was excised from a 17-day-old infant with hydrocephalus. The cyst wall contained not only ependyma-like epithelium, choroid plexus tufts, and glial rests, but also prominent areas of immature neural tissue.
Foramen magnum syndrome caused by a giant aneurysm of the posterior inferior cerebral artery
Authors: Judice Donald , Connolly Edward S.
Published: May 2009

✓ The authors present a case of giant aneurysm of the posterior inferior cerebellar artery. It was successfully excised with reversal of neurological deficits.
Measuring the outcome from head injuries
Authors: Langfitt Thomas W.
Published: May 2009

✓ The author focuses attention on the need to evaluate methods of treatment of head injuries, minimizing as much as possible the variability of criteria that may enter the most careful of reports.
Outcome following severe head injuries in children
Authors: Bruce Derek A. , Schut Luis , Bruno Leonard A. , Wood James H. , Sutton Leslie N.
Published: May 2009

✓ The outcome in 53 children following severe head injury is presented. All children were graded using the Glasgow Coma Scale; 90% made a good recovery or were moderately disabled, and 8% died or were left vegetative. All patients were treated with controlled ventilation and steroids; mannitol, and, if necessary, Nembutal (pentobarbital) were used to maintain the intracranial pressure below 20 torr. With this regimen, only one death occurred due to uncontrollable intracranial hypertension. All patients with a coma scale of 5 or greater recovered well. The worst prognostic sign was the presence of flaccidity: 33% of these patients died or were vegetative. Five of seven patients who were decerebrate or flaccid with bilateral fixed pupils and absent caloric responses made a good recovery or were moderately disabled. The relatively low incidence of mass lesions (23%) and high incidence of diffuse cerebral swelling (34%) suggest a different pathophysiological response of the child's brain to injury, which may play a role in the improved survival of children following severe head injury when compared to adults.
The value of repeat pan-angiography in cases of unexplained subarachnoid hemorrhage
Authors: Forster David M. C. , Steiner Ladislau , Hakanson Sten , Bergvall Ulf
Published: May 2009

✓ Four-vessel angiography was repeated in 56 patients with confirmed subarachnoid hemorrhage in whom the initial investigation was negative. Only one aneurysm was demonstrated. The results suggest that, with good technique, careful observation, and a complete four-vessel cerebral angiography, a false negative rate of less than 2% can be achieved. It is suggested that to repeat pan-angiography is seldom justified unless further bleeding episodes occur.
Detachable balloon catheter
Authors: DiTullio Michael V. , Rand Robert W. , Frisch Eldon
Published: May 2009

✓ Recent Russian reports have described the use of balloon occlusion in both the diagnosis and treatment of various pathological processes affecting intracranial vessels. This intraluminal approach has demonstrated successful results in vascular problems such as carotid-cavernous fistulae, arteriovenous malformations, and large inoperable aneurysms. Despite widespread interest in the neurosurgical community, the application of a similar technique in the Western hemisphere has been hindered by lack of an adequate, functional, inflatable apparatus.

The authors describe their experience with the prototype of a safe, reliable, detachable balloon. Because of a unique development, the apparatus may be filled with liquid and detached from its parent catheter without subsequent leakage. In order to satisfy variable requirements, balloons are available in several sizes ranging from 0.5 to 4.0 mm in diameter. When fully inflated these devices will hold from 1 to 3 cc of fluid. The authors' study involved 18 dogs with artificially created carotid-jugular fistulae that were visualized by angiography. Under fluoroscopic control, detachment of inflated balloons on the venous side of the defect not only successfully occluded the fistulae but also preserved the arterial vasculature. X-ray films taken several weeks later failed to show any change either in size or position of theinflated devices.
Effects of ethanol- and saline-base PGE1 on the canine cerebral circulation
Authors: Radawski Daniel , Daugherty Robert M. , Emerson Thomas E.
Published: May 2009

✓ The effects of ethanol- and saline-base prostaglandin E1 (PGE1) on systemic arterial blood pressure (ABP), cerebral blood flow (CBF), cerebral vascular resistance (CVR), and cerebrospinal fluid (CSF) pressure were determined in anesthetized dogs. Progressively greater carotid intra-arterial infusions of ethanol-base PGE1 moderately decreased systemic ABP and CVR while perfusion of the CSF system with PGE1 moderately increased ABP and CVR; CBF was unaffected by either route of administration and CSF pressure was constant except for a slight decrease at the lowest intraventricular perfusion rate. Similar infusions of PGE1 were administered in saline-base solutions in another group of dogs. Carotid intra-arterial infusion decreased ABP and CBF moderately at the highest infusion rate and caused a transient increase in CSF pressure. Cerebrospinal fluid system perfusion increased ABP moderately but did not affect the other parameters. These data indicate that PGE1 does not have a significant effect on cerebral hemodynamics when infused via the CSF system, but may produce slight cerebral vasodilation when infused into the carotid arteries in an ethanol base. This vasodilation may be due to autoregulation.
The relation of cerebral ischemia, hypoxia, and hypercarbia to the Cushing response
Authors: McGillicuddy John E. , Kindt Glenn W. , Raisis James E. , Miller Carole A.
Published: May 2009

✓ A marked increase in intracranial pressure (ICP) produces a concomitant increase in systemic blood pressure (the Cushing response). In this study a comparison is made between this response of systemic blood pressure to increased ICP and the blood pressure responses produced by ischemia, hypoxia, and hypercarbia of the primate brain. A carotid-to-carotid cross-perfusion system was used to produce a purely cerebral hypoxia and hypercarbia. Each stimulus, except hypercarbia, produced a hypertensive response that was qualitatively and quantitatively similar. These responses were characterized by a short latent period, a rapid development, and an increase in mean arterial pressure of 60% or more. The similarity of the responses suggests that these stimuli act through a final common pathway independent of the purely mechanical effects of increased ICP upon the brain.
Primitive neuroectodermal tumors of the central nervous system in children
Authors: Kosnik Edward J. , Boesel Carl P. , Bay Janet , Sayers Martin P.
Published: May 2009

✓ A series of 18 primitive neuroectodermal tumors in children (15 cerebral and three spinal) is reported. These are highly malignant neoplasms, both histologically and clinically. They are rapidly growing tumors, with a brief duration of symptoms and a rapidly progressive course. Forty percent of the patients were alive at 6 months, only 10% at 1 year, and all patients had died within 2 years following diagnosis.
Aneurysm of azygous anterior cerebral artery
Authors: Katz Raananah Swirsky , Horoupian Dikran S. , Zingesser Lawrence
Published: May 2009

✓ This report describes a patient with a fusiform aneurysm of an azygous anterior cerebral artery (ACA) associated with a ruptured saccular aneurysm at its distal end. Gross, microscopic, and radiological documentation of this anomaly is presented. It is suggested that in cases where the question of an unpaired ACA arises, a projection paralleling the radiological baseline be employed during angiographic studies thus affording better visualization of these vessels. Clinically, in patients with pericallosal aneurysms, their frequent association with azygous ACA's should be borne in mind, as injury to this common arterial trunk will affect both hemispheres and the corpus callosum with tragic results.
Asymptomatic subdural chondrosarcoma
Authors: Alvira Mariano M. , McLaurin Robert L.
Published: May 2009

✓ This report describes a large, asymptomatic, subdural skeletal-type chondrosarcoma originating from the meninges. Distinction between the mesenchymal and skeletal types of intracranial chondrosarcoma is important since they have different prognoses.
Dural mesenchymal chondrosarcoma
Authors: Zucker David K. , Horoupian Dikran S.
Published: May 2009

✓ A dural mesenchymal chondrosarcoma is reported in a 19-year-old man. This tumor had features of angioblastic meningioma (meningeal hemangiopericytoma), by light microscopy. However, ultrastructurally this tumor could be distinguished from angioblastic meningioma, and its similarity to extracranial mesenchymal chondrosarcoma was confirmed.
An unusual late complication of Gasserian ganglion decompression surgery
Authors: DeSousa Alonso L. , Kalsbeck John E. , Batnitzky Solomon
Published: May 2009

✓ The authors report an unusual complication following surgery for decompression of the Gasserian ganglion. Eight years postoperatively this patient developed a left temporal lobe granuloma caused by a piece of wood used to plug the foramen spinosum at surgery. The patient's clinical and radiological findings were suggestive of a glioma involving the temporal lobe.
Transsphenoidal microsurgery for pituitary tumors associated with hyperprolactinemia
Authors: Tindall George T. , McLanahan C. Scott , Christy James H.
Published: May 2009

✓ The results of transsphenoidal microsurgery in treating 37 patients (30 women and seven men) with pituitary tumors associated with hyperprolactinemia are presented. Immediate (10-day) postoperative fasting prolactin levels were normal (< 25 ng/ml) in 19 of 26 patients whose preoperative prolactin level was < 200 ng/ml, and in only three of 11 patients in whom preoperative prolactin was > 200 ng/ml. Twelve of 13 patients with normal preoperative pituitary-target organ function maintained normal axes postoperatively. Thirteen other patients had preoperative deficiencies in one or more pituitary-target organ axes. Postoperatively, in these latter 13 patients, a pituitary-target organ axis that was deficient preoperatively returned to normal in six cases; there was no change in five, and there was impairment in another axis in four instances. Although gross total tumor removal was believed to be complete in 35 of 37 patients, serial postoperative prolactin determinations in four of these 35 patients indicate tumor regrowth. The authors conclude that transsphenoidal microsurgery is currently the operative procedure of choice for the majority of pituitary tumors associated with hyperprolactinemia.
Radiotherapy combined with procarbazine, bleomycin, and CCNU in the treatment of high-grade supratentorial astrocytomas
Authors: Seiler Rolf W. , Greiner Richard H. , Zimmerman Arthur , Markwalder Hans
Published: May 2009

✓ Twenty consecutive patients with supratentorial Grade III and IV astrocytomas were treated with postoperative radiotherapy, and a simultaneous induction chemotherapy with 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU), procarbazine, bleomycin, and maintenance chemotherapy with CCNU. They were compared to 32 retrospective control patients selected similarly, who had received postoperative radiation therapy alone. The median survival time was 56 weeks for the combined treatment group, and 51 weeks for the control group. There was no statistical difference in survival in the two groups of patients.
Pulsatile cerebral echo in diagnosis of brain death
Authors: Uematsu Sumio , Smith Thomas D. , Walker A. Earl
Published: May 2009

✓ Conclusive diagnosis of brain death can be made by the demonstration of prolonged cessation of cerebral blood flow. This report describes a simple method to determine the presence or absence of the blood flow in the brain by recording the pulsatile midline echo on one channel of the electroencephalogram (EEG) or on any four-channel monitoring system in the intensive care unit. A firm transducer holder has been developed to eliminate artifacts caused by transducer motion. The pulsations of the midline echo are assumed to be the result of displacement of the midline structures by the arterial injection of each cardiac systole. Thus, the absence of these midline pulsatile echoes correlates with the absence of cerebral blood flow and, if the absence persists over 30 minutes in the presence of normal blood pressure, then the result is brain death.

Twenty-eight cases of clinical brain death with electrocerebral silence of EEG and 18 obtunded patients with various types of cerebral pathology were examined by the echo-pulsation technique. Twenty-six of the 28 cases showed no pulsation of the midline echo. The validity of the technique was documented in four cases by four-vessel cerebral angiogram.
Management of severe cerebral edema in the metabolic encephalopathy of Reye-Johnson syndrome
Authors: Venes Joan L. , Shaywitz Bennett A. , Spencer Dennis D.
Published: May 2009

✓ Fifteen critically ill children with the diagnosis of Reye-Johnson syndrome were treated with techniques developed to maintain adequate cerebral perfusion pressure and levels of circulating blood glucose. One child died, three sustained neurological deficit, and nine children (70%) recovered without significant neurological dysfunction. The techniques developed during the period these children were treated, the indications for their use, and factors that can interfere with maintaining adequate cerebral perfusion in patients with increased intracranial pressure from metabolic encephalopathy are described. The results suggest that neurological damage in this syndrome results from neuronal injury secondary to inadequate cerebral perfusion and/or hypoglycemia, and that neurological dysfunction like hepatic dysfunction should produce minimal mortality and morbidity if cerebral perfusion and adequate levels of circulating blood glucose are sustained during the period of increased intracranial pressure and liver failure.
Surgery of the superior sagittal sinus in parasagittal meningiomas
Authors: Bonnal Joel , Brotchi Jacques
Published: May 2009

✓ The management of 21 parasagittal meningiomas is described; three were located in the anterior third of the sinus, 14 in the middle third, and four in the posterior third. Of these, four meningiomas were attached only to the lateral wall, two invaded the external layer of only one sinus wall, two involved the lateral recess of the sinus, and seven invaded one or two sinus walls. The remaining six tumors invaded the three walls of the sinus, which was completely blocked. There were bilateral meningiomas in four cases. Complete excision of the meningioma with preservation of the venous flow in the sinus and its collateral veins was attempted in each case. In the first eight cases it was possible to preserve the patency of the sinus without graft. In six of the next seven cases the removal of the two invaded walls permitted preservation of the third healthy wall and entailed the repair of the two involved walls by a partial graft, either dural graft (three cases) or venous graft (three cases). In one of the last six cases, a total vein graft was performed after complete excision of the invaded sinus. Two cortical veins were sutured to a collateral branch of the autogenous vein graft. The surgical technique of the partial and the total vein graft is described and clinical results and angiographic controls are discussed.
Studies of the third circulation
Authors: Drayer Burton P. , Rosenbaum Arthur E.
Published: May 2009

✓ The techniques of Amipaque (metrizamide) computerized tomography (CT) cisternography and Amipaque CT ventriculography are described. Normal, intermediate, delayed, and obstructive cerebrospinal fluid circulation patterns are readily demonstrated by evaluation of ventricular stasis of Amipaque on serial CT scans. Both the morphological and physiological characteristics of intracranial cysts are accurately defined and a diagnostic classification is presented. The functional integrity of ventricular shunts can be appraised using the ventricular persistence of Amipaque as a primary criterion. Other applications of these modalities are described and their place in the neurodiagnostic armamentarium is discussed.
The microscopic effects of ventricular dilatation without increase in head size
Authors: Rowlatt Ursula
Published: May 2009

✓ Eleven brains were studied from patients in whom there was some degree of ventricular dilatation due to obstruction of the cerebrospinal fluid pathways. Six further cases from the files of the Department of Neurosurgery were reviewed. Very few microscopic changes were seen in the gray or white matter even in the presence of marked ventricular dilatation. These findings, although surprising in view of the gross apparent reduction in white matter, are in accordance with the known beneficial results of shunting procedures for relief of ventricular dilatation due solely to obstruction. This study provides a pathological anatomical background for the good prognosis in patients with ventricular dilatation without other neurological disease.
Treatment of experimental cerebral infarction in rats with levodopa or with glycerol
Authors: Popovic Pava , Popovic Vojin , Schaffer Richard , Sutton Carl H.
Published: May 2009

✓ Administration of large amounts of levodopa did not improve survival rates of rats after acute cerebral infarction induced by injection of carbon microspheres. However, when 10% glycerol was used, the number of rats that survived after cerebral infarction was significantly greater than in the control or in the levodopa-treated rats. Combination of levodopa and glycerol therapy also significantly improved the survival rate of infarcted animals. It appears that glycerol alone is the main factor in eliciting this beneficial effect. Pathological findings (gross or microscopic) indicate striking changes in brain tissue after embolization. Development of brain edema of the infarcted left hemisphere corresponded to the type of treatment and to the length of animal survival. Brain-tissue histology indicates that glycerol-treated animals developed less severe edema and had less tissue disruption than control animals. The results suggest that treatment of edema should be one of the primary steps in therapy after acute cerebral infarction.
Elasticity of the spinal cord, pia, and denticulate ligament in the dog
Authors: Tunturi Archie R.
Published: May 2009

✓ The longitudinal elasticities of the dog spinal cord, pia, and denticulate ligaments were obtained by measuring the load-elongation curves. Both pia and denticulate ligaments were moderately elastic, but the spinal cord substance showed an upward curve, which indicated a predominantly viscous character. In situ, the spinal cord and pia were moderately strained. A 40-mm segment of the cord with dorsal and ventral roots severed and denticulate ligaments removed became 1 mm shorter when the cord and pia were transected at both ends. It was estimated that the cord and pia in situ were stressed by a force of 2 to 3 gm, the denticulate ligaments with 3 to 5 gm, and the dura with 50 to 70 gm. The elastic moduli of the spinal cord substance were 1.68 × 105 dynes/sq cm for loading between 5 and 10 gm and 1.19 × 105 dynes/sq cm between 30 and 35 gm.
Evaluation of experimental spinal cord injury by measuring spontaneous spinal cord potentials
Authors: Molt James T. , Poulos Dennis A. , Bourke Robert S.
Published: May 2009

✓ The relationship between the spontaneous spinal electrogram and the degree of spinal cord injury was studied in anesthetic-free, surgically decerebrate cats that received experimental blunt trauma by the graded weight-drop method. It was found that the characteristic spontaneous slow negative potential of the spinal electrogram showed a frequency dependency that correlated positively with the intensity of the injury (impulse expressed in gm-sec). Graphs of the frequency of occurrence of the slow negative potentials as a function of time following initial injury indicated that both the slope and shape of the curve were dependent on the severity of the injury measured in gm-sec at the time of the injury and confirmed histologically. These results indicate that the spontaneous spinal electrogram may serve as a sensitive indicator of the degree of spinal cord injury and may be useful in the assessment of various treatment modalities.
Biomechanics of experimental spinal cord trauma
Authors: Dohrmann George J. , Panjabi Manohar M. , Banks Dennis
Published: May 2009

✓ The biomechanics of the thoracic spinal cord and thorax in experimental trauma were studied in cats. Contusion of the T5–6 level of the feline spinal cord was accomplished by the weight-dropping technique; various combinations of weights and heights were used; and force, deformation/displacement, deformation velocity, and acceleration of deformation were measured. Greater force was associated with larger weights. Force was directly related to the displacement of the spinal cord and of the spinal cord/thorax. The presence of a “destruction point” on the force-displacement curve was suggested and its apparent significance discussed. Maximum deformation of the spinal cord was 1.1 mm, while the spinal cord/thorax was displaced a maximum of 4.6 mm. Deformation of the spinal cord ranged between 22% and 33% of the anteroposterior spinal cord diameter. Maximum deformation of the spinal cord was not associated necessarily with a maximum velocity of deformation; the range of velocity of spinal cord deformation was 0.12 to 0.18 m/sec. The relationship between velocity of deformation and force was a horizontal parabolic one. Greater force was required to obtain the same velocity of deformation of the spinal cord relative to that of the spinal cord/thorax unit. It was concluded that the mechanical alterations in the structures supporting the spinal cord account for a significant portion of the biomechanical measurements of the spinal cord previously reported in trauma. Since the force on the spinal cord and the thorax are the same, force may well be a most reasonable means of quantitating experimental spinal cord trauma.
Subarachnoid hemorrhage and papilledema due to a cervical neurilemmoma
Authors: Luxon Linda M. , Harrison Michael J. G.
Published: May 2009

✓ An unusual case of a cervical neurilemmoma is presented. A 67-year-old man developed papilledema on two occasions in association with the symptoms and signs of a subarachnoid hemorrhage (SAH). He proved to have an otherwise asymptomatic cervical neurilemmoma. It is suggested that both acute and subclinical bleeding from such tumors may sometimes underlie the development of raised intracranial pressure occasionally encountered. The clinical clue to the spinal origin of the SAH was an acute onset with root pain. This case is discussed with reference to similar cases in the literature.
Delayed traumatic intracerebral hematomas
Authors: Brown Frederick D. , Mullan Sean , Duda Eugene E.
Published: May 2009

✓ Three patients are reported who developed delayed intracerebral hematomas following closed head injuries. Two patients showed hematomas within 24 hours after a normal computerized tomogram. All three were treated surgically, and two had good results.
Death following external carotid artery embolization for a functioning glomus jugulare chemodectoma
Authors: Pandya Sunil K. , Nagpal Ranjit D. , Desai Anand P. , Purohit Anil V.
Published: May 2009

✓ A 24-year-old man with left sixth through twelfth cranial nerve palsies and severe, fluctuating, systemic arterial hypertension was found to have a large, vascular, catecholamine-forming glomus jugulare chemodectoma. After his electrolyte imbalance was corrected, left external carotid embolization (using Gelfoam) was carried out. The systemic blood pressure stabilized at around 160/100 mm Hg over the next 12 hours. Ten hours later the hitherto conscious patient developed acute arterial hypotension, lapsed into coma, and died. Autopsy showed tumor infarction, swelling, cerebellar tonsillar herniation, and medullary compression.

An unusual complication of glomus tumor embolization is highlighted. The roles of preliminary decompressive surgery and urgent resuscitation by vasopressors are discussed.
Fast-neutron irradiation of glioblastoma multiforme
Authors: Shaw Cheng-Mei , Sumi S. Mark , Alvord Ellsworth C. , Gerdes Arthur J. , Spence Alexander , Parker Robert G.
Published: May 2009

✓ Various modes of therapy, alone or in combination, have had little effect in improving the survival of patients with glioblastoma multiforme. Recently, in a pilot study, 34 patients with glioblastoma were treated by fast-neutron-beam irradiation of the whole brain. Following treatment, the patients became steroid-dependent and pursued a gradual downhill course with increasing obtundation. Although there was no improvement in the length or quality of survival of these patients, neuropathological studies in the 13 patients who came to autopsy showed the following: 1) extensive coagulative necrosis of much of the tumor mass; 2) dense infiltration by collagenous connective tissue; 3) minimal phagocytic reaction; 4) marked reduction in the amount of viable tumor; 5) abnormal astrocytic proliferation, which may represent either astrocytoma or a radiation-induced bizarre gliosis; and 6) areas of gliosis and white matter degeneration in the brain stem, remote from the tumor site. These observations suggest that continued efforts to further refine this mode of therapy for glioblastoma are warranted.
The distribution of nuclear DNA from human brain-tumor cells
Authors: Hoshino Takao , Nomura Kazuhiro , Wilson Charles B. , Knebel Kathy D. , Gray Joe W.
Published: May 2009

✓ Flow cytometry (FCM) is a technique that measures the quantity of DNA contained in individual nuclei and records a frequency distribution of the DNA content per nucleus in the sampled cell population. Nuclei from a variety of human brain-tumor types were isolated by means of tissue grinding, purified by centrifugation through 40% sucrose (15 minutes at 4000 rpm), fixed with 10% formalin, stained with acriflavin-Feulgen, and analyzed by FCM. Profiles of DNA distribution in histologically benign tumors, such as meningiomas, pituitary adenomas, neuroblastomas, and low-grade astrocytomas, revealed a large diploid population (2C) with a few nuclei in DNA synthesis, as well as a small premitotic population (G2 cells) that contains a 4C DNA complement. In contrast, malignant gliomas, including glioblastomas, consist of more cells in DNA synthesis; these tumor cells show a highly variable distribution of ploidy consisting not only of diploid, and/or aneuploid, but also of triploid, tetraploid, and possibly octaploid populations. Also, a large variability between different regions of each tumor was always observed. In contrast, metastatic brain tumors, despite the fact that they contain a considerable number of cells undergoing DNA synthesis, demonstrate little variability within each individual tumor. The ability to rapidly characterize the cell populations of human brain tumors with FCM may enhance the effectiveness of their clinical management.
Localization of vertex lesions seen on CT scan
Authors: O'Leary Daniel H. , Lavyne Michael H.
Published: May 2009

✓ A simple method is presented for localizing the anatomical site of vertex lesions seen on a computerized tomography (CT) brain scan, using the patient's plain lateral skull film.
Cerebral arterial responses to induced hypertension following subarachnoid hemorrhage in the monkey
Authors: Boisvert Donald P. , Overton Thomas R. , Weir Bryce , Grace Michael G.
Published: May 2009

✓ Regional cerebral blood flow (rCBF), angiographic cerebral arterial caliber, and cerebrospinal fluid (CSF) pressure were measured in rhesus monkeys to determine the effect of experimentally induced subarachnoid hemorrhage (SAH) on cerebral arterial responses to graded increases in blood pressure. These measurements were also performed in a control group of monkeys subjected to a mock SAH by injection of artificial CSF into the cerebral space.

Before subarachnoid injection of blood or artificial CSF, graded increases in mean arterial blood pressure (MABP) to a level 40% to 50% above baseline values had no effect on rCBF. The major cerebral arteries constricted and CSF pressure remained unchanged. Similar responses were observed after injection of artificial CSF. When MABP was increased in animals that had been subjected to subarachnoid injection of blood, rCBF increased and was associated with dilatation of the major cerebral arteries and moderate increases in CSF pressure. These results demonstrate that cerebral arterial responses to increases in blood pressure may be abnormal in the presence of subarachnoid blood. The manner in which abnormal cerebral arterial reactivity, changes in blood pressure, and vasospasm combine to determine the level of cerebral perfusion following SAH is postulated.
Immune surveillance and tumors of the nervous system
Authors: Morantz Robert A. , Shain William , Cravioto Humberto
Published: May 2009

✓ The theory of immune surveillance postulates that one function of the immune system is to eliminate small numbers of malignant cells that arise spontaneously within the organism. Although there has been a great deal of both clinical and experimental evidence in favor of this theory as it applies to general oncology, the question of whether or not such a surveillance system would be effective for tumors arising within the nervous system has never been studied. The young of pregnant rats which had been exposed to the neurocarcinogen ethylnitrosourea (ENU) were divided into control, immunosuppressed, and immunoenhanced groups. These lifetime alterations of the immune system had no effect on the course of nervous system tumor formation. We believe that the most likely explanation for our results is that the “immunological privilege” of the brain prevents the usual interaction of the neoplasm and the immune system from occurring.
Angiotomography of intracranial aneurysms
Authors: Sato Osamu , Kobayashi Masatoshi , Kamitani Hiroshi , Kokunai Takashi , Sato Jinichi
Published: May 2009

✓ The authors have developed a new method of angioautotomography by the use of a special head-swing apparatus. They have studied 70 intracranial aneurysms by this method and have found that it was more useful in clearly detecting the stalk of aneurysms than conventional angiography. The authors conclude that the method is also superior to conventional magnification angiography. Magnification angiotomography performed by this method offers more precise details.
Traumatic intracranial internal carotid aneurysm due to gunshot wound
Authors: Salar Giuseppe , Mingrino Salvatore
Published: May 2009

✓ This patient developed an intracranial carotid artery aneurysm after a bullet wound. A review of the related literature, and the pathogenesis of traumatic false and true aneurysms are presented.
Chronic extradural hematoma presenting 33 years after penetrating cranial trauma
Authors: Punt Jonathan
Published: May 2009

✓ A case is reported of a 53-year-old normotensive man who presented, 33 years after a penetrating cranial war injury, with dysphasia of 10 month's duration, which proved to be due to a chronic extradural hematoma. The pathogenesis and symptomatology are discussed, and it is proposed that the lesion had been present since the original injury.
Nasopharyngeal craniopharyngioma
Authors: Majlessi Heshmatolah , Shariat Ahmad S. , Katirai Abdolali
Published: May 2009

✓ A case is reported of craniopharyngioma with unusual extension through the base of the skull to involve the orbits, pharynx, oropharynx, and neighboring areas.
Successful surgical treatment of giant aneurysm of the basilar artery
Authors: Bhushan Chhabi , Hodges Fred J. , Posey John
Published: May 2009

✓ The authors describe a case of giant aneurysm of the basilar artery successfully treated by bilateral vertebral artery ligation at the sulcus arteriosus of the atlas.
Lumbosacral intradural periradicular ossification
Authors: Varughese George
Published: May 2009

✓ Intrathecal ossification causing progressive myelopathy or radiculopathy does not occur frequently. The majority of the reported lesions have been in the thoracic spine and seldom in the sacral canal. This report presents the occurrence of disabling low backache and sciatica from intradural periradicular ossification in the lumbosacral region in a previously healthy man.
The cryoprobe retractor in the microsurgical dissection of tumors
Authors: Moseley John I. , Rand Robert W.
Published: May 2009

✓ A technique is outlined for retraction of tumors under the operating microscope using the microcryoprobe. The method depends on temperature settings in the −20° to −30° C range to produce a small ice bond uniting tumor and cryoprobe. No attempt is made to create a solid frozen tumor. The locally avascular field and retraction provided ideal circumstances for microdissection. Examples of this approach are outlined with case summaries for spinal cord ependymoma and hemangioblastoma.